Form FEMA Form 519-0-34 FEMA Form 519-0-34 Public Assistance Assessment Customer Satisfaction Surve

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency
PUBLIC ASSISTANCE ASSESSMENT CUSTOMER
SATISFACTION SURVEY (PHONE)

OMB Control Number: 1660-0107
Expiration: MM DD, YYYY

PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this survey is estimated to average 9 minutes per response. The burden estimate includes the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting this form. This
collection of information is voluntary. You are not required to respond to this collection of information unless a valid OMB control number is
displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to:
Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW.,
Washington, DC 20472-3100, Paperwork Reduction Project (1660-0107) NOTE: Do not send your completed form to this address.
PRIVACY ACT STATEMENT
AUTHORITY: Government Performance and Results Act of 1993 (Pub. L. 103-62), as amended, and the GPRA Modernization Act of 2010
(Pub. L. 111-352); Executive Order (EO) 12862, “Setting Customer Service Standards”; and its March 23, 1995 Memorandum addendum,
“Improving Customer Service”; Executive Order 13411 “Improving Assistance for Disaster Victims”; Executive Order 13571 “Streamlining
Service Delivery and Improving Customer Service”; and the related June 13, 2011 Memorandum “Implementing Executive Order 13571 on
Streamlining Service Delivery and Improving Customer Service.”
PRINCIPAL PURPOSE(S): DHS/FEMA collects this information to measure Public Assistance applicants' customer satisfaction with FEMA
services.
ROUTINE USE(S): This information is used for the principal purpose noted above and will not be shared outside of DHS/FEMA, except as
allowed under the routine uses published in System of Records Notice DHS/FEMA-009 - Hazard Mitigation Disaster Public Assistance and
Disaster Loan Programs, 79 FR 16015 (March 24, 2014), or as required by law. The Department's system of records notices can be found on
the Department's website at http://www.dhs.gov/system-records-notices-sorns.
DISCLOSURE: The disclosure of information on this form is strictly voluntary and will assist FEMA in making improvements to its Public
Assistance program; failure to provide the information requested will not impact the provision of FEMA Public Assistance to qualified entities.

DRAFT

Introduction - Phone survey
Hello, I'm calling from FEMA, the Federal Emergency Management Agency. My name is ___. May I please speak with [Contact Name] or the
person who worked with FEMA's Public Assistance Program for the [Disaster Type] that was declared on [Declaration Date] under Disaster
Number [DR No]?
If no: Mark Attempt
If yes: We would like to ask some questions about your overall experience with the FEMA Public Assistance Program. We're looking for ways
to improve the quality of our service based on your opinions. Would you volunteer to take 7-9 minutes to answer some questions?
If no: What would be a better time to call back? Thank you for your time and have a good day/evening.
(Note: if respondent requests electronic survey rather than a call back click below, obtain and verify e-mail address).
Request Electronic Survey
Enter e-mail address
Verify e-mail address
If yes: These questions comply with the Privacy Act of 1974 and have been approved by the Office of Management and Budget under number
1660-0107. Your answers will not affect the outcome of your application for FEMA assistance. This call may be monitored and/or recorded
for quality assurance.
Please click Next to begin the survey:

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This survey is related to Disaster Number [DR No] declared on [Declaration date]. You have recently received funding under the FEMA Public
Assistance program, also known as PA. You were assigned a Program Delivery Manager, or FEMA representative, to lead you through the
PA process. You may have also interacted with other FEMA staff. Please take into account all interactions when answering the following
questions.
FEMA STAFF
Using a scale of 1 to 5, with 1 being Not at all Satisfied and 5 being Very Satisfied, how satisfied were you with the…
1
Not at all
Satisfied

2

3

4

5
Very Satisfied

DRAFT

1. Responsiveness to inquiries and questions from you or your staff
2. Communication about eligibility determinations
3. Updates about the status of your project(s)

4. Consistency of information received from FEMA staff
5. Overall FEMA customer service

Please think about your entire PA experience. Using a scale of 1 to 5, with 1 being Not at all Likely and 5 being Very Likely, how likely were
you to contact each of the following staff when you had a question or needed assistance…
1
Not at all Likely

2

3

4

5
Very Likely

2

3

4

5
Very Helpful

6. Your FEMA staff
7. Your State or Tribal staff
Using a scale of 1 to 5, with 1 being Not at all Helpful and 5 being Very Helpful…
1
Not at all Helpful
8. How helpful has FEMA staff been in guiding you through all phases
of the PA process?
FEMA Process
Using a rating scale of 1 to 5, with 1 being Not at all Satisfied and 5 being Very Satisfied, how satisfied were you with the following aspects of
the FEMA PA process:
1
Not at all
Satisfied

2

3

4

5
Very Satisfied

9. Published information provided such as the website or in the oneon-one meetings
10. Scheduling a site inspection
11. Agreement on scope of work
12. Developing cost estimates
13. Special considerations such as insurance, environmental, and
historic preservation

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Using a scale of 1 to 5, with 1 being Not at all Reasonable and 5 being Very Reasonable, how reasonable were the following documentation
steps:
1
5
Not at all
Very
2
3
4
Reasonable
Reasonable
14. Required pre-disaster documentation
15. Project worksheet review
16. Level of documentation required for grant processing
17. Overall program requirements

DRAFT

Technology
18. Were you able to access the information related to your grant application via the online FEMA system?
o
Yes
o
No
o
Do not remember
Using a scale of 1 to 5 with 1 being Not at all Satisfied and 5 being Very Satisfied, how satisfied were you with the following regarding the
FEMA system:
1
Not at all
Satisfied

2

3

4

5
Very Satisfied

18a. Uploading required documents
18b. Reviewing current status of your request for PA
18c. Monitoring the progress of your projects
Customer Service & Expectations
Thinking about the PA funding you received, using a scale of 1 to 5, with 1 being Not at all Essential and 5 being Very Essential…
1
Not at all
Essential

2

3

4

5
Very Essential

19. How essential was the funding to your organizations disaster'
response and recovery?
Thinking about the entire PA process, on a scale of 1 to 5, with 1 being Not at all Satisfied and 5 being Very Satisfied…
1
Not at all
2
3
4
Satisfied

5
Very Satisfied

20. How would you rate your overall satisfaction with FEMA?
Demographics
21. Previous to the current disaster, have you ever applied for PA disaster assistance with FEMA?
o
Yes
o
No
22. How many years have you been in your current position?
o
0-5
o
6-10
o
11-15
o
16-20
o
21+
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23. On average, how many of your staff worked on FEMA PA projects for this disaster?
o
0-5
o
6-10
o
11-15
o
16-20
o
21+
24. Did you have a contractor or internal grant manager working on your FEMA PA projects during this disaster?
o
Yes
o
No

DRAFT

25. Did you work with your emergency manager in this disaster?
o
Yes
o
No

26. Do you have any comments or suggestions for improvement based on your experience with the FEMA PA program?

CLOSING Phone Survey
Thank you for your time. My name is _____ and my ID number is _______. Have a good day/evening.

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