Form FEMA Form 519-0-38 FEMA Form 519-0-38 Contact Survey (Phone Survey)

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency
CONTACT PHONE SURVEY

OMB Control Number: 1660-NW102
Expiration: MM DD, YYYY

PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this data collection is estimated to average 8 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-NEW) 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 Individual 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-008 - Disaster Recovery
Assistance Files, 78 FR 25282 (April 30, 2013), 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 is making improvements to
its Individual Assistance program; failure to provide the information requested will not impact an individual's ability to qualify for
or receive FEMA Individual Assistance.

DRAFT

Introduction - Phone survey (Applicants who requested US mail will be surveyed by telephone)
Hello, I'm calling from FEMA, the Federal Emergency Management Agency. My name is ___. May I please speak with [Applicant NAME] or
the person who [if inbound contact say “spoke with a FEMA Representative” or if Type = Internet Inquiry say “logged into your FEMA online
account” or if Inspection say “spoke with a FEMA Inspector] on [Call Date]. (Programmer Note: the Inspection date and contact date will both
store in the Call Date field in the sample file)
If no: Thank you for your time and have a good day/evening.
If yes: FEMA is looking for ways to improve services and your opinion is very important. Would you volunteer to take 5-8 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 call back click below, obtain and verify e-mail address. Explain e-mail will be sent within 1 business day from
FEMA-CSA-Survey mailbox).
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-NEW. Your answers will not affect the outcome of your application for FEMA assistance. This call may be monitored and/or recorded
for quality assurance.
(Programmer Note: If phone contact or Internet Inquiry start with Q1 if type - If Inspection contact start with Q6)

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INFORMATION
The first questions are about information provided to you [if Contact Typ Cd = IC say” by the FEMA Representative” or if Contact Typ Cd = II
say “through your online account”] on [IC Dt for IC or II Dt for II]. Using a rating scale of 1 to 5, with 1 being Poor and 5 being Excellent, please
rate the information on…
1
Poor
1. Being easy to understand
2. Answering your questions
3. Being helpful in your recovery
4. Explaining what happens next
5. Overall satisfaction with information

2

3

5
Excellent

4

DRAFT

(Programmer Note: If Contact Typ Cd = II go to Q16)
CUSTOMER SERVICE
These questions are about customer service. Using a rating scale of 1 to 5, with 1 being Poor and 5 being Excellent, please rate the [if
Contact Typ Cd = IC say “FEMA representative” if Contact Typ Cd = IS say “FEMA Inspector”] on the following areas:
1
Poor

2

3

4

5
Excellent

6. Courtesy
7. Showing interest in helping
8. Overall customer service
(Programmer Note: If Contact Typ Cd = IC go to Q9 or if Contact Typ Cd = IS go to Q26)
For the next item, please think back to your experience calling FEMA's toll free number. Using a rating scale of 1 to 5, with 1 being Not at all
Satisfied and 5 being Very Satisfied…
1
Not at all
Satisfied

2

3

4

5
Very Satisfied

9. How satisfied were you with the amount of
time it took for a FEMA representative to answer your call?
(Programmer Note: If Q9 response = 1 or 2 go to Q9a, else go to Q10)
9a.Which of the following would you consider an acceptable amount of time to wait for a FEMA representative to answer your call?
o
o
o
o
o

Less than 2 minutes
2 - 3 minutes
4 - 5 minutes
6 - 7 minutes
More than 7 minutes

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TOLL FREE AUTOMATED INFORMATION SYSTEM
10. When you called FEMA's toll free number, did you use the Automated Information System to hear the status of your application prior to
talking with the Representative?
o Yes
o No
o Don't know / Don't remember
(Programmer Note: If Q10 response = Yes go to Q11, If Q10 response = No or Don't know / Don't remember go to Q25)
Using a rating scale of 1 to 5, with 1 being Poor and 5 being Excellent, how would you rate the Automated Information System on…

DRAFT
1
Poor

11. Being easy to use
12. Providing helpful information
13. Providing current information

2

3

4

5
Excellent

2

3

4

5
Very Likely

14. Overall satisfaction
Using a rating scale of 1 to 5, with 1 being Not at all Likely and 5 being Very Likely…
1
Not at all Likely
15. How likely are you to use the Automated
Information System to check on your FEMA assistance in the future?
(Programmer Note: Go to Q25)
SELF HELP AT DISASTERASSISTANCE.GOV
The next set of questions are about accessing services through your FEMA online account at DisasterAssistance.gov. Please use a rating
scale of 1 to 5, with 1 being Not at all Easy and 5 being Very Easy. If you had no experience with any of the services just say No Experience.
How would you rate the simplicity of…
1
5
No
Not at all
2
3
4
Excellent Experience
Easy
16. Accessing your account
17. Navigating through your account
18. Finding helpful information
19. Viewing correspondence
20. Uploading documents
21. Receiving text or e-mails about account activity
22. Using the Technical Help Desk

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Using a rating scale of 1 to 5, with 1 being Not at all Likely and 5 being Very Likely. How likely are you to…
1
Not at all Likely

2

3

4

5
Very Likely

4

5
Very Easy

23. Use the online status check in the future?
24. Recommend it to a friend of family member?
Using a rating scale of 1 to 5, with 1 being Not at all Easy and 5 being Very Easy…

DRAFT
1
Not at all Easy

2

3

25. How would you rate FEMA on making it easy
to check the status of your application?
(Programmer Note: go to Q35)
INSPECTION SERVICES

The next questions are about the FEMA Inspector's visit on [IS Dt]. Using a rating scale of 1 to 5, with 1 being Poor and 5 being Excellent
please rate the inspector on…
1
Poor

2

3

4

5
Excellent

26. Explaining the reason for the inspection
27. Providing easy to understand information
28. Answering your questions
29. Explaining what happens next
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….
1
5
Not at all
2
3
4
Very Satisfied
Satisfied
30. Timeliness of the inspection
31. Professionalism of the inspector
32. Amount of time spent on the inspection
33. Overall inspection experience
34. Thinking about the length of the inspector's visit, would you estimate it was…
o Less than 30 minutes
o 30 - 45 minutes
o More than 45 minutes

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Demographics
The next set of questions are related to demographics data and are used only for statistical purposes.
35. Would you volunteer to take an additional 2-3 minutes to answer these questions?
o Yes
o No
(Programmer Note: If Q35 response = Yes go to Q36 else go to Q42)
36. Is your gender…
o Female
o Male
o Prefer not to answer
37. Is your age range…
o Under 25
o 25 to 34
o 35 to 44
o 45 to 54
o 55 to 64
o 65 to 74
o 75 or older
o Prefer not to answer

DRAFT

38. Is you marital status…
o Single
o Married
o Separated
o Widowed
o Divorced
o Prefer not to answer
39. Is your current employment status…
o Employed for wages
o Self-employed
o Unemployed
o Homemaker
o Student
o Retired
o Prefer not to answer
40. Which of the following best describes you highest level of formal education
o Did not complete high school
o High school graduate / GED
o Some college
o Associate degree
o Bachelor's degree
o Master's degree
o Doctoral degree
o Prefer not to answer

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41. Which of the following is your race or ethnic group? You may select all that apply.
o American Indian or Alaska Native
o Asian
o Black or African American
o Hispanic or Latino
o Native Hawaiian or Other Pacific Islander
o White
o Prefer not to answer
42. Your opinion is very valuable to us. May we contact you at a later date to ask additional questions?
o Yes
o No

DRAFT

Programmer Note: object name should be FUTCAL.

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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