Form FEMA Form 519-0-39 FEMA Form 519-0-39 Contact Survey (Electronic)

Draft: Contact Survey- Electronic

OMB Control Number 1660-NEW

Expiration Date

PAPERWORK BURDEN DISCLOSURE NOTICE: Public reporting burden for this survey 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 the survey. You are not required to respond to this collection of information unless it displays a valid OMB control number near the title of the electronic collection instrument, or for on-line applications, on the first screen viewed by the respondents. 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, Paperwork Reduction Project (1660-NEW) NOTE: Do not send your completed form to this address.

The following survey is voluntary.

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.

FEMA Form XXX-X-X (Electronic)

Introduction – Electronic (Applicable for sample records where the applicant requested electronic correspondence from FEMA)

FEMA is looking for ways to improve services and your opinion is very important. This questionnaire should be completed by the person in the household who [if inbound 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]. The survey will take 5-8 minutes to complete. (Programmer Note: the Inspection date and contact date will both store in the Call Date field in the sample file)

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.

(Programmer Note: If phone contact or Internet Inquiry start with Q1 if type – If Inspection contact start with Q6

Please click Next to begin the survey:

FEMA Form XXX-X-X (Electronic)

INFORMATION

The first questions are about information provided to you [if Type = phone contact say” by the FEMA Representative” or if Type = Internet Inquiry say “through your online account”] on [Contact Date]. Using a rating scale of 1 to 5, with 1 being Poor and 5 being Excellent, please rate the information on…

	1 Poor	2	3	4	5 Excellent
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

(Programmer Note: If type = Internet Inquiry go to Q16)

CUSTOMER SERVICE

The next 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 type = phone contact say “FEMA representative” if type = Inspector contact 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 type = Phone Contact go to Q9 if type = Inspector Contact 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?

• Less than 2 minutes

• 2 – 3 minutes

• 4 - 5 minutes

• 6 – 7 minutes

• More than 7 minutes

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?

• Yes

• No

• 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…

	1 Poor	2	3	4	5 Excellent
11. Being easy to use
12. Providing helpful information
13. Providing current information
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	2	3	4	5 Very 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 Not at all Easy	2	3	4	5 Very Easy	No Experience
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

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
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…

	1 Not at all Easy	2	3	4	5 Very Easy
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 [Inspection Date]. 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 Not at all Satisfied	2	3	4	5 Very 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…

• Less than 30 minutes

• 30 – 45 minutes

• More than 45 minutes

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?

• Yes

• No

(Programmer Note: If Q35 response = Yes go to Q36 else go to Q42)

36. Is your gender…

• Female

• Male

• Prefer not to answer

37. Is your age range…

• Under 25

• 25 to 34

• 35 to 44

• 45 to 54

• 55 to 64

• 65 to 74

• 75 or older

• Prefer not to answer

38. Is you marital status…

• Single

• Married

• Separated

• Widowed

• Divorced

• Prefer not to answer

39. Is your current employment status…

• Employed for wages

• Self-employed

• Unemployed

• Homemaker

• Student

• Retired

• Prefer not to answer

40. Which of the following best describes you highest level of formal education

• Did not complete high school

• High school graduate / GED

• Some college

• Associate degree

• Bachelor’s degree

• Master’s degree

• Doctoral degree

• Prefer not to answer

41. Which of the following is your race or ethnic group? You may select all that apply.

• American Indian or Alaska Native

• Asian

• Black or African American

• Hispanic or Latino

• Native Hawaiian or Other Pacific Islander

• White, Not Hispanic or Latino

• Prefer not to answer

42. Your opinion is very valuable to us. May we contact you at a later date to ask additional questions?

• Yes

• No

CLOSING ELECTRONIC SURVEY

Thank you for your time. Have a good day/evening.

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