Form 1 Fast Track Toolkit Survey Instrument

OMB Control No: 0970-0401

Expiration date: 5/31/2018

Attachment

Survey Instrument

(Will be completed online)

Survey

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)

Public reporting burden for this collection of information is estimated to average .5 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

Q1 Is your organization an AFI (Assets for Independence) grantee or partner organization?

Yes

No

Don’t know/Not sure

Q2 Approximately how many full-time employees currently work for your organization?

1-10

11-50

51-100

101-200

201+

Q3 How often does your organization solicit client input or feedback when designing new services or improving existing ones?

Always

Often

Sometimes

Rarely

Never

Q4 Which of the following describe your program-related role(s) at your
organization? Select all that apply.

Design and strategy for program

Oversight or management of program

Work directly with clients (e.g. coach/counselor, customer service
representative)

Other, please specify

Q5 How much do you like or dislike the Toolkit?

I love it

I like it

I neither like nor dislike it

I dislike it

I hate it

Q6 What are the things that you like most about this Toolkit?

Q7 What are the things that you would like to improve in this Toolkit?

Q8 How well does the Toolkit accomplish its stated goals as described in the draft
reviewed?

Very poorly

Poorly

Fair

Well

Very well

Q9 How likely are you to ever use the Toolkit?

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

Q10 How, if at all, would you use the Toolkit?

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Sharon Henderson
File Modified	0000-00-00
File Created	2021-01-22