Preparedness Survey- Electronic
OMB Control Number 1660-NW103
Expiration
PAPERWORK BURDEN DISCLOSURE NOTICE
FEMA Form 519-0-45 (Preparedness Electronic Survey)
Public reporting burden for this data collection is estimated to average 10 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 (PROGNEW) 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.
Introduction – Electronic (Applicable for sample records where the applicant requested electronic correspondence from FEMA)
FEMA is looking for ways to improve the quality of our services and your opinion is very important. This questionnaire should be completed by the person in the household most familiar with the FEMA application. The survey will take 8-10 minutes to complete.
These questions comply with the Privacy Act of 1974 and have been approved by the Office of Management and Budget under number (New OMB Number). Your answers will not affect the outcome of your application for FEMA assistance.
Please click Next to begin the survey:
DISASTER WARNINGS AND ACTIONS
This survey is related to the [Disaster Type] that occurred in [Disaster Month, Disaster Year]. Let’s start with some questions about how you found out what was happening and what actions you took.
1. Did you get an advance warning of the disaster from any of the following sources… (Select all that apply)
Television
Radio
Social media – Facebook, Twitter, etc.
Smartphone app
Friend, neighbor or other individual
Local community notification by siren, phone call, email and/or text
Other
Did not receive advance warning
Do Not Remember
(Programmer Note: If Q1 response = Did not receive advance warning or Do Not Remember go to Q5 else go to Q2)
2. How far in advance did you receive warning that you and your household might be impacted by the hazard…
Less than 15 minutes
From 15 minutes to less than 3 hours
From 3 hours to less than 6 hours
From 6 hours to less than 24 hours
More than 24 hours
3. In certain types of disasters, local authorities may make recommendations for actions the public should take. Those may be provided through local news or warning and alert systems. Did you receive advice from authorities on any of the following: (Select all that apply)
Evacuate based on advice from authorities
Best routes to use when evacuating
Roads to avoid due to flooding or dangerous conditions
Move to a protected location (higher ground, storm shelter, etc.)
Shelter locations
Other
No advice from local authorities
(Programmer Note: If Q3response = No advice from local authorities go to Q5 else go to Q4)
4. As a result of the warning, which of the following actions did you take: (Select all that apply)
Evacuated based on directions
Stayed where you were at home, work, school, or other location
Moved to a protected location
Went to a shelter
Went to stay with friends or family
Went to a hotel/motel
Other
No action taken/required
DISASTER PREPAREDNESS INFORMATION
There are a variety of sources for obtaining information about what should be included in your emergency plans – storing supplies you might need, how to protect yourself, and how to reduce property damages.
5. Before the disaster, did you look for information on how to prepare?
Yes
No
Don’t Remember
(Programmer Note: If Q5 response = No or Do Not Remember go to Q6 else go to Q5a)
5a. Which of the following sources did you use to get information on how to prepare: (Select all that apply)
O FEMA.gov and/or DisasterAssistance.gov
O Ready.gov
O Community.fema.gov for America’s PrepareAthon
O Other federal government websites
O State government sources including websites
O Local government sources including websites (City, County/Parish, Tribal, etc.)
O Non-profit, faith-based or local community organizations
O Friends or family
O School or other educational institution
O Did not use any type of information
O Other
(Programmer Note: Randomize List; When Did not use any type of information is selected clear all other selections)
6. Did you receive any disaster preparedness training through your local government?
O Yes
O No
O Don’t Remember
(Programmer Note: if Q6 response = Yes go to Q6a else go to Q6b)
6a. Which of the following best describes the types of training you participated in:
(Select all that apply)
Steps you can take to prepare for disasters
Skills for how to respond to a disaster
Ways to protect your home or business
How to evacuate including routes or public transportation methods
Natural hazards and risks relevant to your community
Local government actions and plans for preparing and responding to disasters
6b. Did you participate in any community planning hosted by your local government?
Yes
No
Don’t Remember
(Programmer Note: if Q6b response = Yes go to Q6c else go to Q7)
6c. Was that planning about any of the following, community: (Select all that apply)
Preparedness
Response
Mitigation for hazards
Long-term recovery
Other
Don’t know or Don’t remember
7. Using a rating scale of 1 to 5 where 1 is Not at all Useful and 5 is Very Useful, how would you rate the advice you received on how to prepare:
1 Not at all Useful |
2 |
3 |
4 |
5 Very Useful |
6 Did not receive any Advice |
O |
O |
O |
O |
O |
O |
(Programmer Note: If Q7 response = 1 or 2 go to Q7a else go to Q8)
7a. What changes are needed to make the advice more useful? (500 characters max)
8. Which of the following are the best ways to provide you with disaster preparedness information on how to protect yourself, your household and your property: (Select all that apply)
Radio, television or newspaper
Internet websites
Webinars such as interactive online presentations
Postal mail
Social media – Facebook, Twitter, etc.
Community or neighborhood meetings
Faith-based organizations
Workplace
Schools
Other
DISASTER READINESS – Immediate Needs
Please think back to the preparations you made for meeting immediate needs that would help you during the first few days after the disaster.
For these questions please use a rating scale of 1 to 5 where 1 is Not at all Prepared and 5 is Fully Prepared.
9. Prior to the disaster happening, how would you have rated your level of preparation?
1 Not at all Prepared |
2 |
3 |
4 |
5 Fully Prepared |
O |
O |
O |
O |
O |
10. After the disaster happened, how would you rate your actual level of preparation?
1 Not at all Prepared |
2 |
3 |
4 |
5 Fully Prepared |
O |
O |
O |
O |
O |
(Programmer Note: If Q10 response = 1 or 2 go to Q10a else go to Q11)
10a. Based on what you learned from this experience, which of the following supplies, equipment, and services did you need and not have: (Select all that apply)
O Safe drinking water
O Food
O Critical documents for identity, banking, insurance, etc.
O Plans for how to get in touch with family, friends, etc.
O Generator for emergency power
O Medication or medical supplies
O Cash
O Gasoline for vehicles or generator
O Utilities (water/gas/electric/phone/internet)
O Disability/Accessibility needs (wheelchair, hearing devices, etc.)
O Other
11. Using a rating scale of 1 to 5 where 1 is Very Unlikely and 5 is Very Likely, how likely are you to take more steps to prepare for immediate needs in the future?
1 Very Unlikely |
2 |
3 |
4 |
5 Very Likely |
O |
O |
O |
O |
O |
12. What have you done or will you do to increase your preparedness before the next disaster? (500 characters max)
DISASTER RECOVERY
13. The next questions relate to your progress in recovering from the impacts of this disaster. Using a rating scale of 1 to 5, with 1 being Not at all Recovered and 5 being Completely Recovered, how would you rate your current level of recovery?
1 Not at all Recovered |
2 |
3 |
4 |
5 Completely Recovered |
O |
O |
O |
O |
O |
(Programmer Note: If Q13response = 1, 2 OR 3 go to Q13a else go to Q13b)
13a. Which of the following are primary causes for delays in your recovery: (Select all that apply)
Money for home repairs
Money for personal property
Money to move to a new residence
Delayed or denied insurance settlement
Delayed FEMA appeal
Lack of affordable and/or accessible housing
Lack of time to make repairs
Lack of contractors and or materials
Medical or disability conditions
Unemployed as a result of the disaster
13b. To improve your ability to recover, did you need and not have information on… (Select all that apply)
Available rental housing
Insurance coverage and claims
Local contractors and repair services
Local zoning, building codes and permits
Disaster unemployment assistance
Disaster loans from the Small Business Administration (SBA)
Operational status of schools, colleges, etc.
Available public transportation
Locator services for finding displaced family and friends
14. What would help you most to be ready for another disaster? (500 characters max)
DEMOGRAPHICS
15. We’re almost done. Would you volunteer to answer a few demographic questions for statistical purposes?
Yes
No
(Programmer Note: If Q15 response = Yes go to 16 else go to Q22)
16. Is your gender…
Female
Male
17. Is your age range..
Under 25
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or older
18. Is your marital status…
Single
Married
Separated
Widowed
Divorced
19. Is your current employment status…
Employed for wages
Self-employed
Unemployed
Homemaker
Student
Retired
20. Which of the following best describes your 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
21. What is your ethnicity?
Hispanic or Latino
Not Hispanic or Latino
22. What is your race? You may select all that apply.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
23. Your opinion is very valuable to us, may we contact you at a later date to ask some additional questions?
Yes
No
CLOSING ELECTRONIC SURVEY
Press any key or click on the X button to submit your survey. Thank you for your time. Have a good day/evening.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Fry, Gena |
File Modified | 0000-00-00 |
File Created | 2021-01-21 |