Form FEMA Form 519-0-45 FEMA Form 519-0-45 Preparedness Survey- Electronic

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

• E-mail

• 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.