Customer Service Questionnaire

OMB NO. 0503-0021

Customer Service Questionnaire

At USDA Rural Development, we strive to provide our customers with the best service possible. To maintain this high level of satisfaction, we would appreciate your comments on the service you receive from the staff at USDA Rural Development in the _______________________.

Please take a few moments to complete this questionnaire and return it to our Internal Compliance Division by email to: _________________________ or mail your response to USDA Rural Development ATTN: _________ __________________________________________________________________________________________.

Your responses will provide Rural Development with the information needed to improve our program delivery.

If any of your responses are “Poor” or “Fair”, provide an explanation in the Comments section. Thank you!

1. How would you rate the Rural Development staff?

	Poor	Fair	Good	Excellent
Prompt
Friendly
Knowledgeable

2. How would you rate the quality of Rural Development’s response to your inquiries?

	Poor	Fair	Good	Excellent
Clear
Accurate
Consistent

3. How would you rate the response time to your inquiry?

	Poor	Fair	Good	Excellent
Timeliness

4. How would you rate the Rural Development process?

	Poor	Fair	Good	Excellent
Information was easy to obtain
Forms are easy to use
Concerns were resolved

5. Comments:

OPTIONAL INFORMATION

NAME/ORGANIZATION:

MAILING ADDRESS:

TELEPHONE NUMBER: __________________________________________________________________________________

EMAIL ADDRESS: _______________________________________________________________________________________

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form (PDF), found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing

all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of

Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at [email protected].

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of

information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0503-0021. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.