Financial Coaching Survey Host Sites and Partners

Privacy Notice
The Consumer Financial Protection Bureau (“CFPB” or “Bureau”) is gathering data to learn more about your experiences with the CFPB Financial
Coaching Initiative. Your participation in this survey will provide the Bureau with a deeper understanding of the impact of coaching services on host
sites and referral partners.
Participation is voluntary. You are not required to participate, and no identifying information will be collected.
Paperwork Reduction Act Statement

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and not withstanding any other provision of law a
person is not required to respond to a collection of information unless it displays a valid OMB control number. The OMB control number for this
collection is 3170-0036. It expires on 8/31/2019. The time required to complete this information collection is estimated to average approximately 30
minutes per response. Comments regarding this collection of information, including the estimated response time, suggestions for improving the
usefulness of the information, or suggestions for reducing the burden to respond to this collection should be submitted to the Consumer Financial
Protection Bureau (Attention: PRA Office), 1700 G Street NW, Washington, DC 20552, or by email to [email protected].
Please do not share any Personally Identifiable Information (PII), including, but not limited to, name, address, phone number, email address, etc. on this survey.
Section One: Overall experience and program implementation
Question Type
Question
Multiple Choice
1. To what extent did the CFPB Financial Coaching Program meet
your organization’s expectations?
[include an optional “please explain” box with this question]
Multiple Choice

2. What population did your local coach serve?

Multiple Choice

3. Since the start of the coaching program, did the coach at your
site ever change (for example, due to turnover or
replacement)?
4. What impact did coach turnover or replacement have on the
partnership at your organization? (Improved, No impact,
Weakened, Not sure)

Contingent Matrix (ask
only if respondent
answered “yes” to

Response(s)
A. Completely
B. Mostly
C. Somewhat
D. Not at all
E. Not sure
A. Only Veterans
B. Only Economically Vulnerable Consumers
C. Both Veterans and Economically Vulnerable Consumers
D.
A.
B.
C.
A.
B.

Not sure
Yes
No
Not sure
Quality of coaching services
Coaching program’s relationship with my organization

Section One Question
#3)
Open Response

5. What aspects of this program helped make it successful?
6. What aspects of this program created challenges or barriers to
success?

Section Two: Integration
Question Type
Question
Matrix
1. What does your organization’s partnership with your financial
coach look like? (each option has Yes/No/Not Sure)

Multiple Choice

2. Which of these categories best describes how your organization
connected clients to coaching?

Multiple Choice

3. How would you describe the integration of coaching into your
organization’s existing services?

Multiple Choice

4. Did your organization have a process for identifying which
clients to connect to the Financial Coach?
Open response
5. How did your organization identify which clients to connect to
the Financial Coach?
Open Response
6. What (if any) challenges or barriers did your organization
experience in integrating the financial coaching program with
your existing services?
Section Three: Sustainability
Question Type
Question

Response(s)
A. We refer clients to the coach
B. The coach offers 1:1 coaching at my organization
C. The coach leads presentations and/or workshops for
my organization
D. The coach has regularly scheduled hours at my
organization
E. Other (write in)
A. Clients were required to participate in coaching to
access services or benefits from my organization
B. Clients were offered an incentive to participate in
coaching
C. There was no incentive or requirement for clients
referred to coaching services
D. Other (please specify)
E. Not sure
A. All clients were offered coaching (e.g., coaching option
included on intake forms)
B. Most clients were offered coaching
C. Some clients were offered coaching
D. Very few clients were offered coaching
E. Not sure
A. Yes
B. No

Response(s)

Multiple Choice

1. How beneficial have the financial coaching services been to the
clients your organization serves?

Multiple Choice +
Optional Explain

2. If the program did not end in March, would you continue to
partner with the financial coach?

Multiple Choice
Multiple Choice

[add not required “please explain” box to this question]
3. Is your organization actively seeking to continue financial
coaching or a similar service in your community?
4. Does a similar service already exist in your community that
adequately replaces the CFPB Financial Coaching Program?

Contingent: Open
5. What challenges or barriers could you or have you faced in
Response (Only ask if
attempting to ensure Financial Coaching services stay in your
respondent answers
community?
“yes” to Section 3,
Question #3)
Section Four: Demographics
Question Type
Question
Multiple Choice
1. What best describes your role in your organization?

Multiple Choice

2. Have you worked for the host site organization since the
coaching program began?

Multiple Choice

3. What type of community is your site/program?

Multiple Choice

4. In what region is your site/program located?

A.
B.
C.
D.
E.
A.
B.
C.
D.
A.
B.
A.
B.
C.

Very beneficial
Beneficial
A little beneficial
Not at all beneficial
Not sure
Yes
No
Maybe
Not Sure
Yes
No
Yes
No
Not sure

Response(s)
A. Administrator
B. Program Manager
C. Front-Line Service Provider
D. Other (write in)
A. Yes
B. No
C. Not sure
A. Urban
B. Semi-Urban/Suburban
C. Rural
A. Mid Atlantic (DC, MD, NJ, NY, PA, VA, WV)
B. Midwest (IL, IN, MI, MN, MO, OH, WI)
C. Mountain (AZ, CO, NV, OK, TX)
D. New England (CT, ME, MA, NH, RI, VT)
E. Plains (ID, KS, MT, NE, ND, SD)
F. South (AL, AR, FL, GA, KY, LA, MS)
G. West Coast (AK, CA, HI, OR, WA)

Choose up to 3

5. In what general category would you place your organization?
(choose up to 3)

Choose all that apply

6. Please select your organization’s service areas that referred
clients to our coaching program.

A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
A.
B.

C.
D.
E.
F.
G.
H.
I.
J.
E.

Non-Profit (501(c)3)
City Government
State Government
Federal Government
Healthcare
Higher Education
Legal Services
Faith-Based
Active Duty Military
Reserve Component
Veteran Only
Workforce Development
Federal Assistance Programs (Temporary Assistance for
Needy Families or TANF, Supplemental Nutrition
Assistance Program or SNAP, or other state-specific
benefits)
Homeownership
Tax Time Support (includes Volunteer Income Tax
Assistance or VITA)
Small Business Development
Student Services
Mental Health Services
Addiction/Rehabilitation Services
Veteran Benefits
Other (write in)
Other (write in)