5800-035 Meeting Facilitation Questionnaire

OMB Number: 2010-0042

Approval Expiration Date: 3/31/2021

Meeting Facilitation Questionnaire

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2010-0042). Responses to this collection of information are voluntary. 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. The public reporting and recordkeeping burden for this collection of information is estimated to range from 3 to 32 minutes per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

Please rate the extent to which you agree with the following statements about the meeting.

1. [0=Not at all, 10=Completely].I was able to participate effectively in this meeting.

2. The facilitator(s) managed the meeting effectively.

3. The information provided (for example, documents and presentations) was useful for the issues or the topics discussed.

4. The objectives of the meeting were expressed clearly.

5. The objectives for the meeting were fully met.

6. The meeting was worth my time to attend.

7. I had the opportunity to fully express my views.

8. This meeting was an important opportunity for me to learn about the views of others.

9. Please provide any comments you would like to make about this meeting and ways that you think similar meetings in the future could be improved. [open ended]

Thank you for taking the time to complete this questionnaire.

PERSONS WITH DISABILITIES WHO REQUIRE ALTERNATIVE MEANS FOR COMMUNICATION OF PROGRAM EVALUATION INFORMATION SHOULD CONTACT THE CPRC OFFICE.

Public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, gathering information, and completing and reviewing the collection of information. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates, and any suggestions for reducing the burden, including the use of automated collection techniques to:

CONFLICT PREVENTION AND RESOLUTION CENTER

U.S. Environmental Protection Agency (MC: 2388A)

1200 Pennsylvania Avenue, NW, Washington, DC 20460

Telephone: 202.564.0214, Fax: 202.501.1715

Website: www.epa.gov/adr

Email: [email protected]

109873601Form # 5800-035