Form 5800-016 EJScreen 2022 Impact Survey

OMB Control No. 2010-0042

Approval Expiration Date: 3/31/21

Customer Service Generic Survey

Burden Statement

“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 (Executive Order 12898). 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 be ten 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.”

Submission Dates: TBD

EJSCREEN | 2022 IMPACT SURVEY

With the release of EJSCREEN 2021, the Office of Environmental Justice (OEJ) at the Environmental Protection Agency (EPA) is excited to announce the launch of the EJSCREEN Impact Survey! The goals of this survey are twofold: 1.) To capture and highlight how partners and the public are using EJSCREEN to support their analysis of potential environmental justice concerns; and 2.) To identify opportunities for improvement to EJSCREEN. Your support and continued feedback on EPA’s environmental justice screening tool is invaluable, and so we want to hear from you on how EJSCREEN is impacting your work. Participation is open to all individuals and organizations. Enter your submission by TBD for a chance to have your story featured on EPA’s EJSCREEN website.

Please select or write your responses to the following questions. You can provide additional information in the comment boxes.

Case Use Questions

1. How did you learn of EJSCREEN?

• EJSCREEN webinar

• Colleague

• Internet

• EPA partner program or staff

• Professional Association

• News or social media

• Other [Include a box for write-in suggestions]

2. When did you first use EJSCREEN?

• 6-12 months ago

• 1-5 months ago

• Within the last 30 days

3. In the last one year, how often have you used EJSCREEN?

• Daily

• 1-3 times

• 4-6 times

• 7-12 times

• >12 times

1. Please share a specific example of when you used EJSCREEN. Include information on:
   a) the title of your analysis
   b) the purpose of your analysis
   c) the geographic area of analysis
   d) the map layers selected, reports, and/or data incorporated into EJSCREEN
   e) the results of your analysis
   f) how the results were useful for your intended purpose
   (COMMENT BOX – 275 words or less)

2. What function or data layer would you like to be added to EJSCREEN? How could this function or data layer have affected your analysis in your previous example?

(COMMENT BOX – 150 words)

6. Would you consider your use of EJSCREEN mentioned above normal or unusual when compared to your previous uses? Why or why not?

(COMMENT BOX – 150 words or less)

Contact Information

Organization:

Email Address:

Thank you for participating in the EJSCREEN Impact Survey!

Please direct all comments, questions, or suggestions about this survey to:

Tai Lung

[email protected]

Phone: 202.566.1296

U.S. Environmental Protection Agency

1200 Pennsylvania Avenue, NW

Washington, DC 20460

Mail Code 2201A

EPA Form Number 5800-016