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OMB Number: 2010-0042
Approval
Expiration Date: 3/31/2021
Follow-up Effects Survey Participant
Administrative Proceeding
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.
The U.S. Environmental Protection
Agency, Conflict Prevention and Resolution Center (CPRC) requests
your assistance in evaluating this facilitated process. As a part of
this evaluation, we ask the various participants who have been
involved in this project or case to provide us with information about
their experience. The data compiled will be used to improve future
facilitation services provided by the CPRC.
The CPRC will not report information from this evaluation in a way
that respondents or their organizations can be identified. Moreover,
the identity of individual respondents will be kept confidential and
will not be disclosed. 
	- Please indicate the extent to which
	agreement was reached.
To answer this question, think about
those issues that were central to the discussions and needed to be
addressed to resolve or advance the matter
THE
TERM "AGREEMENT" APPLIES TO THE WRITTEN OR UNWRITTEN
AGREEMENT(S) YOU REACHED WITH OTHER PARTICIPANTS IN THE PROCESS,
INCLUDING PLANS, PROPOSALS/RECOMMENDATIONS, PROCEDURES, COLLABORATIVE
DECISIONS TO WORK TOGETHER AND SETTLEMENTS.  WE USE THE TERM
AGREEMENT
RECOGNIZING THAT THERE MAY HAVE BEEN MORE THAN ONE AGREEMENT.
(CHECK
ONLY ONE)
	
		- 
		Agreement
		on all key issues
- 
		Agreement
		on most key issues 
		
- 
		Agreement
		on some key issues
- 
		No
		agreement on key issues; progress was made towards addressing the
		matter. (To
		Q13)
- 
		No
		agreement, the process ended without us making much progress. (To
		Q13)
USE
THE SPACE BELOW IF YOU WOULD LIKE TO ELABORATE ON YOUR RESPONSE:
	- Rate your level of agreement with the
	following statements regarding the agreement.
Scale
0=Not at all, 10=Completely
	- The agreement reached takes
	account of our key interests. 
- The agreement reached will
	effectively resolve the matter. 
- The agreement reached can be
	implemented. 
	 
- The facilitator’s
	involvement was important to efforts to reach agreement 
	- Were there any important issues that
	were not addressed by the agreement?- 
		- 
		Yes
		
		
- 
		No
		(to
		5)
- 
		Not
		sure (to
		5)
 
- Are those important issues from the
	previous question satisfactorily addressed or likely to be addressed
	by another process that has been agreed to by the parties?
- Were you satisfied with the agreement
	reached using the facilitated process? 
	
Scale
0=Not at all, 10=Completely
_____
Effects of the
Agreement
In the next
set of questions, you will be asked about the size and the likelihood
of the most important condition that you expect will change as a
result of the agreement reached through the facilitated process.
We recognize
that there can be uncertainty about your answers to these questions.
Without you answering all questions, we cannot produce the needed
estimate of effects from the agreement reached through the
facilitated process.
	- From your perspective, what condition
	has been or will be the most importantly affected or changed as a
	result of the agreement made in this facilitated process?
please
select the condition most importantly affected or changed.
	
		- 
		Community
		/ social 
		
- 
		Economic
		/ commercial 
		
- 
		Historic
		/ cultural resource
- 
		Natural
		resource/ environmental 
		
- 
		Public
		safety / public health 
		
- 
		Recreational
		
		
- 
		Other
		(please comment)
		_______________________________________________________
Please
describe the condition you selected above that you expect to change.
	- For the first [insert number] years
	after the agreement (state years) to what extent will the change in
	the [pipe
	from Q6]
	condition be better or worse than existed before the
	facilitated process? 
	
Scale
-4 to +4 with -4=significantly worse and +4=significantly better 
	- For the first [insert number] years
	after the agreement (state years) how likely is it that the changes
	in the [pipe
	from Q6] condition will occur?
Scale
0=will not occur, 10=has occurred or definitely will occur.  
	- Please explain your answers about the
	amount and likelihood of change in the [pipe from Q6] condition.
- Do you anticipate further change in
	(pipe
	from Q6) effects beyond [insert number] years?- 
		- 
		Yes
		(describe)
- 
		No
- 
		Uncertain
 
- Please explain your response. 
	
- Were there benefits from the
	facilitated process that were not part of the agreement?
- Did
	the process break an impasse on this matter? 
	- 
		- 
		Yes
- 
		No
		(to
		8)
- 
		Don’t
		know (to
		8)
 
- How
	important was breaking the impasse to the overall result of the
	process?
[0=Not at all, 10=Essential]
	- To what extent was there change over
	the course of the process in the ability of participants to work
	together on this matter and in your level of trust in each other?   
		
	- 
	
		
		
		
		
		
		
		
			| 
				
 | 
				Much improved | 
				Somewhat improved | 
				About the same | 
				Somewhat worse | 
				Much worse |  
			| Change
				in our ability to work together cooperatively. | 
				 | 
				 | 
				 | 
				 | 
				 |  
			| Change
				in our trust of each other. | 
				 | 
				 | 
				 | 
				 | 
				 |  
 
Please use this
space if you wish to elaborate on changes in the levels of
cooperation and trust. 
_________________________________________________________________
	- Did you participate in developing the
	approach for the facilitated process (e.g., agenda setting, meeting
	frequency and location, ground rules)?- 
		- 
		I/we
		participated and my participation was appropriate
- 
		I/we
		participated and my participation was unnecessary 
		
- 
		I/we
		participated and my participation was insufficient
- 
		I/we
		declined to participate
- 
		I
		was/we were unable to participate
- 
		My/our
		participation was unnecessary
- 
		Other
		(please describe)
 
- If you and the other party(ies) had
	not used a facilitated process what is the alternative decision
	making process that would most likely have been used to reach
	an agreement or decision the matter?  In responding to this
	question, please choose the most likely alternative forum/entity to
	the facilitated process that would have produced a decision or
	agreement on the same matter, regardless of whether that agreement
	or decision might be later appealed in other forums.- 
		- 
		We
		would have reached a negotiated agreement/settlement with other
		party(ies) without the assistance of a facilitator.
- 
		The
		administrative tribunal would have issued a ruling to decide the
		matter before any other appeals occurred.
- 
		The
		case would have been withdrawn from the administrative tribunal
		before a ruling was issued.
- 
		Other
		(please describe)
 
- Imagine the [pipe
	selected response from Q6] condition that would have occurred
	during the first
	[insert number] years after a decision or agreement from the
	alternative process you identified above (i.e., [pipe Q17]). 
	Would the [pipe selected
	response from Q6] condition
	be better or worse than existed before you began the
	facilitated process?
Please
indicate the extent to which the decision or agreement from the
alternative process would have produced a better or worse [pipe
selected response from Q6] condition than what existed before the
facilitated process
began.
Scale -4 to +4 with
-4=significantly worse and +4=significantly better
	- How likely would the result you
	indicated in Q18 be for the [pipe
	from Q6] condition be during the first [insert number] years
	after a decision or agreement from the alternative process?
Scale 0=would not occur, 10=would
have already occurred or definitely would occur.
	- Please explain your answers about the
	amount and likelihood of change in the [pipe from Q6] condition
	following the alternative process (i.e., [pipe Q17]) and
	agreement/decision.
- Would you anticipate further change in
	(pipe
	from Q6) effects beyond [insert number] years
	following the alternative process?- 
		- 
		Yes
		(describe)
- 
		No
- 
		Uncertain
 
- Please explain your response. 
	
The next several questions
ask for your views about how the facilitated process and the
alternative you selected above (i.e.,
[Q17])
would compare.
	- Please
	consider how the total costs (time and expenses) of the facilitated
	process compare with the potential costs of the alternative that you
	identified in Q17 [i.e., pipe
	from Q17].
		
The facilitated process was likely CHECK ONE:
	
		- 
		Significantly
		more costly than the alternative
- 
		Somewhat
		more costly that the alternative
- 
		Costs
		were about the same
- 
		Somewhat
		less costly that the alternative
- 
		Significantly
		less costly than the alternative
- 
		Don’t
		know
- How do you think the facilitated
	process would compare with the alternative that you selected
	(i.e.,[Q17])?
 [0=Not
at all, 10=Completely]
	
		- 
		The
		facilitated process better served the interests of my/our
		organization.
- 
		The
		facilitated  process resulted in more timely decisions and
		implementation
- 
		The
		participants are more likely to be able to work together in the
		future on matters related to this case.
- 
		The
		agreement we reached through the facilitated process is less likely
		to be challenged.
- 
		The
		agreement we reached through the facilitated process is better for
		us.
	- In your view, what is the greatest
	advantage and disadvantage that the agreement from the facilitated
	process provided compared to what would have been possible with the
	alternative process you selected (i.e.,
	[Q17])?
Greatest advantage
Greatest disadvantage
	- What is your top suggestion on how the
	facilitated process could have been improved?
PLEASE WRITE
"NONE" IF YOU FEEL THIS PROCESS COULD NOT HAVE BEEN
IMPROVED.     
	- Please use the space below for any
	additional comments you would like to make.
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.
Burden Statement: Public reporting
burden for this collection of information is estimated to average 19
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]
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| Author | Eric | 
| File Modified | 0000-00-00 | 
| File Created | 2021-11-18 |