Pre-Event Survey

Consumer Financial Protection Bureau
Customer Experience Survey #1
Pre-Event Survey
Purpose: Measure customer needs and concerns before an event occurs.

Privacy Notice
The information you provide through your responses to the Bureau of Consumer Financial
Protection (“Bureau”) will be used to evaluate any pre-event needs by the Bureau
The Bureau will not collect any personally identifiable information from you.
Participation in this survey is voluntary.
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 3170-0024. It expires on xx/xx/xxxx. The time required to complete
this information collection is estimated to average approximately 3 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 Bureau of Consumer Financial
Protection (Attention: PRA Office), 1700 G Street NW, Washington, DC 20552, or by email to
[email protected].

Question

Answer Options

1. Please let us know where you work.

Part 1 - [Department / Org / Sector / Etc.]
(drop down menu
or open field)
Part 2 - [Sub-category. Ex. Local gov] (drop
down menu
or open field)

2. What are you hoping to get out of the
event? (click all that apply)

[TOPIC / SUBJECT AREA 1]
[TOPIC / SUBJECT AREA 2]
Etc.
Other (Open Ended)

3. How confident do you feel in your
knowledge of [SUBJECT MATTER]?

Not at all
Slightly
Moderately
Very
Extremely

4. How do you feel about the location of the
event?

Very dissatisfied
Somewhat dissatisfied
Neither satisfied nor dissatisfied
Somewhat satisfied
Very satisfied

Important note about Open-Ended questions:
Please do not share any Personally Identifiable Information (PII), including, but not limited to, your name,
address, phone number, email address, Social Security number, etc.

5. How did you hear about this event?

Direct email from a friend/colleague
Email listserv
Flyer
Social media
Website
Word of mouth
Other: (open field)

6. Do you have any accessibility needs we
can help with?

No
Yes (with open text field)

7. How can we make [EVENT] valuable to
you?
8. What should we do to ensure this event
[MEETS YOUR NEEDS / IS A SUCCESS]?

Open-ended
Open-ended

Thank you for helping us improve our services.