Alternative Dispute Resolution Program Survey

OMB No. 3170-0024
Expiration Date: XX/XX/XXXX

Alternative Dispute Resolution (ADR) Program Survey:
Equal Employment Opportunity (EEO) ADR
Purpose of Survey
The purpose of this survey is to allow employees, contractors, and applicants of the Consumer Financial
Protection Bureau (Bureau) who have participated in the Alternative Dispute Resolution (ADR)
Program to freely express their views with regard to the effectiveness of this program. This survey is
conducted by the ADR Program in an effort to better understand any concerns or questions regarding
Equal Employment Opportunity (EEO)-related ADR and how to improve it.
Your participation in this survey is completely voluntary. This survey should take less than 10 minutes.
Your responses and/or comments will remain anonymous. The ADR Program will not try and identify
you nor will ADR distribute your individual responses or comments to anyone else (unless required to do
so by law). ADR will only analyze all survey responses from all survey participants on a quarterly basis in
order to improve the effectiveness of the process. Your responses and/or comments (or lack thereof)
will not be made part of the relevant complaint file, or be used or considered in any way in any current
or subsequent informal or formal EEO complaint (unless required by law).
Confidentiality is critical to the integrity and success of the ADR Program. All participants in ADR must
keep everything said and done during ADR sessions completely confidential. In answering the questions
in this survey or providing comments below, please be sure not to include any information about the
substantive discussions or anything specific that occurred during any particular ADR session.
If you need a reasonable accommodation to participate in or complete this survey, you can contact
the Bureau’s reasonable accommodation coordinator at
[email protected]. If you have questions or concerns about the Bureau’s
reasonable accommodation policy or procedures, you can also contact the Office of Civil Rights at 202435-9EEO, 1-855-233-0362, 202-435-9742 (TTY) or [email protected].

Privacy Notice
5 U.S.C. 552a(e)(3)
The information you provide through your responses as employees of the Consumer Financial
Protection Bureau (Bureau) who have participated in the Alternative Dispute Resolution (ADR)
Program will allow the ADR Program better understand any concerns or questions regarding Equal

Employment Opportunity (EEO)-related ADR and how to improve it.
The CFPB will not obtain or access personally identifiable information.
This collection of information is authorized by Pub. L. No. 111-203, Title X, Sections 1013 and 1022,
codified at 12 U.S.C. §§ 5493 and 5512.
Participation in this study is voluntary; you are not required to participate.
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. 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].
ADR Program – Aggrieved Individuals/Complainants
This page will ask you specific questions about your experience as an individual who has participated in
the Bureau's informal and/or formal EEO process and who has elected to use the ADR program to help
resolve your EEO matter. If you are not the individual who pursued EEO counseling or filed a formal EEO
complaint, please skip to the next question.
Confidentiality is critical to the integrity and success of the ADR Program. All participants in EEO-related
ADR must keep everything said and done during mediation sessions completely confidential. In
answering the questions in this survey or providing comments below, please be sure not to include any
information about the substantive discussions or anything specific that occurred during any particular
mediation. For each question below, please select the best response.
1. ADR Program – Aggrieved Individuals/Complainants
The ADR Program gave me sufficient information about the ADR process to enable me to make an
informed decision about whether to select ADR to try to resolve my EEO matter.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:

I freely and voluntarily decided to participate in the ADR Program.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Program personnel involved in arranging the ADR session(s) answered all of my questions
about the program and process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I am satisfied with the time it took to schedule the date for the ADR session(s).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
Before the mediation, I had a chance to specify the particular matters I wanted addressed during the
ADR session.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
Before the mediation, I was made aware that I have the right to representation during the ADR
process.
Strongly Agree
Agree

Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
Before the mediation, I was assured that I would be free to end the ADR process at any time, and that
I would retain the right to proceed with the EEO process instead (if the matter was not resolved).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
Before the mediation, I was assured that no one could force a resolution on me (not agency
management, EEO officials, or the ADR Professional or Mediator).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I participated in the ADR process in good faith.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The Bureau management representative(s) who participated in the ADR process participated in good
faith.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The Bureau management representative(s) who participated in the ADR process was/were the most
appropriate official(s) to participate in the mediation to facilitate a resolution of my EEO matter.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The Bureau management representative(s) who participated in the ADR process came informed and
prepared regarding the particular matters to be addressed during the mediation.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Professional or Mediator came informed and prepared regarding the particular matters to be
addressed during the mediation.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Professional or Mediator was impartial/unbiased.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Professional or Mediator was sufficiently knowledgeable about ADR.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Professional or Mediator was effective overall.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
During the mediation, I was allowed to fully express my concerns and perspectives.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The particular matters I wanted to address during the mediation were in fact raised and discussed
thoroughly (even if they were not resolved).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I did not feel any inappropriate pressure to resolve my EEO matter during or after the mediation.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Provide suggestions on how the ADR Program may be more efficient and achieve better results:
Matters discussed during the mediation will remain confidential.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
Part or all of my EEO matter was resolved as a result of the ADR process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I was satisfied with the result of the mediation.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I have confidence in the ADR Program.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
ADR Program/ADR Professional or Mediator adequately responded to my questions or concerns
about possible retaliation for participating in EEO-related ADR.
Strongly Agree
Agree

Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I feel sufficiently protected from retaliation for having engaged in EEO-related ADR.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
If you needed a reasonable accommodation (for disability-related reasons) to participate in the ADR
Program: My request for a reasonable accommodation was promptly and adequately handled.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:

2. If dissatisfied with the results of ADR, explain why. Check all that apply. w
Management did not offer any remedy to me.
Management did not offer me the remedy I requested.
Management offered me only part of the remedy I requested.
The facilitator did not do a good job controlling the conversation.
Management was not prepared to respond to the concerns I raised.
Other: Please Explain:
ADR Program – Bureau Management Representative(s)
This page will ask you specific questions about your experience as a Bureau management representative
who has participated in the ADR Program to help resolve an EEO matter. If you were not a Bureau
management representative who participated in a recent mediation, please skip to the next question.
Confidentiality is critical to the integrity and success of the ADR Program. All participants in EEO-related
ADR must keep everything said and done during mediation sessions completely confidential. In

answering the questions in this survey or providing comments below, please be sure not to include any
information about the substantive discussions or anything specific that occurred during any particular
mediation.
3. ADR Program– Bureau Management Representative(s)
The ADR Program personnel involved in arranging the ADR session(s) answered all of my questions about the
program and process.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I am satisfied with the time it took to schedule the date for the ADR session(s).

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
Before the mediation, I had a chance to specify the particular matters I wanted addressed during the mediation.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I participated in the ADR process in good faith.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:

The aggrieved individual/complainant who participated in the ADR process participated in good faith.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The representative for the aggrieved individual/complainant (if any) who participated in the ADR process
participated in good faith.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Professional or Mediator came informed and prepared regarding the particular matters to be
addressed during the mediation.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Professional or Mediator was impartial/unbiased.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Professional or Mediator was sufficiently knowledgeable about ADR.

Strongly Agree
Agree
Neutral

Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Professional or Mediator was effective overall.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
During the mediation, I was allowed to fully express my concerns and perspectives.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The particular matters I wanted to address during the mediation were in fact raised and discussed
thoroughly (even if they were not resolved).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I did not feel any inappropriate pressure to settle the EEO matter during or after the mediation.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
Matters discussed during the mediation will remain confidential.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
Part or all of the EEO matter was resolved as a result of the ADR session(s).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I was satisfied with the result of the ADR session.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I have confidence in the ADR program.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
ADR Program/ADR Professional or Mediator adequately explained my need to refrain from retaliating
in any way against any individual (including the aggrieved individual/complainant) for their
participation in EEO-related ADR.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Provide suggestions on how the ADR Program may be more efficient and achieve better results:

If you needed a reasonable accommodation (for disability-related reasons) to participate in the ADR
Program: My request for a reasonable accommodation was promptly and adequately handled.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:

Thank you for taking the time to fill out this survey!
The responses that you have provided will be extremely helpful in ensuring that ADR Program is
providing the best service possible.
Your responses and/or comments will remain anonymous. ADR Program will not distribute your
individual responses or comments to anyone else (unless required to do so by law). Your responses
and/or comments (or lack thereof) will not be made part of the relevant complaint file, or be used or
considered in any way in a subsequent informal or formal EEO complaint or ADR proceeding (unless
required by law).

OMB No. 3170-0024
Expiration Date: XX/XX/XXXX

Alternative Dispute Resolution (ADR) Program Survey:
Non-Equal Employment Opportunity (EEO) ADR
Purpose of Survey
The purpose of this survey is to allow employees, contractors, and applicants of the Consumer Financial
Protection Bureau (Bureau) who have participated in the Alternative Dispute Resolution (ADR)
Program to freely express their views with regard to the effectiveness of this program. This survey is
conducted by the ADR Program in an effort to better understand any concerns or questions regarding
ADR and how to improve it.
Your participation in this survey is completely voluntary. This survey should take less than 10 minutes.
Your responses and/or comments will remain anonymous. The ADR Program will not try and identify
you nor will ADR distribute your individual responses or comments to anyone else (unless required to do
so by law). ADR will only analyze all survey responses from all survey participants on a quarterly basis in
order to improve the effectiveness of the process. Your responses and/or comments (or lack thereof)
will not be made part of the relevant complaint file, or be used or considered in any way in any current
or subsequent informal or formal EEO complaint (unless required by law).
Confidentiality is critical to the integrity and success of the ADR Program. All participants in ADR must
keep everything said and done during ADR sessions completely confidential. In answering the questions
in this survey or providing comments below, please be sure not to include any information about the
substantive discussions or anything specific that occurred during any particular ADR session.
If you need a reasonable accommodation to participate in or complete this survey, you can contact
the Bureau’s reasonable accommodation coordinator at
[email protected]. If you have questions or concerns about the Bureau’s
reasonable accommodation policy or procedures, you can also contact the Office of Civil Rights at 202435-9EEO, 1-855-233-0362, 202-435-9742 (TTY) or [email protected].
Privacy Notice
5 U.S.C. 552a(e)(3)
The information you provide through your responses as employees of the Consumer Financial
Protection Bureau (Bureau) who have participated in the Alternative Dispute Resolution (ADR)
Program will allow the ADR Program better understand any concerns or questions regarding ADR related
matters and how to improve it.

The CFPB will not obtain or access personally identifiable information.
This collection of information is authorized by Pub. L. No. 111-203, Title X, Sections 1013 and 1022,
codified at 12 U.S.C. §§ 5493 and 5512.
Participation in this study is voluntary; you are not required to participate.
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. 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].
ADR Program – Requesting Employee
This page will ask you specific questions about your experience as an individual who has participated in
the Bureau's informal ADR process and who has elected to use the ADR Program to help resolve your
matter. If you are not the individual who pursued ADR, please skip to the next question.
Confidentiality is critical to the integrity and success of the ADR Program. All participants in ADR must
keep everything said and done during ADR sessions completely confidential. In answering the questions
in this survey or providing comments below, please be sure not to include any information about the
substantive discussions or anything specific that occurred during any particular ADR session.
1. ADR Program – Requesting Employee
The ADR Program gave me sufficient information about the ADR process to enable me to make an
informed decision about whether to select ADR to try to resolve my matter.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I freely and voluntarily decided to participate in the ADR Program.
Strongly Agree
Agree

Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Program personnel involved in arranging the ADR session(s) answered all of my questions
about the program and process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I am satisfied with the time it took to schedule the date for the ADR session(s).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
Before the ADR session, I had a chance to specify the particular matters I wanted addressed during the
ADR session.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I participated in the ADR process in good faith.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:

The responding employee(s) who participated in the ADR process participated in good faith.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The responding employee who participated in the ADR process was/were the most appropriate
official(s) to participate in the ADR session to facilitate a resolution of my matter.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The responding employee who participated in the ADR process came informed and prepared
regarding the particular matters to be addressed during the mediation.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Professional or Mediator came informed and prepared for the mediation.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Professional or Mediator was impartial/unbiased.
Strongly Agree
Agree
Neutral

Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Professional or Mediator was sufficiently knowledgeable about ADR.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Professional or Mediator was effective overall.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
During the mediation, I was allowed to fully express my concerns and perspectives.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The particular matters I wanted to address during the mediation were in fact raised and discussed
thoroughly (even if they were not resolved).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:

I did not feel any inappropriate pressure to resolve my matter during or after ADR session.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
Matters discussed during the mediation will remain confidential.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
Part or all of my matter was resolved as a result of the ADR process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I was satisfied with the result of the mediation.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I have confidence in the ADR Program.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Provide suggestions on how the ADR Program may be more efficient and achieve better results:
If you needed a reasonable accommodation (for disability-related reasons) to participate in the ADR
Program: My request for a reasonable accommodation was promptly and adequately handled.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:

2. If dissatisfied with the results of ADR, explain why. Check all that apply. w
The responding employee did not offer any remedy to me.
The responding employee did not offer me the remedy I requested.
The responding employee offered me only part of the remedy I requested.
The ADR Professional or Mediator did not do a good job controlling the conversation.
The responding employee was not prepared to respond to the concerns I raised.
Other: Please Explain:
ADR Program – Responding Employee
This page will ask you specific questions about your experience as a responding employee who has
participated in the ADR Program to help resolve a matter. If you were not a responding employee who
participated in a recent mediation, please skip to the next question.
Confidentiality is critical to the integrity and success of the ADR Program. All participants in ADR must
keep everything said and done during mediation sessions completely confidential. In answering the
questions in this survey or providing comments below, please be sure not to include any information
about the substantive discussions or anything specific that occurred during any particular mediation.
3. ADR Program – Responding Employee
The ADR Program personnel involved in arranging the ADR session(s) answered all of my questions about the
program and process.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:

I am satisfied with the time it took to schedule the date for the ADR session(s).

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
Before the mediation, I had a chance to specify the particular matters I wanted addressed during the mediation.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I participated in the ADR process in good faith.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The requesting employee who participated in the ADR process participated in good faith.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Professional or Mediator came informed and prepared regarding the particular matters to be
addressed during the mediation.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Professional or Mediator was impartial/unbiased.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Professional or Mediator was sufficiently knowledgeable about ADR.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The ADR Professional or Mediator was effective overall.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
During the mediation, I was allowed to fully express my concerns and perspectives.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
The particular matters I wanted to address during the mediation were in fact raised and discussed
thoroughly (even if they were not resolved).
Strongly Agree
Agree

Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I did not feel any inappropriate pressure to settle the matter during or after the mediation.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
Matters discussed during the mediation will remain confidential.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
Part or all of the matter was resolved as a result of the ADR session(s).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I was satisfied with the result of the ADR session.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
I have confidence in the ADR program.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:
If you needed a reasonable accommodation (for disability-related reasons) to participate in the ADR
Program: My request for a reasonable accommodation was promptly and adequately handled.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Provide suggestions on how the ADR Program may be more efficient and achieve better results:

Thank you for taking the time to fill out this survey!
The responses that you have provided will be extremely helpful in ensuring that the ADR Program is
providing the best service possible.
Your responses and/or comments will remain anonymous. The ADR Program will not distribute your
individual responses or comments to anyone else (unless required to do so by law). Your responses
and/or comments (or lack thereof) will not be made part of the relevant file, or be used or considered
in any subsequent proceeding (unless required by law).

OMB No. 3170-0024
Expiration Date: XX/XX/XXXX

Equal Employment Opportunity (EEO) Survey:
Formal Complaint Process
Purpose of Survey
The purpose of this survey is to allow individuals who have participated in the Formal Equal Employment
Opportunity (EEO) Process at the Consumer Financial Protection Bureau (Bureau) to freely express their
views with regard to the effectiveness of this process. This survey is conducted by the Bureau's Office of
Civil Rights (OCR) in an effort to better understand any concerns or questions regarding the formal
complaint process and how to improve it.
Your participation in this survey is completely voluntary. This survey should take less than 10 minutes.
Your responses and/or comments will remain anonymous. OCR will not try and identify you nor will
OCR distribute your individual responses or comments to anyone else (unless required to do so by
law). OCR will only analyze all survey responses from all survey participants on a quarterly basis in order
to improve the effectiveness of the process. Your responses and/or comments (or lack thereof) will not
be made part of the relevant complaint file, or be used or considered in any way in any current or
subsequent informal or formal EEO complaint (unless required by law).
If you need a reasonable accommodation to participate in or complete this survey, you can contact
the Bureau’s reasonable accommodation coordinator at
[email protected]. If you have questions or concerns about the Bureau’s
reasonable accommodation policy or procedures, you can also contact the Office of Civil Rights at 202435-9EEO, 1-855-233-0362, 202-435-9742 (TTY) or [email protected] Notice
5 U.S.C. 552a(e)(3)
The information you provide through your responses as employees of the Consumer Financial
Protection Bureau (Bureau) who have participated in the Formal Equal Employment Opportunity (EEO)
Process will allow the Bureau's Office of Civil Rights (OCR) to better understand any concerns or
questions you may have about the Formal EEO Process and how to improve it.
The CFPB will not obtain or access personally identifiable information.
This collection of information is authorized by Pub. L. No. 111-203, Title X, Sections 1013 and 1022,
codified at 12 U.S.C. §§ 5493 and 5512.
Participation in this study is voluntary; you are not required to participate.

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. 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].

Your experience during the Formal EEO Complaint Process – Complainants
The Formal EEO Complaint Process begins when you file a formal complaint of discrimination with the
Bureau's Office of Civil Rights (OCR). This page will ask you specific questions about your experience as a
complainant during the Formal EEO Complaint Process only. If you did not participate in the formal
complaint process recently as a complainant, please skip to the next question.
1. Formal EEO Complaint Process – Complainants
After I filed my formal complaint, OCR or its contract EEO investigator clearly explained the steps and
deadlines of the formal complaint process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
OCR accurately captured the substance of my claims in its initial letter accepting my claims (if any
claim was accepted).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:

OCR clearly explained to me why claims were dismissed (if any claim was dismissed).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO investigator clearly explained my rights and responsibilities in the formal complaint process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO investigator was impartial/unbiased.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO investigator was thorough.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO investigator provided me with ample time to complete the interview or affidavit process.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO investigator allowed me to suggest additional sources of relevant information (e.g.,
witnesses, documents, etc.).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO investigator contacted the relevant witnesses that I identified.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I had an opportunity to provide a rebuttal to witness statements.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I had an opportunity to identify any perceived deficiencies in the Report of Investigation after the
Report of Investigation was issued.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The Report of Investigation accurately captured the relevant facts and evidence regarding
my formal complaint.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The investigation was completed promptly (in accordance with regulations, a timely investigation is
completed within 180 days after a formal complaint is filed or up to 360 calendar days if
an amendment is filed or an extension is granted).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
At the end of the EEO investigation, I clearly understood my right to request either a final decision
from the agency or a hearing before an EEOC Administrative Judge.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:

If a final agency decision was requested or issued: The Bureau’s final decision after the investigation
was easy to understand.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
If a final agency decision was requested or issued: I understood my appeal rights described at the end
of the Bureau's final agency decision.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The OCR case manager assigned to my complaint was responsive to my inquiries.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The OCR case manager kept me up to date on the progress of my complaint throughout the formal
process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:

I felt comfortable communicating with the OCR case manager.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The formal complaint process is fair.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The formal complaint process is useful.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I am satisfied with the formal complaint process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I feel sufficiently protected from retaliation for having engaged in the formal complaint process.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
OCR adequately responded to my questions or concerns about possible retaliation.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
If you needed a reasonable accommodation (for religious or disability-related reasons) to participate
in the formal complaint process: My request for a reasonable accommodation was promptly and
adequately handled.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The Formal EEO Complaint Process begins when a complainant files a formal complaint of discrimination
with the Bureau's OCR. This page will ask you specific questions about your experience as a named
responsible management official or alleged discriminating individual during the Formal EEO Complaint
Process only. If you did not participate in the formal complaint process recently as a named alleged
responsible management official or alleged discriminating individual, please skip to the next question.
2. Formal EEO Complaint Process – Alleged Responsible Management Officials/ Alleged Discriminating
Individual
OCR or its contract EEO investigator clearly explained the steps and deadlines of the formal complaint
process.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO investigator clearly explained my rights and responsibilities in the formal complaint process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO investigator was impartial/unbiased.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO investigator was thorough.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO investigator allowed me to suggest additional sources of relevant information (e.g.,
witnesses, documents, etc.).
Strongly Agree
Agree

Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO investigator provided me with ample time to complete the interview or affidavit process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The formal complaint process is fair.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I am satisfied with the formal complaint process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
OCR adequately explained my need to refrain from retaliating in any way against any individual
(including the complainant) for their participation in the EEO formal complaint process.
Strongly Agree
Agree
Neutral
Disagree

Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
OCR adequately explained my right to be free from retaliation of any kind for participating in the EEO
formal complaint process as a witness.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
If you needed a reasonable accommodation (for religious or disability-related reasons) to participate
in the formal complaint process: My request for a reasonable accommodation was promptly and
adequately handled.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The Formal EEO Complaint Process begins when a complainant files a formal complaint of discrimination
with the Bureau's OCR. This page will ask you specific questions about your experience as a witness
other than the complainant or named alleged responsible management official/alleged discriminating
individual during the Formal EEO Complaint Process only. If you are the complainant or an alleged
responsible management official/alleged discriminating individual named in this formal complaint,
please skip to the next question.
3. Formal EEO Complaint Process – Other Witnesses
OCR or its contract EEO investigator clearly explained the steps and deadlines of the formal complaint
process.
Strongly Agree
Agree
Neutral
Disagree

Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO investigator clearly explained my rights and responsibilities in the formal complaint process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO investigator was impartial/unbiased.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO investigator was thorough.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO investigator allowed me to suggest additional sources of relevant information (e.g.,
witnesses, documents, etc.).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know

If you have any specific comments you would like to leave you can do so here:
The EEO investigator provided me with ample time to complete the interview or affidavit process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The formal complaint process is fair.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I am satisfied with the formal complaint process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
OCR adequately explained my need to refrain from retaliating in any way against any individual
(including the complainant) for their participation in the EEO formal complaint process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:

OCR adequately explained my right to be free from retaliation of any kind for participating in the EEO
formal complaint process as a witness.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
If you needed a reasonable accommodation (for religious or disability-related reasons) to participate
in the formal complaint process: My request for a reasonable accommodation was promptly and
adequately handled.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
Thank you for taking the time to fill out this survey!
The responses that you have provided will be extremely helpful in ensuring that OCR is providing
the best service possible. Your responses and/or comments will remain anonymous. OCR will not distribute
your individual responses or comments to anyone else (unless required to do so by law). Your responses and/or
comments (or lack thereof) will not be made part of the relevant complaint file, or be used or considered in any
way in a subsequent formal or informal EEO complaint (unless required by law).

OMB No. 3170-0024
Expiration Date: XX/XX/XXXX

Equal Employment Opportunity (EEO) Survey:
Informal Complaint Process
Purpose of Survey
The purpose of this survey is to allow individuals who have participated in the Informal Equal
Employment Opportunity (EEO) Process (also called EEO counseling) at the Consumer Financial
Protection Bureau (Bureau) to freely express their views with regard to the effectiveness of this process.
This survey is conducted by the Bureau's Office of Civil Rights (OCR) in an effort to better understand
any concerns or questions regarding the informal EEO process and how to respond to those concerns
and questions.
Your participation in this survey is completely voluntary. This survey should take less than 10 minutes.
Your responses and/or comments will remain anonymous. OCR will not try and identify you nor will
OCR distribute your individual responses or comments to anyone else (unless required to do so by
law). OCR will only analyze all survey responses from all survey participants on a quarterly basis in order
to improve the effectiveness of the process. Your responses and/or comments (or lack thereof) will not
be made part of the relevant complaint file, or be used or considered in any way in any current or
subsequent informal or formal EEO complaint (unless required by law).
If you need a reasonable accommodation to participate in or complete this survey, you can contact
the Bureau’s reasonable accommodation coordinator at
[email protected]. If you have questions or concerns about the Bureau’s
reasonable accommodation policy or procedures, you can also contact the Office of Civil Rights at 202435-9EEO, 1-855-233-0362, 202-435-9742 (TTY) or [email protected].
Privacy Notice
5 U.S.C. 552a(e)(3)
The information you provide through your responses as employees of the Consumer Financial
Protection Bureau (Bureau) who have participated in the Informal Equal Employment Opportunity (EEO)
Process will allow the Bureau's Office of Civil Rights (OCR) to better understand any concerns or
questions you may have about the Informal EEO Process and how to improve it.
The CFPB will not obtain or access personally identifiable information.
This collection of information is authorized by Pub. L. No. 111-203, Title X, Sections 1013 and 1022,
codified at 12 U.S.C. §§ 5493 and 5512.

Participation in this study is voluntary; you are not required to participate.
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. 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].
EEO Counseling – Aggrieved Individuals
This page will ask you specific questions about your experience as an "aggrieved individual" during the
Informal EEO process/EEO counseling. Please answer this question if you are/were an individual who
sought advice or help from the Bureau's OCR about possible violations of your rights under the EEO
laws. If you are not the "aggrieved individual" please skip to the next question.
1. Informal EEO Process
It was easy to figure out how to contact OCR.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I was aware before I contacted OCR that I generally had to request EEO counseling within 45 calendar
days of the act I believed may have been discriminatory.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
OCR responded within 2 business days after I contacted them.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
An EEO counselor was available to meet with me within 5 business days after I first contacted OCR.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO counselor appeared knowledgeable about the EEO complaint process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I was comfortable communicating with the EEO Counselor.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO counselor was impartial/unbiased.
Strongly Agree
Agree
Neutral

Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO counselor clearly explained my rights and responsibilities during the informal EEO process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO counselor clearly explained the informal and formal complaint process and related time
frames.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO counselor clearly explained the options for attempting resolution of my claim, including
the use of Alternate Dispute Resolution (ADR).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
If you requested to remain anonymous during the informal EEO process: The EEO counselor and OCR
preserved my anonymity during the informal EEO process.
Strongly Agree
Agree
Neutral

Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
EEO counseling generally must be completed within 30 calendar days of your initial request for
counseling. If ADR is offered/accepted, it can take up to 90 calendar days. Considering these
deadlines, the informal process was completed promptly.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The informal EEO process is a fair process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The informal EEO process is a useful process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I am satisfied with the assistance I received from the EEO counselor/OCR personnel during the
informal EEO process.
Strongly Agree
Agree
Neutral

Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I am satisfied with the informal EEO process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I understand that I have the right to remain free from any retaliation for having engaged in the
informal EEO process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I feel sufficiently protected from retaliation for having engaged in the informal EEO process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
OCR/the EEO counselor adequately responded to my questions or concerns about possible retaliation.
Strongly Agree
Agree
Neutral
Disagree

Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
If you needed a reasonable accommodation (for religious or disability-related reasons) to participate
in the informal EEO process: My request for a reasonable accommodation was promptly and
adequately handled.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
EEO Counseling – Alleged Responsible Management Officials/ Alleged Discriminating Individual
This page will ask you specific questions about your experience as a named alleged responsible
management official or alleged discriminating individual during the informal EEO process only. If you did
not participate in the informal EEO process recently as a named alleged responsible management official
or alleged discriminating individual, please skip to the next question.
2. Informal EEO Process – Alleged Responsible Management Officials/ Alleged Discriminating Individual
The EEO counselor appeared knowledgeable about the EEO complaint process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I was comfortable communicating with the EEO Counselor.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know

If you have any specific comments you would like to leave you can do so here:
The EEO counselor was impartial/unbiased.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO counselor clearly explained my rights and responsibilities during the informal EEO process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO counselor clearly explained the informal and formal complaint process and related time
frames.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The informal EEO process is a fair process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:

The informal EEO process is a useful process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I am satisfied with the assistance I received from the EEO counselor/OCR personnel during the
informal EEO process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I am satisfied with the informal EEO process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
OCR/the EEO counselor adequately explained my need to refrain from retaliating in any way against
any individual (including the aggrieved individual who sought EEO counseling) for their participation in
the informal EEO process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:

OCR/the EEO counselor adequately explained my right to be free from retaliation of any kind for
participating in the informal EEO process as a witness.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
If you needed a reasonable accommodation (for religious or disability-related reasons) to participate
in the informal EEO process: My request for a reasonable accommodation was promptly and
adequately handled.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
EEO Counseling – Other Witnesses
This page will ask you specific questions about your experience as a witness (other than the aggrieved
individual or named responsible management official/alleged discriminating individual) during the
informal EEO process only. If you are the aggrieved individual who sought EEO counseling or an alleged
responsible management official named as part of the informal EEO process, please skip to the next
question.
3. Informal EEO Process – Other Witnesses
The EEO counselor appeared knowledgeable about the EEO complaint process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I was comfortable communicating with the EEO Counselor.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO counselor was impartial/unbiased.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO counselor clearly explained my rights and responsibilities during the informal EEO process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The EEO counselor clearly explained the informal and formal complaint process and related time
frames.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The informal EEO process is a fair process.
Strongly Agree
Agree

Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
The informal EEO process is a useful process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I am satisfied with the assistance I received from the EEO counselor/OCR personnel during the
informal EEO process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
I am satisfied with the informal EEO process.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
OCR/the EEO counselor adequately explained my need to refrain from retaliating in any way against
any individual (including the aggrieved individual who sought EEO counseling) for their participation in
the informal EEO process.
Strongly Agree
Agree

Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
OCR/the EEO counselor adequately explained my right to be free from retaliation of any kind for
participating in the informal EEO process as a witness.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:
If you needed a reasonable accommodation (for religious or disability-related reasons) to participate
in the informal EEO process: My request for a reasonable accommodation was promptly and
adequately handled.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable or I Do Not Know
If you have any specific comments you would like to leave you can do so here:

Thank you for taking the time to fill out this survey!
The responses that you have provided will be extremely helpful in ensuring that OCR is providing
the best service possible. Your responses and/or comments will remain anonymous. OCR will not distribute
your individual responses or comments to anyone else (unless required to do so by law). Your responses and/or
comments (or lack thereof) will not be made part of the relevant complaint file, or be used or considered in any
way in a subsequent formal or informal EEO complaint (unless required by law).