0917-0036 OIT Customer Satisfaction Survey – Problem Ticket (scree

OIT Customer Satisfaction Survey- Problem Ticket

REQUIRED OMB INFORMATION: 
Indian Health Service (IHS) FY_ Classroom Post Class Survey  

Form Approved 
OMB Form No. 0917­0036 
Expiration Date:  

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB 
control number. The valid OMB control number for this information collection is 0917­0036. The time required to complete this information 
collection is estimated to average 5 minutes per response, including the time to review instructions, search existing data resources, gather the data 
needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions 
for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336E, 
Washington D.C. 20201, Attention: PRA Reports Clearance Officer. 

*1. To follow up on your comments if necessary, please provide your name and ticket

number.
Name:

Ticket Number:

*2. Has the service you requested been provided? If not, please contact the OIT Help

Desk by phone (18888307280) or email ([email protected]) so that your ticket can be
reopened and escalated.

j Yes
k
l
m
n
j No
k
l
m
n

3. Please rate the overall quality of service that you received.
Overall quality of service

Service Not Provided

Poor

Satisfactory

Very Good

Excellent

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

4. Please rate the speed with the service you requested was provided.
Speed of service

Service Not Provided

Poor

Satisfactory

Very Good

Excellent

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

5. (Optional) Do you have any recommendations or comments?
5
6  

Page 1