Form 0917-0036 Indian Health Service (IHS) FY_ Satellite Classroom Post

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: IHS Customer Service Satisfaction and Similar Surveys

FY_Satellite Classroom Post Class Survey

Indian Health Service (IHS) FY_ Satellite Classroom Post Class Survey

OMB: 0917-0036

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2. Satellite Classroom Post Class Survey
REQUIRED OMB INFORMATION: 
Indian Health Service (IHS) FY_ Satellite 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. 
OIT values your input on the course you have just completed. Comments included on this post class survey will be used 
to help improve the effectiveness of OIT's training program. 

*1. How did you hear about this OIT sponsored RPMS course?
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c Other (please specify)
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*2. Was the registration process easy?
 

j Yes
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j No
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If you answered no, please identify ways to make the registration process easier. 

*3. Please rate the facility components below.
The presentation 

Strongly Disagree

Disagree

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Agree

Strongly Agree

N/A

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equipment/computers 
functioned properly.
The room was a 
comfortable learning 
environment.
Local IT support was 
responsive to class needs.
Electronic materials were 
available on the training 
computers.

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2. Satellite Classroom Post Class Survey

*4. Is there anything that would improve this training center?
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j Yes
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If yes, please note how this training center may be improved: 

*5. Please rate the presentation materials.
Strongly 
Disagree

Disagree

Somewhat Agree

Agree

Strongly Agree

Access to the materials was issued prior to the session.

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Direction regarding printed materials was provided prior 

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Training was paced appropriately.

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Sufficient practice time was provided.

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The hands­on exercises enhanced the learning 

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to the session.
I liked being able to choose which materials to print.
Comments (please specify) 

*6. Please rate the presentation methods.
Strongly 
Disagree
Objectives were clearly stated at the beginning of the 
session.

experience.
The hands­on exercises were useful in reinforcing the 
course objectives.

*7. Please rate the instructor.
Strongly 
Disagree
Arrived prepared and organized.

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Explained objectives clearly at the start of the training.

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Demonstrated knowledge of the subject material.

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Provided useful feedback on performance throughout the 

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Provided clear instructions.

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Addressed participant questions.

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Made the course interesting.

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session.

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2. Satellite Classroom Post Class Survey

*8. Please rate the proctor.
Strongly 
Disagree

Disagree

Somewhat Agree

Agree

Strongly Agree

Arrived prepared and organized.

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Provided clear instructions.

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Addressed participant questions.

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Quickly addressed technical issues contacting local IT 

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Actively participated in the training session.

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Remained in the training room the duration of the 

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support if necessary.

session.

*9. What part of the training did you find most useful?
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*10. What part of this training did you find least useful?
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11. Please make additional comments here.
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