Form FEMA Form FF-104-F FEMA Form FF-104-F Temporary Housing Unit Survey- Phone

T emporary Housing Units (THU) Survey- Phone

OMB Control Number 1660-0145

Expiration: XX/XX/20XX

PAPERWORK BURDEN DISCLOSURE NOTICE:

Public reporting burden for this data collection is estimated to average 8 minutes per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting this form. This collection of information is voluntary. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW., Washington, DC 20472-3100, Paperwork Reduction Project (1660-0143) NOTE: Do not send your completed form to this address.

PRIVACY ACT STATEMENT

AUTHORITY: Government Performance and Results Act of 1993 (Pub. L. 103-62), as amended, and the GPRA Modernization Act of 2010 (Pub. L. 111-352); Executive Order (EO) 12862, “Setting Customer Service Standards”; and its March 23, 1995 Memorandum addendum, “Improving Customer Service”; Executive Order 13411 “Improving Assistance for Disaster Victims”; Executive Order 13571 “Streamlining Service Delivery and Improving Customer Service”; and the related June 13, 2011 Memorandum “Implementing Executive Order 13571 on Streamlining Service Delivery and Improving Customer Service.”

PRINCIPAL PURPOSE(S): DHS/FEMA collects this information to measure Individual Assistance applicants’ customer satisfaction with FEMA services.

ROUTINE USE(S): This information is used for the principal purpose noted above. Summary and/or aggregate survey results and analysis may be shared with Congress and the Government Accountability Office; however, no Personally Identifiable Information (PII) will be shared externally, except as allowed under the routine uses published in System of Records Notice DHS/FEMA-008 - Disaster Recovery Assistance Files, 78 FR 25282 (April 30, 2013), or as required by law. The Department's system of records notices can be found on the Department's website at http://www.dhs.gov/system-records-notices-sorns.

DISCLOSURE: The disclosure of information on this form is strictly voluntary and will assist FEMA is making improvements to its Individual Assistance program; failure to provide the information requested will not impact an individual’s ability to qualify for or receive FEMA Individual Assistance. Questions regarding this form may be submitted via email to [email protected].

Introduction – Phone Survey (Applicants who requested US mail will be surveyed by telephone)

Hello, I’m calling from FEMA, the Federal Emergency Management Agency. My name is _____ and my PIN number is ____. May I please speak with [Applicant Name] or the person most familiar with the Temporary Housing Unit provide by FEMA?

If no: Thank you for your time and have a good day/evening.

If yes: FEMA is looking for ways to improve services and your opinion is very important. Would you volunteer to take 8-10 minutes to answer some questions?

If no: What would be a better time to call back? Thank you for your time and have a good day/evening. (Note: if respondent requests electronic survey rather than call back click below, obtain and verify e-mail address. Explain e-mail will be sent within 1 business day from FEMA-CSA-Survey mailbox).

Enter e-mail address

Verify e-mail address

If yes: These questions comply with the Privacy Act of 1974 and have been approved by the Office of Management and Budget under number (New OMB Number). Your answers will not affect the outcome of your application for FEMA assistance. This call may be monitored and/or recorded for quality assurance.

Please click Next to begin the survey:

INFORMATION

Using a scale of 1 (Poor) to 5 (Excellent), how would you rate the Temporary Housing Program Information provided by FEMA on…

	1 Poor	2	3	4	5 Excellent
1. Being easy to understand	O	O	O	O	O
2. Answering your questions	O	O	O	O	O
3. Being helpful	O	O	O	O	O
4. Explaining what happens next	O	O	O	O	O
5. Overall satisfaction with information	O	O	O	O	O

CUSTOMER SERVICE

Using the same rating scale, please rate FEMA Representatives on…

	1 Poor	2	3	4	5 Excellent	Did not talk to FEMA Representative
6. Courtesy	O	O	O	O	O	O
7. Showing interest in helping	O	O	O	O	O	O
8. Overall customer service	O	O	O	O	O	O

TEMPORARY HOUSING ASSISTANCE

Using a scale of 1 (Not at all Satisfied) to 5 (Very Satisfied), how would you rate the housing provided by FEMA on the following areas:

	1 Not at all Satisfied	2	3	4	5 Very Satisfied	Don’t Know or Not Applicable
9. Timeliness of availability for move in	O	O	O	O	O	O
10. Being equipped with basic household items	O	O	O	O	O	O
11. Being conveniently located	O	O	O	O	O	O
12. Accommodating household members with access and functional needs	O	O	O	O	O	O
13. Quality of maintenance or repair services	O	O	O	O	O	O
14. Timeliness of maintenance or repair services	O	O	O	O	O	O

	1 Not at all Satisfied	2	3	4	5 Very Satisfied
15. Overall, how satisfied are you with FEMA’s temporary housing unit?	O	O	O	O	O

Using a scale of 1 (Not at all Easy) to 5 (Very Easy), how would you rate FEMA on making it easy to…

	1 Not at all Easy	2	3	4	5 Very Easy	Don’t Know or Not Applicable
16. Obtain a temporary housing unit	O	O	O	O	O	O
17. Renew continuation of housing assistance	O	O	O	O	O	O

(Programmer Note: If VACATEDDT is not null go to Q18 else go to Q19)

Using a scale of 1 (Not at all Easy) to 5 (Very Easy), how would you rate FEMA on making it easy to…

	1 Not at all Easy	2	3	4	5 Very Easy	Don’t Know or Not Applicable
18. Move out of temporary housing	O	O	O	O	O	O

19. What suggestions do you have for improving FEMA’s Temporary Housing Assistance Program? (500 Character Maximum)

DEMOGRAPHICS

20. We’re almost done. Would you volunteer to answer a few demographic questions for statistical purposes?

• Yes

• No

(Programmer Note: If Q20 response = Yes go to 21 else go to Q27)

Q21. Is your gender…

◘ Female

◘ Male

◘ Other (e.g., transgender, nonbinary, or gender variant)

◘ Prefer not to answer

Q22. Is your age range…

◘ Under 25

◘ 25 to 34

◘ 35 to 44

◘ 45 to 54

◘ 55 to 64

◘ 65 to 74

◘ 75 or older

◘ Prefer not to answer

Q23. Is your marital status…

◘ Never married

◘ Married or living with partner

◘ Separated

◘ Widowed

◘ Divorced

◘ Prefer not to answer

Q24. Is your current employment status…

◘ Employed for wages

◘ Self-employed

◘ Unemployed

◘ Homemaker

◘ Student

◘ Retired

◘ Prefer not to answer

Q25. Which of the following best describes your highest level of formal education?

◘ Did not complete high school

◘ High school graduate / GED

◘ Some college

◘ Associate degree

◘ Bachelor’s degree

◘ Master’s degree

◘ Doctoral degree

◘ Prefer not to answer

Q26. Are You Hispanic or Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.)

◘ Yes

◘ No

Q27. Please select the racial category or categories that you most closely identify with. Select as many as apply.

• American Indian or Alaska Native

• Asian

• Black or African American

• Native Hawaiian or Other Pacific Islander

• White

• Prefer not to answer

Q28. Do you or anyone in your household have a disability that affects your ability to carry out activities of daily living or requires an assistive device such as, but not limited to, a wheelchair, walker, cane, hearing aid, communication device, service animal, personal care attendant, oxygen or other similar medically-related devices or services?

◘ Yes

◘ No

(Programmer Note: If Q28 response = Yes go to Q29, else go to Q30)

Q29. Are the devices or services used to assist with any of the following? (You may select all that apply.)

• Mobility

• Cognitive, Developmental Disabilities, Mental Health

• Hearing and/or Speech

• Vision

• Self-Care

• Independent Living

• Other

Q30. Your opinion is very valuable to us. May we contact you later to ask additional questions?

◘ Yes

◘ No

Close

Thank you for your time. Have a good day/evening

FEMA Form FF-104-FY-21-184 (formerly 519-0-48)

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Fry, Gena
File Modified	0000-00-00
File Created	2022-05-02