Survey Quesionnaire

OMB control number 0910-0360

Expires 10/31/2023

Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 0910-0360. The time required to complete this information collection is estimated to average 5 minutes per respondent, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to [email protected].

The survey we are conducting is on behalf of the U.S. Food and Drug Administration.

CDRH Customer Service Survey

Document Type: Form

Date Effective: 12/20/2019

Point of Contact: Reeves, Paris

Excellent customer service is important to us. Thank you for providing feedback about the service you received. It should take less than three minutes to complete the survey. Your response is anonymous and will be used to improve CDRH Customer Service.

The CDRH customer service survey does not replace existing formal complaint mechanisms and is not intended to measure satisfaction with CDRH regulatory decisions. Your participation/nonparticipation is completely voluntary, and your responses will not influence your eligibility in receiving any FDA services.

1. I am satisfied/dissatisfied with the customer service I recently received.

Strongly Agree	Agree	Somewhat Agree	Somewhat Disagree	Disagree	Strongly Agree
○	○	○	○	○	○

2. During my most recent interaction, CDRH…

Factors	Strongly Agree	Agree	Somewhat Agree	Somewhat Disagree	Disagree	Strongly Disagree	N/A
Treated me with courtesy and respect	○	○	○	○	○	○	○
Resolved differences honestly and respectfully	○	○	○	○	○	○	○
Gave or accepted feedback with a positive and open- minded outlook	○	○	○	○	○	○	○
Communicated clearly and concisely	○	○	○	○	○	○	○
Provided a clear process to follow	○	○	○	○	○	○	○
Actively listened and encouraged the exchange of perspectives and ideas	○	○	○	○	○	○	○
Set reasonable expectations for follow-up	○	○	○	○	○	○	○
Collaborated in a creative, proactive and flexible manner, proposing viable solutions to address the problem or question	○	○	○	○	○	○	○
Provided initial response within 2 business days	○	○	○	○	○	○	○

3. Please provide any additional information that would help us understand your overall satisfaction rating and improve our services.

4. Which Office(s) did you interact with at CDRH? (Question available when survey is accessed via web only)

   • OCD – Office of the Center Director

   • OCE - Office of Communication and Education

   • OM - Office of Management

   • OP-Office of Policy

   • OPEQ - Office of Product Evaluation and Quality (formerly OC, ODE, OIR, and OSB)

   • OSEL - Office of Science and Engineering Laboratories

   • OST-Office of Strategic Partnership and Technology Innovation

   • I don't know

5. Please help us understand who you are by checking the box that applies to you.

   • Patient/ Consumer/ Caregiver

   • Health Care Provider/ Health Professional Organization

   • Industry/ Industry Consultants/ Industry Trade Associations

   • Academia

   • Food and Drug Administration (FDA)

   • Other Federal Agency

   • Non-U.S. Regulator

6. What FDA Center or Office are you part of?

   • Office of the Commissioner

   • CBER

   • CDER

   • CDRH

   • CFSAN

   • CTP

   • CVM

   • ORA

7. Which CDRH Office are you part of? (Question available when “CDRH” is selected for

Q. 6)

• OPEQ – Office of Product Evaluation and Quality

• OCD – Office of the Center Director

• OST – Office of Strategic Partnership and Technology Innovation

• OP – Office of Policy

• OM – Office of Management

• OCE – Office of Communication and Education

• OSEL – Office of Science and Engineering Laboratories

8. Your feedback is important to us. If you want to speak with CDRH about your feedback, contact the CDRH Quality Management and Organizational Excellence Program at [email protected].

SWIFT Document Change Control

Version	Description of Changes	Document Approver	Date Approved	Date Effective
3	Updated Q.2 to reflect CDRH Guiding Principles.	Braier, Nancy C.	11/7/2019	12/20/2019

The Version field for new documents (Version = 1.00) and major revisions (Version = 2.00, 3.00, etc.) display above as whole numbers (“1”, “2”, “3”, etc.).

This document was created using the following template: Form ID = 01009.07.00. Complete SWIFT Document Change Control history (all versions) retained in SWIFT Docs.

Doc ID 01034.03.00

Downloaded and/or hard copy uncontrolled. Controlled version in CDRH Docs.

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