Appendix A 5_Example Client Survey

Appendix A 5_Client Survey-10.14.docx

ACF Behavioral Interventions to Advance Self-Sufficiency Next Generation (BIAS-NG) Project

Appendix A 5_Example Client Survey

OMB: 0970-0502

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Expiration Date: XX/XX/XXXX


Appendix A.5:

Survey Questions for Clients


DRAFT Survey Questions


Overall, how satisfied are you with the services you received from [PROGRAM/AGENCY]?


  1. Very satisfied

  2. Somewhat satisfied

  3. Neutral

  4. Not very satisfied

  5. Not at all satisfied


How much effort did it take to get the services you needed?

  1. Very Difficult

  2. Difficult

  3. Neutral

  4. Easy

  5. Very Easy


How often did you interact with the staff?

  1. Every day or almost every day

  2. 3 or 4 times per week

  3. 1 or 2 times per week

  4. 2 or 3 times in the past month

  5. Once in the past month

  6. Less than once a month

  7. Not at all


Overall, how would you rate your interactions with the staff?

  1. Excellent

  2. Good

  3. Average

  4. Fair

  5. Poor

  6. Don’t know/not applicable




What types of services and help did you receive?


Yes

No

DK

Help with resume writing?




Assistance with identifying potential employers?




Assistance with completing job applications?




Help with job interviewing skills?




Help arranging child care




Transportation assistance




Help with work-appropriate clothing




General money management assistance





Overall, how would you rate the quality of the services and help?

  1. Very high

  2. High

  3. Neither high nor low

  4. Low

  5. Very low


How well did the services meet your needs?

  1. Extremely well

  2. Very well

  3. Somewhat well

  4. Not so well

  5. Not well at all


How much have these services helped you in the following areas?


Not at all

A little

A fair amount

A lot

Resume writing





Identifying potential employers





Completing job applications





Interviewing skills





Arranging child care





Transportation assistance





Choosing work-appropriate clothing





General money management











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