Form 6200-11 Whad do you think about the U.S. EPA's Community In

OMB Control Number: 2050-0179

Expiration Date: XX/XX/2019

EPA Form Number: 6200-11

What Do You Think About the U.S. EPA’s Community

Involvement Efforts at the ________ Site?

Purpose for this Questionnaire: This customer satisfaction survey is meant to help understand how well EPA staff are listening to community member concerns about the cleanup and how well EPA staff make it possible for community members to participate in the planning and decision making process.

Instructions: You may be asked some or all of the questions on this questionnaire. This questionnaire should take no more than 15 minutes to complete.

PRA Burden Statement: This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2050-0179). Responses to this collection of information are voluntary (40 CFR 300.430 and 300.435). An agency may not conduct or sponsor, and a person is not required to, respond to a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to average 15 minutes per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed survey to this address.

The U.S. Environmental Protection Agency (U.S. EPA) is cleaning up the contamination at the __________ Superfund site in your community. The U.S. EPA believes the active, meaningful involvement of community members is critical to the success of a cleanup effort. This survey is an opportunity for you to tell us how well we are doing at listening to your concerns about the cleanup and making it possible for you to participate in the planning and decision making process. Please take a few minutes to answer the questions. Your views are important and will help us to be more responsive to your needs and interests.

This survey is being conducted in accordance with the Federal Paperwork Reduction Act Information Collection Request # 1487.13. You will need about 15 minutes to answer the questions.

*Note to surveyors: It is intended that each survey given will include the introductory paragraph, above, and Section G with the closing disclosure. Sections A-F are optional sections with questions that may be used as a specific situation dictates. This survey is NOT intended to be given in its entirety. The surveyor may also choose, in addition to paper copies, to provide the survey to participants online via commercially available software.

Section A: Assessing Overall U.S. EPA Community Involvement Efforts

A-1. How do you rate the U.S. EPA at each of the following? (Circle one choice for each question)

EPA provides the information you need.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
The information is easy to understand.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
EPA makes it easy to get involved.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
EPA listens to your concerns.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
EPA responds to your concerns.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
EPA staff treats you courteously.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
EPA uses your input.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
EPA explains decisions.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree

Section B: Assessing U.S. EPA Efforts at Keeping Communities Informed

B-1. How do you learn about the U.S. EPA’s work at the site? (Check all that apply)

_____	U.S. EPA mailings
_____	Newspaper articles
_____	Radio or TV news
_____	U.S. EPA’s web page
_____	Community members/family/friends
_____	Public meeting or information session held by the U.S. EPA
_____	Direct conversation with someone from the U.S. EPA
_____	Information about the site is “common knowledge”
_____	Know someone who worked at the site
_____	Through one or more community organizations, business associations, or advisory groups (CAG)
_____	Social Media (Facebook, Twitter, etc.)
_____	Other (Please specify): ____________________________________________________________

B-2. How would you prefer to receive information from the U.S. EPA about the site?

(Check up to 3 choices)

_____	Mailings—short (1-2 pages) very focused (issue-specific) sent more frequently
_____	Mailings—longer, general information, sent periodically
_____	Emails—brief, very focused (issue-specific) sent more frequently
_____	Emails—longer, general information, sent periodically
_____	Meetings—short, very focused, held frequently
_____	Meetings—longer, general informational meetings, held periodically
_____	Social media (Facebook, Twitter)
_____	Direct communication with an U.S. EPA representative
_____	The U.S. EPA website
_____	Presentations at local clubs and organizations
_____	Other (Please specify): ____________________________________________________________

B-3. Are you interested in obtaining information about the following topics? (Circle one answer for each question)

I would like to receive information about U.S. EPA’s Superfund Program.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I would like information about Contamination at the site.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I would like information about how the site might affect human health.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I am interested in information about how the site might affect the environment.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I would like to receive information about site cleanup decisions.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I would like to receive information about site reuse or redevelopment.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I would like to receive information about other (Please specify):_____________	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree

B-4. In what ways do you prefer to participate at this site? (Check all that apply)

_____	Through opportunities to provide written comments on U.S. EPA documents.
_____	Through public meetings.
_____	Through opportunities to meet and talk informally with U.S. EPA staff.
_____	By attending community club/organization meetings that U.S. EPA staff have been invited to.
_____	By calling a toll-free telephone number.
_____	Through a community group.
_____	Through opportunities to talk with independent experts.
_____	Through a web site or social media.
_____	Other (Please specify): ___________________________________________________________
_____	Not interested in being involved.

B-5. Please tell us whether you have ever:

Provided information to the U.S. EPA about the site and its history.	Yes	No
Expressed your concerns about the site to the U.S. EPA.	Yes	No
Offered suggestions or advice about the site to the U.S. EPA.	Yes	No
Given comments to the U.S. EPA on materials available for public review.	Yes	No
Requested information from the U.S. EPA about the site.	Yes	No
Attended a U.S. EPA-sponsored meeting or event about the site.	Yes	No
Visited the site’s information repository.	Yes	No

B-6. Are you concerned that the site may be harmful to each of the following: (Circle one answer for each question.)

I am concerned about my or my family’s health.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
I am concerned the site may be harmful to the environment.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
I am concerned the site may be harmful for property values.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
I am concerned the site may be harmful for jobs in the community.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
I am concerned the site may be harmful to business in the community.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
I am concerned the site may be harmful to community historical or cultural integrity.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
I am concerned the site may be harmful to site redevelopment or reuse.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable

B-7 In a few words, what is your understanding of the cleanup work U.S. EPA plans to do at the site?

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Section C: Public Meeting Feedback Questions

These questions will help the U.S. EPA better understand what worked well and what improvements to consider making before holding future public meetings.

C-1. How did you learn about this public meeting? (Check all that apply)

_____	U.S. EPA mailings (other than this survey)
_____	Newspaper articles
_____	Radio or TV news
_____	Community organization
_____	Family or friends
_____	Email from U.S. EPA
_____	U.S. EPA’s website
_____	Social media (Facebook, Twitter, etc.)
_____	Flyers in store windows/bulletin boards
_____	Direct conversation with someone from the U.S. EPA
_____	Other (Please specify): ___________________________________________________________

C-2. Please give us your feedback on the following: (Circle one choice for each question)

a. Information about the meeting was available early enough to make plans to attend.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
b. Meeting location was convenient.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
c. Meeting facility was comfortable.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
d. Meeting time was convenient.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
e. The length of the meeting was appropriate.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
f. Language interpreters were available (if needed).	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
g. Provisions were made to accommodate the needs of persons with disabilities	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Meeting facility was well-equipped for all planned activities (enough seats, work space, supplies, etc.).	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree

C-3. What topics were of most interest to you at the meeting?

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________

C-4. How was the meeting useful to you? ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________

C-5. How can U.S. EPA improve the next public meeting?

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________

Section D: Questions for Use During Site Cleanup-Removal/Relocation

These questions will help the U.S. EPA better understand what worked well and what improvements to consider when implementing future removals requiring temporary relocation of residents.

Introduction: You were recently relocated while removal and restoration activities were completed at your property. These activities were designed to remove significant potential sources of _[contaminant]_ from your property, thereby reducing any potential _[contaminant]_-related health exposures. We would appreciate it if you could take a few moments to provide feedback on your relocation experience and the removal/restoration work that was completed on your property.

D-1. Relocation (Circle one choice for each question)

a. U.S. EPA staff were friendly and helpful.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
b. The relocation handouts I was given were useful and understandable.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
c. U.S. EPA staff responded to my questions in a timely manner.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
d. I was treated with courtesy and respect by U.S. EPA staff.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
e. U.S. EPA staff contacted me as often as I would have liked:
Before my relocation.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
While I was relocated.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
After my property was cleaned up and I was back in my home.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
f. I was well-informed of my choices for relocation (hotel, friend’s home, etc.).	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
g. I was well-informed about the expected length of my relocation and was kept informed of any changes.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
h. I was told when I needed to relocate with enough time to plan my move.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
i. The reimbursement paperwork was understandable.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
j. I received my reimbursement within 30 days.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable

D-2. U.S. EPA’s Work on My Property: Removal and Restoration (Circle one choice for each question)

a. I was well-informed about the extent of the work U.S. EPA would do on my property.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
b. The specifics of the property restoration were explained in writing and provided to me.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
c. I was informed of the landscape options for my property.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
d. I understood what I had to do following the removal at my property in order for the landscaping to be successful.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
e. The on-site workers were courteous and respectful.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
f. I was kept informed about any changes in the schedule for the work on my property.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
g. I was informed if any of my possessions could NOT be decontaminated.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
h. My property was restored to a condition at least equal to its previous condition (recognizing that it may take time and water/aerating on my part for the seed to take or plants to grow).	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
i. The work done on my property met my expectations.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable

D-3. Do you have any additional comments/feedback regarding your relocation or the removal/restoration work on your property? (Use the space below)

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________

Section E: Questions for Use at Sites with Institutional Controls

These questions will help the U.S. EPA better understand whether community members are aware of, or interested in, information about any institutional controls (ICs) at the site­, which are administrative and legal controls, including limitations on land use or resource use, deed restrictions, or building codes. An example of an IC might be building code restrictions to prevent vapor intrusion, or preventing development on a landfill cap to avoid damage to the integrity of the cap surface. Community input can be essential to selecting, using, and monitoring ICs that are the best fit for the community and the protectiveness of the remedy.

E-1. Are you aware of any restrictions (institutional controls) in place at the site including limitations on land and/or resource use, building code requirements or deed restrictions?

___Yes ___ No ___ I do not know

E-2. Would you like more information about restrictions (institutional controls) on the use of land or resources or any deed restrictions in place at the site?

___Yes ___ No

If yes, please contact (Name and phone number) to request the information.

Section F: Questions about Technical Assistance Resources Provided to the Community

These questions will help the U.S. EPA better understand how to provide the most effective technical assistance resources at sites.

F-1. Do you know of any assistance U.S. EPA has provided to help you and other community members/groups better understand technical and scientific information regarding the site cleanup?

____Yes _____No (Please skip to question F-3)

F-2. How was technical assistance provided to your community? (check all that apply)

____	Through a Technical Assistance Grant (TAG)
____	Through Technical Assistance Services for Communities (TASC)
____	Through U.S. EPA site staff
____	Through assistance from a local, regional or national organization/entity/university
____	Through a Pediatric Environmental Health Specialty Unit (PEHSU)
____	Through a Technical Assistance Plan (TAP)
____	Through Technical Assistance for Public Participation (TAPP)
____	I do not know how the assistance was provided
____	Other (Please specify):__________________________________________________________

Please rate how useful each of the following has been in helping community members better understand information about the site and take a more active role in the process: (Circle one choice for each question)

a. Community informational newsletters and/or factsheets are useful in your understand the site and take a more active role in the process.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
b. Presentations by experts to explain technical site information to the community are useful in your understand the site and take a more active role in the process.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
c. Community informational workshops/trainings are useful in your understand the site and take a more active role in the process.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
d. Redevelopment planning is useful in your understand the site and take a more active role in the process.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
e. U.S. EPA should provide facilitator or mediator to help the community.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
f. U.S. EPA should assist community groups that want to help the community understand or participate in the site cleanup process.	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
g. Other items that are useful in your understand the site and take a more active role in the process (Please specify): ___________________________	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable

F-3. If technical assistance has not been provided to your community, which of the following activities could help you and other community members/groups better understand technical and scientific information regarding the site cleanup? (Check all that apply)

____	Community informational newsletters and/or factsheets.
____	Presentations by experts to explain technical site information to the community.
____	Community informational workshops/trainings.
____	Redevelopment planning.
____	U.S. EPA provided facilitator or mediator to help the community.
____	U.S. EPA gave assistance to one or more community groups that wanted to help the community understand or participate more actively in the site cleanup process.
____	Other (Please specify):__________________________________________________________
____	I don’t feel that any technical assistance is needed.

Section G: General Information [REQUIRED Section]

This section must be included at the end of all surveys.

G-1. Is there anything else you would like to tell us about the U. S. EPA’s community involvement efforts or about the cleanup activities at this site?

__________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________

Thank you for taking the time to share your views with us. If you would like to be on the U.S. EPA’s mailing list, please contact (Name, Telephone Number).

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