B Attachment B_ECS TACC Webinar Survey

OMB Control Number: 0915-0212

Expiration: 4/30/2024

ECS TACC Webinar Survey

Public Burden Statement: The purpose of this information collection request is to assess participant satisfaction with various training and TA activities offered through a contracted TA provider, Altarum Institute. The OMB control number for this project is 0915-0212, expiring 04/30/2024. Public reporting burden for this collection of information is estimated to average 0.08 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857.

1. Overall, how satisfied were you with the information provided in the webinar?

1. Very Satisfied

2. Satisfied

3. Neither Satisfied nor Satisfied

4. Dissatisfied

5. Very Dissatisfied

Please rate how useful you found the webinar to be in terms of the following topics?		Not Useful	Slightly Useful	Neutral	Useful	Very Useful
	Topic 1	¡	¡	¡	¡	¡
	Topic 2	¡	¡	¡	¡	¡
	Topic 3, etc.	¡	¡	¡	¡	¡

Please rate your satisfaction with the content of the webinar by indicating your level of agreement or disagreement with each of the following statements.		Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
	The webinar delivered the information I expected to receive	¡	¡	¡	¡	¡
	The subject matter was presented effectively	¡	¡	¡	¡	¡
	The pace of the webinar was satisfactory	¡	¡	¡	¡	¡
	The duration of the webinar was sufficient for the material covered	¡	¡	¡	¡	¡
	The speaker(s) were knowledgeable	¡	¡	¡	¡	¡
	As a result of this webinar, I gained new knowledge applicable to my work.	¡	¡	¡	¡	¡
	I plan to apply what I learned in this webinar	¡	¡	¡	¡	¡

4. Please check how you feel about the webinar.

___ I need more time to think about the information presented in the webinar

___ I am not sure how to implement the changes described in the webinar

___ I am ready to make some changes because of the information presented in the webinar

___ My state is already addressing the some of the issues discussed in the webinar

___ Other: ____________________

5. What types of actions are you pursuing or considering pursuing based on the webinar?

6. What was the most helpful takeaway you gained from this webinar?

7. What was the least helpful aspect of this webinar?

8. Please provide any recommendations for ways to improve this webinar:

9. Please provide any suggestions for topics for future webinars: