OMB Control No. 2080-0085
Expiration Date - 8/31/2023
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq.OMB Control No. 2080-0085. Responses to this collection of information are voluntary (5 CFR 1320.5; 40 CFR 9; 40 CFR 48). 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 .25 hours (per year) 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 to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.
First Name: _________________________________________________
Last Name: _________________________________________________
Title: _________________________________________________
Organization Name: _________________________________________________
Email Address: _________________________________________________
You can find the title of the product in the survey request email that was distributed to you
_________________________________________________
( ) Very Unfamiliar ( ) Unfamiliar ( ) Neutral ( ) Familiar ( ) Very Familiar
____________________________________________________________________________________________________________________________________________________________
Select all that apply and add any additional uses of this product that apply
|
Have used in the past for: |
Expect to use in the future for: |
Do NOT expect to use for this purpose: |
Regulatory decision-making |
[ ] |
[ ] |
[ ] |
Site-specific (such as Superfund) decision-making |
[ ] |
[ ] |
[ ] |
Providing guidance or support to other Programs, Regions, or non-EPA partners |
[ ] |
[ ] |
[ ] |
Preparedness exercises |
[ ] |
[ ] |
[ ] |
Provides relevant scientific information |
[ ] |
[ ] |
[ ] |
Other (please describe) |
[ ] |
[ ] |
[ ] |
____________________________________________________________________________________________________________________________________________________________
( ) Strongly Disagree ( ) Disagree ( ) Neutral ( ) Agree ( ) Strongly Agree ( ) Not applicable/Don't know
( ) Strongly Disagree ( ) Disagree ( ) Neutral ( ) Agree ( ) Strongly Agree ( ) Not applicable/Don't know
( ) Strongly Disagree ( ) Disagree ( ) Neutral ( ) Agree ( ) Strongly Agree ( ) Not applicable/Don't know
( ) Strongly Disagree ( ) Disagree ( ) Neutral ( ) Agree ( ) Strongly Agree ( ) Not applicable/Don't know
( ) Strongly Disagree ( ) Disagree ( ) Neutral ( ) Agree ( ) Strongly Agree ( ) Not applicable/Don't know
( ) Strongly Disagree ( ) Disagree ( ) Neutral ( ) Agree ( ) Strongly Agree ( ) Not applicable/Don't know
( ) Strongly Disagree ( ) Disagree ( ) Neutral ( ) Agree ( ) Strongly Agree ( ) Not applicable/Don't know
( ) Strongly Disagree ( ) Disagree ( ) Neutral ( ) Agree ( ) Strongly Agree ( ) Not applicable/Don't know
( ) Strongly Disagree ( ) Disagree ( ) Neutral ( ) Agree ( ) Strongly Agree ( ) Not applicable/Don't know
( ) Strongly Disagree ( ) Disagree ( ) Neutral ( ) Agree ( ) Strongly Agree ( ) Not applicable/Don't know
( ) Strongly Disagree ( ) Disagree ( ) Neutral ( ) Agree ( ) Strongly Agree ( ) Not applicable/Don't know
( ) I had no specific expectation or requirement for when I needed this product
( ) I had a deadline for which I needed this product and that deadline was met
( ) I had a deadline for which I needed this product and that deadline was NOT met
( ) Other - Write In (Required): _________________________________________________
____________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________
( ) Yes
( ) No
( ) Not for this product specifically, but for we have requested work in this topic area
( ) I don't know
( ) Other - Write In (Required): _________________________________________________
Select all that apply
[ ] I/We were involved in strategic research planning of this topic area.
[ ] I/We requested this product from ORD.
[ ] I/We have worked with ORD on related research but not this specific product.
[ ] I/We helped conceptualize this product.
[ ] I/We were involved in the design or execution of the research.
[ ] I/We received regular updates on the status of the research.
[ ] I/We provided feedback on preliminary findings or drafts of the product.
[ ] I/We co-authored this product.
[ ] I/We were not involved in the planning or development of this product.
[ ] Don't know/Don't remember
( ) Not at all involved ( ) Somewhat involved ( ) Moderately involved ( ) Very involved ( ) I don't know
( ) I am satisfied with my level of involvement
( ) I would like to have been more involved but didn’t have the time
( ) I would like to have been more involved but was not aware of the opportunity to participate
( ) I would like to have been more involved but was not sure how I could best contribute
( ) Not applicable
( ) Other - Write In: _________________________________________________
____________________________________________________________________________________________________________________________________________________________
( ) I received it from a contact in ORD
( ) I received it from a non-ORD colleague
( ) I learned about it through an EPA forum or community of practice
( ) I learned about it through an ORD newsletter
( ) I learned about it through an ORD meeting or webinar
( ) I learned about it at an academic or professional conference
( ) I found it independently through the public internet
( ) I found it independently through the EPA Intranet
( ) I received it for the first time with this survey
( ) I don't remember
( ) Other - Write In: _________________________________________________
( ) Very Dissatisfied ( ) Dissatisfied ( ) Neutral ( ) Satisfied ( ) Very Satisfied
( ) Very Dissatisfied ( ) Dissatisfied ( ) Neutral ( ) Satisfied ( ) Very Satisfied ( ) Not applicable
____________________________________________________________________________________________________________________________________________________________
( ) Very Dissatisfied ( ) Dissatisfied ( ) Neutral ( ) Satisfied ( ) Very Satisfied
( ) Very Dissatisfied ( ) Dissatisfied ( ) Neutral ( ) Satisfied ( ) Very Satisfied
____________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________
EPA Form No. 6000-021
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Gurkas, Alyssa |
File Modified | 0000-00-00 |
File Created | 2024-07-24 |