Form ETA 9124B ETA 9124B Host Agency Survey

SCSEP Host Agency
Customer Satisfaction Survey

OMB Approval Number: 1205-0040
Expiration Date: ##/##/20##

HOST AGENCY CUSTOMERS
The Older Worker Program, also known as the Senior Community Service Employment Program
(SCSEP) or Title V of the Older Americans Act, wants to provide the highest quality services to
its customers, even in the midst of the COVID-19 pandemic. You can help improve services by
answering the following questions about your experiences as a host agency. Please base your
answers on your entire experience as a host agency unless directed otherwise in a particular
question.
Please be frank in your responses. Your answers will be kept private to the extent permitted by
law and will be used for program evaluation and improvement only. No one in the agency will
see your individual responses.
Please fill in your response to each answer like this:

, NOT this

Choose the number on the scale below each question that best represents your opinion. The last
two questions allow you to express your ideas about the program in your own words. If there is
someone else in your agency better suited to answer the survey, please give that person the
survey to complete. Thank you in advance for your help.
1. Utilizing the scale below, what is your overall satisfaction with the services provided by the
Older Worker Program/SCSEP? (Choose one number)
Very
dissatisfied

1

2

3

4

5

6

7

8

9

Very
satisfied

Didn't
receive

10

90

2. Considering all of the expectations you may have had about the services of the Older Worker
Program/SCSEP, to what extent have the services met your expectations? (Choose one
number)
Fall
short

1

2

3

4

5

6

7

8

9

Exceed

Didn't
receive

10

90

3. Now, think about the ideal services for people in your circumstances. How well do you think
the services you received compare with the ideal services? (Choose one number)
Not at all
close

1

Very
close

2

3

4

5

6

Didn't
receive

7
8
9
10
90
Please continue on other side

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection
displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average
minutes per response,
se10continue
on oter
including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Completion of this survey is completely voluntary, and information collected will be kept private to the
extent permitted by law and used for program evaluation purposes only. Thank you for your participation. If you have any comments regarding
this estimate or any other aspect of this survey, including suggestions for reducing this burden; please send them to the U.S. Department of Labor,
Office of Workforce Investment, Room C-4510, 200 Constitution Avenue, NW, Washington, DC 20210. (Please do not return surveys to this
address.)

ETA-9124 – Part B
(Rev. 1/15/2023)

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SCSEP Host Agency Customer Satisfaction Survey
4. The Older Worker Program/SCSEP staff make the process of assigning participants easy for
me. (Choose one number)
Strongly
disagree

1

2

3

4

5

6

7

8

9

Strongly
agree

Don’t
know

10

90

5. The Older Worker Program/SCSEP staff who make the assignments have a good
understanding of my business needs. (Choose one number)
Strongly
disagree

1

2

3

4

5

6

7

8

9

Strongly
agree

Don’t
know

10

90

6. I receive sufficient information about the backgrounds of the participants assigned to my
agency. (Choose one number)
Strongly
disagree

1

2

3

4

5

6

7

8

9

Strongly
agree

Don’t
know

10

90

7. Consider the last time the Older Worker Program/SCSEP staff proposed an assignment for
your agency. What choice did you feel you had at that time? (Choose one answer )
o
o
o

I can accept the individual offered or not
I have a choice among several potential participants
I really have no choice

8. The participants assigned are a good match with my agency. (Choose one number)
Strongly
disagree

1

2

3

4

5

6

7

8

9

Strongly
agree

Don’t
know

10

90

9. Would you like the participants to have been better prepared in any of these areas? (Choose
Yes, No, or N/A for each statement)
1) Basic computer knowledge
2) Basic employability skills, like how to dress, how to interact
with co-workers and supervisors, and punctuality
3) Knowledge of what the assignment required
4) How to interact with the host agency’s customers or clients

Yes

No

N/A

Yes
Yes
Yes

No
No
No

N/A
N/A
N/A

10. The Older Worker Program/SCSEP staff stay in touch with my agency throughout the
assignment to make sure it goes well. (Choose one number)
Strongly
disagree

1

2

3

4

5

6

7

8

9

Strongly
agree

Don’t
know

10

90

Please continue on next page
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SCSEP Host Agency Customer Satisfaction Survey
11. Do any of the older workers assigned to your agency need supportive services, such as
assistance with transportation, uniforms, safety equipment, or medical care, to be successful
in their assignments? (Choose one answer)
1
None

2
Few

3
Many

4
Nearly all

9
Don’t know

12. Has the Older Worker Program/SCSEP removed any participants from your agency before
you thought they were ready to leave? (Choose one number)
1
Never

2
Occasionally

3
Frequently

4
Nearly always

9
Don’t know

13. Has your agency requested that the Older Worker Program/SCSEP remove a participant
because the participant was not working out? (Choose one answer)
Yes

No

Don’t know

14. How has your participation in the Older Worker Program/SCSEP affected the amount of
service your agency provides to the community? (Choose one answer)
1
Decreased
significantly

2
Somewhat
decreased

3
Neither decreased
nor increased

4
Somewhat
increased

5
Increased
significantly

9
Don’t
know

15. What effects or challenges from the COVID-19 pandemic have you experienced as a SCSEP
host agency? (Choose all that applied at any time over the last year)
o
o
o
o
o
o

It was difficult to find out when, or if, participants would be returning to work
Participants were not able to come to the workplace
It was difficult to ensure the safety of participants who continued to work or returned to work
It was difficult to find work for participants to do because our normal operations were greatly affected
It was difficult to re-integrate participants into the organization after they were on hiatus due to COVID
We experienced no serious effects from the COVID-19 pandemic

16. Based on your experience, what makes the Older Worker Program/SCSEP most effective?
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_________________________________________________________________________________________________________________

17. Based on your experience, what would you recommend to make the Older Worker
Program/SCSEP more effective?
___________________________________________________________________________________________________
___________________________________________________________________________________________________
____________________________________________________________________________________________________

Thank you for taking the time to complete this survey.
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