Form 5800-095 Feedback Survey: Northwest Environmental Justice Center

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (Renewal)

Feedback Survey Northwest Environmental Justice Center Launch Event

Feedback Survey: NWEJC Launch Event

OMB: 2030-0051

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OMB Control Number: 2030-0051

Expiration Date: 05/31/2024

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. OMB Control Number: 2035-NEW. Responses to this collection of information are voluntary. 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 be 5 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 to Director, Information Engagement Division; 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.


Feedback Survey: Northwest Environmental Justice Center Launch Event

  1. What about the Northwest Environmental Justice Center are you most interested in? [text box]


  1. What about the Northwest Environmental Justice Center do you still have questions about? [text box]


  1. How likely are you to interact with the Northwest Environmental Justice Center in the future? Why? [text box]


  1. Overall, how would you rate this event?
    Choose one option: excellent, very good, satisfactory, poor, very poor

If you would like to explain your answer, please do so here. [text box]



EPA Form: 5800-095

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File Modified0000-00-00
File Created2024-07-21

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