EPA TCTAC ICR_Instruments - Feedback Surveys_General

Feedback Surveys: General

Center	Page Numbers
Center A	2 – 4
Center B	5 – 6
Center C	7 – 9
Center I	10 – 11

Feedback Survey: General
Center A

OMB Control Number = 2035-NEW, Expiration Date = mm/dd/yyyy

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 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 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. 

 

Organization Name:

The following list includes the activities and services provided by Center A.     Please select all those that you were aware of, regardless of whether you accessed them.

Organizational Development (building your organizational structure, leadership, and board; member recruitment and outreach)  Identifying Issues and Prioritizing Needed Change (convening community members to identify priority environmental and energy justice issues)  Building Organizational Capacity to Pursue Needed Change (building knowledge and skills in environmental and energy justice; developing research skills to access, collect, and analyze data)  Making the Case for Change (GIS mapping, community profile development; storytelling)  Building Relationships (engaging partners, including peers, local, state, and federal decision makers, regulatory agencies, etc.)  Grant Writing, Research, Submission, and Management Skills (building skills to identify and access grant opportunities; write and submit competitive applications; and managing awarded grants)

Which of the Center A’s activities and services did you access this year?    Please select all that apply.

Organizational Development (building your organizational structure, leadership, and board; member recruitment and outreach)  Identifying Issues and Prioritizing Needed Change (convening community members to identify priority environmental and energy justice issues)  Building Organizational Capacity to Pursue Needed Change (building knowledge and skills in environmental and energy justice; developing research skills to access, collect, and analyze data)  Making the Case for Change (GIS mapping, community profile development; storytelling)  Building Relationships (engaging partners, including peers, local, state, and federal decision makers, regulatory agencies, etc.)  Grant Writing, Research, Submission, and Management Skills (building skills to identify and access grant opportunities; write and submit competitive applications; and managing awarded grants)

Which activities are you interested in accessing in the upcoming year?    Please select all that apply.

Organizational Development (building your organizational structure, leadership, and board; member recruitment and outreach)  Identifying Issues and Prioritizing Needed Change (convening community members to identify priority environmental and energy justice issues)  Building Organizational Capacity to Pursue Needed Change (building knowledge and skills in environmental and energy justice; developing research skills to access, collect, and analyze data)  Making the Case for Change (GIS mapping, community profile development; storytelling)  Building Relationships (engaging partners, including peers, local, state, and federal decision makers, regulatory agencies, etc.)  Grant Writing, Research, Submission, and Management Skills (building skills to identify and access grant opportunities; write and submit competitive applications; and managing awarded grants)

Since engaging with the Center A, how would you rate your…
1. Overall organizational capacity	Much Lower  Lower  No Change  Higher  Much Higher
2. Network of partners
3. Ability to access, analyze, and use data
4. Available financial resources
Has your organization met your self-developed goals and objectives?	Yes  No
Has your organization identified any EPA, DOE, or other federal/state/NG grants?	Yes  No
Has your organization applied for any EPA, DOE, or other federal/state/NG grants?	Yes  No
Has your organization won any EPA, DOE, or other federal/state/NG grants	Yes  No
How satisfied are you with the services provided by the Center A?	Not satisfied  Somewhat satisfied  Very satisfied
Which services were most valuable to your organization?
Were there any services that did not meet your expectations?  If yes, please list them.	Yes ______________________________  No
Were there any services not currently offered by the Center A that you think should be included in future Center A programming?  If yes, please list your ideas.	Yes ______________________________  No
Were there any barriers to participation in the services provided?  If yes, please list them.	Yes ______________________________  No
Please provide any additional feedback on activities, services, content, or logistics

 

Feedback Survey: General
Center B

OMB Control Number = 2035-NEW, Expiration Date = mm/dd/yyyy

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 5-10 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. 

 

1. Please let us know how you heard about Center B. [text box] 
    

2. Below is a list of activities and services that Center B has provided over the past year. For each item on the list, please indicate whether you were aware of it or not. 

Event/Activity/Service 1: aware, not aware, not sure 

Event/Activity/Service 2: aware, not aware, not sure 

etc.  

NOTE: Center B will list their specific activities, events, and services, in place of the generic “Event/Activity/Service” label that is currently used in the question. 

 

3. Below is a list of activities and services that Center B has provided over the past year. For each item on the list, please choose one response option that indicates the extent to which you would be interested in it.  

Event/Activity/Service 1: not interested, a little interested, somewhat interested, very interested  

Event/Activity/Service 2: not interested, a little interested, somewhat interested, very interested  

etc.
 

NOTE: Center B will list their specific activities and services, in place of the generic “Event/Activity/Service” label that is currently used in the question. 

 

4. Please review the list of activities and services that Center B has provided over the past year (below), and check the box next to each one that you participated in.   
   NOTE: Each Center B will list their specific activities and services. Next to each item will be a check-box that respondents can check if they participated. 
    

5. Please reflect on the activities and services that you participated in over the last year.  
   List the factors that encouraged you to participate and/or enabled you to participate. Consider things such as the subject matter being covered by the activity or service; the format and timing in which the activity or service was offered; aspects of your own life (e.g., having the time to participate); and anything else that may occur to you. [text box] 

 

6. Please reflect on the activities and services that you participated in over the last year.  
   List the factors that discouraged you from participating or made it hard to participate. Consider things such as the subject matter being covered by the activity or service; the format and timing in which the activity or service was offered; aspects of your own life (e.g., no help with childcare); and anything else that may occur to you. [text box] 

 

7. Overall, how satisfied are you with the Center B’s activities and services? Please choose one response option: very unsatisfied, unsatisfied, somewhat unsatisfied, somewhat satisfied, satisfied, very satisfied 

 

8. Please list how the Center B’s activities and services impacted your work (e.g., helped you identify grant opportunities, helped build partnerships, help develop grant application, etc.) 
   
   

 

9. What is working well at the Center B? Please list some positive aspects of the Center B’s activities and services. [text box] 

 

10. What could be better at the Center B? Please list some suggestions for improving the Center B’s activities and services. [text box] 
    
    

 

11. If you have any additional comments about the Center B’s work, please note them here.
    [text box] 

Annual Feedback Survey 
Center C 

OMB Control Number = 2035-NEW, Expiration Date = mm/dd/yyyy

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 to 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 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. 

  

This survey will be distributed to the email address of the organization’s primary contact for each organization that attended an event or received individualized TA from the TC TAC in the previous year. Each organization will only be asked to complete one survey regardless of the number of people participating in TC TAC activities from that organization. Individuals who participated in the TC TAC in the previous year but are not part of an organization will also be sent the survey and asked a subset of these questions.  

  

1. Are you completing this survey representing an organization or as an individual? 

1. Organization 

2. Individual 

 

[POST LOGIC: SKIP PATTERNS WILL BE PROGRAMMED BELOW TO ONLY SHOW ORGANIZATIONAL QUESTIONS TO THOSE REPRESENTING AN ORGANIZATION.] 

  

2. Below is a list of activities and services that the TC TAC provided over the past year. For each item on the list, please indicate whether you participated in or were aware of each one. 

Event/Activity/Service 1: participated, did not participate but was aware of it, not aware, not sure 

Event/Activity/Service 2: participated, did not participate but was aware of it, not aware, not sure 

etc.  

NOTE: We will list the specific activities, events, and services here in place of the generic “Event/Activity/Service” label that is currently used in the question. 

  

3. Please reflect on the activities that you participated in over the last year.  
   Select the factors that encouraged you to participate and/or enabled you to participate. 
   [select ALL that apply] 

1. Activity topic  

2. Format (e.g., online vs in-person) 

3. Timing/schedule 

4. Felt comfortable attending 

5. Had enough information beforehand 

6. Trust in the TC TAC 

7. Support from my employer 

8. Availability of transportation for in-person events  

9. Availability of childcare for in-person events 

10. Other: [Text box] 

  

4. Please reflect on the activities and services offered by REACT4EJ over the last year.  
   Select the factors that discouraged you from participating or made it hard to participate.  
   [select ALL that apply]  

1. Activity topic 

2. Format (e.g., online vs in-person) 

3. Timing/schedule 

4. Did not feel comfortable attending 

5. Lack of information beforehand 

6. Lack of trust in the TC TAC 

7. Lack of support from my employer 

8. Lack of transportation for in-person events  

9. Lack of childcare for in-person events 

10. Other: [Text box] 

  

5. Did you receive individual technical assistance (TA) from the REACT4EJ TC TAC this year? Individual TA includes one-on-one contact with a REACT4EJ representative, likely from a university in your state, to help solve a need or question from your community/your organization.   

1. Yes 

2. No 

3. Not sure 

  

6. [ORGANIZATIONS ONLY] Does your organization have 501c3 nonprofit status?  

1. Yes 

2. No 

3. Don’t know 

  

7. [ORGANIZATIONS ONLY] How would you rate your organization’s capacity to prepare a federal grant application (such as submitting a funding application to the US Environmental Protection Agency or US Department of Energy)?  
   By capacity we mean having leadership, infrastructure, staff, knowledge, funding, and partnerships to successfully complete the application process. 

1. Strong capacity (Our organization has the leadership, systems/infrastructure, staff, skills, financial resources, and partnerships to prepare an application.)   

2. Moderate capacity (Our organization is knowledgeable about grant writing and can prepare a successful grant but faces challenges in developing the application or budget/management systems.) 

3. Basic capacity (Our organization knows about grants and sometimes submits applications but lacks procedures or sufficient support to do so regularly.) 

4. Low capacity (Our organization does not have the resources to apply for grants.) 

  

8. To what extent do you agree or disagree with the following statement:  
   I understand what Environmental Justice or Energy Justice grants are available to [my organization/me]. 

1. Strongly agree 

2. Somewhat agree 

3. Somewhat disagree 

4. Strongly disagree 

  

9. To what extent do you agree or disagree with the following statement?  
   I’m confident I can help fix the environmental challenges in my community.  

1. Strongly agree 

2. Somewhat agree 

3. Somewhat disagree 

4. Strongly disagree 

  

10. [ORGANIZATIONS ONLY] Please list any grants you applied for this year related to your environmental justice work.  
    
    

Funding Source (e.g., Environmental Protection Agency/EPA, Department of Energy/DOE)	Grant Name	Potential Funding Amount	Status (e.g., Draft, Submitted, Funded, Not Funded)	Did you receive application help from this TC TAC? (Y/N)

  

  

11. Overall, how satisfied are you with Center C’s activities and services?  

1. Very unsatisfied 

2. Somewhat unsatisfied 

3. Somewhat satisfied 

4. Very satisfied 

  

12. What is working well at Center C? Please list some positive aspects of the Center’s activities and services. [text box] 

  

13. What could be better at Center C? Please list some suggestions for improving REACT4EJ’s activities and services. [text box] 

  

14. If you have any additional comments about Center C’s work, please note them here. [text box] 

 

Feedback Survey: General 
Center I

OMB Control Number = 2035-NEW, Expiration Date = mm/dd/yyyy

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 ​30 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. 

 

1. Please let us know how you heard about this Center. [text box] 
    

2. Below is a list of activities and services that this Center​​ has provided over the past year. For each item on the list, please indicate whether you were aware of it or not. 

Event/Activity/Service 1: aware, not aware, not sure 

Event/Activity/Service 2: aware, not aware, not sure 

etc.  

NOTE: Each Center will list their specific activities, events, and services, in place of the generic “Event/Activity/Service” label that is currently used in the question. 

 

3. ​​​Please describe the community that you represent​:

 

4. Below is a list of activities and services that this Center has provided over the past year. For each item on the list, please choose one response option that indicates the extent to which you would be interested in it.  

Event/Activity/Service 1: not interested, a little interested, somewhat interested, very interested 

Event/Activity/Service 2: not interested, a little interested, somewhat interested, very interested  

NOTE: Each Center will list their specific activities and services, in place of the generic “Event/Activity/Service” label that is currently used in the question. 

 

5. Please review the list of activities and services that this Center has provided over the past year (below), and check the box next to each one that you participated in.   
   NOTE: Each Center will list their specific activities and services. Next to each item will be a check-box that respondents can check if they participated. 
    

6. Please reflect on the activities and services that you participated in over the last year.  
   List the factors that encouraged you to participate and/or enabled you to participate. Consider things such as the subject matter being covered by the activity or service; the format and timing in which the activity or service was offered; aspects of your own life (e.g., having the time to participate); and anything else that may occur to you. [text box] 

 

7. Please reflect on the activities and services that you participated in over the last year.  
   List the factors that discouraged you from participating or made it hard to participate. Consider things such as the subject matter being covered by the activity or service; the format and timing in which the activity or service was offered; aspects of your own life (e.g., no help with childcare); and anything else that may occur to you. [text box] 

 

8. Overall, how satisfied are you with this Center’s activities and services?
   Please choose one response option: very unsatisfied, unsatisfied, somewhat unsatisfied, somewhat satisfied, satisfied, very satisfied 

9. ​​Please list how the Center’s activities and services impacted your work (e.g., helped you identify grant opportunities, helped build partnerships, help develop grant application, etc.​ 

10. What is working well at the Center? Please list some positive aspects of the Center’s activities and services. [text box] 

 

11. What could be better at the Center? Please list some suggestions for improving the Center’s activities and services. [text box] 
     

12. If you have any additional comments about the Center’s work, please note them here. [text box] 

13