Waitlist - 02 - Screener - Interest and Availability - FINAL

Waitlist Data Management & Burden Improvement

Screener – Interest and Availability

Share your feedback with HUD

Thank you for your interest in sharing your feedback with the U.S. Department of Housing and Urban Development (HUD) about your experience with affordable housing and housing waitlists.

By filling this out, you are consenting to provide this data. The HUD project team will store your data in a secure location and will not share your personal data with the rest of HUD or anyone else.

OMB Control Number: 2511-0001

Expiration Date: 09/30/2024

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. The time required to complete this information collection is estimated to average 5 minutes. All responses to this collection of information are voluntary. If you have comments or concerns regarding this collection, please contact Mac Bailey of HUD’s Customer Experience team at [email protected].

* Required

1. Please provide your first and last name *

______________________________________

2. Please provide your email *

_______________________________________

3. Please provide your phone number *

_______________________________________

4. For a virtual meeting (for example, Zoom), do you need any accommodation for a disability? *

• Yes. I do need an accommodation.

• No. I don’t need an accommodation.

5. What dates and times would you be able to join a focus group? (Check all that apply) *

   1. [Date and Time A]

   2. [Date and Time B]

   3. [Date and Time C]

   4. [Date and Time D]

   5. [Date and Time E]

   6. [Date and Time F]

6. What state do you currently work in? *

_______________________________________

7. We are doing research throughout the Spring (2023). Would you being willing to participate in additional feedback sessions? *

1. Yes. Please feel free to reach out to me again.

2. No. I am not interested in participating.

[Upon completing/submitting Microsoft Form]

Thanks!

Thank you for completing these questions! If you are chosen to participate, the HUD customer experience team will reach out to you via email.

HUD Customer Experience | Draft – For discussion Purposes Only [email protected] 2