Form 0920-1355 TA Feedback Form – Universal Events

TA Feedback Form – Universal Events

Form Approved

OMB No. 0920-1355

Exp. Date: 11/30/2024

Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-1355)

Description and Administration 

This survey goes to all TA recipients participating in a group TA (Webinar/Peer exchange). TA team will send survey links along with the “thank-you message” via email immediately after each session. 

Questions

Please indicate the DOP TAC state-recipient organization you are affiliated with: [drop-down list of all the state jurisdictions]

Please indicate the DOP TAC local-recipient organization you are affiliated with: [drop-down list of all the local jurisdictions]

Which of the following best describes your role on the DOP TAC team?

• Project manager

• Prevention staff

• Surveillance staff

• Evaluator

• Other (please specify)

1. The information provided is relevant to my work:

• Strongly disagree

• Disagree

• Neither

• Agree

• Strongly agree

2. The format of the session provided the opportunity for participant engagement and interaction:

• Strongly disagree

• Disagree

• Neither

• Agree

• Strongly agree

3. What did you like most about the session? 

4. What aspects of the session could be improved? 

5. How do you plan to apply the information from the session to your work? 

6. What additional technical assistance needs do you or your organization have?