DAF Community Involvement Plan (CIP) Community Surveys

[INSTALLATION NAME HERE] Community Survey

OMB CONTROL NUMBER: 0704-0553

OMB EXPIRATION DATE: 0X/XX/202X

AGENCY DISCLOSURE NOTICE

The public reporting burden for this collection of information, 0704-0553 is estimated to average 20 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. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

[INSTALLATION NAME HERE] believes the active, meaningful involvement of community members is critical to the success of the environmental restoration program. This survey is an opportunity for you to tell us how well we are doing at listening to your concerns about ongoing environmental restoration and cleanup efforts at the installation. Please take a few moments to answer the questions as your views are crucial to the program and will help us to be more responsible to the community’s needs and interests.

Section A: Assessing Overall Installation Community Involvement Efforts
A-1 - How do you rate the installation at each of the following? (Circle one choice for each question)
a.	Providing the information you need.	Very Poor	Poor	Neutral	Good	Very Good
b.	Making the information easy to understand.	Very Poor	Poor	Neutral	Good	Very Good
c.	Making it easy to get involved.	Very Poor	Poor	Neutral	Good	Very Good
d.	Listening to your concerns.	Very Poor	Poor	Neutral	Good	Very Good
e.	Responding to your concerns.	Very Poor	Poor	Neutral	Good	Very Good
f.	Treating you courteously.	Very Poor	Poor	Neutral	Good	Very Good
g.	Using your input.	Very Poor	Poor	Neutral	Good	Very Good
h.	Explaining decisions.	Very Poor	Poor	Neutral	Good	Very Good

Section B: Assessing Installation Efforts at Keeping the Community Informed

B-1 - How do you learn about cleanup activities being completed on the installation? (Check all that apply)

Mailings

Newspaper articles

Radio or TV news

Installation webpage

Community members/family/friends

Public meetings or information sessions held by the installation

Direct conversations with someone from the installation

Information about the site is "common knowledge"

Know someone who worked at the installation

Through one or more community organizations, business associations, or advisory groups

Social Medial (Facebook, Twitter, etc.)

Other (Please specify):

B-2 - How would you prefer to receive information from the installation? (Check up to 3 choices)

Mailings -- short (1-2 pages) very focused (issue-specific) sent frequently

Mailings-- longer, general information, sent periodically

Emails-- brief, very focused (issue-specific) sent frequently

Emails-- longer, general information, sent periodically

Meetings-- short, very focused, held frequently

Meetings-- longer, general information meetings, held periodically

Social media (Facebook, Twitter)

Direct communication with an installation representative

Installation webpage

Presentations at local clubs and organizations

Other (Please specify):

B-3 - How interested are you in obtaining information about the following topics? (Circle one choice for each question)
a.	Installation Restoration Program.	Not Interested	Somewhat Interested	Interested	Very Interested
b.	Environmental contamination.	Not Interested	Somewhat Interested	Interested	Very Interested
c.	How contamination might affect human health.	Not Interested	Somewhat Interested	Interested	Very Interested
d.	How contamination might affect the environment.	Not Interested	Somewhat Interested	Interested	Very Interested
e.	Installation cleanup decisions.	Not Interested	Somewhat Interested	Interested	Very Interested
f.	Site reuse or redevelopment.	Not Interested	Somewhat Interested	Interested	Very Interested
g.	Other (Please specify):	Not Interested	Somewhat Interested	Interested	Very Interested

B-4 - In what ways do you prefer to participate in the installation's environmental restoration program? (Check all

that apply)

Through opportunities to provide written comments on installation documents.

Through public meetings.

Through opportunities to meet and talk informally with installation personnel.

By attending community club/organization meetings that installation personnel have been invited to.

By calling a toll-free telephone number.

Through a community group.

Through opportunities to talk with independent experts.

Through a web site or social media.

Not interested in being involved.

Other (Please specify):

B-5 - Please tell us whether you have ever:
a.	Provided information to the installation about the site and its history.	Yes	No
b.	Expressed your concerns about the installation.	Yes	No
c.	Offered suggestions or advice about the installation.	Yes	No
d.	Given comments to the installation on materials available for public review.	Yes	No
e.	Requested information from the installation.	Yes	No
f.	Attended an installation-sponsored meeting or event.	Yes	No
g.	Visited the site's information repository.	Yes	No

B-6 - In a few words, what is your understanding of cleanup work being conducted at the installation? Please do not include any personally identifiable information in your response.

B-7 - How concerned are you that the installation may be harmful to each of the following? (Circle one answer for each question)
a.	My or my family's health.	Not Concerned	Somewhat Concerned	Concerned	Very Concerned	Not Applicable
b.	The environment.	Not Concerned	Somewhat Concerned	Concerned	Very Concerned	Not Applicable

c.	Property values.	Not Concerned	Somewhat Concerned	Concerned	Very Concerned	Not Applicable
d.	Jobs in the community.	Not Concerned	Somewhat Concerned	Concerned	Very Concerned	Not Applicable
e.	Business in the community.	Not Concerned	Somewhat Concerned	Concerned	Very Concerned	Not Applicable
f.	Community historical or cultural integrity.	Not Concerned	Somewhat Concerned	Concerned	Very Concerned	Not Applicable
g.	Site redevelopment or reuse.	Not Concerned	Somewhat Concerned	Concerned	Very Concerned	Not Applicable

Section C: Questions about Technical Assistance Resources Provided to the Community
C-1 - Do you know of any assistance the installation has provided to help you and other community members/groups better understand technical and scientific information regarding work being done at the installation?
Yes	No

C-2 - If technical assistance has not been provided to your community, which of the following activities could help you

and other community members/groups better understand technical and scientific information regarding the installation restoration program? (Check all that apply)

Community informational newsletters and/or factsheets.

Presentations by experts to explain technical information to the community.

Community informational workshops/trainings.

Installation-provided facilitator or mediator to help the community.

I don't feel that any technical assistance is needed.

Other (Please specify):

Section D: General Information (REQUIRED Section)

D-1 - Is there anything else you would like to tell us about the installation community involvement efforts or about cleanup activities at this installation? Please do not include personally identifiable information in your response.

Thank you for taking the time to share your views with us!