TECHNICAL TRANSFER EVALUATION

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OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT
TECHNOLOGY TRANSFER EVALUATION

OMB Control #:
1029-0114
Expiration Date:
10/31/2026

The Office of Surface Mining Reclamation and Enforcement recently provided a technology transfer project
or activity as listed below. Your response to this survey will assist us in evaluating and improving our
performance as required by the Government Performance and Results Act. Your response is voluntary.
OSM Use Only

Technology Transfer Event Title: ________________________________________________
Agency/Organization Assisted: _________________________________________________
Dates Held: Beginning Date:

Ending Date:

Name/Location of Sponsoring OSM Office: _______________________________________
Type of Technology Transfer Event:
Workshop [ ] Webinar
Other

[]

Presentation

[]

Consultation [ ]

Please describe __________________________________
Please rate us using the following scale:
(Please circle)
Very Poor Poor
Neutral
Good Very Good

1. Please rate the quality of our assistance:

1

2

3

4

5

2. Please rate our professionalism and courtesy:

1

2

3

4

5

3. Please rate how well we met your objectives:

1

2

3

4

5

4. Please rate your overall satisfaction:

1

2

3

4

5

5. How may we improve our service to you, or do you have any additional comments:

Your Name ___________________________
Return to:
Office of Surface Mining Reclamation and Enforcement
OSM's
Office Name
Address

Date ________________
or email:
Fax to:

PAPERWORK REDUCTION ACT STATEMENT
The Paperwork Reduction Act of 1995 (44 U.S.C. 3501) requires us to inform you that: Federal Agencies 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. This information is being collected in order to better serve you in
the future and as part of OSM's performance of its responsibilities under the Government Performance and Results Act. The obligation to respond is voluntary.
Public reporting burden for this form is estimated to average 5 minutes per response, including time for reviewing instructions, gathering and maintaining data, and
completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to the Information Collection Clearance
Officer, Office of Surface Mining Reclamation and Enforcement, Room 203 SIB, 1951 Constitution Ave, NW, Washington, D.C. 20240.