Retailer Pilot Test Survey

OMB Control No. 0660-XXXX

Expiration Date: XX-XX-XXXX

TV Converter Box Coupon Program

Pilot Program Retailer Pilot Test Survey

Retailer Name

Person completing survey

E-mail address

Phone

Thank you for your participation in the TV Converter Box Coupon Program Pilot Test. Your participation and the feedback on this form are valuable and help the NTIA, IBM and CLC Services improve the Coupon Program for all retailers.

We appreciate your honest and detailed feedback.

1. Did your store have adequate inventory in the store when the Pilot began? ____Yes ____No

If No, please explain. We did not have adequate inventory because: 1.________; 2._______

2. Were you able to maintain adequate inventory throughout the Pilot period? _____Yes _____No

If No, please explain. We could not maintain an adequate inventory because: 1.______: 2______

3. Did your store have the technical ability to redeem coupons when the Pilot began? ______Yes ______No. If No, please explain. We did not have the technical ability to redeem coupons because: 1.______ ; 2._____

_

4. If No, please comment on the ease or difficulty of preparing and maintaining your systems for the Pilot.

5. Did your site receive training materials before the Pilot began? ____Yes ____No.

6. Were employees at your site trained before the Pilot began? ____Yes _____No.

7. Please rate the quality of the employee training materials. Use the “Poor- to Excellent” Scale of 1-9. __

8. Please rate the usefulness of the employee training materials. Use the “Poor- to- Excellent” Scale of 1-9. __

9. Please comment on the quality and usability of the employee training materials.

10. Did you contact the Retailer Support Center during the Pilot? ___Yes ___No

11. How would you rate the quality of the support you received? Use the “Poor- to Excellent” Scale of 1-9. ­­__

12. Have you been paid from the US Treasury for all authorized coupon redemptions? ___Yes ____No. How soon did you receive payment?

13. Please rate the payment process. Use the “Poor- to Excellent” Scale of 1-9.

14. Please provide comments on the payment process.

15. Have you used your web account at www.ntiadtv.gov to monitor payments? ___Yes ____No.

16. Please rate the usefulness of the retailer Web site. Use the “Poor- to Excellent” Scale of 1-9. __

17. Please comment on the usefulness and functionality of the website.

18. To your knowledge, did any consumers participating in the Pilot Test purchase a product or service (TV with a digital tuner, Cable, satellite or other pay service) rather than a Coupon Eligible Converter Box? ____Yes ____No.

19. Please comment on the consumer’s purchases.

20. Were any coupon eligible converter boxes exchanged or returned during the Pilot? _____Yes _____No..

21. Please comment on the exchange or return process.

Quick Rating: Poor Acceptable Excellent

Inventory Availability 1 2 3 4 5 6 7 8 9

Systems Ease of Use 1 2 3 4 5 6 7 8 9

Training Materials 1 2 3 4 5 6 7 8 9

Retailer Support Center 1 2 3 4 5 6 7 8 9

Payment Process 1 2 3 4 5 6 7 8 9

Website 1 2 3 4 5 6 7 8 9

Refund Process 1 2 3 4 5 6 7 8 9

Consumer Experience 1 2 3 4 5 6 7 8 9

Paperwork Reduction Act Information: Public reporting burden for this collection of information is estimated to be 15 minutes per response. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestion for reducing this burden, to Milton Brown, NTIA, U.S. Department of Commerce, Room 4713, 14^th and Constitution Avenue, NW, Washington, DC 20230 or at MBrown@ntia.doc.gov.

Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subjected to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number.

Please fax this completed form to (316) 771-7882 by 2/15/08.