Form 1 customer satisfaction survey

MATERNAL AND CHILD HEALTH BUREAU

Division of Home Visiting and Early Childhood Systems

Customer Satisfaction Feedback of MIECHV Post-Award Grant Monitoring Process

The Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau’s (MCHB) Division of Home Visiting and Early Childhood Systems (DHVECS) is asking for your feedback to assess the overall performance of our post-award grants monitoring function. We need your input to assess how we are doing in providing post-award grant monitoring to the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program grantees. Your feedback will be used internally for general service improvement and program management purposes and is not intended for release outside of the agency.

Feedback participants include grantee staff who are involved in the post-award management or oversight of the MIECHV grants. You were selected to participate because of your involvement in the management, and/ or administration of one or more MIECHV grant projects—the formula or the competitive grants. We are asking for your feedback for the overall post-award grant monitoring from the beginning of the MIECHV program to date.

Please provide feedback based on your experience with the performance of DHVECS since you received your first MIECHV grant to the present time. If you wish, you may use the “boxes” to further elaborate on any answer. Please remember to answer the questions only in the context of the MIECHV grant program.

Providing feedback should take no more than 15 minutes to complete. This exercise is voluntary. You do not have to identify yourself. Your response will have no impact on your current funding, eligibility for, or receipt of, future funding. If you have any questions about this feedback, please contact Romuladus Azuine, DrPH, MPH, RN (razuine@hrsa.gov). We ask that you provide feedback within the next 10 days and no later than MM-DD-YYYY.

Your cooperation is greatly appreciated and will assist DHVECS in assessing the overall performance of its post-award grant monitoring program, thus enabling us to ensure that we are providing effective customer service and identifying any areas needing improvement for the future.

1. How satisfied are you with the timeliness of post-award program information you received since you were awarded the MIECHV grant to date?

1. Very dissatisfied

2. Somewhat dissatisfied

3. Neither dissatisfied nor satisfied

4. Somewhat satisfied

5. Highly satisfied

2. Have you received at least one technical assistance (TA) from the MIECHV TA providers since you received the MIECHV grant?

1. Yes

2. No

3. Overall, how satisfied are you with the post-award technical assistance (TA) you received from the MIECHV TA providers since you were awarded the MIECHV grant?

1. Very dissatisfied

2. Somewhat dissatisfied

3. Neither dissatisfied nor satisfied

4. Somewhat satisfied

5. Highly satisfied

4. Overall, in your opinion, how can the MIECHV post-award technical assistance be improved? Please type your response in the box below.

5. How likely are you to recommend the MIECHV grant to the people you know?

   1. Very unlikely

   2. Somewhat likely

   3. Neither unlikely nor likely

   4. Somewhat likely

   5. Highly likely

6. Have you had at least one quarterly post-award grant monitoring communication call with your HRSA Regional Project Officer in that last three months?

1. Yes

2. No

7. How satisfied are you with the quarterly post-award grant monitoring communication calls that you hold with your HRSA Regional Project Officer?

1. Very dissatisfied

2. Somewhat dissatisfied

3. Neither dissatisfied nor satisfied

4. Somewhat satisfied

5. Highly satisfied

8. How satisfied are you with the quality of information that you receive during the quarterly post-award grant monitoring communication calls?

1. Very dissatisfied

2. Somewhat dissatisfied

3. Neither dissatisfied nor satisfied

4. Somewhat satisfied

5. Highly satisfied

9. How satisfied were you with the clarity of information that you received during the quarterly post-award monthly communication calls (that is, was the information clear)?

1. Very dissatisfied

2. Somewhat dissatisfied

3. Neither dissatisfied nor satisfied

4. Somewhat satisfied

5. Highly satisfied

10. How likely are you to recommend the quarterly post-award grant monitoring communication calls to other grantees?

1. Very unlikely

2. Somewhat likely

3. Neither unlikely nor likely

4. Somewhat likely

5. Highly likely

11. In your opinion, how can the quarterly post-award grant monitoring communication calls be improved? Please type your response in the box below.

12. Have you had at least one in-person post-award monitoring site visit since you were awarded the MIECHV grant?

1. Yes

2. No

13. How satisfied were you with the last post-award monitoring site visit?

1. Very dissatisfied

2. Somewhat dissatisfied

3. Neither dissatisfied nor satisfied

4. Somewhat satisfied

5. Highly satisfied

14. How satisfied were you with the overall preparation for the site visit?

1. Very dissatisfied

2. Somewhat dissatisfied

3. Neither dissatisfied nor satisfied

4. Somewhat satisfied

5. Highly satisfied

15. How satisfied were you with the clarity of information that HRSA provided to you before the site visit (that is, was the information clear)?

1. Very dissatisfied

2. Somewhat dissatisfied

3. Neither dissatisfied nor satisfied

4. Somewhat satisfied

5. Highly satisfied

16. How satisfied were you with the clarity of information that HRSA provided to you after the site visit?

1. Very dissatisfied

2. Somewhat dissatisfied

3. Neither dissatisfied nor satisfied

4. Somewhat satisfied

5. Highly satisfied

17. How likely are you to recommend an in-person site visit to other grantees?

1. Very unlikely

2. Somewhat likely

3. Neither unlikely nor likely

4. Somewhat likely

5. Highly likely

18. In your opinion, how satisfied were you with the timeliness of the post-site-visit report (that is, was the report submitted within a reasonable time)?

1. Very dissatisfied

2. Somewhat dissatisfied

3. Neither dissatisfied nor satisfied

4. Somewhat satisfied

5. Highly satisfied

19. Overall, how satisfied are you with the post-award monitoring experience with the MIECHV grant program to date?

    1. Very dissatisfied

    2. Somewhat dissatisfied

    3. Neither dissatisfied nor satisfied

    4. Somewhat satisfied

    5. Highly satisfied

20. In your opinion, how can the MIECHV post-award grant monitoring site visit be improved? Please type your response in the box below.

Thank you for providing your feedback!

Please click “SUBMIT” below to send us your feedback.

Public Burden Statement: 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. The OMB control number for this project is 0915-0212. Public reporting burden for this collection of information is estimated to average .25 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-29, Rockville, Maryland, 20857.

OMB Number (0915-0212); Expiration date (7/31/2015) Page 8 of 8