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pdfCALL CENTER
OMB# 1121-XXXX
Date of Expiration: XXXX
Feedback Form
We have identified you as someone who has recently been in contact with the OVC TTAC Call Center. In order to help OVC
TTAC better serve the field, we are reaching out to you and others to obtain feedback on assistance provided. We will protect the
privacy of your information in accordance with the Federal Privacy Act, and we will protect the confidentiality of your responses
using procedures we have in place. Only members of the Needs Assessment and Evaluation Team have access to information that
could identify respondents. Answers to these questions will only be reported after aggregating all responses, and the results will
never identify you as an individual. Other participants, presenters, OVC staff, OVC TTAC staff, and your employer will not have
access to what you as an individual say. Your participation is completely voluntary. If you have any questions about this survey or
the evaluation, please contact TTACEval@icfi.com.
Please indicate the extent to which you agree or disagree with the following statements.
Strongly
Disagree
Disagree
Neither
Agree nor
Disagree
Agree
Strongly
Agree
Not
Applicable
1. OVC TTAC was responsive to my questions and needs.
1
2
3
4
5
NA
2. The information/assistance I received was easy for me to
understand.
1
2
3
4
5
NA
3. The information/assistance I received will help me in my work.
1
2
3
4
5
NA
4. The information/assistance I received met my goals.
1
2
3
4
5
NA
5. I am satisfied with the information/assistance I received.
1
2
3
4
5
NA
6. I will return to OVC TTAC for my training and technical
assistance needs.
1
2
3
4
5
NA
7.
How did you find out about OVC TTAC?
8.
How often have you used OVC TTAC in the last 12 months?
9.
Via the OVC TTAC Web site
Via an OVC TTAC exhibit or presentation at a conference
Via a link from another Web site/Searching the Internet
Via a colleague who is familiar with OVC TTAC resources
Via my OVC program monitor or other OVC staff person
Other (please specify): _______________________________________________________________
1 - 3 times
4 - 6 times
7 - 9 times
10+ times
E-mail
TTY
Other (please specify): __________________________
How did you access OVC TTAC? (Mark all that apply.)
OVC TTAC Web site
Toll-free number for call center
OVC program monitor or other OVC staff person
10. Why have you used/contacted OVC TTAC? (Mark all that apply.)
Request general information about OVC or OVC
TTAC
Obtain general information about victim services
Obtain a referral for direct services
Access online materials or training
Join the listserv or mailing list
Apply to be a consultant/trainer
Acquire help for technical problems on Web site
Request or apply for assistance:
Technical assistance
Training
Funding for a conference/event or speaker
Scholarship
National Victim Assistance Academy
Other (please specify): _______________________
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is10 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the OVC TTAC Evaluation Team at TTACEval@icfi.com or 9300 Lee Highway, Fairfax, VA 22031.
CALL CENTER
OMB# 1121-XXXX
Date of Expiration: XXXX
Feedback Form
11. In general, how promptly was your request acknowledged?
Immediately
Within a day
Within 2-3 days
Within a week
12. Would you recommend OVC TTAC to others? □ Yes
More than a week
My request was not acknowledged
□ No
13. What did you find most helpful about OVC TTAC’s resources?
14. What could have been done differently to improve your experience with OVC TTAC?
15. Do you have any other comments or suggestions?
16. Which of the following best describes the organization in which you work? (Mark all that apply.)
Community-Based/Grassroots
Criminal Justice Agency
Education
Faith-Based
Health Services
Human/Social Services
Legal Services
Legislation/Policymaking
Military
Research
Other (please specify):
__________________________
17. Which types of victim services do you provide for crime victims in your current position? (Mark all that apply.)
I do not provide direct services
Child Care
Compensation/Restitution
Counseling
Crisis Intervention
Criminal Justice System
Advocacy/Assistance
Medical Assistance
24-Hour Hotline
Information/Referral
Notification
Shelter
Transportation
Other (please specify):
__________________________
18. Which of the following best describes the number of years of experience you have in your field of work? (Mark one.)
Less than 3 years
3 to 5 years
6 to 10 years
More than 10 years
19. Which of the following best describes your primary role in your current position? (Mark all that apply.)
Direct Delivery/Front Line Staff
Management/Administrative Staff
Consultant/Trainer
Volunteer
Other (please specify):
__________________________
20. Which of the following best describes the population you serve? (Mark all that apply.)
National
State
Tribal
International, list country:
_______________________________
Local
Urban
Rural
Suburban
Culturally specific population(s):__________________
Thank you for taking the time to complete this form and helping to improve OVC TTAC activities.
File Type | application/pdf |
File Title | OVC TTAC - USER FEEDBACK FORM |
Author | goellen |
File Modified | 2013-05-30 |
File Created | 2013-05-30 |