Form VS 1-10A VS 1-10A Customer Service Survey

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0377. The time required to complete this information collection is estimated to average .083 hours 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.			OMB APPROVED 0579-0377 Exp. 08/2015
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE AND Department of Health and Human Services		CUSTOMER SERVICE SURVEY
1. IN WHAT CAPACITY DID YOU CONTACT the Federal Select Agent Program?
Responsible Official Biosafety Official Entity Senior Official Principal Investigator Entity Manager Other (specify)
2. HOW SATISFIED WERE YOU WITH THE FEDERAL SELECT AGENT PROGRAM IN THE FOLLOWING CATEGORIES?
COURTESY Satisfied Somewhat Satisfied Neither Satisfied nor Dissatisfied Somewhat Dissatisfied Dissatisfied
PROFESSIONALISM Satisfied Somewhat Satisfied Neither Satisfied nor Dissatisfied Somewhat Dissatisfied Dissatisfied
HELPFULNESS Satisfied Somewhat Satisfied Neither Satisfied nor Dissatisfied Somewhat Dissatisfied Dissatisfied
TIMELINESS Satisfied Somewhat Satisfied Neither Satisfied nor Dissatisfied Somewhat Dissatisfied Dissatisfied
KNOWLEDGE Satisfied Somewhat Satisfied Neither Satisfied nor Dissatisfied Somewhat Dissatisfied Dissatisfied
COMMUNICATION Satisfied Somewhat Satisfied Neither Satisfied nor Dissatisfied Somewhat Dissatisfied Dissatisfied
TREATING YOU AS A VALUED CUSTOMER Satisfied Somewhat Satisfied Neither Satisfied nor Dissatisfied Somewhat Dissatisfied Dissatisfied
3. HOW SATISFIED WERE YOU WITH YOUR OVERALL EXPERIENCE IN OUR OFFICE?
Satisfied Somewhat Satisfied Neither Satisfied nor Dissatisfied Somewhat Dissatisfied Dissatisfied
4. WHAT WAS GOOD ABOUT OUR SERVICE?
5. WHAT COULD WE DO BETTER?
IF YOU WOULD LIKE A RESPONSE FROM THE FEDERAL SELECT AGENT PROGRAM, PLEASE PROVIDE YOUR NAME AND PHONE NUMBER OR EMAIL.
NAME:
PHONE NUMBER :	EMAIL ADDRESS:
Your answers are voluntary, confidential, and anonymous. They will be used by the Federal Select Agent Program to evaluate and improve customer service. Please fold this survey and return it by mail or in-person to the office you visited.

VS Form 1-10 A

AUG 2015

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PLACE STAMP

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Animal and Plant Health Inspection Service

Agriculture Select Agent Services

4700 River Rd., Unit 2

Riverdale, MD 20737

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VS Form 1-10 A

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