Form xxxx CRS Quality of Service Survey

OMB Number 1103-_ _ _ _

Expiration date:  xx-xx-xxxx

	City:______________________ State:________________________	Date:_____________
U.S. DEPARTMENT OF JUSTICE COMMUNITY RELATIONS SERVICE (CRS)
CUSTOMER SATISFACTION SURVEY Please use the scale below to rate your level of agreement with each of the following statements. 5- Strongly Agree 4- Agree 3- Neither Agree nor Disagree 2- Disagree 1- Strongly Disagree Circle the appropriate number for each question or write your responses in the space provided. Should you need more space, please use the back of the survey.
CRS’ assistance helped prevent violence.			1 2 3 4 5
CRS’ assistance reduced community tension.			1 2 3 4 5
CRS responded in a timely manner.			1 2 3 4 5
CRS assisted my community in a professional and collaborative manner.			1 2 3 4 5
CRS demonstrated neutrality and impartiality.			1 2 3 4 5
I am satisfied with my experience with CRS.			1 2 3 4 5
I would recommend CRS’ services to someone else.			1 2 3 4 5
8) If you could change anything about your experience with CRS, what would you change? -------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------
If you would like to speak to someone in more detail about your experience with CRS services, please contact the Washington, DC, Headquarters office at phone telephone (202) 305-2935.

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Federal agencies may not conduct or sponsor an information collection, and a person is not required to respond to a collection of information, unless it displays a currently valid OMB Control Number. Public reporting burden for this collection of information is estimated to average 1 minute per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate, or any other aspects of this collection of information, including suggestions for reducing this burden, to the Deputy Director, U.S. Department of Justice, Community Relations Service, Washington, DC 20530.