Form SV-20013-0003 AMERICAN CITIZENS SERVICES CUSTOMER SERVICE SATISFACTION

U. S. Department of State

EMBASSIES/CONSULATES OF THE UNITED STATES OF AMERICA

OMB No. 1405-0193
EXPIRES: xx/xx/xxxx
Estimated Burden - 5 minutes

AMERICAN CITIZENS SERVICES CUSTOMER SERVICE SATISFACTION SURVEY
Welcome and thank you for visiting the United States diplomatic mission. To assess the level of customer satisfaction and effectiveness of the
customer service provided, we have a brief questionnaire about your visit. Your responses are completely voluntary, confidential and will in no way be
associated with your name or your application. We are only conducting this survey to improve the service provided.
Upon completion of the survey, please submit the survey to the U.S. diplomatic mission you visited. The survey can be submitted by fax, email, mail
or in-person.
1. Which U.S. diplomatic mission did you visit? (Please choose the diplomatic mission you visited from the drop-down list below)

2. What consular service(s) did you seek? (Please place a check in the checkbox for the consular service(s) you seeked)
U.S. Passport
Federal Benefits

Consular Report of Birth Abroad
(i.e. SSA, VA, OPM, etc. benefits)

Notary Services

Financial Assistance

U.S. Citizenship Claim

Other consular services (If other, Please Specify)
3. Please rate your experience obtaining information and scheduling an appointment.
How would you rate the following areas of service?

Excellent

Good

Fair

Poor

Very Poor

Excellent

Good

Fair

Poor

Very Poor

Excellent

Good

Fair

Poor

Very Poor

Excellent

Good

Fair

Poor

Very Poor

Excellent

Good

Fair

Poor

Very Poor

The appointment scheduling method
The accuracy of the information provided
The payment method
4. Please rate the consular information website.
How would you rate the following areas of service?
Our website
Form and application accessibility
Time and effort to complete our online form(s) and/or
application(s)
5. Please rate your visit to the U.S. diplomatic mission.
How would you rate the following areas of service?
Politeness of the Security Guards
Waiting area
The wait time
6. Please rate the consular staff.
How would you rate the following areas of service?
Politeness and professionalism
Level of general knowledge displayed by the staff
Thoroughness of the explanation of all applicable documents
and individual circumstance(s) regarding my case
7. Overall Rate
How would you rate the service?
Overall experience of the entire process
8. If you feel we fell short in meeting your service expectations, please describe the situation and any service-related improvements
you would recommend:

Public reporting burden for this collection of information is estimated to average 5 minutes per response, including time required for searching
existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final
collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on
the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: U.S. Department of State, CA/OCS/L, SA-17,
Floor 10, Washington, D.C. 20522-1707.
SV-2013-0003
04-2014

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