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.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
AND
DEPARTMENT OF HEALTH AND HUMAN SERVICES

OMB APPROVED
0579-0377
Exp. 08/2015

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

Somewhat Satisfied

Neither Satisfied nor Dissatisfied

Somewhat Dissatisfied

Dissatisfied

Somewhat Satisfied

Neither Satisfied nor Dissatisfied

Somewhat Dissatisfied

Dissatisfied

Somewhat Satisfied

Neither Satisfied nor Dissatisfied

Somewhat Dissatisfied

Dissatisfied

Somewhat Satisfied

Neither Satisfied nor Dissatisfied

Somewhat Dissatisfied

Dissatisfied

Somewhat Satisfied

Neither Satisfied nor Dissatisfied

Somewhat Dissatisfied

Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Dissatisfied

Dissatisfied

Somewhat Dissatisfied

Dissatisfied

PROFESSIONALISM
Satisfied
HELPFULNESS
Satisfied
TIMELINESS
Satisfied
KNOWLEDGE
Satisfied
COMMUNICATION
Satisfied

TREATING YOU AS A VALUED CUSTOMER
Satisfied

Somewhat Satisfied

3. HOW SATISFIED WERE YOU WITH YOUR OVERALL EXPERIENCE IN OUR OFFICE?
Satisfied

Somewhat Satisfied

Neither Satisfied nor 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

TAPE HERE
_____Fold here

PLACE STAMP
HERE

Animal and Plant Health Inspection Service
Agriculture Select Agent Services
4700 River Rd., Unit 2
Riverdale, MD 20737

_____Fold here

VS Form 1-10 A
REVERSE