Form DHS-9042 OEC Technical Assistance (TA) Evaluation Form

DEPARTMENT OF HOMELAND SECURITY

Office of Emergency Communications

OMB No. 2014-0005
Expiration Date: 10/31/2014

Technical Assistance (TA) Evaluation Form

Instructions
Read all instructions before completing this form
Authority: Title XVIII of the Homeland Security Act of 2002, 6 U.S.C. § 101
et seq., and the Implementing Recommendations of the 9/11 Commission
Act or 2007 (6 U.S.C. 579(m) authorizes the collection of this information to
improve emergency communications capabilities in States, territories, local
jurisdictions, and tribal governments.
Purpose: DHS will use this information to conduct a review of the
effectiveness and adequacy of technical assistance services provided to
State and local officials for interoperable and operable communications.
These evaluation forms will be filled in at the completion of technical
assistance services to participants of those events.
Routine Uses: This information will be used by and disclosed to DHS
personnel and contractors or other agents who need the information to
assist in activities related to technical assistance services. DHS may share
the information with course development and course curriculum developers
as necessary to improve on the service offerings that are created to
enhance interoperable and operable emergency communications.
Disclosure: Furnishing this information (including your name and e-mail
address) is voluntary; however, failure to furnish the requested information
may delay or prevent completion of the review of adequacy and
effectiveness of technical services provided by the OEC.

What is the purpose of this form?
DHS Form 9042, Office of Emergency Communications Technical
Assistance (TA) Evaluation Form, is voluntarily completed by
stakeholders receiving OEC TA.
OEC will use the information collected through these evaluations to
assess the effectiveness of its TA service offerings and for continued
improvement to its TA planning.
TA service offerings are described in the OEC TA Catalog.
(www.publicsafeytools.info)

Filling out DHS Form 9042
Technical Assistance Engagement Evaluator:
Each participant in an OEC TA work shop or the principal stakeholder
involved with a TA engagement is requested to complete this form.

SECTION 1
Title: Enter the name of the Technical Assistance service provided,
(e.g., SOP-DEV, COMU-PLAN, TICP-WKSP)
Work Order Number: Enter Work Order Number (e.g., WO14-056)
SWIC/TA Point of Contact: Enter the name of the person completing
this form, (Primary/on-site contact for the TA service)
Location: Enter the workshop, seminar, course location, (where was the
TA service provided)
Date: Enter the date of the workshop, seminar, course (date TA
service was provided)
Instructor(s): Enter the name of the OEC Staff/SME that provided the
TA service

SECTION 2
Evaluate the Technical Assistance service provided:
Please answer the following 7 questions by checking the appropriate
box using the below evaluation scale:
1- Strongly Disagree
2- Somewhat Disagree
3- Neutral
4- Somewhat Agree
5- Strongly Agree

SECTION 3
Please answer the following 5 questions to improve the quality of future
Technical Assistance Service Offerings.
Submitting the completed form:
TA Evaluations may be completed and submitted electronically at
www.publicsafetytools.info or PDF copies may be submitted via email to:
TAEvaluations@hq.dhs.gov.

Paperwork Reduction Act Notice. The public reporting burden to complete this information collection is estimated at 25 minutes per response, including time for reviewing
instructions, searching data sources, gathering and maintaining the data needed, and the completing and reviewing the collected information. An agency may not conduct or
sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number and expiration date. Send comments regarding
this burden estimate or any other aspect of this collection information, including suggestions for reducing this burden to DHS / National Protection and Programs Directorate / Office
of Cybersecurity and Communications / Office of Emergency Communications, Serena Maxey, 202-235-2822, Serena.Maxey@hq.dhs.gov, ATTN: PRA [1670-0023]

DHS Form 9042 (2/14)

Page 1

DEPARTMENT OF HOMELAND SECURITY

Office of Emergency Communications
Technical Assistance (TA) Evaluation Form

SECTION 1
Course Title:

Work Order Number:

SWIC/TA Point of Contact:

Location:

Date(s):

Instructor(s):

Please answer the following questions about your experience in this Technical
Assistance Workshop according to the scale below:

SECTION 2
1

2

Strongly
Disagree

3

Somewhat
Disagree

Neutral

4

5

Somewhat Agree

1

2

3

Strongly
Agree
4

1. This Technical Assistance service was successful in assisting
us with our Objectives and Goals.
2. The workshop material was presented in a professional manner
and was clear and easily understood by the participants.
3. The Technical Assistance met or exceeded expectations.
4. This Technical Assistance was received on time, as scheduled
during the planning process with OEC.
5. The instructor’s presentation, content knowledge and class
exercises were effective in enhancing course content.
6. This Technical Assistance improved our interoperable
emergency communications knowledge and capabilities.
7. I would recommend this Technical Assistance Service Offering.
Please E-Mail this completed form to: TAevaluations@hq.dhs.gov
Or complete it on-line at:
http://www.publicsafetytools.info/ta_evaluation/ta_evaluation_state_request.php

5

SECTION 3
Please use the following sections to provide any additional information to improve
the quality of future Technical Assistance Service Offerings

1.

What did you like most about this Technical Assistance?

2.

What did you not like, or what seemed to not work well?

3.

What suggestions do you have for improving the learning experience?

4.

What would you add or delete from this Technical Assistance Workshop?

5.

How does this Technical Assistance support and/or enhance interoperable
emergency communications in your State/region/locality?

For More Information about OEC/ICTAP Technical Assistance (TA) Offerings
and Tools Visit:
www.publicsafetytools.info