CSOSA - 1 Community Resource Day Program Participant Feedback Surv

Form Approved:

OMB No. 3225-0002

Exp. Date: 09/30/2020

Form: CSOSA-1

^23h

COMMUNITY RESOURCE DAY

PROGRAM PARTICIPANT FEEDBACK SURVEY

TODAY’S DATE: ______________________

CSOSA respectfully requests that you complete the following survey upon completion of your participation in today’s Videoconference. The feedback received from this survey will be used solely to help improve future Community Resource Day programs. Completion of this survey is voluntary. Refusing to complete this survey will not result in any penalties. Your responses are important, encouraged, and will be treated as confidential. Your responses will only be disclosed as permitted under the Privacy Act (5 U.S.C. 552a).

Once completed, please return the survey face down to designated Bureau of Prisons personnel, who will give the form to CSOSA. Thank you.

1. In general, how would you rate today’s program?

□ Excellent □ Good □ Fair □ Poor

2. What did you find most useful about Community Resource Day?

_____________________________________________________________________________

3. What did you find least useful about Community Resource Day?

_____________________________________________________________________________

4. What, if any, important information was left out?

_____________________________________________________________________________

5. Which of the following services will you need upon your release? (Check all that apply.)

□ Substance Abuse Treatment □ Job Training Programs

□ Medical Care □ Education

□ Housing □ None

□ Employment Referrals □ Other, please explain: ___________________

5. As a result of today’s program, do you know where to get the services you need upon your release?

□ Yes, for all services □ Yes, for some services □ No, not for any services

5. Do you expect to visit any of the programs or services presented today?

□ Definitely □ Probably □ Might or might not □ Probably not □ Definitely not

5. Do you have any suggestions for improving this program in the future?

_____________________________________________________________________________

__________________________________________________________________________________________

Public reporting burden for this collection of information is estimated to be 6 minutes, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of 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 Office of Management and Budget (OMB) control number. Send comments regarding this burden estimate or another aspect of this collection of information, including suggestions for reducing this burden to:

Court Services and Offender Supervision Agency | Office of Research and Evaluation | 601 Indiana Ave. NW, Suite 512 | Washington, DC 20004