OMB xxxx HUD Direct TA Survey TA Recipient Version

OMB Approval Number: XXXX-XXXX (Exp. XX/XX/XXXX)

Paperwork Reduction Act Burden: According to the Paperwork Reduction Act of 1995, no persons
are required to respond to a collection of information unless such collection displays a valid OMB
control number. This collection of information is optional and will assist HUD to improve the quality,
relevance, and delivery of technical assistance resources. The total time required to complete this
survey is estimated to average 15 minutes including the time to review instructions, gather the data
needed, and complete and review the survey. If you have any comments concerning the accuracy of
the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of
Housing and Urban Development, Office of Economic Development, 451 7th Street SW, Room 7136,
Washington, D.C. 20410.
Privacy Act Statement: The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain
information in connection with the request for information solicited on this form. Accordingly,
pursuant to the requirements of the Act, please be advised:
Authorization: This collection of information is authorized under Sec. 501 of Title V of the
Housing and Urban Development Act of 1970, Public Law 91-609, which authorizes the Secretary
“to undertake such programs of research, studies, testing, and demonstration relating to the
mission and programs of the Department as he determines to be necessary and appropriate.”
Purpose: This collection of information is necessary in order to systematically gather user
feedback and outcomes data to evaluate and improve HUD’s deployment and management of its
technical assistance resources. This type of information on outcomes has been consistently
requested by both OMB and Congressional Appropriations Committee staff.
Uses: This information collection is entirely voluntary. Any information collected may be seen
and used by HUD staff that are responsible for analysis of HUD’s technical assistance program.
Results of individual surveys will not be shared with TA providers, other TA recipients, or HUD
program office staff that have assisted in coordination of the technical assistance engagement.
Survey results may be shared in aggregated form with TA providers or HUD program office staff
that coordinate technical assistance. Survey results may also be shared in aggregated form with
other HUD stakeholders and Congress.
Disclosure: Voluntary. Any information collected in this information collection may be made
accessible to the public and shared widely. Please do NOT submit any personally identifiable
information as part of this information collection form, defined as any information which can
be used to distinguish or trace an individual's identity, such as name, social security number,
biometric records, etc. alone, or when combined with other personal or identifying information
which is linked or linkable to a specific individual, such as date and place of birth, mother’s
maiden name, etc.

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OMB Approval Number: XXXX-XXXX (Exp. XX/XX/XXXX)

HUD DIRECT TA SURVEY: TA RECIPIENT VERSION
Your organization, [TA RECIPIENT], recently received HUD-funded technical assistance led by [LEAD TA
PROVIDER NAME] from [LEAD TA PROVIDER ORGANIZATION]. You may have received assistance from multiple
firms on various topics, but please think about the assistance coordinated through [LEAD TA PROVIDER
ORGANIZATION] as you are completing this survey.
[The following description will be pre-filled for the respondent when they receive the survey.]

TECHNICAL ASSISTANCE ENGAGEMENT DETAILS
LEAD TA PROVIDER NAME: ______________________________________________________________________________________
LEAD TA PROVIDER ORGANIZATION: ___________________________________________________________________________
PERIOD OF PERFORMANCE: _XX/XX/XXXX – XX/XX/XXXX_
TA DESCRIPTION:
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
We would like to ask you a few questions regarding your experience with this specific
engagement and your impression of the effectiveness of the TA . Before proceeding, please
confirm that you were directly involved in this TA program and feel qualified to provide general
feedback on the Direct TA engagement, including questions about how well it met intended
outcomes.
Yes, I was directly involved in this TA program and feel qualified to answer this survey.
No, I am not the right person to participate in this survey.
IF RESPONSE = NO, I am not the right person to participate in this survey; Please enter the name and
email for an individual who had direct experience with the technical assistance provided to your organization
and whom would be qualified to answer questions regarding achievement of intended outcomes and general
feedback.
The correct respondent is:
[NAME]________________________________________
___________________________ [EMAIL]________________________________________
Please complete this survey by [DATE].
If you have any questions while taking this survey, please contact [EMAIL ADDRESS].
Note: Please do not use the "Back" or "Forward" buttons on the top of your browser while in the
survey. By doing so, the survey will not work prope rly, and your responses will not be saved.

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OMB Approval Number: XXXX-XXXX (Exp. XX/XX/XXXX)

SURVEY QUESTION 1: SATISFACTION WITH TA PROVIDED
1A. Overall, how satisfied were you with the TA provided?
☐ Very Satisfied
☐ Satisfied
☐ Dissatisfied
☐ Very Dissatisfied
☐ I don’t know

1B. How satisfied were you with the following TA elements:
Direct TA Elements

Very

Dissatisfied

Satisfied

Very Satisfied

I don’t know

☐

☐

☐

☐

☐

☐

☐

☐

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☐

Provider communication

☐

☐

☐

☐

☐

Provider follow-through

☐

☐

☐

☐

☐

Length of TA Engagement

☐

☐

☐

☐

☐

Level of TA Support Provided

☐

☐

☐

☐

☐

Focus of the TA Engagement

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

Provider knowledge and skills
Provider organization and
management of the work

Dissatisfied

Coordination among parties,
including the TA recipient, TA
provider(s), and HUD/Field
Office staff
Other, please specify:
_________________________________
_________________________________
_________________________________

Please provide any additional comments related to your ratings:
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
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OMB Approval Number: XXXX-XXXX (Exp. XX/XX/XXXX)

ANTICIPATED OUTCOMES FOR THIS TA ENGAGEMENT
[This section comes pre-filled for the survey respondent; Questions 2-5 will be asked for each Outcome]

At the start of this engagement, the TA provider(s) and your organization agreed to work toward
improving your organization’s capacity in the following areas:
[List HUD Outcomes and TA provider-supplied outcome descriptions in table format]

SURVEY QUESTION 2: PROGRESS TOWARD ACHIEVING SELECTED OUTCOME(S)
To what extent has your organization [insert outcome]? See attachment at end for a sample of
how this would look for a respondent.
○ 100%-Outcome fully achieved ○ 80% ○ 60% ○ 40% ○ 20% ○ 0%-Outcome was not achieved ○ I don’t know

SURVEY QUESTION 3: FOLLOW-UP ON FACTORS RELATED TO SUCCESS
[Note: This is a skip pattern question (dependent on score of 20-100% on Question 2)]

3A. What factors contributed to the improvement in the identified area? (select all that apply)
☐ Guidance or support provided by the TA provider
☐ Guidance or support provided directly by HUD
☐ Increase in funding or revenue dedicated to the area
☐ Increase in number of staff assigned to work in that area
☐ New organizational structure or new/increased leadership support for the area
☐ New political leadership
☐ Improvement in local economy or other external factors
☐ Other, please specify: ________________________________________________________________________________________
☐ I don’t know

3B. How likely do you think it is that your organization will sustain improvement in the identified
area over the next year?
☐ Very Likely
☐ Likely
☐ Unlikely
☐ Very Unlikely
☐ I don’t know/ Not applicable, because there was no improvement in the identified area

SURVEY QUESTION 4: FOLLOW-UP ON FACTORS RELATED TO BARRIERS TO SUCCESS
[Note: This is a skip pattern question (dependent on score of 0-80% on Question 2)]

In your opinion, which of the following prevented your organization from fully achieving this
outcome? [Select all that apply]
☐ Assistance from the TA Provider was not adequate (please explain specific concern in the comments section)
☐ Guidance provided directly by HUD was not adequate (please explain specific concern in the comments section)
☐ Level of engagement of our organization’s staff was not adequate
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OMB Approval Number: XXXX-XXXX (Exp. XX/XX/XXXX)
☐ Turnover in our organization’s staff or leadership
☐ Insufficient number of available staff at our organization
☐ Inadequate support from our organization’s leadership/management
☐ Decrease in or insufficient political support
☐ Decrease in funding or revenue dedicated to this area
☐ Decline in economy or other external factors
☐ Other, please specify: _______________________________________________________________________________________
☐ I don’t know

Please provide any additional comments related to factors affecting progress toward outcomes:
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________

SURVEY QUESTION 5: STATUS OF THE TECHNICAL ASSISTANCE
Is the TA provider continuing to provide support to your organization on this issue as part of a
follow-up TA engagement?
☐ Yes
☐ No
☐ I don’t know

Please explain your response:
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________

SURVEY QUESTION 6: RECOMMENDATIONS FOR IMPROVING HUD’S TA PROGRAM
Please provide any recommendations for ways to improve HUD’s technical assistance program:
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
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OMB Approval Number: XXXX-XXXX (Exp. XX/XX/XXXX)

EXAMPLE SURVEY QUESTION 2 – TA RECIPIENT RESPONDENT VIEW
SURVEY QUESTION 2: PROGRESS TOWARD ACHIEVING SELECTED OUTCOME(S)
Outcome

Outcome Description

Improved capacity to design system-wide

Provide Technical Assistance and Capacity Building to

strategies that address community needs

the Puerto Rico Public Housing Administration and the

(e.g., designed innovative multi-disciplinary

Puerto Rico Department of Housing to include:

strategies, designed coordinated place-based

preparation of a redevelopment/Repositioning Plan for

development to leverage neighborhood

the 9 priority sites identified by PRPHA and HUD and

impacts)

to provide recommendations for prioritizing
modernization and development projects.

To what extent has your organization [improved capacity to design system-wide strategies that
address community needs]?
☐ 100% -Outcome was fully achieved
☐ 80%
☐ 60 %
☐ 40%
☐ 20%
☐ 0%-Outcome was not achieved
☐ I don’t know
Outcome

Outcome Description

Improved coordination and alignment with

Provide Technical Assistance and Capacity Building to

other community or regional plans

the Puerto Rico Public Housing Administration and the

(e.g., HUD plans aligned with plans of other HUD

Puerto Rico Department of Housing to include:

or federal programs, local and regional

recommendations regarding PRPHA's Five (5) Year

government agencies, service providers, or

Plan, including alignment with the strategic plan from

nonprofit organizations)

regional advisory board and the city’s Five (5) Year
Plan.

To what extent has your organization [improved coordination and alignment with other
community or regional plans]?
☐ 100%-Outcome was fully achieved
☐ 80%
☐ 60%
☐ 40%
☐ 20%
☐ 0%-Outcome was not achieved
☐ I don’t know
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