Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

U.S. DEPARTMENT OF STATE
AMERICAN CITIZEN SERVICES APPLICANT
SATISFACTION SURVEY

美国国务院关于美国公民服务申请人满意度调查问卷

OMB No编号: 1405-0193

Expiration Date截止日期: 07/31/2017

Estimated Burden预计花费时间: 3 minutes分钟
SV-2015-0005

We ask that you take a brief survey to assess your experience with the United States consular section at the U.S. [Embassy/Consulate General name]. Your responses will be kept private and not associated with you or your case. We are only conducting this survey to improve our service.

我们邀请您对在美国驻 ____________大使馆（领事馆）接受服务的过程进行问卷调查。此问卷调查不记名， 旨在提升我们的服务质量， 不会对您本人和你的申请造成任何影响。

1. U.S. Embassy/Consulate General _[Dropdown option choices for electronic survey or write-in option for paper]_
   美国驻______________大使馆 （领事馆）[电子问卷请点击下拉选项， 纸质问卷请标注选项]

2. Indicate service received:

请标示您所接受的服务类型：

• U.S. Passport 美国护照

• Consular Report of Birth Abroad 海外领事出生证明

• Notary Services 公证

• Other 其他____________________________

If used,
was source helpful? 从该渠道获得的信息对您是否有帮助？

PREPARING FOR YOUR APPOINTMENT预约

1. 3. How did you obtain information to prepare for your appointment? Check all that apply.

2. 您如何获得预约服务信息？请选择所有适用的选项。

	Yes是	No否
Family member or friend 亲属或朋友
Attorney/Notary 律师/公证人员
Consultant 顾问
U.S. Department of State website (travel.state.gov) 美国国务院官网(travel.state.gov)
[Embassy/Consulate General name] website in English 美国驻______大使馆（领事馆）英文网站
[Embassy/Consulate General name] website in [country’s official language] 美国驻______大使馆（领事馆）的中文网站
[Embassy/Consulate General name] phone or email in English 美国驻______大使馆（领事馆）的英语服务电话或英文邮件
[Embassy/Consulate General name] phone or email in [country’s official language] 美国驻______大使馆（领事馆）的汉语服务电话或中文邮件
[Embassy/Consulate General name] social media (e.g., Facebook, Twitter) 美国驻______大使馆（领事馆）的社交媒体（例如， 脸书，推特）
Other其他渠道____________________________

4. Did you need help in completing the forms?

您填表时需要他人协助吗？

• No 不需要

• Yes, by a family member or friend 需要， 通过家人或朋友的帮助

• Yes, by an attorney/notary 需要， 通过律师或公证人员的帮助

• Yes, by contacting the [Embassy/Consulate General name] by phone or email in English

需要，通过美国驻______大使馆（领事馆）的英语电话或英文邮件咨询服务

• Yes, by contacting the [Embassy/Consulate General name] by phone or email in [country’s official language]

需要，通过美国驻______大使馆（领事馆）的汉语电话或中文邮件咨询服务

• Yes, other 需要， 其它____________________________

• No forms were required for the service I received我所接受的服务不需要填写表格.

4. If you used the [Embassy/Consulate General name] website, were instructions and requirements clear (i.e., documents needed for appointment, items allowed inside the [Embassy/Consulate General])?

如果您曾经浏览过美国驻_______大使馆（领事馆）的官方网站, 您认为该网站的说明指导和要求是否清晰明确（例如：服务所需文件及允许携带进入大使馆或领事馆的物品）：

• Yes 是

• No 否

• I did not use the [Embassy/Consulate General name] website 我从未浏览过美国驻______大使馆（领事馆）的官方网站

4. Prior to your appointment, which of the following would you have liked to receive additional information about?

在面谈之前，您希望获得下列哪些额外信息？

• What to expect at the appointment (i.e., the security process, waiting room experience, parking, appointment time and duration) 服务流程（例如：安全检查， 等候室取号叫号， 停车， 面谈时间及服务所用时间）

• Prohibited items that are not allowed in the [Embassy/Consulate General name] 禁止携带入馆的物品

• Supporting documentation required (e.g., proof of identity, birth certificate) 要求提交的文件（例如：身份证明， 出生证）

• Information on how to change appointment time 如何更改预约时间

• Document delivery service 文件送达服务

• Other其它 ______________________________________

APPOINTMENT SCHEDULING预约服务

4. Was it convenient to make an appointment for the date and time you wanted?

预约到您想要的日期和时间是否便利？

• Yes 是

• No, I needed an earlier appointment date, and one was not available.

否，我需要一个更早的预约日期，但没有可选日期

• No, other:否，其它 _______________________________________________

4. If it was difficult for you to schedule or reschedule your appointment, please indicate why. Check all that apply.

当您预约面谈或者更改预约时间时，是否遇到困难， 请您列举原因。可选择所有适用的选项：

• The scheduling or rescheduling process was confusing.预约流程复杂难懂

• I do not have access to or use the internet. 我不会使用网络或没有网络连接

• I had to call the [Embassy/Consulate General].我必须致电美国驻______大使馆（领事馆）才能预约或更改预约

• Other其它_________________________________________

4. 9. Please rate your visit to [Embassy/Consulate General name].

5. 请评价您在美国驻______大使馆（领事馆）的感受

DURING THE APPOINTMENT 面谈过程

	Excellent 非常满意	Satisfactory 满意	Needs Improvement 有待提高
Courtesy of the security guards 安保人员的态度
Courtesy of the consular staff 领事处工作人员的态度
Answers to your questions解答疑问
Explanation regarding your case 对于您所申请服务的说明
Cleanliness and comfort of the waiting area等候室的舒适程度和整洁程度
Duration of wait time 排队等候时间

10. Please use the space below for any additional suggestions on what we could improve.

请您在空白处向我们提出如何提升服务质量的更多建议。

Public reporting burden for this collection of information is estimated to average 3 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: Department of State, Bureau of Consular Affairs, ATTN: Catherine Barry, 600 19^th Street, N.W., Washington, DC 20036.

完成该调查报告的预计花费时间是3分钟，其中包括查阅现有资料，收集必要文件，提供所需信息和/或文件并回顾最终所采集的信息所需的时间。该调查报告需显示当前有效的OMB控制编号，否则您将无需向其提供所需信息。如果您对该报告的预计完成时间和/或减少该花费时间有任何意见或建议，请将您的意见或建议发送至：Department of State, Bureau of Consular Affairs, ATTN: Catherine Barry, 600 19th Street, N.W., Washington, DC 20036.

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