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

Walk-In Customer Survey

OMB Control No.: 1405-0193
EXPIRES: 07-31-2017
ESTIMATED BURDEN: 5 minutes
SV-2016-0002

The Department of State’s Directorate of Passport Services would like your help in improving
the customer experience at Passport Agencies. This survey is voluntary and all responses will be
kept anonymous.

Location:

Date:
Scheduled Travel Date:

Why did you choose to visit the Passport Agency without an appointment
today?
I attempted to make an appointment, but: (please select the one response which
best describes your situation)

o The only available appointments were after my scheduled travel date
o The only available appointments were too close to my scheduled travel date
and I didn’t know if I would be able to obtain my passport in time for my
scheduled travel

o There were no appointments available
o The only available appointments were inconvenient for my personal
schedule

o Other:
I did not attempt to make an appointment because: (please select the one
response which best describes your situation)

o I was told (via word of mouth, Yelp, Twitter, etc.) that an appointment
wasn’t necessary or difficult to make

o I was unaware that appointments could be made
o I did not have time to make an appointment due to the emergency nature of
my travel

o I did not have time to make an appointment due to my personal schedule
o Other:
I have an appointment for a later date, but chose to come in earlier without an
appointment
Is there any other feedback you would like to share?

Thank you for participating in this survey. Once completed, please leave this survey in the WalkIn Customer Survey box next to the Check-In Window.
Public reporting burden for this collection of information is estimated to average 5 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 NPIC@state.gov.