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

Paperwork Reduction Act Notice
The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the
clearance requirements of the Paperwork Reduction Act. We may not conduct or sponsor, and you are not required to
respond to, a collection of information unless it displays a currently valid 0MB control number. This includes the time it
will take for reviewing instructions. The 0MB control number for this collection is 2132-0572 and the expiration date is
09/30/2017. The time required to complete this information collection is estimated to average 8 minutes per response,
including the time to review the instructions and complete and review the information collection. The information wilt be
used by FTA to assess customer needs, determine how well FTA is responding to those needs and improve service, if
needed. Response to this request is voluntary.

1. What was your level of satisfaction with the customer service you received in your most
recent Contact Us submission?

(3 Very Satisfied

Q Satisfied
Neither Satisfied nor Dissatisfied

() Dissatisfied
() Very Dissatisfied
2. Was your submission resolved to your satisfaction?

(3Yes
Neither Satisfied nor Dissatisfied

(3No
3. How satisfied were you with the timeliness of the response to your question or
comment?

C) Very Satisfied
Satisfied

() Neither Satisfied nor Dissatisfied
(3 Dissatisfied
() Very Dissatisfied

4. What is your affiliation?
General Public

LII

Government Agency
International
Student

LI

Transit Agency (Grantee)
Transit Industry (Contractor, Manufacture, Supplier)

Other (please specify)

5. Are there any other comments or suggestions that you would like to add? If you were
not satisfied, please provide suggestions for improvement.