National Disability Forum Evaluation
State of Medicine - Biomarkers
OMB Number 0960-_0788 ___
Thank you for taking the time to participate in this evaluation. Your comments will enable us to improve future forums and tailor them to meet your expectations.
Demographics
1. Your organization type:
Federal Government - SSA only
Federal Government - Military only
Federal Government - All Others
State Government
Local Government
Business
Nonprofit
College/University
Health care
Faith-based
Military
Other (please specify) ___________________
2. How did you learn about the forum?
Email from SSA
Colleague
Socialscurity.gov
Social media
Other (please specify)_________________________________
3. Did you attend the forum by live streaming or in person?
Live Streaming
Person
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4. On a scale of 1 to 5, with 5 being the best score and 1 being the worst score, how would you rate the following aspects of the forum?
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5 |
Forum Overall |
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Content |
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Format/Structure |
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Length |
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Location |
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Opportunity for audience participation |
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Usefulness of the topic |
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Discussions |
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Live Streaming |
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Presenters |
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Other (please specify) _______________________________________ _______________________________________
5. If you rated any of the items in Question 4 above as "1" or "2," please explain why.
___________________________________________________________________________________________________________________________________________________________________________
6. What did you like best about the forum?
___________________________________________________________________________________________________________________________________________________________________________
7. What did you like least about the forum?
____________________________________________________________________________________________________________________________________________________________________________
Future Forums
National Disability Forum Evaluation
8. What recommendations do you have for future Disability Forums?
Topic 1___________________________________________________
Topic 2___________________________________________________
Topic 3___________________________________________________
Communication Resources
National Disability Forum Evaluation
9. How do you typically review news and information about SSA? (Select all that apply)
SSA website
SSA emails
Social media
Newspapers
Congressional testimony
"Social Security Matters" blog
Other (specify)_______________________________________
Contact Information
National Disability Forum Evaluation
10. Your contact information (optional)
and the Modern Day Workforce
Name___________________________________________________
Email address_____________________________________________
Paperwork Reduction Act Statement – This information collection meets the requirements of 44 U.S.C. §3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions (OR participate in this focus group OR
complete this telephone survey) unless we display a valid Office of Management and Budget control number. We estimate that it will
take about 2 minutes to read the instructions, gather the facts, and answer the questions. You may send comments on our time
estimate above to: SSA, 6401 Security Blvd., Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this
address, not the completed form.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Sim, Joann |
| File Modified | 0000-00-00 |
| File Created | 2021-01-15 |