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pdfOMB Control Number: 0970-0519
Expiration Date: 10/31/2021
CALL CENTER
FEEDBACK
Form
In order to help the National Human Trafficking Training and Technical Assistance Center (NHTTAC) better serve the field, we are
reaching out to obtain your feedback. We will protect the privacy of your information in accordance with the Federal Privacy Act, and
we will protect the confidentiality of your responses using procedures we have in place, including reporting all information in aggregate
to avoid identifying information. Only members of the NHTTAC Evaluation Team have access to information that could identify
respondents. If you have any questions about this survey or the evaluation, please contact NHTTACEval@icf.com.
Please provide the information below to create an anonymous ID:
______
______
______
Birth Month
(insert just the month
for your date of birth,
example: 08 for August)
First letter of first name
(example: S for Sara)
First letter of your middle name
(example: M for Maria)
Please indicate the extent to which you agree or disagree with the following statements.
Strongly
Disagree
1
OVERALL ASSISTANCE
3
Strongly
Agree
4
Not
Applicable
NA
Disagree
Agree
2
1.
NHTTAC staff was responsive to my questions and needs.
2.
The information/assistance I received was easy for me to
understand.
1
2
3
4
NA
3.
The information/assistance I received was grounded in
current evidence-based research or promising practices.
1
2
3
4
NA
4.
The information/assistance I received was traumainformed.
1
2
3
4
NA
5.
The information/assistance I received was survivorinformed.
1
2
3
4
NA
6.
The information/assistance I received was grounded in a
multidisciplinary approach to addressing human trafficking.
1
2
3
4
NA
7.
The information/assistance I received reflected a public
health approach to addressing human trafficking.
1
2
3
4
NA
8.
The information/assistance I received will help me in my
work.
1
2
3
4
NA
9.
The information/assistance I received met my professional
needs.
1
2
3
4
NA
10. The information/assistance I received met my educational
needs.
1
2
3
4
NA
11. I am satisfied with the information/assistance I received.
1
2
3
4
NA
12. I will return to NHTTAC staff for my training and technical
assistance needs.
1
2
3
4
NA
13. Please rate the overall quality of the assistance you received.
1
2
3
4
Poor
Fair
Good
Excellent
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 5 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.
OMB Control Number: 0970-0519
Expiration Date: 10/31/2021
CALL CENTER
FEEDBACK
Form
14. How did you first hear about NHTTAC?
□
□
□
□
□
□
The NHTTAC Website
An exhibit or presentation at a conference
A link from another website/Searching the Internet
A colleague or friend
A publication or newsletter
My OTIP program monitor or other OTIP staff
person
□ Other (please specify):
___________________________________
15. How often have you used NHTTAC in the last 12 months?
□
□
1 – 3 times
4 – 6 times
□
□
7 – 9 times
10+ times
16. How did you most recently access NHTTAC? (Mark all that apply.)
□ NHTTAC Website
□ Toll-free number for Call Center
□ OTIP program monitor or other OTIP staff person
__________________________
□
□
□
Email
TTY
Other (please specify):
17. Why did you use/contact NHTTAC? (Mark all that apply.)
□
□
□
□
□
□
□
□
□
□
Request general information about OTIP or NHTTAC
Obtain a referral for direct services
Access online materials or training
Join the listserv or mailing list
Apply to be a consultant/trainer
Obtain information on services for people who are currently being trafficked, at risk of trafficking, or have been
trafficked.
Acquire help for technical problems on website
Request or apply for assistance:
□ Technical assistance
□ Training
Funding for a conference/event or speaker
Other (please specify): __________________________
18. In general, how promptly was your request(s) acknowledged?
□ Within 24 hours
□ Between 24-48 hours
□ Between 3-5 days
□ Between 6-7 days
□ More than a week
□ My request was not
acknowledged
□ Yes
19. Would you recommend NHTTAC to others to receive T/TA?
□ No
20. Do you have any other comments or suggestions?
______________________________________________________________________________
______________________________________________________________________________
21. Which of the following best describes the organization in which you work? (Mark all that apply.)
□
□
Academic institution
Anti-trafficking organization
□
□
Business/For-profit organization
Coalition/Multidisciplinary team/Task force
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 5 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.
OMB Control Number: 0970-0519
Expiration Date: 10/31/2021
CALL CENTER
FEEDBACK
Form
□
□
□
□
□
□
□
□
□
□
□
Federal government
Faith-based organization
State and local government
Nonprofit/Community-based organization
OTIP grantee
Self-employed
Survivor-led organization
Tribal government
Union/Worker advocacy organization
Victim service provider
Other, please specify: _____________________
22. Which of the following best describes your professional capacity or types of services you provide? (Mark all that
apply.)
□
□
□
□
□
□
□
□
Behavioral health professional (e.g., psychologist,
psychiatrist, mental health/substance use counselor)
Child welfare (e.g., state agency staff, child welfare
contractor, nonprofit personnel)
Corrections-based services (e.g., parole, probation)
Criminal justice (e.g., law enforcement, prosecutor,
probation, court, forensic interviewer)
Educator (e.g., teacher, professor, school
administrator)
Health care (e.g., physician, physician assistant,
nurse practitioner, dentist, nurse, pharmacist)
Housing (e.g., case worker, shelter director, public
housing authority agencies)
□
□
□
□
□
Legal (e.g., immigration, civil and/or rights-based
attorney and/or paralegal, clinic)
Public health (e.g., licensure board, health
department staff, health care executive, community
health workers)
Social worker (e.g., case manager, school
counselor, supervisor, administrator)
Survivor empowerment, mentoring, or peer to peer
Violence prevention (e.g., Child abuse and neglect;
elder abuse; domestic violence, sexual violence,
youth violence)
Other (please specify):
_______________________________
23. Is your organization responsible for working with people who are currently being trafficked or have been trafficked?
□ Yes
□ No
24. Which of the following best describes the number of years of experience you have in your current field of work? (Mark one.)
□ Less than 3 years
□ 3 to 5 years
□ 6 to 10 years
□ More than 10 years
25. Which of the following best describes your primary role in your current position?
□ Direct delivery/frontline staff
□ Consultant/Trainer
□ Management
□ Volunteer
□ Other (please specify): _______________
□ Administration
□ Peer Educator
26. In your professional capacity, how frequently do you come into contact with people who are currently being trafficked, at risk
of being trafficked, or have been trafficked?
1
2
3
4
Never
Occasionally
Frequently
All the Time
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 5 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.
OMB Control Number: 0970-0519
Expiration Date: 10/31/2021
CALL CENTER
FEEDBACK
Form
27. Which of the following best describes your geographic population? (Mark all that apply.)
□ National
□ State (please specify): ______________
□ Tribal
□ International (please specify country):
_________________________________
□ Local
□ Urban
□ Rural
□ Suburban
28. Please select any of the following populations you currently work with in a professional capacity (Mark all that apply.)
□
□
□
□
□
Human trafficking
□ Commercial sexual exploitation of
children
□ Sex trafficking
□ Adults
□ Minors
□ Labor trafficking
□ Adults
□ Minors
Children/youth
□ Out of home/Foster care/Kinship care
□ Juvenile justice
□ Runaway/Homeless youth
People with disabilities
Deaf/Hearing impaired
Elderly
□
□
□
□
□
□
□
□
□
Lesbian, gay, bisexual, transgender, and
questioning
Foreign nationals (migrant workers, undocumented
immigrants, refugees)
People with low incomes
Racial and ethnic minorities
□ American Indian or Alaska Native
□ Asian
□ Black or African American
□ Native Hawaii or other Pacific Islander
□ White
□ Hispanic or Latino ethnicity
History of substance use
Domestic and dating violence
Gang-related crime
Sexual abuse/Violence
Other (Please specify): __________________
29. What is your race? (Mark all that apply.)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaii or other Pacific Islander
White
Other (please specify): _______________________________________
30. What is your ethnicity? (Mark all that apply.)
Hispanic or Latino
Middle Eastern or North African
Other (please specify): ________________________________________
31. What is your gender? (Mark all that apply.)
Male
Female
Transgender
Other (please specify): ________________________________________
Thank you for taking the time to complete this form and helping to improve NHTTAC activities.
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 5 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.
File Type | application/pdf |
Author | Field, Michael |
File Modified | 2019-11-01 |
File Created | 2019-11-01 |