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OMB
Number: 2010-0042
Approval
Expiration Date: 3/31/2021
Follow-up Effects Survey Participant Agency
Decision
This
collection of information is approved by OMB under the Paperwork
Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2010-0042).
Responses to this collection of information are voluntary. An
agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a
currently valid OMB control number. The public reporting and
recordkeeping burden for this collection of information is estimated
to range from 3 to 32 minutes per response. Send comments
on the Agency’s need for this information, the accuracy of the
provided burden estimates and any suggested methods for minimizing
respondent burden to the Regulatory Support Division Director, U.S.
Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW,
Washington, D.C. 20460. Include the OMB control number in any
correspondence. Do not send the completed form to this address.
The U.S. Environmental Protection
Agency, Conflict Prevention and Resolution Center (CPRC) requests
your assistance in evaluating this facilitated process. As a part of
this evaluation, we ask the various participants who have been
involved in this project or case to provide us with information about
their experience. The data compiled will be used to improve future
facilitation services provided by the CPRC.
The CPRC will not report information from this evaluation in a way
that respondents or their organizations can be identified. Moreover,
the identity of individual respondents will be kept confidential and
will not be disclosed.
Please indicate the extent to which
agreement was reached.
To answer this question, think about
those issues that were central to the discussions and needed to be
addressed to resolve or advance the matter
THE
TERM "AGREEMENT" APPLIES TO THE WRITTEN OR UNWRITTEN
AGREEMENT(S) YOU REACHED WITH OTHER PARTICIPANTS IN THE PROCESS,
INCLUDING PLANS, PROPOSALS/RECOMMENDATIONS, PROCEDURES, COLLABORATIVE
DECISIONS TO WORK TOGETHER AND SETTLEMENTS. WE USE THE TERM
AGREEMENT
RECOGNIZING THAT THERE MAY HAVE BEEN MORE THAN ONE AGREEMENT.
(CHECK
ONLY ONE)
Agreement
on all key issues
Agreement
on most key issues
Agreement
on some key issues
No
agreement on key issues; progress was made towards addressing the
matter. (To
Q13)
No
agreement, the process ended without us making much progress. (To
Q13)
USE
THE SPACE BELOW IF YOU WOULD LIKE TO ELABORATE ON YOUR RESPONSE:
Rate your level of agreement with the
following statements regarding the agreement.
Scale
0=Not at all, 10=Completely
The agreement reached takes
account of our key interests.
The agreement reached will
effectively resolve the matter.
The agreement reached can be
implemented.
The facilitator’s
involvement was important to efforts to reach agreement
Were there any important issues that
were not addressed by the agreement?
Yes
No
(to
5)
Not
sure (to
5)
Are those important issues from the
previous question satisfactorily addressed or likely to be addressed
by another process that has been agreed to by the parties?
Were you satisfied with the agreement
reached using the facilitated process?
Scale
0=Not at all, 10=Completely
_____
Effects of the
Agreement
In the next
set of questions, you will be asked about the size and the likelihood
of the most important condition that you expect will change as a
result of the agreement reached through the facilitated process.
We recognize
that there can be uncertainty about your answers to these questions.
Without you answering all questions, we cannot produce the needed
estimate of effects from the agreement reached through the
facilitated process.
From your perspective, what condition
has been or will be the most importantly affected or changed as a
result of the agreement made in this facilitated process?
please
select the condition most importantly affected or changed.
Community
/ social
Economic
/ commercial
Historic
/ cultural resource
Natural
resource/ environmental
Public
safety / public health
Recreational
Other
(please comment)
_______________________________________________________
Please
describe the condition you selected above that you expect to change.
For the first [insert number] years
after the agreement (state years) to what extent will the change in
the [pipe
from Q6]
condition be better or worse than existed before the
facilitated process?
Scale
-4 to +4 with -4=significantly worse and +4=significantly better
For the first [insert number] years
after the agreement (state years) how likely is it that the changes
in the [pipe
from Q6] condition will occur?
Scale
0=will not occur, 10=has occurred or definitely will occur.
Please explain your answers about the
amount and likelihood of change in the [pipe from Q6] condition.
Do you anticipate further change in
(pipe
from Q6) effects beyond [insert number] years?
Yes
(describe)
No
Uncertain
Please explain your response.
Were there benefits from the
facilitated process that were not part of the agreement?
Did
the process break an impasse on this matter?
Yes
No
(to
8)
Don’t
know (to
8)
How
important was breaking the impasse to the overall result of the
process?
[0=Not at all, 10=Essential]
To what extent was there change over
the course of the process in the ability of participants to work
together on this matter and in your level of trust in each other?
-
|
Much improved
|
Somewhat improved
|
About the same
|
Somewhat worse
|
Much worse
|
Change
in our ability to work together cooperatively.
|
|
|
|
|
|
Change
in our trust of each other.
|
|
|
|
|
|
Please use this
space if you wish to elaborate on changes in the levels of
cooperation and trust.
_________________________________________________________________
Did you participate in developing the
approach for the facilitated process (e.g., agenda setting, meeting
frequency and location, ground rules)?
I/we
participated and my participation was appropriate
I/we
participated and my participation was unnecessary
I/we
participated and my participation was insufficient
I/we
declined to participate
I
was/we were unable to participate
My/our
participation was unnecessary
Other
(please describe)
If you and the other party(ies) had
not used a facilitated process what is the alternative decision
making process that would most likely have been used to reach
an agreement or decision the matter? In responding to this
question, please choose the most likely alternative forum/entity to
the facilitated process that would have produced a decision or
agreement on the same matter, regardless of whether that agreement
or decision might be later appealed in other forums.
We
would have reached a negotiated agreement/settlement with the other
party(ies) without the assistance of a facilitator.
The
EPA would have made a decision if we had not reached an
agreement/settlement with the help of a facilitator.
We
would have reached a voluntary agreement through another process.
Other
(please describe)s
Imagine the [pipe
selected response from Q6] condition that would have occurred
during the first
[insert number] years after a decision or agreement from the
alternative process you identified above (i.e., [pipe Q17]).
Would the [pipe selected
response from Q6] condition
be better or worse than existed before you began the
facilitated process?
Please
indicate the extent to which the decision or agreement from the
alternative process would have produced a better or worse [pipe
selected response from Q16] condition than what existed before the
facilitated process
began.
Scale -4 to +4 with
-4=significantly worse and +4=significantly better
How likely would the result you
indicated in Q18 be for the [pipe
from Q6] condition be during the first [insert number] years
after a decision or agreement from the alternative process?
Scale 0=would not occur, 10=would
have already occurred or definitely would occur.
Please explain your answers about the
amount and likelihood of change in the [pipe from Q6] condition
following the alternative process (i.e., [pipe Q17]) and
agreement/decision.
Would you anticipate further change in
(pipe
from Q6) effects beyond [insert number] years
following the alternative process?
Yes
(describe)
No
Uncertain
Please explain your response.
The next several questions
ask for your views about how the facilitated process and the
alternative you selected above (i.e.,
[Q17])
would compare.
Please
consider how the total costs (time and expenses) of the facilitated
process compare with the potential costs of the alternative that you
identified in Q17 [i.e., pipe
from Q17].
The facilitated process was likely CHECK ONE:
Significantly
more costly than the alternative
Somewhat
more costly that the alternative
Costs
were about the same
Somewhat
less costly that the alternative
Significantly
less costly than the alternative
Don’t
know
How do you think the facilitated
process would compare with the alternative that you selected
(i.e.,[Q17])?
[0=Not
at all, 10=Completely]
The
facilitated process better served the interests of my/our
organization.
The
facilitated process resulted in more timely decisions and
implementation
The
participants are more likely to be able to work together in the
future on matters related to this case.
The
agreement we reached through the facilitated process is less likely
to be challenged.
The
agreement we reached through the facilitated process is better for
us.
In your view, what is the greatest
advantage and disadvantage that the agreement from the facilitated
process provided compared to what would have been possible with the
alternative process you selected (i.e.,
[Q17])?
Greatest advantage
Greatest disadvantage
What is your top suggestion on how the
facilitated process could have been improved?
PLEASE WRITE
"NONE" IF YOU FEEL THIS PROCESS COULD NOT HAVE BEEN
IMPROVED.
Please use the space below for any
additional comments you would like to make.
Thank you for taking
the time to complete this questionnaire.
PERSONS WITH
DISABILITIES WHO REQUIRE ALTERNATIVE MEANS FOR COMMUNICATION OF
PROGRAM EVALUATION INFORMATION SHOULD CONTACT THE CPRC OFFICE.
Burden Statement: Public reporting
burden for this collection of information is estimated to average 19
minutes per response, including the time for reviewing instructions,
gathering information, and completing and reviewing the collection of
information. Send comments on the Agency’s need for this
information, the accuracy of the provided burden estimates, and any
suggestions for reducing the burden, including the use of automated
collection techniques to:
CONFLICT PREVENTION AND RESOLUTION
CENTER
U.S. Environmental Protection Agency
(MC: 2388A)
1200 Pennsylvania Avenue, NW,
Washington, DC 20460
Telephone: 202.564.0214, Fax:
202.501.1715
Website: www.epa.gov/adr
Email: adr@epa.gov
109873200:
Form # 5800-032
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Eric |
File Modified | 0000-00-00 |
File Created | 2021-04-07 |