MSOA TTT Evaluation Form OMB

Session Feedback Form

Money Smart for Older Adults Train-the-Trainer
About this training:

Training location:_____________________
Training date:________________________
Trainer(s):__________________________

City: ________________________
State:________________________
Number of participants:__________

Thank you for participating in the Money Smart for Older Adults Train-the-Trainer session. To
help us improve future sessions, please complete this form.
1)

How was the
training conducted?

In-person
presentation

Webinar

Small
discussion
session

Other

2)

The information
presented today
was clear and easy
to understand.

Strongly
disagree

Disagree

Neutral

Agree

Strongly
Agree

3)

The length of the
session was:

Too short

Just right

Too long

4)

The handouts were
useful.

Strongly
disagree

Disagree

Neutral

Agree

Strongly
Agree

5)

Did you experience
any technical
difficulties?

Yes

No

N/A

Disagree

Neutral

Agree

Strongly
Agree

6)

I feel comfortable
teaching Money
Smart for Older
Adults after today.

If yes, briefly explain:

Strongly
disagree

If disagree or strongly disagree, why not?

OMB No. 3170-0024, expiration date 11/30/2018

7)

8)

9)

I would recommend
this Money Smart
for Older Adults
train-the-trainer
session to my
peers.

I am likely to train
clients using the
Money Smart for
Older Adults
curriculum.

Strongly
disagree

Disagree

Neutral

Agree

Strongly
Agree

Agree

Strongly
Agree

If disagree or strongly disagree, why not?

Strongly
disagree

Disagree

Neutral

Other comments or
suggestions (use
reverse side if you
need more space):

Privacy Act Statement
5 U.S.C. 552a(e)(3) The information you provide to the Consumer Financial Protection Bureau (“CFPB”) will only be used to
evaluate the Money Smart for Older Americans Training Sessions. The Bureau may obtain or access directly identifying
information about participants. Information collected will be treated in accordance with the System of Records Notice (“SORN”),
CFPB.021 – CFPB Consumer Education and Engagement Records, 83 FR 23435. Although the Bureau does not anticipate
further disclosing the information provided, it may be disclosed as indicated in the Routine Uses described in the SORN. Direct
identifying information will only be used to facilitate the training and will be kept private except as required by law. This collection
of information is authorized by Pub. L. No. 111-203, Title X, Sections 1013 and 1022, codified at 12 U.S.C. §§ 5493 and 5512.
Participation in this evaluation is voluntary. You are not required to participate or share any identifying information and you may
withdraw participation at any time. However, if you do not include the requested information, you may not be able to participate
in the evaluation.
Paperwork Reduction Act
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and not withstanding any other
provision of law a person is not required to respond to a collection of information unless it displays a valid OMB control number.
The OMB control number for this collection is 3170-0024. It expires on XX/XX/XXXX. The time required to complete this
information collection is estimated to average approximately 3 minutes per response. Comments regarding this collection of
information, including the estimated response time, suggestions for improving the usefulness of the information, or suggestions
for reducing the burden to respond to this collection should be submitted to Consumer Financial Protection Bureau (Attention:
PRA Office), 1700 G Street NW, Washington, DC 20552, or by email to CFPB_PRA@cfpb.gov.

OMB No. 3170-0024, expiration date 11/30/2018