Feedback Questions on Technical Assistance Support Provided to Community Services Block Grant (CSBG) Project Impact Grant Recipients

OMB Control Number: 0970-0401, Expiration Date: June 30, 2024

Project Impact TA Support:

Feedback Questions for Grant Recipients

November 2021

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN:

The purpose of this information collection is to gather feedback from recipients of a Project Impact: CSBG Rapid Cycle Program grant after they attend technical assistance activities. Public reporting burden for this collection of information is estimated to average 5 minutes per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0401 and the expiration date is 06/30/2024. If you have any comments on this collection of information, please contact Roneika Carr at Roneika.Carr@acf.hhs.gov.

The below questions are to gather feedback from recipients of a Project Impact: CSBG Rapid Cycle Program grant after they attend technical assistance activities. The proposed questions gather feedback about their experience attending technical assistance activities and suggestions about ongoing needs and future technical assistance activities. Responses to the proposed feedback questions will be gathered through two means: (1) the registration process for webinars to capture data before an event and (2) web-based surveys following an event. No more than eight questions from the below set will be selected for each technical assistance activity.

1. Name

(STRING (NUM))

2. Email address

(STRING (NUM))

Select one per row

Rate your agreement with this statement:	Strongly agree	Agree	Disagree	Strongly disagree
I found this [insert TA activity or title] to be engaging.	1 	2 	3 	4 
The content of this [insert TA activity or title] was clear and well organized.	1 	2 	3 	4 
I found this [insert TA activity or title] to be relevant to my current or future work.	1 	2 	3 	4 
I found this [insert TA activity or title] to be responsive to my current or future needs.	1 	2 	3 	4 
After [insert TA activity or title], I understand [insert topic].	1 	2 	3 	4 
After [insert TA activity or title], I feel ready to use the content in my work.	1 	2 	3 	4 
I believe that [insert topic] is/are important to my ability to understand and carry out my Project Impact project.	1 	2 	3 	4 
After [insert TA activity or title], I understand the next steps to [insert activity or topic.]	1 	2 	3 	4 

Select one per row

	I have never heard of it	I have heard of it, but don't know what it is.	I have some idea of what it is, but it’s still not clear.	I know what it is and can explain it to others.	I know what it is, can explain it to others, and have applied it in my work.	I know what it is and could teach others how to apply it to their work.
How familiar are you with [insert topic]?	1 	2 	3 	4 	5 	6 

12. What part of [insert TA activity or title] was most useful or interesting to you?

(STRING (NUM))

13. What, if any, remaining questions on the material presented at [insert TA activity or title] do you have?

(STRING (NUM))

14. What suggestions do you have for us to improve our [insert TA activity]?

Select up to three

 Less speakers presenting information 1

 More small group discussion/breakout rooms 2

 More grant recipient staff sharing their experiences 3

 More poll questions 4

 More question-and-answer time 5

 Other (SPECIFY) 99

Specify (STRING (NUM))

15. What other content should we consider for future [insert TA activity]?

(STRING (NUM))