National Center on Early Childhood Quality Assurance Feedback Surveys for Technical Assistance Groups

OMB #: 0970-0401

Expiration Date: 6/30/2024

Provider and Family Work Groups

DATE

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We want to learn about your experiences with the NAME OF WORKGROUP. Your answers are private and will be used to improve the NAME OF WORKGROUP work. Thank you for taking the time to complete this brief survey.

Please rate your agreement with the following statements about the WORK GROUP NAME	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Sure
Participating in the WORK GROUP NAME meetings has been a good use of my time.	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Sure
Participating in the Workgroup has been a good learning experience for me	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Sure
The facilitator is well prepared and effectively guides discussions	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Sure
The facilitator helps the group value the contributions of each member.	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Sure
I feel my participation is contributing to a national dialogue	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Sure

Please share what you have learned.

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Please share how you will use this experience in your work or community.  

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PAPERWORK REDUCTION ACT OF 1995 (Public Law 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to collect feedback from recipients participating in Training and Technical Assistance (T/TA) activities provided by the National Center on Early Childhood Quality Assurance (NCECQA). The public reporting burden for this collection of information is estimated to average 3 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 6/30/2024. If you have any comments on this collection of information, please contact Leatha Chun at leatha.chun@acf.hhs.gov.