Individualized TA - OCC OMB GC - Feedback Survey

April 2024

Feedback Form: Child Care State Capacity Building Center Individualized Technical Assistance

TITLE OF INFORMATION COLLECTION: Child Care State Capacity Building Center Feedback on Individualized Technical Assistance

OMB control number: 0970-0401

Expiration date: May 31, 2027

Email Invitation/Script

Subject line: Your Feedback on [Event Name]

Good morning/afternoon,

The Child Care State Capacity Building Center (SCBC) is collecting feedback about its technical assistance services. According to our records, you recently participated in SCBC’s [NAME OF EVENT]. Your feedback is voluntary, and we will use it to inform future technical assistance efforts.

If you would like to provide feedback, please respond to this brief survey using this link by [DATE]: [LINK TO SURVEY].

Information will be kept private and the survey is estimated to take about 5 minutes.

Thank you!

The Child Care State Capacity Building Center

Feedback Form

Technical Assistance Activity: Child Care State Capacity Building Center Individualized Technical Assistance

Question Number	Question/Prompt	Response Options
	Delivery of Technical Assistance The following questions aim to get feedback on SCBC’s delivery of technical assistance (TA) .
	Your Satisfaction with TA Services
1	Think about TA services you received and then indicate your level of agreement or disagreement with the following statements. The TA is/was responsive to our needs. We received TA services within a reasonable time of our request. The TA services matched our requests We are happy/satisfied with the TA services received.	1 = Strongly disagree 2 = Disagree 3 = Agree 4 = Strongly agree N/A = Not applicable
	Your Satisfaction with TA Resources
2	Indicate your level of agreement or disagreement with the following statements about the TA resources you received. The received TA resources meet our needs. The resources are of high quality.	1 = Strongly disagree 2 = Disagree 3 = Agree 4 = Strongly agree N/A = Not applicable
	Your Satisfaction with TA Specialist(s)
3	Indicate your level of agreement or disagreement with the following statements about the TA Specialist(s) that supported you. The TA Specialist understands our state/territory context. The TA Specialist gave us strategies and examples that are relevant to our state/territory context. The TA Specialist was a helpful thought partner for us. The TA Specialist helped us identify good and doable next steps. The TA Specialist showed us where and how to find resources and solutions in the future.	1 = Strongly disagree 2 = Disagree 3 = Agree 4 = Strongly agree N/A = Not applicable
4	What aspect(s) of the TA was most useful for you?	Open-ended response
5	What could SCBC do to improve its TA services and resources?	Open-ended response
	Impact of Technical Assistance The following questions aim to get your feedback on the impact of SCBC’s TA.
6	Indicate your level of agreement or disagreement with the following statements. The TA increased my awareness and knowledge. The TA services and resources will advance my/our work After this TA, I am more confident in my ability to find solutions or answers to similar issues The TA will help our agency or organization better implement CCDF.	1 = Strongly disagree 2 = Disagree 3 = Agree 4 = Strongly agree N/A = Not applicable
7	Indicate how likely you are to do each of the following. Review the suggested TA materials or resources. Use strategies learned during the TA. Share what I/we learned during the TA with my colleagues.	1 = Very unlikely 2 = Unlikely 3 = Likely 4 = Very likely 5 = Already using
8	Please share any examples of how you used or plan to use what you learned from this TA.	Open-ended response
9	What factors, if any, are preventing you from using what you have learned in this TA? Select all that apply.	Competing priorities of my role Lack of authority or influence to make changes Lack of buy-in or support from partners Lack of funds or financial resources Lack of staffing Lack of time Need additional TA support, professional development, or both I don’t see any barriers Other factor (please describe):
10	What TA supports or resources would help you overcome these barriers?	Open-ended response
	General Feedback The following questions aim to get your feedback about the TA provided by SCBC.
11	What other topics or resources would you like to see addressed by TA?	Open-ended response
	Thank you for participating!

Paperwork Reduction Act Statement: The purpose of this information collection is to collect feedback from recipients participating in training and technical assistance activities provided by the Child Care State Capacity Building Center. 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 5/31/2027. If you have any comments on this collection of information, please contact Caroline Faux at caroline.faux@icf.com.

This document was developed with funds from contract/task order GS-00F-010CA/75ACF122F80021 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Child Care, by the Child Care State Capacity Building Center.