RSA: Customer Satisfaction Survey
FY 2010 Monitoring of Vocational Rehabilitation Agencies, OMB# 1800-0011

Affiliation of Respondent:
State Agency staff
Service Provider
SILC member
SRC member
CIL staff /board
Other (please identify)

In the space provided below, on a scale of 1 to 5 indicate the extent to which you agree with the following statements about the review process for FY 2010. Elaborate your rating in the Comments section as needed. Please keep in mind that the "review process" refers to the entire review process, not just the on-site visit. The survey takes about 5-10 minutes to complete and it is completely voluntary. No individual, agency or organization will be required to participate.

Statement Strongly
2 3 4 Strongly

The entire review process for FY 2010

1. facilitated the sharing of information among participants in the review process regarding the agency's performance;



2. considered opinions from different perspectives;



3. fostered collaboration among all review participants;



4. identified the agency's strengths;



5. focused on issues regarding the agency's performance;



6. was efficient;



7. included effective communication.



8. Additional comments or suggestions that will benefit both RSA and your organization to improve the review process in the future:




Paperwork Burden Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1800-0011. The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to:

U.S. Department of Education
Washington, DC 20202-4651

If you have comments or concerns regarding the status of your individual submission of this form, write directly to:

Rehabilitation Services Administration
U.S. Department of Education
400 Maryland Avenue, SW
PCP Room 5014
Washington, DC 20202-2800

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Last Modified: 06/01/2011