Form 1 Survey with Burden Disclosure Statement

OMB#: 0925-0648 Exp.03/2018
Help Us Better Serve You

The NIH Library is evaluating its Information Desk service and your comments are vital to help us better serve you. This survey will only take a few minutes to complete. The information you provide will remain anonymous. Please place your survey in the collection box or fold, staple, and send, using the address on the back via campus mail, to: Karen M. Stakes, NIH Library, BLDG 10/1L-21D, MSC 1150. The survey may also be found at https://www.surveymonkey.com/r/8TMLTSK.

Your Affiliation:

____ NIH staff member

____ ACL, ACF, IHS, OS, PSC, SAMHSA staff member

____ Other

Please answer the following questions using the scale of Strongly Disagree (1) to Strongly Agree (10).

The staff member at the Information Desk was courteous.

1 2 3 4 5 6 7 8 9 10 Don’t Know/Not Applicable

Strongly Disagree Strongly Agree

My request was addressed in a timely manner.

1 2 3 4 5 6 7 8 9 10 Don’t Know/Not Applicable

Strongly Disagree Strongly Agree

I was confident that the staff member at the Information Desk understood my question.

1 2 3 4 5 6 7 8 9 10 Don’t Know/Not Applicable

Strongly Disagree Strongly Agree

The information I received was complete.

1 2 3 4 5 6 7 8 9 10 Don’t Know/Not Applicable

Strongly Disagree Strongly Agree

The information that I received was accurate.

1 2 3 4 5 6 7 8 9 10 Don’t Know/Not Applicable

Strongly Disagree Strongly Agree

How satisfied were you with the service you received?

1 2 3 4 5

Very Dissatisfied Dissatisfied Neutral Satisfied Very Satisfied

How likely are you to recommend this Information Desk service to your colleagues?

1 2 3 4 5

Very Unlikely Unlikely Neutral Likely Very Likely

What was done well?

What needs to be improved?

Other comments?

Public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA#0925-0648. Do not return the completed form to this address.

Karen M. Stakes

NIH Library

BLDG 10/1L-21D, MSC 1150