Form 1 Telephone Service Customer Satisfaction survey

OMB Control Number 0925-0648
Expiration Date 3/31/2018

APPENDIX C
NIMH Telephone Service Customer Satisfaction Survey
Public reporting burden for this collection of information is estimated to average 2 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, Maryland 20892-7974, ATTN: PRA
(0925-0648). Do not return the completed form to this address.

Your feedback is very important to the National Institute of Mental Health. Please press 1 if you
would like to take a 3-question customer satisfaction survey.
Please press 2 if you do not want to take a 3-question customer satisfaction survey.
Thank you.

1. Did the National Institute of Mental Health information specialist who helped you with
your request meet your needs?
Press 1 for “YES”
Press 2 for “NO”

2. On a scale of 1 to 5, where ‘1’ is ‘Not Satisfied’ and ‘5’ is ‘Completely Satisfied,’ how
satisfied are you with the National Institute of Mental Health customer service you
received today?
Please press 1, 2, 3, 4, or 5

September 2015

3.

How likely are you to recommend the National Institute of Mental Health and its
publications and services to others? Please press the number on a scale of 0 to 9, with 0
indicating very unlikely and 9 very likely:
Very Unlikely
0

Very likely

1 2 3 4 5 6 7 8 9

4. If you have additional feedback about the service you received today from the National
Institute of Mental Health, please feel free to state it verbally after the beep. If you have
no additional feedback, simply hang up. Thank you.

September 2015