2 Email Service survey

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

APPENDIX A
NIMH Email Services Customer Satisfaction Survey
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, Maryland 20892-7974, ATTN: PRA
(0925-0648). Do not return the completed form to this address.
This federal government-sponsored survey should take approximately 3 minutes to complete.
Your responses will be protected to the extent allowed by law. Participation is voluntary; you
may decline to answer any or all of the questions.

1. Which of the following categories best describes your role when requesting National
Institute of Mental Health information? (Select only one category.)
o
o
o
o
o
o
o
o
o
o
o
o

Seeking help for self
Seeking help for someone else
Military service member
Prisoner/inmate/detainee
Advocate or advocacy
organization
NIMH Outreach Partner
Health educator/information
specialist
Researcher
Educator K-12
Educator: Post-Secondary
Student: K-12
Student: Post-Secondary

o
o
o
o
o
o
o

o
o
o
o
o

Clinician: Medical doctor
Clinician: Nurse practitioner
Clinician: Nurse (e.g., RN)
Clinician: Psychiatrist
Clinician: Psychologist
Clinician: Social Worker
Other clinician (e.g., paramedic/EMT,
substance use counselor, physician
assistant)
Government employee or agency
Congressional Member or staff
Media (e.g., reporter)
Law enforcement/court system
Other (please specify) _____________

September 2015

2. How easy was it for you to find the NIMH email address?
o
o
o
o
o

Very easy
Easy
Somewhat easy
Difficult
Very difficult

3. How timely was the response you received to your inquiry?
o
o
o
o
o

Very timely
Timely
Somewhat timely
Delayed
Very delayed

4. How helpful was the information or referral you received?
o
o
o
o
o

Very helpful
Helpful
Somewhat helpful
Not helpful
Not at all helpful

5. How satisfied were you with the services you received?
o
o
o
o
o

Very satisfied
Satisfied
Somewhat satisfied
Unsatisfied
Very unsatisfied

6. Do you have any suggestions for improving our e-mail services?
[Open text field]

September 2015

7. How do you prefer to contact NIMH? Check all that apply. [Multiple select]
o
o
o
o
o

Email
Telephone
Web/Live Help (online chat)
Mail
No preference

8. On a scale of 0 to 4, with 0 indicating least likely and 4 indicating most likely, how likely
are you to recommend the National Institute of Mental Health and its publications and
services to others?

Very Unlikely
0

1

Very likely
2

3

4

9. Ongoing feedback from our customers is very important to us. May we contact you in the
future to get your additional feedback on our materials?
o Yes
o No
If Yes, please provide the best email to reach you: [open text field]

Thank you for your time and participation!
Submit

September 2015