3 Attachment C_Project Officer Survey

OMB No: 0915-0212

Expiration date: 04/30/2024

Project Officer Survey

Sent after a Level 2 or 3 Request is Completed

Public Burden Statement: The purpose of this information collection request is to assess participant satisfaction with various training and TA activities offered through a contracted TA provider, the Education Development Center. 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. This data collection is voluntary. The OMB control number for this project is 0915-0212 and is valid until 04/30/2024. Public reporting burden for this collection of information is estimated to average .08 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857.

1. Overall, how satisfied are you with the delivery of targeted technical assistance?

1. Extremely satisfied

2. Satisfied

3. Dissatisfied

4. Extremely dissatisfied

2. [If chosen “Dissatisfied” or “Extremely dissatisfied”] Please explain why you were dissatisfied with the TA request: [Open text]

3. Below are the objectives created during the TA request by the awardee and the TA Specialist. Please indicate the extent to which you agree that these objectives were met: [Matrix]

   1. Objective

   2. Objective

4. How can we improve future TA requests? [Open text]

5. We are particularly interested in whether this TA was provided in a culturally appropriate manner. Please rate your agreement with the following statement: This TA was provided in a culturally responsive manner (respectful of individual beliefs, language, perspectives, and needs)

   1. Strongly agree

   2. Agree

   3. Neither agree nor disagree

   4. Disagree