FEMA Form FF-104-F Acknowledgement Survey – Phone

OMB No. 1660-0130

Expiration: 06/30/2028

PAPERWORK BURDEN DISCLOSURE NOTICE

                                                        FEMA Form FF-104-FY-24-120     

  

Public reporting burden for this data collection is estimated to average 4-6 minutes per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting this form. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street. SW, Washington, DC  20472-3100, Paperwork Reduction Project (1660-0130) NOTE: Do not send your completed form to this address.

PRIVACY ACT STATEMENT

AUTHORITY: Government Performance and Results Act of 1993 (Pub. L. 103-62), as amended, and the GPRA Modernization Act of 2010 (Pub. L. 111-352); Executive Order (EO) 12862, “Setting Customer Service Standards”; and its March 23, 1995 Memorandum addendum, “Improving Customer Service”; Executive Order 13411 “Improving Assistance for Disaster Victims”; Executive Order 13571 “Streamlining Service Delivery and Improving Customer Service”; and the related June 13, 2011 Memorandum “Implementing Executive Order 13571 on Streamlining Service Delivery and Improving Customer Service.”

PRINCIPAL PURPOSE(S): DHS/FEMA collects this information to measure Hermit’s Peak/Calf Canyon claimant satisfaction with Claims Office services.

ROUTINE USES:

This information is used for the principal purpose noted above. Summary and/or aggregate survey results and analysis may be shared with Congress and the Government Accountability Office; however, no Personally Identifiable Information (PII) will be shared externally, except as allowed under the routine uses published in System of Records Notice DHS/FEMA-008 - Disaster Recovery Assistance Files, 78 FR 25282 (April 30, 2013), or as required by law. The Department's system of records notices can be found on the Department's website at http://www.dhs.gov/system-records-notices-sorns.

DISCLOSURE: The disclosure of information on this form is strictly voluntary and will assist the Hermit’s Peak/Calf Canyon Claims Office in making improvements to its Claims program; failure to provide the information requested will not impact an individual’s ability to qualify for or receive Claims Office assistance. Questions regarding this form may be submitted via email to FEMA-CSA-Survey@fema.dhs.gov.

Introduction – Phone Survey (Where Claim Type = Individual)

Hello, I’m calling from FEMA, the Federal Emergency Management Agency. My name is _______ and my PIN is ____. May I please speak with [Claimant name]?

Introduction – Phone Survey (Where Claim Type = Business, Government, Tribal, or Not-for-Profit and the Name field does not include a person’s name )

Hello, I’m calling from FEMA, the Federal Emergency Management Agency. My name is _______ and my PIN is ____. May I please speak with the person most familiar with the Hermits Peak/Calf Canyon Claim? [Claimant name]?

If no: Thank you for your time and have a good day/evening.

If yes: You recently received an Acknowledgement letter from the Hermit’s Peak/Calf Canyon Claims Office and may have had interactions with Claims Office staff in-person or over the phone. The Claims Office is looking to improve the process and value your input to help us do that. This confidential survey helps the Claims Office make sure that your needs are being heard and our process is continuously improved. Would you volunteer to take 4-6 minutes to answer some questions?

If no: What would be a better time to call back? Thank you for your time and have a good day/evening.

If yes: These questions comply with the Privacy Act of 1974 and have been approved by the Office of Management and Budget under number 1660-0130. Your answers will not affect the outcome of your claim. This call may be monitored and/or recorded for quality assurance.

INFORMATION

The first questions are about information provided to you by Claims Office staff. Using a scale of 1 (Poor) to 5 (Excellent), please rate the quality of information provided to you by Claims Office staff on…

	1 Poor	2	3	4	5 Excellent
1. Being easy to understand	◘	◘	◘	◘	◘
2. Answering your questions	◘	◘	◘	◘	◘
3. Helpfulness in explaining the general claims process	◘	◘	◘	◘	◘
4. Explaining the steps to prepare and finalize your claim	◘	◘	◘	◘	◘
5. Explaining the necessary documentation needed in the process	◘	◘	◘	◘	◘
6. Providing information in your preferred language.	◘	◘	◘	◘	◘
7. Explaining the 150-day timeline for submitting requests under your claim.	◘	◘	◘	◘	◘

Using a scale of 1 (Not at all Satisfied) to 5 (Very Satisfied), how would you rate your…

	1 Not at all Satisfied	2	3	4	5 Very Satisfied
8. Overall satisfaction with information provided by Claims Office staff	◘	◘	◘	◘	◘

These questions are about programs that may be available to you. Using a scale of 1 (Poor) to 5 (Excellent), or No Experience, please rate the quality of information provided by Claims Office staff on…

	1 Poor	2	3	4	5 Excellent	No Experience
9. Explaining the Disaster Case Management program and providing a referral if you need immediate assistance with an urgent need	◘	◘	◘	◘	◘	◘
10. Explaining the National Flood Insurance program and providing you with information about receiving coverage paid for by the Claims Office	◘	◘	◘	◘	◘	◘
11. Explaining the National Resources Conservation Service and how to request a Conservation Restoration Plan for your property	◘	◘	◘	◘	◘	◘

STAFF

Using a scale of 1 (Poor) to 5 (Excellent), please rate the Claims Office staff who assisted you on…

	1 Poor	2	3	4	5 Excellent
12. Politeness and respect towards you	◘	◘	◘	◘	◘
13. Showing interest in helping	◘	◘	◘	◘	◘
14. Taking the time to listen to you	◘	◘	◘	◘	◘
15. Their overall customer service	◘	◘	◘	◘	◘

CUSTOMER SERVICE & EXPECTATIONS

Thinking about your experience with staff and various meetings, on a rating scale of 1 (Not at all Satisfied) to 5 (Very Satisfied), or No Experience, how satisfied were you with the following:

	1 Not at all Satisfied	2	3	4	5 Very Satisfied	No Experience
16. The overall Claims Office experience at this point in time?	◘	◘	◘	◘	◘	◘

Closing

Thank you for your time. Have a good day/evening