Form SV2011-0019 Visa Applicant Satisfaction Survey

U.S. Department of State OMB No: 1405-0193

VISA APPLICANT SATISFACTION SURVEY Expiration Date: 05/31/2014

Estimated Burden: 3 minutes

United States [Embassy or Consulate]

We have a brief, three-minute questionnaire about your visit to the United States [embassy or consulate]. Your responses are completely confidential and will in no way be associated with your name or your application. We are only conducting this survey to improve the service provided.

Statement	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable (N/A)
My overall visa application experience was positive.	1	2	3	4	5	N/A

Please rate your experience obtaining information and scheduling an appointment.
The appointment scheduling method was problem free.	1	2	3	4	5	N/A
The information provided was accurate.	1	2	3	4	5	N/A
The payment method was problem free.	1	2	3	4	5	N/A
The appointment date I was given was within a reasonable amount of time.	1	2	3	4	5	N/A

Please rate the consular information website and the on-line visa application form (DS-160).
The website was easy to understand.	1	2	3	4	5	N/A
The on-line application form was easy to find and access.	1	2	3	4	5	N/A
The time and effort to complete the on-line application form was reasonable.	1	2	3	4	5	N/A

Please rate other services you received.
The individuals who took my picture (if applicable) and fingerprints were polite and professional.	1	2	3	4	5	N/A

Now, thinking about your visit to the Consulate.
The security guards were courteous.	1	2	3	4	5	N/A
The waiting area was comfortable.	1	2	3	4	5	N/A
The wait time at the Consulate was reasonable.	1	2	3	4	5	N/A

Please rate the Consular Official who interviewed you.
The Officer treated me courteously and with respect.	1	2	3	4	5	N/A
The Officer asked questions to clarify my individual circumstances.	1	2	3	4	5	N/A
The Officer explained his or her decision.	1	2	3	4	5	N/A

At what window were you interviewed?	#___
Did you previously have a visa?	Yes	No
Today, was your visa application approved or denied?	Approved		Denied		Pending
Today, what type of visa did you apply for?	Tourist/ Business		Education			Work	Other:_________

Please include any additional comments or suggestions.

Thank you for your time and input!

SV-2011-0019

05-2011