Example Surveys for NCSIA TA Feedback Surveys

Example Feedback Instruments for NCSIA Events

_{OMB Control Number 0970-}0401

Expiration Date: 9/30/2026

Feedback for National Center on Subsidy Innovation and Accountability Events

Generic clearance: ACF’s fast track for customer service feedback

Poll or written discussion questions used during meetings (e.g., webinars, peer learning opportunities, on-site visits with more than nine participants)

Below are instrument examples for each type of technical assistance. Specific technical assistance events may use some but not all the questions in the example as well as pull from other questions in the bank of poll questions submitted for review and approval. All examples will include an OMB control number, expiration date, and Paperwork Reduction Act Statement of Burden.

Instrument Examples

Universal Technical Assistance Webinars (e.g., Program Integrity Webinar Series)

Please rate the following statements:

	Strongly Disagree	Disagree	Agree	Strongly Agree
The content of this session was relevant to my work.
The technical assistance provided was useful to my work.
The resources provided during the webinar were useful for my work.
I learned something during this event that I plan to use in my work.
I was satisfied with the quality of this session.

	Very Unlikely	Unlikely	Likely	Very Likely
What is the likelihood you or your staff would participate in a peer learning opportunity on this topic?

How did you find out about this event? _____________________________________________________

What is your preferred way of learning virtually? _____________________________________________

What is your preferred technical assistance session length? Less than 60 minutes ___ 60 minutes _____ 90 minutes ____ More than 90 minutes ____

What is your preferred meeting schedule for ongoing technical assistance? Every Two Weeks_________ Once Per Month ________ Quarterly________ Other___________

What topics would you like to learn more about in the future? _____________________________________________________________________________________

Would you be willing to share the work of your Lead Agency related to this technical assistance opportunity? Yes____ No_____

What type of follow-up support or resource(s) would be most useful to you on the topic? _____________________________________________________________________________________

PAPERWORK REDUCTION ACT OF 1995 (Public Law 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to obtain feedback regarding technical assistance received. Public reporting burden for this collection of information is estimated to average 3 minutes per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0401 and the expiration date is 05/31/2027. If you have any comments on this collection of information, please contact …

NCSIA-led Individualized Technical Assistance (e.g., Process Mapping)

Poll questions may be used during and at the conclusion of the on-site visit.

Please rate the following statements:

	Strongly Disagree	Disagree	Agree	Strongly Agree
The technical assistance provided was useful to my work.
The resources provided during this event were useful for my work.
I learned something during this event that I plan to use in my work.
I plan to share the information received during the training with others.
The presenter(s) was effective in engaging participants.

	Far Too Advanced	A Bit Too Advanced	Just Right	A Bit Too Simple	Far Too Simple
Please let us know whether you found the content presented in this event to be too simple, too advanced, or just about right.

	No Increase	Small Increase	Moderate Increase	Large Increase
How much did the event increase your knowledge of the topic(s) presented?

Of the topics addressed in this event, what would you most like to improve or achieve? _____________________________________________________________________________________

What additional T/TA opportunities would help you further improve your policies or practices? _____________________________________________________________________________________

What factors, if any, may prevent you from using what you learned? _____________________________

PAPERWORK REDUCTION ACT OF 1995 (Public Law 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to obtain feedback regarding technical assistance received. Public reporting burden for this collection of information is estimated to average 3 minutes per grantee, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0401 and the expiration date is 05/31/2027. If you have any comments on this collection of information, please contact …

OMB Control Number 0970-0401

Targeted Technical Assistance Opportunities (e.g., Promoting Informed Child Care Choices, Cost-Based Subsidy Payments)

Poll questions may be used before or during individual sessions and in conclusion of a project or a multiple-part peer learning opportunity.

Please rate the following statements:

	Strongly Disagree	Disagree	Agree	Strongly Agree
The content of the session was relevant to my work.
The technical assistance provided was useful to my work.
The resources provided during the session/event were useful for my work.
The identified goals and outcomes of the technical assistance were met.
The content of the presentation was inclusive of diverse cultural experiences and backgrounds.
The presenters were responsive to participants' questions.
I was satisfied with the quality of this technical assistance.
The presenters were knowledgeable in the content area.
The presenters were effective in engaging participants.

	Far Too Advanced	A Bit Too Advanced	Just Right	A Bit Too Simple	Far Too Simple
Please let us know whether you found the content presented in this event to be too simple, too advanced, or just about right.

	No Knowledge	Minimal Knowledge	Moderate Knowledge	High Level of Knowledge
BEFORE this technical assistance opportunity, my knowledge of the content/topics addressed can best be described as …
AFTER this technical assistance opportunity, my knowledge of the content/topics addressed can best be described as …

	No Comfort	Minimal Comfort	Moderate Comfort	High Level of Comfort
BEFORE this technical assistance opportunity, my comfort with implementation efforts related to (specific content/topics addressed) can best be described as …
AFTER this technical assistance opportunity, my comfort with implementation efforts related to (specific content/topics addressed) can best be described as …

	No Increase	Small Increase	Moderate Increase	Large Increase
How much did the event increase your knowledge of (specific topic presented)?
How much did the event increase your comfort with communicating about (specific topic presented)?
How much did the technical assistance increase your skill level in planning and implementing related policies and practices?

	Small Group Discussions	Large Group Discussions	Presentations	Combination of Above
What is your preferred way of learning virtually?

	Less Than 60 Minutes	60 Minutes	90 Minutes	More Than 90 Minutes
What is your preferred technical assistance session length?

	Every Two Weeks	Once per Month	Quarterly	Other (Please Provide Detail)
What is your preferred meeting schedule for ongoing technical assistance?

Please identify one concept or skill you learned you will use in your work. _________________________

What outcome or desired result, if any, was achieved with the support of this technical assistance? _____________________________________________________________________________________

How could this technical assistance opportunity be more inclusive of or responsive to diverse audiences? _____________________________________________________________________________________

_____________________________________________________________________________________

What information would help you further improve your policies or practices? _____________________________________________________________________________________

_____________________________________________________________________________________

What factors, if any, may prevent you from using what you learned? _____________________________

How can we improve this technical assistance? ______________________________________________

What type of follow-up support or resource(s) would be most useful to you on (this specific topic)? ____________________________________________________________________________________

Would you be willing to share the work of your Lead Agency related to this technical assistance opportunity? Yes ______ No ______

PAPERWORK REDUCTION ACT OF 1995 (Public Law 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to obtain feedback regarding technical assistance received. Public reporting burden for this collection of information is estimated to average 3 minutes per grantee, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0401 and the expiration date is 05/31/2027. If you have any comments on this collection of information, please contact …

Intensive Technical Assistance (ASSIST)

Poll questions may be used before or during individual intensive technical assistance sessions and at the conclusion of the intensive technical assistance.

OMB Control Number 0970-0401

Please rate the following statements:

	Strongly Disagree	Disagree	Agree	Strongly Agree
The content of this session was relevant to my work.
The resources provided during this event were useful for my work.
I am satisfied with the quality of this event.
I am satisfied with the timeline of this event.
I would recommend this event to my colleagues.
The presenters were effective in communicating key information.
The identified goals and outcomes of this technical assistance were met.
The TA provided increased our agency’s use of audits to identify and address policy and procedural gaps.
The TA increased our agency’s use of process mapping and/or system analysis to identify and address policy and procedural gaps.
The information presented was respectful, nonjudgmental, and supportive of diverse populations.

	No Increase	Small Increase	Moderate Increase	Large Increase
How much did the event increase your knowledge of the topic(s) presented?
How much did the technical assistance increase your skill in assessing, planning, and implementing related policy and practice changes?
How much did the technical assistance increase your agency’s awareness and use of high-quality training or technical assistance opportunities?
How much did the technical assistance increase your agency’s access to and use of training or technical assistance resources and tools designed to support (specific topic area) staff orientation and ongoing training?
How much did the technical assistance increase your agency’s compliance with CCDF rules and policies?
How much did the technical assistance increase your agency’s use of CQI techniques?
How much did the technical assistance increase integration of your agency technological, policy, and administrative functions?
How much did the technical assistance increase your Tribal agency’s access to TA support in establishing agreements with states?
How much did the technical assistance increase your agency’s ability to establish and leverage partnerships to improve coordination and collaboration with other agencies?

	No Knowledge	Minimal Knowledge	Moderate Knowledge	High Level of Knowledge
BEFORE this technical assistance opportunity, my knowledge of the content/topics addressed can best be described as …
AFTER this technical assistance opportunity, my knowledge of the content/topics addressed can best be described as …

	No Comfort	Minimal Comfort	Moderate Comfort	High Level of Comfort
BEFORE this technical assistance opportunity, my comfort with implementation efforts related to (specific content/topics addressed) can best be described as …
AFTER this technical assistance opportunity, my comfort with implementation efforts related to (specific content/topics addressed) can best be described as …

What aspects of this technical assistance were most useful? ____________________________________

_____________________________________________________________________________________

What aspects of this technical assistance were least useful? ____________________________________

_____________________________________________________________________________________

What outcomes or desired result, if any, have you achieved with the support of this technical assistance? _____________________________________________________________________________________

How can we improve this technical assistance? _____________________________________________________________________________________

_____________________________________________________________________________________

What additional T/TA opportunities would help you further improve your policies or practices? _____________________________________________________________________________________

PAPERWORK REDUCTION ACT OF 1995 (Public Law 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to obtain feedback regarding technical assistance received. Public reporting burden for this collection of information is estimated to average 3 minutes per grantee, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0401 and the expiration date is 05/31/2027. If you have any comments on this collection of information, please contact …

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May 2025