Department of the Interior Office of Insular Affair's Satisfaction Survey_Survey Instrament

Department of the Interior Office of Insular Affair's
Satisfaction Survey                  
OMB Control No. 1040-0001
Expiration Date 01/31/2028
The Department of the Interior's Office of Insular Affairs service survey aims to gather feedback from key stakeholders to
improve how we best serve the needs of the Insular Communities. The survey covers various aspects of our mission.
Stakeholders are encouraged to participate by November 16 to help the Department better meet the needs of the Insular
Communities.
Paperwork Reduction Act Statement:  We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C.
3501) to better understand community perspectives about the Department of the Interior's Office of Insular Affairs. Your
response is voluntary and we will not share it publicly. We may not conduct or sponsor and you are not required to respond
to a collection of information unless it displays a currently valid OMB Control Number. OMB has reviewed and approved this
survey and assigned OMB Control Number 1040-0001.   

Estimated Burden Statement:  We estimate the burden associated with this information collection to be 10 minutes for the
completion of the survey questions, including time to read instructions, gather information, and complete and submit the
survey. You may submit comments on any aspect of this information collection to the Department Information Collection
* This form will record your name, please fill your name.
Clearance Officer, Jeff Parrillo, at jeffrey_parrillo@ios.doi.gov. 

1. Based on your engagement with OIA during the past year, on a scale of 1 to 10 how well has the
Office facilitated coordination of federal policies?
0

1

2

3

4

5

6

7

8

9

Not at all well

10
Extremely well

2. Based on your engagement with OIA during the past year, on a scale of 1 to 10 how satisfied are
you with the Office?
0

1

2

3

4

5

6

7

8

Not at all satisfied

9

10

Extremely satisfied

3. Based on your engagement with OIA during the past year, on a scale of 1 to 10 how responsive
was OIA at serving and responding to urgent and needs to help achieve your intended goal(s) or
priorities(s)? 
0

1

2

3

4

5

Not at all responsive

6

7

8

9

10

Extremely responsive

4. Please provide additional comments, including specific information as it pertains to your ratings
for Questions 1-3

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