PBMS Technical Assistance Feedback Survey

Thank you for your Feedback

ASCA staff recently provided technical assistance for you regarding the Performance Based Measures System. To improve our process and ensure our assistance is useful and prompt, we need your feedback. Please answer these brief questions and provide suggestions for how we might better assist you. Thank you.

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* 1. Month TA was provided?

	Month
Month TA was Provided	Month TA was Provided Month menu

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* 2. Year Technical Assistance was Provided?

	Year
Year	Year Year menu

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* 3. Please rate the information or assistance that you received?

	1 - Poor	2	3	4	5 - Excellent
Prompt	Prompt 1 - Poor	Prompt 2	Prompt 3	Prompt 4	Prompt 5 - Excellent
Useful	Useful 1 - Poor	Useful 2	Useful 3	Useful 4	Useful 5 - Excellent
Quality of Service	Quality of Service 1 - Poor	Quality of Service 2	Quality of Service 3	Quality of Service 4	Quality of Service 5 - Excellent

Comment

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* 4. Was your question(s) answered or problem(s) resolved?

Yes

Partial

Comment

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* 5. Any suggestions on how we could improve our PBMS technical assistance process?

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* 6. May we contact you to discuss any of the answers you have provided?

Yes

If yes, Please provide your name and phone number.

Thank you for your participation in PBMS and this technical assistance survey.
Please click done to submit the survey.