2011 CSEA Customer Survey

Child Support Enforcement Customer Service Survey

We want to know your opinion about our services. Please complete this Survey and submit it. Your response is very important to us. We will not be asking you to identify yourself on the Survey, but you may do so if you desire an answer back. Thank you.

1. Today's date:

	MM		DD		YYYY
Month, Day, Year	Today's date: Month, Day, Year Month	/	Day	/	Year

2. Your age group:

Your age group: under 18

18-25

26-45

46-60

over 60

3. Ethnicity:

Ethnicity: Caucasian

African-American

Asian

Eastern Indian

Hispanic/Latino

Native American/Eskimo

Other

Other (please specify)

4. Gender:

Gender: Male

Female

5. I most recently contacted the Child Support Enforcement Agency:

I most recently contacted the Child Support Enforcement Agency: In person

By phone

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