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* 1. Gender

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* 2. Branch of Military Service

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* 3. What service did the assistance organization provide you?

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* 4. The service provider has helped me with what I need.

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* 5. The service provider and I have established a good understanding of the kind of assistance/changes that help me with a long-term solution to my need.

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* 6. The service provider treated me with respect and dignity.

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* 7. How satisfied are you with local service provider staff who helped you, including employee courtesy, friendliness, and knowledge, and whether staff members adequately identify themselves to customers by name, including the use of name plates or tags for accountability?

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* 8. How satisfied are you with local service provider’s communications, including access to a live person, the average time you spend on hold, call transfers, letters, and electronic mail?

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* 9. How satisfied are you with the local service provider’s complaint handling process, including whether it is easy to file a complaint and whether responses are timely?

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* 10. How satisfied are you with the local service provider’s ability to timely serve you, including the amount of time you wait for service in person (or for remote service)?

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* 11. Please rate your overall satisfaction with the local service provider.

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* 12. Is there anything else we need to know about your experience with the service provider? (Optional)

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