Please complete the following survey regarding the services you received for CSEA Administrative Hearings Division (paternity/support/intake).

1. Today's date:

Month, Day, Year

2. Your age group:

3. Race/Ethnicity:

4. Gender:

5. Which Service Area(s) did you most recently visit in person?

6. Was the Reception staff helpful and professional?

7. Which CSEA representative assisted you today? (optional)

8. How long did you wait to be seen by a CSEA Representative today?

9. Was the CSEA representative concerned with helping you?

10. Did the CSEA Representative explain the actions being taken on your case?

11. Do you feel your questions/concerns were adequately addressed and answered?

12. Was the CSEA representative sensitive to your culture and treated you with respect?

13. How was your overall experience with CSEA?

14. Are you familiar with the CSEA website: ?

15. If you are familiar with the CSEA Website, what do you use the website for?

16. Are you aware that you can chat with a CSEA Specialist live and on-line at ?

17. Please provide additional comments, suggestions or positive experiences here: