FY 2026 POMP Information and Assistance Satisfaction Information and Assistance Satisfaction Survey Question Title * 1. First, did you contact (NAME OF PROVIDER) to obtain help or services for yourself, for a relative or someone you know, or were you inquiring from an agency for a client or a patient? (CHECK ALL THAT APPLY) A. For yourself B. For a relative or friend C. For a client or patient Other (please specify) Question Title * 2. Please tell me the reason why you contacted (NAME OF PROVIDER). (CHECK ALL THAT APPLY) A. To get information B. To obtain services (transportation, housing, health care, meals, etc.) C. To refer a client for services D. To follow up on a prior call E. To express health insurance concerns F. To file a complaint G. To express financial concerns H. Family caregiver problem I. Other (describe) Question Title * 3. Had you ever used this service before last week? Yes No 3a. About how many times have you used it in the past year? Question Title * 4. If you called (name of provider) last week, did you get a busy signal? Yes No N/A - did not call 4a. How many times did you call before getting through? Question Title * 5. How quickly was your call answered? Immediately, such as after 1 ring or 2 rings Quickly, less than 5 rings After a little while, 5-15 rings Had to wait a long time, more than 15 rings N/A - did not call Question Title * 6. Was the initial phone call answered by voice mail or by a person? Person (Skip to question 7) Voicemail If a voicemail was left, please describe (Did you understand the instructions? Did someone call you back? When did they call you back?) Question Title * 7. Overall, did the person listen carefully to what you wanted? Yes, definitely Yes, I think so No, I don't think so No, definitely not Question Title * 8. Overall, did the person understand what you wanted? Yes, definitely Yes, I think so No, I don't think so No, definitely not Question Title * 9. Did she/he explain things in a way that you could understand? Yes, definitely Yes, I think so No, I don't think so No, definitely not Question Title * 10. Did you experience any of the following communication problems? (Check all that apply) A. Language problem (e.g. did no speak Spanish) B. Hearing problem C. Staff needed to speak louder or more slowly D. Staff needed to listen more E. NONE Other (please specify) Question Title * 11. Overall, did you receive the information from (NAME OF PROVIDER) that you were looking for? Yes, definitely Yes, I think so No, I don't think so No, definitely not Question Title * 12. Overall, how satisfied were you with the way your inquiry was handled? Excellent Very good Good Fair Poor Question Title * 13. Would you recommend this service to a friend or colleague who needs the kind of information and assistance you did? Yes, definitely Yes, I think so No, I don't think so No, definitely not Question Title * 14. Do you expect that the information you received from (NAME OF PROVIDER) will be helpful in resolving the issue you inquired about? Yes, definitely Yes, I think so No, I don't think so No, definitely not Question Title * 15. Were you referred to any other places for a service or more information? Yes, I was referred to another agency Yes, I was referred to another office in this agency No N/A If yes, please describe (Did you contact any of them? Why or why not? Have you started receiving services from any of the places you were referred to?) Question Title * 16. If you were referred to another office or agency, did you contact any other places besides that referral to get the information you needed? Yes No N/A If yes, please describe. (Did you get the information you needed? About how many calls did you have to make before you got the information you needed?) Question Title * 17. Do you have any recommendations on how to make (NAME OF PROVIDER) better? (CHECK ALL THAT APPLY) A. NONE B. Increase hours the service is available C. Reduce waiting time to speak to someone D. Eliminate voice mail system/ have persons answer the phone E. Get more knowledgeable persons to answer questions F. Try to answer questions during first contact G. Be more timely in returning phone calls H. Better advertising of services I. Reduce the wait time on services Other (please specify) Next