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: