Confidentiality Agreement

The Privacy Act of 1974, 5 USC 552a, provides protection to individuals by ensuring that personal information collected by Federal agencies is limited to that which is legally authorized and necessary and is maintained in a manner which precludes unwarranted intrusions upon individual privacy.  Collection of this data is for program improvement and efficiency only and is purely voluntary towards its provisions.  

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* 1. What is your gender?

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* 2. What is your branch of Service or SM's branch of Service?

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* 3. What is your relationship to the Service Member or Self?

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* 4. What is your age?

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* 5. What is your rank (or rank of SM)?

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* 6. What is your duty status (or SM duty status)?

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* 7. What is your marital status?

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* 8. I know where to go if I need help with Military and Family Programs.

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* 9. The location of the Family Assistance Center and/or Military & Family Readiness Center is easily accessible.

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* 10. The hours of the Family Assistance Center and/or Military & Family Readiness Center are adequate to address my needs.

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* 11. Any additional comments? 

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* 12. I have enough money to meet my basic needs each month (housing, utilities, food, etc.).

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* 13. I have enough money for an unexpected emergency.

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* 14. I know how to create a budget.

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* 15. Any additional comments? (open text box)

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* 16. I know where to go to get help and support during deployment/mobilization/long-term missions.

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* 17. I have a circle of friends or people I can turn to in times of needed support.

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* 18. I am satisfied with my intimate partner relationship.

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* 19. Any additional comments? (open text box)

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* 20. My spouse/partner has adequate employment.

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* 21. I am satisfied with my current level of employment.

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* 22. I am satisfied with my work-life balance.

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* 23. Any additional comments? (open text box)

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* 24. My community has adequate housing to meet my needs.

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* 25. I have food security (i.e., no worry about where next meal will come from)

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* 26. I know where to find financial support resources in my community.

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* 27. Any additional comments? (open text box)

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* 28. I am satisfied with the level of support I receive from my leadership (or SM's leadership).

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* 29. I have the skills/resources I need to be successful in my military/T5 civilian career (or SM has the skills/resources).

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* 30. I plan to continue my service career (I support the continuation of my loved one's service career)

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* 31. Any additional comments? (open text box)

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* 32. I have knowledge of the following programs (check all that apply):

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* 33. I know where to go to access the following services (check all that apply):

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* 34. I have utilized the following programs or referred someone to the following services (check all that apply):

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* 35. I would like more information about the following programs (check all that apply):

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* 36. Please provide your contact details to obtain additional program information.

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* 37. Any additional comments? (open text box)

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* 38. I am satisfied with the level of customer service I receive from Military & Family Readiness Programs.

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* 39. The Military & Family Readiness Program staff keeps my confidentiality.

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* 40. The Military & Family Readiness Program staff responds to my need(s) in a timely manner.

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* 41. Any additional comments? (open text box)

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* 42. Would you like someone from the Military and Family Readiness Program Office to contact you? Your responses are kept confidential.

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* 43. If so, what is your contact information?

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* 44. Preferred method of contact?

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* 45. Area of Concern? (open text box or boxes to be checked?)

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 100% of survey complete.

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