ATTENTION: THIS SURVEY IS FOR REVIEW OF CUSTOMER SERVICE ONLY.

IF YOU HAVE A CONCERN, ISSUE OR PRAISE REGARDING A PARTICULAR STAFF MEMBER OF THIS AGENCY, PLEASE ADDRESS IN LETTER FORM TO BRYAN NIX, SR. APPEALS OFFICER IN A CONFIDENTIALLY ADDRESSED ENVELOPE.

* 1. Please indicate the location your customer service experience took place:

* 2. In evaluating your most recent customer service experience, the quality of service you received was:

* 3. Which of the following qualities apply to your experience with the service that was provided by the Hearings Division Staff (select any that apply):

* 4. If you had a negative experience, please briefly explain in the space provided below:

* 5. Please rate the following features of your customer service experience by checking the most appropriate box for each feature:

  Very Good Good Fair Poor Very Poor
Responsiveness
Professionalism
Politeness
Knowledge of the problem
Efficiency in solving the problem
Manner of handling follow-up questions
Report a problem

T