Dear Family Child Care Home/Child Care Center/Preschool Licensee or Applicant:

Time is important and so are your comments and suggestions. Please take this opportunity to rate us related to your most recent interaction with our department. The Nebraska Department of Health and Human Services (DHHS), Division of Public Health, Licensure Unit, asks your assistance in helping us evaluate and improve our Children’s Services Licensing program’s application and licensing process. Your comments and suggestions are a vital part of our ongoing evaluation and improvement efforts.

To ensure confidentiality, your identity is not recorded. However, if you choose to identify yourself, it will provide the Licensure Unit with an opportunity to seek your additional comments and suggestions about improving our process. Either way, your ratings and comments will be kept confidential.

We appreciate your candid responses and the opportunity to work with you on our shared goals of quality services for children and youth.

If you would rather fill out a paper copy of the Feedback Survey, please contact:

Sara Dodder Furr, MA
DHHS - Division of Public Health, Licensure Unit
301 Centennial Mall South Nebraska State Office Building, PO Box 94986
Lincoln, NE 68509-4986
(402) 471-4973
Please provide some background information about your license and application.

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* 1. Please check the type of license you have:

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* 2. What type of application did you submit?

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* 3. Please tell us the county in which the facility resides.

Please answer the following questions about the availability and responsiveness of the Child Care Licensing staff.

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* 4. When you called, was someone available to answer your call?

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* 5. If you called and left a voice mail, how long did it take before someone returned your call?

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* 6. If you contacted Child Care Licensing staff by email, how long did it take for the staff to respond to you?

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* 7. If you came to the Child Care Licensing office in person, was there a staff person available to assist you?

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* 8. When you requested an application or other documents, how many days did it take to receive what you requested?

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* 9. The next series of questions are related to the application packet. Thinking about the instructions in the packet, please rate the extent to which you agree or disagree with each statement. NOTE: Rate the last statement only if the packet was returned to you with a request for additional information to complete the packet.

  Strongly Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Strongly Disagree N/A
The instructions were easy to understand.
The instructions were thorough.
The instructions regarding what I needed to do in order to complete the packet were clear and easy to understand.

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* 10. The next series of questions is related to the staff with whom you had contact during the application process. Please rate the extent to which you agree or disagree with each statement.

  Strongly Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Strongly Disagree N/A
The staff answered my questions.
The staff were professional in their interactions with me.
The staff were courteous to me.

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* 11. If you would like to be contacted regarding a complaint, concern or question, please provide your name:

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* 12. If you would like to be contacted regarding a complaint, concern or question, please provide your phone number (000-000-0000):

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* 13. Please use the space below to provide any additional comments you would like to share.

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