### 1 OMB Control No: 2050 - 0179 Expiration Date xx/xx/xxxx 

## What Do You Think About **the U.S. EPA’s Community**  **Involvement Efforts at the ________ Site?** The U.S. Environmental Protection Agency (U.S. EPA) is cleaning up the contamination at the __________ Superfund site in your community . The U.S. EPA believes the active, meaningful involvement of community members is critical to the success of a cleanup effort. This survey is an opportunity

for you to tell us how well we are doing at listening to your concerns about the cleanup and making it possible for you to participate in the planning and decision making process. Please take a few minutes to answer the questions. Your views are important and wi ll help us to be more responsive to your needs and interests. This survey

is being conducted in accordance with the Federal Paperwork Reduction Act In formation Collection Request # 1487.11 . You will need about 15 minutes to answer the questions. ***Note to surveyors: It is intended that each survey given will include the introductory**  **paragraph, above, and Section G**  **with the c losing disclosure. Sections A** **- F**  **are optional sections**  **with questions that may be used as a**  **specific situation dictates. This surv ey is NOT**  **intended to be given in its entirety. The surveyor may also choose, in addition to paper copies,**  **to provide the survey to participants online via commercially available software. Section A**  **: Assessing Overall**  **U.S. EPA Community Involvement**  **Efforts A** **- 1.**  **How do you rate the U.S.**  **EPA at each of the following? (Circle one choice for each question)**  a. Providing the information you need. **Very Poor**  **Poor Average**  **Good Very**  **Good** b. Making the information easy to understand. **Very Poor**  **Poor Average**  **Good Very**  **Good** c. Making it easy to get involved. **Very Poor**  **Poor Average**  **Good Very**  **Good** d. Listening to your concerns. **Very Poor**  **Poor Average**  **Good Very**  **Good** e. Responding to your concerns. **Very Poor**  **Poor Average**  **Good Very**  **Good** f. Treating you courteously. **Very Poor**  **Poor Average**  **Good Very**  **Good** g. Using your input. **Very Poor**  **Poor Average**  **Good Very**  **Good** h. Explaining decisions. **Very Poor**  **Poor Average**  **Good Very**  **Good**

### 2

**Section B :**  **Assessing U.S. EPA Efforts at Keeping Communities Informed B**  **- 1**  **. How do**  **you learn about the U.S. EPA’s work at the site? (Check all that apply)** 

**_____** U.S. EPA mailings

**_____** Newspaper articles

**_____** Radio or TV news



### _____ U.S. EPA’s web page

**_____** Community member s/family/friends

**_____** Public meeting or information session held by the U.S. EPA

**_____** Direct conversation with someone from the U.S. EPA

**_____** Information about the site is “common knowledge”

**_____** Know someone who worked at the site

**_____** Through one or more community organizations , business associations, or advisory groups (CAG)

**_____** Social Media (Facebook, Twitter, etc.)

**_____** Other (Please specify): __________________

________________________ _______ __ _________ 

### B **- 2**  **. How would you prefer to receive information**  **from the U.S. EPA about the site?**  **(Check up to 3 choices**  **)**



### _____ Mailings

—short (1 - 2 pages) very focused (issue - specific) sent frequently



### _____ Mailings

—longer, general information, sent periodically



### _____ Emails

—

brief , very focused (issue - specific) sent frequently



### _____ Emails

—longer, general information, sent periodically



### _____ Meetings

—short, very focused, held frequently



### _____ Meetings

—longer, general informational meetings, held periodically



### _____ Social media (Facebook, Twitter)



### _____ Direct communication with an U.S. EPA representative



### _____ The U.S. EPA website



### _____ Presentations at local clubs and organizations



### _____ Other (Please specify): ___

_________________________ ______________

_______ ___________

### 3

**B -** **3 .**  **How interested are you in obtaining information about the following topics? (Circle**  **one answer for each question)**  a. U.S. EPA’s Superfund Program . **Not Interested**  **Som ewhat** 

**Interested Interested**  **Very Interested**  b. Contamination at the site. **Not Interested**  **Som ewhat** 

**Interested Interested**  **Very Interested**  c. How the site might affect human health. **Not Interested**  **Som ewhat** 

**Interested Interested**  **Very Interested**  d. How the site might affect the environment. **Not Interested**  **Som ewhat** 

**Interested Interested**  **Very Interested**  e. Site cleanup decisions. **Not Interested**  **Som ewhat** 

**Interested Interested**  **Very Interested**  f. Site reuse or redevelopment. **Not Interested**  **Som ewhat** 

**Interested Interested**  **Very Interested**  g. Other (Please specify):______

______ _ **Not**

**Interested Som** **ewhat**

**Interested Interested**  **Very Interested**  

### B **- 4**  **. In what ways**  **do you prefer to**  **participate at this site**  **? (Check all that**  **apply)**

**_____** Through opportunities to provide written comments on U.S. EPA documents .

**_____** Through public meetings .

**_____** Through opportunities to meet and talk informally with U.S. EPA staff .

**_____** By attending community club/organization meetings that U.S. EPA staff have been invited to .

**_____** By calling a toll - free telephone number .

**_____** Through a community group .

**_____** Through opportunities to talk with independent experts .

**_____** Through a web site or social media .

**_____** Other (Please specify) : ______

___________________

__ ___________________

_____________

**_____** Not interested in being involved . 

### B **- 5**  **. Please tell us**  **whether you have ever:** a. Provided information to the U.S. EPA about the site and its history. **Yes No**  b. Expressed your concerns about the site to the U.S. EPA. **Yes No**  c. Offered suggestions or advice about the site to the U.S. EPA. **Yes No**  d. Given comments to the U.S. EPA on materials available for public review. **Yes No**  e. Requested information from the U.S. EPA about the site. **Yes No**  f. Attended a U.S. EPA - sponsored meeting or event about the site. **Yes No**  g. Visited the site’s information repository. **Yes No**  

### B **- 6**  **. In a few words, what is your understanding of**  **the cleanup work**  **U.S. EPA plans to do**  **at the site?**

**_ ________________________________________________________________________________** 

**____________________________________________________________________________ __**  **___**

**____________________________________________________ _________** 

**____________________**

### 4

**B -**  **7 .**  **How concerned are you that the site may be harmful to each of the following: (Circle one**  **answer for each question.)** a. My or my family’s health . **Not C**  **oncerned Som** **ewhat**

**Concerned Concerned**  **Very Concerned**  **Not**

**Applicable** b. The environment . **Not Concerned**  **Som ewhat** 

**Concerned Concerned**  **Very Concerned**  **Not**

**Applicable** c. Property values . **Not Concerned**  **Som ewhat** 

**Concerned Concerned**  **Very Concerned**  **Not**

**Applicable** d. Jobs in the community . **Not Concerned**  **Som ewhat** 

**Concerned Concerned**  **Very Concerned**  **Not**

**Applicable** e. Business in the community . **Not Concerned**  **Som ewhat** 

**Concerned Concerned**  **Very Concerned**  **Not**

**Applicable** f. Community historical or cultural integrity . **Not Concerned**  **Som ewhat** 

**Concerned Concerned**  **Very Concerned**  **Not**

**Applicable** g. Site redevelopment or reuse. **Not Concerned**  **Som ewhat** 

**Concerned Concerned**  **Very Concerned**  **Not**

**Applicable**

### 5

**C -**  **1 .**  **How did you learn about this public meeting? (**  **Check all that apply)** 

**_____** U.S. EPA mailings (other than this survey)

**_____** Newspaper articles

**_____** Radio or TV news

**_____** Community organization

**_____** Family or friends

**_____** Email from U.S. EPA

**_____** U.S. EPA’s web site

**_____** Social media (Facebook, Twitter, etc.)

**_____** Flyers in store windows/bulletin boards

**_____** Direct conversation with someone from the U.S. EPA

**_____** Other (P lease specify) :

_ ___________________________ _______________________________ 

### C **- 2.**  **Please give us your feedback on the following: (C**  **ircle one choice for each question)** a. Information about the meeting was available early enough to make plans to attend . **Strongly Disagree**  **Disagree Agree**  **Strongly A**  **gree** b. Meeting location was convenient . **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  c. Meeting facility was comfortable . **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  d. Meeting time was convenient . **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  e. The length of the meeting was appropriate . **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  f. Language interpreters were available (if needed) . **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  g. Provisions were made to accommodate the needs of persons with disabilities **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  h. Meeting facility was well - equipped for all planned activities ( enough seats, work space, supplies, etc.) . **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  

### Section **C :**  **Public Meeting Feedback Questions**  **These questions will help the U.S. EPA better understand what worked well and what**  **improvements to consider making before holding future public meetings.**

### 6

**C -** **3 .**  **What topics were of most interest to you at the meeting?**

________________________________________________________ _________________________

_________________________________________________________________________________

__________________________________________________________________ _________

______

____________________________________________________________________ _____________ **C -**  **4 .**  **How was the meeting useful to you ?** 

_________________________________________________________________________________

_________________________________________________________________________________

_______________________________________________________________________ _________

_

**____________**

**_____________________________________________________________________ C**  **- 5**  **. How can**  **U.S. EPA**  **improve the next public meeting**  **?**

**_________________________________________________________________________________**

**_________________________________________________________________________________**

**______________________________________________________________________ _________** 

**__**

**____________**

**_____________________________________________________________________**

### 7

**Introduction:** You were recentl y relocated while removal and restoration activities were completed at your property . These activities were designed to remove significant potential sources of _[contaminant] _ from your property, thereb y reducing any potential

_ [contaminant]

_- related health exposures. We would appreciate it if you could take a few moments to provide feedback on your relocation experience and the removal/restoration work that was completed on your property. **D -**  **1 .**  **Relocation (Circle one choice for each question)**  a . U.S. EPA staff were friendly and helpful . **Strongly Disagree**  **Disagree Agree**  **Strongly Ag**  **ree N**  **ot**

**A pplicable**  b. The relocation handouts I was given were useful and understandable. **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** c. U.S. EPA staff responded to my questions in a timely manner . **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** d. I was treated with courtesy and respect by U.S. EPA staff

. **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** e. U.S. EPA staff contacted me as often as I would have liked:  Before my relocation. **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable**  While I was relocated. **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable**  After my property was cleaned up and I was back in my home. **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** f. I was wel l - informed of my choices for relocation (hotel, friend’s home, etc.) . **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** g. I was well - informed about the expected length of my relocation and was kept informed of any changes . **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** h. I was told when I needed to relocate with enough time to plan my move. **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** i. The reimbursement paperwork was understandable . **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** j. I received my reimbursement within 30 days . **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** 

### D **- 2**  **. U.S. EPA’s Work on**  **M y Property: Removal and Restoration**  **(Circle one choice for each** 

### Section **D :**  **Questions for Use During Site Cleanup**  **- Removal/Relocation**  These questions will help the U.S. EPA better understand what worked well and what improvements to consider when implementing future removals requiring temporary relocation of residents.

### 8 **question)** a. I was well - informed about the extent of the work U.S. EPA would do on my property. **Strongly Disagree**  **Disagree Agree**  **Strongly Ag**  **ree Not** 

**Applicable** b. The specifics of the property restoration were explained in writing and provided to me. **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** c. I was informed of the landscape options for my property. **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** d. I understood what I had to do following the removal at my property in order for the landscaping to be successful. **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** e. The on - site workers were courteous and respectful. **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** f. I was kept informed about any changes in the schedule for the work on my property. **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** g. I was informed if any of my possessions could NOT be decontaminated. **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** h. My property was restored to a condition at least equal to its previous condition (recognizing that it may take time and water/aerating on my part for the seed to take or plants to grow). **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** i. The work done on my property met my expectations. **Strongly Disagree**  **Disagree Agree**  **Strongly Agree**  **Not**

**Applicable** 

### D **- 3.**  **Do you have any a dditional comments/feedback regarding**  **your relocation or the**  **removal/restoration work on your property**  **? (Use the space belo**  **w)**



### ______________________________________________________________________________ **___**

**_________________________________________________________________________________**

**_________________________________________________________________________ _______**  **_**

**_________________________________________________________________________________**

### 9

**Section E**  **: Questions for Use at Sites with Institutional Controls**  These questions will help the U.S. EPA better understand whether community members are aware of, or interested in, information about any institutional controls (ICs) at the site , which are administrative and legal controls, including limitations on land use or resource use, deed restrictions, or building code s . An example of an IC might be building code restrictions to prevent vapor intrusion, or preventing development on a landfill cap to avoid damage to the integrity of the cap surface. Community

input can be essential to selecting, using , and monitoring ICs that are the best fit for the community and the protectiveness of the remedy . **E -**  **1. Are you aware of any restrictions (institutional controls) in place at the site including**  **limitations on land and/or resource use, building code requirements or deed restrictions?** 

_ **__Yes**

**_**

**__ No E**  **- 2.**  **Would you like more information**  **about restrictions (institutional controls)**  **on the use of land or resources or any deed restrictions in place at the site?** 

**_ _**  **_Yes**

**_**

**_ _ No**  If yes, please contact (Name and phone number) t o request the information.

### 10

**Section F**  **: Questions**  **about Technical Assistance**  **Resources Provided to the Community** These questions will help the U.S. EPA better understand how to provide the most effective technical assistance resources at sites. **F -**  **1. Do you kno** **w of any assistance**  **U.S. EPA has provided**  **to help you and other community members** **/groups better understand technical and scientific information regarding the**  **site cleanup? ____Yes**  **_____No (Please skip to question F**  **- 3)**  **F -**  **2. How was technical assistance provided to your community?**  **(check all that apply)**



### ____ Through a Technical Assistance Grant (TAG)

**____** Through Technical Assistance Services for Communities (TASC)

**____** Through U.S. EPA site staff

**____** Through assistance from a local, regional or national organization/entity /university

**____** Through a Pediatric Environmental Health Specialty Unit (PEHSU)

**____** Through a Technical Assistance Plan (TAP)

**____** Through Technical Assistance for Public Participation (TAPP)

**____** I do not know how the assistance was provided

**____** Other ( P lease specify) :

_____________________________ ___________________________ __

### 11

**Please rate how useful each of the following has been in helping community members better understand information about the site and take a more active role in the process:**  a. Community informational newsletters and/or factsheets. **Not Helpful**  **Som ewhat** 

**H el** **pful Helpful**  **Very Helpful**  **N ot** 

**Applicable** b. Presentations by experts to explain technical site information to the community. **Not Helpful**  **Som ewhat** 

**Helpful Helpful**  **Very Helpful**  **Not**

**Applicable** c. Community informational workshops/trainings. **Not Helpful**  **Som ewhat** 

**Helpful Helpful**  **Very Helpful**  **Not**

**Applicable** d. Redevelopment planning. **Not Helpful**  **Som ewhat** 

**Helpful Helpful**  **Very Helpful**  **Not**

**Applicable** e. U.S. EPA provides facilitator or mediator to help the community. **Not Helpful**  **Som ewhat** 

**Helpful Helpful**  **Very Helpful**  **Not**

**Applicable** f. U.S. EPA assists community groups that want to help the community understand or participate in the site cleanup process. **Not Helpful**  **Som ewhat** 

**Helpful Helpful**  **Very Helpful**  **Not**

**Applicable** g. Other (Please specify) :

___________

_________

___ ____ **Not**

**Helpful Som** **ewhat**

**Helpful Helpful**  **Very Helpful**  **Not**

**Applicable**


### F **- 3**  **. If technical assistance**  **has not been provided to your community,**  **which of the following**  **activities could**  **help you and other community members /groups**  **better understand technical and scientific information regarding the site cleanup?**  **(C heck all that apply)** 



### ____ Community informational newsletters and/or factsheets.



### ____ Presentations by experts to explain technical site information to the community.



### ____ Community informational workshops/trainings.



### ____ Redevelopment planning.



### ____ U.S. EPA provided facilitator or mediator to help the community .



### ____ U.S. EPA gave assistance to one or more community groups that wanted to help the community

understand or participate more actively in the site cleanup process.



### ____ Other ( P lease specify) :

_____________________________ _____________________ _ _____ __



### ____ I don’t feel that any technical assistance is needed.

### 12

**Section G**  **: General Information**  **[REQUIRED Section**  **]** This section must be included at the end of all surveys. **G -**  **1. Is there anything else you would like to tell us about**  **the U. S.**  **EPA’s community involvement efforts or about the cleanup activities at this site?** 

**_________________________________________________________________________________**

**_______________________________________________________________________ _____**  **_____**

**_________________________________________________________________________________**

**____________**

**________________________________________________________________ ____**  **_ Thank you for taking the time to share your views with us.**  **If you would like to be on the U.S.**  **EPA’s mailing list, please contact (Name, Telephone Number)**  **.**
The public reporting and recordkeeping burden for this collection of information is estimated to average 15 minutes per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing re spondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460 . Include the OMB control number in any correspondence. Do not send the completed survey to this address .