OMB Control Number: 3170

- XXXX Expiration Date: XX/XX/XXXX

Page 1 

## Instrument 2: Survey for Trainer Feedback on Curriculum Following
Usage with Case Managers
Respondents: Trainer Cohort Members
Collection Strategy: Paper Form

Thank you for completing this survey as part of our evaluation of trainings based on the FET Toolkit. Please note that your responses will be kept confidential, and when survey results are reported none of your answers will be connected to your organizatio n.



### Please enter your organization’s name: _________________________________

Contextual Information

1) How many case managers participated in this training ?

____________

2) In what city and state was the training held? __________

_______________ __

3) What was the total duration of this training (excluding breaks) ? ______

________ ______

4) Describe the backgrounds of the case managers that participated in this training and the range of the organizations for which they work.

__________________________________________________________________________________

__________________________________________________________________________________

5) Please check any of the following that describe the clients with whom the case managers yo u train will be working ( check all that apply ).

Race/Ethnicity Geography Socio

- economic  Mostly W hite  Mostly Urban  Mostly Low

- Income  Mostly Non

- White Minority  Mostly Suburban  Mostly African

- American  Mostly Rural Gender  Mostly Hispanic/Latino  Mostly Female  Mostly Male

6) Will the case managers you train usually be working with their clients face

- to

- face or by
telephone?

 Face

- to

- face

 By telephone

 Both face

- to

- face and by telephoneOMB Control Number: 3170

- XXXX Expiration Date: XX/XX/XXXX

Page 2 7) What type s of services are clients generally seeking when they contact the case managers that
you will be training? (For example, a re they looking for assistance with housing? Assistance with health issues?, etc.)

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________



### Feedbac k on Toolkit Modules

In the following section of the survey, we would like you to describe your experiences and satisfaction

with each of the individual modules in the Financial Empowerment Toolkit. If you need additional space
for any of your answers, please use the back of the page.OMB Control Number: 3170

- XXXX Expiration Date: XX/XX/XXXX

Page 3 Module On a scale of 1 to 5, how useful do you
think these
resources will be to

the participants ? H ow many minutes did you spend discussing
this module? What content in this
module will be most useful for participants ? What content or tools in
this module will be less
useful for participants, if any, and why ? What feedback do you
have for how this module
should be revised?

Module 1 : Introduction to
the Toolkit  5: Extremely useful  4  3  2  1: Not at all useful ___________

 I did not
discuss this
module during this training

Module 2: Assessing the

Situation  5: Extremely useful  4  3  2  1: Not at all useful ___________

 I did not
discuss this
module during this trainingOMB Control Number: 3170

- XXXX Expiration Date: XX/XX/XXXX

Page 4 Module On a scale of 1 to 5, how useful do you
think these
resources will be to

the participants ? H ow many minutes did you spend discussing
this module? What content in this
module will be most useful for participants ? What content or tools in
this module will be less
useful for participants, if any, and why ? What feedback do you
have for how this module
should be revised?

Module 3: Starting the

Conversation  5: Extremely useful  4  3  2  1: Not at all useful ___________

 I did not
discuss this
module during this training

Module 4: Setting Goals  5: Extremely useful  4  3  2  1: Not at all useful ___________

 I did not
discuss this
module during this trainingOMB Control Number: 3170

- XXXX Expiration Date: XX/XX/XXXX

Page 5 Module On a scale of 1 to 5, how useful do you
think these
resources will be to

the participants ? H ow many minutes did you spend discussing
this module? What content in this
module will be most useful for participants ? What content or tools in
this module will be less
useful for participants, if any, and why ? What feedback do you
have for how this module
should be revised?

Module 5: Saving for the Unexpected, Emergencies,
and Goals  5: Extremely useful  4  3  2  1: Not at all useful ___________

 I did not
discuss this
module during this training

Module 6: Managing Cash
Flow  5: Extremely useful  4  3  2  1: Not at all useful ___________

 I did not
discuss this
module during this trainingOMB Control Number: 3170

- XXXX Expiration Date: XX/XX/XXXX

Page 6 Module On a scale of 1 to 5, how useful do you
think these
resources will be to

the participants ? H ow many minutes did you spend discussing
this module? What content in this
module will be most useful for participants ? What content or tools in
this module will be less
useful for participants, if any, and why ? What feedback do you
have for how this module
should be revised?

Module 7: Dealing with
Debt  5: Extremely useful  4  3  2  1: Not at all useful ___________

 I did not
discuss this
module during this training

Module 8: Understanding Credit Reports
and Scores  5: Extremely useful  4  3  2  1: Not at all useful ___________

 I did not
discuss this
module during this trainingOMB Control Number: 3170

- XXXX Expiration Date: XX/XX/XXXX

Page 7 Module On a scale of 1 to 5, how useful do you
think these
resources will be to

the participants ? H ow many minutes did you spend discussing
this module? What content in this
module will be most useful for participants ? What content or tools in
this module will be less
useful for participants, if any, and why ? What feedback do you
have for how this module
should be revised?

Module 9: Evaluating
Financial

Service Providers, Products, and

Services  5: Extremely useful  4  3  2  1: Not at all useful ___________

 I did not
discuss this
module during this training

Module 10: Protecting

Consumer Rights  5: Extremely useful  4  3  2  1: Not at all useful ___________

 I did not
discuss this
module during this trainingOMB Control Number: 3170

- XXXX Expiration Date: XX/XX/XXXX

Page 8 

### Overall Reaction and Feedback

8) Is there anything that you did during this training that worked particularly well?

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

9) Is t here anything that you would do differently if you were to do this training again?

___________________________________________________________________________________

___________________________________________________________________________________

_____ ______________________________________________________________________________

10) Are there any topics that you believe should be covered in more detail in the Toolkit, or any

additional tools or resources that should be added?

_______________________________ ____________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

11) Thinking about the goal of equippin g case managers to integrate financial empowerment into
their work, p lease provide any other suggestions you have for how the Toolkit could be improved.

___________________________________________________________________________________

___________________ ________________________________________________________________

___________________________________________________________________________________

Paperwork Reduction Act

According to the Paperwork Reduction Act of 1995, an agency may not conduct or spo nsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number.
The OMB control number for this collection is 3170

- XXXX . It expires on MM/DD/YYYY . The time required to complete this information collection is estimated to average approximately 20 minutes perOMB Control Number: 3170

- XXXX Expiration Date: XX/XX/XXXX

Page 9 response, including the time for reviewing any instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of informat ion. The obligation to respond to this collection of information is voluntary. Comments regarding this collection of information, including the estimated response time, suggestions for improving the usefulness of the information, or suggestions for reducin g the burden to respond to this collection should be submitted to Bureau at the Consumer Financial Protection Bureau (Attention: PRA Office), 1700 G Street NW, Washington, DC 20552, or by email to CFPB_Public_PRA@cfpb.gov.

The Bureau will not disclose any personally identifiable information collected except to the extent that it is required to do so by law and as provided in the Privacy Act Statement listed below. Additionally, the
Bureau will treat the information collected consistent with its confide ntiality regulations at 12 C.F.R. Part 1070, et seq.