## What Do You Think About the U.S. EPA’s Community Involvement Efforts at the ________ Site?

Purpose for this Questionnaire: This customer satisfaction survey is meant to help understand how well EPA staff are listening to community member concerns about the cleanup and how well EPA staff make it possible for community members to participate in the planning and decision making process. Instructions: You may be asked some or all of the questions on this questionnaire. This questionnaire should take no more than 15 minutes to complete.

Burden Statement: The public reporting and recordkeeping burden for this collection of

info rmation 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 respondent burden, including through the use of automa ted 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 sur vey to this address.

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 t he 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 will help us to be more responsive to your needs and interests.

This survey is being conducted in accordance with the Federal Paperwork Reduction Act Information Collection Request # 1 487.13. 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 closing disclosure. Sections A

- F are optional

sections with questions that may be used as a specific situation dictates. This survey 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

softwa re.

### 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)

• Providing the information you need. Very

Poor Poor Average Good Very

Good

• Making the information easy to

understand. Very

Poor Poor Average Good Very

Good

• Making it easy to get involved. Very

Poor Poor Average Good Very

Good

• Listening to your concerns. Very

Poor Poor Average Good Very

Good

• Responding to your concerns. Very

Poor Poor Average Good Very

Good

• Treating you courteously. Very

Poor Poor Average Good Very

Good

• Using your input. Very

Poor Poor Average Good Very

Good

• Explaining decisions. Very

Poor Poor Average Good Very

Good



### 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 members/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



### _____ Em ails

— 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):

____________________________________________________________



### B

- 3. How interested are you in obtaining information about the following topics? (Circle one answer for each question)

• U.S. EPA’s Superfund Program. Not

Interested Somewhat

Interested Inte rested Very

Interested

• Contamination at the site. Not

Interested Somewhat

Interested Interested Very

Interested

• How the site might affect human health. Not

Interested Somewhat

Interested Interested Very

Interested

• How the site might affect the

environment. Not

Interested Somewhat

Interested Interested Very

Interested

• Site cleanup decisions. Not

Interested Somewhat

Interested Interested Very

Interested

• Site reuse or redevelopment. Not

Interested Somewhat

Interested Interested Very

Interested

• Other (Please specify):_____________ Not

Interested Somewhat

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:• Provided information to the U.S. EPA about the site and its history. Yes No

• Expressed your concerns about the site to the U.S. EPA. Yes No

• Offered suggestions or advice about the site to the U.S. EPA. Yes No

• Given comments to the U.S. EPA on materials available for public

review. Yes No

• Requested information from the U.S. EPA about the site. Yes No

• Attended a U.S. EPA

- sponsored meeting or event about the site. Yes No

• 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?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

_________ B

- 7. How con cerned are you that the site may be harmful to each of the following: (Circle one answer for each question.)

• My or my family’s

health. Not

Concerned Somewhat

Concerned Concerned Very

Concerned Not Applicable

• The environment. Not

Concerned Somewhat

Concerned Concerned Very

Concerned Not Applicable

• Property values. Not

Concerned Somewhat

Concerned Concerned Very

Concerned Not Applicable

• Jobs in the community. Not

Concerned Somewhat

Concerned Concerned Very

Concerned Not Applicable

• Business in the community. Not

Concerned Somewhat

Concerned Concerned Very

Concerned Not Applicable

• Community historical or cultural integrity. Not

Concerned Somewhat

Concerned Concerned Very

Concerned Not Applicable

• Site redevelopment or

reuse. Not

Concerned Somewhat

Concerned Concerned Very

Concerned Not Applicable

### 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.

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 website

_____ Social media (Facebook, Twitter, etc.)

_____ Flyers in store windows/bulletin boards

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

_____ Other (Please specify):

___________________________________________________________



### C

- 2. Please give us your feedback on the following: (Circle one choice for each question)

a. Information about the meeting was available early enough to make plans to

attend. Strongly Disagree Disagree Agree Strongly Agree

b. Meeting location was convenient. Strongly Disagree Disagree Agree Strongly Agree

c. Meeting facility was comfortable. Strongly Disagree Disagree Agree Strongly Agreed. 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

• Meeting facility was well

- equipped for all planned activities (enough seats, work space, supplies, etc.). Strongly Disagree Disagree Agree Strongly Agree



### 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?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

_________

______________________________________________________________________________

___

### 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 implementin g future removals requiring temporary relocation

of residents.

Introduction: You were recently 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, thereby 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 Agree Not Applicable

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 well

- 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 Applicablej. I received my reimbursement within 30 days. Strongly Disagree Disagree Agree Strongly Agree Not Applicable



### D

- 2. U.S. EPA’s Work on My Property: Removal and Restoration (Circle one choice for each 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 Agree 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 additional comments/feedback regarding your relocation or the removal/restoration work on your property? (Use the space below)



### ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

_________

______________________________________________________________________________

___

### 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 codes. An example of an IC might be building code restriction s 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 protecti veness 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 inf ormation 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) to request the information.

### 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 know 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 w as provided

____ Other (Please

specify):__________________________________________________________



### 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 Somewhat

Hel pful Helpful Very Helpful Not Applicable

b. Presentations by experts to explain

technical site information to the community. Not Helpful Somewhat Helpful Helpful Very Helpful Not Applicable

c. Community informational workshops/trainings. Not Helpful Somewhat Helpful Helpful Very Helpful Not Applicable

d. Redevelopment planning. Not Helpful Somewhat Helpful Helpful Very Helpful Not Applicable

e. U.S. EPA provides facilitator or mediator to help the community. Not Helpful Somewhat 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 Somewhat Helpful Helpful Very Helpful Not Applicable

g. Other (Please specify):

___________________________ Not Helpful Somewhat 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? (Check 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 (Please

specify):__________________________________________________________



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



### 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)

.