### 1 OMB Control No: 2050

- 0179 Expiration Date



## 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 Information Collection Request # 1487.12 . 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 s pecify): __________________

________________________ _______ ___________



### 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 a n U.S. EPA representative



### _____ The U.S. EPA website



### _____ Presentations at local clubs and organizations



### _____ Other ( Please s pecify):

____________________________ ______________ _______ ___________

### 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 Somewhat

Interested Interested Very

Interested

b. Contamination at the site. Not

Interested Somewhat

Interested Interested Very

Interested

c. How the site might affect human health. Not

Interested Somewhat

Interested Interested Very

Interested

d. How the site might affect the environment. Not

Interested Somewhat

Interested Interested Very

Interested

e. Site cleanup decisions. Not

Interested Somewhat

Interested Interested Very

Interested

f. Site reuse or redevelopment. Not

Interested Somewhat

Interested Interested Very

Interested

g. Other ( Please s pecify):______

_______ 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 p ublic 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 s pecify ) : ______

___________________ __ ___________________

_____________

_____ 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 Somewhat

Concerned Concerned Very

Concerned Not

Applicable

b. The environment

. Not

Concerned Somewhat

Concerned Concerned Very

Concerned Not

Applicable

c. Property values

. Not

Concerned Somewhat

Concerned Concerned Very

Concerned Not

Applicable

d. Jobs in the community

. Not

Concerned Somewhat

Concerned Concerned Very

Concerned Not

Applicable

e. Business in the community

. Not

Concerned Somewhat

Concerned Concerned Very

Concerned Not

Applicable

f. Community historical or cultural integrity

. Not

Concerned Somewhat

Concerned Concerned Very

Concerned Not

Applicable

g. Site redevelopment or reuse. Not

Concerned Somewhat

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 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]

_ - r elated health

exposures. We would appreciate it if you could take a few moments to provide feedback on your relocation experience and the removal/restoration wo rk 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 m y 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

- info rmed 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 proper ty ? (Use the space below)



### ______________________________________________________________________________ ___

_________________________________________________________________________________

_________________________________________________________________________ ________

_________________________________________________________________________________

### 9

Sect ion 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 a void 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 Somewhat

H elpful Helpful Very Helpful N ot

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? (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 incl uded 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 contac t (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 respondent 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

.