GPRA-PEF

Training and Technical Assistance (TTA)
GPRA Post-Event Form (GPRA-PEF)
Form Approved
OMB No. 0930-0389
Exp. Date 05/31/2025
See burden statement at the bottom

Event Name - Getting Paid: Drug Medi-Cal and MAT Reimbursement (AHP Financing Series, Webinar #2)

Event Code - 4222061820

Event Date - 6/18/2020

This questionnaire aims to gather your feedback regarding the quality and usefulness of this event. The information you provide will be used to enhance and improve future training events. Your answers will not be released to anyone and will remain anonymous. Your name will not be written on the questionnaire or be kept in any other records. All responses you provide for this study will remain confidential.
When the results of the questionnaire are reported, you will not be identified by name or any other information that could be used to infer your identity. Only SAMHSA and its grantee will have access to view any data collected. Your participation is voluntary, and you may withdraw from completing this questionnaire at any time you wish or skip any question you don�t feel like answering.
Your refusal to participate will not result in any penalty or loss of benefits to which you are otherwise entitled.
The following questions are designed to assess the quality of today's event.

1. How satisfied were you with the overall quality of this event?

2. I expect this event to benefit me and/or my community.

3. I expect this event will improve my ability to work effectively.

4. I would recommend this event to a friend/colleague.

Open ended questions

5. What about the event was most useful to you?

6. How could this event be improved?

In order for SAMHSA to continuously improve its training programs, it is important that we know a bit about those we are currently serving.
Your reply to these demographic questions will help SAMHSA to improve its technical assistance programs. Please note that your responses will be reported in aggregate.

7. What do you consider yourself to be?

8. Are you Hispanic, Latino/a, or Spanish origin?

9. What is your race? You may indicate more than one.

10. Do you think of yourself as...

11. Please select the best category that describes your community (Select one or more):

12. What is the highest degree you have received? (Select one):

13. What is your primary occupation/profession? (Select one):

15. Which of the following best describes your principal employment setting? (Select one):

16. What is the ZIP Code of your principal employment setting or school (if you are a student)?

17. Would you be willing to complete an online follow-up survey?
Note: We will not use the information you provide here for any
other purpose than contacting you regarding the follow-up survey for this event.
We do not sell or otherwise distribute your e-mail address.

Burden Statement: Public reporting burden for this collection of information is estimated to average 10 minutes to complete this questionnaire. Send comments regarding this burden estimate or any other aspect of this collection of information to the Substance Abuse and Mental Health Services Administration (SAMHSA) Reports Clearance Officer, Room 15E57A, 5600 Fishers Lane, Rockville, MD 20857. An agency may not conduct, or sponsor and a person is not required to respond to a collection of information unless it displays a currently valid Office of Management and Budget (OMB) control number. The control number for this project is 0930-0389.

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