Control No.
______
Republic of the Philippines
OFFICE OF THE PRESIDENT
NATIONAL COMMISSION ON INDIGENOUS PEOPLES
AGUSAN DEL SUR PROVINCIAL FIELD OFFICE
San Luis Community Service Center
Dona Maxima, San Luis, Agusan del Sur
Email Address:
[email protected](External)
HELP US SERVE YOU BETTER!
This Client Satisfaction Measurement (CSM) tracks the customer experience of government offices. Your feedback on your recently
concluded transaction will help this office provide a better service. Personal information shared will be kept confidential and you always
have the option to not answer this form.
Client type: ☐ Citizen ☐ Business ☐ NCIP Employees ☐ Government (Employee or another agency)
Date: ____________ Sex: ☐ Male ☐ Female Age: ___________ Region of residence: _____________________
Service/s Availed (Kindly check the appropriate box/es)
□ Request for Certification Precondition (CP) for Extractive/Large-Scale □ Culturally appropriate/responsive and Gender-sensitive Socio-
Activities economic and Ecology Development and Protection Services
□ Request for Certification Precondition (CP) for Non-Extractive/Small- □ IP Education and Advocacy Services
Scale Activities □ IP Culture Services
□ Request for Certification Precondition (CP) for Community □ IP Health Program and Services
Solicited/Initiated, LGU, and other government projects □ Gender and Rights-Based Services
□ Request for the issuance of Certificate of Non-Overlap (CNO) □ Request for Legal Assistance/Opinion
□ Application for Issuance of Certificate of Confirmation (COC) □ Certificate of Appearance
INSTRUCTIONS: Check mark (✔ ) your answer to the Citizen’s Charter (CC) questions. The Citizen’s Charter is an official document
that reflects the services of a government agency/office including its requirements, fees, and processing times among others.
CC1 Which of the following best describes your awareness of a CC?
☐ 1. I know what a CC is and I saw this office’s CC. ☐ 3. I learned of the CC only when I saw this office’s CC.
☐ 2. I know what a CC is but I did NOT see this office’s ☐ 4. I do not know what a CC is and I did not see one in this
office. (Answer ‘N/A’ on CC2 and CC3)
CC2 If aware of CC (answered 1-3 in CC1), would you say that the CC of this office was …?
☐ 1. Easy to see ☐ 4. Not visible at all
☐ 2. Somewhat easy to see ☐ 5. N/A
☐ 3. Difficult to see
CC3 If aware of CC (answered codes 1-3 in CC1), how much did the CC help you in your transaction?
☐ 1. Helped very much ☐ 3. Did not help
☐ 2. Somewhat helped ☐ 4. N/A
INSTRUCTIONS: For SQD 0-8, please put a check mark (✔ ) on the column that best corresponds to your answer.
N/A
Not
Applicable
Strongly Disagree Neither Agree Agree Strongly
Disagree nor Disagree Agree
SQD0. I am satisfied with the service that I availed.
SQD1. I spent a reasonable amount of time for my transaction.
SQD2. The office followed the transaction’s requirements and
steps based on the information provided.
SQD3. The steps (including payment) I needed to do for my
transaction were easy and simple.
SQD4. I easily found information about my transaction from the
office or its website.
SQD5. I paid a reasonable amount of fees for my transaction. (If
service was free, mark the ‘N/A’ column)
SQD6. I feel the office was fair to everyone, or “walang
palakasan”, during my transaction.
SQD7. I was treated courteously by the staff, and (if asked for
help) the staff was helpful.
SQD8. I got what I needed from the government office, or (if
denied) denial of request was sufficiently explained to me.
Suggestions on how we can further improve our services (optional):
_______________________________________________________________________________________________________________________
Email address (optional): ________________________________________________________
THANK YOU!
