Name-Surname: 

Number of names: 

Gender :  Male  female

Age:  Under 20 years /  21-40 years /  41-60 years /  60 years and up

Highest level of education:

 Primary education

 Junior/high school/equivalent 

 Bachelor's degree

 Postgraduate degree     

Status of the person receiving the service:

 Farmers/Farming Organizations

 Operator 

 People receiving services

 Community organizations/community organization networks

 Other

Matters requesting service:

 Requesting government information

 Requesting a living allowance for the elderly

 Filing a complaint/complaint

 Requesting living allowance for disabled people

 Using the internet in community ICT learning centers

 Requesting a living allowance for AIDS patients

 Requesting permission to construct a building.

 Rabies vaccination

 Requesting house plans for the public

 Spraying chemicals to protect against dengue fever.

 Building design

 Water payment

 Payment of solid waste fees

 Payment of land and building taxes.

 Requesting to operate a business that is hazardous to health

 Payment of sign tax

 Borrowing materials, equipment, etc.

 Application for commercial registration

 Requesting permission to advertise using a loudspeaker  

 Other

The officers speak politely, are courteous, dress politely, and present themselves neatly:

 the most

 a lot

 Medium

 little

 should be improved

Staff provide service with willingness, speed, and care:

 the most

 a lot

 Medium

 little

 should be improved 

Officer gives advice. Answer questions clearly Accurate and reliable:

 the most

 a lot

 Medium

 little

 should be improved

Officials can solve problems and obstacles that arise appropriately:

 the most

 a lot

 Medium

 little

 should be improved

There are various service channels:

 the most

 a lot

 Medium

 little

 should be improved 

The steps for providing services are systematic, not complicated, and clear:

 the most

 a lot

 Medium

 little

 should be improved

Each step of the service process is convenient and fast:

 the most

 a lot

 Medium

 little

 should be improved 

There is a clear flowchart of steps and duration of service:

 the most

 a lot

 Medium

 little

 should be improved 

Arrangement of facilities in service locations such as parking and drinking water:

 the most

 a lot

 Medium

 little

 should be improved 

There are tools/equipment/systems for providing information services:

 the most

 a lot

 Medium

 little

 should be improved 

There is a clear, convenient and appropriate layout of services and use of the building:

 the most

 a lot

 Medium

 little

 should be improved 

What aspects of service do you think the agency should improve?

 Services provided by agency officials

 Information that provides services to the public

 Places for information services

 Methods for public participation in the preparation of development plans.

 Tax payment services

 Building construction permit services 

 Other