Name-Surname : 

Phone number : 

Gender :  Male  Female

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

Highest level of education:

 Primary education

 Junior/high school/equivalent 

 Bachelor's degree

 Postgraduate     

Status of the person receiving the service:

 Farmers/Farming Organizations

 Entrepreneur 

 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

 Vaccination against rabies

 Requesting a house plan for the public

 Spraying chemicals to protect against dengue fever

 building design

 Payment of tap water

 Paying for solid waste

 Payment of land and building taxes

 Requesting to operate a business that is hazardous to health

 Payment of sign tax

 Borrowing materials, equipment, etc.

 Requesting commercial registration

 Requesting permission to advertise using a loudspeaker  

 Other

The officers speak politely, are courteous, dress politely and behave neatly:

 the most

 a lot

 Medium

 little

 Should improve

Staff provide service with willingness, speed, and care:

 the most

 a lot

 Medium

 little

 Should improve 

The staff gives advice. Answer questions clearly Accurate and reliable:

 the most

 a lot

 Medium

 little

 Should improve

Officials can solve problems and obstacles that arise appropriately:

 the most

 a lot

 Medium

 little

 Should improve

There are various service channels:

 the most

 a lot

 Medium

 little

 Should improve 

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

 the most

 a lot

 Medium

 little

 Should improve

Each step of the service process is convenient and fast:

 the most

 a lot

 Medium

 little

 Should improve 

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

 the most

 a lot

 Medium

 little

 Should improve 

Arrangement of facilities at the service location such as parking and drinking water:

 the most

 a lot

 Medium

 little

 Should improve 

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

 the most

 a lot

 Medium

 little

 Should improve 

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

 the most

 a lot

 Medium

 little

 Should improve 

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

 Services provided by agency staff

 In terms of information provided to the public

 Places for providing information services

 Methods for participation of the people in the preparation of development plans

 Tax payment service

 Building Permission Services 

 Other