1.
發文文號 (KIA Letter Ref. No.)： (開放性問題)
2.
陳情事由 (Petition Subject)： (開放性問題)
3.
請問您提出陳情的時間 (The date of your)：
-
西元年 (year) (開放性問題)
-
月 (month) (開放性問題)
-
日 (day)。 (開放性問題)
4.
請問您是用那一種方式陳情 (How did you present your petition)？
親自到場 (personally)
3 % /
3票
5.
請問您多久後收到正式答覆 (How many days later did the formal answer reach you)？ （答31天以上者請續答第6題） (in case more than 31 days, please continue the following 3-1）
10天內 (within 10 days)
91 % /
86票
11－20天 (11－20 days)
5 % /
5票
21－30天 (21－30 days)
3 % /
3票
31天以上 (more than 31 days)
0 % /
0票
忘記了 (can’t remember)
0 % /
0票
6.
請問有關機關是否先行通知您本案未能於30天內辦結的理由 (Have you ever been informed by the competent authority that your petition may take more than 30 days and its reasons)？
7.
請問您是否一次向多個機關陳情同一事件 (Have you petitioned to several different authorities for the same case)？
8.
請問您的問題解決了嗎 (Whether your problem has been resolved)？
完全解決 (totally resolved)
45 % /
43票
部分解決 (partially resolved)
14 % /
14票
完全沒有解決 (not resolved at all)
23 % /
22票
只是提出建議供參考 (the comments are for reference only)
8 % /
8票
9.
請問您對於有關機關的答覆內容滿意嗎 (Did the answer from the competent authorities satisfy you)？ （答不滿意或非常不滿意者，請續答10題） (if your answer is unsatisfactory or very unsatisfactory, please continue the following 6-1）
非常滿意(very satisfactory)
37 % /
35票
滿意(satisfactory)
22 % /
21票
不滿意(unsatisfactory)
6 % /
6票
非常不滿意(very unsatisfactory)
22 % /
21票
10.
請問您不滿意的理由(Why you were unsatisfied？) （可複選 ）(You may tick more than one.）
問題未解決(the problem remained unsolved)
34 % /
24票
處理態度不佳(bad attitude in handling)
1 % /
1票
處理時間太慢(too slow)
4 % /
3票
內容係例稿，欠缺誠意(the answer was routine and lack of sincerity)
13 % /
9票
曲解法令或引用錯誤(the laws or regulations were distorted or wrongly quoted)
4 % /
3票
相關機關推諉責任(the authorities concerned pass the buck to each other)
7 % /
5票
答復內容與實際情形不符(the answer was inconsistent with the facts)
14 % /
10票
其他(others)(字數50以內)
20 % /
14票
11.
請問您以前是否曾向本機關陳情 (Have you ever petitioned to this Administration before)？
12.
請問您這次陳情是否針對以前曾陳情的相同事由再來陳情 (Did you petition this time for the same old case you had made before)？ (答是者請續答13題） (If yes, please continue the following 8-1)
13.
請問您為什麼一再陳情(Why did you petition again)？ （可複選）(You may tick more than one.)
案件沒有處理(Your previous petition had not been answered)
7 % /
2票
處理結果與期望相差太遠(the result was against your expectations)
40 % /
11票
機關推諉責任(the authorities concerned pass the buck to each other)
3 % /
1票
案情另有新發展(the case had new development)
0 % /
0票
與大眾權益有關(the case was closely related to public interests)
33 % /
9票
其他(others) (字數50以內)
14 % /
4票
14.
陳情人基本資料 ）(Petitioner basic data)：
-
姓名(Name) (開放性問題)
-
Email(Email) (開放性問題)
-
性別(Sex)
-
年齡(Age)
-
教育程度(Education)
國小及以下(elementary school or under)
0 % /
0票
國中(junior high school)
2 % /
2票
高中、職(senior high school or vocation school)
6 % /
6票
專科(technological academy)
11 % /
11票
大學及以上(college/university or higher)
79 % /
75票
-
職業(Occupation)
軍公教(soldier/government employee/teacher)
12 % /
12票
企業主(entrepreneur)
9 % /
9票
一般企業職員(industry employee)
32 % /
31票
家管、退休人員(housekeeping/retired)
5 % /
5票
自由業（醫師、律師、會計師等）professional (doctor, lawyer, accountant and etc.)
17 % /
16票
其他(others)(字數50以內)
10 % /
10票