The informal feedback TA programs received from facility staff generally took the form of a paper questionnaire given to facility staff at the end of a TA visit, asking facilities to provide information rating the performance of the TA staff and how helpful the visit had been. Some facility staff in Florida and Washington, where TA staff also function as surveyors, told the research team that they are hesitant to give any negative feedback on these questionnaires for fear that the staff member making the TA visit might be conducting their next LTC survey or complaint investigation. Texas was the only state that reported using the Internet for feedback on its program. In Washington, the survey staff holds quarterly forums with executives from the nursing home industry to discuss issues related to quality. Maryland state officials reported using the information collected as feedback on the TA program's first year to establish the focus for the second year's visits.