Attachment K- One Week Phone

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

Attachment K:

One-Week Phone Reminder for Mail Survey Nonrespondents

[Telephone Script]

[Hello X]:

My name is _________ and I am calling from NORC, a not-for-profit research organization that has been contracted by the Agency for Healthcare Research and Quality (AHRQ) to help with their assessment of the Emergency Severity Index (ESI), a triage tool used in emergency departments (EDs). When you requested the ESI training materials (handbook and DVDs), you provided your contact information to participate in a telephone survey about the ESI.

We recently mailed you a letter indicating that we would be contacting you within 1 - 2 weeks to participate in the survey via telephone. As a reminder, your participation in this study is critical to the success of this assessment, and will provide AHRQ with important information about the use and acceptance of the ESI tool by emergency departments.

The survey should take no more than 20 minutes.

Are you available to complete the survey with me now?

<YES>

[Go through survey]

<NO>

I would be happy to work with you to find a more convenient time to call you back.

[Thank respondent for their time and ask if they have any questions. Notify them of toll free number and email address, in case they have questions or want more information in the future]

Public reporting burden for this collection of information is estimated to average 20 minutes per response, the estimated time required to complete the survey. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.