Attachment M- Three Week Email

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

Attachment M:

Three-Week Email Reminder and Subsequent Email Reminders for Mail Survey Nonrespondents

[Dear X]:

The Agency for Healthcare Research and Quality (AHRQ) at the Department of Health and Human Services (HHS) is conducting an assessment of the Emergency Severity Index (ESI), a triage tool used in emergency departments (EDs). We recently emailed you a link to complete a web-based survey about the ESI. When you requested the ESI training materials (handbook and DVDs), you provided your contact information to participate in a survey about the ESI. We are interested in your thoughts about the ESI tool.

We ask that you complete the web-based survey by visiting www.XXXX.com. If it would be more convenient for you to complete the survey over the phone, or if you would like to receive a hard copy of the survey with a self addressed and stamped envelope, please contact NORC at 1-866-XXXX.

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 satisfaction with the ESI tool; the extent to which the product has improved emergency services, surge planning and preparation; the usefulness of the ESI as compared to other similar triage tools; and potential improvements to the tool.

If you have any questions or would like more information about the assessment, please email NORC at [email protected] or call toll free at 1-866-XXX-XXXX. Thank you in advance for taking the time to complete the survey.

Thank you in advance for taking the time to complete the survey.

Sincerely,

Bruce Siegel, MD, MPH

Research Professor, Department of Health Policy

The George Washington University

Daniel S. Gaylin, MPA

Executive Vice President for Health Research

NORC

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.