0990-0281 Healthy People 2020 Consortium Member Assessment

Form Approved

OMB No. 0990-0281

Exp. Date XX/XX/XX12

Healthy People 2020 Consortium Member Assessment

Purpose of the Assessment

• To learn more about the interests and needs of the Healthy People 2020 Consortium members

• To gather information to develop a Consortium Networking and Communication Plan that will serve and benefit you

• To allow tailoring of Healthy People information—so you receive the information you are interested in; information you can readily use with your networks and colleagues.

1. “Where is your organization located?

 Region I

(Connecticut, Maine, Massachusetts., New Hampshire, Rhode Island, Vermont)

 Region II

(New Jersey, New York, Puerto Rico, Virgin Islands)

 Region III

(Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia)

 Region IV

(Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee)

 Region V

(Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin)

 Region VI

(Arkansas, Louisiana, New Mexico, Oklahoma, Texas)

 Region VII

(Iowa, Kansas, Missouri, Nebraska)

 Region III

(Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming)

 Region IX

(American Samoa, Arizona, California, Guam, Hawaii, Nevada, Northern Mariana Island, Federated States of Micronesia, Marshall Islands, Paulau)

 Region X

(Alaska, Idaho, Oregon, Washington)

OMB BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0281. The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 537-H, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

2. “Which of the following best describes your organization?”

 National  Tribal

 Federal  Territorial

 State  Private

 County  Other (Please specify:) _____

 Local/Community

3. What type or sector best describes your organization?

 Agriculture  Justice/Law Enforcement

 Business/Corporate  Labor

 Community-based  Public Health

 Education (Primary/Secondary)  Professional

 Education (Higher Education)  Research

 Environmental Health  School-based Health

 Faith-based Promotion

 Healthcare/Medical  Transportation

 Housing  Worksite Health Promotion

 Other (Please specify:)

4. Please mark the level of priority each of the Healthy People 2020topic areas has for your organization.

Answer Options	Low Priority	Moderate Priority	High Priority	Very High Priority	Highest Priority	N/A
Access to Health Services
Adolescent Health
Arthritis, Osteoporosis, and Chronic Back Conditions
Blood Disorders and Blood Safety
Cancer
Chronic Kidney Disease
Diabetes
Disability and Secondary Conditions
Early and Middle Childhood
Environmental Health
Family Planning
Food Safety
Genomics
Global Health
Health Communications and Health IT
Healthcare-Associated Infections
Hearing and Other Sensory or Communication Disorders
Heart Disease and Stroke
HIV/AIDS
Immunization and Infectious Diseases
Injury and Violence Prevention
Maternal, Infant and Child Health
Medical Product Safety
Mental Health and Mental Disorders
Nutrition and Weight status
Occupational Safety and Health
Older Adults
Oral Health
Physical Activity and Fitness
Public Health Infrastructure
Quality of Life and Well-Being
Respiratory Diseases
Sexually Transmitted Diseases
Social Determinants of Health
Substance Abuse
Tobacco Use
Vision
Other

5. How important are each of the following in your organization’s decision to participate as a Consortium member?

Answer Options	Not Important	Slightly Important	Moderately Important	Very Important	Critical	N/A
Network and communicate with a wide range of organizations around the goals, objectives and activities of Healthy People 2020
Showcase organizational programs and initiatives that help to achieve the goals and objectives of Healthy People 2020
Receive timely, up-to-date progress on information, activities and resources related to Healthy People 2020
Learn about interventions and implementation strategies that work towards achieving the Healthy People 2020 goals and objectives

6. How likely are you to implement Healthy People 2020 in each of the following ways?

Answer Options	Highly Unlikely	Unlikely	Likely	Highly Likely	N/A
Develop new partnerships within the public health community
Develop new partnerships outside the public health community (Non-traditional partners)
Strengthen current partnerships
Create new disease prevention and health promotion programs/initiatives for the population your organization serves
Strengthen current disease prevention and health promotion programs/initiatives for the population your organization serves
As a tool for measuring program performance
Create your own tailored, organizational-level Healthy People 2020 document using a subset of the national objectives
As a catalyst for funding

7. How likely are you to do each of the following?

Answer Options	Highly Unlikely	Unlikely	Likely	Highly Likely	N/A
Share information about Healthy People 2020 and within your organization
Share information about Healthy People 2020 with your organization’s stakeholders
Share information about Healthy People 2020 with Policy Makers
Discuss through organizational online networking site (e.g., blogs)
Post Healthy People 2020 information on your organization’s Web site
Display the Healthy People 2020 logos on your organization’s Web site
Include information about Healthy People 2020 in your organization’s presentations and events
Disseminate information about Healthy People 2020 in your organization’s publications (e.g., Newsletters)
Participate actively in Healthy People 2020 meetings and activities throughout the decade

8. How useful are each of the following for you to share information about your organization with consortium members?

Answer Options	Not Useful	Somewhat Useful	Useful	Very Useful	N/A
Healthy People 2020 online networking site (e.g., blog)
Online “Activity Registry” to share Healthy People 2020-related programs and activities
Healthy People 2020 Toolkit and/or Planning Guides
Webinars
Healthy People 2020 e-newsletter
Ready-to-use, standard Healthy People 2020 presentation
Ready-to-use, e-announcements and updates
Participation in quarterly conference calls
Participation in bi-annual conference calls
Participation in an annual in-person meeting

9. How useful are each of the following for you to learn about the activities of other consortium members?

Answer Options	Not Useful	Somewhat Useful	Useful	Very Useful	N/A
Healthy People 2020 online networking site (e.g., blog)
Online “Activity Registry” to share Healthy People 2020-related programs and activities
Healthy People 2020 Toolkit and/or Planning Guides
Webinars
Healthy People 2020 e-newsletter
Ready-to-use, standard Healthy People 2020 presentation
Ready-to-use, e-announcements and updates
Participation in quarterly conference calls
Participation in bi-annual conference calls
Participation in an annual in-person meeting

10. In your opinion, what are the most important actions the Consortium can take to help expand the reach of Healthy People 2020?

11. Please provide any additional comments or suggestions you feel would be helpful for the Consortium. (optional)

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