Form NFI 2009 NFI 2009 NFI Survey

OMB No. 0915-0212

Exp. Date: XX/XX/20XX

New Freedom Initiative Caregiver Broadcast Survey

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0915-0212. Public reporting burden for this collection of information is estimated to average 2.5 minutes per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: HRSA Reports Clearance Officer, 5600 Fishers Lane,

Room 10-33, Rockville, MD 20857

1. How did you first learn about the broadcast?

From a work colleague

From a friend or relative

At a meeting or conference

From the radio, newspaper or magazine

From an e-mail, listserv or website

Other

2. What is your background or place of employment?

I am a caregiver (paid)

I am a caregiver (unpaid)

I work for a state or local government

I work for a Federal agency

I work for a non-profit

Tribe or Tribal organization

Other

3. Has the webcast increased your knowledge and awareness about caregiving issues?

(5=maximum knowledge and awareness, 1=no knowledge or awareness gained)

5

4

3

2

1

4. Overall, I think the webcast was:

Very interesting and informative

Somewhat interesting and informative

Not at all interesting and informative

5. Please rate the webcast: how useful was it to you?

(5=very useful, 1=not useful)

5

4

3

2

1