| Custom Questions for OMB Approval |
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| CMS Noridian DME MAC |
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| What led you to visit this site? |
Mailing list |
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Email from CMS / Noridian |
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Web advertisement |
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Prior experience with CMS / Noridian |
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Recommendation from a friend/family member/colleague |
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Search engine |
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New supplier to Noridian |
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Remittance Advice/Noridian Letter |
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Peer or Association Referral |
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Noridian customer service representative |
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Other (please specify) |
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| NCI Main |
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| Did you notice that certain information is available in both patient and health professional versions? |
Yes |
| No |
| Not sure |
| Did you look at: |
Patient |
| Health professional |
| Both versions |
| Neither version |
| Not sure |
| Please complete this sentence: I am visiting the NCI Web site today to find information on _____ (Check all that apply). |
How to prevent cancer |
| Emotional concerns relating to cancer |
| Cancer risk factors or causes (including genetics/family history) |
| Testing for cancer (detection/screening) |
| How to find cancer treatment facilities |
| Standard cancer treatments or therapies |
| Alternative cancer treatments or therapies |
| Managing cancer pain and side effects |
| Medicines or prescription drugs |
| Physicians or cancer specialists |
| Cancer information to print out for a doctor's visit |
| Clinical trials |
| Quitting smoking |
| News related to cancer |
| Cancer statistics |
| The National Cancer Institute |
| Cancer information for a report/paper |
| Cancer prognosis |
| Financial concerns related to cancer |
| Research funding (grants, contracts, etc.) |
| Research tools and resources |
| Research training opportunities |
| Just browsing for cancer information |
| Other (please specify) |
| How many times in the past 6 months have you visited the NCI Web site? |
First time |
| Daily |
| About once a week |
| About once a month |
| Every few months |
| Once or twice |
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| CMS Palmetto GBA J1 MAC |
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| If you would like to be contacted by Palmetto GBA regarding your feedback, please provide your e-mail address. |
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| NIH Main |
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| Which of the following best describes what you are looking for at NIH.gov today? |
Health information for family member, friend, or myself |
| Health information for caregivers |
| Recent medical findings |
| News releases, publications, e-newsletters, video or pod casts |
| Subscription(s) to e-newsletters or RSS feeds |
| Directions or visitor information |
| Clinical trials |
| Career opportunities at NIH |
| Health promotion ideas or materials for organizations or communities |
| Details on NIH Institute and Centers’ programs or products |
| Recovery Act Opportunities |
| Other |
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| CMS NGS J13 MAC |
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| CMS NGS Title XVIII |
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| CMS NGS DME MAC |
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| From time to time, NGS likes to reach out to website visitors to learn more their experiences using the website. If you are over the age of 18 and would be willing to be contacted in the future, please provide your email address. |
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| Are you subscribed to our Listserv? |
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| Please share with us your reason for not subscribing to our Listserv. |
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