Survey Quick Health Data online

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

0990-0379_QHDO Survey Screen Shots (with skip logic notation 6-4-12)

Survey Quick Health Data online

OMB: 0990-0379

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[FOR THOSE RESPONDING YES; A NO RESPONSE SKIPS TO LAST ITEM]







[FOR THOSE RESPONDING YES; A NO RESPONSE SKIPS TO ‘REPORTS’ QUESTION]



[FOR THOSE RESPONDING MODERATELY HELPFUL TO NOT HELPFUL; OTHER RESPONSES SKIP TO ‘REPORTS’ QUESTION]






[FOR THOSE RESPONDING YES; A NO RESPONSE SKIPS TO ‘HOW DID YOU FIRST HEAR ABOUT QHDO’ QUESTION]








[FOR THOSE RESPONDING YES; A NO RESPONSE SKIPS TO ‘WHAT DATA WERE YOU LOOKING FOR?’ QUESTION]



[FOR THOSE RESPONDING 1, 2, OR 3; A RESPONSE OF 4 OR 5 SKIPS TO ‘SYSTEM OUTPUT’ QUESTION]



[FOR THOSE RESPONDING NO ABOVE]








[A YES OR NO RESPONSE TO THE PRIOR LEADS TO THE FOLLOWING QUESTIONS]












[FOR THOSE RESPONDING ‘BUSINESS/WORK ACTIVITY’; OTHERS WILL SKIP TO ‘TELL US WHAT YOU THINK’]





[A RESPONSE OF PERSONAL, SCHOOL, OR BUSINESS LEADS TO THE FOLLOWING]



[ALL RESPONDENTS GET TO THIS FINAL ITEM]


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