3A and 3B SEER Screener for HC Prof and Public

Attachment A: Screener for SEER Stats Reorganization –

Health Care Professionals

Attachment B: Screener for SEER Stats Reorganization - Participants—Public

20548 Deerwatch Place, Ashburn, VA 20147 TEL: (703) 729-0998

Attachment A: Screener for SEER Stats Reorganization -

Health Care Professionals

OMB No.: 0925-0642-03

Expiration Date: 9/30/2014

PRIVACY ACT NOTIFICATION STATEMENT

The National Cancer Program—Sec. 411 [285a] provides authority for collection of information. (For details about the authority see http://codes.lp.findlaw.com/uscode/42/6A/III/C/1.) Personally identifying information (name, address, phone number, and email) are collected to contact participants and arrange a time of participation and to provide an incentive as a thank you for their time. This information will be shared only with those who need to contact participants about the time or with those who will compensate participants for their time. Providing this information is voluntary although without this information, the participant cannot be scheduled or paid. This information is not shared further and it is destroyed after it has been used for these purposes.

NOTIFICATION TO RESPONDENT OF ESTIMATED BURDEN

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0642). Do not return the completed form to this address.

Three Health Care providers are needed to participate in interviews about the presentation of SEER data.

Hello, my name is _________________, calling for User-Centered Design, under contract with the National Cancer Institute. We are recruiting members of the health professions. We would like to ask you a few questions to find out if you qualify and would like to participate. This will only take a few minutes of your time and no one will attempt to sell you anything. This is strictly for research purposes. If you are interested and qualify for the usability testing, you will receive an incentive to participate. Can I ask you a few questions?

1. Do you or anyone in your household work

In the field of web design or usability

In the field of market research

(DISMISS if yes to either of the above)

2. Have you participated in a market research study, such as a focus group or an in-person interview, within the last six months?

Within the last 6 months? (DISMISS)

Over 6 months?

Never?

3. Are you a researcher, a health professional, or media professional with concerns about cancer?

Yes (transfer researcher, or media professional to the other screening)

No DISMISS

4. As a member of a health profession, please tell me your job title and describe what you do. __________________________________________________________________

5. Are any of your responsibilities associated with cancer?

Yes

No DISMISS

6. Have you ever used SEER statistics that are located at the NCI website?

Yes DISMISS

No

7. Please describe the highest level of education you completed.

Less than high school (DISMISS)

High school degree (DISMISS)

Completed a technical or vocational school

Some College

College degree

Some graduate school

Completed graduate school

Graduate degree (MD, PhD.)

Recruit a mix.

8. How many hours per week do you use the Internet for business or personal use, excluding checking your e-mail?

Less than 2 hours a week (DISMISS)

Between 2-5 hours a week

Between 6-15 hours a week

Over 15 hours a week

9. How would you rate your Internet experience? Where 5 is Advanced, 3 is Intermediate, and 1 is Novice. ____________________ (DISMISS anyone who rates him/herself less than 3)

10. Which of the following activities have you done on the Internet? (Check all that apply)

Made a purchase online

Pay bills online

Are active on a Facebook or MySpace account

Downloaded Music or Videos

Looked for information about a hobby or interest

Looked at information from a local, state or government web site

Looked for current news, sports, or weather

DISMISS if respondent has not done at least two of the activities above.

Thank you for taking the time to answer my questions. We will have to check with our client to see if you meet their requirements for participants. If they do approve, we will invite you to participate in a remote interview. For the interview, you will be working one on one with an interviewer and you may look at materials using a computer. This will take about 45 minutes. The sessions will be held between XXXday and YYYday (N1 to N2 dates), at mutually convenient time. We will email you a reminder and directions for participating, and we will call you the day before to confirm your attendance. For your participation, we can offer you an incentive of $75 as a thank you for your time.

Respondent's name ______________________________________

Respondent's availability ______________________________________

Respondent’s email address _______________________________

Telephone number _______________________________________

Attachment B: Screener for SEER Stats Reorganization—Public

N

OMB No.: 0925-0642-03

Expiration Date: 9/30/2014

PRIVACY ACT NOTIFICATION STATEMENT

The National Cancer Program—Sec. 411 [285a] provides authority for collection of information. (For details about the authority see http://codes.lp.findlaw.com/uscode/42/6A/III/C/1.) Personally identifying information (name, address, phone number, and email) are collected to contact participants and arrange a time of participation and to provide an incentive as a thank you for their time. This information will be shared only with those who need to contact participants about the time or with those who will compensate participants for their time. Providing this information is voluntary although without this information, the participant cannot be scheduled. This information is not shared further and it is destroyed after it has been used for these purposes.

NOTIFICATION TO RESPONDENT OF ESTIMATED BURDEN

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0642). Do not return the completed form to this address.

ine (9) individuals are needed to participate in interviews about the presentation of SEER data.

Hello, my name is _________________, calling for User-Centered Design, under contract with the National Cancer Institute. We are recruiting members of the general public who are interested in health matters. We would like to ask you a few questions to find out if you qualify and would like to participate. This will only take a few minutes of your time and no one will attempt to sell you anything. This is strictly for research purposes. If you are interested and qualify for the usability testing, you will receive an incentive to participate. Can I ask you a few questions?

1. Do you or anyone in your household work

In the field of web design or usability

In the field of market research

(DISMISS if yes to either of the above)

2. Are you a researcher, health care professional, or media professional with concerns about cancer?

Yes (transfer these to the other screening)

No

2. Have you participated in a market research study, such as a focus group or an in-person interview, within the last six months?

Within the last 6 months? (DISMISS)

Over 6 months?

Never?

2. Would you say you have an active interest in health matters?

Yes

No

2. Which of these activities have you done in pursuit of your health interests?

Watched TV programs/ listened to radio

Read magazines or books

Researched using the Internet

Obtained brochures or other materials from health care providers

Listened to/watched podcasts

DISMISS if they do not say yes to “Researched using the Internet.”

2. Of the health issues listed here, which of them have you personally pursued for your own interest?

Foodborne illnesses (e.g., salmonella, listeria)

Concussion studies

Heart disease and stroke

Cancer

Orthopedics or Arthritis

Diabetes

Obesity

Vaccine studies

DISMISS if they do not say yes to “Cancer.”

2. Please describe the highest level of education you completed.

Less than high school (DISMISS)

High school degree (DISMISS)

Completed a technical or vocational school

Some College

College degree

Some graduate school

Completed graduate school

Graduate degree (MD, PhD.)

Recruit a mix.

2. How many hours per week do you use the Internet for business or personal use, excluding checking your e-mail?

Less than 2 hours a week (DISMISS)

Between 2-5 hours a week

Between 6-15 hours a week

Over 15 hours a week

2. How would you rate your Internet experience? Where 5 is Advanced, 3 is Intermediate, and 1 is Novice. ____________________ (DISMISS anyone who rates him/herself less than 3)

2. Which of the following activities have you done on the Internet? (Check all that apply)

Made a purchase online

Pay bills online

Are active on a Facebook or MySpace account

Downloaded Music or Videos

Looked for information about a hobby or interest

Looked at information from a local, state or government web site

Looked for current news, sports, or weather

DISMISS if respondent has not done at least two of the activities above.

Thank you for taking the time to answer my questions. We will have to check with our client to see if you meet their requirements of participants. If they do approve, we will invite you to participate in an interview. For the interview, you will be working one on one with an interviewer and you may look at materials using a computer. This will take about 45 minutes. You will participate at the National Cancer Center in Rockville. The sessions will be held on XXXday, DATE at [time] at the lab at Rockville, MD. We will email you a confirmation & directions, and we will call you the day before to confirm your attendance. For your participation, we can offer you an incentive $75 as a thank you for your time.

Respondent's name ______________________________________

Respondent's availability ______________________________________

Respondent’s email address _______________________________

Telephone number _______________________________________

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