Form 4 Suggested Interviewees Form

Form Approved

OMB No. 0920-xxxx

Exp.Date xx/xx/xxxx

Suggested Interviewees Form

Public reporting burden of this collection of information is estimated to average one hour 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 CDC Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN:  OMB 0920-XXXX

Purpose

The purpose of Suggested Interviewees Form is to determine in advance individuals who could be interviewed during the site visit. On the form you will identify people who represent the categories of program functions that we are interested in learning about. Because every program uses its own names, terms, and arrangements, the information on the tables will help you to be clear about what types of persons we would like to talk with.

Please return the Suggested Interviewees Form to ________ at ICF Macro Inc (insert email address) by (insert date).

After you have returned the Suggested Interviewees Form, an ICF Macro representative will follow up with a call to you to confirm what specific people are to be interviewed. From the list of possible interviewees you provide, we will work with you to set up the number and schedule of interviews that the site visitors will follow during the visit.

• Provide names and affiliation as indicated for each of the categories listed.

• Return the form to ICF Macro by e-mail for review. An ICF Macro representative will arrange a conference call with you and the assigned site visitors to review the list and to ensure that appropriate people have been identified for the interviews.

• After the telephone review, make any needed revisions. An ICF Macro representative will provide you with instructions and a template to assist with confirming each of the selected persons to be interviewed and at what time and location.

Suggested Interviewees Form for __________________

The purpose of this table is to identify a range of people involved with the program and note how they are involved. List the names of the persons involved in the design, delivery, and/or evaluation of the program along with their titles and the main program activities with which they are involved.

Lead Administrator(s) The person who has general oversight of the program. This person usually is involved in higher level conceptual planning and developing the vision for the program, sometimes in securing and managing funding as well. This person usually is in charge of other staff working with the program, including the day-to-day coordinator (if different). Time Required per Interview: 2 hours
Title/Position	Name	Main Program Involvement
Program Staff These roles may include the day-to-day program manager/coordinator who works with the program closely and has oversight for the activities of other staff. This category also includes staff who carry out the daily activities of the program, such as teachers, coaches, nutritionists, cafeteria menu planners, etc. Time Required per Interview: 1 hour
Title/Position	Name	Main Program Involvement
Evaluator(s) If the program has been (or is being) evaluated by others—either internally or externally—please provide the names of those primarily involved with conducting the evaluation. Time Required per Interview: 1 hour
Title/Position	Name	Main Program Involvement
Partner(s) Programs may have external partners who are not staff of the program but who assist with the program activities or its infrastructure in important ways. These could be organizations or specific people who provide various resources to the program. Please note the key partners for the program. Time Required per Interview: 1 hour
Title/Position	Name	Main Program Involvement
Other Stakeholders This category includes people affected by the program (program participants, community members who are closely involved with the program or who could speak about its activities, etc…). Time Required per Interview: 1 hour
Title/Position	Name	Main Program Involvement