Survey Instructions

D5. Survey Instructions

Form Approved

OMB No. 0920-XXXX

Exp. Date: XX/XX/XXXX

CDC Pilot Study of Community-Based Surveillance of Supports for Healthy Eating/Active Living

INSTRUCTIONS FOR ACCESSING THE WEB-BASED SURVEY SYSTEM

INSTRUCTIONS: Thank you for your participation in the CDC’s Pilot Study of Community-Based Surveillance of Supports for Healthy Eating/Active Living (CBS HE/AL Surveillance Pilot Study). You may need to consult with another person to provide the most accurate and complete information on your local government’s policies. Examples of people with whom you might need to consult include a parks & recreation department representative, procurement/purchasing office representative, or a transportation department representative.

• To access the survey, go to https://www.WEBSITEHERE.com.

• Next enter your unique access ID, or token: XXXXXXXXX. Your token can be used an infinite amount of times until the survey is submitted as final.

• Use your mouse to click on the best response option based on what you know about the policies and initiatives in place in your community. Do not use the browser's back button to navigate through the questionnaire. Please use the arrows at the bottom of each page.

• Your answers will automatically be saved as you advance through the questionnaire.

• You may notice that the numbering of the questions may not progress sequentially as you advance through the questionnaire. This is due to skip patterns resulting from previous answer choices. This is intentional, and requires no action or resolution on your part.

• If you need input from others to complete the survey, you can share the token with your colleagues. Please note, however, that two people cannot access the system with the same token at the same time.

• Your data will be stored, but the survey is not complete until the SUBMIT AS FINAL button is selected. Once this option is selected, the data is final and cannot be changed.

• Your token ID is valid until the survey is saved and submitted.

• Once the survey is completed, you have the option of printing the completed instrument for your records. You can print by selecting the X command.

• Submit your survey as final by selecting the SUBMIT AS FINAL button.

Option: Completing a Paper Copy of the Survey. If you prefer, you can complete the survey in hard-copy form by saving the survey as X file, and printing it on your local computer. By hand, write the token as your ID number on the first page of the hard copy form. The completed, hard-copy survey should be mailed care of Marta Royer, CBS Survey, ICF International, and 11785 Beltsville Dr, Suite 300, Calverton, MD 20705.

Public reporting burden of this collection of information is estimated to average 60 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 CDC Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-XXXX).