Vital Signs Survey

Vital Signs Survey

Form Approved
OMB No: 0920-0956
Exp. Date: March 31, 2016

Online Welcome Message and Consent Form

Thank you for agreeing to help the Centers for Disease Control and Prevention (CDC) evaluate their website. Your feedback is extremely important. We anticipate that it will take approximately 7 minutes to complete these questions.

Your responses to all questions will be kept in a secure manner. All information is used for evaluation purposes only, and CDC does not plan to share the data with anyone outside CDC.

To proceed through the survey, select your answer for each question and click “Agree & Continue”.

Public reporting burden of this collection of information is estimated to average 7 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/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0735)

Survey Questions

1. Which of the following best describes you?

• Individual interested in health issues

• Patient, friend or family member of an individual interested in health issues

• State, county or local health department professional

• Physician

• Nurse, physician's assistant, nurse practitioner

• CDC employee or contractor

• Scientist/Researcher

• Policymaker, legislator or staff

• Other: _________________

2. Which of the following ways do you use Vital Signs?

• As a tool for working with civic leaders and policymakers to consider policy changes in your community

• As a tool that provides easy-to-understand information on a health topic

• As a resource for your partners to use (e.g. Public Health collaborators, Research collaborators, etc.)

• As a tool to present how different states are doing with the health topic

• As a tool for presenting the health problem and what can be done about it to others

• As a resource for you and your family

3. How well does Vital Signs provide you with the amount of information you need to take action on this health topic?

• It provides the right amount of information

• It provides too much information

• It provides too little information

4. Does the information in Vital Signs explain the health issues well?

• Yes

• No

5. How did you find the CDC Vital Signs site?

• Online or mobile advertisement

• CDC text message

• Search engine

• Email subscriptions/RSS Feeds

• Referral or links from other sites

• @Twitter or Facebook site

• Blog post mentioning CDC Vital Signs

• Media/news story

• Other: _________________

Thank you Message

Thank you! You have completed the survey. We appreciate your participation in this evaluation. We value your input and look forward to using your feedback to help us in our ongoing effort to improve the website.

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