ATSDR Customer Satisfaction Survey for DCHI Documents (o

Form Approved

OMB No. 0923-0047

Exp. Date 05/31/2016

Attachment C. ATSDR Customer Satisfaction Survey for DCHI Documents (text)

The Agency for Toxic Substances and Disease Registry (ATSDR) recently sent you a public health document. ATSDR is interested in your opinion about the document you received. The information you provide will be used to help us improve our products and services. Your responses will be completely confidential.

1. What is the name of this site? (Select name of site from drop down menu.)

2. How satisfied were you with the accuracy of the document you received from ATSDR?

• Extremely satisfied

• Satisfied

• Neither satisfied nor dissatisfied

• Dissatisfied

• Extremely dissatisfied

3. How clear was the language in the document?

• Extremely clear

• Very clear

• Moderately clear

• Slightly clear

• Not at all clear

4. To what extent do you agree with the following statement: The information in ATSDR’s document is useful to me.

• Strongly Agree

• Agree

• Somewhat Agree

• Somewhat Disagree

• Disagree

• Disagree Completely

Public reporting burden of this collection of information is estimated to average 5 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0923-0047).

5. To what extent do you agree with the following statement: The document answered the questions I had about this site.

• Strongly Agree

• Agree

• Somewhat Agree

• Somewhat Disagree

• Disagree

• Disagree Completely

6. How long did you have to wait before receiving the document you requested?

• Not long at all

• Slightly long

• Moderately long

• Very long

• Extremely long

7. To what extent do you agree with the following statement: The document’s conclusions made sense to me and were supported by the data presented.

• Strongly Agree

• Agree

• Somewhat Agree

• Somewhat Disagree

• Disagree

• Disagree Completely

8. To what extent do you agree with this statement: The visuals in the document (graphs, charts, images) helped me to better understand the information in the document.

• Strongly Agree

• Agree

• Somewhat Agree

• Somewhat Disagree

• Disagree

• Disagree Completely

9. Please rate your overall satisfaction with the document you received from ATSDR (10 = highest satisfaction, 1 = lowest satisfaction)

1 __ 2__ 3__ 4__ 5__ 6 __ 7__ 8__ 9__ 10__

10. Please rate your overall satisfaction with ATSDR as a whole (10 = highest satisfaction, 1 = lowest satisfaction)

1 __ 2__ 3__ 4__ 5__ 6 __ 7__ 8__ 9__ 10__