Radiation Dose Tool Feedback

Form Approved
OMB No. 0923-0047
Exp. Date 05/31/2016

ATTACHMENT D: Public Information Officers/Public Health Planners

Screening Instrument

Radiation Dose Tool

(Interview)

Public Information Officers/Public Health Planners

interview	Location	Date/Time	Audience
#1	Atlanta, Georgia	TBD	Public Information Officers/Public Health Planners
#2	Atlanta, Georgia	TBD	Public Information Officers/Public Health Planners
#3	Atlanta, Georgia	TBD	Public Information Officers/Public Health Planners
#4	Atlanta, Georgia	TBD	Public Information Officers/Public Health Planners
#5	Atlanta, Georgia	TBD	Public Information Officers/Public Health Planners
#6	Atlanta, Georgia	TBD	Public Information Officers/Public Health Planners
#7	Atlanta, Georgia	TBD	Public Information Officers/Public Health Planners
#8	Atlanta, Georgia	TBD	Public Information Officers/Public Health Planners
#9	Atlanta, Georgia	TBD	Public Information Officers/Public Health Planners

Interview	Location	Date/Time	Audience
#1	Remote	TBD	Public Information Officers/Public Health Planners
#2	Remote	TBD	Public Information Officers/Public Health Planners
#3	Remote	TBD	Public Information Officers/Public Health Planners
#4	Remote	TBD	Public Information Officers/Public Health Planners
#5	Remote	TBD	Public Information Officers/Public Health Planners
#6	Remote	TBD	Public Information Officers/Public Health Planners
#7	Remote	TBD	Public Information Officers/Public Health Planners
#8	Remote	TBD	Public Information Officers/Public Health Planners
#9	Remote	TBD	Public Information Officers/Public Health Planners

Recruit

• Recruit 9 public information officers/ public health planners for interviews to be conducted in Atlanta, Georgia

• Recruit 9 public information officers/ public health planners to be conducted remotely

Public Information Officers/ Public Health Planners

• Recruitment: Recruit 18 participants for onsite and remote interviews

• Incentive: $ 40 for each participant

• Duration: 60 minutes for each session

Hello, my name is ______________ and I am calling from _________, a professional market research firm. I am not selling anything. We are recruiting participants for the Centers for Disease Control and Prevention (CDC) to gather feedback on information CDC provides. May I ask you a few questions to see if you are eligible to participate-this will take about 10 minutes?

[IF RESPONDENT INDICATES THAT THIS IS NOT A GOOD TIME, SCHEDULE A CALL BACK TIME]

[IF NO, THANK YOU and HANG UP]

Call back date/time: _____________________

[Terminate screener as soon as recruiting staff realizes the person does not speak or understand English]

1. Do you work for one of the following:

a. local/county health department

b. state health department

c. tribal health department

d. other (Thank and Terminate)

RECUIT A MIX - NO FEDERAL, NATIONAL ORGS - JUST STATE (RECRUIT 9) and LOCAL/TRIBAL (RECRUIT 9)]

Document on Grid

2. Do you use/access the internet?

   1. Yes

   2. No [IF NO, THANK AND TERMINATE]

3. Do you have internet access through which we can show you streaming video and images?

   1. Yes

   2. No [IF NO, THANK AND TERMINATE]

4. During the interview you will need to view a website with video streaming and images. How will you be viewing the website?

   1. Mobile/Smart Phone [THANK AND TERMINATE]

   2. Tablet (i.e., Ipad, Samsung Galaxy, etc.)

   3. Laptop or Desktop Computer

5. Is communicating information to the public in emergencies a part of your job responsibilities?

   1. Yes

   2. No [IF NO, Question 6]

6. Is planning for emergencies a part of your job responsibilities?

   1. Yes

   2. No [IF NO, THANK AND TERMINATE]

7. What is your current job title? ______________________________________

[ONLY RECRUIT PUBLIC HEALTH WORKERS WHO WORK IN PUBLIC INFORMATION AND COMMUNICATIONS OR PUBLIC HEALTH PLANNING, SUCH AS:]

• Public Information Officer

• Risk Communicator

• Health Communicator

• Radiation Emergency Planner

• WMD Coordinator/Planner

• Emergency/Public Health Preparedness Planner

• Emergency Manager/Planner

8. How many years have you worked in public health? ______________[ RECRUIT A MIX ]

9. In what state, city, and zip code do you currently live? (A.8.a) [ENSURE RECRUITMENT FROM WEST COAST AND/OR ALASKA AND NORTH CAROLINA, SOUTH CAROLINA, GEORGIA, FLORIDA, ALABAMA, MISSISSIPPI, LOUSIANA, TEXAS]

1. West Coast

2. East Coast

3. South

4. North

5. Midwest

10. How would you describe the area in which you serve?

    1. Rural

    2. Suburban

    3. Urban

    4. Mixture of _________

11. Does the area in which you serve include a nuclear power plant, or emergency planning zones for a nuclear power plant?

    1. Yes [RECRUIT 9]

    2. No [RECRUIT 9]

12. ASSESS AND VERIFY ABILITY TO SPEAK AND UNDERSTAND ENGLISH

Those are all of my questions. You do qualify for our interviews and we would like to invite you to join us on _______ at ______ PM. The discussion will last about 60 minutes and will be audio taped. In appreciation for your time, you will be given $40.00 after completing the interview.

Are you willing to participate?

a. Yes [COLLECT CONTACT INFORMATION]

b. No [THANK AND TERMINATE]

If after we hang up, you have a question about the interview or decide you can’t participate, please contact me at ________________.

Contact Information

First and Last Name: _____________________________

Best phone number to reach: ______________________

Email: _________________________________________

Preferred method of contact: ______________________

Best time of day to contact: ________________________

Public reporting burden of this collection of information is estimated to average 10 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 (0920-0572).