Survey - English

Form Approved

OMB No. 0920-1003

Exp. Date: 12/13/2016

Attachment B: Interactive Voice Response Survey for Callers (English)

Interactive Voice Response Survey

"We would like to get feedback on your experience with CDC-INFO. If you would like to participate in a very brief customer satisfaction survey, please press 1. We expect it to take 2 minutes to complete the survey."

If you do not wish to offer feedback about your experience… press 2.

(If the caller does not consent, they will hear a concluding message that says)

Thank you for calling CDC-INFO. Goodbye.

“We will ask you a short set of questions. For each question, you will be given a list of responses. Please listen to all responses before selecting your answer. Then press the appropriate key on your telephone keypad.”

(The options repeat automatically if the caller does not respond)

1. How satisfied are you with the agent who handled your call today?

• Very satisfied (press 1)

• Satisfied (press 2)

• Neutral (press 3)

• Dissatisfied (press 4)

• Very Dissatisfied (press 5)

2. Did you receive the health information you were looking for?

• Yes (press 1)

• No (press 2)

3. Based on the information you received, would you say you are likely to make changes to your lifestyle or your family’s lifestyle.

   • Not Applicable (press 1)

   • Very Likely (press 2)

   • Likely(press 3)

   • Not Likely (press 4)

   • Not Likely at all (press 5)

4. Why did you contact CDC-INFO by phone? – Select option.

• Did not have internet access when you placed your call (press 1)

• Could not find the information you were looking for (press 2)

• Public reporting burden of this collection of information is estimated to average of 2 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 (0920-1003)

  You preferred to speak to a live agent (press 3)

• You do not have access to a doctor or healthcare provider (press 4)

• Other (press 5)

5. Please let us know about any other forms of communication you would like CDC-INFO to offer:

• Texting (press 1 for yes, or 2 for no)

• Social media channels like Facebook and Twitter (press 1 for yes, or 2 for no)

• E-mail (press 1 for yes, or 2 for no)

• Live chat (press 1 for yes, or 2 for no)

The last few questions will help CDC INFO learn more about the people we’re reaching with our service.

6. Are you male or female?

For male, press 1.

For female, press 2.

7. How old are you?

If you are age 19 or under, press 1.

If you are 20-34 years old, press 2

If you are 35-49 years old, press 3.

If you are 50-64 years old, press 4.

If you are age 65 or older, press 5.

8. What ethnicity do you identify with?

If you are Hispanic or Latino, press 1.

If you are Not Hispanic or Latino, press 2.

9. What race do you identify with most?

If you are American Indian or Alaska Native, press 1.

If you are Asian, press 2.

If you are Black or African American, press 3.

If you are Native Hawaiian or Other Pacific Islander, press 4.

If you are White, press 5.

“Again, CDC thanks you for participating in this survey, thank you, good bye.