Form 0920- Att D4_Key_Informant_Recruitment Scheduling

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

Key Informant Recruitment/Scheduling

Evaluation of CDC’s CCC 1017 Program

Name of CCC program is one of 13 CDC-funded comprehensive cancer control (CCC) programs that were awarded additional resources to increase their focus on Policy, System, and Environmental (PSE) change strategies. The additional resources received include staff, ongoing technical assistance and training, and a menu of PSE strategies from which to select those that best fit local context and priorities. This program is known at CDC as the 1017 program.

CDC has asked Battelle, a non-profit research firm with a dedication to furthering public health, to conduct an evaluation of the 1017 program. A major goal of the evaluation is to learn how local programs together with the members of local PSE coalitions/workgroups and other strategic partners have planned and implemented selected PSE strategies and to learn what approaches are successful in advancing PSE change and making a difference to local cancer control efforts. An important part of the evaluation is talking to people who are directly involved with and/or who are familiar with cancer control efforts in each community.

You were selected as a possible participant because you are involved in Name of coalition/task force or because you play an important role in your community. We would like to schedule a time to talk with you about your perceptions of the Name of coalition/task force’s activities and achievements. Through these discussions, we expect to gain insights into how local programs and their partners can be successful in addressing the cancer challenges faced by local communities and states.

We are excited to be part of this national effort. We hope you will be willing to share your perspective and experiences with us. The research team here at Battelle is committed to sharing our results with all of the 1017 programs and their partners so that everyone involved can benefit from what is learned.

We will be visiting your community on _________ and would like to schedule a time to talk to you in person. All of the interviews will follow a standard guide but they will be flexible, informal and conversational in feel. We are requesting about _________ of your time. If you agree to participate, we will contact you again two years later to ask about your impressions of changes during the intervening years. The second interview will be by telephone.

Can we include you in the study? What is your availability to meet during those two days?

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 Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-xxxx).