Survey

Attachment D: Web Survey Questions

Form Approved

OMB No: 0920-0956

Exp. Date: March 31, 2016

Thank you for agreeing to help the Centers for Disease Control and Prevention (CDC) evaluate public health fact sheets. Your feedback is extremely important. We anticipate that it will take approximately 10 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 answers for each question and click “Next”.

Public reporting burden of this collection of information is estimated to average 10 minutes, 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 (0920-0956)

1. Are you a(n)

   1. Individual interested in health issues or with a specific health concern   

   2. Physician

   3. Nurse, physician’s assistant, nurse practitioner

   4. Health department staff

e. Other

2. How frequently do you use CDC’s web site?

1. Daily

2. Weekly

3. Monthly

4. A couple of times a year

5. About once a year

6. I've never visited the CDC web site  

3. I can find information easily on CDC’s web site.

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

In order to answer the remaining questions, please open and read the [insert fact sheet title] fact sheet. Note: The fact sheet may open up into a new tab or window. Keep the survey open to record your response.

4. In your own words, what is the main point that CDC is trying to communicate?

5. I am able to find the information that I need in the material.

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

6. I understand what CDC wants me to learn or do after reading the information.

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

7. The information is easy to understand.

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

8. In your opinion, what would make this information easier to understand?

Public reporting burden of this collection of information is estimated to average 10 minutes, 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 (0920-0956).