Evaluation Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCIRD)

Attachment 2_2015 Immunization Awardee Meeting Evaluation_Survey_Screenshots

2015 Immunization Awardee Meeting Evaluation

OMB: 0920-1026

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2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
Thank you for your participation in the 2015 Immunization Awardee Meeting! Please take time to
complete this evaluation. Your feedback is very important and will be used to help inform future
meetings.

The survey is estimated to take approximately 8 minutes to complete.

Public reporting burden of this collection of information is estimated to average 8 minutes per response. 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. Please 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 Rd., NE (MS D-24); Atlanta, GA 30333; ATTN: PRA (0920-1026).

2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
Meeting Attendance
* 1. I attended the Immunization Awardee Meeting (IAM) on...(Please check all the apply):
Tuesday, July 14th, 2015
Wednesday, July 15th, 2015
Thursday, July 16th, 2015
Friday, July 17th, 2015
I did not attend this meeting

2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
Demographics
* 2. Please indicate your organization (select one):
State health agency
Tribal health department
Local health department
Territorial health department
Partner organization
CDC
Other (please specify)

2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
* 3. Please indicate your position (select all that apply):
Program Manager
VFC Coordinator
AFIX Coordinator
Vaccine Manager
IIS Coordinator
CDC PHA/Field Assignee
CDC Headquarters Staff
Other (please specify)

2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
* 4. How long have you been working in your current position?
<1 year
1-2 years
3-4 years
5-9 years
10+ years

2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
* 5. How long have you been working in the field of immunizations?
<1 year
1-2 years
3-4 years
5-9 years
10+ years
Not applicable -- I do not currently work in this field.

2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
* 6. Have you previously attended the AIM-sponsored Program Manager's Meeting?
Yes
No
Not sure/Don't know

2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
* 7. Please select the column which accurately reflects your level of agreement with the following statements:
As a result of attending the 2015 IAM...
Strongly Agree

Agree

Neither Agree nor
Disagree

Disagree

Strongly Disagree

…I have a better understanding
of CDC’s
requirements/recommendations
for immunization awardees
(i.e., as specified in the IPOM).
…I learned more about how to
implement CDC’s immunization
awardee
requirements/recommendations
(i.e., as specified in the IPOM).
…I was able to establish or
strengthen professional
relationships with CDC staff.
…I was able to establish or
strengthen professional
relationships with non-CDC
staff (e.g., awardees,
partners).
I plan to directly apply what I
learned from the meeting to my
job.
What I learned at the IAM will
improve my job effectiveness.
The content and learning
materials addressed a need or
a gap in my knowledge or skills.
I was able to attend most of the
concurrent sessions that were
of interest to me.
In the future, I would attend a
similar meeting hosted by CDC.

2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
* 8. Was the meeting space comfortable and conducive to learning?
Yes
No
Not sure/Don't know

2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
* 9. What could be improved to make the meeting space comfortable and conducive to learning?
Amount of space available in sessions
Temperature
Lunch options
Other (please specify)

2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
* 10. In your opinion, were some key topics missing from the IAM agenda?
No
Not sure/Don't know
Yes (please specify)

2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
* 11. Were most or all of the key staff from your program/organization able to attend the IAM?
Yes
No
Not sure/Don't know

2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
* 12. What was the primary reason key staff from your program/organization were unable to attend the
IAM (check only one):
Budget/travel restrictions
Conflicts due to personal obligations
Conflicts due to professional obligations
Other (please specify)

2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
* 13. Please select the column which most accurately reflects your answer to the following:
Too little

Just about right

Too much

The amount of time
spent by CDC staff to
provide technical
assistance/training
provided was…
The amount of time
spent by CDC staff to
provide updates or
communicate priorities
was…
The amount of
information provided by
non-CDC staff (e.g.,
awardees, partners)
was…
The amount of “free”
time (e.g., between
sessions for networking,
meetings, or breaks)
was…
The overall length of the
meeting (TuesdayFriday, with two full and
two half days) was…
The amount of time
spent on VFC/PEAR
was...
The amount of time
spent on AFIX was...
The amount of time
spent on IIS was...
The amount of time
spent on HPV
vaccination was...
The amount of time
spent on IPOM and the
cooperative agreement
was...

Too little

Just about right

Too much

The amount of time
spent on the budget
was...
The amount of time
spent on pandemic
influenza/preparedness
was...
The amount of time
spent on adult activities
was...
The amount of time
spent on vaccine
management/spend
plan/VTrckS was...
The amount of time
spent on school
coverage and
exemptions was...
The amount of time
spent on vaccine storage
and handling was...
The amount of time
spent on
communications
strategies was...

2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
14. What did you like most about the IAM?

2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
15. What did you like least about the IAM?

2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
16. Other comments/suggestions:

2015 Immunization Awardee Meeting (IAM) Evaluation
Approved Form
OMB No. 0920-1026
Exp. Date: 07/31/2017
Thank you for completing the Immunization Awardee Meeting (IAM) Evaluation!
Public reporting burden of this collection of information is estimated to average 8 minutes per response. 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. Please 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 Rd., NE (MS D-24); Atlanta, GA 30333; ATTN: PRA (0920-1026).

File Type	application/pdf
File Title	View Survey
File Modified	0000-00-00
File Created	2015-07-29