Assessing Satisfaction with Training and Technical Assistance Provided to PICH and REACH Awardees

Form Approved

OMB No. 0920-1050

Exp. Date 02/28/2018

Division of Community Health Training, Translation, and Technical Assistance Evaluation

Awardee Survey

REMOTE TECHNICAL ASSISTANCE

Interview Script for Respondents Completing the Survey via Telephone

Public reporting burden of this collection of information is estimated to average 20 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 (0920-1050)

The Centers for Disease Control and Prevention’s (CDC) Division of Community Health (DCH) would like your feedback on the remote technical assistance (TA) you have received from [your evaluation TA Liaison (TAL) / your communication TA Liaison (TAL) / a TACTIC TA provider].

You are being asked to participate in this survey because DCH records show that you received remote TA on [topic] at least once during the past 30 days. Remote TA includes TA you received by phone, videoconference (e.g., Skype, FaceTime, screen sharing apps), and email. The feedback you provide will help DCH assess the quality and utility of training and TA services. Participation in the phone survey is voluntary and strongly encouraged. The survey will take up to 20 minutes to complete. Your responses to this survey will also help DCH enhance existing services and shape future training and TA efforts.

During the data collection phase of the DCH Training and Technical Assistance Evaluation (approximately 3 months), you will be invited to complete this brief survey for each unique training or TA service you receive. CDC has contracted with an independent research institute, RTI, to collect evaluation data. RTI will report findings to CDC in summary form. We will not share individually identifiable responses with CDC.

Do you give your consent to participate in this survey?

• Yes [continue]

• No [thank awardee for their time and end call]

DCH records show that you received [in-person/phone-base TA or in-person/online training] on [topic] at least once recently. Please answer survey questions about this specific TA service.

[Administer survey-CATI]

Thank you for your time. If you have any questions about this survey or the DCH Training and Technical Assistance Evaluation, please contact Tim LaPier at (404) 488-5772 or [email protected].