Form 9550 950 HRSA enewsletter

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Overview

Welcome and Thank You Text
Model Qsts
Current Custom Qsts
BPHC Insider Custom Qsts
Primary HC Digest Custom Qsts

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Sheet 1: Welcome and Thank You Text

Model Instance Name:
HRSA Email Survey 2015
MID:
Date:	3/12/2015
Welcome and Thank You Text
	Directions:
	This welcome text is shown at the top of the questionnaire window and the thank you text at the bottom. This is a good place to mention the site/company/agency name so the visitor knows whom they are taking the survey for. Feel free to modify the standard Welcome text shown in the box below.
					Examples
					Welcome Text Example
	Welcome Text
	Please take a few minutes to share your opinions, which are essential in helping us provide the best email experience possible.
					Thank You Text Example
	Thank You Text
	Thank you for taking our survey - and for helping us serve you better. Please note you will not receive a response from us based on your survey comments.

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Sheet 2: Model Qsts

Model Instance Name:
HRSA e-newsletter Survey 2015
MID:
Partition: No
Date:	11/3/2015
HRSA e-newsletter Survey
Model questions utilize the ForeSee methodology to determine scores and impacts
	ELEMENTS (drivers of satisfaction)		CUSTOMER SATISFACTION		FUTURE BEHAVIORS
	Look and Feel (1=Poor, 10=Excellent, Don't Know)		Satisfaction		Visit Website (1=Very Unlikely, 10=Very Likely)
	Please rate the visual appeal of the BPHC e-newsletter		What is your overall satisfaction with the BPHC e-newsletter? (1=Very Dissatisfied, 10=Very Satisfied)		How likely are you to visit the BPHC website as a result of receiving the BPHC e-newsletter?
	Please rate the balance of graphics and text in the BPHC e-newsletter.		How well does the BPHC e-newsletter meet your expectations? (1=Falls Short, 10=Exceeds)		Primary Resource (1=Very Unlikely, 10=Very Likely)
	Please rate the readability of the BPHC e-newsletter.		How does the BPHC e-newsletter compare to your ideal e-newsletter? (1=Not Very Close, 10=Very Close)		How likely are you to use the BPHC website as a primary resource for information related to the BPHC e-newsletter?
	E-Newsletter Content (1=Poor, 10=Excellent, Don't Know)				Social Share Content (1=Very Unlikely, 10=Very Likely)
	Please rate the timeliness of the content in the BPHC e-newsletter.				How likely are you to share a BPHC e-newsletter on social media?
	Please rate the relevancy of the BPHC e-newsletter to your information needs.				Future e-newsletter Behavior (1=Very Unlikely, 10=Very Likely)
	Please rate the clarity of information in the BPHC e-newsletter.				How likely are you to open future e-newsletters from BPHC?

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Sheet 3: Current Custom Qsts

Model Instance Name: HRSA e-newsletter Survey 2015				red & strike-through: DELETE	Insider	BPHC Insider
				underlined & italicized: RE-ORDER	Digest	Primary Health Care Digest
				pink: ADDITION
Partition: No
Date:		11/3/2015		blue + -->: REWORDING
HRSA e-newsletter Survey
QID (Group ID)		Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
	ALL		Is the frequency of the HRSA e-newsletters appropriate?	Yes		Drop down, select one	Single	Y		Frequency
				No, I would like to receive them more often
				No, I would like to receive them less often
	ALL		How often would you like to receive e-newsletters from HRSA?	Weekly		Drop down, select one	Single	Y		Frequency Preference
				Every 2 weeks
				Monthly
				Quarterly
	ALL		When would you prefer to receive e-newsletters from HRSA?	Mornings		Drop down, select one	Single	Y		Frequency_Preference of Time
				Afternoons
				Evenings
				No preference
	ALL		What day of the week do you prefer to receive e-newsletters from HRSA?	Monday		Drop down, select one	Single	Y		Frequency_Preference of Day
				Tuesday
				Wednesday
				Thursday
				Friday
				No preference
	ALL		What is your preferred language to receive e-newsletters ?	English		Drop down, select one	Single	Y	Skip Logic Group	Preferred Language
				Spanish
				Both English and Spanish
				Other	A
	ALL	A	What is your preferred language to receive e-newsletters ?			Text area, no char limit		N	Skip Logic Group	Other Preferred Language
	Digest		Which of these organization types best describe the organization to which you belong?	Health Center Program award recipient or grantee		Drop down, select one	Single	Y	OPS Group	Organization Type
				Health Center Program look-alike
				State/Regional Primary Care Association
				National Cooperative Agreement
				Health Center Controlled Network
				Free Clinic
				Bureau of Primary Health Care
				Other bureaus/offices in the Health Resources and Services Administration
				Other	A
	Digest	A	Please describe your organization:			Text field, <100 char		N	OPS Group	Other Organization Type
	Insider		Which of these BPHC offices best describe the one to which you belong?	Office of the Associate Administrator		Radio button, one-up vertical	Single	Y	OPS Group	BPHC Office Type
				Office of Strategic Business Operations
				Office of Policy and Program Development
				Office of Quality Improvement
				Office of Northern Health Services
				Office of Southern Health Services
				Other	A
	Insider	A	Please describe your office:			Text field, <100 char		N	OPS Group	Other BPHC Office
	Digest		Which of these roles best describe you?	Chief Executive Officer or Executive Director	B	Radio button, one-up vertical	Single	Y	Skip Logic Group	Role
				Chief Operating Officer	B
				Chief Financial Officer	B
				Chief Medical Officer or Medical Director	B
				Quality Improvement Officer or Coordinator	B
				Clinician	B
				Pharmacist	B
				Other health professional	B
				Researcher	B
				Consultant	B
				HRSA staff	B
				Prospective Health Center Program Participant
				Other	A,B
	Digest	A	Please describe your role:			Text area, no char limit	Single	N	Skip Logic Group	Other Role
	Digest	B	How long has your organization been a BPHC program participant?	Less than 1 year		Radio button, one-up vertical	Single	Y	Skip Logic Group	BPHC Program Participant
				1 year to less than 5 years
				5 years to less than 10 years
				10 years to less than 20 years
				20 years or more
				Don't know
				Not applicable; I work for HRSA
	Insider		How long have you worked for BPHC?	Less than 1 year		Radio button, one-up vertical	Single	Y		BPHC Employee Length
				1 year to less than 5 years
				5 years to less than 10 years
				10 years to less than 20 years
				20 years or more
				Don't know
	All		Please select your level of agreement with these statements about the BPHC e-newsletters:
			Subject lines are relevant and easy to understand	Agree		Radio button, one-up vertical	Single	Y	Matrix Group	Rate_Subject Lines
				Somewhat Agree
				Somewhat Disagree
				Disagree
			The length of the e-newsletter is appropriate	Agree		Radio button, one-up vertical	Single	Y	Matrix Group	Rate_Email Length
				Somewhat Agree
				Somewhat Disagree
				Disagree
			There is enough information provided for me to take action (if requested)	Agree		Radio button, one-up vertical	Single	Y	Matrix Group	Rate_Enough Info to Take Action
				Somewhat Agree
				Somewhat Disagree
				Disagree
	All		On what device do you typically read BPHC e-newsletters?	Desktop/laptop computer		Radio button, one-up vertical	Single	Y		Device Used to Read Newsletter
				Tablet (iPad, Xoom, Galaxy Tab, Playbook, etc.)
				Smartphone (iPhone, Android, Blackberry, etc.)
				Other
	All		Where do you usually read BPHC e-newsletters ?	At home		Radio button, one-up vertical	Single	Y	Skip Logic Group	Where Read Newsletter
				At work
				Both at home and work
				On the go/during commute
				Other	A
	All	A	Where are you when you read the BPHC e-newsletters?			Radio button, one-up vertical		N	Skip Logic Group	Other Where Read Newsletter
	All		Which of these topics would you like to see in BPHC's e-newsletters?	Health Center Program Policies		Checkbox, one-up vertical	Multi		Skip Logic Group	Topic Preference
				Samples, Templates, or Tool Kits				Y
				Operational Site Visit
				Data and Research
				Trainings and Webinars
				Program Opportunities
				Other	A
	All	A	What other topics would you like to see in BPHC e-newsletters?			Text area, no char limit		N	Skip Logic Group	Other Topic Preference
			What else would you like to see in BPHC e-newsletters?	Success Stories		Checkbox, one-up vertical	Multi	Y		Newsletter Features
				Grantee Spotlights
				Best Practices
				Uniform Data System Data and Research
				Special Populations
				Other
	All		What other improvements would you like BPHC to make to their e-newsletters?			Text area, no char limit		N		Improvements

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Sheet 4: BPHC Insider Custom Qsts

Model Instance Name: HRSA e-newsletter Survey 2015				red & strike-through: DELETE	Insider	BPHC Insider
				underlined & italicized: RE-ORDER	Digest	Primary Health Care Digest
				pink: ADDITION
Partition: No
Date:		11/3/2015		blue + -->: REWORDING
HRSA e-newsletter Survey
QID (Group ID)		Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
	ALL		Is the frequency of the HRSA e-newsletters appropriate?	Yes		Drop down, select one	Single	Y		Frequency
				No, I would like to receive them more often
				No, I would like to receive them less often
	ALL		How often would you like to receive e-newsletters from HRSA?	Weekly		Drop down, select one	Single	Y		Frequency Preference
				Every 2 weeks
				Monthly
				Quarterly
	ALL		When would you prefer to receive e-newsletters from HRSA?	Mornings		Drop down, select one	Single	Y		Frequency_Preference of Time
				Afternoons
				Evenings
				No preference
	ALL		What day of the week do you prefer to receive e-newsletters from HRSA?	Monday		Drop down, select one	Single	Y		Frequency_Preference of Day
				Tuesday
				Wednesday
				Thursday
				Friday
				No preference
	ALL		What is your preferred language to receive e-newsletters ?	English		Drop down, select one	Single	Y	Skip Logic Group	Preferred Language
				Spanish
				Both English and Spanish
				Other	A
	ALL	A	What is your preferred language to receive e-newsletters ?			Text area, no char limit		N	Skip Logic Group	Other Preferred Language
	Insider		Which of these BPHC offices best describe the one to which you belong?	Office of the Associate Administrator		Radio button, one-up vertical	Single	Y	OPS Group	BPHC Office Type
				Office of Strategic Business Operations
				Office of Policy and Program Development
				Office of Quality Improvement
				Office of Northern Health Services
				Office of Southern Health Services
				Other	A
	Insider	A	Please describe your office:			Text field, <100 char		N	OPS Group	Other BPHC Office
	Insider		How long have you worked for BPHC?	Less than 1 year		Radio button, one-up vertical	Single	Y		BPHC Employee Length
				1 year to less than 5 years
				5 years to less than 10 years
				10 years to less than 20 years
				20 years or more
				Don't know
	All		Please select your level of agreement with these statements about the BPHC e-newsletters:
			Subject lines are relevant and easy to understand	Agree		Radio button, one-up vertical	Single	Y	Matrix Group	Rate_Subject Lines
				Somewhat Agree
				Somewhat Disagree
				Disagree
			The length of the e-newsletter is appropriate	Agree		Radio button, one-up vertical	Single	Y	Matrix Group	Rate_Email Length
				Somewhat Agree
				Somewhat Disagree
				Disagree
			There is enough information provided for me to take action (if requested)	Agree		Radio button, one-up vertical	Single	Y	Matrix Group	Rate_Enough Info to Take Action
				Somewhat Agree
				Somewhat Disagree
				Disagree
	All		On what device do you typically read BPHC e-newsletters?	Desktop/laptop computer		Radio button, one-up vertical	Single	Y		Device Used to Read Newsletter
				Tablet (iPad, Xoom, Galaxy Tab, Playbook, etc.)
				Smartphone (iPhone, Android, Blackberry, etc.)
				Other
	All		Where do you usually read BPHC e-newsletters ?	At home		Radio button, one-up vertical	Single	Y	Skip Logic Group	Where Read Newsletter
				At work
				Both at home and work
				On the go/during commute
				Other	A
	All	A	Where are you when you read the BPHC e-newsletters?			Radio button, one-up vertical		N	Skip Logic Group	Other Where Read Newsletter
	All		Which of these topics would you like to see in BPHC's e-newsletters?	Health Center Program Policies		Checkbox, one-up vertical	Multi		Skip Logic Group	Topic Preference
				Samples, Templates, or Tool Kits				Y
				Operational Site Visit
				Data and Research
				Trainings and Webinars
				Program Opportunities
				Other	A
	All	A	What other topics would you like to see in BPHC e-newsletters?			Text area, no char limit		N	Skip Logic Group	Other Topic Preference
			What else would you like to see in BPHC e-newsletters?	Success Stories		Checkbox, one-up vertical	Multi	Y		Newsletter Features
				Grantee Spotlights
				Best Practices
				Uniform Data System Data and Research
				Special Populations
				Other
	All		What other improvements would you like BPHC to make to their e-newsletters?			Text area, no char limit		N		Improvements

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Sheet 5: Primary HC Digest Custom Qsts

Model Instance Name: HRSA e-newsletter Survey 2015				red & strike-through: DELETE	Insider	BPHC Insider
				underlined & italicized: RE-ORDER	Digest	Primary Health Care Digest
				pink: ADDITION
Partition: No
Date:		11/3/2015		blue + -->: REWORDING
HRSA e-newsletter Survey
QID (Group ID)		Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
	ALL		Is the frequency of the HRSA e-newsletters appropriate?	Yes		Drop down, select one	Single	Y		Frequency
				No, I would like to receive them more often
				No, I would like to receive them less often
	ALL		How often would you like to receive e-newsletters from HRSA?	Weekly		Drop down, select one	Single	Y		Frequency Preference
				Every 2 weeks
				Monthly
				Quarterly
	ALL		When would you prefer to receive e-newsletters from HRSA?	Mornings		Drop down, select one	Single	Y		Frequency_Preference of Time
				Afternoons
				Evenings
				No preference
	ALL		What day of the week do you prefer to receive e-newsletters from HRSA?	Monday		Drop down, select one	Single	Y		Frequency_Preference of Day
				Tuesday
				Wednesday
				Thursday
				Friday
				No preference
	ALL		What is your preferred language to receive e-newsletters ?	English		Drop down, select one	Single	Y	Skip Logic Group	Preferred Language
				Spanish
				Both English and Spanish
				Other	A
	ALL	A	What is your preferred language to receive e-newsletters ?			Text area, no char limit		N	Skip Logic Group	Other Preferred Language
	Digest		Which of these organization types best describe the organization to which you belong?	Health Center Program award recipient or grantee		Drop down, select one	Single	Y	OPS Group	Organization Type
				Health Center Program look-alike
				State/Regional Primary Care Association
				National Cooperative Agreement
				Health Center Controlled Network
				Free Clinic
				Bureau of Primary Health Care
				Other bureaus/offices in the Health Resources and Services Administration
				Other	A
	Digest	A	Please describe your organization:			Text field, <100 char		N	OPS Group	Other Organization Type
	Digest		Which of these roles best describe you?	Chief Executive Officer or Executive Director	B	Radio button, one-up vertical	Single	Y	Skip Logic Group	Role
				Chief Operating Officer	B
				Chief Financial Officer	B
				Chief Medical Officer or Medical Director	B
				Quality Improvement Officer or Coordinator	B
				Clinician	B
				Pharmacist	B
				Other health professional	B
				Researcher	B
				Consultant	B
				HRSA staff	B
				Prospective Health Center Program Participant
				Other	A,B
	Digest	A	Please describe your role:			Text area, no char limit	Single	N	Skip Logic Group	Other Role
	Digest	B	How long has your organization been a BPHC program participant?	Less than 1 year		Radio button, one-up vertical	Single	Y	Skip Logic Group	BPHC Program Participant
				1 year to less than 5 years
				5 years to less than 10 years
				10 years to less than 20 years
				20 years or more
				Don't know
				Not applicable; I work for HRSA
	All		Please select your level of agreement with these statements about the BPHC e-newsletters:
			Subject lines are relevant and easy to understand	Agree		Radio button, one-up vertical	Single	Y	Matrix Group	Rate_Subject Lines
				Somewhat Agree
				Somewhat Disagree
				Disagree
			The length of the e-newsletter is appropriate	Agree		Radio button, one-up vertical	Single	Y	Matrix Group	Rate_Email Length
				Somewhat Agree
				Somewhat Disagree
				Disagree
			There is enough information provided for me to take action (if requested)	Agree		Radio button, one-up vertical	Single	Y	Matrix Group	Rate_Enough Info to Take Action
				Somewhat Agree
				Somewhat Disagree
				Disagree
	All		On what device do you typically read BPHC e-newsletters?	Desktop/laptop computer		Radio button, one-up vertical	Single	Y		Device Used to Read Newsletter
				Tablet (iPad, Xoom, Galaxy Tab, Playbook, etc.)
				Smartphone (iPhone, Android, Blackberry, etc.)
				Other
	All			At home		Radio button, one-up vertical	Single	Y	Skip Logic Group	Where Read Newsletter
				At work
				Both at home and work
				On the go/during commute
				Other	A
	All	A	Where are you when you read the BPHC e-newsletters?			Radio button, one-up vertical		N	Skip Logic Group	Other Where Read Newsletter
	All		Which of these topics would you like to see in BPHC's e-newsletters?	Health Center Program Policies		Checkbox, one-up vertical	Multi		Skip Logic Group	Topic Preference
				Samples, Templates, or Tool Kits				Y
				Operational Site Visit
				Data and Research
				Trainings and Webinars
				Program Opportunities
				Other	A
	All	A	What other topics would you like to see in BPHC e-newsletters?			Text area, no char limit		N	Skip Logic Group	Other Topic Preference
			What else would you like to see in BPHC e-newsletters?	Success Stories		Checkbox, one-up vertical	Multi	Y		Newsletter Features
				Grantee Spotlights
				Best Practices
				Uniform Data System Data and Research
				Special Populations
				Other
	All		What other improvements would you like BPHC to make to their e-newsletters?			Text area, no char limit		N		Improvements