Form 1 NLM MedlinePlus Survey Instrument

OMB Control Number: 0925-0648
Expiration Date: 03/31/2018
Public reporting burden for this collection of information is estimated to average 1 minute 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
current 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 NIH, Project clearance
Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0648). Do not
return the completed form to this address.

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Question Set 1
1. How likely are you to recommend this web page to someone else?
[Multiple choice]
a) Very likely
b) Somewhat likely
c) Not sure
d) Somewhat unlikely
e) Very unlikely

2. Please tell us why:
[Free text response]
Question Set 2
1. How helpful is this web page to you?
[5 star rating selection from “Not helpful” to “Very helpful”]

2. How can we improve this web page?
[Free text response]
Question Set 3
1. Did you find the information you are looking for?
a) Yes
b) No
c) Not sure

2. What is your role in visiting this web page? [Free text response]
a)
b)
c)
d)
e)
f)

Student
Patient, family, friend or general public
Healthcare professional
Researcher or educator
Librarian or information professional
Other

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Sample screenshot of the OMB Burden Statement included at the bottom of a MedlinePlus English
Health Topic page:

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