OMB No. 0990-0379
Exp. Date 08/31/2017
How can we improve? Tell us in this six-question survey.
Why did you visit BeTobaccoFree.hhs.gov today? [Multiple choice]
To learn about the health effects of smoking.
To find facts and statistics about smokers.
To learn about US federal and state laws on the use and sale of tobacco.
To learn about nicotine addiction.
To learn about the health effects of secondhand smoke.
I am doing research for a school or professional project.
I am not sure
Other [free text field]
2. Were you able to find what you were looking for? [Single choice]
Yes
Partially
No
Not sure yet/still looking
3. What were you looking for specifically? [Free text field]
4. Do you agree with the following statements? The pages I have read: [Matrix Question]
Are easy to understand
Yes
No
Not sure
Are up to date
Yes
No
Not sure
Allow me to take action
Yes
No
Not sure
5. How can we improve your experience on HHS.gov [free text field]?
6. With which of the following groups do you most strongly identify? [Single choice]
Educators/Researchers
Grantees
Health Care Professionals
HHS Employees/Contractors
Human Services Professionals
Media/Journalists
Government Employees (non-HHS)
Public Policy Professionals/Advocates
Parents/Caretakers
Students/Youth
General Public – please consider other options first.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0379. The time required to complete this information collection is estimated to average five minutes per response, including the time to review instructions, and complete and review the information. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Windows User |
File Modified | 0000-00-00 |
File Created | 2021-01-22 |