Screenshots of all Survey Instruments

Attachment J:
Screenshots of All Web-Based Survey
Measures
Research on the Efficacy and Feasibility of
Essentials for Parenting Toddlers and Preschoolers
Division of Violence Prevention
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention

ScreenShots
Document Information:
System

CDC EFP Assessments

Contract #

200-2014-59973

This document has screenshots for assistance in creating the OMB submission package.

Contents
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SCREENER ................................................................................................................. 2
DETAILED ASSESSMENT .............................................................................................. 6
ROTATING ASSESSMENT #1 ....................................................................................... 24
ROTATING ASSESSMENT #2 ....................................................................................... 29
ROTATING ASSESSMENT #3 ....................................................................................... 30
ROTATING ASSESSMENT #4 ....................................................................................... 31
CORE ASSESSMENT .................................................................................................. 32
KNOWLEDGE ASSESSMENT ........................................................................................ 36
KNOWLEDGE ASSESSMENT MODULE 1 ....................................................................... 39
USEFULNESS ASSESSMENT MODULE 1 ....................................................................... 40
KNOWLEDGE ASSESSMENT MODULE 2 ....................................................................... 41
USEFULNESS ASSESSMENT MODULE 2 ....................................................................... 42
KNOWLEDGE ASSESSMENT MODULE 3 ....................................................................... 43
USEFULNESS ASSESSMENT MODULE 3 ....................................................................... 44
KNOWLEDGE ASSESSMENT MODULE 4 ....................................................................... 45
USEFULNESS ASSESSMENT MODULE 4 ....................................................................... 46
KNOWLEDGE ASSESSMENT MODULE 5 ....................................................................... 47
USEFULNESS ASSESSMENT MODULE 5 ....................................................................... 48
CONSUMER SATISFACTION ASSESSMENT ................................................................... 49
SYSTEM USABILITY ASSESSMENT ............................................................................... 53

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For use with IT SOPs

1. Screener

SCRNScrn01_Rev.png

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SCRNScrn02_OMB.png
If any question on SCRNScrn02 results in “Not Eligible”, the next screen is SCRNScrn04_NotEligible.

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SCRNScrn03.png

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SCRNScrn04_NotEligible.png

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2. Detailed Assessment

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DTLDScrn02.jpg

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DTLDScrn03.jpg

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DTLDScrn05.jpg

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DTLDScrn07.jpg

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DTLDScrn08_FemaleParent.jpg

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DTLDScrn08_MaleParent.jpg

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DTLDScrn09_FemaleParent.jpg

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DTLDScrn09_MaleParent.jpg

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DTLDScrn14.jpg

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DTLDScrn16.jpg

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DTLDScrn18.jpg

DTLDScrn19.jpg
If this is the end of study collection of assessment, the assessment ends.

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DTLDScrn20.jpg

DTLDScrn21_NonWorkingParent.jpg

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DTLDScrn21_WorkingParent.jpg

DTLDScrn22.jpg
If the question “What is your marital/couple status?” is answered “Single, never married”, “Divorced/separated”,
“Widowed”, or “Choose not to answer”, the next screen is DTLDScrn26.

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DTLDScrn23_PartneredParent.jpg

DTLDScrn24_PartneredParent_NonWorkingPartner.jpg

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DTLDScrn24_PartneredParent_WorkingPartner.jpg

DTLDScrn25_PartneredParent.jpg

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DTLDScrn26_OMB.jpg

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3. Rotating Assessment #1

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ROT1Scrn02_FemaleParent.jpg

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ROT1Scrn02_MaleParent.jpg

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ROT1Scrn03_FemaleParent.jpg

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ROT1Scrn03_MaleParent.jpg

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4. Rotating Assessment #2

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ROT2Scrn02.jpg

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5. Rotating Assessment #3

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ROT3Scrn02.jpg

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6. Rotating Assessment #4

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ROT4Scrn02.jpg

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7. Core Assessment

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COREScrn03.jpg

COREScrn04.jpg

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COREScrn05.jpg

COREScrn06.jpg
If time-out was “Never” used in the past 7 days, the assessment ends.

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COREScrn07_UsedTimeOut.jpg

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8. Knowledge Assessment

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KNOWScrn02.jpg

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KNOWScrn03.jpg

KNOWScrn04.jpg

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KNOWScrn05.jpg

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9. Knowledge Assessment Module 1

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10. Usefulness Assessment Module 1

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11. Knowledge Assessment Module 2

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12. Usefulness Assessment Module 2

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13. Knowledge Assessment Module 3

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14. Usefulness Assessment Module 3

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USF3Scrn02.jpg

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15. Knowledge Assessment Module 4

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16. Usefulness Assessment Module 4

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USF4Scrn02.jpg

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17. Knowledge Assessment Module 5

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18. Usefulness Assessment Module 5

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USF5Scrn02.jpg

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19. Consumer Satisfaction Assessment

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20. System Usability Assessment

SUSEScrn01_OMB.jpg

For Document Control use only – do not modify
Template Version Control
Date (yyyymmdd)
2009 09 02

Editor
Mark Friedman

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Description
Modified signature area and updated for Office 2007

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