Key Informant Interview Invitation Phone Call Checklist

Appendix P – Key Informant Interview Invitation

Phone Call Checklist

P

Form Approved

OMB No. 0923-XXXX

Exp. Date xx/xx/20xx

romotion of the National ALS Registry to

Non-referral Centers: Checklist for Key Informant Interview Invitation to Participate Phone Call to Selected Neurologists’ Offices

Checklist of points to be covered during each call to selected neurologists one week after the Key Informant Interview invitation mailing:

All practices:

• Identify self, where calling from and project

• Identify name and title of person who answered the phone

• Request to speak with neurologist selected for KII (or his/her support staff)

• Remind neurologist (or his/her support staff) about the KII invitation letter that was mailed one week ago

• Do you remember receiving a letter about the KII? Yes/No

• If no:

  • Confirm address and fax number

  • Ask neurologist (or his/her nurse) if we can:

    • Read/summarize the letter over the phone

      • If yes, summarize letter over the phone

      • Do you have any questions about the letter? Yes/No

OR

• Fax a copy of the letter

  • If yes, inform we will call back within 24 hours of sending the fax
    
    

• If yes or if read letter over the phone:

  • Do you have any questions about the letter? Yes/No

  • Would you be interested in being interviewed? Yes/No

  • What days/times work best for you? ______________________________________________________________________________________________________________________________

• Set interview date/time

• Ask if there are any questions

• Confirm mailing address

• Inform neurologist (or his/her support staff) that a confirmation letter and informed consent form will be mailed within 24 hours

• Provide our contact information for any questions in the future

• Thank speaker for their time

Public reporting burden of this collection of information is estimated to average 6 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0923-XXXX).