CDC Zika website User Experience (UX): Questionnaire

Attachment D

CDC Zika website User Experience (UX): Questionnaire

Form Approved

OMB No. 0920-1050

Expires 02/28/2018

Public reporting burden of this collection of information is estimated to average 30 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 Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0956) 

1. Please tell us about your job:

• Job Title: ____________________________________________________

• Organization where you work: __________________________________

• Number of years you have been in this field: ________________________

• Subject(s) that you teach: ______________________________________

• Grades of the students you work with: ____________________________

2. Please tell us your role:

• Healthcare professionals (including general practitioners, physicians’ assistants, and nurses)

• OBGYNs (including physicians, physicians’ assistants, and nurses)

• Pregnant women and their male partners

• Women who are considering getting pregnant and their male partners

• Individuals who have traveled (or are planning to travel) to an area where Zika is currently present

• Individuals who have live in an area where Zika is currently present

• Parents

• State and local health professionals

• Laboratory staff

• Blood and tissue collection center staff

• Student

• Media

• Other: ____________________________
  
  
  

3. How frequently do you use the CDC website?

• Daily

• Weekly

• Monthly

• Yearly

• Never

4. Are you male or female?

• Male

• Female
  
  
  

5. How old are you?

• 19 or under

• 20-34 years old

• 35-49 years old

• 50-64 years old

• 65 or older

6. What is your highest level of education?

• High school or less

• Some college

• College degree

• Advanced degree

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