Survey - Word

Questions for DVP’s Technical Package Web Survey_November 17, 2016

Form Approved

OMB No. 0920-1050

Exp. Date: 2/28/2018

Public Reporting burden of this collection of information is estimated at 5 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 NW, MS D-74, Atlanta, GA 30333; Attn: PRA (0920-1050).

The following 5-question survey will be presented in a pop-up box when a user initiates a download of a technical package for violence prevention at the following link: http://www.cdc.gov/violenceprevention/pub/technical-packages.html.

Thank you for downloading one of the technical packages. As a way to monitor the uptake of the technical packages and better serve the public, we are requesting that you please complete a voluntary, brief 5-question survey. We appreciate your time and effort.

1. Please indicate what type of organization you are affiliated with:

• Local Business

• Community-based Organization

• Education (check one)

• Preschool

• Elementary school

• Middle school

• High school

• College or university

• Other (please specify)

• General Population

• Government (check one)

• Local Health Department

• State Health Department

• Housing/urban development

• Social Services

• Criminal Justice

• Parks and Recreation

• Other (please specify)

• Public or Private Healthcare

• Library

• Media  

• Professional Organization

• Other (please describe)

2. What is your violence prevention focus area? [Please check all that apply]

• Child abuse and neglect

• Teen dating violence

• Intimate partner violence

• Sexual violence

• Suicide

• Youth crime and violence

• Elder abuse

• Other, please specify

3. How did you find out about the Technical Packages website?

• CDC announcement

• Social media

• Search engine

• Referral or links from other sites

• Referral from a colleague

• Media/news story

• Site bookmarked

• Email subscriptions/RSS feeds

• Don’t know/Not sure

• Other, please describe

4. Which of the following best describes how you will use the Technical Package(s)? [Please check all that apply]

• To inform my own work in violence prevention

• To share information about violence prevention with interested stakeholders from other organizations

• To share information about violence prevention with decision-makers in my city or state

• To help with preparing a grant application

• To help select evidence-based strategies to prevent violence in my community

• To learn more about violence prevention in general

• To gather content for training/education materials

• Other, please describe

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