Web Usability Study for CDC's Radiation Emergencies Website

Form approved
OMB No: 0920-1050
Expiration Date: 6/30/2019

Attachment A: Public Health Officials Screening Instrument

Interview	Location	Date/Time	Audience
#1	Remote	TBD	Public Information Officers
#2	Remote	TBD	Public Information Officers
#3	Remote	TBD	Public Information Officers
#4	Remote	TBD	Public Information Officers
#5	Remote	TBD	Public Information Officers
#6	Remote	TBD	Public Information Officers
#7	Remote	TBD	Public Information Officers
#8	Remote	TBD	Public Information Officers
#9	Remote	TBD	Public Information Officers
#10	Remote	TBD	Public Information Officers
#11	Remote	TBD	Public Information Officers
#12	Remote	TBD	Public Information Officers
#13	Remote	TBD	Public Information Officers
#14	Remote	TBD	Public Information Officers
#15	Remote	TBD	Public Information Officers
#16	Remote	TBD	Public Information Officers
#17	Remote	TBD	Public Information Officers
#18	Remote	TBD	Public Information Officers

Recruit

• Recruit 18 public health officials for remote interviews

Public Health Officials

• Recruitment: Recruit 18 participants for remote interviews

• Incentive: $20 for remote participants

• Duration: 60 minutes for each session

Hello, my name is ______________ and I am calling from _________, a professional market research firm. I am not selling anything. We are recruiting participants for the Centers for Disease Control and Prevention (CDC) to gather feedback on information CDC provides. May I ask you a few questions to see if you are eligible to participate-this will take about 10 minutes?

[IF RESPONDENT INDICATES THAT THIS IS NOT A GOOD TIME, SCHEDULE A CALL BACK TIME]

[IF NO, THANK YOU and HANG UP]

Call back date/time: _____________________

[Terminate screener as soon as recruiting staff realizes the person does not speak or understand English]

1. Do you work for one of the following:

• local/county health department

• state health department

• emergency management agency

• tribal health department [THANK AND TERMINATE]

• other [THANK AND TERMINATE]

[DOCUMENT ON GRID]

2. Is planning for radiological and nuclear incidents a part of your job responsibilities?

• Yes

• No [IF NO, THANK AND TERMINATE]

[DOCUMENT ON GRID]

3. Do you use/access the internet?

• Yes

• No [IF NO, THANK AND TERMINATE]

4. During the interview you will need to view a website. How will you be viewing the website?

• Mobile/Smart Phone [THANK AND TERMINATE]

• Tablet (i.e., IPad, Samsung Galaxy, etc.) [THANK AND TERMINATE]

• Laptop or Desktop Computer

5. What is your current job title? ______________________________________

PLEASE RECRUIT A MIX OF THE FOLLOWING POSITIONS:

• Public Information Officer

• Risk Communicator

• Health Communicator

• Public Health Preparedness

• Radiation Control

• Emergency Management

[DOCUMENT ON GRID]

6. How many years have you worked in radiological and nuclear planning?

• 0-5 Years

• 6-10 Years

• 11 Years or more

[RECRUIT A MIX]

[DOCUMENT ON GRID]

7. In what area of the country do you currently live?

• West Coast

• East Coast

• South

• North

• Midwest

[RECRUIT A MIX]

[DOCUMENT ON GRID]

8. How would you describe the area in which you serve?

• Rural

• Suburban

• Urban

• Mixture of _________

[RECRUIT A MIX]

[DOCUMENT ON GRID]

9. Does the area in which you serve include a nuclear power plant, or emergency planning zones for a nuclear power plant?

   1. Yes [RECRUIT 5]

   2. No [RECRUIT 4]

[DOCUMENT ON GRID]

Those are all of my questions. You do qualify for our interviews and we would like to invite you to join us on _______ at ______ AM/PM. The discussion will last about 60 minutes. In appreciation for your time, you will be given $20.00 after completing the interview.

Are you willing to participate?

a. Yes [COLLECT CONTACT INFORMATION]

b. No [THANK AND TERMINATE]

Prior to the start of the interview, you will receive an information sheet with such information as sponsorship of the study and who to contact for more information via email. If after we hang up, you have a question about the interview or decide you can’t participate, please contact me at ________________.

Contact Information

First and Last Name: _____________________________

Address for remote participants to receive their gift cards:

__________________________________________

Best phone number to reach: ______________________

Email: _________________________________________

Preferred method of contact: ______________________

Best time of day to contact: ________________________

CDC estimates the average public reporting burden for this collection of information as 10 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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 (0920-1050)