0920-0879 PHEP Instrument Word version

Attachment B – PHEP Instrument: Word Version

Form Approved

OMB No. 0920-0879

Expiration Date 01/31/2021

Welcome! This data collection is meant for state, local, and territorial health department preparedness directors. The purpose of this data collection is to understand how useful preparedness-related success stories are to the Public Health Emergency Preparedness (PHEP) grantees, understand how these grantees hear about success stories, and how and with whom stories are shared.

Your feedback is important to us and will help us. Data will be used by DSLR to learn about the reach of stories, improve the story submission process, and identify how DSLR can better support state and local distribution of stories.

Completing the questionnaire is voluntary and takes approximately 3 minutes. All data will be shared in aggregate form. There are no known risks or direct benefits to you from participating or choosing not to participate, but your answers will help CDC improve the utility and distribution of the Centers for Disease Control and Prevention (CDC) Division of State and Local Readiness (DSLR) Public Health Emergency Preparedness (PHEP) Success Stories and collect feedback from stakeholders to improve content of future editions.

If you have any questions or concerns about this assessment, please contact Kelcie Landon at [email protected].

To begin, please click OK.

CDC estimates the average public reporting burden for this collection of information as 3 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 burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0879).

1. Has your jurisdiction developed stories with DSLR?

   • Yes

   • No

   • Not sure

2. I think that stories are an effective way of raising awareness about the importance of preparedness.

• Strongly agree

• Agree

• Disagree

• Strongly disagree

3. The value of having success stories is worth the time commitment of developing stories with DSLR.

• Strongly agree

• Agree

• Disagree

• Strongly disagree

• None of the above (have not developed stories)

4. How does your jurisdiction find out about new PHEP success stories developed by DSLR?

• CDC website

• CDC newsletter (e.g. Friday Update, MCM newsletter)

• Partner (e.g. ASTHO, NACCHO newsletter)

• Social media

• Direct notification from CDC staff

• Other (please specify)

• Not applicable

5. We have received requests for success stories from policymakers or other community members.

• True

• False

6. Who has your jurisdiction shared success stories written by DSLR with (check all that apply):

• With policymakers/representatives

• With preparedness partners (e.g. ASTHO, NACCHO)

• Other (please specify)

• None of the above (have not shared stories)

7. How many policymakers has your jurisdiction sent stories to in the past year?

   • None (I have not shared stories)

• 1-2

• 3-5

• 6-10

• 11 or more

8. How has your jurisdiction shared local and state success stories written by DSLR (check all that apply):

   • I have not shared stories

   • Social media (e.g., Facebook, Twitter, LinkedIn)

   • Public events

   • Media/news outlets

   • In-person meetings

   • Website

   • Newsletter

   • Other (please specify)

9. On average, how often does your jurisdiction share stories?

• I have not shared stories

• Daily

• Weekly

• Monthly

• Quarterly

• Annually (once a year)

10. Our jurisdiction has received positive feedback from audiences with whom we have shared stories.

• True

• False

• Not applicable (have not shared stories)