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A
Pretest
Form
Approved
OMB
No. 0920-0953
Exp.
Date 08/31/2021
PRE-TEST
DEMOGRAPHIC DATA SURVEY FOR occupational Data for Health (ODH)
Prototype usability Testing
Please
circle or highlight
your answers.
What is your
current employment status?
Employed
Unemployed, not
seeking employment
Unemployed, seeking
employment
Prefer not to say
What is your
current retirement status?
Not retired
Retired
Prefer not to say
What is your age
bracket?
18-25
26-39
40-59
>60
Prefer not to say
What is your gender
identify?
Female
Male
Non-binary/third gender
Prefer to
self-describe________________________________________
Prefer not to say
Public
reporting burden of this collection of information is estimated to
average 7 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 (0920-0953).
What is the highest
level of education you’ve achieved?
High-school diploma or GED
Some college
College degree
Graduate degree
None of the above
Prefer not to say
Please rate your
comfort level using computing devices:
Low
Moderate
High
Prefer not to say
Please tell us
about your computing device usage:
Often throughout the day
A few times a day
Several times a week
Rarely
Never
Prefer not to say
Do you have any
prior or current professional experience with electronic health
records software (EHRs)?
Yes
No
Prefer not to say
Do you have any
prior or current experience working in a health-related field?
Yes
No
Prefer not to say
Have you ever held
a job or worked at a business?
Yes
No
Prefer not to say
If you answered yes to
the previous question, please answer the following two questions.
What kind of
business or industry was this? (For example: TV and radio mgt.,
retail shoe store, State Department of Labor)
__________________________________________________________________________________________
What kind of work
were you doing? (For example: farming, mail clerk, computer
specialist.)
_________________________________________________________________________________________
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Kalennyy, Igor (CDC/NIOSH/RHD/SB) (CTR) |
File Modified | 0000-00-00 |
File Created | 2021-01-15 |