Att 8 Letters_scripts

NHANES - Attachments to Supporting Statement - Attachment 8

Attachment 8

Letters and Scripts

Advance Letter

School Excuse Letter

DEPARTMENT OF HEALTH & HUMAN SERVICES

National Center for Health Statistics

3311 Toledo Road

Hyattsville, Maryland 20782

Dear Principal:

Please excuse the below named student from class to participate in a national health survey conducted by the Centers for Disease Control and Prevention. The date and arrangements we have made for transportation are indicated below.

NAME

DATE

Parent will pick up.

Taxi will pick up.

One of our representatives will pick up.

Student will leave from home.

Thank you for your cooperation and your appreciation of the valuable contribution this student is making to our study. If you need to contact us, please call ___________________.

Sincerely,

__________________________

Stand Manager

As parent/guardian of the above named child, I consent to the arrangements indicated.

__________________________

Signed (Parent/Guardian)

Authorization for Transportation (under 18 yrs)

CDC HEALTH SURVEY

AUTHORIZATION FOR TRANSPORTATION ARRANGEMENTS FOR

PERSONS UNDER 18 YEARS OF AGE

NAME OF CHILD: AGE:

 I consent to transportation of my child to and from the Mobile Exam Center/
Field Office by members of the CDC health survey staff.

 I consent to transportation of my child to and from the Mobile Exam Center/
Field Office in a taxi arranged and paid for by the CDC health survey.

 I will drive.

Children under 16 must come to the Mobile Exam Center accompanied by someone aged 18 and over. Please complete the subsequent section with this in mind. Children under 16 who arrive alone will not be examined.

 Mother will accompany.

 Father will accompany.

 Other person 18 and over will accompany _______________________

Specify

 Will come alone (only for children ages 16 and 17).

(Signature of Parent or Guardian) (Date)

SP ID __ __ __ __ __ __

(Witness)

Example Non-Response Letter

Screener Brochure

Confidentiality Brochure

Suggested Script for Explaining Remuneration for the NHANES examination

The interviewer mentions remuneration using a script such as the following:

After you complete your exam at the mobile exam center we will give you a cash expression of appreciation of the time you’ve given to the survey. We would like to schedule {you/SP} for a {morning/afternoon or evening} appointment. If we are able to schedule you at that time of day {you/SP} will receive {age specific amount of remuneration for coming to randomly assigned session}. It is very important that {you/SP} arrive on time for your appointment. We can also make it easier for {you/SP} to get to the examination center by helping with gasoline, getting a taxi or child care if needed.