Invitation and Consent Form for Consumer Survey

OMB Control Number: 0990-0281

ODPHP Generic Information Collection Request: Prevention Communication and Formative Research

Audience Research to Inform Physical Activity Guidelines Strategic Communication

Attachment A:

Invitation and Consent Form for Consumer Survey (Supplemental Materials)

March 28, 2019

Submitted to:

Sherrette Funn

Office of the Chief Information Officer

U.S. Department of Health and Human Services

Submitted by:

Frances Bevington

Strategic Communication and Public Affairs Advisor

Office of Disease Prevention and Health Promotion

U.S. Department of Health and Human Services

Survey Invitation

Sample Email Invitation – sent by Qualtrics

10 Minutes

Consent Form

Who is working on this project?

This project is being coordinated by CommunicateHealth, a health communication consulting firm, on behalf of the Office of Disease Prevention and Health Promotion (ODPHP), which is part of the U.S. Department of Health and Human Services (HHS).

What is the goal of this project?

We are working to identify the best way to communicate about physical activity at the local level. Our goal is to develop information and tools that help people be more physically active.

How can I help?

We are interested in learning about the role physical activity plays in your life. Your feedback in this survey will help us make sure we create physical activity-related information and tools that meet the needs of people like you.

Do I have to participate in this project?

No. It is your choice whether to participate or not. You can stop at any time.

How will you protect my privacy?

Survey data will be kept private to the extent allowable by law. We will not collect or store any of your personal information. Also, your responses will not be linked with your name.

For more information:

If you have questions about the project, contact Senior Health Communication Researcher Lizzie Barnett at [email protected] or (413) 582-0425. 

1. I have read the above information and agree to participate. By clicking Yes, you consent that you are willing to answer the questions in this survey.

• Yes

• No [TERMINATE]