0920-1050 Remote Interview Guide

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Att3_ Prong 2 Remote Video Interviews

Dating Matters Customer Satisfaction Survey

OMB: 0920-1050

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Note: Sample sizes (N) indicate the number of respondents who will complete each version of the interview.










OMB Control No. 0920-1050

Exp. Date 05/31/2022


The public reporting burden of this collection of information is estimated to average 60 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 (0920-1050)


Version 1: Coach & Coaches Playbook (N= 2)


You reviewed the page about the role of the Coach in the Dating Matters model:


  1. In your own words, how would you describe the Dating Matters Coach role of the prevention model?

    • Probes: What does it entail? What kinds of activities are involved in carrying it out?

  2. How easy was it to find the information you were interested in on this page?

    • Probe: Did the organization and scope of the information make sense to you? Did you know where to start?

  3. Did you find the kinds of information you would expect to see if you were planning to take on the role of Coach for Dating Matters implementation?

    • Probe: Was anything missing? Was there anything else you would have liked to see here? [Note: This information may be provided elsewhere on the website. If so, state that in response and ask whether they have feedback on that placement of the information.]

    • Probe: Which of the available resources do you think would be most useful to someone planning to serve as a Coach?


Next, please download and open the Coaches Playbook


  1. Was this the document that you reviewed prior to this interview?

  • Yes

  • No


If no, could we take some time to review it now? (prompt to review the table of contents)


  1. If you were serving as the Coach in your community or organization, do you think this guide would provide the information you needed to get started?

  2. What other information or tools would be helpful to you?

  3. How would you rate your interest in implementing or serving in the Coach role?

  • Very Interested (4)

  • Somewhat Interested (3)

  • A Little Interested (2)

  • Not Interested (1)

  1. Based on the information on the Prevention Lead role page and in the Guide to Implementation, how would you rate the feasibility of implementing the model in your community or organization, and why?

  • Definitely Feasible (4)

  • Probably Feasible (3)

  • Probably Not Feasible (2)

  • Definitely Not Feasible (1)


[If needed, define feasibility: By feasibility, we mean the extent to which it would be possible to carry out this component, assuming the required resources were available.]

  1. Please tell me a little more about what makes implementing the Model seem more or less feasible.








Version 2: Prevention Lead and Guide to Implementation (N= 2)


You reviewed the page about the role of the Prevention Lead in the Dating Matters Model:


  1. In your own words, what is the Prevention Lead responsible for?

    • Probes: What might their day-to-day job look like as part of Dating Matters?

  2. How easy was it to find the information you were interested in on this page?

    • Probe: Did the organization and the scope of the information make sense to you? Did you know where to start?

  3. Did you find the kinds of information you would expect to see if you were planning to take on the role of Prevention Lead for Dating Matters Implementation?

    • Probe: Was anything missing? Was there anything else you would have liked to see here? [Note: This information may be provided elsewhere on the website. If so, state that in response and ask whether they have feedback on that placement of the information.]

    • Probe: Which of the available resources do you think would be most useful to someone planning to serve as Prevention Lead?


Next, please download and open the Dating Matters Guide to Implementation pdf.


  1. Was this the document that you reviewed prior to this interview?

  • Yes

  • No

  1. If no, could we take some time to review it now? (prompt to review the table of contents)

    • If you were serving as the Prevention in your community or organization, do you think this guide would provide the information you needed to get started?

    • What other information or tools would be helpful to you?

  2. How would you rate your interest in implementing the Dating Matters Comprehensive Model in your community or organization?

    • Very Interested (4)

    • Somewhat Interested (3)

    • A Little Interested (2)

    • Not Interested (1)

  3. Based on the information on the Prevention Lead role page and in the Guide to Implementation, how would you rate the feasibility of implementing the model in your community or organization, and why?

  • Definitely Feasible (4)

  • Probably Feasible (3)

  • Probably Not Feasible (2)

  • Definitely Not Feasible (1)


[If needed, define feasibility: By feasibility, we mean the extent to which it would be possible to carry out this component, assuming the required resources were available.]

  1. Please tell me a little more about what makes implementing the Model seem more or less feasible.








Version 3: Youth Programs Facilitator (N= 3)


You reviewed the page about the role of the Youth Program Facilitator in the Dating Matters model.


  1. In your own words, what is the Youth Program Facilitator responsible for?

    • Probe: What might their day-to-day job look like as part of Dating Matters?

  1. How easy was it to find the information you were interested in on this page?

    • Probe: Did the organization of the information make sense to you? Did you know where to start?

  1. Did you find the kinds of information you would expect to see if you were planning to take on the role of Youth Program Facilitator?

    • Probe: Was anything missing? Was there anything else you would have liked to see here? [Note: This information may be provided elsewhere on the website. If so, state that in response and ask whether they have feedback on that placement of the information.]

    • Probe: Which of the available resources do you think would be most useful to someone planning to serve as a Youth Program Facilitator?


Next, you reviewed the component page about the Dating Matters Youth Programs:


  1. Did the organization and scope of the information on the main page for the youth programs make sense to you?

    • Probe: Did you know where to start?

  1. In your own words, how would you describe the Youth Programs?

    • Probes: What does it entail? What kinds of activities are involved in carrying it out?

  1. Did you review the At-A-Glance document on the page?

    • Did it include the information you would want to see?

    • Did it provide a sufficient overview for you to determine your level of interest in learning more?

  1. How would you rate your interest in implementing the Youth Programs in your community or organization?

  • Very Interested (4)

  • Somewhat Interested (3)

  • A Little Interested (2)

  • Not Interested (1)

  1. Based on the information on the Prevention Lead role page and in the Guide to Implementation, how would you rate the feasibility of implementing the model in your community or organization, and why?

  • Definitely Feasible (4)

  • Probably Feasible (3)

  • Probably Not Feasible (2)

  • Definitely Not Feasible (1)


[If needed, define feasibility: By feasibility, we mean the extent to which it would be possible to carry out this component, assuming the required resources were available.]

  1. Please tell me a little more about what makes implementing the Model seem more or less feasible.







Version 4: Prevention Lead and Guide to Using Indicator Data (N= 2)


You reviewed the page about the role of Prevention Lead in the Dating Matters model.


  1. In your own words, what is the Prevention Lead responsible for?

    • Probes: What might their day-to-day job look like as part of Dating Matters

  1. How easy was it to find the information you were interested in on this page?

    • Probe: Did the organization of the information make sense to you? Did you know where to start

  1. Did you find the kinds of information you would expect to see if you were planning to take on the role of Prevention Lead for Dating Matters Implementation?

    • Probe: Was anything missing? Was there anything else you would have liked to see here? [Note: This information may be provided elsewhere on the website. If so, state that in response and ask whether they have feedback on that placement of the information.]

    • Probe: Which of the available resources do you think would be most useful to someone planning to serve as Prevention Lead?


Next, you reviewed the component page about the Guide to Using Indicator Data:


  1. Did the organization and scope of the information on the main page for the Guide to Using Indicator Data make sense to you? Did you know where to start?

  2. In your own words, how would you describe the Guide to Using Indicator Data?

    • Probe: what does it entail? What kinds of activities are involved in carrying it out?

  1. Did you review the At-A-Glance document on the page?

    • Did it include the information you would want to see?

    • Did it provide a sufficient overview for you to determine your level of interest in learning more?


Next, please download and open the Dating Matters Guide to Implementation pdf.


  1. Was this the document that you reviewed prior to this interview?

  • Yes

  • No

  1. If no, could we take some time to review it now? (prompt to review the table of contents)

    • If you were serving as the Prevention in your community or organization, do you think this guide would provide the information you needed to get started?

    • What other information or tools would be helpful to you?

  1. How would you rate your interest in implementing the Dating Matters Guide to Using Indicator Data in your community or organization?

    • Very Interested (4)

    • Somewhat Interested (3)

    • A Little Interested (2)

    • Not Interested (1)

  1. Based on the information on the Prevention Lead role page and in the Guide to Implementation, how would you rate the feasibility of implementing the model in your community or organization, and why?

  • Definitely Feasible (4)

  • Probably Feasible (3)

  • Probably Not Feasible (2)

  • Definitely Not Feasible (1)


[If needed, define feasibility: By feasibility, we mean the extent to which it would be possible to carry out this component, assuming the required resources were available.]

  1. Please tell me a little more about what makes implementing the Model seem more or less feasible.

Version 5: Prevention Lead Role & Guide to Informing Policy (N= 2)


You reviewed the page about the role of the Prevention Lead in the Dating Matters model.


  1. In your own words, what is the Prevention Lead responsible for?

    • Probe: What might their day-to-day job look like as part of Dating Matters?

  1. How easy was it to find the information you were interested in on this page?

    • Probe: Did the organization of the information make sense to you? Did you know where to start?

  1. Did you find the kinds of information you would expect to see if you were planning to take on the role of Prevention Lead for Dating Matters Implementation?

    • Probe: Was anything missing? Was there anything else you would have liked to see here? [Note: This information may be provided elsewhere on the website. If so, state that in response and ask whether they have feedback on that placement of the information.]

    • Probe: Which of the available resources do you think would be most useful to someone planning to serve as Prevention Lead?


Next, return to the home page and find the page about the Guide to Informing Policy.


  1. Did the organization and scope of the information on the component page for the Guide to Informing Policy make sense to you?

    • Probe: Did you know where to start?

  1. In your own words, how would you describe the Dating Matters Guide to Informing Policy?

    • Probe: What does it entail? What kinds of activities are involved in carrying it out?

  1. Did you review the At-A-Glance document on the page?

    • Did it include the information you would want to see?

    • Did it provide a sufficient overview for you to determine your level of interest in learning more?

  1. How would you rate your interest in implementing the Guide to Informing Policy in your community or organization?

  • Very Interested (4)

  • Somewhat Interested (3)

  • A Little Interested (2)

  • Not Interested (1)

  1. Based on the information on the Prevention Lead role page and in the Guide to Implementation, how would you rate the feasibility of implementing the model in your community or organization, and why?

  • Definitely Feasible (4)

  • Probably Feasible (3)

  • Probably Not Feasible (2)

  • Definitely Not Feasible (1)


[If needed, define feasibility: By feasibility, we mean the extent to which it would be possible to carry out this component, assuming the required resources were available.]

  1. Please tell me a little more about what makes implementing the Model seem more or less feasible.


Next, return to the Guide to Informing Policy page and access the online Guide.


  1. Did you review the Interactive Guide to Informing Policy prior to this interview?

  • Yes

  • No

  1. If no, could we take some time to review it now? (prompt each primary navigation link)

    1. If you were serving as Prevention Lead for implementing Dating Matters in your community or organization, do you think this guide would provide the information you needed to get started?

    2. What other information or tools would be helpful to you?

  2. When you reviewed the Dating Matters Guide Interactive to Informing Policy, where did you go first?

    1. The three top navigation boxes OR

    2. The Policy Process

  3. Did you watch the videos in the Overview section?

    1. Yes

    2. No

  4. After exploring the Dating Matters Interactive Guide to Informing Policy, I understand how to support policy efforts in my community.

    1. Yes

    2. No

  5. What was the most helpful information in the Dating Matters Interactive Guide to Informing Policy?

  6. What improvements would make the Dating Matters Interactive Guide to Informing Policy more helpful?































Version 6: Parent Program Facilitator (N= 3)


You reviewed the page about the role of the Parent Program Facilitator in the Dating Matters model.


  1. In your own words, what is the Parent Program Facilitator responsible for?

    1. Probe: What might their day-to-day job look like as part of Dating Matters?

  1. How easy was it to find the information you were interested in on this page?

    1. Probe: Did the organization of the information make sense to you? Did you know where to start?

  1. Did you find the kinds of information you would expect to see if you were planning to take on the role of Parent Program Facilitator for Dating Matters?

    1. Probe: Was anything missing? Was there anything else you would have liked to see here? [Note: This information may be provided elsewhere on the website. If so, state that in response and ask whether they have feedback on that placement of the information.]

    2. Probe: Which of the available resources do you think would be most useful to someone planning to serve as Parent Program Facilitator?


Next, you reviewed the component page about the Dating Matters Parent Programs:


  1. Did the organization and scope of the information on the main page for the Parent Programs make sense to you?

    1. Probe: Did you know where to start?

  1. In your own words, how would you describe the Parent Programs?

    1. Probes: What do they entail? What kinds of activities are involved in carrying it out?

  1. Did you review the At-A-Glance document on the page?

    1. Did it include the information you would want to see?

    2. Did it provide a sufficient overview for you to determine your level of interest in learning more?

  1. How would you rate your interest in implementing the Parent Programs in your community or organization?

  • Very Interested (4)

  • Somewhat Interested (3)

  • A Little Interested (2)

  • Not Interested (1)

  1. Based on the information on the Prevention Lead role page and in the Guide to Implementation, how would you rate the feasibility of implementing the model in your community or organization, and why?

  • Definitely Feasible (4)

  • Probably Feasible (3)

  • Probably Not Feasible (2)

  • Definitely Not Feasible (1)


[If needed, define feasibility: By feasibility, we mean the extent to which it would be possible to carry out this component, assuming the required resources were available.]

  1. Please tell me a little more about what makes implementing the Model seem more or less feasible.







Version 7: i2i Program Facilitator (N= 2)


You reviewed the page about the role of the i2i Program Facilitator in the Dating Matters Model


  1. In your own words, what is the i2i Program Facilitator responsible for?

    1. Probe: What might their day-to-day job look like as part of Dating Matters?

  1. How easy was it to find the information you were interested in on this page?

    1. Probe: Did the organization of the information make sense to you? Did you know where to start?

  1. Did you find the kinds of information you would expect to see if you were planning to take on the i2i Program Facilitator role for Dating Matters implementation?

    1. Probe: Was anything missing? Was there anything else you would have liked to see here? [Note: This information may be provided elsewhere on the website. If so, state that in response and ask whether they have feedback on that placement of the information.]

    2. Probe: Which of the available resources do you think would be most useful to someone planning to serve as an i2i Program Facilitator?


Next, you reviewed the component page about the Dating Matters i2i Youth Communications Program:


  1. Did the organization and scope of the information on the main page for the i2i Youth Communications Program make sense to you?

    1. Probe: Did you know where to start?

  1. In your own words, how would you describe the i2i Youth Communications Program?

    1. Probes: What does it entail? What kinds of activities are involved in carrying it out?

  1. Did you review the At-A-Glance document on the page?

    1. Did it include the information you would want to see?

    2. Did it provide a sufficient overview for you to determine your level of interest in learning more?

  1. How would you rate your interest in implementing the i2i Youth Communications Program in your community or organization?

  • Very Interested (4)

  • Somewhat Interested (3)

  • A Little Interested (2)

  • Not Interested (1)

  1. Based on the information on the Prevention Lead role page and in the Guide to Implementation, how would you rate the feasibility of implementing the model in your community or organization, and why?

  • Definitely Feasible (4)

  • Probably Feasible (3)

  • Probably Not Feasible (2)

  • Definitely Not Feasible (1)


[If needed, define feasibility: By feasibility, we mean the extent to which it would be possible to carry out this component, assuming the required resources were available.]

  1. Please tell me a little more about what makes implementing the Model seem more or less feasible.






Version 8: Coach Role, Training for Educators Component, and DM-CAPT (N= 1)


You reviewed the page about the role of the Coach in the Dating Matters model:


  1. In your own words, what is the Coach responsible for?

    1. Probe: What might their day-to-day job look like as part of Dating Matters?

  1. How easy was it to find the information you were interested in on this page?

    1. Probe: Did the organization and scope of the information make sense to you? Did you know where to start?

  1. Did you find the kinds of information you would expect to see if you were planning to take on the role of Coach for Dating Matters implementation?

    1. Probe: Was anything missing? Was there anything else you would have liked to see here? [Note: This information may be provided elsewhere on the website. If so, state that in response and ask whether they have feedback on that placement of the information.]

    2. Probe: Which of the available resources do you think would be most useful to someone planning to serve as a Coach?


Next, return to the home page. Now we will review the Dating Matters Training for Educators:


  1. Did the organization and scope of the information on the main page for the Training for Educators make sense to you?

    1. Probes: Did you know where to start?

  1. In your own words, how would you describe the Training for Educators?

    1. Probes: What does it entail? What kinds of activities are involved in carrying it out?

  1. Did you review the At-A-Glance document on the page?

    1. Did it include the information you would want to see?

    2. Did it provide a sufficient overview for you to determine your level of interest in learning more?

  1. How would you rate your interest in implementing the Training for Educators in your community or organization?

  • Very Interested (4)

  • Somewhat Interested (3)

  • A Little Interested (2)

  • Not Interested (1)

  1. Based on the information on this page you just discussed how would you rate the feasibility of implementing the Training for Educators in your community or organization, and why?

  • Definitely Feasible (4)

  • Probably Feasible (3)

  • Probably Not Feasible (2)

  • Definitely Not Feasible (1)


  • [If needed, define feasibility: By feasibility, we mean the extent to which it would be possible to carry out this component, assuming the required resources were available.]

  • Please tell me a little more about what makes the component seem more or less feasible.


Next, return to the home page. Now we will review the Dating Matters Capacity and Planning Tool.


  1. Did the organization and scope of the information on the main page for the Capacity and Planning Tool make sense to you?

    1. Probes: Did you know where to start?

  1. In your own words, how would you describe the Capacity and Planning Tool?

    1. Probes: What does it entail? What kinds of activities are involved in carrying it out?

  1. Did you review the At-A-Glance document on the page?

    1. Did it include the information you would want to see?

    2. Did it provide a sufficient overview for you to determine your level of interest in learning more?

  1. How would you rate your interest in implementing the Capacity and Planning Tool in your community or organization?

  • Very Interested (4)

  • Somewhat Interested (3)

  • A Little Interested (2)

  • Not Interested (1)

  1. Based on the information on the Prevention Lead role page and in the Guide to Implementation, how would you rate the feasibility of implementing the model in your community or organization, and why?

  • Definitely Feasible (4)

  • Probably Feasible (3)

  • Probably Not Feasible (2)

  • Definitely Not Feasible (1)


[If needed, define feasibility: By feasibility, we mean the extent to which it would be possible to carry out this component, assuming the required resources were available.]

  1. Please tell me a little more about what makes implementing the Model seem more or less feasible.




























End of interview for all assignments


Overall, on a scale of 1-10 with 10 being exceptional, how would you rate the quality, scope, and accessibility of the resources available from the Dating Matters Toolkit?


Are there any other thoughts you would like to share about the Dating Matters model, the Toolkit resources, or the design of the website?





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