Cognitive interview

Attachment D – Cognitive Interview Telephone/Video Introduction Script

Form Approved  

OMB No. 0920-XXXX 

Exp. Date: XX/XX/XXXX 

 

Notice – CDC estimates the average public reporting burden for this collection of information as 60 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 this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road, MS D-74, Atlanta, GA 30333; ATTN: PRA (0920-0278).

Assurance of Confidentiality – We take your privacy very seriously.  All information that relates to or describes identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes.  NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (Title III of the Foundations for Evidence-Based Policymaking Act of 2018 (Pub. L. No. 115-435, 132 Stat. 5529)).  In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you.

If respondent has been successfully contacted, continue...

...Hello, my name is [CCQDER Interviewer’s name]. Is this a safe time to talk? If you are driving, I will call you back. I can also call you back if you are too busy.

Introduction and verification of respondent’s name.

Explain why calling

 We are asking for your help as we evaluate questions on public health matters relating to the coronavirus outbreak that will go on CDC surveys

 Phone call takes on average 60 minutes to complete.

Share confidentiality, informed consent, and voluntary participation information.

 All information which would permit identification of an individual, a practice, or an establishment will be held confidential, and will be used for statistical purposes only by NCHS staff and agents and will not be disclosed or released to other persons without your consent. If you have any questions about your rights as a participant in this research study, call NCHS’ Confidentiality Officer at (888) 642-1459.

 CDC Protocol ID: 2016-16, NCHS Laboratory-Based Questionnaire Design.

 Participation is voluntary but will assist greatly in helping further our nation’s understanding of health and how we ask the public about public health issues.

 They may refuse to answer any question, and they may end the interview at any time.

 Nothing that they say will be associated with their identity

 There are no names attached to recordings.

Request consent

 To begin the interview.

 To record the interview.

Begin interview: [See questionnaire in Attachment B]

Thank you and closure