1 Customer Service and Demographic Questions

NCI/Office of Communications and Public Liaison

APPENDIX 1AB

AUTOMATED CUSTOMER SERVICE AND demographic QUESTIONS

Customer Service Questions

The Public Burden statement for the phone demographics is on the workspace:

https://livehelp.cancer.gov/ci/documents/detail/5/1/12/d20f5cee1379622717570b0dd5ba13012e07435c

The VA Demographics share the public burden statement, which is on the workspace above, here is the actual VA survey:

https://livehelp.cancer.gov/ci/documents/detail/5/6/12/3d59acc925ccbfd3f780e854ed1be3795a3be5a7

Questions:

• Have you used service before?

• How did you find our Service?

• Zip Code?

Demographic Survey Questions

Please select a response from the following responses:

What is your age?

• 1- 18-34

• 2- 35-49

• 3- 50-64

• 4- 65-74

• 5- 75+

What is your Gender?

• 1- Male

• 2- Female

• 3- Don’t know

• 4- I do not wish to respond

Which of These Categories Best Describes You?

• 1- Hispanic or Latino

• 2- Not Hispanic or Latino

• 3- Don’t know

• 4- I do not wish to respond

Which of These Categories Best Describes You?

• 1- American Indian or Alaska Native

• 2- Asian

• 3- Black or African American

• 4- Native Hawaiian or Other Pacific Islander

• 5- White

What Is the Highest Level of Education You Have Completed?

• 1- Some high school or less

• 2- High school graduate

• 3- College graduate

• 4- Post-graduate

• 5- I do not wish to respond

Is There a Place You Usually Go to When You are Sick or Need Advice About Your Health?

• 1- Yes

• 2 -No

• 3- Don't Know

• 4- I do not wish to respond

What Kind of Place Do You Go Most Often?

• 1- A doctor’s office

• 2- A clinic or health center

• 3- The emergency room or urgent care

• 4- Some other place, or

• 5- Don’t know

What Was Your Total Household Income from All Sources Before Taxes Last Year?

• 1- Less than $25,000

• 2- $25,000 - $49,000

• 3- $50,000 - $74,000

• 4- more than $75,000

• 5- I do not wish to respond

Including Yourself, How Many People Living in Your Household are Supported by This Total Household Income?

• 1- 1

• 2- 2

• 3- 3

• 4- 4 or more

• 5- I do not wish to respond