1 Customer Service and Demographic Questions

Collection of Customer Service, Demographic and Smoking/Tobacco Use Information from NCI's Contact Center, Cancer Information Service (CIS) Clients (NCI)

Appendix 1AB Customer Service and Demographic Questions_2021

OMB: 0925-0208

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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




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleAPPENDIX 1A
SubjectCustomer Service and Demographic Questions
AuthorBurstyn, Ilene (NIH/NCI) [E]
File Modified0000-00-00
File Created2022-03-07

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