Center for States (CBCS) Evaluation: Event Poll

OMB #: 0970-0XXXX

Expiration Date: XX/XX/XXXX

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to gather feedback on capacity building products and services to better meet the needs of child welfare professionals. Public reporting burden for this collection of information is estimated to average 2 minutes per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The control number for this project is 0970-XXXX. The control number expires on XX/XX/XXXX. If you have any comments on this collection of information, please contact Beth Claxon, ACF, Administration on Children, Youth and Families by e-mail at Beth.Claxon@acf.hhs.gov.

Event Poll

PURPOSE: Most peer events with less than will 100 registrants will receive a short event survey in the form of a poll. The exception is when a Center for States product is used or marketed during a specific event, then the event will get a brief survey rather than a live poll in order to collect additional information about product perceptions, use and satisfaction. Live polls consist of questions that are integrated into the technology platform (e.g., Adobe Connect, WebEx) and asked at the end of events.

Instructions for Development of Event Poll

Most peer events with less than will 100 registrants will receive a short event survey in the form of a poll. The exception is when a Center for States product is used or marketed during a specific event, then the event will get a brief survey rather than a live poll in order to collect additional information about product perceptions, use and satisfaction. Live polls consist of questions that are integrated into the technology platform (e.g., Adobe Connect, WebEx) and asked at the end of events. The poll questions listed below will be administered as is; the questions will NOT be tailored to each event. Content specialists will choose the appropriate set of poll questions to ask for each event based on the learning outcomes of the event, either: 1) increasing awareness, knowledge, and skills or 2) improving collaboration and enhancing connections.

Poll Questions for Peer Events Focused on Increasing Awareness, Knowledge or Skills

	Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree or Disagree	Somewhat Agree	Agree	Strongly Agree	NA	Don’t Know
Overall, I was satisfied with the peer activity or event.	SD	2	3	4	5	6	SA	NA	DK
The peer activity or event will be helpful in my work.	SD	2	3	4	5	6	SA	NA	DK
The peer activity or event has increased my knowledge about [Topic].	SD	2	3	4	5	6	SA	NA	DK
Please select the various ways you plan to apply the information from this peer activity or event in your work. (Select all that apply) Support program improvement Support policy development Provide information to clients/families Share with peers Support public awareness/advocacy Grant writing/Fundraising Train staff/colleagues Conduct research & evaluation My own professional development (e.g., increased knowledge) I will not be able to apply this to my work Other (Please describe): __________

Poll Question for Events Focused on Improving Collaboration or Enhancing Connections

	Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree or Disagree	Somewhat Agree	Agree	Strongly Agree	NA	Don’t Know
Overall, I was satisfied with this peer activity or event.	SD	2	3	4	5	6	SA	NA	DK
As a result of my involvement in this Peer activity or event, I have improved my connections with peers/colleagues.	SD	2	3	4	5	6	SA	NA	DK
I have discovered new tools, ideas, & ways of thinking from the relationships developed during this peer activity or event.	SD	2	3	4	5	6	SA	NA	DK
Please select the various ways you plan to apply the information from this peer activity or event in your work. (Select all that apply) Support program improvement Support policy development Provide information to clients/families Share with peers Support public awareness/advocacy Grant writing/Fundraising Train staff/colleagues Conduct research & evaluation My own professional development (e.g., increased knowledge) I will not be able to apply this to my work Other (Please describe): __________

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