Exposure assessment community event survey

Form Approved

OMB No. 0923-0059

Exp. Date 06/30/2022

Appendix A1:

ATSDR estimates the average public reporting burden for this collection of information as 5 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 NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0923-0059).

PFAS Exposure Assessment Community Event Evaluation Survey

Thank you for attending this event. We would appreciate your feedback.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Information Provided
The information presented today was clear and easy to understand.
The materials were helpful and contained useful information used (for example, presentation slides, brochures, videos, etc.).
I understand what is happening in my community regarding the PFAS Exposure Assessment.
I understand who to get in touch with if I have a question about the Exposure Assessment project.
I understand what ATSDR will do next in my community for the Exposure Assessment.
Presenter
The presenter spoke in a way that was clear and easy to understand.
The presenter interacted well with the audience.
The presenter seemed well-informed about my community.
Logistics
This event was held at a time that was convenient for me.
This event was held at a location that was convenient for me.

HHS/ATSDR Lockup Graphic

Please continue on the back.

11. How did you hear about this event? Please check all that apply:

□ Letter □ Email □ Flier □ Facebook/Twitter □ Friend or family member

□ ATSDR website □TV □ Other _______________­­­­­­­­____________

12. Was there any information you expected to receive at this event but did not get? Y / N Please explain ___________________________________________________________

13. Do you understand how individuals are selected for potential participation in the Exposure Assessment? Y / N

14. Anything else you want to share? ____________________________________________

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