Form 9600-033 Train-the-Trainer Pre-Survey

OMB Control No. 2030-0051

Expiration Date 5/31/2024

Train-the-Trainer Pre-Survey

 

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2030-0051). Responses to this collection of information are voluntary (40 CFR §745). 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. The public reporting and recordkeeping burden for this collection of information is estimated to range from five to fifteen minutes per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address. 

 

This survey is anonymous, and EPA will use your answers solely to improve outreach for future sessions. We will not share this information with any third party. 

 

To provide participants with the best experience possible, EPA has designed a short survey to help gather information about you and your community’s knowledge and awareness of lead. Thank you for taking the time to answer our questions.

 

Survey Questions: 

 

1. In which community are you located? 

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2. How informed are you about the risk of lead exposure and lead poisoning in your community? 

   1. Scale: 1 (Not informed) – 2 (Slightly informed) – 3 (Moderately informed) – 4 (Well informed)  

 

3. How familiar are you with lead poisoning prevention efforts in your community? 

   1. Scale: 1 (Not familiar) – 2 (Slightly familiar) – 3 (Moderately familiar) – 4 (Very familiar) 

4. Which actions are you aware of to help reduce potential lead exposure?

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5. Have you heard of any of the following EPA lead exposure prevention programs? (Check all that apply) 

1. Renovation, Repair and Painting Program 

2. Protect Your Family From Lead in Your Home pamphlet 

3. Lead Awareness Curriculum - A curriculum built for community leaders to help tribes and communities protect children from potential lead exposure and lead poisoning.  

4. None of the Above 

5. Other ________ 

5. The session you're about to participate in is meant to improve your ability to provide effective training on preventing lead exposure. How confident are you in your ability to educate others about lead, its impacts, and lead prevention efforts?

   1. Scale: 1 (Not Confident) – 2 (Slightly confident) – 3 (Moderately confident) – 4 (Very confident)  

5. Are you aware of any local organizations, programs and/or resources for reducing lead exposure available to community members? 

1. Yes 

3. No 

 

5. Please list any local organizations and/or programs you know of working to prevent lead exposure and lead poisoning in your community. 

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Thank you for taking the time to fill out this survey! For more information about the Lead Awareness Curriculum, please visit: www.epa.gov/lead/tribal-lead-curriculum.  

EPA Form: 9600-033