2024 CDC SAF Focus Group Availability (WORD)

Att_3_0920-1163_2024_SAF Focus Group Availability Poll.docx

[PHIC] Data Collection for CDC Fellowship Programs

2024 CDC SAF Focus Group Availability (WORD)

OMB: 0920-1163

Document [docx]
Download: docx | pdf

Form Approved
OMB No. 0920-1163

Expiration Date: 02/28/2026




Attachment 3. 2024 CDC SAF Focus Group Availability



[Page 1 – Introduction]



Thank you for participating in the CDC Science Ambassador Fellowship! We are conducting one or more focus groups to better understand your experiences as a fellow. If you are interested in being a participant, we ask that you fill out the following poll to help us select times to host the focus groups. All current fellows are invited to participate. Please only fill out the poll if you intend to participate.


This poll will take approximately 1 minute to complete. By continuing to the next page, you have consented to complete this poll. Please contact [email protected] if you have any questions or problems.

















The public reporting burden of this collection of information is estimated to average 1 minute per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data 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 Reports Clearance Officer; 1600 Clifton Road NE, MS H21-8, Atlanta, Georgia 30333 ATTN: PRA (0920-1163).

 

[Page 2 Participant Characteristics]


  1. Please provide your name.*

    1. First Name:

    2. Last Name:


  1. Which times are you available to participate in a 1-hour focus group hosted virtually over Teams? Select all that apply.*

  • DATE/TIME

  • DATE/TIME

  • DATE/TIME

  • DATE/TIME

  • DATE/TIME

  • DATE/TIME

  • DATE/TIME




[Custom Thank You]

Thank you for completing the poll. We will schedule the focus group(s) based on your response. We intend to send these by email early next week. If you have any questions or concerns, please contact us at [email protected].

1


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorSommer, Audrey (CDC/DDPHSS/CSELS/DSEPD)
File Modified0000-00-00
File Created2024-11-14

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