Attachment J- One Week Email

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

Attachment J:

One-Week Email Reminder for Mail Survey Nonrespondents

[Date]

[Name of ESI Tool Requester]

[Dear X:]

We recently emailed you a link to complete a survey about the Emergency Severity Index (ESI), a triage tool used in emergency departments (EDs). The Agency for Healthcare Research and Quality (AHRQ) at the Department of Health and Human Services (HHS) is conducting an assessment of the ESI. When you requested the ESI training materials (handbook and DVDs), you provided your contact information to participate in a survey about the ESI. We are interested in your thoughts about the ESI tool.

If you have not yet had the chance to complete your survey, we would appreciate your timely response. We ask that you complete the web-based survey by visiting www.xxxxx.com.

Your participation in this study is critical to the success of this assessment, and will provide AHRQ with important information about the use and acceptance of the ESI tool by EDs.

If you have any questions or would like more information about the assessment, please email NORC at XXXX@norc.org or call toll free at 1-866-XXX-XXXX.

Thank you in advance for taking the time to complete the survey.

Sincerely,

Bruce Siegel, MD, MPH

Research Professor, Department of Health Policy

The George Washington University

Daniel S. Gaylin, MPA

Executive Vice President for Health Research

NORC

Public reporting burden for this collection of information is estimated to average 20 minutes per response, the estimated time required to complete the survey. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.