Attachment N- Three Week Phone

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

Attachment N:

Three-Week Phone Reminder and Subsequent Phone Reminders for Mail Survey Nonrespondents

[Hello X]:

My name is _________ and I am calling from NORC, a not-for-profit research organization that has been contracted by the Agency for Healthcare Research and Quality (AHRQ) to help with their assessment of the Emergency Severity Index (ESI), a triage tool used by emergency departments.

We recently tried calling you to participate in a telephone survey about the ESI. When you requested AHRQ’s ESI handbook and accompanying DVDs, you indicated that we could contact you to participate in the assessment by completing a survey via telephone.

As a reminder, 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 emergency departments; the satisfaction with the ESI tool; the extent to which the product has improved emergency services, surge planning and preparation; the usefulness of the ESI as compared to other similar triage tools; and potential improvements to the tool.

The survey should take no more than 20 minutes; are you available to complete the survey with me now?

<YES>

[Go through survey]

<NO>

I would be happy to work with you to find a more convenient time to call you back; or, if it is more convenient for you, we can send you a hard copy of the survey along with a self addressed and stamped envelope. You may also complete the survey online at www.xxxxx.com.

[Thank respondent for their time and ask if they have any question. Notify them of toll free number and email address, in case they have questions or want more information in the future]

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.