Form 0920-1009 16JS Youth Violence Training

Form Approved

OMB No. 0920-1009

Exp. Date: 3/31/2017

Public Reporting burden of this collection of information is estimated at 15 minutes 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 NW, MS D-74, Atlanta, GA 30333; Attn: PRA (0920-1009).

Youth Violence Prevention Training and Technical Assistance

Customer Satisfaction Survey

Instructions:

The Youth Violence Prevention Training and Technical Assistance (YV TTA) Customer satisfaction questions will be asked via telephone and given the opportunity to provide any additional comments after the survey. These questions will target the Centers for Disease Control and Prevention (CDC) services being provided by the American Institute for Research (AIR).

Telephone Script:

Hello my name is __________. I’m a member of the National Center for Injury Prevention and Control (NCIPC). I’m currently conducting a programmatic assessment. The goal of today’s call is to discuss whether the CDC funded Youth Violence Training and Technical Services Cooperative Agreement with the American Institute for Research (AIR) is meeting the needs of the participating local health departments. Today’s discussion will last fifteen minutes. I hope you feel comfortable sharing your thoughts and experiences with me, but if at any time you don’t want to answer a question, that is fine. Please note that our conversation will be transcribed after the call. Do you have any questions before we begin?

Scale:

Using a scale from 1 to 4, where

Strongly Agree Agree Disagree Strongly Disagree

4 3 2 1

To what extent do you agree or disagree with the follow statements about the Youth Violence Prevention Training and Technical Assistance (YV TTA) services on the following questions?

Questions:

Timeliness:

1. American Institute for Research is providing services in a timely manner.

Accuracy:

2. American Institute for Research provides services appropriate for the initiative.

Helpfulness:

3. American Institute for Research employees demonstrate a willingness to help customers.

Expertise:

4. American Institute for Research employees demonstrate knowledge and expertise.

Availability:

5. American Institute for Research employees have been available for your Training and Technical Assistance needs, including making resources and materials available for you.

Additional comments:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Thank you for participating in today’s phone interview.