Form Parents' Nigtht Ou Parents' Nigtht Ou Parents' Nigtht Out During Presentation Survey

Form Approved

OMB No. 0930-0197

Expiration Date: 02/28/2023

Disclaimer: This presentation will contain five short customer satisfaction questions asking your opinions about various pieces of the presentation. All answers will be presented as totals or percentages, and no one will be able to tell by name who answered each question. When you answer the questions, you are agreeing to have your answers presented as totals and percentages.

1. What made you decide to attend today? Was it because (select all that apply):

   1. You have concerns based on past behavior

   2. You have concerns about current behavior

   3. You have concerns about future behavior

   4. You want to learn more about the topic

   5. You want to learn conversational skills to use with your child/children on a variety of topics

2. Have you noticed any changes in your child’s or children’s attitude and/or behavior regarding underage drinking and other drug use since the pandemic began?

   1. Yes, they seem more interested.

   2. Yes, they seem less interested.

   3. No, I have not noticed any changes.

   4. Not sure.

3. Do you think you know the right thing to say to your child about underage drinking and other drug use?

   1. Yes

   2. No

   3. Not sure/depends

4. Based on what you have seen so far, do you think you will access the “Talk. They Hear You.” ® campaign website for help with conversations about underage drinking and other drug use with your child/children?

   1. Yes

   2. No

   3. Not sure

5. How likely are you to download and use the “Talk. They Hear You.” app?

   1. Likely to download and use

   2. Likely to download, but not use

   3. Not likely to download or use

   4. Not sure

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is #0930-0197. The time required to complete this information collection is estimated to average 7 minutes per response, including the time to review instructions, search existing data resources, and gather the data needed to review and complete the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to the SAMHSA Reports Clearance Officer at Carlos D. Graham, DHA, LCSW, LCAS, 5600 Fishers Lane, 15E57A

Rockville, MD  20857 or email at Carlos.Graham@samhsa.hhs.gov.