Special Session Survey

F orm Approved

OMB No. 0920-1050

Expiration Date: 06/30/2025

Attachment B: Instrument 2–Special Session Survey (Word and Web Versions)

Plenary, Town Hall, and Coffee Chat Session Feedback

Please take a moment to tell us about your session experience. Your feedback is confidential, and we will not be able to identify you when we receive it. The questions should take less than 2 minutes to answer.

For help, please contact PHIT evaluator, Brittany Argotsinger, at 404-498-0263 or bargotsinger@cdc.gov.

CDC estimates the average public reporting burden for this collection of information as 2 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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 burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0879).

1. How satisfied are you with the quality of this session?

   1. Not at all satisfied

   2. Minimally satisfied

   3. Moderately satisfied

   4. Very satisfied

   5. Extremely satisfied

2. How satisfied are you with the format of this session?

   1. Not at all satisfied

   2. Minimally satisfied

   3. Moderately satisfied

   4. Very satisfied

   5. Extremely satisfied

3. As a result of this session, how would you describe your level of energy or enthusiasm for performance improvement efforts in your agency or community?

   1. It has declined substantially

   2. It has declined somewhat

   3. It is about the same

   4. It has increased somewhat

   5. It has increased substantially

4. Please share any comments you have about this session.

This completes our survey. Thank you for your feedback!

Plenary, Town Hall, and Coffee Chat Session Feedback – Web Version

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