Form 0920- Att D3_Key_Informant_Selection_10_29_13

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

Key Informant Selection

Evaluation of CDC’s CCC 1017 Program

We need your assistance to help us select key informants for our evaluation of the 1017 program in your community!

Battelle plans to interview approximately 12 people in each case study site. These individuals will include:

• CCC Program Directors and program managers/coordinators;

• The PSE Coordinator hired and/or supported by 1017 funds;

• CCC program staff with a high degree of involvement in PSE change initiatives;

• Partners who are members of the PSE Workgroup;

• Community members who play an important role in implementation of the PSE change initiatives, including four main types:

• Decision maker – an individual within an organization or entity who can make decisions about PSE approaches to improve health impact (e.g., city council member, school superintendent, business owner, or an agency director). As a reminder, Federal funds may not be used to engage in advocacy or lobbying activities for legislative policies (see box, below). Program staffers are, however, permitted to provide information and data to legislative decision makers as requested as a part of the normal executive legislative processes;

• Promoter – an individual or organization that supports or actively promotes policy, system and environmental strategies that emerge from the PSE agenda to improve public health. Examples of promoters may include organizations such as medical societies, employers or advocacy organizations;

• Stakeholder – an individual or organizational representative who will be affected by the proposed PSE strategy (e.g., employee, community resident, consumer, client, parent, student, employer, school, or healthcare institution); and

• Ally (Allies) – an individual or group with a similar interest in the proposed PSE strategy.

In selecting which people to interview, we wish to consider not only their roles in the 1017 program, but also the perspectives they offer based on their history within the community, their professional background, and their personal connections to cancer control and PSE change strategies. We want to talk to people who cover the range from those who have been involved in this work for many years, to those who may be newly engaged.

We would like you to help us select those individuals in your community that as a group will provide a rich understanding of how the 1017 program is being conducted in your location and the roles that staff, partners and decision makers play in PSE change.

Please use the following table to organize possible candidates (list as many as appropriate). We will use this list to talk with you about the candidates and select the best mix of key informants from among these. In addition, please attach a list of your PSE Workgroup members.

Name	Organization	Role in 1017	Comments on individual’s perspective
Key Staff
PSE Workgroup Members
Other Community Members who are Decision Makers, Influencers, Stakeholders, or Allies

Public reporting burden of this collection of information is estimated to average 8 hours 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 NE, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-xxxx).