Contact email

Form Approved

OMB No. 0990-

Exp. Date XX/XX/20XX

Attachment B3

Subject: Office on Women’s Health IPV Provider Network Project Online Survey, Upcoming Data Submission

Dear [Service Provider]:

The U.S. Department of Health and Human Services, Office on Women’s Health (OWH) contracted NORC at the University of Chicago (NORC) to implement a program evaluation of the Intimate Partner Violence (IPV) Provider Network Project. The program requires collaboration between health care providers and IPV service programs to evaluate systems for integrating IPV intervention into basic clinical care. The purpose is to assess the impact, outcomes, and utility of OWH’s efforts to support IPV screening/referral strategies for women and girls.

It is our understanding that you are providing services to clients referred by [GRANTEENAME/PROVIDERNAME], through a Memo of Understanding that covers your organization providing feedback about the program for OWH’s evaluation purposes.

This letter is to let you know about a brief web-based survey (we anticipate it will take 30 minutes at most to complete) that NORC will field on a semi-annual basis over the duration of the OWH project. We anticipate sending you the link to this survey in approximately two weeks.

At the end of each year, we will also contact you to schedule a brief interview (45-60 minutes) with the key staff person on this project to provide an opportunity to add more detail about your experience with the IPV Provider Network Project. This will be an opportunity for an in-depth discussion about your experience.

We will not be asking any questions about individual clients. The NORC Institute Review Board has determined that this research does not fall under its purview as human subjects research.

We very much appreciate your collaborative efforts with [GRANTEENAME/PROVIDERNAME] through this project, and would like to thank you in advance for participating in OWH’s evaluation of the program.

Sincerely,

X