Rapid Message Testing With Consumer Panel - Medical Countermeasure Messages

OMB Control No. 0910-0695

Expiration date: 2/28/2021

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 0910-0695 and the expiration date is 2/28/2021. The time required to complete this information collection is estimated to average 3 minutes per response, including the time for reviewing instructions and completing and reviewing the collection of information.

FDA RAPID – MESSAGE #16

Medical Countermeasures

Introduction

The U.S. Food and Drug Administration, or FDA, hired Westat to help them get opinions about health information. Prodege is helping Westat and FDA find people who may be interested in being interviewed about health information. To make sure you are a good fit for the interview, please take about 3 minutes to answer the questions below.

1. Do you, or does any member of your household or immediate family work…?

1. For a market research company  INELIGIBLE

2. For an advertising agency or public relations firm  INELIGIBLE

3. In the media (TV, radio, newspapers, magazines)  INELIGIBLE

4. As a healthcare professional (doctor, nurse, pharmacist, dietician, etc.)  INELIGIBLE

5. In the pharmaceutical industry  INELIGIBLE

6. None of the above  GO TO Q2

2. Are you an/a…?

1. Employee of the U.S. Department of Health and Human Services, or any of its agencies including the Food and Drug Administration, Centers for Disease Control and Prevention, and National Institutes of Health INELIGIBLE

2. Employee of a state or local health department INELIGIBLE

3. Employee of the Department of Homeland Security INELIGIBLE

4. Employee of a state or local emergency management agency INELIGIBLE

5. Biologist, chemist, health physicist, or in a related field involved with radiological, biological, or chemical hazards INELIGIBLE

6. None of the above  GO TO Q3

3. What is your sex?

1. Female

2. Male

4. What is your age?

1. Under 18  INELIGIBLE

2. 18 to 24

3. 25 to 34

4. 35 to 44

5. 45 to 54

6. 55 to 64

7. 65 to 74

8. 75 to 80

9. 81 or older  INELIGIBLE

5. Are you the parent or guardian of a child 17 years old or younger who lives in your household?

YES

NO  GO TO Q7

Don’t Know  INELIGIBLE

6. What age are the children living in your household? Mark all that apply.

1. 4 years old or younger

2. 5 to 7 years old

3. 8 to 12 years old

4. 13 to 17 years old

5. 18 years old or older

7. What is the highest grade or level of education you have completed?

1. Less than High School

2. High School Diploma or GED

3. Some College, including Associate’s Degree  INELIGIBLE

4. Bachelor’s Degree (for example: BA, BS)  INELIGIBLE

5. Graduate or Professional Degree  INELIGIBLE

8. Are you of Hispanic, Latino, or Spanish origin?

YES

NO

9. What is your race? Please select one or more.

White

Black or African-American

American Indian or Alaska Native

Asian

Native Hawaiian or other Pacific Islander

10. What state do you live in? [DROP DOWN LIST OF US STATES, INCLUDING “OUTSIDE OF THE US”] [“OUTSIDE OF THE US”  INELIGIBLE]

Request for Contact Information

C1. Thank you for answering the questions. Based on your answers, you may be chosen for the interview. If you are chosen for the interview and you finish it, you will get $5000SB. At the start of the interview, the interviewer will ask if it’s okay to audio record it. This helps Westat to make sure they hear everything you say correctly. If you are chosen for an interview, Westat will send you an email with an attachment at the time of the interview. Make sure to have your device ready to receive and view the attachment during the interview. Is it okay with you for Prodege to share your contact information with Westat?

YES

NO  INELIGIBLE

Thank and Terminate

Thank you for taking our survey. Unfortunately, based on your responses, you are not eligible for this study. However, we appreciate you taking the time to answer our questions today.

Contact Information

C2. In the space below, please give us the best information to contact you by phone, email, and regular mail. Please know that Westat will not share your information with anyone else. Your personal information will be deleted upon completion of the research project.

Contact Information

Name ______________________________________________________________________

Address 1 ___________________________________________________________________

Address 2 ___________________________________________________________________

City, State, ZIP _______________________________________________________________

Phone Number _______________________________________________________________

Email Address________________________________________________________________

Technology Preferences

C3. The Westat interviewer would like to share computer screens during the interview while you review the email attachment. Westat will send directions for how to do this. Which app do you prefer for screen sharing? [SINGLE SELECT]

1. Skype

2. Google Hangouts

3. WebEx

4. I am not able to use any of these, please just call me

Closing

Thank you for your answers to these questions. If you are chosen for an interview, someone will contact you within the next 1-2 days.