Form 0920-20QJ Web Questionnaire Developer Logic

Form Approved

OMB No.: XXXX-XXXX

Expiration Date: xx/xx/xxxx

Community Based Survey of Supports for Healthy Eating and Active Living

Web Questionnaire Specifications

Public Reporting burden of this collection of information is estimated to average 30 minutes 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 NW, MS D-74, Atlanta, GA 30333; ATTN: PRA 0920-xxxx). Do not return the completed form to this address.

Web Login Screen:

Header: CDC Logo, Survey title: Community Based Survey of Supports for Healthy Eating and Active Living (CBS HEAL), OMB Approval information: Form Approved OMB No: XXXX-XXXX Expiration Date: xx/xx/xxxx

TEXT:

Welcome to the Community Based Survey of Supports for Healthy Eating and Active Living

(CBS HEAL)!

You have been invited to take part in CBS HEAL, a study sponsored by the Centers for Disease Control and Prevention (CDC). The national study seeks to gather information on the existence of certain policies, standards, and practices enacted or implemented by local governments that promote more healthful eating and physical activity for residents.

Please enter your Personal Identification Number in the space below and hit ‘Continue’ to access the survey.

_________

CONTINUE

Footer: OMB Burden Statement, NORC Contact Info

Public Reporting burden of this collection of information is estimated to average 30 minutes 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 NW, MS D-74, Atlanta, GA 30333; ATTN: PRA 0920-xxxx). Do not return the completed form to this address.

If you have any questions, please contact NORC at the University of Chicago, toll free at 800-239-5036 or vial e-mail (cbsheal@norc.org).

Screen Two: Consent

CONSENT

On behalf of the Centers of Disease Control and Prevention (CDC), NORC at the University of Chicago (NORC) is conducting the Community-Based Survey for Healthy Eating and Active Living (CBS HEAL). The national study seeks to gather information on the existence of certain policies, standards, and practices enacted or implemented by local governments that promote more healthful eating and physical activity for residents.

Your municipality was selected randomly to participate and you were identified as the person best able to address questions about the policies enacted by your local government. The survey includes questions on the communitywide planning documents of local government, policies that improve the built environment to support physical activity, and policies that support increasing access to healthful foods.

The survey will take approximately 30 minutes to complete. Your participation is voluntary. You may choose not to answer any of the questions or you may choose to not participate without penalty. There are no expected risks to participating in the survey.

CDC will use this information to evaluate the extent to which local communities have in place policy and environmental supports for healthy eating and active living consistent with recommendations from expert groups. In addition, communities, such as yours, may use the data collected to see how they compare with other communities nationally or with communities of a similar geography, population size, and urban status.

By clicking ‘CONTINUE’ below, you acknowledge that you have read the above consent statement and agree to participate.

CONTINUE

Screen Three: Survey Instructions

Thank you for agreeing to participate in this study. The survey is divided into 7 sections. All questions are non-mandatory, so feel free to leave any blank you are not comfortable answering.

It is important to the accuracy of this survey though that if you have difficulties answering a section completely, to please click the "NOMINATE" button at the top of the screen. Clicking this button will allow you to reach out through email to someone else you know who you feel could answer this section on your behalf. You will be given the opportunity to customize the email text to your nominee if you'd like to instruct them on the specific sections you need their help with. Once your email is sent, you will exit the current section and be able to navigate to the next if one is available.

Please use the “NEXT” and “BACK” buttons to navigate within the survey. Click the "EXIT" button if you wish to exit the survey at any time while any sections are still in progress. Once the final incomplete / unstarted section is answered, the survey will end.

Please note, sections marked as "COMPLETE" can only be re-entered by those who completed them, but nominees you provide with a link will be able to answer any incomplete / unstarted sections.

Screen Four: Definitions

For the purposes of this survey, please refer to the definitions below for the following terms.

• Jurisdiction: The geographic territory that is subject to a municipal government

• Local government: The administrative and legal body that oversees a particular jurisdiction

• Community: The people who live within a particular jurisdiction

New Section/Resume

Please select the section below you'd like you'd like to complete.

Entering sections marked "COMPLETE" will reset them to "IN PROGRESS", but your previous answers will be retained. As changing your answers in sections previously marked "COMPLETE" may cause different questions to be asked, please navigate to the very end of the section again so it is reclassified as "COMPLETE" once again.

All questions are non-mandatory, so feel free to leave any blank you are not comfortable answering.

Please use the “NEXT” and “BACK” buttons to navigate within the survey. Click the "EXIT" button if you wish to exit the survey at any time while any sections are still in progress. Once the final incomplete / unstarted section is answered, the survey will end.

Please note, sections marked as "COMPLETE" can only be re-entered by those who completed them, but nominees you provide with a link will be able to answer any incomplete / unstarted sections.

Delegation Screen (to appear when “NOMINATE” button is selected)

Screen 1

Please fill out the below information for your nominee. A 10 digit phone number is not required, but recommended.

Title: ________________

Full Name: _________________

Business Email Address: ________________

Business Phone Number: ________________

Screen 2

Please enter a message you would like to send to [NAME] so they know it is from you and what section(s) you would like them to complete.

[OPEN TEXT BOX]

Email text sent to nominated individuals:

Greetings [NOMINEE],

NORC at the University of Chicago is conducting the Community Based Survey of Supports for Healthy Eating and Active Living (CBS HEAL), a national study sponsored by the CDC. [NAME] started the survey, but was not able to answer some of the questions posed to them in the survey and has nominated you as someone who might be able to answer these questions instead.

In order to access the survey, please use the unique link below.

Survey Link

[NAME] included this personalized message for you during the nomination process:

[INSERT PERSONALIZED NOTE]

If you have any questions, please contact NORC at cbsheal@norc.org or XXX-XXX-XXXX.

Sincerely,

The CBS HEAL team
NORC at the University of Chicago

Section 1: Structure of Your Local Government

[INTRO1] The first question asks about the structure of your local government.

1. [GOVSTRUCT_x] Does your local government have a Department, Office, Division, or other similar entity that is responsible for...?

	Yes	No	Don’t know
Transportation	1	2	77
Planning	1	2	77
Housing	1	2	77
Parks and Recreation	1	2	77
Health or Public Health	1	2	77
Health Equity	1	2	77

Section 2: Communitywide Planning Efforts for Healthy Eating and Active Living

[INTRO2] These questions ask about communitywide planning documents that local governments may have created or adopted that promote healthy eating and active living. These may include Comprehensive/General/Master Plans, or other plans, such as a transportation plan, a parks and recreation plan, or a bicycle and pedestrian plan.

2. [GENPLAN] Does your local government have a Comprehensive/General/Master Plan?

   1. Yes

   2. No [GO TO OTHPLAN_A]

77. Don’t know [GO TO OTHPLAN_A]

3. [GENMANDATE] Was the development of your Comprehensive/General/Master Plan mandated by the state?

   1. Yes

   2. No

77. Don’t know

4. [GENPLANYR] When was your Comprehensive/General/Master Plan first adopted?

   1. Less than 5 years ago

   2. 5 years to less than 10 years ago

   3. 10 years to less than 15 years ago

   4. 15 years to less than 20 years ago

   5. More than 20 years ago

77. Don’t know

5. [GENPLANUP] When was your Comprehensive/General/Master Plan last revised or updated?

   1. Less than 5 years ago

   2. 5 years to less than 10 years ago

   3. More than 10 years ago

   4. Currently being revised or updated

   5. It has not been revised or updated

77. Don’t know

6. [OTHPLAN_x] Does your local government have any of the following types of master plans, including stand-alone plans that are not a part of the Comprehensive/General/Master Plan?

	Yes	No	Don’t know
A land use plan (for new development and growth management)	1	2	77
A transportation plan	1	2	77
A parks and recreation plan	1	2	77
A bicycle or pedestrian plan	1	2	77
A health equity plan	1	2	77

[PROGRAMMER: IF GENPLAN=(2 OR 77) AND OTHPLAN_A=(2 OR 77) AND OTHPLAN_B=(2 OR 77) AND OTHPLAN_C=(2 OR 77) AND OTHPLAN_D=(2 OR 77), AND OTHPLAN_E=(2 OR 77), GO TO ADAPLAN ELSE CONTINUE.]

7. [OBPLAN_x] Does your local government have any of the following objectives included in the plan(s)? These objectives should be written in the plan. However, they do not have to have been implemented yet.

	Yes	No	Don’t know
Implementing a Complete Streets policy (as defined by the National Complete Streets Coalition) for new and retrofit projects? A Complete Streets policy, as defined by the National Complete Streets Coalition, is a policy ensuring that transportation planners and engineers consider the needs of all users during the design of major road projects, including bicyclists, pedestrians of all ages and abilities, public transit vehicles and riders, and motorists.	1	2	77
Developing regulations that promote street connectivity (for example, shorter block lengths or adding pedestrian routes between blocks)	1	2	77
Establishing new parks, green spaces, or recreational walking and bicycling paths	1	2	77
Encouraging mixed-use development that combines residential land use with one or more commercial, institutional, or other public land uses	1	2	77
Supporting farmers markets or community gardens	1	2	77
Preserving land for agricultural uses	1	2	77
Providing free safe/clean drinking water in outdoor public places such as parks	1	2	77

8. [ADAPLAN] Has your local government developed or updated an Americans with Disabilities Act (ADA) Transition Plan since 2010? An ADA Transition Plan is a plan local governments develop to ensure equal access to facilities, public rights-of-way, and services with people with disabilities.

   1. Yes

   2. No, but planning to develop or update

   3. No, and not planning to develop or update

77. Don’t know

9. [EQPLAN] Does your local government have a plan for the allocation of resources to low income or traditionally under-resourced areas?

   1. Yes, we have a stand-alone plan

   2. Yes, it is incorporated into other plans

3) No, but we are planning to develop one or incorporate into other plans

4) No, and we are not planning to develop one or incorporate into other plans

77) Don’t know

Section 3: The Built Environment and Policies That Support Physical Activity

[INTRO3] The next questions ask about policies or standards that support the physical activity of your community’s residents, even if the policy or standard was passed by another level of government (such as a regional transportation planning authority). You may find it helpful to consult with a representative in either the parks and recreation department or transportation department if you cannot answer a question.

10. [PAGOV_x] Does your local government have design standards, guidelines, or policies that require…?

	Yes	No	Don’t know
Installation of dedicated bicycle infrastructure for roadway expansion projects or when retrofitting streets	1	2	77
Developers to reserve space for use by the local jurisdiction for development of bicycle infrastructure	1	2	77
Traffic-calming features (for example, speed bumps, reduced speed zones, or signal modifications) that increase roadway safety in areas with high pedestrian and bicycle volume (not including school zones)	1	2	77

11. [STREETCOMP] Does your local government have a formal Complete Streets policy, as defined by the National Complete Streets Coalition, for designing and operating streets with safe access for all users? A Complete Streets policy, as defined by the National Complete Streets Coalition, is a policy ensuring that transportation planners and engineers consider the needs of all users during the design of major road projects, including bicyclists, pedestrians of all ages and abilities, public transit vehicles and riders, and motorists.

1. Yes

2. No [GO TO STREETZERO]

77. Don’t know [GO TO STREETZERO]

12. [STREETGOV] What level of government adopted the Complete Streets policy?

1. Municipality

2. Metropolitan area (e.g. MPO)

3. County

4. Region (e.g. regional transportation planning authority)

5. Other

77. Don’t know

13. [STREETADOPT] When was your Complete Streets policy first adopted?

    1. Less than 5 years ago

    2. 5 years to less than 10 years ago

    3. 10 years to less than 15 years ago

    4. 15 years to less than 20 years ago

    5. More than 20 years ago

77. Don’t know

14. [STREETREVISE] When was your Complete Streets policy last revised or updated?

    1. Less than 5 years ago

    2. 5 years to less than 10 years ago

    3. More than 10 years ago

    4. Currently being revised or updated

    5. It has not been revised or updated

77. Don’t know

15. [STREETMEAS] Does the Complete Streets policy establish specific performance measures that will be used to monitor success? These measures assess the impact of the policy. Examples include miles of sidewalks or bike lanes completed, pedestrian or cyclist counts, or pedestrian or cyclist injuries.

1. Yes

2. No

77. Don’t know

16. [STREETZERO] Does your local government have a Vision Zero Action Plan or Strategy in place, as defined by the Vision Zero Network? A Vision Zero Action Plan or Strategy, as defined by the Vision Zero Network, is a plan or strategy to eliminate all traffic fatalities and severe injuries, while increasing safe, healthy, equitable mobility for all. Include a plan or strategy even if it was adopted by another level of government (such as a regional transportation planning authority).

1. Yes

2. No

77. Don’t know

17. [STREETFORM] Does your local government have Form-Based Code regulations in place, as defined by the Form-Based Codes Institute? A Form-Based Code, as defined by the Form-Based Codes Institute, is a land development regulation that fosters predictable built results and a high-quality public realm by using physical form (rather than separation of uses) as the organizing principle for the code. A form-based code is a regulation, not a mere guideline, adopted into city, town, or county law.

1. Yes

2. No

77. Don’t know

18. [BIKERACK] Does your local government have a written requirement or official objective to install bicycle racks at public facilities, such as public parks, government buildings, or transit stations?

1. Yes

2. No

77. Don’t know

[INTRO3A] The next questions ask about parks and outdoor recreation areas and policies supporting recreation.

19. [PARKPOL_x] Does your local government have policies or budget provisions related to parks or outdoor recreation areas, such as…?

	Yes	No	Don’t know
Lighting in parks or outdoor recreation areas	1	2	77
Patrols by police or security in parks or outdoor recreation areas	1	2	77
Maintenance of green space and equipment	1	2	77
Prohibition of unleashed or unrestrained dogs in parks and outdoor recreation areas (excluding dog parks)	1	2	77
Provision of safe/clean drinking water fountains or water bottle filling stations in parks or outdoor recreation areas.	1	2	77
Maintenance of drinking water fountains in parks or outdoor recreation areas	1	2	77

20. [SCHREC] Has your local government adopted a joint or shared use agreement or memorandum of understanding with any school that allows the public to use school recreational facilities (for example, gymnasiums, athletic fields, or playgrounds) during non-school hours?

1. Yes

2. No [GO TO LOCALTAC]

3. Our municipality does not have schools in our jurisdiction [GO TO LOCALTAC]

77. Don’t know [GO TO LOCALTAC]

21. [SCHJOINT] Who is your joint use or shared use agreement with?

1. Local school district or board

2. Individual school

3. Other

77. Don’t know

22. [SCHDOOR] What school recreational facilities are covered by the joint or shared use agreement or memorandum of understanding?

1. Outdoor facilities only

2. Indoor facilities only

3. Outdoor and indoor facilities

77. Don’t know

23. [LOCALTAC] Does your local government have a pedestrian, bicycle, or active transportation advisory committee?

1. Yes

2. No [GO TO INTRO4]

77. Don’t know [GO TO INTRO4]

24. [REPTAC_x] Is there a designated health/public health or community representative on the pedestrian, bicycle, or active transportation advisory committee?

	Yes	No	Don’t Know
Health/public health representative	1	2	77
Community representative	1	2	77

Section 4: Zoning That Supports Healthy Eating and Active Living

[INTRO4] These next questions ask about zoning and design or development codes that support healthy eating and active living.

25. [ZONELOC] Does your local government have a planning and/or zoning commission?

1. Yes

2. No [GO TO ZONECODE_A]

77. Don’t know [GO TO ZONECODE_A]

26. [ZONEREP_x] Is there a designated health/public health or community representative on the planning and/or zoning commission?

	Yes	No	Don’t Know
Health/public health representative	1	2	77
Community representative	1	2	77

27. [ZONECODE_x] Does your local government include the following features in policies for development, including zoning codes design/development guidelines?

	Yes	No	Don’t know
Require short- to medium pedestrian-scale block sizes	1	2	77
Require continuous sidewalk coverage	1	2	77
Require minimum sidewalk widths of 5 feet	1	2	77
Require buildings are oriented to pedestrian scale (for example, require entrances or windows face the street or reduced front setbacks)	1	2	77
Require pedestrian amenities such as trees or furniture along the street	1	2	77
Allow mixed land uses (for example, zoning that combines residential land use with one or more commercial, institutional, or public land uses)	1	2	77
Require or incentivize accessibility of safe/clean drinking water in outdoor public places	1	2	77

28. [ZONEREM] Does your local government have policies that remove zoning barriers (e.g. lot size requirements) or provide other zoning incentives to encourage supermarkets to open in underserved areas or food deserts?

1. Yes

2. No

3. My community does not have underserved areas or food deserts

77. Don't know

29. [ZONEPOL] Does your local government have specific zoning policies to address recurring non-permanent farmers markets?

1. Yes

2. No

77. Don’t know

Section 5: Public Transportation Policies that Support Healthy Eating and Active Living

[INTRO5] The next questions ask about public transportation and related policies and processes that support healthy eating and active living in your community, even if the policy or process was passed by another level of government (such as a regional transportation planning authority).

30. [PUBAUTH] Is transportation planning for your community performed in part or completely by a regional/metropolitan authority or organization?

1. Yes, in part

2. Yes, completely

3. No

77. Don’t know

31. [PUBTRANS] Does your local government have a defined process or set of criteria for prioritizing or selecting transportation projects?

1. Yes

2. No [GO TO PUBCURRENT]

77. Don’t know [GO TO PUBCURRENT]

32. [PUBMODES] Does this process include criteria that prioritizes providing multiple transportation choices (including non-motorized modes and transit) for people to access homes, jobs, schools, food, or other retail?

1. Yes

2. No

77. Don’t know

33. [PUBCURRENT] Is the community currently served by public transit (e.g. buses, light rails, subway commuter rail)?

1. Yes

2. No, but planning for transit [GO TO PUBSPECS]

3. No, and not planning for transit [GO TO PUBDEMAND]

77. Don’t know [GO TO PUBDEMAND]

34. [PUBCOMM_x] Does your community have the following types of public transit available?

	Yes	No	Don’t know
Bus (e.g. fixed-route)	1	2	77
Light rail	1	2	77
Subway or commuter rail	1	2	77
Paratransit (e.g. county or regional van service)	1	2	77
Other	1	2	77

35. [PUBSPECS] Are requirements for public transit facilities specified (e.g. access, lighting, shelter) in community policies and plans?

1. Yes

2. No

77. Don’t know

36. [PUBMULTI] Are there multimodal use requirements near transit stops (e.g. provision of bicycle lanes and sidewalks present within a certain radius of a transit stop)?

1. Yes

2. No

77. Don’t know

37. [PUBTOD] Are there incentives offered to promote transit-oriented development (TOD) (e.g. increased density, different parking requirements)? Transit-oriented development, or TOD, is a type of urban development that maximizes the amount of residential, business, and leisure space within walking distance of public transportation.

1. Yes

2. No

77. Don’t know

38. [PUBLOC_x] When planning public transit, does your local government consider locating near the following destinations? Include planning done by your local government or another level of government such as the regional transportation planning authority.

	Yes	No	Do not have this destination in our community	Don’t know
Community health clinics, health hubs, or medical offices	1	2	3	77
Farmers markets	1	2	3	77
Supermarkets or other full-service grocery stores	1	2	3	77
Parks or recreation facilities	1	2	3	77
Schools (including colleges/universities)	1	2	3	77

39. [PUBDEMAND] Even if your community is not served by mass transit, does your local government operate paratransit community vans or shuttle buses that operate on as-needed or on-demand basis?

1. Yes

2. No [GO TO INTRO6]

77. Don’t know [GO TO INTRO6]

40. [DESTINAT_x] Do these vans or shuttle buses provide transportation to any of the following destinations?

	Yes	No	Do not have this destination in our community	Don’t know
Community health clinics, health hubs, or medical offices	1	2	3	77
Farmers markets	1	2	3	77
Supermarkets or other full-service grocery stores	1	2	3	77
Parks or recreation facilities	1	2	3	77

Section 6: Other Policies and Practices that Support Access to Healthy Food and Healthy Eating

[INTRO6] The next questions are about policies that may affect access to healthy food options in your community, even if the policy or standard was passed by another level of government. If you feel you cannot provide the best answer, you may find it helpful to consult with the following types of representatives within your local government: a public health official, a representative in the tax assessor’s office, or a purchasing or procurement representative.

41. [OTHFOOD] Not including schools, does your local government or a subcontractor sell foods or beverages to employees or visitors on local government-owned or operated properties? This could include cafeterias, vending machines, park concession stands, or other food venues.

1. Yes

2. No [GO TO OTHSERVE]

77. Don’t know [GO TO OTHSERVE]

42. [OTHGOV] Not including schools, does your local government have written nutrition standards for foods and beverages sold to employees or visitors in or on government-owned or operated properties?

1. Yes

2. No [GO TO OTHSERVE]

77. Don’t know [GO TO OTHSERVE]

43. [OTHCONTRACT] Are any of these nutrition standards included in food purchasing agreements and/or food service contracts?

1. Yes

2. No

77. Don’t know

44. [OTHSERVE] Not including schools, does your local government or a subcontractor serve food (at little or no cost) to facility residents or program participants in facilities or programs owned or operated by the local government? This could include correctional facilities, senior centers/programs, recreation programs, or other settings that serves congregate meals.

1. Yes

2. No [GO TO INTRO6A]

77. Don’t know [GO TO INTRO6A]

45. [OTHOWN] Not including schools, does your local government have written nutrition standards for foods served to facility residents or program participants in facilities or programs it owns or operates?

    1. Yes

    2. No [GO TO INTRO6A]

77. Don’t know [GO TO INTRO6A]

46. [OTHAGREE] Are these nutrition standards included in food purchasing agreements and/or food service contracts?

1. Yes

2. No

3. Don’t know

[INTRO6A] The next questions ask you about policies that support increasing access to healthful foods. Supermarkets and full-service grocery stores typically stock a higher proportion of healthier foods than smaller stores, including convenience and corner stores. Supermarkets and full-service grocery stores sell a general line of foods, including canned and frozen foods; fresh fruits and vegetables; and fresh and prepared meats, fish, and poultry.

47. [STOREOPEN_x] Does your local government currently use any of the following approaches to encourage supermarkets and other full-service grocery stores to open stores?

	Yes	No	Don’t know
Tax incentives (for example, tax abatement, tax credit, or property tax exemption)	1	2	77
Grant or loan programs	1	2	77
Programs to link store openings to broader neighborhood revitalization projects (for example, improvements to lighting, signage, safety, or walkability in the surrounding commercial corridor)	1	2	77

[PROGRAMMER” IF STOREOPEN_A=(2 OR 77) AND STOREOPEN_B=(2 OR 77) AND STOREOPEN_C=(2 OR 77), GO TO INTRO6B. ELSE CONTINUE.]

48. [LOWINCOME] Do any of these policies or programs used by your community to encourage supermarkets and other full-service grocery stores to open stores explicitly prioritize low-income or under-resourced areas?

1. Yes

2. No

3. Our community does not have any low-income or under-resourced areas

4. Don’t know

[INTRO6B] In addition to supermarkets and full-service grocery stores, food can be sold in smaller venues such as convenience or corner stores. Some local governments use incentives, training, or grants to help convenience or corner stores sell healthier foods.

49. [HEALTHFOOD_x] Does your local government provide any of the following to help convenience or corner stores sell healthier foods?

	Yes	No	Don’t know
Grant or low-interest loan programs to purchase equipment for storage or sales of healthful foods (e.g. refrigeration or a point of sales system)	1	2	77
Technical assistance or training programs to increase the ability to sell healthier foods (e.g. support for new point of sales systems, marketing assistance, produce handling training, product placement)	1	2	77
Programs to link convenience or corner store improvements to broader neighborhood revitalization projects (improvements to lighting, signage, safety, walkability)	1	2	77

[PROGRAMMER: IF HEALTHFOOD_A=(2 OR 77) AND HEALTHFOOD_B=(2 OR 77) AND HEALTHFOOD_C=(2 OR 77), GO TO INTRO6C. ELSE CONTINUE.]

50. [HLTHFOODLOW] Do any of these policies or programs used to help convenience or corner stores sell healthier foods explicitly prioritize low-income or under-resourced areas?

1. Yes

2. No

3. Our community does not have any low-income or under-resourced areas

4. Don’t know

[INTRO6C] These next questions ask about policies and standards that your community may use to support access to farmers markets operated by the local government or other entities within the community. Please answer the questions, even if you don’t currently have farmers markets in your community.

51. [FARMPOLICY_x] Does your local government have any policies related to farmers markets, farm stands, or green/produce carts that…?

	Yes	No	Don’t know
Allow vendors to sell fresh produce on city-owned property	1	2	77
Streamline processes for obtaining health and food safety permits and licenses	1	2	77
Extend waivers of required business permits or retail licensing fees or taxes	1	2	77
Provide funds or in-kind services for personnel, signage, or advertising	1	2	77
Encourage opening in lower income neighborhoods lacking supermarkets or full-service grocery stores	1	2	77

52. [FARMMRKT] Does your community have a farmers’ market, farm stand, or green/produce cart?

1. Yes, we currently have one

2. No, but we are working on getting one

3. No, but we had one or more in the past

4. No, we have never had one

77. Don’t know

53. [FARMEBT] Does your local government provide funding for Electronic Benefits Transfer (EBT) machines or provide technical assistance on how to obtain or use EBT machines at local farmers markets, farm stands, or green/produce carts? Electronic Benefit Transfer (EBT) is an electronic system that allows the government to provide assistance benefits. Assistance benefits include the Supplemental Nutrition Assistance Program [SNAP], formerly known as Food Stamps, or the Temporary Assistance for Needy Families [TANF]) via a plastic debit card to eligible constituents.

1. Yes

2. No

3. Our community does not have a farmers’ market, farm stand, or green/produce cart

77. Don’t know

54. [FOODSEC] Does your community have a local, county, or regional food policy council, food security coalition, or other community group working to increase access to healthy food? A food policy council is a council that brings together stakeholders from diverse food-related sectors in a specific geographical area to examine how the food system is operating in that area and to develop recommendations for improvement.

1. Yes

2. No [GO TO SNAP]

77. Don’t know [GO TO SNAP]

55. [FOODCOUN] Is a local government employee or elected official a member of the food policy council, food security coalition, or other community groups working to increase access to healthy food?

1. Yes

2. No

77. Don’t know

56. [PHCOUNC_X] Is there a designated health/public health or community representative on the food policy council, food security coalition, or other community groups working to increase access to healthy food?

	Yes	No	Don’t Know
Health/public health representative	1	2	77
Community representative	1	2	77

57. [SNAP] Does your local government offer incentive programs that allow Supplemental Nutrition Assistance Program (SNAP) recipients to purchase healthier foods at a subsidized or discounted rate beyond standard SNAP benefits? (For example, programs that provide extra SNAP funds for the purchase of healthy foods in places such as farmers markets, corner stores, or grocery stores.)

1. Yes

2. No

77. Don’t know

58. [LEADTEST] Not including schools, does your local government require testing for lead in tap water in buildings owned or operated by local government?

    1. Yes

    2. No

77. Don’t know

Section 7: Policies that Support Employee Breastfeeding

[INTRO7] These next questions ask about policies that support employee breastfeeding.

59. [FEMWORK] Federal law requires employers to provide breast-feeding employees with break time and a private space other than a bathroom to pump breast milk. The law applies only to women who work for hourly wages. Does your local government have a policy that allows ALL (salaried and hourly) local government employees break time and space to pump breast milk?

1. Yes

2. No

77. Don’t know

60. [FEMMAT] Does your local government provide paid maternity leave for its employees? Paid maternity leave is paid leave that does not use already accrued leave such as vacation or sick leave. It also does not include leave allowed under the Family Medical Leave Act (FMLA). A human resources department representative may be helpful in answering this question.

    1. Yes

    2. No [GO TO THANKYOU]

77. Don’t know [GO TO THANKYOU]

61. [FEMWEEK] How long is this maternity leave?

1. Less than 4 weeks

2. 4-7 weeks

3. 8-12 weeks

4. More than 12 weeks

THANKYOU. Thank you for your participation in the CBS HEAL study. We appreciate your time and efforts. A summary report will be sent to you when all data has been collected and summarized. If you have any questions, please contact our study partner, NORC at the University of Chicago, at cbsheal@norc.org or 800-239-5036.

Please hit “SUBMIT” to submit your survey responses.