Form 6 Custom Web Survey with Consumer and Provider Paths

Federal COVID Response - Audience Feedback to Inform Ongoing Messaging and Strategies for "Combat COVID" (OD)

Attachment 6 - Custom Web Survey with Consumer and Provider Paths 060221

Benchmark & Follow-Up Web Survey – HCP Audience

OMB: 0925-0769

Document [docx]
Download: docx | pdf

Welcome Screen



dmConsent

Public reporting burden for this collection of information is estimated to average 15 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 current

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 NIH, Project clearance

Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (XXXX-XXXX). Do

not return the completed form to this address.








dmCntry

Shape3

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



dmGen & dmAge

Shape4

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



dmHispUS

Shape5

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX





dmRaceMUS

Shape6

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX

































Q5

Shape7

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX

















dmEmploy

Shape8

OMB Control Number: XXXX-XXXX Expiration Date: XX/XX/XXXX

































Q10

Shape9

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX





















Q20

Shape10

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q30

Shape11

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX













Q40

Shape12

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q50

Shape13

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX

















Q60

Shape14

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX































Q100

Shape15

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q105

Shape16

OMB Control Number: XXXX-XXXX Expiration Date: XX/XX/XXXX













Q108

Shape17

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q110

Shape18

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q111

Shape19

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX





Q115

Shape20

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q119

Shape21

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q120

Shape22

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q125

Shape23

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX

Q130

Shape24

OMB Control Number: XXXX-XXXX Expiration Date: XX/XX/XXXX



Q135

Shape25

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q136

Shape26

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX









Q137

Shape27

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q200

Shape28

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX





















Q201

Shape29

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX























Q202

Shape30

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX





















Q205

Shape31

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q210

Shape32

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX











Q215

Shape33

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX





















Q220

Shape34

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q300

Shape35

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q305

Shape36

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q310

Shape37

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q315

Shape38

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX







Q320

Shape39

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q335

Shape40

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX









Q340

Shape41

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q405

Shape42

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX













Q410

Shape43

OMB Control Number: XXXX-XXXX Expiration Date: XX/XX/XXXX



Q415

Shape44

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Q420

Shape45

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX

Q425

Shape46

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



Real Answer Check

Shape47

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX

ISQ Check

Shape48

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



dmStateUS

Shape49

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



dmZipUS

Shape50

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX











Q330

Shape51

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



dmEduUS

Shape52

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX

















dmMarStat

Shape53

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



dmAdultHh

Shape54

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX



dmChildHh

Shape55

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX













dmHhIncUS

Shape56

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorAndrew Walton
File Modified0000-00-00
File Created2021-06-04

© 2024 OMB.report | Privacy Policy