Form 0923-0047 AttB EJI Breakout Session Survey (online)

Attachment A.

Environmental Justice Index Breakout Session Survey

Thank you for your interest in the EJI. This brief 3-minute survey is voluntary. Your answers will be anonymous. Here is some more information about this survey and how you can consent to take part.

PURPOSE: The Environmental Justice Index Team is conducting this survey to gather feedback on how the EJI preforms. The information will be used to help improve the EJI in data, accessibility, effectiveness, and instruction for the benefit of communities and policy makers around the country.

CONSENT: Taking part in this survey is completely voluntary. Your responses are anonymous. Digital data will be stored in secure computer files. By proceeding, you indicate that you are 18 years of age or older, and CONSENT to participate in this survey.

ADDITIONAL INFO: ATSDR estimates the average public reporting burden for this collection of information is 3 minutes per survey, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0923-0047).

Form Approved | OMB No. 0923-0047 | Exp. Date 02/28/2025

1. What Breakout Session did you attend?

   1. Social Vulnerability Module

   2. Environmental Burden Module

   3. Health Vulnerability Module

2. Do you agree with the following statement: This module captures the topic in an effective and understandable manner.

   1. Strongly disagree

   2. Disagree

   3. Neutral

   4. Agree

   5. Strongly Agree

3. Do you agree with the following statement: The methods used to process and combine indicators for this module are optimal.

   1. Strongly disagree

   2. Disagree

   3. Neutral

   4. Agree

   5. Strongly Agree

4. Do you have suggestions for methods that should be considered? If so, please provide a description.

5. Are there indicators or datasets you would consider adding to this module? If so, please provide a description.

6. Do you agree with the following statement: The information presented in this module was communicated in a way that is clear and easy to understand.

   1. Strongly disagree

   2. Disagree

   3. Neutral

   4. Agree

   5. Strongly Agree

7. What information from this module would you like to see more thoroughly explored in EJI materials? Please provide a description.