National ALS Registry Website Satisfaction Survey

Form Approved
OMB No. 0923-0047
Exp. Date 12/31/2018




1. I am a (select all that apply)





  

2. How did you learn about the National ALS Registry website (https://wwwn.cdc.gov/als/)?











  

3. How often do you visit the National ALS Registry website?






4. I came to the National ALS Registry website to find information and resources for the following: (Check all that apply)








  

5. I was able to find what I was looking for? (If no, please specify what you were looking for)

   I could not find

6. Which features of the National ALS Registry website do you find most useful (Check all that apply)













7. Please rate the following attributes of the National ALS Registry website.
Rating Scale (1 = Very Dissatisfied; 2 = Dissatisfied; 3 = Neutral; 4 = Satisfied; 5 = Very Satisfied)
Layout/design
Quantity of content
Easy to find information
Meeting my needs
Quality of content
Clear information
Overall satisfaction

8. How likely are you to recommend the National ALS Registry website to a friend or patient in the future?





9. How likely are you to visit the National ALS Registry website again if you need more information?






10. What areas of the National ALS Registry website can we improve? (Select all that apply)






  

11. Did you register for the National ALS Registry?



12. (If selected yes to #11) Please rate:
Rating Scale (1 = Very Dissatisfied; 2 = Dissatisfied; 3 = Neutral; 4 = Satisfied; 5 = Very Satisfied)
Clear directions
The website responded as expected
Time to complete
Overall Satisfaction


13. Did you complete risk factor surveys?



14. (If selected yes to #13) Please rate:
Rating Scale (1 = Very Dissatisfied; 2 = Dissatisfied; 3 = Neutral; 4 = Satisfied; 5 = Very Satisfied)
Clear directions
The website responded as expected
Time to complete
Overall Satisfaction

15. Many items on our site will soon be translated into Spanish. Is there another language you think we should also use? (If yes, please type below)

   If Yes, What language?

16. How old are you?

17. What is your race? (select all that apply)





18. What is your ethnicity?


   

ATSDR estimates the average public reporting burden for this collection of information as approximately 5 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 collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden statement or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0923-0047).


USA.gov: The U.S. Government's Official Web PortalDepartment of Health and Human Services
Agency for Toxic Substances and Disease Registry, 4770 Buford Hwy NE, Atlanta, GA 30341, USA
Contact CDC: 800-232-4636 / TTY: 888-232-6348