National Intimate Partner and Sexual Violence Survey: 2010 Summary Report

Form Approved
OMB No. 0920-0847
Exp. Date 02/28/2013

Public reporting burden of this collection of information is estimated to be 10 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 NE, MS D-74, Atlanta, GA 30033; Attn: PRA (0920-0847).

Please answer all questions as indicated.

1

Which of the following agencies/categories best describes where you work?

Federal government

State government

State level, non-governmental organization

Local, county, or tribal government

University or college

School or school system

Hospital or healthcare system

Faith-based organization

Media, marketing, or public relations

Community-based organization

Advocacy organization

Other, please specify

2

This product is relevant to me in my work.

Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
*This product is relevant to me in my work. Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable

3

This product has improved/will improve the way I work to prevent violence.

Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
*This product has improved/will improve the way I work to prevent violence. Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable

4

This product has increased my knowledge of intimate partner violence, sexual violence, and stalking.

Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
* This product has increased my knowledge of intimate partner violence, sexual violence, and stalking. Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree

5

I have used or plan on using this product in a training.

Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
*I have used or plan on using this product in a training. Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable

6

I have used or plan on using this product in the development of a policy.

Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
* I have used or plan on using this product in the development of a policy. Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable

7

This product contains credible information.

Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
*This product contains credible information. Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable

8

This product is easy to understand.

Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
*This product is easy to understand. Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable

9

The utilization of this product has led to concrete changes in the programs or services provided by my organization.

Never	Rarely	Sometimes	Often	Very Often	Not Applicable
*The utilization of this product has led to concrete changes in the programs or services provided by my organization. Never	Rarely	Sometimes	Often	Very Often	Not Applicable

10

Overall, in the field of my professional practice, this product is pertinent for my professional practice.

Never	Rarely	Sometimes	Often	Very Often	Does Not Apply
* Overall, in the field of my professional practice, this product is pertinent for my professional practice. Never	Rarely	Sometimes	Often	Very Often	Does Not Apply

11

What changes would you recomment to improve this product to make it more effective?

12

What would you add to future versions of this product?

13

What was most useful about this product?

14

What was least useful about this product?