CHECKLIST 
TESTING DATA COLLECTION INSTRUMENTS AND DATA COLLECTION SYSTEMS

         
                                           
A.   PURPOSE AND AUTHORITY                                
                                           
    1. Purpose of the questionnaire is clearly stated including a description of how the data are to be used.
                                           
    2. Clear, specific statements about who is requested to complete the questionnaire are included.            
    3. Clear statements on the authority to collect the information and on the voluntary nature of participation are on the first page of the form.        
    4. A Privacy Act statement and a statement regarding data confidentiality appear on the first page of the questionnaire.
    5. Reference is made to any groups officially supporting the survey.            
    6. OMB clearance number is placed in the upper right-hand corner of the first page of the questionnaire.      
    7. Expiration date, form number and edition dates are located on each page of the questionnaire.      
                                           
B. DATA REQUIREMENTS                                  
                                           
    1. Each data element is needed to support the purpose of the survey.            
    2. Time requirements for completing the questionnaire is not excessive (in most cases, less than 30-45 minutes).  
                                           
C. QUESTION CONTENT AND WORDING                            
                                           
    1. Question structure (i.e. open-ended, multiple choice, etc.) is the most suitable for information requested.        
    2. Questions do not lead to biased answers.                        
    3. Wording is geared to the particular respondents. 4. Double or compound questions are not used.                      
    5. Only commonly accepted abbreviations are used.                      
    6. Reference periods or dates are clearly specified.                    
                                           
D. FORMATTING                                    
                                           
    1. Questions on the same general topic are grouped together.                
    2. Skip patterns, clearly identified, are used to ensure that only appropriate questions are asked of each respondent.    
    3. Complex skip patterns and ambiguous questions are avoided. 4. Sufficient space is provided for responses.              
    5. Use of check boxes and preprinted data is maximized. 6. All items are numbered.                  
                                           
E. INSTRUCTIONS                                    
                                           
    1. All necessary definitions are provided.                          
    2. Instructions are provided for each item on the form where necessary to avoid ambiguities or uncertainties.  
    3. Instructions for specific questions are numbered to correspond to the questions they explain and are located next to the question where feasible. 4. Instructions for returning questionnaire are provided.      
    5. A phone number is provided for respondent inquiries.                  
                                           
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