Icr 2528-0248 5_5

PART B STATISTICAL METHODS OF DATA COLLECTION

A2) How and By Whom the Data Will Be Used

A3) Use of Improved Technologies

A4) Efforts to Identify Duplication

A5) Involvement of Small Entities

A6) Consequences of Less Frequent Data Collection

A7) Special Circumstances

A8) Consultations outside the Agency

A10) Arrangements and Assurances Regarding Confidentiality

A11) Sensitive Questions

A12) Estimate of Annualized Burden Hours

Exhibit 1

A13) Estimated Record Keeping and Reporting Cost Burden on Respondents

A14) Estimated Cost to the Federal Government

A15) Reasons for Changes in Burden

A16) Tabulation Plans, Statistical Analysis, and Study Schedule

A17) Expiration Date Display Exemption

A18) Exceptions to Certification

B1) Potential Respondent Universe

B2) Sampling Method and Respondent Universe

B3) Procedures to Deal with Non-Response

B4) Pre-Testing of Procedures

B5) Persons Responsible for Statistical Aspects of the Design

Annex A - Application for Alternative Housing Pilot Program

Supplementary Questionnaire - January 16, 2008

CONTACT INFORMATION

A2.1 Project Overview

A2.2 Purpose of the Data Collection

A2.3 Who Will Use the Information

A2.4 Instrument--Item-By-Item Justification

45. CONTACT #1:

46. CONTACT #2:

HUD is conducting an evaluation of FEMA’s Alternative Housing Pilot Program (AHPP). Four states affected by Hurricanes Katrina and Rita received AHPP grants to test out alternative approaches to providing temporary housing after a disaster. HUD is charged with measuring what benefits and costs are associated with each of the alternatives being implemented by the states. Benefits and costs are to be measured in terms of the cost, quality, durability, and speed of construction and delivery of the housing units; health, satisfaction, and general well-being of the occupants; and acceptance and impact on the communities in which they are placed.

FEMA will use the information from this evaluation in two distinct ways:

To know what type of temporary housing solution is the best approach for the range of housing needs from an expected stay of only a few months to a semi-permanent long-term housing solution. FEMA also wants to think about these solutions within the context of “group sites” versus placement on personal home sites and in the context of a variety of population types - such as persons with disabilities and the elderly.

To assess how well states’ administer temporary housing programs.

This baseline survey is needed to know the characteristics of eligible households applying to participate in the program.

The Alternative Housing Pilot Program is authorized under Section 2403 of Public Law 109-234, enacted on June 15, 2006. This data collection activity is authorized under [12.U.S.C. 1701z-1], which reads as follows:

TITLE 12--BANKS AND BANKING

CHAPTER 13--NATIONAL HOUSING

Sec. 1701z-1. Research and demonstrations; authorization of

appropriations; continuing availability of funds

The Secretary of Housing and Urban Development is authorized and

directed to undertake such programs of research, studies, testing, and

demonstration relating to the mission and programs of the Department as

he determines to be necessary and appropriate. There is authorized

to be appropriated to carry out this title [12 U.S.C. 1701z-1 et seq.]

$35,000,000 for fiscal year 1993 and $36,470,000 for fiscal year 1994.

HUD plans to measure the impact of the AHPP program on the people who receive an AHPP unit compared to similar persons who do not receive an AHPP unit. The first step in measuring this impact is collecting baseline data on households applying for an AHPP unit.

Ideally, each of the sites will implement a selection process that results in randomly ordering eligible applicants to receive an AHPP unit. HUD is working with each site to establish such protocols, where possible. This will result in a “treatment group” - those offered an AHPP unit - and the “control group” - those not offered an AHPP unit.

As noted under A1, this baseline survey is needed to know the characteristics of eligible households applying to participate in the program. This information is critical as an evaluation tool to:

Document the demographic characteristics of those that apply for the program;

Provide information about how the disaster affected their pre-storm housing and information on their expectations at securing permanent housing at some point; and

Capture limited baseline information for comparison at a later time on impact measures of interest (such as income, source of income, perceptions of housing and neighborhood quality, and physical and mental health).

These data are also important as covariates in estimating program impacts after 2-years and 4-years of occupancy. HUD is working with states to make selection of those that actually receive a unit (from a pool of those eligible and applying) to be random. A random selection process will allow HUD to evaluate program impacts by comparing the outcomes of those offered a unit against outcomes for those not offered a unit.

HUD's Office of Policy Development and Research (PD&R) in conjunction with FEMA, will use the data collected as baseline information to assess the impact of alternative housing options on victims of a disaster. The information collected in the baseline survey will be initially presented in four case studies, one for each state grantee as it reaches a point where most of the planned units are occupied. Each case study will indicate the characteristics of households who are being served by the different programs. A follow-up survey (which will be submitted for non-expedited OMB approval) is expected to be conducted in July 2008 of the treatment and control groups to measure the human impact of receiving an AHPP unit versus not receiving an AHPP unit approximately a year after being offered (or not offered) an AHPP unit. The data from this baseline survey will be used to show change over time for both the treatment and control groups, as covariates in the analysis of impacts, and as a way to divide the sample to conduct subgroup analysis. The baseline data will be used in a similar manner following a 2010 survey to measure impacts 3-years after being offered (or not offered) an AHPP unit.

Well it is not yet clear how many households will apply for an AHPP unit, HUD is estimating that this survey will be given to approximately 10,000 program applicants. Of those 10,000 applicants, HUD estimates 5,000 will receive AHPP units. The content of the survey has the following elements:

Contact Information

The first 6 questions obtain name, date of birth, FEMA registration number, current address, email address, and various phone numbers. This information is critical for matching to state data on who ultimately is offered and obtains an AHPP unit. It is also critical to enhance our ability to locate applicants for the second and third wave of interviews.

Demographic Information

Questions 7 to 13 collect basic demographic information on the principal respondent and the household members they expect to move into the AHPP unit. Information collected includes sex, race/ethnicity, highest education, and if any household member has a disability. This information is important for describing the characteristics of those who apply for the program, identifying if demographic characteristics impact an applicant’s likelihood of choosing to occupy a unit, and for later subgroup analysis to see if impacts are different by demographic subgroup (for example, elderly vs. family). The disability information is particularly important because of the need to know if the program adequately serves persons with disabilities.

Income Information

Questions 14 to 17 collect information on income and other sources of living support. The goal of these questions is to understand the stability of applicants’ economic and living situation at the time they apply. These data will be analyzed in a manner similar to other demographic information (above).

Pre-hurricane Housing - all households

Questions 18 to 21 seek out basic information on the type of housing individuals applying lived in pre-storm, including the address of the housing unit. The type of housing, extent of damage, and tenure are likely strong determinants on how long a person will live in an AHPP unit. These questions will allow us to test this hypothesis.

Pre-hurricane Housing - owners

Questions 22 to 30 ask questions specific to individuals who owned their homes pre-storm. The questions want information on their mortgage, estimated cost to repair, how much insurance will cover, what other grants or loans have been approved or denied, if they plan to repair, and status of repairs. All of these factors are likely to have a strong effect on the length of time a household might be expected to stay in an AHPP unit.

Current Housing

Questions 31 to 38 want basic information about the applicant’s current housing and neighborhood. This includes information on number of homes lived in since the storm, what type of housing they are currently living, if they are getting any subsidy for that current housing, the main reason they are applying for an AHPP unit, any quality problems with their current unit, basic satisfaction questions about the neighborhood they live, how safe they feel during the day and night, and if they have been a victim of a crime. These questions are directly related to an applicant’s motivation for participating in the AHPP program. They can also tell us a lot about an applicant’s view of the existing FEMA provided housing (among those who are currently receiving that housing).

Health

Questions 39 to 44 ask about general health, exercise, height and weight (to calculate in individual’s Body Mass Index), and mental health (using the K6 questions used widely in other surveys). Recent research on the Moving To Opportunity program (Orr, et al, 2003) shows that a change in neighborhood environment and housing can have a large impact on mental and physical health. To see if the AHPP program has similar impacts, this survey collects some basic data on health. This information will be used for baseline descriptive analysis and as covariates in later impact analysis.

The survey may be modified for each AHPP grantee to ensure it is relevant to the specific program designed in each state. For example, in Mississippi, their program will not have a formal application process. Rather, they plan to simply randomize the list of current households in FEMA travel trailers and offer the new AHPP units in order from that list. As a result, the questions in this survey would be modified to remove reference to an application and to remove response categories referring to current housing that is other than FEMA travel trailers. These minor modifications from state-to-state are not expected to have any impact on the estimated number of burden hours. Further, any modifications will not substantially change the substance of the form.

HUD will use improved technologies to the extent that they are consistent with a state’s approach to receiving applications for their program. The baseline survey is expected to be included as part of the application materials each state develops. If a state uses a web-based application, there will be a web-based survey that the state application requires applicants to complete. If a state is using information sessions to discuss the program and have participants in those sessions complete applications, applicants will be asked to complete the survey in a group proctored session. If the state is mailing out applications to individuals, HUD will use a mail survey. The key to the data collection approach is flexibility, to ensure a high response rate to the survey.

While there are a number of surveys that have been conducted of individuals impacted by Hurricane’s Katrina and Rita, those surveys have reflected different sampling schemes and purpose than this survey, which is specifically intended to measure the baseline characteristics of households applying for the Alternative Housing Pilot Program.

All respondents to this survey will be individuals impacted by Hurricanes Katrina and Rita.

This is a one-time collection. Future surveys of this population will be requested through the regular Paperwork Reduction Act process. Without collecting these baseline data, it will significantly reduce the ability of the research team to measure AHPP program impacts. Baseline data are critical for knowing the characteristics and motivations of applicants at the time they are signing up for the program. Baseline data allow for an unbiased tool to create subgroups for analysis and to adjust impact estimates to adjust for any random differences between groups at baseline that might later affect the impact estimates.

The extension of the clearance for t he baseline survey is critical to the success of HUD’s evaluation of FEMA’s AHPP. Originally, HUD requested expedited clearance for this baseline survey. Mississippi, the largest grantee, indicated that it planned to start accepting applications in May of 2007. To date, Mississippi has, in fact, made considerable progress in AHPP implementation; placing hundreds of households in manufactured housing. However, implementation of the AHPP by the other three grantee states has taken much longer than expected. Hence, the baseline survey must continue to be available for administration to hundreds of potential AHPP participant households. Therefore, it is critical that this survey still be available for collecting baseline data prior to states making resident selections.

A Federal Register Notice was published on January 16, 2008 on Page 2932. No comments were received. Since the inception of the AHPP, HUD has continuous consulted with FEMA as well as with State and local agencies in all four of the AHPP grantee States, i.e., Louisiana, Mississippi, Texas and Alabama. It is estimated that of the four grantees, Louisiana and Mississippi will produce more than 4,500 of the estimated 5,000 units to be developed under the program. The comments of FEMA and the Louisiana, Mississippi, and Alabama grantees have been incorporated into the survey. FEMA staff requested that the survey collect more information on income and health. Mississippi and Alabama grantee staff made several comments on how the survey should be tailored to them specifically but also noted places where the survey could be simplified to make it easier for participants to complete, and Louisiana staff commented as well.

A9) Payments to Respondents.

No payments are being made to respondents who voluntarily agree to participate in this data collection.

The names, addresses, date of birth, telephone numbers and other private data of program applicants are to be collected by this survey. The data to be collected are protected under the 1974 Privacy Act. After collection of the data, the private data and survey responses will be separated into two files, only linkable by a unique program-specific identifier. The data will be accessible to only members of the HUD research team who have a need to access the data. Access to the data will be on password protected computers. Back-ups of the data, both paper and electronic, will be maintained in locked file cabinets. Any data collected through the internet will be protected through SSL encryption.

Respondents will be informed as part of the survey that the data are protected under the 1974 Privacy Act.

This survey asks questions about income, race/ethnicity, and health (including height and weight). Income and race/ethnicity questions are critical information for knowing the characteristics of people applying for the program. They both will allow subgroup analysis to assess if program impacts are different based on income or race/ethnicity. The health data are important because other research on housing strategies (Orr, et al. 2003) show that ones living environment can have large effects on such items as obesity and mental health.

Total annualized burden hours are estimated at 4,167. Exhibit 1 provides detailed information on the estimated respondents’ time to complete the data collection and the total respondents’ burden for the data collection effort.

Number of Respondents

Burden per Respondent (Minutes)

Total Annual Burden (Minutes)

Number of Responses

Total Respondent Burden (Minutes)

Total Burden per Respondent

Total Project Burden (Hours)

(A x B)

(C x D)

(B x D)

10,000

250,000

4,167

The cost burden to respondents is the time required to respond to the survey questions, approximately 25 minutes. The survey is requesting information that cannot be obtained any other way. No additional record keeping is required.

The estimated cost to the federal government is staff time to design and administer the survey. This is estimated to be 200 hours. HUD is currently in the process of procuring a contractor to analyze the baseline data as well as develop, administer, and analyze two follow-up surveys. The follow-up surveys will be submitted separately to OMB for review through the regular OMB clearance process.

This request is an extension to a currently approved collection and there is no change in burden..

The baseline data will be used in three reports:

A case study for each state’s program at time of general occupancy
Initial Comprehensive Evaluation Report reporting on progress and impacts through year 2.
Final Comprehensive Evaluation Report reporting on progress and impacts through year 4.

The information collected in the baseline survey will be initially presented in individual case studies for each state grantee to indicate the characteristics of households who are being served by the different programs. A follow-up survey (which will be submitted for non-expedited OMB approval) is expected to be conducted in July 2008 of the treatment and control groups to measure the human impact of receiving an AHPP unit versus not receiving an AHPP unit approximately a year after being offered (or not offered) and AHPP unit. The data from this baseline survey will be used to show change over time for both the treatment and control groups, as covariates in the analysis of impacts, and as a way to divide the sample to conduct subgroup analysis. The baseline data will be used in a similar manner following a 2010 survey to measure impacts 3-years after being offered (or not offered) an AHPP unit. If for some state programs the randomization fails, or the analysis of baseline data shows it to not be truly random, the baseline data will instead be used to show pre- and post- impacts for those receiving the AHPP units.

Any reproduction of the data collection instrument will prominently display the OMB approval number and expiration date.

This submission, describing data collection, requests no exceptions to the Certificate for Paperwork Reduction Act (5 CFR 1320.9).

This survey will be of applicants (or equivalent) for the Alternative Housing Pilot Program. In general, only victims of Hurricane Katrina or Rita are potential applicants. States are currently establishing their eligibility criteria for the program so the actual universe will be those households who the state determines to meet their eligibility criteria (such as currently living in a travel trailer). If the state has a formal application process, the universe will be further limited to those that apply for the program.

In states with a small number of likely applicants (Texas and Alabama), our plan is to have all of the applicants complete a baseline survey. In other states (Mississippi and Louisiana) with a very high number of likely applicants, we are planning to take a sample of applicants, as discussed below. With this approach we will limit the number of respondents to 10,000 or less.

If Texas and Alabama each have fewer than 500 applicants, we will ask all 500 to complete the baseline survey in each site. In Mississippi and Louisiana, where we anticipate several thousand more applicants (or equivalent) than there will be available units, we would undertake a plan to survey a subset of the total number of applicants.

Louisiana has not yet established their eligibility criteria, so the sampling approach is not yet developed. Mississippi, however, has said that their approach to offering their expected 3,500 AHPP units is to randomize their list of current occupants of FEMA trailers and mobile homes (approximately 19,000). As AHPP units become ready to ship, Mississippi will contact individuals on the list and determine if they meet the basic requirements (such as need for a unit 6 months or longer). If they do and desire to have an AHPP unit, they will be offered one. We are estimating 50 percent of households will be eligible and want an AHPP unit. We plan to survey the first 4,000 households on Mississippi’s randomized list to have at least 2,000 that receive a unit. To find a control group that has very little chance of being offered a unit, we would draw that control group from the 1,000 households on the list that have a randomized number of 9,000 or higher. We would plan to survey approximately 4,000 households in Louisiana using an approach that works well with the local program.

Two follow-up surveys, which will be submitted for clearance under the regular OMB process, will sample from among the households that completed a baseline survey. That sampling frame has yet to be determined and will be driven by expected minimum detectable effects and evaluation resources.

All surveys are subject to sources of errors, including: non-response, reporting, and processing errors. To reduce non-response, HUD intends to include this survey as part of the application package that AHPP applicants must complete if they want to participate in the program. Ideally, a state will be holding information sessions where individuals can complete their applications on-site. In those situations, the applications will be filled out in a “classroom” setting with a HUD staff person discussing each question and responding to any confusion. If the state uses an on-line application process, the survey would be administered through a web survey. Finally, if applications are mailed out to individuals, the survey would be mailed out and returned with the application. In Mississippi, for example, we will mail out the survey to the sample discussed in B2 and use various forms of follow-up, including phone, to increase response.

This data collection instrument was previously approved and is currently in the field with approximately 1200 completes.

Todd Richardson, Director of the Program Evaluation Division, is responsible for the statistical aspects of the survey design. He can be contacted at (202) 402-5706.

Mississippi Emergency Management Agency

Mississippi Alternative Housing Program

PARTICIPANT DEMONSTRATION ENROLLMENT FORM

The Mississippi Emergency Management Agency (MEMA) has special housing available through the Mississippi Alternative Housing Program (MAHP) for people who were displaced by Hurricane’s Katrina or Rita who are currently living in, or eligible to live in, a FEMA trailer. These special housing units have been made available through funding from FEMA.

FEMA has asked the US. Department of Housing and Urban Development (HUD) and its contractor

Abt Associates Inc., a research company in based in Bethesda, MD to help them keep in touch with people who apply for these special housing units. As part of this process, the enclosed survey asks questions about you and the people who live with you. You may be contacted by researchers from Abt Associates, Inc. and asked to fill out other surveys or be interviewed from time to time over the next 4 years.

This study will follow strict rules to protect your confidentiality. The information on these surveys will be kept confidential to the extent permitted under the Privacy Act. Your information will be used for research purposes only. We are conducting surveys with about 5,000 people across five sites. Only results from groups of people will be reported. Abt Associates will use this information to let HUD and FEMA know how families that receive these special housing units are doing.

Your participation is voluntary. You can refuse to answer any questions if you like. You may stop the survey at any time or skip specific questions. You will not lose any benefits if you decide not to participate, skip specific questions, or stop the interview. At this time, we would like to ask you to agree to participate in this study. Please review the statements on the next page. If you agree with the statements and are willing to cooperate in this study, please check the “Yes” box and then sign and date the form.

If you get a unit through the Mississippi Alternative Housing Program (MAHP), you may be asked to come to meetings to talk about your housing and neighborhood, and changes you and your family have experienced over time. Even if you agree to participate in the study, you can decide not to participate in the future surveys without penalty. However, your experiences are important to the study.

Abt

Institutional Review Board

Approval Date: 10/29/07

Expiration Date: 10/28/08

) acknowledge that by signing

this form, I understand the following statements:

People who apply for this housing may become part of a research study. The research study is being done by Abt Associates, Inc. and the Department of Housing and Urban Development for FEMA.

This housing and this research study are open only to those families who were displaced by Hurricanes Katrina or Rita.

Participation in this research study may include completing surveys periodically during the next four years. These surveys will ask questions about my housing, employment, family, and health.

My participation in this study is voluntary and I can quit at any time.

When doing these surveys, I can choose not to answer any questions I am uncomfortable with.

Approximately 5000 people applying for alternative housing program will be asked to answer these questions.

In no way does my participation in this survey affect any other forms of housing assistance I may or may not receive now, and

My responses will be used for research purposes only.

Signature

Date

FEMA #

Name: Please Print

Abt ID:

Case ID:

□ YES, I have read this form and I am willing to participate in the study. I agree to let the researchers studying this program contact me about participating in future surveys or interviews and get information about me or my children from FEMA, HUD, or other government agencies. Your individual responses will be maintained securely and only be seen by the researchers working on this project.

□ NO, I have read this form and have decided not to participate in this study.

I (PRINT NAME:

All of my responses will be kept private, and no one will be able to see my name and answers together.

Mississippi Alternative Housing Program Questionnaire

The U.S. Department of Housing and Urban Development (HUD) is evaluating the Mississippi Alternative Housing Program (MAHP) for FEMA. It is a requirement of the grant that the Mississippi Emergency Management Agency (MEMA) assist with this evaluation.

If you are selected to receive an MAHP unit, the federal government needs to know how living in the unit affects you. This will allow FEMA and HUD to make better decisions about how to respond to future disasters.

The information obtained through this survey will be used as baseline information to compare your responses to a follow-survey that will be conducted approximately two years from now. It is important that you respond to the later survey in addition to this baseline survey. The results from these surveys will be used to determine if the AHPP houses should be used as housing after future disasters.

Public reporting burden for this collection of information is estimated to average 25 minutes per response. This agency may not collect this information, and you are not required to complete this Form, unless it displays a currently valid OMB control number. The OMB Control Number for this survey is 2528-0248, expiring on 4/30/2008. This collection is authorized by 12.U.S.C. 1701z-1, which authorizes HUD to undertake studies of this type.

Sensitive Information: Your individual responses will be maintained securely and will only be seen by the researchers working on this project. If you have any questions about this survey, please contact Erin Wilson at 301-634-1776.

When you fill out this form, please indicate your answer by circling the number next to the response you want to select or filling in the blank boxes provided for your answer.

Please fill in the following information about yourself and how you can be contacted:

1. First Name

2. Last Name:

3. Date of birth:

Month Day Year

4. FEMA Registration Number:

5. Please provide the address of where you are currently living:

Address:			Apt. #:

City:	State:	Zipp:

6a. If possible, please provide us with up to three phone numbers where we might be able to reach you or another household member if we need to ask you a question. Please also tell us what phone it is (for example, “My mobile phone”, “Home Phone”, “Work Phone”, “My Husband/Wife’s mobile phone”).

Area Code Number

Phone Number 1:

Whose Phone?

Area Code Number

Phone Number 2:

Whose Phone?

Area Code Number

Phone Number 3:

Whose Phone?

6b. If possible, please provide us with up to three email addresses where we might be able to reach you or another household member if we need to ask you a question. Please also tell us whose email address it is.

Email 1:		@
Whose email?

Email 2:		@
Whose email?

Email 3:		@
Whose email?

Please provide us the following information about yourself. Please circle the number next to your response.

7. Are you Male or Female?

	1	Male
	2	Female

8a. What ethnicity do you consider yourself?

	1	Hispanic or Latino
	2	Not Hispanic or Latino

8b.What race do you consider yourself? You may indicate more than one.

	1	American Indian or Alaska Native
	2	Asian
	4	Black or African American
	5	Native Hawaiian or Other Pacific Islander
	6	White

9. What is the highest degree or level of school you have completed? (select only one)

	1	Nusery School to 6th grade or no schooling
	2	7th to 12th grade - NO DIPLOMA
	3	High School Graduate or Equivalent (for example, GED)
	4	Some College
	5	Associates Degree
	6	Bachelors Degree
	7	Masters Degree, Doctorate Degree, or other Professional Degree (for example, MD, DDS, DVM, LLB, JD)

Now we would like to know something about who currently lives with you.

10. How many people do you live with? Please write the number in the box below.

11. Please provide the information for each person that lives with you in the table below.:

First Name	Last Name	Age	Gender (M/F)	Relationship to you	Currently Living with you? (Y/N)

12. Do you or anyone in the household have a physical disability or condition that limits one or more basic activity such as walking, climbing stairs, reaching, lifting, or carrying? Please circle the number of your response. If you select yes, please answer question 12a as well.

1	Y es	12a. Is anyone in a wheelchair or otherwise unable to climb stairs at all?
2	No		1	Y es
			2	N o

13. Do you or anyone in the household have a sensory disability such as blindness or deafness?

	1	Yes
	2	No

The next set of questions ask about your income in the past month and generally what resources you are depending on to support yourself. This information is important for understanding what impact the AHPP program might have.

14a. Are you currently:

	1	Employed full-time (30 hours of work per week or more)
	2	Employed part-time (less than 30 hours per week)
	3	Self-employed
	4	Unemployed Looking for Work
	5	Not working for pay (retired, disabled, taking care of family, etc...)

14b. How many of the people your household (including yourself) are employed full-time or part-time?

15a. Please check ALL of your HOUSEHOLD’S sources of income in the past month: (you may check more than one)

	1	Wages, salary, commissions, bonuses or tips from a job
	2	Self-employment income
	3	Interest, dividends, net rental income, royalty income, or income from estates and trust
	4	Social Security or Railroad Retirement
	5	Supplemental Security Income (SSI)
	6	Alimony or Child Support
	7	Any public assistance or welfare payments from the state or local welfare office (including TANF, but NOT including Food Stamps)
	8	Food Stamps
	9	Retirement, survivor, or disability pensions (NOT including Social Security)
	10	Unemployment Compensation
	11	No income in past month
	12	Other

15b. What is your household’s total monthly income last month from all of the sources checked above. MONTHLY HOUSEHOLD INCOME:

$ .00

16. In the past month, have you or anyone in your household had to use savings, insurance proceeds, state repair grant, or credit card debt in order to cover your living expenses? (check all that apply)

	1	Yes, savings
	2	Yes, insurance proceeds from your homeowner or renters policy
	3	Yes, state grants program for hurricane victims
	4	Yes, new credit card or other debt (that you did not pay off this month)
	5	No

17. In the past month, have you lived in housing or received financial assistance from family, friends, or a charitable organization (such as a church or the Red Cross)? (check all that apply)

	1	Yes, living with friends or family (or in a house provided by friends or family)
	2	Yes, friends or family provided some financial help
	3	Yes, living in housing provided by charitable organization (including a homeless shelter)
	4	Yes, charitable organization provided some financial help
	5	No

Please tell us something about the house or apartment you lived in immediately before the Hurricane.

18. What was the address of the home you lived in before the Hurricane?

Address:			Apt. #:

City:	State:	Zip:

19. What type of building did you live in? (select only one)

	1	A Mobile Home on my own land
	2	A Mobile Home on leased land (in a “trailer park”)
	3	A one-family house detached from any other house
	4	A one-family house attached to one or more houses (duplex, row house)
	5	A building with 2 to 4 apartments or condominiums
	6	A building with 5 or more apartments or condominiums
	7	Hotel or Motel
	8	Homeless Shelter
	9	Homeless - living on the street
	10	Other (such as boat, RV, van, etc.)

20. What best describes the level of damage your home sustained?

	1	Destroyed or more than 50 percent damaged. The house was washed away or damaged so badly that it is uninhabitable without major reconstruction.
	2	Major Damage - 20 to 50 percent damaged. The house needed substantial repairs such as a new roof and repair of most walls and fixtures.
	3	Moderate Damage - 5 to 20 percent damaged. One or more rooms in the house needed substantial repairs but other rooms were relatively undamaged.
	4	Low Damage - 1 to 5 percent damaged. The home had limited damage such as roof shingles blown off, damaged siding, or minor water damage.
	5	No Damage
	98	Don’t Know
	7	Homeless before the hurricane

21. Did you own or rent?

1	Own or buying
2	R ent
3	Other (such as homeless) (skip to question 31)

		21a. Pre-hurricane, how much were you paying in monthly rent?
			$ .00	(skip to question 31)

Answer questions 22 to 30 ONLY if you or someone else in the household OWNED OR WAS BUYING the house or condominium you lived in immediately prior to the Hurricane. Otherwise, SKIP to question 31.

22a. How much do you estimate the home you lived in was worth before the storm?

	$ .00			or range:	$ .00	to	$ .00
		98	Don’t Know

22b. Do you or the person that owned the home still own the home that was damaged?

1	Yes
2	N o	If you no longer own the home, what happened to the house?
		1	Lender foreclosed (skip to question 31)
		2	Sold it (skip to question 31)
		3	Other (specify, then skip to question 31) ___________________________________________

23. If you still own the home, do you have a mortgage on the damaged home?

	1	Yes
	2	No (skip to question 25)

24. For owners with a mortgage on the house, are you up-to-date on your monthly payments?

	1	Yes
	2	No, lender is not requiring me to pay currently
	3	No, lender has indicated I am delinquent in my payments
	4	No, lender is in the process of foreclosing

25. How much is it estimated that it will cost to repair your home?

$ .00

or range:

$ .00

Don’t Know

26. What percent of the estimated cost to repair has the insurance company said it would cover?

	1	All
	2	More than half
	3	Some, but less than half
	4	None, wrong type of insurance or insurance company will not pay
	5	None, did not have insurance
	98	Don’t Know

27. Please indicate what programs you have been approved to receive assistance from because your home was damaged in the storm.

28. Do you plan to repair/rebuild your home?

1	Yes
2	N o	If you do not plan on repairing or rebuilding your, what are you planning to do with it?
		1	Sell it (skip to question 31)
		2	Nothing (skip to question 31)

29. If you are planning to repair or rebuild, what is the status of the rebuilding?

	1	Completed
	2	Construction started and will be completed in less than 6 months
	3	Construction has just begun
	4	Plan to start construction within 6 months
	5	Plan to start construction within 1 year
	6	Do not know when construction might start

30. When construction is completed, do you expect to move back into your rebuilt home?

	1	Yes
	2	No

Now, please tell us something about your current housing.

31. How many different places have you lived for a week or longer since the hurricane that caused you to leave your house? For example, if you lived in a shelter, moved to a motel, and then received a FEMA travel trailer, that would be “3”.

32. Please indicate the type of housing you are currently living in:

	1	FEMA travel trailer on my property
	2	FEMA mobile home on my property
	3	FEMA travel trailer in a “group site”
	4	FEMA mobile home in a “group site”

33. What is the MAIN reason you would like an AHPP unit?

	1	To have a LARGER place to live
	2	To have a SAFER place to live
	3	To be CLOSER TO HOME
	4	To have a NEWER place to live
	5	To have a PERMANENT house
	6	Some Other Reason (specify) __________________________________________

We’d like to know a few things about the quality of your current housing and neighborhood.

35. Does your current housing have any of the following problems ...

	Yes	No
a. Is there mildew, mold, or water damage on any wall, floor, or ceiling?	1	2
b. Are there any floor problems such as boards, tiles, carpeting or linoleum that are missing, curled, or loose?	1	2
c. Are there any holes or large cracks where outdoor air or rain can come in?	1	2
d. In your home, do you smell bad odors such as sewer, natural gas, etc.?	1	2
e. In the last three months has any bathroom floor been covered by water because of a plumbing problem?	1	2
f. In the last three months has your toilet not worked for 6 hours or more?	1	2
g. In the last three months has your electricity not worked for 2 hours or more?	1	2
h. In cold weather, do you ever need to use your oven to heat your home?	1	2
i. Do all outside doors and windows have locks that work?	1	2

Now, please tell us how satisfied you are with the following neighborhood amenities for your current housing...

	Satisfied	Neither satisfied or unsatisfied	Unsatisfied	Not Applicable or Don’t Know
a. Distance to your job?	1	2	3	4
b. Distance to your child/children’s school?	1	2	3	4
c. Quality of your child/children’s school?	1	2	3	4
d. Garbage pick-up?	1	2	3	4
e. Police response?	1	2	3	4
f. Quality of outdoor space, such as parks?	1	2	3	4
g. Distance to grocery store?	1	2	3	4
h. Friendliness of your neighbors?	1	2	3	4
i. Availability of child care?	1	2	3	4
j. Availability of health care?	1	2	3	4

Now we’d like to get a sense of how safe you think the area is where you currently live.

37. How safe do you feel…

	Very safe	Safe	Unsafe	Very Unsafe
a. On the streets near your home during the day?	1	2	3	4
b. On the streets near your home at night?	1	2	3	4

38. Please tell me if any of the following things has happened to you or anyone who (lives/lived) with you in the past 6 months...

	Yes	No
a. Was anyone’s purse, wallet, or jewelry snatched from them?	1	2
b. Was anyone threatened with a knife or a gun?	1	2
c. Was anyone beaten or assaulted?	1	2
d. Did someone try to break into your home?	1	2
e. Was anyone stabbed or shot?	1	2

Several recent studies have shown a relationship between health and housing. To see if the AHPP has any impact on your health, please tell us about your current health.

39. Would you say your health in general is excellent, very good, good, fair, or poor?

	1	Excellent
	2	Very Good
	3	Good
	4	Fair
	5	Poor

40. Have you ever been told by a doctor or other health professional that you have asthma?

	1	Yes
	2	No

Past studies have shown that the where you live and the type of housing you live in can affect how much you exercise and your weight. To see if the AHPP program might have a similar impact, the next questions ask about moderate physical activity and your height and weight. As noted earlier, these data will be used for this study only and averaged with other respondents. Your individual responses will be kept private.

41. In a usual week, do you do moderate activities on three or more days for at least 10 minutes at a time, such as brisk walking, bicycling, vacuuming, gardening, or anything else that cause small increases in breathing or heart rate?

	1	Yes
	2	No

42. About how tall are you without shoes?

Feet

Inches

43. About how much do you weigh without shoes?

Pounds

We also want to know about how you are feeling.

44. How much of the time during the past month have you felt ...

	All of the time	Most of the time	Some of the time	A little of the time	None of the time
a. So sad that nothing could cheer you up?	1	2	3	4	5
b. Nervous?	1	2	3	4	5
c. Restless or fidgety?	1	2	3	4	5
d. Hopeless?	1	2	3	4	5
e. That everything was an effort?	1	2	3	4	5
f. Worthless?	1	2	3	4	5
g. Calm and peaceful?	1	2	3	4	5

Thank you very much for your time today. To help us be able to get back in touch with you in the future, we would like to collect the names, telephone numbers and addresses of two people who will always know how to reach you. Please tell me about people who live at a different address than you. The information on these surveys will be kept confidential to the extent permitted under the Privacy Act.

First Name
Last Name
Street Address
Apt # (if applicable)
City
State
Zip Code

Area Code Number

Phone Number Contact #1:

Did not apply

FEMA Housing Assistance Repair Grants

State Disaster Recovery Grant (tailor to each state)

SBA Disaster Recovery Loans

Private Bank or Mortgage Company Financing

Other Program

First Name
Last Name
Street Address
Apt # (if applicable)
City
State
Zip Code

Area Code Number

Phone Number Contact #2:

Thank you for completing this survey. Without your help, we would not know if this program works. Please return this survey to MEMA program staff person before you move into your new unit.

File Type	application/msword
File Title	PART A
Author	HUD
Last Modified By	Preferred User
File Modified	2008-05-05
File Created	2008-04-24