OMB Control No. 2528-0256 Expiration Date XX/XX/XXXX
Appendix B: DHAP IRT Study Follow-up Contact Instrument
Introduction
Hello, my name is ______________. I'm calling from Abt Associates, an independent research firm located in Cambridge, Massachusetts. May I speak with (SAMPLE MEMBER)?
IF NO: It is important that I speak directly to (SAMPLE MEMBER). Do you know when (s)he will be home?
Yes q 1
RECORD CALLBACK DATE _________/______/___________
RECORD CALLBACK TIME: ________:__________ AM/PM
No (SKIP TO TERMINATE) q 2
DECEASED (SKIP TO DECEASED) q 3
REFUSED (SKIP TO TERMINATE) q 97
DON’T KNOW (SKIP TO TERMINATE) q 98
TERMINATE 1: Thank you for your time. I will try (SAMPLE MEMBER) back at another time.
DECEASED: IF ANSWERING PARTY SAYS RESPONDENT IS DECEASED, ASK FOR THE NAME OF THE ANSWERING PARTY AND RECORD BELOW. THEN READ:
I am sorry for your loss. At this time I have no further questions. However, I may call back at a later date to speak with someone else in your household. I’d like to ask your name so that I can record who I spoke to. Could you please tell me your first and last name, including the spelling. RECORD NAME THEN THANK ANSWERING PARTY FOR THEIR TIME AND TERMINATE.
___________________________________________________________________
FIRST MIDDLE LAST
IF YES: This telephone call relates to DHAP Incremental Rent Transition Study which is being conducted by HUD's Office of Policy Development and Research. You may recall completing a survey for this study within the past 12 months. We just want to make sure we have current and complete contact information for you so that we can contact you for a future survey. Please know that anything you tell me will be kept confidential, to the extent allowed by the law.
The information you provide will help HUD improve future housing programs. Your participation is voluntary and any information you share with us is absolutely private. Your responses will only be reported as part of a group for this research. Your name will not be linked with your answers. It is important that we be able to reach you so that we can make sure that HUD understands your experiences and the experiences others have had with DHAP.
This interview will just take about eight minutes. May I talk with you now?
Yes (SKIP TO VERIFICATION) q 1
No q 2
When would be a good time for me to call back?
RECORD CALLBACK DATE _________/______/___________
RECORD CALLBACK TIME: ________:__________ AM/PM
Thank you for your time today. I look forward to talking with you again on [CALL BACK DATE].
VERIFCATION: Just to make sure that I am speaking to the correct person, I’d like to confirm your date of birth with what we have in our records. What is your date of birth?
DOB MATCHES
DOES NOT MATCH (RECORD CORRECT DATE OF BIRTH AND CONFIRM LAST FOUR DIGITS OF SSN)
________/________/19______
I’d also like to verify the last four digits of your social security number. I have the last four digits as: (READ LAST 4 DIGITS OF SSN). Is that correct?
CORRECT (GO TO Q.1)
DOES NOT MATCH (RECORD CORRECTION HERE)
Can you tell me the last four digits of your Social Security Number? _______________________
TERMINATE 2: It appears that the information I have in my records is different. I need to confirm this with my supervisor. I may call you back at a later date once I resolve this discrepancy. Thank you for your time.
1. I’d like to start by confirming the spelling of your name. Our records show your name as (spell name from RIB label). Is that correct?
YES 1
NO (RECORD OTHER NAME--FIRST, MIDDLE, LAST:) 2
1a. What is your first name?____________________________________________________
1b. What is your middle name?_________________________________________________
1c. What is your last name?____________________________________________________
1d. Does your name have a suffix?_______________________________________________
2. Now I’d like to collect information about your current address.
2a. What is your current address?________________________________________________
2b. Is there a complex or building name?__________________________________________
2c. Is there an apartment number?_______________________________________________
2d. In what city?_____________________________________________________________
2e. In what state?____________________________________________________________
2f. What is your zip code?_____________________________________________________
3. Do you use that address as your mailing address, or do you have a different mailing address?
USES RESIDENCE ADDRESS FOR MAIL 1
HAS DIFFERENT MAILING ADDRESS (RECORD BELOW) 2
REFUSED 7
DON'T KNOW 8
3a. What is your current mailing address? _________________________________________
3b. Is there a complex or building name?__________________________________________
3c. Is there an apartment number? _______________________________________________
3d. In what city?_____________________________________________________________
3e. In what state?____________________________________________________________
3f. What is your zip code?_____________________________________________________
4. What is your home telephone number, starting with the area code?
(_______) ________-________
REFUSED 7
DON'T KNOW 8
4a. Do you have a cell phone?
YES 1
NO 2
REFUSED 7
DON'T KNOW 8
4b. What is your cell telephone number, starting with the area code?
(_______) ________-________
REFUSED 7
DON'T KNOW 8
Now I’d like to ask a couple of questions about your current housing situation, and your future plans.
5. I’d like to ask you some questions about where you live right now. Are you…
Renting your home or apartment? 1
Living in a home you own? 2
Living with family or friends and pay part of the rent? 3
Living with family or friends and do not pay rent? 4
Living in a group shelter? 5
Homeless? 6
Incarcerated? 7
Living in a group home, dorm or barracks? 8
Living in a hospital/nursing home/special school? 9
OTHER (SPECIFY:_______________________) 95
6. Do you plan to move in the next 6 months?
YES 1
NO (SKIP TO Q10) 2
REFUSED (SKIP TO Q10) 7
DON'T KNOW (SKIP TO Q10) 8
7. Do you know what your new address might be?
YES 1
NO (SKIP TO Q9) 2
REFUSED (SKIP TO Q9) 7
DON'T KNOW (SKIP TO Q9) 8
8. Please tell me your new street address?___________________________________________
8a. Is there a complex or building name?_____________________________________
8b. Is there an apartment number?_______________________________________________
8c. In what city?_____________________________________________________________
8d. In what state?____________________________________________________________
8e. What is the zip code?______________________________________________________
9. Do you plan to stay in this same city you are living in now or do you plan to move to another city anytime in the next 12 months?
Same City
Different City:
What city and state do you plan to live in? City________________, State: _________
[IF Q6=1:] Will you have a new telephone number when you move?
[IF Q6=2,7,8] Do you plan to change your phone number in the next 6 months?
YES 1
NO (SKIP TO Q11) 2
REFUSED (SKIP TO Q11) 7
DON'T KNOW (SKIP TO Q11) 8
10a. Please tell me the new number starting with area code?
TELEPHONE # WITH AREA CODE: (_______) ________-________
REFUSED
DON'T KNOW
Secondary Contacts
In order to continue to help the government learn how to improve housing programs, it is very important that we talk to study participants periodically to see how things are going. Since people often move, we would like to ask you for the names of friends or relatives who usually keep in touch with you. We would contact these people only if we were unable to reach you at the phone number you have provided us. If we need to contact these friends or relatives, we would be asking them only for your address and telephone information and nothing else. We would not identify you as a recipient of DHAP assistance, nor we would tell them you are part of this study.
11. Could you tell us the name of a person who does not live with you and will always know how to contact you?
YES 1
NO 2
REFUSED 7
DON'T KNOW 8
(OBTAIN INFORMATION FOR TWO RELIABLE CONTACTS.)
Contact #1:
Let’s start with the first person’s name.
12a. What is this person’s first name?__________________________________________
12b. What is his/her middle name?____________________________________________
12c. What is his/her last name?_______________________________________________
12d. Does his/her name have a suffix?__________________________________________
Now I’d like to know where [CONTACT #1 NAME] lives.
13a. What is (his/her) street address?___________________________________________
13b. Is there a complex/building name?_________________________________________
13c. Is there an apartment number?____________________________________________
13d. In what city?__________________________________________________________
13f. In what state?_________________________________________________________
13g. What is the zip code?___________________________________________________
14. What's the best phone number to reach (him/her) at starting with the area code?
Telephone # with area code: (_______) ________-________
15. Is she/he a friend or a relative, or what is (his/her) relationship to you?
FRIEND
RELATIVE
OTHER (SPECIFY:) ___________________________
REFUSED
DON'T KNOW
Contact #2:
16. Could you tell us the name of a second person who does not live with you and will always know how to contact you?
YES
NO
REFUSED
DON’T KNOW
17a. What is the name of someone else who keeps in contact with you?_______________
17b. What is his/her first name?_______________________________________________
17c. What is his/her middle name?____________________________________________
17d. What is his/her last name?_______________________________________________
17e. Does his/her name have a suffix?__________________________________________
Now I’d like to know where [CONTACT #1 NAME] lives.
18a. What is (his/her) street address?___________________________________________
18b. Is there a complex/building name?_________________________________________
18c. Is there an apartment number?____________________________________________
18d. In what city?__________________________________________________________
18f. In what state?_________________________________________________________
18g. What is the zip code?___________________________________________________
19. What's the best phone number to reach (him/her) at starting with the area code?
Telephone # with area code: (_______) ________-________
20. Is she/he a friend or a relative, or what is (his/her) relationship to you?
FRIEND
RELATIVE
OTHER (SPECIFY:) ___________________________
REFUSED
DON'T KNOW
Closing
Those are all the questions I have. Thank you very much for your time.
Abt
Associates Inc. Appendix B: Follow-up Contact Instrument B-
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | A Tes Masho |
| File Modified | 0000-00-00 |
| File Created | 2021-02-03 |