OMB Control #: 1660-0105
Expiration Date: MM/DD/YYYY
FEMA Form: 088-0-2
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 20 minutes hour per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting the survey. You are not required to respond to this collection of information unless it displays a valid OMB control number. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (1660-0105) NOTE: Do not send your completed form to this address.
DHS HOUSEHOLD SURVEY
INTRODUCTION
//ASK ALL//
S1. Hello, my name is ____________ and I am calling from Macro International. We are conducting public opinion research under contract with the Federal Emergency Management Agency (FEMA). For this research, we are obtaining people’s views about how well prepared they are for an emergency or disaster in their communities.
The survey will only take about 20 minutes.
Is this a private residence?
01 Yes, continue
02 No, non-residential [Go to S1_02]
03 Hang-up
04 Answering machine
07 Termination screen
14 CONTINUE IN SPANISH
99 REFUSED [TERMINATE, INITIAL REFUSAL]
//ASK IF S1=02//
(S1_02) Thank you very much, but we are only interviewing private residences. Thank you for your time.
//ASK IF S1=01//
S2. I would like to speak with an adult, age 18 or older, who lives in the household. Would that be you?
YES //GO TO Intro2a//
NO [ASK TO TRANSFER TO ADULT]
99 REFUSED //TERMINATE, INITIAL REFUSAL//
//ASK IF S2=02//
NewS2. May I speak with an adult member of the household?
Yes, transferring
Not available //schedule callback//
99 REFUSED //TERMINATE, INITIAL REFUSAL//
//ASK IF NewS2=01//
S3. Hello, my name is ____________ and I am calling from Macro International. We are conducting public opinion research under contract with the Federal Emergency Management Agency (FEMA). For this research, we are obtaining people’s views about how well prepared they are for an emergency or disaster in their communities.
Continue
99 REFUSED
//ASK IF S2=01 or S3=01//
Intro2a. The survey will only take about 15 minutes.
Your telephone number was chosen randomly. I will not ask for your name, address, or other personal information that can identify you. You do not have to answer any question you do not want to, and you can end the interview at any time. Your participation in this survey is entirely voluntary. Your answers to the survey questions will be held confidential by Macro International. Your name or any other information that could identify you will not be associated with your responses or used in any reports. If you have any questions, I will provide a telephone number—either here at ICF Macro or FEMA—for you to call to get more information or to validate this research.
This interview may be monitored for quality assurance purposes.
Continue
RESPONDENT WANTS MORE INFORMATION
99 REFUSED //TERMINATE, INITIAL REFUSAL//
///ASK IF Intro2a=02///
Intro2b.
For questions about the survey administration/confidentiality concerns: Nicole Vincent (Macro International) 240-747-4942
For questions about the nature of the study or validity of the study: Jenelle Gabriele (FEMA) 202 786-9463
IF RESPONDENT REQUESTS A CALLBACK, TYPE SUSPEND
01 Continue
99 REFUSED //TERMINATE, INITIAL REFUSAL//
A. SCREENER
//ASK ALL//
A1. In your current residence, do you live…?
01 With family members
02 With roommates (including boyfriend/girlfriend)
03 With both family members and roommates
04 Alone
97 DON’T KNOW
99 REFUSED
//ASK IF A1=01 or 02 or 03//
A2. Are there children under the age of 18 living in your residence?
01 YES
02 NO
97 DON’T KNOW
99 REFUSED
//ASK IF A2=01//
A3. Does at least one of the children currently attend a school outside of your home, including day care or part-time kindergarten?
DON’T KNOW
99 REFUSE
//ASK ALL//
A4. Which best describes your job status?
[INTERVIEWER: READ LIST, CHOOSE UP TO TWO RESPONSES]
///MUL=2///
01 Work full-time
02 Work part-time
03 Student
04 Unemployed
05 Retired
95 Other
97 DON’T KNOW
99 REFUSED
B. UTILITY
//ASK ALL//
B1T. I’d like to ask you some questions about different kinds of disasters. Throughout this survey, when I use the term “disaster”, I am referring to events that could disrupt water, power, transportation, and also emergency and public services for up to three days.
//SPECIAL// THROUGHOUT SURVEY MAKE THIS STATEMENT AVAILABLE TO CALLERS WHEN THEY TYPE “SPECIAL”:
Throughout this survey, when I use the term “disaster”, I am referring to events that could disrupt water, power, transportation, and also emergency and public services for up to three days.
//ASK ALL//
B1. In a natural disaster, such as an earthquake, a hurricane, a flood, a tornado, or wildfires, which of the following statements best represents your belief?
01 I can handle the situation without any preparation.
02 Preparation, planning, and emergency supplies will help me handle the situation.
03 Nothing I do to prepare will help me handle the situation.
97 DON’T KNOW
99 REFUSED
//ROTATE B2, B3, B4//
///START ROTATE///
//ASK ALL//
B2. In an act of terrorism, such as a biological, chemical, radiological, or explosive attack, which of the following statements best represents your belief?
01 I can handle the situation without any preparation.
02 Preparation, planning, and emergency supplies will help me handle the situation.
03 Nothing I do to prepare will help me handle the situation.
97 DON’T KNOW
99 REFUSED
//ASK ALL//
B3. In a hazardous materials accident, such as a transportation accident or a power plant accident, which of the following statements best represents your belief?
01 I can handle the situation without any preparation.
02 Preparation, planning, and emergency supplies will help me handle the situation.
03 Nothing I do to prepare will help me handle the situation.
97DON’T KNOW
99 REFUSED
//ASK ALL//
B4. In a severe disease outbreak, such as a bird flu epidemic, which of the following statements best represents your belief?
01 I can handle the situation without any preparation.
02 Preparation, planning, and emergency supplies will help me handle the situation.
03 Nothing I do to prepare will help me handle the situation.
97 DON’T KNOW
99 REFUSED
///END ROTATE///
C. RISK AWARENESS / PERCEPTION
//ASK ALL//
On a scale of 1 to 5, with 5 being “very likely” and 1 being “not likely at all,” how likely do you think…?
C1. Some type of natural disaster will ever occur in your community?
05 VERY LIKELY
04
03
02
01 NOT LIKELY AT ALL
97 DON’T KNOW
99 REFUSED
[CATI: DISPLAY LEAD STATEMENT FROM SECTION C INTRO FOR ITEMS C2through C8: “On a scale of 1 to 5, with 5 being “very likely” and 1 being “not likely at all,” how likely do you think…?”]
//ASK ALL//
C2. Some type of terrorism will ever occur in your community?
//ASK ALL//
C3. Some type of hazardous materials accident will ever occur in your community?
//ASK ALL//
C4. Some type of disease outbreak will ever occur in your community?
D. Severity
//ASK ALL//
D1. If a [fill in from below] were to happen in your community how severe do you think the impact would be to you? Please use a scale of 1 to 5, with 5 being “very severe” and 1 being “not severe at all.”
//ROTATE A - D//
A natural disaster, such as an earthquake, a hurricane, a flood, a tornado, or wildfires
An act of terrorism, such as biological , chemical, radiological, or explosive attack
A hazardous materials accident, such as a transportation accident or a power plant accident
A highly contagious disease outbreak, such as a bird flu epidemic
05 VERY SEVERE
04
03
02
01 NOT SEVERE AT ALL
97 DON’T KNOW
99 REFUSED
E. STAGES OF CHANGE
//ASK ALL//
EINTRO. As we continue with the survey, I will ask you questions about being prepared for a disaster. When I use the words “preparing” or “prepared”, I’m referring to actions people can take at any time to prevent or reduce the impact of disasters on their lives.
//ASK ALL//
E1. How confident are you about your own ability to prepare for a disaster? Please use a scale of 1 to 5, with 5 being “very confident” and 1 being “not at all confident.”
05 VERY CONFIDENT
04
03
02
01 NOT VERY CONFIDENT
97 DON’T KNOW
99 REFUSED
//ASK ALL//
E2. In thinking about preparing yourself for a major disaster, which best represents your preparedness?
[INTERVIEWER: READ ENTIRE LIST, CHECK ONLY ONE RESPONSE]
01 I have not yet prepared but I intend to in the next 6 months
02 I have not yet prepared but I intend to in the next month
03 I just recently began preparing
04 I have been prepared for at least the past 6 months
05 I am not planning to do anything about preparing
97 DON’T KNOW
99 REFUSED
//ASK IF E2=01, 02, or 05//
E3. For each of the following statements, please tell me whether it is “The primary reason”, “Somewhat of a reason,” or “Not a reason at all” why you have not taken any disaster preparedness steps?
//ROTATE A - G//
a. I don’t know what I’m supposed to do.
b. I just haven’t had the time.
c. I don’t want to think about it
d. It costs too much.
e. I don’t think it will make a difference
f. I don’t think I’d be able to
g. I think that emergency responders, such as fire, police or emergency personnel, will help me.
01 A Primary Reason
02 Somewhat of a reason
03 Not a reason at all
97 DON’T KNOW
99 REFUSED
F. RELIANCE
//ASK ALL//
F1. In the first 72 hours following a disaster, please indicate how much you would expect to rely on the following for assistance. Please use a scale of 1 to 5, with 5 being “expect to rely on a great deal” and 1 being “do not expect to rely on at all.”
//ROTATE A - F//
Household members
People in my neighborhood
Non-profit organizations, such as the American Red Cross or the Salvation Army
My faith community, such as a congregation
Fire, police, emergency personnel
State and Federal Government agencies, including FEMA
05 EXPECT TO RELY ON A GREAT DEAL
04
03
02
01 DO NOT EXPECT TO RELY ON AT ALL
97 DON’T KNOW
99 REFUSED
//ASK ALL//
F2. In the event of a disaster, would you expect to need help to evacuate from the area?
01 YES
02 NO
97 DON’T KNOW
99 REFUSED
//ASK IF F2=01//
F3. What kind of help do you think you would need to evacuate from the area?
//DO NOT READ LIST//
[PROBE: Anything else? Record all responses]
///MUL=7///
01 DON’T HAVE A PLACE TO GO
02 INFORMATION ON THE EVACUATION ROUTE
03 TRANSPORTATION OUT OF THE AREA
04 HAVE A DISABILITY AND NEED HELP GETTING OUT OF MY HOME/WORKPLACE
05 HELP EVACUATING MY PET(S)
06 CONCERNED ABOUT GETTING GAS FOR MY VEHICLE
95 OTHER [RECORD RESPONSE]
97 DON’T KNOW
99 REFUSED
///ASK IF F3=95
F3OTH. ENTER OTHER RESPONSE ______________
G. PERSONAL RESPONSE/EFFICACY
//ASK ALL//
G1. How confident are you in your ability to know what to do in the first 5 minutes of [fill in from below]? Please use a scale of 1 to 5, with 5 being “very confident” and 1 being “not at all confident.”
///ROTATE A-D///
A terrorist act such as an explosion of a radiological or dirty bomb?
A hazardous materials accident such as the release of a chemical agent?
An explosion or bomb?
A sudden natural disaster such as an earthquake or tornado that occurs without warning?
05 VERY CONFIDENT
04
03
02
01 NOT VERY CONFIDENT
97 DON’T KNOW
99 REFUSED
//ASK ALL//
G2. How much do you think preparing for a ///fill in from below/// will make a difference in how you handle the situation? Please use a scale of 1 to 5, 5 being “very much” and 1 being “not much at all.”
///ROTATE A - D///
A terrorist act such as an explosion of a radiological or dirty bomb?
A hazardous materials accident such as the release of a chemical agent?
An explosion or bomb?
A highly contagious disease outbreak such as bird flu?
A natural disaster?
05 VERY MUCH
04
03
02
01 NOT MUCH AT ALL
97 DON’T KNOW
99 REFUSED
//ASK ALL//
G3. In the past 2 years, have you done any of the following? Have you… ///ROTATE ITEMS a-e///
a. Attended a meeting on how to be better prepared for a disaster
b. Attended CPR training
c. Attended first aid skills training
d. Attended training as part of a Community Emergency Response Team or CERT
e. Talked about getting prepared with others in your community
01YES
02 NO
97 DON’T KNOW
99 REFUSED
[If any of G3a-d=01]
G4. What motivated you to take this training?
[INTERVIEWER: DO NOT READ LIST]
[PROBE: Anything else? Record all responses]
///MUL=9///
01 MANDATORY FOR JOB/SCHOOL
02 EASY TO SIGN UP (E.G., OFFERED AT WORK, SCHOOL OR PLACE OF WORSHIP)
03 CONCERN FOR PERSONAL SAFETY
04 CONCERN FOR SAFETY OF FAMILY OR OTHERS
05 TO HAVE THE NECESSARY SKILLS TO HELP OTHERS
06 GENERAL INTEREST/HOBBY
07 TO BE PREPARED
08 BECAUSE OTHERS (FAMILY OR FRIENDS) DID
95 OTHER (Specify)
97 DON’T KNOW
99 REFUSED
///ASK IF G4=95
G4OTH. ENTER OTHER RESPONSE ______________
[If all of G3a-d <> 01 ask G5]
G5. What is the main reason you have not received any preparedness training? DO NOT READ LIST.
[PROBE: Anything else? Record all responses]
//MUL=8//
01 LACK OF TIME
02 LACK OF MONEY/TOO EXPENSIVE
03 DON’T THINK IT’S IMPORTANT
04 HAVEN’T THOUGHT ABOUT IT
05 DIFFICULT TO GET INFORMATION ON WHAT TO DO
06 DON’T THINK IT WILL BE EFFECTIVE
07 ALREADY KNOW HOW TO BE PREPARED
08 PHYSICALLY UNABLE TO GET TO A TRAINING
97 DON’T KNOW
99 REFUSED
H. PREVENTION
//ASK ALL//
Now I’d like to ask you a series of questions about noticing and reporting suspicious behavior or circumstances.
H1. In the past 12 months, have you seen any suspicious behavior or circumstances?
01 YES
02 NO
97 DON’T KNOW
99 REFUSED
//ASK If H1=01//
H2. What did you do?
[INTERVIEWER: DO NOT READ LIST, Record all responses]
///MUL=5///
01 CALLED POLICE AND/OR A TIPLINE
02 CALLED NEIGHBOR/FRIEND
03 WAITED FOR SOMEONE ELSE TO DO SOMETHING
04 LEFT THE AREA/SITUATION/EVENT
05 NOTHING
95 OTHER (Specify)
97 DON’T KNOW
99 REFUSED
///ASK IF H2=95
H2OTH. ENTER OTHER RESPONSE ______________
//ASK ALL//
H3. Do you feel you have a personal responsibility to report suspicious behavior or circumstances to the authorities?
01 YES
02 NO
97 DON’T KNOW
99 REFUSED
I. DISASTER SupplIES
//ASK ALL//
For this next set of questions, I’d like to ask you about some specific things you may or may not have done to prepare yourself and/or your household.
I1. Do you have supplies set aside in your home to be used only in the case of a disaster?
01 YES
02 NO
97 DON’T KNOW
99 REFUSED
//ASK IF I1=01//
I2. Could you tell me the disaster supplies you have in your home?
[DO NOT READ LIST]
[PROBE: Anything else?. Record all responses]
///MUL=12///
A SUPPLY OF BOTTLED WATER
A SUPPLY OF PACKAGED FOOD
A FLASHLIGHT
A PORTABLE, BATTERY-POWERED RADIO
BATTERIES
A FIRST AID KIT
EYEGLASSES
MEDICATIONS
PHOTOCOPIES OF PERSONAL IDENTIFICATION
FINANCIAL DOCUMENTS
CASH
OTHER (Specify)
97 DON’T KNOW
99 REFUSED
///ASK IF I2=95
I2OTH. ENTER OTHER RESPONSE ______________
//ASK IF I1=01//
I3. How often do you update these supplies? Would you say…
01 Never
02 Less than once a year
03 Once a year
04 More than once a year
97 DON’T KNOW
99 REFUSED
//ASK ALL//
I4. Do you have supplies set aside in your car to be used only in the case of a disaster?
01 YES
02 NO
03 DON’T OWN A CAR
97 DON’T KNOW
99 REFUSED
//ASK IFA4=01 or 02//
I5. Do you have supplies set aside in your workplace to be used only in the case of a disaster?
01 YES
02 NO
97 DON’T KNOW
99 REFUSED
J. Household Plan
//ASK ALL//
J1. Does your household have an emergency plan that includes instructions for household members about where to go and what to do in the event of a disaster?
01 YES
02 NO
97 DON’T KNOW
99 REFUSED
//ASK IFJ1=01//
J2. Have you discussed this plan with other members in your household?
01 YES
02NO
97 DON’T KNOW
99 REFUSED
//ASK ALL//
J3. Do you have copies of important financial or insurance documents in a safe place to help you rebuild or seek assistance following a disaster?
01 YES
02 NO
97 DON’T KNOW
99 REFUSED
K. COMMUNITY PLAN
//ASK ALL//
K1. Using a scale of 1 to 5 with 5 being “very familiar” and 1 being “not at all familiar,” how familiar are you with…
//ROTATE A - F//
Alerts and warning systems in your community?
Official sources of public safety information?
Community evacuation routes?
Shelter locations near you?
How to get help with evacuating or getting to a shelter?
Information on what your local hazards are?
How to get local information about a public health emergency, such as the H1N1 virus or swine flu?
01 NOT AT ALL FAMILIAR
02
03
04
05 VERY FAMILIAR
97 DON’T KNOW
99 REFUSED
//ASK IF A3=01//
K2. Are you aware of the details of the emergency or evacuation plan of the child(ren)’s school including where the school plans to evacuate and how to get information about the child in the event of a disaster?
01 YES
02 NO
97 DON’T KNOW
99 REFUSED
K3. From which organizations in your community have you received information about the recent outbreak of the H1N1 virus or swine flu? We are talking about information that may have been provided through tv/radio, emails, flyers, presentation, phone calls),? [read all responses. Multiple choices allowed]
Local media
Local government official
Health care provider
Neighborhood association
Faith-based organization
Schools or childcare facilities
Workplace
None
Other [record response]
L. DRILLS/EXERCISES
//ASK ALL//
L1. Aside from a fire drill, in the past 12 months, have you participated in any of the following?
//ROTATE LIST //
///ASK ALL/// A home evacuation drill
///ASK IFA4=01 or 02/// A workplace evacuation drill
///ASK IFA4=01 or 02///A workplace shelter in place drill
///ASK IF A3=01 OR A4=03///A school evacuation drill
///ASK IF A3=01 OR A4=03///A school shelter in place drill
01 YES
02 NO
97 DON’T KNOW
99 REFUSED
M. VOLUNTEERING
//ASK ALL//
M1. During the past 12 months, have you given any time to help support emergency responder organizations or an organization that focuses on community safety, such as Neighborhood Watch?
01 YES
02 NO
97 DON’T KNOW
99 REFUSED
//ASK IFM1=01//
M2. Which one or ones?
01 [Record all responses]
97 DON’T KNOW
99 REFUSED
///ASK IF M2=01///
M2O. ENTER RESPONSE ___________________
//ASK ALL//
M3. Have you ever volunteered to help in a disaster?
01 YES
02 NO
97 DON’T KNOW
99 REFUSED
//ASK ALL//
M4. Would you be willing to take a 20 hour training course to be qualified to help your community recover from disasters?
01 YES
02 NO
97 DON’T KNOW
99 REFUSED
n. Demographics and Context
//ASK ALL//
Lastly, I would like to ask you for some information about you and your household. Again, all information that you provide will be held confidential.
N1. Would you describe the location of your residence as…?
01 Urban
02 Suburban
03 Rural
97 DON’T KNOW
99 REFUSED
//ASK IF A4=01,02,03//
N2 Do you generally use public transportation, such as subways or buses, to get to school or work?
01 YES
02 NO
97 DON’T KNOW
99 REFUSED
//ASK ALL//
N3. What is the highest level of education that you attained? Would it be…?
01 Less than 12th Grade (no diploma)
02 High School Graduate or GED
03 Some College but No Degree
04 Associate Degree in College
05 Bachelor’s Degree
06 Masters Degree
07 Doctorate Degree
97 DON’T KNOW
99 REFUSED
//ASK ALL//
N4. Do you have a disability that would affect your capacity to respond to an emergency situation?
01 YES
02 NO
97 DON’T KNOW
99 REFUSED
//ASK ALL//
N5. Do you currently live with or care for someone with a disability, including someone elderly who requires assistance?
01 YES
02 NO
97 DON’T KNOW
99 REFUSED
//ASK ALL//
N6. How religious would you say you are? Would you say…
01 Very religious
02 Somewhat religious
03 Barely religious
04 Not at all religious
97 DON’T KNOW
99 REFUSED
//ASK ALL//
N7. Which of the following best describes your race? Would you consider yourself to be…?
///MUL=6///
01 White
02 Black or African American
03 Asian
04 American Indian or Alaska Native
05 Native Hawaiian or Other Pacific Islander
95 Something else (Specify)
97 DON’T KNOW
99 REFUSED
///ASK IF N7=95///
N7OTH. ENTER RESPONSE _____________________
//ASK ALL//
N8. Are you of Hispanic or Latino or Spanish origin?
01 YES
02 NO
97 DON’T KNOW
99 REFUSED
//ASK ALL//
N9. In what year were you born?
Enter response _ _ _ _ [RANGE 1900-1991//]
9997 DON’T KNOW
9999 REFUSED
//ASK ALL//
N10. Which of the following income ranges represents your annual household income in 2008? Feel free to stop me at the correct range. Was your household income…?
01 Less than $25,000
02 $25,000 to less than $50,000
03 $50,000 to less than $75,000
04 $75,000 or more
97 DON’T KNOW
99 REFUSED
//ASK ALL//
N11. What state do you live in? _ _
AL Alabama MD Maryland SC South Carolina
AK Alaska MA Massachusetts SD South Dakota
AZ Arizona MI Michigan TN Tennessee
AR Arkansas MN Minnesota TX Texas
CA California MS Mississippi UT Utah
CO Colorado MO Missouri VT Vermont
CT Connecticut MT Montana VA Virginia
DE Delaware NE Nebraska WA Washington
DC District of Columbia NV Nevada WI Wisconsin
FL Florida NH New Hampshire WV West Virginia
GA Georgia NJ New Jersey WY Wyoming
HI Hawaii NM New Mexico
ID Idaho NY New York AS American Samoa
IL Illinois NC North Carolina CN Northern Mariana Islands
IN Indiana ND North Dakota GU Guam
IA Iowa OH Ohio PR Puerto Rico
KS Kansas OK Oklahoma VI Virgin Islands
KY Kentucky OR Oregon 95 Other
LA Louisiana PA Pennsylvania 97 DON'T KNOW
ME Maine RI Rhode Island 99 REFUSED
///ASK IF N11=95///
N11OTH.. ENTER OTHER RESPONSE ______________
//ASK ALL//
N12. What is your zip code? _ _ _ _ _ //RANGE 00000-99996//
99997 DON’T KNOW
99999 REFUSED
///ASK ALL///
N13. Record gender [Do not ask]
01 Men
02 Women
CLOSE1. Those are all of the questions that I have. On behalf of Macro International and FEMA, I would like to thank you for your time and participation. Thank you again.
[ INTERVIEWER: DO NOT ASK!! ]
In what language was this interview completed?
1 English
2 Spanish
| File Type | application/msword |
| Author | Stephanie.K.Rubel |
| Last Modified By | nbouchet |
| File Modified | 2010-03-04 |
| File Created | 2009-09-11 |