12 month Tracking Outreach Log

Evaluation of the Rapid Re-Housing for Homeless Families Demonstration Program

Appendix E - Tracking Outreach Log 03-17-11

12 month Tracking Outreach Log

OMB: 2528-0268

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Rapid Re-Housing for Homeless Families Demonstration Study

Appendix E: 12-month Tracking Outreach Log


Instructions: This form is intended to be used in cases when a study participant cannot be contacted directly at the time of the 12-month follow-up survey. In this event, the follow-up survey interviewer should reach out to the contacts (landlord, family, and friends) identified by the study participant during the initial informed consent process. Using one form per contact, all attempts to reach each contact should be documented. If the interviewer reaches the identified contacts, the interviewer should use this form to record any relevant information that could be used to locate the individual or document the person’s whereabouts. [Note: this form will be automated in a database format, and the original information will be pre-populated to facilitate the tracking process and reduce duplicative data entry.]


Contact Attempt

Contact Name


Participant’s Housing Status

Verified participant still in same unit

Verified participant has moved – new address recorded

Verified participant has moved – location unknown

Contact was not willing to provide information about the participant

Contact Attempt Date(s)




Additional Notes from Discussion



Add participant contact information, if new information is provided.


Participant Information (Adult who signed the Participation Agreement)

First Name


Middle Initial


Last Name


Suffix


Street Address


Apt #


City


State


Zip Code


Email


Home Phone


Mobile Phone



Updated Landlord Contact Information (if the participant moved to a new unit)

Landlord’s Name


Company Name


Address (where rent is paid)


City


State


Zip Code


Work Phone


Mobile Phone




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleHousehold Information
AuthorSaty Patrabansh
File Modified0000-00-00
File Created2021-02-01

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