Parents-Minor Surveys

Healthy Incentives Pilot Evaluation

Attachment 5 QRE with Added Cell Question 2-2-12

Parents-Minor Surveys

OMB: 0584-0561

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4 Intro.04 (R 2) My name is [INTERVIEWER NAME] from Westat. I am calling about the USDA SNAP. We interviewed you about the program in Hampden County on {MONTH_DAY_YEAR OF COMPLETED R1 INTERVIEW}. We are calling back again, to ask some of the same questions, as well as some new questions about the foods you eat.


Just to make sure I am speaking with the correct person, your name is {FIRST NAME} {MIDDLE NAME} {LAST NAME} and your approximate age is {ADM.AGE}. Is that correct?


Yes – exact match 1

Yes – qualified match 2

No – does not match 3

REFUSED 7

DON'T KNOW 9


CNT2232 Are you talking to us on your cell phone?


Yes 1

No 2


IntroExtended I would like to ask you some questions about food and shopping that will help SNAP improve services and better meet the needs of the people who use this program. The interview takes about 45-60 minutes and you will receive a $30 check as a token of appreciation. {IF CNT2232=YES Becase we’re talking to you on your cell phone, we’ll be giving you an additional $10 in appreciation of your using your cell phone minutes to complete the survey}.

Your participation is voluntary. You have the right to stop at any time or skip questions. Taking part in this study will not affect your benefits in any way – either now or in the future.

We do not plan to share this information with anyone other than USDA staff and its contractors, except otherwise required by law. Data that identify you or your family members will not be included in any report. There is a small risk of the loss of privacy of your data, but our data security plans and procedures minimize this risk.


Agree_R We sent you a letter about the study that provides more information. If you did not receive the letter, I can read it to you.

Do you agree to participate?

YES

IF NO, ADDRESS ISSUES/CONCERNS ABOUT STUDY. CODE AS REFUSAL

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