Form FEMA Form 008-0-11 FEMA Form 008-0-11 In-Depth Case Study Pulse Survey

OMB Control Number: 1660-NEW

Expiration: None

FEMA Form Number: 008-0-11

PAPERWORK BURDEN DISCLOSURE NOTICE

(In-Depth Case Study Pulse Survey)

Public reporting burden for this form is estimated to average 15 minutes 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 form. This collection of information is voluntary. You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. 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, 1800 South Bell Street, Arlington VA 20598-3005, Paperwork Reduction Project (1660-NEW). NOTE: DO NOT SEND YOUR COMPLETED FORM TO THIS ADDRESS.

CASEID

QID:142273 I.D.#:

CASEID(1-6)

FVALIFON

QID:142274 **AREA CODE AND TELEPHONE NUMBER:

FVALIFON(1161-1179)

CINTTIME

QID:142286 **INTERVIEW TIME:

CINTTIME(1716-1721)

(Programmer: All interviews are recorded. The recording begins when the respondent answers the phone. This statement is read after the "Continue" response is entered after the Introduction and before the first question.)

FRECCONS

QID:142293 This interview will be recorded for internal quality assurance.

1 (Continue)

2 (Refused) - (Thank and Terminate)

FRECCONS(1984)

ENTITYID

QID:179384 ENTITY ID (New):

ENTITYID(916-925)

QID:180143 **HOUSEHOLD SAMPLE:

__X__ Single Household
_____ Multi-household

SA

QID:179374 STATE (2-Digit FIPS code):

(Programmer: Code from fone file)

SA(374-375)

SB

QID:179376 SAMPLE:

New York:11

1. Sullivan

2. Ulster

3. Orange

4. Putnam

5. Rockland

6. Westchester

7. Bronx

8. Queens

9. Nassau

10. Kings

11. Richmond

12. Suffolk

 

New Jersey:21

1. Sussex

2. Passaic

3. Warren

4. Morris

5. Essex

6. Hudson

7. Union

8. Hunterdon

9. Somerset

10. Mercer

11. Middlesex

12. Monmouth

13. Ocean

14. Burlington

15. Camden

16. Gloucester

17. Salem

18. Cumberland

19. Atlantic

20. Cape May

21. Bergen

 

Connecticut:31

1. Fairfield

2. Litchfield

3. New Haven

4. Middlesex

5. New London

6. Windham

7. Tolland

Rhode Island: 41

8. Kent

9. Washington

10. Newport

11. Bristol

SB(376)

SC

QID:179377 SAMPLE TYPE:

(Programmer: Code from fone file)

1 Landline

2 Cell

SC(377)

SD

QID:179378 Age from G1K

(Programmer: Code from sample file)

SD(332-334)

SE

QID:179380 Gender from G1K

(Programmer: Code from sample file)

1 Male

2 Female

SE(372)

SF

QID:179382 Census region

(Programmer: code from sample file)

1 Northeast

2 Midwest

3 South

4 West

SG

QID:188418 ENTITY ID (Original for G1K and Panel):

SG(60-69)

INTRO2

QID:179393 Hello, my name is _______, and I am calling from The Gallup Poll. I am calling on behalf of the Department of Homeland Security. We're conducting a survey about disaster preparedness.  We previously conducted a survey with a (response from SD - 5) to (response from SD + 5) year old (response from SE) in this household) who gave permission for us to call again.  May I speak with that person?

1 Respondent - (Skip to S1B)

2 Someone else in household - (Ask to speak to that person and reset to Intro)

4 No such person/person moved - (Thank and Terminate)

7 Respondent not available/Not a good time - (Set time to call back)

8 Soft Refusal

9 Hard Refusal - (Thank and Terminate)

S1B

QID:179402 Have I reached you on a cell phone or landline phone?

1 Landline

2 Cell

3 (DK)

4 (Refused)

S1B(2021)

QID:179403 Skip: (If code 2 in S1B, Continue;
Otherwise, Skip to Read before S2)

S1C

QID:172055 For your safety, are you currently driving?

1 Yes

2 No

3 (DK)

4 (Refused)

S1C(2022)

QID:180057 Skip: (If code 1 in QNS1C, Set time to call back;
If code 2 in QNS1C, Continue;
Otherwise, Thank and Terminate)

(Interviewer: READ:)

QID:180058 This is an important study of people's experiences in Hurricane Sandy. Your assistance in this study is voluntary, but your opinions are needed to help other people be better prepared. If there is any question you do not wish to answer, just tell me. Your answers will be kept private to the extent allowable by law and will be combined with those of others. You, as an individual, will never be identified. This survey is estimated to take about 15 minutes to complete.  

S2

QID:179569 What is your zip code?

(Interviewer: Open ended and code all five digits of zip code)

99998 (DK)

99999 (Refused)

QID:179412 Interviewer: Verify ZIPCODE COUNTY to match SB. If match CONTINUE, Otherwise THANK AND TERMINATE

QID: XXXX Were you in the area last October when Hurricane Sandy made landfall?

1	Yes
2	No
98	(DK)
99	(Refused)

PROGRAMMER NOTE: If CODE 1 in Q## CONTINUE, if CODE 2 THANK AND TERMINATE

GENERAL

Q1. Prior to Hurricane Sandy had you ever experienced a disaster where you considered leaving or left your home because of safety concerns?

1	Yes
2	No
98	(DK)
99	(Refused)

PROGRAMMER NOTE: If CODE 1 in Q## CONTINUE, Otherwise SKIP to Q##

Q2. Prior to Hurricane Sandy, which statement would have best described your household’s preparedness for an emergency?

1. We never thought about preparing

2. We had only talked about preparing

3. We had planned to prepare but never got around to it

4. We had done a few things

5. We had taken many steps to prepare

98 (DK)

99 (Refused)

Q3. Was a hurricane or severe storm watch or warning issued for your area?

1	Yes
2	No
3	(DK)
4	(Refused)

Q4a. Did you leave or evacuate your home BEFORE the hurricane made landfall?

1	Yes
2	No
3	(DK)
4	(Refused)

PROGRAMMER NOTE: If CODE 1 in Q4a CONTINUE to Q4b and Q4c; If CODE 2 in Q4a SKIP to Q4d; Otherwise SKIP to Q5

Q4b. What was the primary reason you decided to leave?

Open question coded:

1. Mandatory evacuation

2. Recommended evacuation

3. Watch or warning

4. Concern for my/my family’s safer

5. I would be safer outside of the area

6. Others around me were leaving

7. Trusted advisor told me to go (family member, faith leader, etc)

8. Other

9. DK

10. Refused

Q4c. Where did you go?

1. Friends or relatives

2. Hotel

3. Community shelter

4. Other

5. DK

6. Refused

Q4d. What was the primary reason you decided to stay?

Open question coded:

1. I didn’t think the storm would be so bad

2. I waited too long / waiting to see if the storm would weaken or miss me

3. I wanted to protect my house

4. I didn’t have a place to go

5. I didn’t have transportation to leave

6. I was not under mandatory evacuation

7. People around me weren’t leaving

8. Concern about taking my pet or service animal

9. Other

10. DK

11. Refused

For the next set of questions I want you to think specifically about what you did to prepare or to get ready for Hurricane Sandy.

Q5. What motivated you to take action to prepare or get ready?

1. Observing others taking action

2. Advice on the news

3. Advice from my state or local government

4. My past experience with emergencies

5. I wanted to protect myself and my family

6. My job, school, or faith community encouraged me to get ready

7. Other

8. (DK)

9. (Refused)

Q6. Did any of the following prevent you from getting ready before the hurricane made landfall?

1. I didn’t know what steps to take (y/n)

2. I didn’t know where to get information on what to do (y/n)

3. Didn’t have time (y/n)

4. It was hard to get supplies / stores were out (y/n)

5. Too expensive (y/n)

6. (DK)

7. (Refused)

Q7. Where did you stay for the first 3 days AFTER Hurricane Sandy passed through the area?

1. In my home

2. At a community shelter

3. With family or friends

4. At a hotel

5. Other

6. DK

7. Refused

Q8. For those 3 days, were all members of your household able to stay together?

1	Yes
2	No
3	(DK)
4	(Refused)

For the next set of questions I want you to think about the things you did or learned about that made the biggest difference for you and your household in the first 3 days after Hurricane Sandy made landfall.

Q9. What was the information you read or heard about before the storm hit that helped you the most during the first 3 days after Hurricane Sandy made landfall? [Open-ended]

Q10. What did you do or know how to do before the storm that were the most useful to you in the first 3 days after Hurricane Sandy made landfall? [Open-ended]

Q11. What supplies or tools did you have on hand that were most useful to you in the first 3 days after Hurricane Sandy made landfall? [Open-ended]

For the next set of questions I want you to think about the things you did NOT do or learn about that would have helped you and your household the most in the first 3 days after Hurricane Sandy made landfall.

Q12. What do you wish you had known before Hurricane Sandy made landfall? [Open-ended]

Q13. What do you wish you had done or learned how to do before the storm that would have been most useful to you in the first 3 days after Hurricane Sandy made landfall? [Open-ended]

Q14. What supplies or tools did you NOT have that would have been the most useful to you in the first 3 days after Hurricane Sandy made landfall? [Open-ended]

Q15. Overall, were you satisfied or dissatisfied with your ability to immediately respond to Hurricane Sandy?

1	Satisfied
2	Dissatisfied
8	(DK)
9	(Refused)

Q16. In the first 72 hours following Hurricane Sandy, please indicate how much help you received from the following sources. Please use a scale of 1 to 5, with 5 being “a great deal of help” and 1 being “no help”.

A. People in my neighborhood

B. Non-profit organizations, such as the American Red Cross or the Salvation Army

C. My faith community, such as a congregation

D. Fire, police, emergency personnel

E. Local government agency

F. State government agency

G. Federal government agency, including FEMA

Q17. If you could have done one thing differently to prepare for Hurricane Sandy, what would it have been? [Open-ended]

______________________________________________________

Q18. Does your household have a pet or service animal? (y/n)

Q19. Does anyone in your household have access or functional needs? (y/n)

Q20. Are you the primary caretaker for another person in your household? (y/n)

CLOSE1. Those are all of the questions that I have. On behalf of The Gallup Poll and the Federal Government, I would like to thank you for your time and participation. Thank you again.

FEMA Form 008-0-11