Form 2 RSVP Survey Final

NOT FOR DISTRIBUTIONS

Retired and Senior Volunteer Program

Survey of Volunteers

May 29, 2014

Consent Process

My name is (name) and I am doing a survey for (SPONSOR NAME/VOLUNTEER STATION) of the RSVP program. The purpose is to collect information to better understand how to support volunteers like you who provide services to meet the needs of your community.Your experience as a volunteer is important because it will help your (SPONSOR NAME/VOLUNTEER STATION) better support you in serving your community.

Your participation is voluntary. The survey asks questions about you, your volunteer service experience. Your responses are anonymous and will be analyzed by the JBS research team. Your input will remain anonymous. Do you have any questions?

Would you be willing to take the survey?

If YES, continue.

If NO, thank the person and end the call.

“Thesurvey will take about 30 minutes. Do you have some time to answer questions now?”

If YES, continue.

If NO, ask for a better time to do the survey, and write the time to call back.

To begin the survey, say:

“Thank you for taking the time to complete this survey. I will read the question, and then I will write down the answer you give me. You may choose not to answer any question as we go.All information will be anonymous.”(Continue to questions and go through the survey.)

Ending the Call

“Those are all the questions I have for you. Thank you very much for your time. If you have any questions about this survey, you can call (name) at (Organization).”

Part 1: Sponsoring Organization

This section is pre-loaded based on information gathered from the project director or another representative from the sponsoring organization.

1. Organization Name: ____________________________________________

2. Grant Number: ___________________________

3. Name of Volunteer: _________________________________________

4. Salutation for the volunteer

   1. Ms. or Mrs.

   2. Mr.

5. Primary work plan of the volunteer [PROVIDE DROP DOWN WITH THE CODES USED BY CNCS TO IDENTIFY WORK PLANS]

   1. Focus Area _________________________

   2. Objective ___________________________

   3. Service Activity ______________________

   4. Output _____________________________

   5. Outcome ___________________________

The remaining sections of the survey are questions to be answered by the volunteer during the telephone interview.

6. Date of Interview ___________

Part 2: Length of service and hours served

7. When did you begin volunteering with the RSVP program?

1. Month _____

01. JAN	02. FEB	03. MAR	04. APR	05. MAY	06. JUN	07. JUL
08. AUG	09. SEP	10. OCT	11. NOV	12. DEC	98. Don’t Know	99. Refuse

2. Year_____

9998. Don’t Know

9999. I prefer not to answer

INTERVIEWER: If the respondent cannot recall the month and date PROBE:

7a. How many years have you been volunteering with the RSVP program?

_______ years

INTERVIEWER: If the respondent cannot recall number of years PROBE with the following options

7b. Would you say you have been volunteering with the RSVP program for:

1. Less than 1 year

2. 1 to 2 years

3. 2 to 5 years

4. 5 to 9 years

5. More than 9 years

8. Last month, on approximately how many days did you volunteer with the Retired and Senior Volunteer Program?

________days

9998. Don’t know/Don’t remember

9999. I prefer not to answer

INTERVIEWER: If the respondent cannot recall the number of days, PROBE:

8a. Would you say the number of days you volunteer with the Retired and Senior Volunteer Program last month was:

1. 1 to 5 days

2. 6 to 10 days

3. 11 to 15 days

4. 16 to 20 days

5. More than 20 days

9. Last month, approximately how many hours would you say youvolunteeredwith the Retired and Senior Volunteer Program?

________ hours

9998. Don’t know/Don’t remember

9999. I prefer not to answer

INTERVIEWER: if the respondent cannot recall the number of hours, PROBE

9a. Would you say the number of hours you volunteered with the Retired and Senior Volunteer Program last month was

1. 1 to 5 hours

2. 6 to 10 hours

3. 11 to 15 hours

4. 16 to 20 hours

5. More than 20 hours

Now, I am going to ask about your activities as a volunteer with the RSVP program. This information will help (SPONSOR NAME/VOLUNTEER STATION) better support you in serving your community.

Part 3: Type of work andactivities

10. In the past month, did your volunteer hours include any of the following activities[ASK EACH ONE, CHECK ALL THAT APPLY]

In the past month, did you ….	1. Yes	No	Prefer not to answer
Volunteer withpeople who are homebound to stay in their own home.
Volunteerwithpeople living in group care situations (such as adult daycare center).
Volunteerwith children or youths to help them with their academic skills.
Do any volunteer hourswhere you help to care for infants or children, or help young mothers).
Do any volunteer hourswhere you help to build or repair houses, assist adults with basic education, or financial services)
Do any volunteer hours where you helped veterans or military families.
Do any volunteer hours where you helped preparefor or helped to respond to emergency events.
Do any volunteer hourswhere you helpedsupport other volunteers at social service and volunteer agencies.
Did you volunteer with the RSVP programin other ways that I did not mention.Specify: ____________________________________

INTERVIEWER: If the respondent reported one volunteer activity in question10, question 11 verifies the activity reported. If respondent has more than one volunteer activityin question 10, question 11 probes for the volunteer activity where the respondent spends the most hours volunteering.

11. In the last month, which of the volunteer activities you spend the most hours doing? [SELECT ONLY ONE, INTERVIEWER REPEAT THE VOLUNTEER ACTIVITIES REPORTED IN QUESTION 10]

a. Volunteer with people who are homebound to stay in their own home. (GO TO questions 12 and 13)

b. Volunteer with people living in group care situations (such as adult daycare center).(GO TO questions 14 and 15)

c. Volunteer with children or youths to help them with their academic skills. (GO TO questions 16 and 17)

d. Do any volunteer hours where you help to care for infants or children, or help young mothers).(GO TO questions 18 and 19)

e. Do any volunteer hours where you help to build or repair houses, assist adults with basic education, or financial services)(GO TO questions 20 and 21)

f. Do any volunteer hours where you helped veterans or military families (GO TO questions 22 and 23)

g. Do any volunteer hours where you helped preparefor or helped to respond to emergency events. (GO TO questions 24 and 25)

h. Do any volunteer hours where you helped support other volunteers at social service and volunteer agencies.(GO TO questions 26 and 27)

i. Other ways (Specify: ___________________) (GO TO questions 28 and 29)

8. Don’t know

9. I prefer not to answer

12. [If option A is selected in question 10]Whatwere some of the activities that you did when you helped homebound people stay in their own home?

INTERVIEWER: MARK ALL RESPONSES MENTIONED; AND PROBE FOR ANY ACTVITY LISTED THAT THE RESPONDENT DID NOT MENTION.

	Yes	No
Helped with errands
Helped with light housekeeping or odd jobs around the home
Delivered meals
Provided information on health insurance or healthcare access
Provided health education
Helped with personal and health care needs
Provided translation
Helped by driving them places
Provided companionship or emotional support
Distributed information
Distributed food
Collected food/Food pantry support
Other (Specify): _____

13. Last month, how many hours would you say you volunteered doing these activities?

________hours

INTERVIEWER: if the respondent cannot recall the number of hours, PROBE

13a. Would you say the number of hours you volunteered doing these activities last month was

1. 1 hour

2. 2 to 3 hours

3. 3 to 5 hours

4. More than 5 hours

GO TO QUESTION 30

14. [If Option B in Question 11] Whatwere some of the activities that you did when you volunteered to help people in group care situations?

INTERVIEWER: MARK ALL RESPONSES MENTIONED; AND PROBE FOR ANY ACTVITY LISTED THAT THE RESPONDENT DID NOT MENTION.

	Yes	No
Helped peoplewith personal and health care needs
Provided information on health insurance or healthcare access
Provided health education
Provided translation
Helped by driving people places
Provided clients with companionship or emotional support
Distributed information
Worked on Preventing Elder Abuse
Provided Training & Coaching (such as through bone builder classes)
Other (Specify): _____

15. Last month, how many hours would you say you volunteered doing these activities?

________hours

INTERVIEWER: if the respondent cannot recall the number of hours, PROBE

15a. Would you say the number of hours you volunteered doing these activities last month was

1. 1 hour

2. 2 to 3 hours

3. 3 to 5 hours

4. More than 5 hours

GO TO QUESTION 30

16. [If Option C in question 11] Whatwere some of the activities that you did when you volunteered with children or youths to help them improve their academic skills?

INTERVIEWER: MARK ALL RESPONSES MENTIONED; AND PROBE FOR ANY ACTVITY LISTED THAT THE RESPONDENT DID NOT MENTION.

	Yes	0.No
Assisted in a classroom (including Head Start classrooms)
Tutored in school or other community settings
Mentored in school or other community settings
Other (Specify): _____

17. Last month, how many hours would you say you volunteered doing these activities?

________hours

INTERVIEWER: if the respondent cannot recall the number of hours, PROBE

17a. Would you say the number of hours you volunteered doing these activities last month was

1. 1 hour

2. 2 to 3 hours

3. 3 to 5 hours

4. More than 5 hours

GO TO QUESTION 30

18.[If Option D in question 11] Whatwere some of the activities where you help to care for infants or children, or help young mothers)?

INTERVIEWER: MARK ALL RESPONSES MENTIONED; AND PROBE FOR ANY ACTVITY LISTED THAT THE RESPONDENT DID NOT MENTION.

	1.Yes	0.No
Provided comfort to children
Cared for infants
Helpedyoung mothers
Other (Specify): _____

19. Last month, how many hours would you say you volunteered doing these activities?

________hours

INTERVIEWER: if the respondent cannot recall the number of hours, PROBE

19a. Would you say the number of hours you volunteered doing these activities last month was

1. 1 hour

2. 2 to 3 hours

3. 3 to 5 hours

4. More than 5 hours

GO TO QUESTION 30

20. [If Option E in question 11] Whatwere some of the activities that you didwhere you help to build or repair houses, assist adults with basic education, or financial services)?

INTERVIEWER: MARK ALL RESPONSES MENTIONED; AND PROBE FOR ANY ACTVITY LISTED THAT THE RESPONDENT DID NOT MENTION.

	1.Yes	0.No
Built or repaired homes for Habitat for Humanity
Built or repaired homes for another organization
Provided assistance with housing search
Provided Adult Basic Education/helped with GED/ Adult ESOL/ESL
Provided assistance related to income tax
Worked on Preventing Elder Abuse
Providedfinancial services
Other (Specify): _____

21. Last month, how many hours would you say you volunteered doing these activities?

________hours

INTERVIEWER: if the respondent cannot recall the number of hours, PROBE

21a. Would you say the number of hours you volunteered doing these activities last month was

1. 1 hour

2. 2 to 3 hours

3. 3 to 5 hours

4. More than 5 hours

GO TO QUESTION 30

22. [If Option F in question 11] Whatwere some of the activities that you didwhere you helped with veterans and military families?

INTERVIEWER: MARK ALL RESPONSES MENTIONED; AND PROBE FOR ANY ACTVITY LISTED THAT THE RESPONDENT DID NOT MENTION.

	1.Yes	0.No
Provided assistance to a DOL VETS Program
Provided coaching/counseling
Provided referrals to services
Provided support for Mental Health Access
Provided support for Legal Assistance Access
Participated in activity supporting veterans with disabilities and older veterans
Participated in activity supporting veterans in rural communities
Assisted veterans with transportation
Assisted with access to state and federal benefits
Provided other community-based activities that serve veterans and military families
Participated in National Guard Volunteer Services
Mentored military connected children
Other (Specify): _____

23. Last month, how many hours would you say you volunteered doing these activities?

________hours

INTERVIEWER: if the respondent cannot recall the number of hours, PROBE

23a. Would you say the number of hours you volunteered doing these activities last month was

1. 1 hour

2. 2 to 3 hours

3. 3 to 5 hours

4. More than 5 hours

GO TO QUESTION 30

24. [If Option G in question 11] Whatwere some of the activities that you did to help prepare for or help to respond to emergency events?

INTERVIEWER: MARK ALL RESPONSES MENTIONED; AND PROBE FOR ANY ACTVITY LISTED THAT THE RESPONDENT DID NOT MENTION.

	1.Yes	0.No
Created disaster kits
Performed outreach
Set up Call Centers
Staffed Call Centers
Transportedvictims
Setup shelter
Staffshelter
Provided Health/First Aid Services
Distributedmeals
Cleared Debris
Renovated Housing
Provided Housing Transition Support
Provided counseling
Participated in fire mitigation (such as by removing brush and other dead vegetation)
Participated in tornado/hurricane mitigation (such as by building shelters)
Other Disaster Mitigation (Specify_ ___________
Assisted with disaster preparedness
Provided assistance with disaster recovery
Other (Specify): _____

25. Last month, how many hours would you say you volunteered doing these activities?

________hours

INTERVIEWER: if the respondent cannot recall the number of hours, PROBE

25a. Would you say the number of hours you volunteered doing these activities last month was

2. 1 hour

2. 2 to 3 hours

3. 3 to 5 hours

4. More than 5 hours

GO TO QUESTION 30

26. [If Option H in question 11] Whatwere some of the activities that you did when you helped support other volunteers at social service and volunteer agencies?

INTERVIEWER: MARK ALL RESPONSES MENTIONED; AND PROBE FOR ANY ACTVITY LISTED THAT THE RESPONDENT DID NOT MENTION.

	1.Yes	0.No
Recruited volunteers
Managedvolunteers
Trainedvolunteers
Helped obtain money or in-kind donations
Provided support for Blood Drives
Collected food/Food Pantry Support
Other (Specify): _____

27. Last month, how many hours would you say you volunteered doing these activities?

________hours

INTERVIEWER: if the respondent cannot recall the number of hours, PROBE

27a. Would you say the number of hours you volunteered doing these activities last month was

1. 1 hour

2. 2 to 3 hours

3. 3 to 5 hours

4. More than 5 hours

GO TO QUESTION 30

28. [If Option I in question 13] You also mentioned that you did [INTERVIEWER: Refer to response in option I in question 13 if the respondent reported other type of work.]. What were the activities that you typically did?

(specify)

29. Last month, how many hours would you say you volunteered doing these activities?

________hours

INTERVIEWER: if the respondent cannot recall the number of hours, PROBE

29a. Would you say the number of hours you volunteered doing these activities last month was

2. 1 hour

2. 2 to 3 hours

3. 3 to 5 hours

4. More than 5 hours

GO TO QUESTION 30

I am now going to ask about your volunteer experience. This information will help (SPONSOR/VOLUNTEER STATION) better understand how to support volunteers like you in providing services to meet the needs of their community.

Part 4: Volunteer Experience

30. Do you agree or disagree with this statement: My RSVP volunteer work is a good match for my skills?

If disagree: Do you

1. Strongly disagree

2. Somewhat disagree or

3. Slightly disagree

If agree: Do you

4. Slightly agree

5. Somewhat agree or

6. Strongly agree

31. Do you agree or disagree with this statement: My RSVP volunteer work is interesting?

If disagree: Do you

1. Strongly disagree

2. Somewhat disagree or

3. Slightly disagree

If agree: Do you

4. Slightly agree

5. Somewhat agree or

6. Strongly agree

32. Do you agree or disagree with this statement: My RSVP supervisor provides me with the support and information I need to serve?

If disagree: Do you

1. Strongly disagree

2. Somewhat disagree or

3. Slightly disagree

If agree: Do you

4. Slightly agree

5. Somewhat agree or

6. Strongly agree

Other volunteer services

33. Do you volunteer with other organizations other than RSVP?

0. Yes Go to Question 34

1. No Go to Question 35

8. Don’t know/not sure Go to Question 35

9. I prefer not to answer Go to Question 35

34. In the past month, how many hours did you volunteer with these other organizations?

_______________ hours

88. Don’t know

99 I prefer not to answer

INTERVIEWER: if the respondent cannot recall the number of hours, PROBE

34a. Would you say the number of hours you volunteered with these other organizations last month was

1. 1 to 5 hours

2. 6 to 10 hours

3. 11 to 15 hours

4. 16 to 20 hours

5. More than 20 hours

The next six questions will help (SPONSOR/VOLUNTEER STATION) better support you in serving your community. All responses are used in aggregate summary analysis. Please tell me how much you agree or disagree with the following:

Part 5: Self efficacy and Loneliness

Self efficacy

35. Do you agree or disagree with this statement:I can do just about anythingI really set my mind to? ⁱ

If disagree: Do you

1. Strongly disagree

2. Somewhat disagree or

3. Slightly disagree

If agree: Do you

4. Slightly agree

5. Somewhat agree or

6. Strongly agree

36. Do you agree or disagree with this statement:I can do the things that I want to do?ⁱⁱ

If disagree: Do you

1. Strongly disagree

2. Somewhat disagree or

3. Slightly disagree

If agree: Do you

4. Slightly agree

5. Somewhat agree or

6. Strongly agree

Social Loneliness

37. How much of the time do you feel that you are alone? Would you say often, some of the time, or hardly ever or never [Check one]ⁱⁱⁱ

1. Often

2. Some of the time

3. Hardly ever or never

8. Don’t know

9. I prefer not to answer

38. How much of the time do you feel that you lack companionship? Would you say often, some of the time, or hardly ever or never [Check one]^iv

1. Often

2. Some of the time

3. Hardly ever or never

8. Don’t know

9. I prefer not to answer

Emotional Loneliness

39. How much of the time do you feel that there are people you feel close to? Would you say often, some of the time, or hardly ever or never [Check one]^v

1. Often

2. Some of the time

3. Hardly ever or never

8. Don’t know

9. I prefer not to answer

40. How much of the time do you feel that there are people you can turn to? Would you say often, some of the time, or hardly ever or never [Check one] ^vi

1. Often

2. Some of the time

3. Hardly ever or never

8. Don’t know

9. I prefer not to answer

I want to ask a few more questions about yourself. Your answers will help us understand the characteristics of the people who participated in this survey.

Part 6: Demographics

41. In what month and year were you born?

1. Month

01. JAN	02. FEB	03. MAR	04. APR	05. MAY	06. JUN	07. JUL
08. AUG	09. SEP	10. OCT	11. NOV	12. DEC	98. Don’t Know	99. Prefer not answer

2. Year _______________

9998. Don’t Know

9999. I prefer not to answer

42. Are you male or female?^vii

1. Male

0. Female

9. I prefer not to answer

43. Are you of Hispanic or Latino origin?^viii

0. Yes

0. No

43. What is your race? Please select one or more.[Interviewer: Read options only 1-5]^ix

0. White

1. Black or African American

2. Asian

3. Native Hawaiian or other Pacific Islander

4. American Indian or Alaska Native

9. I prefer not to answer

43. Which of the following apply to you?[Read each option. Check all that apply]

1. Active duty or Reserve Component

2. Military family

3. Veteran

4. Family of veteran

5. None, not a veteran

8. Don’t Know

9. I prefer not to answer

43. What is the highest grade or year of school or year of college you completed?^x

1. No formal education

2. Grades 1-11

3. Grade 12 (High School Diploma or GED)

4. Some College

5. Associate’s Degree

6. Bachelor’s Degree/College Graduate

7. Some graduate school

8. Completed a graduate/professional degree

9. Other

98. I don’t know

99. I prefer not to answer

43. Are you currently married, with a partner as if married, separated, divorced, widowed, or never married?^xi

1. Married

2. Have partner

3. Separated

4. Divorced

5. Widowed

6. Never Married

7. Other

9. I prefer not to answer

Next, the next questions are about employment, retirement and income. This information is asked to help (SPONSOR/VOLUNTEER STATION) better understand the people who participated in the survey.

Part 7: Employment, Retirement and Income

48. Are you …. [ASK EACH ONE, CHOOSE ALL THAT APPLY]^xii

Are you …	1. Yes	0. No	8. Don’t know	9. Prefer not to answer
a. Working now
b. Unemployed and looking for work
c. Temporarily laid off, on sick or other leave
d. Disabled
e. Retired
f. Homemaker
g. Other (Please Specify) _____

INTERVIEWER:

If the respondent report UNEMPLOYED then GO TO question 49

If the respondent report LAID OFF then GO TO question 50

If the respondent report RETIRED then GO TO questions 51 and 52

If not unemployed, laid off or retired then GO TO question 53

49. (If UNEMPLOYED) In what month and year did this period of unemployment start?^xiii

1. Month _____

01. JAN	02. FEB	03. MAR	04. APR	05. MAY	06. JUN	07. JUL
08. AUG	09. SEP	10. OCT	11. NOV	12. DEC	98. Don’t Know	99. Prefer not to answer

2. Year _______________

9998. Don’t Know

9999. I prefer not to answer

50. (If LAID OFF) In what month and year were you laid off?^xiv

1. Month _____

01. JAN	02. FEB	03. MAR	04. APR	05. MAY	06. JUN	07. JUL
08. AUG	09. SEP	10. OCT	11. NOV	12. DEC	98. Don’t Know	99. Prefer not to answer

1. Year _______________

9998. Don’t Know

9999. I prefer not to answer

51. (If RETIRED) In what month and year did you retire?^xv

1. Month _____

01. JAN	02. FEB	03. MAR	04. APR	05. MAY	06. JUN	07. JUL
08. AUG	09. SEP	10. OCT	11. NOV	12. DEC	98. Don’t Know	99. Prefer not to answer

2. Year _______________

9998. Don’t Know

9999. I prefer not to answer

52. (If RETIRED) Thinking back to the time you [partly/completely] retired, was that something you wanted to do or something you felt you were forced into? [Check one]^xvi

1. Wanted to do

2. Forced into

3. Part wanted, part forced

8. I don't know

9. I prefer not to answer

53. Are you able to drive?^xvii

1. Yes GO TO 54

0. No GO TO 55

8. I Don’t know GO TO 55

9. I prefer not to answer GO TO 55

54. Do you limit your driving to nearby places, or do you also drive on longertrips?^xviii

1. Limit to nearby

2. Drive long trips

8. I Don’t know

9. I prefer not to answer

55. Thinking about the total combined income from all sources for all persons in your household, including income from jobs, Social Security, retirement income, public assistance, and all other sources was your total household annual income during the last calendar year above or below $20,000?^xix

1. Below  GO TO 57

2. Above  GO TO 56

8. D

   GO TO 57

   on’t Know

9. I prefer not to answer

56. IF ABOVE $20,000,Which category best describes your total household annual income during the last calendar year? Would you say…

1. 20,000 to $29,999

2. $30,000 to $39,999

3. $40,000 to $49,999

4. $50,000 to $59,999

5. $60,000 to $69,999

6. $70,000 to $79,999

7. $80,000 to $89,999

8. $90,000 to $99,999

9. $100,000 to $149,999

10. $150,000 or more

98. Don’t Know

99. I prefer not to answer

Part 8: Additionalinformation about volunteer experience

57. What else would you like us to know about your RSVP volunteer service?

58. Is there anything else you would like to let us know?

iHealth and Retirement Study, Core, Section LB, Q23

iiHealth and Retirement Study, Core, Section LB, Q23

iiiHealth and Retirement Study, Core, section LB*, Q20a,iHughes, M. E., Waite, L. J., Hawkley, L. C., &Cacioppo, J. T. (2004)

ivHealth and Retirement Study, Core, Section LB*, Q20a Hughes, M. E., Waite, L. J., Hawkley, L. C., &Cacioppo, J. T. (2004)

vHealth and Retirement Study, Core, Section LB*, Q20iHughes, M. E., Waite, L. J., Hawkley, L. C., &Cacioppo, J. T. (2004)

viHealth and Retirement Study, Core, Section LB*, Q20g

viiHealth and Retirement Study, Core Section, Section A, A008

viiiHealth and Retirement Study,Core Section, Section B , B028

ixHealth and Retirement Study, Core Section, Section B B091M

xHealth and Retirement Study, Core Section, Section B, B014

xiHealth and Retirement Study, Core Section, Section B, B063

xiiHealth and Retirement Study, Core, Section J, J005M1

xiiiHealth and Retirement Study, Core, Section J, J007, J008

xivHealth and Retirement Study, Core, Section J, J011, J012

xvHealth and Retirement Study, Core, Section J, J017, J012

xviHealth and Retirement Study, Core, Section J, J583

xviiHealth and Retirement Study, Core, Section G, G037

xviiiHealth and Retirement Study, Core, Section G, G039

xix Administration for Community Living, http://www.aoa.gov/AoARoot/Program_Results/POMP/Demographics.aspx

Page 25 of 25