Participant survey tracking letter

Procedural Justice Informed Alternative to Contemp (PJAC)

IC 5 Participant Survey Tracking Letter

Participant survey tracking letter

OMB: 0970-0505

Document [doc]
Download: doc | pdf


INFORMATION COLLECTION #5

Procedural Justice informed alternatives to contempt (pjac)

Participant survey tracking letter

Dear <First Name> <Last Name>,


I am writing to you as part of the Procedural Justice-Informed Alternatives to Contempt Study, also known as PJAC or [LOCAL PROGRAM NAME]. PJAC is trying to learn more about the experiences of parents trying to pay child support. It is sponsored by [LOCAL CS AGENCY NAME] and funded by the U.S. Department of Health and Human Services. My company, Decision Information Resources (DIR), is part of the study team.


We would like to interview you during ///season/// ///year/// to learn more about your experiences with the child support program. This survey interview will take about ///time/// minutes of your time and can be done over the phone. As a thank you for your participation, we will provide you with a gift in the amount of ///amount/// when you complete the interview in ///season/// ///year///. We will mail you a reminder about the survey one month before.


To prepare for the interview, we would like to make sure we have your latest contact information. Please review the form included with this letter that lists the information we obtained from [LOCAL PROGRAM NAME]. Please let us know if the information is correct or if it needs to be updated. We also would like you to name a person outside of your household who usually knows where to reach you. We would call this person only if we cannot get in touch with you using your contact information.


There are three ways you can update your information:


  1. Return the completed form to us in the postage-paid envelope included with this letter.


  1. Call DIR toll-free at 1-XXX-XXX-XXXX and give your updated information to an interviewer over the phone. If you hear a recorded message, please leave your name, telephone number, and the best time to call you. One of our interviewers will call you back very soon.


  1. Log on to www.///webaddress/// and provide updated information on our secure website.


A $2 bill has been included in this letter to thank you for your time and effort. Your participation in the study is completely voluntary, and if you decide not to participate there is no penalty. All information you provide will be kept private to the extent permitted by law. Your responses will be combined with other people’s responses and will be reported together as a group. No individual responses will be identified.


If you have any questions or concerns about the study, please feel free to call James Cooper at 1-888-864-1425, ext 138.


Si le gustaría recibir esta información en Español, favor de llamar a DIR al 1-888-XXX-XXXX.


Sincerely,


James P. Cooper, Project Director

Decision Information Resources, Inc.

Houston, Texas 77098

[email protected]

Contact Information Update Form


Please review this form and make changes as necessary. Use any of these ways to respond:

  1. Return this form using the enclosed postage-paid envelope.

  2. Call our office toll-free at 1-XXX-XXX-XXXX.

  3. Log on to www.///webaddress///



CURRENT INFORMATION WE HAVE FOR YOU…

CORRECT AS IS

PLEASE MAKE ANY CORRECTIONS IN THIS COLUMN…

YOUR NAME

«fn» «mi» «ln»

Info on the left is correct as is


YOUR PRIMARY PHONE NUMBER

«bp1» «bp2» «bp3»

Info on the left is correct as is


( _______ ) _____________________

area code phone number

Is this a cell phone? Yes No

Can we send texts? Yes No

AN ALTERNATE PHONE NUMBER FOR YOU

«ap1» «ap2» «ap3»

Info on the left is correct as is

( _______ ) _____________________

area code phone number

Is this a cell phone? Yes No

Can we send texts? Yes No

YOUR ADDRESS

«str1»

«str2»

«cty», «st» «zp»

Info on the left is correct as is


YOUR E-MAIL ADDRESS

«email»

Info on the left is correct as is


YOUR ALTERNATE E-MAIL ADDRESS

«email2»



Please provide the information for someone who could help us get in touch with you if we can’t contact you directly at the time of your interview:


Name ___________________________________________________


( __________ ) ____________________________ Is this a cell phone? Yes No Don’t know

area code phone number

Relationship to you ____________________________________


File Typeapplication/msword
File TitleAppendix A
AuthorJoseph Broadus
Last Modified BySYSTEM
File Modified2017-08-09
File Created2017-08-09

© 2024 OMB.report | Privacy Policy