Attachment 15 – HC Validation Letter

Form Approved

OBM# 0935-0118

Exp. Date 12/31/2015

Date:

Dear

On behalf of the Department of Health and Human Services, I thank you for participating in the Medical Expenditure Panel Survey (MEPS). By being a participant in this important national research effort, you are fulfilling a valuable public service.

As a member of the quality assurance team, it is my responsibility to see that all interviews are completed according to study procedures. The questions on the enclosed form refer to your most recent MEPS interview. Please answer these questions for me, and feel free to offer any comments you may have about the interview or the interviewer.

Thank you for your time and participation in this important survey. Please return the form using the enclosed postage-paid envelope.

Sincerely,

MEPS Quality Assurance Team

Encl (2)

MEPS POST-INTERVIEW FORM

1. Approximately how long did your most recent MEPS interview take?

_____ HOURS AND _____ MINUTES

2. Were you interviewed in person or over the telephone?

IN PERSON

TELEPHONE (GO TO Q4)

Comment: __________________________________

___________________________________________

___________________________________________

3. Did the interviewer use a laptop computer to record your answers?

YES

NO (Please comment.)

Comment: __________________________________

___________________________________________

___________________________________________

4. Were you asked about everyone living in your household?

YES

NO (Please comment.)

NOT APPLICABLE

Comment: __________________________________

___________________________________________

___________________________________________

5. Did you receive a monetary gift from the interviewer at the end of the interview?

YES 5a. How much did you receive? ________________________________

NO

6. Did you receive any token gifts for your participation?

YES 6a. What gifts did you receive? _________________________________

NO

7. Was your interviewer courteous and professional?

YES

NO (Please comment.)

Comment: __________________________________

___________________________________________

___________________________________________

8. Please add any comments you have about the interview or the person who interviewed you.

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

RUID:

FIID:

Round:

13-305