Screener Verification

Attachment L2

Screener Verification

Form Approved

OMB No. 0920-0314

E

Public reporting burden of this collection of information is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, GA 30333; ATTN: PRA (OMB No. 0920-0314)

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xp. Date xx/xx/20xx

1. Hello, my name is [NAME] with the Institute for Social Research at the University of Michigan. Our records show that one of our interviewers recently contacted you/your household regarding the National Survey of Family Growth. I'm calling to verify that one or our interviewers, [IWER NAME], spoke with someone at your household on [DATE OF INTERVIEW] for the National Survey of Family Growth. Do you remember [IWER NAME] contacting you?

2. According to our interviewer, your household includes no one between the ages of 15 and 49. Is this correct?

3. In your opinion, did the interviewer conduct herself in a professional manner?

4. Are there any additional comments that you want to share about the interview or the interviewer?

Those are all the questions that I have. Thank you very much for your help with this study.

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