Main Interview Verification

Attachment L3

Main Verification

Form Approved

OMB No. 0920-0314

E

Public reporting burden of this collection of information is estimated to average 5 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 of our interviewers, [IWER NAME], spoke with someone at your household on [DATE OF IW] for the National Survey of Family Growth. Do you remember [IWER NAME] contacting you?

2. [IWER NAME] would have asked you about child bearing, contraceptive use, sexual activity, marriage and divorce, and your attitudes about marriage, children and family life. Do you remember a visit where someone asked you questions about such things?

3. How long did the interview take?

4. Was the interview conducted over the phone or in person?

5. To verify our records, what is your date of birth?

6. For MINOR Rs: Did you sign a form on the computer agreeing to participate in the survey?

For ADULT Rs: Did you sign a receipt on the computer for the token of appreciation you received to participate in the survey?

7. Did you receive a token of appreciation for completing the interview?

8. Did you enter some of your responses into the computer yourself?

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

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

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

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