Attachment A Interim Contact Questionnaire

Attachment A: Contact Information Update

This voluntary collection of information is being collected under OMB Control Number 1220-0157 (Expiration: 3/31/2019).   Without this currently approved number we could not collect this information.  These questions should take only 1 minute.  In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2002, the Privacy Act, and other applicable Federal laws, the Bureau of Labor Statistics, its employees and agents, will, to the full extent permitted by law, use the information you provide for statistical purposes only, will hold your responses in confidence, and will not disclose them in identifiable form without your informed consent.

Please confirm the spelling of your name:

FirstNam First _______________________________

MiddleNm Middle ____________________

LastName Last _____________________________

Please provide your contact information: (

addrLin1 Address Line 1 ______________________________

addrLin2 Address Line 2 ______________________________

Unit Unit/Apt: ____________

City City/Town _________________

State State/Province___________ _____

ZipCode Zip/Postal Code __________

Country Country (if outside of US): _________________________

Homephon Landline Phone: ____________________

Cellphon Cell Phone: __________________

Workphon Work Phone: ______________________

Email Email Address: _______________________________

Thank you screen: Thank you for taking the time to update your contact information. We will be in touch with you again in the Fall of 2019 for your next interview!

If you have any question or concerns about the questions you just answered or the NLSY97 study in general, please contact us at xxx-xxx-xxxx or email us at [email protected].