0920-1154 Interview Guide For Brief Family Interview

Appendix C

Version Date: 3.22.19

Form approved

OMB 0920-1154

Exp. 1/31/2023

INTERVIEW GUIDE FOR BRIEF FAMILY INTERVIEW

1. What was the most important thing you learned during this home assessment process with respect to preparing for disasters/emergencies?

2. What was the most unexpected thing you learned during the home assessment process with respect to preparing for disasters/emergencies?

3. After going through this process, what challenges do you face getting ready for disasters/emergencies? What do you need most to overcome those challenges? (Prompts: knowing what to do? Financial resources? )

4. What are your biggest fears about [name of child] during a disaster/emergency? How did the home assessment help you

5. What was it like to go through this home assessment process with our team? [Prompts- comfort with team members, length of the visit, number of questions we asked you] should this question come later?

6. Would you recommend that other caregivers or CYSHCN go through this process (home assessment for disasters/emergencies)? Why or why not?
   
   

7. Is there anything our home assessment team did not cover that you would have liked us to cover? What could we have done better or differently?
   
   

8. Please tell us anything else you would like to share or feel you need more support with.

Public reporting burden of this collection of information is estimated to average 15 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 aspect 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, Georgia 30333; ATTN: PRA (0920-1154).