N-SUMHSS 2021 CATI N-SUMHSS 2021 CATI Questionnaire

National Substance Use and Mental Health Services Survey (N-SUMHSS)

Attachment B4_N-SUMHSS 2021 CATI Questionnaire 061220

OMB: 0930-0386

Document [docx]
Download: docx | pdf

Attachment B4- N-SUMHSS 2021 CATI questionnaire


MPRID – MPRID

SCREEN:

Shape1


MPRID






aCallSQL – Before proceeding with the interview we need to get the latest Facility information. To do this you need to click on the box with three dots in the input field.

SCREEN:

Shape2


Before proceeding with the interview we need to get the latest Facility information. To do this you need to click on the box with three dots in the input field.





aBadSQL – There was a problem reading external database. Click on the box with three dots in the input field to exit the case and inform your supervisor of the problem reading the SQL database. Make note of the MPRID ([MPRID]) before exiting.

SCREEN:

Shape3


There was a problem reading external database. Click on the box with three dots in the input field to exit the case and inform your supervisor of the problem reading the SQL database. Make note of the MPRID ([MPRID]) before exiting.





aSMSStatus – THIS CASE IS BEING RE-STATUSED TO [current N-SUMHSS Status Code of case without leading zeros] BY THE SMS

SCREEN:

Shape4


[If the case does have a final N-SUMHSS Status Code, then display: “ THIS CASE IS BEING RE-STATUSED TO [current N-SUMHSS Status Code of case without leading zeros] BY THE SMS”]




[RB] 1. ENTER 1 TO CONTINUE





Sample_Info (MainTab) – Directory Eligible, et al

SCREEN:

Shape5


Directory Eligible: [IsDirectoryEligible, as YES/NO]

State Approved: [IsStateApproved, as YES/NO] StatusCode: [CurrStatus]

Interviewer Group: [INTERVIEWER GROUP]

Respondent’s Time: [Local time AND time zone, separated by spaces]

Days Since Left Msg: [# of days since last message was left]

Director’s Name: [DirName] Phone: [DirPhone] Int: [DirPhoneInt]

Previous Round Resp Name: [PrevRdRespName] Phone: [PrevRdRespPhone] Int: [PrevRdRespPhoneInt]

Current Round Resp Name: [CurrRdRespName] Phone: [CurrRdRespPhone] Int: [CurrRdRespPhoneInt]

Facility Name: [Facility Name 1]

Current Address: [Location Address Line 1]

[Location Address Line 2]

[Location City], [Location State] [Location Zip]



Facility Telephone: [FacPhone] Ext: [Facility Phone Number Extension] Int: [FacPhoneInt]

Dialing Telephone: [DialPhone] Ext: [Dialing Phone Number Extension] Int: [DialPhoneInt]

Parent ID: [ParentID]

Block A Note: [BlkANt]

Block A Note Date: [BlkANtDtTm]

Locating Note: [LocNt]

Locating Note Date: [LocNtDtTm]

CONFIRM THE FACILITY INFORMATION ON THIS SCREEN WITH THE RESPONDENT







CaseHistory (MainTab) – Case History

SCREEN:

Shape6


[Display the following fields and the full dialing history of the case, where the column headers are in red text, and the data rows are in black text.]


Date/Time

Phone

Outcome

WhoMade

Appt

Notes





MakeDialPhone – Phone Number Details

SCREEN:

Shape7


[FinalizedMessage]

PHONE NUMBER DETAILS:

CALL CENTER DIAL PREFIX = [DialPrefix]

PHONE NUMBER = [Dialing Phone Number, as “###-###-####”]

EXTENSION = [Dialing Phone Number Extension]

INTERNATIONAL = [Dialing Phone International flag, as YES/NO]




[RB] 1. AUTO DIAL

[RB] 3. QUICK EXIT

[RB] 2. MANUAL DIAL

[RB] 4. RESPONDENT CALLING IN





DialResult – CODE RESULT OF DIALING

SCREEN:

Shape8


CODE RESULT OF DIALING




[RB] 1. SOMEONE ANSWERS

[RB] 4. ANSWERING MACHINE

[RB] 7. PHONE/LINE PROBLEMS

[RB] 2. NO ANSWER

[RB] 5. ANSWERING SERVICE

[RB] 8. CHANGED TO NEW NUMBER

[RB] 3. BUSY

[RB] 6. PRIVACY MANAGER

[RB] 9. NEED TO REDIAL NUMBER





PhoneNumber[1] (MainTab) – Please give me the telephone number, area code first.

SCREEN:

Shape9

Please give me the telephone number, area code first.




HaveExten[1] (MainTab) – Is there an extension number?

SCREEN:

Shape10


TELEPHONE NUMBER: [PhoneNumber[1] (MainTab), as “###-###-####”]


Is there an extension number?




[RB] 1. YES [RB] 0. NO





Extension[1] (MainTab) – What is the extension number?

SCREEN:

Shape11


TELEPHONE NUMBER: [PhoneNumber[1] (MainTab), as “###-###-####”]


What is the extension number?





Confirm[1] (MainTab) – CONFIRM THE INFO ABOVE WITH THE RESPONDENT, THEN PRESS ENTER.

SCREEN:

Shape12


TELEPHONE NUMBER: [Dialing Phone Number, as “###-###-####”]

EXTENSION: [Dialing Phone Number Extension]

COUNTRY CODE: [CountryCode]

TIME ZONE: [aTimeZone]

OBSERVE DST: [ObserveDST]

TYPE OF PHONE: [PhoneType]

TIME OF DAY: [TimeOfDay]


CONFIRM THE INFO ABOVE WITH THE RESPONDENT, THEN PRESS ENTER.





Verified – DID RECORDING VERIFY [Facility Name 1 AND Facility Name 2, separated by a space] AT THIS NUMBER.

SCREEN:

Shape13


DID RECORDING VERIFY [Facility Name 1 AND Facility Name 2, separated by a space] AT THIS NUMBER.




[RB] 1. YES [RB] 0. NO





AnsService – Is this the answering service for [Facility Name 1 AND Facility Name 2, separated by a space]?

SCREEN:

Shape14


Is this the answering service for [Facility Name 1 AND Facility Name 2, separated by a space]?




[RB] 1. YES, FACILITY’s ANSWERING SERVICE

[RB] 2. NO, DEFINITELY NOT FACILITY’s

[RB] 3. DON’T KNOW, WOULDN’T SAY, NO


ANSWERING SERVICE

NAME WAS GIVEN





AnsOther – PLEASE ENTER WHAT WAS SAID.

SCREEN:

Shape15


PLEASE ENTER WHAT WAS SAID.





PhoneProb – CODE PHONE PROBLEM

SCREEN:

Shape16


CODE PHONE PROBLEM




[RB] 1. NOT-IN-SERVICE; DISCONNECTED,

[RB] 4. FAST BUSY; FAST RING; NO RING

[RB] 8. OTHER PHONE DEVICE

NON-WORKING

[RB] 5. COMPUTER/FAX LINE


[RB] 2. TEMPORARILY NOT-IN-SERVICE

[RB] 6. PAGER


[RB] 3. CIRCUIT PROBLEMS; CIRCUITS

[RB] 7. CELL PHONE


OVERLOADED







Hello – Hello, my name is [INTERVIEWER NAME] and I am calling concerning the Federal Government's annual survey of substance use and mental health treatment providers, called N-SUMHSS or the National Substance Use and Mental Health Services Survey. The N-SUMHSS survey is sponsored by SAMHSA, the Substance Abuse and Mental Health Services Administration.

SCREEN:

Shape17


Hello, my name is [INTERVIEWER NAME] and I am calling concerning the Federal Government's annual survey of substance use and mental health treatment providers, called N-SUMHSS or the National Substance Use and Mental Health Services Survey. The N-SUMHSS survey is sponsored by SAMHSA, the Substance Abuse and Mental Health Services Administration.


PRESS ENTER TO CONTINUE





Confirm[R] – Is this [FacName1 FacName2] located at [FacAddressLine1] …

SCREEN:

Shape18


Is this [FacName1 FacName2] located at

[FacAddressLine1]

[FacAddressLine2]

[FacAddressCity, FacAddressState, FacAddressZip]?


N-SUMHSS is the only source of data on all known substance use and mental health treatment programs in the nation. Your participation will make a difference.




[RB] 1. INFORMATION IS CORRECT

[RB] 2. CORRECT FACILITY, BUT NEEDS

[RB] 3. WRONG NUMBER


NAME/ADDRESS UPDATE

[RB] 4. HUNG UP DURING INTRODUCTION





GetDir – May I speak with [RESPONDENT SALUTATION AND NAME] regarding this facility’s 2021 N-SUMHSS survey?

SCREEN:

Shape19


May I speak with [RESPONDENT SALUTATION AND NAME] regarding this facility’s 2021 N-SUMHSS survey?




[RB] 1. SPEAKING WITH FACILITY

[RB] 3. FACILITY DIRECTOR NOT AVAILABLE

DIRECTOR/APPROPRIATE PERSON

[RB] 4. ANSWERING MACHINE

[RB] 2. CONNECTED TO FACILITY


DIRECTOR/APPROPRIATE PERSON






Hello2 – Hello, my name is [INTERVIEWER NAME] and I am calling concerning the Federal Government's annual survey of substance use and mental health treatment providers, called N-SUMHSS or the National Substance Use and Mental Health Services Survey. The N-SUMHSS survey is sponsored by SAMHSA, the Substance Abuse and Mental Health Services Administration.

SCREEN:

Shape20


Hello, my name is [INTERVIEWER NAME] and I am calling concerning the Federal Government's annual survey of substance use and mental health treatment providers, called N-SUMHSS or the National Substance Use and Mental Health Services Survey. The N-SUMHSS survey is sponsored by SAMHSA, the Substance Abuse and Mental Health Services Administration.


PRESS ENTER TO CONTINUE





Sorry – I’m sorry. Thank you for your time.

SCREEN:

Shape21


I’m sorry. Thank you for your time.





Received – All facilities providing substance use and mental health treatment services were recently sent the 2021 N-SUMHSS packet. Did your facility receive that?


SCREEN:

Shape22


All facilities providing substance use and mental health treatment services were recently sent the 2021 N-SUMHSS packet. Did your facility receive that?


READ, IF NECESSARY: The survey packet your facility was mailed, contained:

1. Letters requesting your facility’s participation from SAMHSA and your State or Federal Agency.

2. A fact sheet with frequently asked questions and their answers.

3. A blue flyer with information on how to complete this year’s survey on the Internet.

4. A New Features flyer listing new functionality for the web survey.

5. A 2021 N-SUMHSS Client Counts Worksheet.





[RB] 1. RECEIVED PACKET

[RB] 5. DUPLICATE FACILITY

[RB] 9. FACILITY IS A JAIL/PRISON

[RB] 2. DID NOT RECEIVE OR NOT CERTAIN

[RB] 6. MERGED WITH ANOTHER FACILITY

[RB] 10. CLIENT COUNTS REPORTED BY

[RB] 3. NO LONGER PROVIDES SUBSTANCE

[RB] 7. FACILITY CLOSED/NO LONGER

ANOTHER FACILITY

USE OR MENTAL HEALTH TREATMENT

EXISTS


[RB] 4. NEVER PROVIDED SUBSTANCE USE OR

MENTAL HEALTH SERVICES

[RB] 8. SATELLITE FACILITY








Intro – Recently your facility was mailed a letter from XXXXX at SAMHSA along with a letter from your State. Both letters requested the participation of your facility in the 2021 N-SUMHSS. We are calling at this time to complete the survey. Is this a good time?

Note: The 2nd Interviewer Note appears on this screen only during a Full survey round.


SCREEN:

Shape23


Recently your facility was mailed a letter from XXXXX at SAMHSA along with a letter from your State. Both letters requested the participation of your facility in the 2021 N-SUMHSS. We are calling at this time to complete the survey. Is this a good time?


CONFIRM THE FACILITY INFORMATION ON THE MPRContact.Review TAB WITH THE RESPONDENT.


IF RESPONDENT INDICATES THEIR CLIENT COUNTS WILL BE REPORTED BY ANOTHER FACILITY, READ: Putting the client information aside, it is important for every facility to answer a few questions regarding the specific characteristics of their facility - even if an administrative unit or parent facility will report your client information for you. Could I ask you these questions now? It will only take about 15 minutes.




[RB] 1. YES, CONTINUE

[RB] 5. NEVER PROVIDED SUBSTANCE USE

[RB] 9. SATELLITE FACILITY

[RB] 2. SCHEDULE CALLBACK AT

OR MENTAL HEALTH SERVICES

[RB] 10. WRONG NUMBER

CONVENIENT TIME

[RB] 6. DUPLICATE FACILITY

[RB] 11. COMPLETING BY MAIL

[RB] 3. COMPLETING ON THE WEB

[RB] 7. MERGED WITH ANOTHER FACILITY

[RB] 12. FACILITY IS A JAIL/PRISON

[RB] 4. NO LONGER PROVIDES SUBSTANCE

[RB] 8. FACILITY CLOSED/NO LONGER


ABUSE OR MENTAL HEALTH

TREATMENT

EXISTS






Good – Good, I am glad to hear that your facility received the packet. Have you had a chance to complete the survey online? If you would like, we could complete it by phone right now, or you could complete it online. The Web is the most efficient way to complete the survey.

SCREEN:

Shape24


Good, I am glad to hear that your facility received the packet. Have you had a chance to complete the survey online? If you would like, we could complete it by phone right now, or you could complete it online. The Web is the most efficient way to complete the survey.


IF COMPLETED ON THE WEB, ASK WHEN THE SURVEY WAS COMPLETED.




[RB] 1. NOT COMPLETED

[RB] 3. PREFERS TO DO ON WEB (WEB

[RB] 5. PREFERS TO COMPLETE

[RB] 2. COMPLETED ON THE WEB

SURVEY AT: [Survey Website URL]

SURVEY NOW BY PHONE


[RB] 4. PROBLEM COMPLETING ON WEB



WANTS HELP






When – Do you have any questions about completing the survey that I might be able to help you with?

SCREEN:

Shape25


Do you have any questions about completing the survey that I might be able to help you with?


ANSWER RESPONDENT’S QUESTIONS OR SEEK YOUR SUPERVISOR’S ASSISTANCE.


If you would prefer to complete it on the Web now, it is the most efficient way to complete the survey. I can give you the log-on information you’ll need. Would you like that information now?


WEB SURVEY AT [Survey Website URL]

User ID: [MPRID] and Password: [Password]


Considering the other demands on your time, when do you think you might have a few minutes to finish the survey?

ENTER NUMBER OF WEEKS BEFORE CALLING BACK.





Verify – Let me verify the mailing address we have for your facility, we have…

SCREEN:

Shape26


Let me verify the mailing address we have for your facility, we have…


MAIL ADDRESS:

[Director First Name, Middle Initial, AND Last Name, separated by spaces] (Current Facility Director) at

[Mailing Address Line 1]

[Mailing Address Line 2]

[Mailing City], [Mailing State] [Mailing Zip]


Is that correct?




[RB] 1. YES

[RB] 4. PROBLEM COMPLETING ON WEB

[RB] 2. NO

WANTS HELP

[RB] 3. PREFERS TO DO ON WEB (WEB

[RB] 5. PREFERS TO COMPLETE THE

SURVEY AT [Survey Website URL])

SURVEY NOW BY PHONE





AddrCheck – The address we have is :

SCREEN:

Shape27


The address we have is :

[Mailing Address Line 1]

[Mailing Address Line 2]



[Mailing City] [Mailing State] [Mailing Zip]


Is that correct?


PLEASE CONFIRM FULL ADDRESS. IF RESPONDENT REFUSES TO CONFIRM ADDRESS, ASK WHICH ADDRESS THEY WOULD LIKE THE REMAILED PACKET SENT TO. IF RESPONDENT DOESN’T KNOW CORRECT MAILING ADDRESS, ASK IF THERE IS SOMEONE ELSE AVAILABLE WHO WOULD BE FAMILIAR WITH THE INFORMATION.




[RB] 1. YES [RB] 0. NO





Remail – We will mail a new packet immediately. If you have any questions when you receive the packet, please call the toll-free N-SUMHSS helpline that is indicated on the survey.

SCREEN:

Shape28


We will mail a new packet immediately. If you have any questions when you receive the packet, please call the toll-free

N-SUMHSS helpline that is indicated on the survey.


If you prefer, you can complete the survey on the Web and I can give you the log-on information you’ll need. The Web is the most efficient way to complete the survey. Would you like that information now?


WEB SURVEY AT [Survey Website URL]

User ID: [MPRID] and Password: [Password]





RE1 – We’ll watch for that information to come in.

SCREEN:

Shape29


We’ll watch for that information to come in.


Putting the client information aside, it is important for every facility to answer a few questions regarding the specific characteristics of their facility – even if an administrative unit or parent facility will report your client information for your facility. Could I ask you these questions now? It will only take about 15 minutes.




[RB] 1. YES

[RB] 3. NO, NOT THE PROPER PERSON TO TALK WITH

[RB] 2. NO, NOT A CONVENIENT TIME

[RB] 4. NO, WILL COMPLETE ON WEB





RE3 – Who could answer facility-specific questions such as which types of services are offered at this facility?

SCREEN:

Shape30


Who could answer facility-specific questions such as which types of services are offered at this facility?


WRITE DOWN THE NEW PERSON’S NAME, AND INCLUDE IT IN THE CASE NOTES WHEN YOU CLOSE THIS CASE.





RE4 – Could I please speak with that person?

SCREEN:

Shape31


Could I please speak with that person?




[RB] 1. YES

[RB] 2. [Option2Text]

[RB] 3. CONNECTED TO ANSWERING



MACHINE





RE5 – Hello, my name is [INTERVIEWER NAME] and I am calling on behalf of the Federal Government’s annual survey called the National Substance Use and Mental Health Services Survey. This survey is sponsored by SAMHSA, the Substance Abuse and Mental Health Services Administration. I have a few questions I’d like to ask you. It will only take about 15 minutes. Is now a good time?

SCREEN:

Shape32


Hello, my name is [INTERVIEWER NAME] and I am calling on behalf of the Federal Government’s annual survey called the National Substance Use and Mental Health Services Survey. This survey is sponsored by SAMHSA, the Substance Abuse and Mental Health Services Administration. I have a few questions I’d like to ask you. It will only take about 15 minutes. Is now a good time?




[RB] 1. YES, CONTINUE

[RB] 2. NO, NOT A CONVENIENT TIME

[RB] 3. NO, WILL COMPLETE ON WEB





vJail – Just to confirm, this facility provides substance use and mental health treatment services only to incarcerated persons or juvenile detainees. Is that correct?

SCREEN:

Shape33


Just to confirm, this facility provides substance use and mental health treatment services only to incarcerated persons or juvenile detainees.


Is that correct?




[RB] 1. YES, THAT IS CORRECT [RB] 0. NO, THAT IS NOT CORRECT





Duplicate – Which facility is a duplicate of this one?

SCREEN:

Shape34


Which facility is a duplicate of this one?


PRESS ENTER TO CHOOSE FROM LIST OR TO ENTER FACILITY INFO





Merged – Which facility was this one merged with?

SCREEN:

Shape35


Which facility was this one merged with?


PRESS ENTER TO CHOOSE FROM LIST OR TO ENTER FACILITY INFO





Satellite – Which facility is this one associated with?

SCREEN:

Shape36


Which facility is this one associated with?


For the purpose of this survey a satellite facility is one that does not have permanent staff on location. Often times staff will travel from another location to provide treatment on a limited schedule.


PRESS ENTER TO CHOOSE FROM LIST OR TO ENTER FACILITY INFO





MainFacility – May I have the name, address and phone number of the facility?

SCREEN:

Shape37


May I have the name, address and phone number of the facility?




[RB] 1. ENTER 1 TO CONTINUE





Facility1 – What is the name of the facility? (1)

SCREEN:

Shape38


NAME OF FACILITY 1: [Facility1]

NAME OF FACILITY 2: [Facility2]


What is the name of the facility?





Facility2 – What is the name of the facility? (2)

SCREEN:

Shape39


NAME OF FACILITY 1: [Facility1]

NAME OF FACILITY 2: [Facility2]


What is the name of the facility?





Confirm[2] (MainTab) – CONFIRM THE FACILITY NAME ABOVE WITH THE RESPONDENT, THEN PRESS ENTER.

SCREEN:

Shape40


NAME OF FACILITY 1: [Facility1]

NAME OF FACILITY 2: [Facility2]


CONFIRM THE FACILITY NAME ABOVE WITH THE RESPONDENT, THEN PRESS ENTER.





Address1 – What is the address?

SCREEN:

Shape41


FACILITY’S ADDRESS: [Address1]

[Address2]



[City] [State] [ZipCode]



What is the address?





Address2 – READ IF NECESSARY Second part of the address.

SCREEN:

Shape42


FACILITY’S ADDRESS: [Address1]

[Address2]



[City] [State] [ZipCode]



READ IF NECESSARY Second part of the address.





City – Town or city?

SCREEN:

Shape43


FACILITY’S ADDRESS: [Address1]

[Address2]



[City] [State] [ZipCode]



Town or city?





State – State?

SCREEN:

Shape44


FACILITY’S ADDRESS: [Address1]

[Address2]



[City] [State] [ZipCode]



State?

USE TWO CHARACTER ABBREVIATION.

PRESS ENTER TO ENTER A FOREIGN COUNTRY.





ZipCode – And what is the zip code?

SCREEN:

Shape45


FACILITY’S ADDRESS: [Address1]

[Address2]



[City] [State] [ZipCode]



And what is the zip code?





Confirm[3] (MainTab) – CONFIRM THE ADDRESS ABOVE WITH THE RESPONDENT, THEN PRESS ENTER.

SCREEN:

Shape46


FACILITY’S ADDRESS [Address1]

[Address2]



[City] [State] [ZipCode]



CONFIRM THE ADDRESS ABOVE WITH THE RESPONDENT, THEN PRESS ENTER.





PhoneNumber[2] (MainTab) – Please give me the telephone number, area code first?

SCREEN:

Shape47

Please give me the telephone number, area code first?




HaveExten[2] (MainTab) – Is there an extension number?

SCREEN:

Shape48


TELEPHONE NUMBER: [PhoneNumber[2] (MainTab), as “###-###-####”]


Is there an extension number?




[RB] 1. YES [RB] 0. NO





Extension[2] (MainTab) – What is the extension number?

SCREEN:

Shape49


TELEPHONE NUMBER: [PhoneNumber[2] (MainTab), as “###-###-####”]


What is the extension number?





Confirm[4] (MainTab) – CONFIRM THE INFO ABOVE WITH THE RESPONDENT, THEN PRESS ENTER.

SCREEN:

Shape50


TELEPHONE NUMBER: [PhoneNumber[2] (MainTab), as “###-###-####”]

EXTENSION: [Extension[2] (MainTab)]

COUNTRY CODE: [CountryCode]

TIME ZONE: [aTimeZone]

OBSERVE DST: [ObserveDST]

TYPE OF PHONE: [PhoneType]

TIME OF DAY: [TimeOfDay]


CONFIRM THE INFO ABOVE WITH THE RESPONDENT, THEN PRESS ENTER.





Message_R – *** REMINDER CALL MESSAGE *** …

SCREEN:

Shape51


*** REMINDER CALL MESSAGE ***


DID YOU LEAVE THE MESSAGE?




[RB] 1. YES [RB] 0. NO





Message_Q – *** SURVEY CALL MESSAGE *** …

SCREEN:

Shape52


*** SURVEY CALL MESSAGE ***


DID YOU LEAVE THE MESSAGE?




[RB] 1. YES [RB] 0. NO





WebHelp – I’ll try to answer your questions, or I’ll find someone who can. What problems are you having completing the survey on the Web?

SCREEN:

Shape53


I’ll try to answer your questions, or I’ll find someone who can. What problems are you having completing the survey on the Web?


WEB SURVEY AT [Survey Website URL] with User ID: [MPRID] and Password: [Password]


RESPOND TO QUESTIONS. IF NECESSARY, SEEK YOUR SUPERVISOR’S ASSISTANCE.


AFTER ANSWERING QUESTIONS, READ: So you can reach us if you have additional questions about the survey or how to respond on the Web, please jot down our toll-free helpline. It is 1-888-324-8337.





Thanks[1] (MainTab) – Thank you so much for your time. Your responses are very important to the study and we look forward to receiving your completed survey.

SCREEN:

Shape54


Thank you so much for your time. Your responses are very important to the study and we look forward to receiving your completed survey.


ENTER 1 TO CONTINUE





Callback – USE THE 'APPOINTMENT' TAB ABOVE TO MAKE AN APPOINTMENT.

SCREEN:

Shape55


USE THE 'APPOINTMENT' TAB ABOVE TO MAKE AN APPOINTMENT.





BeginSurvey – Click on the three dots to connect to the Web Browser.

SCREEN:

Shape56


[If Confirm[R] = “2”, then display: Thank you for your time. Earlier, you mentioned that some contact information for your facility needs to be updated. I’d like to do that now.]


Click on the three dots to connect to the Web Browser.


DO NOT CLICK THE THREE DOTS MORE THAN ONCE. IF NECESSARY, EXIT BLAISE AND RE-OPEN THE CASE TO RECONNECT TO THE BROWSER.

YOU SHOULD HAVE ONLY ONE BROWSER WINDOW OPEN WHILE ACCESSING THE WEB INSTRUMENT.

IF YOUR BROWSER DOES NOT APPEAR TO OPEN, CONFIRM IF THERE IS A BROWSER WINDOW MINIMIZED AT THE BOTTOM OF YOUR SCREEN. IF THERE IS, CLOSE IT.

WHILE IN THE WEB INSTRUMENT, DO NOT CLOSE YOUR BROWSER WINDOW UNTIL THE CASE IS COMPLETE OR AFTER A BREAK OFF.

IF YOU ARE UNABLE TO ACCESS THE WEB INSTRUMENT, OR HAVE ANY PROBLEMS OR QUESTIONS, CONTACT THE FLOOR SUPERVISOR IMMEDIATELY.





aGetSMSStatus – Click on the three dots to get the SMS status.

SCREEN:

Shape57


Click on the three dots to get the SMS status.





aBadSQL2 – There was a problem reading external database. Click on the box with three dots in the input field to exit the case and inform your supervisor of the problem reading the SQL database. Make note of the MPRID ([MPRID]) before exiting.

SCREEN:

Shape58


There was a problem reading external database. Click on the box with three dots in the input field to exit the case and inform your supervisor of the problem reading the SQL database. Make note of the MPRID ([MPRID]) before exiting.





ContinueStatus – Press 1 to Continue

SCREEN:

Shape59


Press 1 to Continue




[RB] 1. ENTER 1 TO CONTINUE





StatusResult – INTERVIEWER: WAS THIS A …


SCREEN:

Shape60

INTERVIEWER: WAS THIS A …




[RB] 1. REFUSAL

[RB] 3. SUPERVISOR

[RB] 2. APPOINTMENT

[RB] 4. REMINDER CALL COMPLETE




SelectRefusal – USE THE 'BREAKOFF' TAB ABOVE TO EXIT.

SCREEN:

Shape61


USE THE 'BREAKOFF' TAB ABOVE TO EXIT.





SelectAppointment – USE THE 'APPOINTMENT' TAB ABOVE TO MAKE AN APPOINTMENT.

SCREEN:

Shape62


USE THE 'APPOINTMENT' TAB ABOVE TO MAKE AN APPOINTMENT.





SupReviewA – THIS CASE WILL GO TO SUPERVISORY REVIEW.

SCREEN:

Shape63


THIS CASE WILL GO TO SUPERVISORY REVIEW.




[RB] 1. ENTER 1 TO CONTINUE





KindOfExit (MainTab) – RECORD THE KIND OF EXIT.

SCREEN:

Shape64


RECORD THE KIND OF EXIT.


THE WEB VERSION IS AVAILABLE. OFFER THE WEB OPTION.

If you prefer, you can complete the survey on the web.




[RB] 1. REFUSES TO CONTINUE

[RB] 4. SEND TO SUPERVISOR REVIEW

[RB] 6. HUNG UP DURING INTRODUCTION

[RB] 2. RESPONDENT WILL CALL

[RB] 5. RESPONDENT WILL COMPLETE ON THE


[RB] 3. RESPONDENT ON CELL PHONE

WEB






WhoRefused (MainTab) – INDICATE WHO REFUSED.

SCREEN:

Shape65


INDICATE WHO REFUSED.


THE WEB VERSION IS AVAILABLE. OFFER THE WEB OPTION.

If you prefer, you can complete the survey on the web.




[RB] 1. REFUSAL BY KNOWN RESPONDENT

[RB] 2. REFUSAL BY GATEKEEPER

[RB] 3. REFUSAL BY UNKNOWN PERSON





RefusalReason (MainTab) – INDICATE THE REASON FOR THE REFUSAL.

SCREEN:

Shape66


INDICATE THE REASON FOR THE REFUSAL.




[RB] 1. CONFIDENTIALITY

[RB] 4. DOESN’T BELIEVE STUDY WILL MAKE

[RB] 0. OTHER (GENERIC)

[RB] 2. NOT INTERESTED

A DIFFERENCE

[RB] 98. DON’T CALL AGAIN

[RB] 3. INTERVIEW TOO LONG

[RB] 5. DOESN’T LIKE TOPIC OR



ORGANIZATION






RefusalSeverity (MainTab) – INDICATE SEVERITY OF THE REFUSAL.

SCREEN:

Shape67


INDICATE SEVERITY OF THE REFUSAL.




[RB] 1. SOFT

[RB] 2. MEDIUM

[RB] 3. ADAMANT





CallInInfo (MainTab) – You can call us back at 1-800-783-6483 and please use reference #[MPRID]. We look forward to hearing from you.

SCREEN:

Shape68


You can call us back at 1-800-783-6483 and please use reference #[MPRID].

We look forward to hearing from you.




[RB] 1. ENTER 1 TO CONTINUE





WebInfo (MainTab) – Okay, that would be fine. If you would prefer to complete it on the Web, I can give you the log-on information you’ll need. Would you like that information?

SCREEN:

Shape69


Okay, that would be fine. If you would prefer to complete it on the Web, I can give you the log-on information you’ll need. Would you like that information?


WEB SURVEY AT [Survey Website URL] [<Survey Website URL>]

User ID: [User ID] and Password: [Web Password]




[RB] 1. ENTER 1 TO CONTINUE





ExitRemark (MainTab) – MAKE ANY EXIT REMARKS.

SCREEN:

Shape70


MAKE ANY EXIT REMARKS.





LeaveExit (MainTab) – YOU ARE NOW LEAVING THE EXIT MODULE.

SCREEN:

Shape71


YOU ARE NOW LEAVING THE EXIT MODULE.




[RB] 1. ENTER 1 TO CONTINUE





Thanks[2] (MainTab) – Thank you for your time.

SCREEN:

Shape72


Thank you for your time.




[RB] 1. ENTER 1 TO CONTINUE





Finished – ENTER A REMARK FOR CASE [MPRID] AND GO TO THE NEXT FIELD TO SEE THE STATUS OF THE CASE.

SCREEN:

Shape73


ENTER A REMARK FOR CASE [MPRID] AND GO TO THE NEXT FIELD TO SEE THE STATUS OF THE CASE.


[If the case is suspended, then display: “ THIS CASE IS SUSPENDED.”]





aBadStatus – WARNING - NO STATUS CODE ASSIGNED. …

SCREEN:

Shape74


WARNING - NO STATUS CODE ASSIGNED.


NOTIFY YOUR SUPERVISOR IMMEDIATELY.




[RB] 1. ENTER 1 TO CONTINUE





LeaveCase – THE STATUS OF CASE [MPRID] IS: …

SCREEN:

Shape75


THE STATUS OF CASE [MPRID] IS:


CODE = [new CODE]

CDSP = [new CDSP]

FINAL = [new FINAL]


NSSATS FINAL = [new N-SUMHSS Status Code of case without leading zeros;

EXCEPTION: when N-SUMHSS Status Code = “007”, display “21” instead of “7”]




[RB] 1. ENTER 1 TO CONTINUE





Make Appointment – Make Appointment

SCREEN:

Shape76


[Display the following fields, allowing the interviewer to set up an appointment with the respondent.]

Date

Type (Exact date, Period, Weekday, No date)

Month

Year

[Calendar allowing interviewer to show any date >= System Date

Time

Type (Exact time, Day part, No time)

From (time)

To (time)

Summary [From and To date(s) and time(s) for appointment(s) selected]

[Btn: OK, Cancel, Today, Clear, Begin, Help]





HardSoft – INTERVIEWER, PLEASE INDICATE THE KIND OF APPOINTMENT.

SCREEN:

Shape77


INTERVIEWER, PLEASE INDICATE THE KIND OF APPOINTMENT.




[RB] 1. FIRM APPOINTMENT

[RB] 2. MEDIUM APPOINTMENT

[RB] 3. SOFT APPOINTMENT





AskForWhom – Who should we ask for when calling back?

SCREEN:

Shape78


Who should we ask for when calling back?




[RB] 1. ENTER 1 TO CONTINUE





FirstName (Appointment) – First name?

SCREEN:

Shape79


NAME: [FirstName, MiddleName, AND LastName (all Appointment), separated by spaces]


First name?





MiddleName (Appointment) – Middle initial?

SCREEN:

Shape80


NAME: [FirstName, MiddleName, AND LastName (all Appointment), separated by spaces]


Middle initial?





LastName (Appointment) – Last name?

SCREEN:

Shape81


NAME: [FirstName, MiddleName, AND LastName (all Appointment), separated by spaces]


Last name?





Confirm[1] (Appointment) – CONFIRM THE NAME ABOVE WITH THE RESPONDENT, THEN PRESS ENTER.

SCREEN:

Shape82


NAME: [FirstName, MiddleName, AND LastName (all Appointment), separated by spaces]


CONFIRM THE NAME ABOVE WITH THE RESPONDENT, THEN PRESS ENTER.





PhoneNumber (Appointment) – Please change the number if needed, area code first.

SCREEN:

Shape83


TELEPHONE NUMBER: [PhoneNumber (Appointment)]

Please change the number if needed, area code first.





Extension (Appointment) – What is the extension number?

SCREEN:

Shape84


TELEPHONE EXTENSION:


What is the extension number?





Confirm[2] (Appointment) – CONFIRM THE INFO ABOVE WITH THE RESPONDENT, THEN PRESS ENTER.

SCREEN:

Shape85


PHONE NUMBER: [PhoneNumber (Appointment)]

EXTENSION: [Extension (Appointment)]


CONFIRM THE INFO ABOVE WITH THE RESPONDENT, THEN PRESS ENTER.





Thanks (Appointment) – Thank you for your time.

SCREEN:

Shape86


Thank you for your time.


ENTER ANY NOTES OR COMMENTS IN THE FOLLOWING REMARKS FIELD BEFORE ENTERING CODE TO END INTERVIEW.




[RB] 1. ENTER 1 TO CONTINUE





ApptRemark – MAKE ANY GENERAL APPOINTMENT REMARKS.

SCREEN:

Shape87


MAKE ANY GENERAL APPOINTMENT REMARKS.





LeaveAppt – YOU ARE NOW LEAVING THE APPOINTMENT MODULE.

SCREEN:

Shape88


YOU ARE NOW LEAVING THE APPOINTMENT MODULE.




[RB] 1. ENTER 1 TO CONTINUE




Attachment B4   N-SUMHSS 2021 CATI Questionnaire page 90 5/4/2021

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMatt Potts
File Modified0000-00-00
File Created2021-05-04

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