N-SUMHSS 2021 CATI N-SUMHSS 2021 CATI Questionnaire

Attachment B4- N-SUMHSS 2021 CATI questionnaire

MPRID – MPRID

SCREEN:

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:

 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:

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:

[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:

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:

[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:

[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:

 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:

Please give me the telephone number, area code first.

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

SCREEN:

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:

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:

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:

 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:

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:

 PLEASE ENTER WHAT WAS SAID.

PhoneProb – CODE PHONE PROBLEM

SCREEN:

 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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

FACILITY’S ADDRESS: [Address1]

[Address2]

[City] [State] [ZipCode]

What is the address?

Address2 – READ IF NECESSARY Second part of the address.

SCREEN:

FACILITY’S ADDRESS: [Address1]

[Address2]

[City] [State] [ZipCode]

 READ IF NECESSARY Second part of the address.

City – Town or city?

SCREEN:

FACILITY’S ADDRESS: [Address1]

[Address2]

[City] [State] [ZipCode]

Town or city?

State – State?

SCREEN:

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:

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:

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:

Please give me the telephone number, area code first?

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

SCREEN:

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:

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:

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:

*** REMINDER CALL MESSAGE ***

 DID YOU LEAVE THE MESSAGE?

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

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

SCREEN:

*** 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:

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:

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:

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

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

SCREEN:

[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:

 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:

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:

Press 1 to Continue

[RB] 1. ENTER 1 TO CONTINUE

StatusResult – INTERVIEWER: WAS THIS A …

SCREEN:

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:

 USE THE 'BREAKOFF' TAB ABOVE TO EXIT.

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

SCREEN:

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

SupReviewA – THIS CASE WILL GO TO SUPERVISORY REVIEW.

SCREEN:

 THIS CASE WILL GO TO SUPERVISORY REVIEW.

[RB] 1. ENTER 1 TO CONTINUE

KindOfExit (MainTab) – RECORD THE KIND OF EXIT.

SCREEN:

 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:

 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:

 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:

 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:

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:

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:

 MAKE ANY EXIT REMARKS.

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

SCREEN:

 YOU ARE NOW LEAVING THE EXIT MODULE.

[RB] 1. ENTER 1 TO CONTINUE

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

SCREEN:

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:

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:

WARNING - NO STATUS CODE ASSIGNED.

NOTIFY YOUR SUPERVISOR IMMEDIATELY.

[RB] 1. ENTER 1 TO CONTINUE

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

SCREEN:

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:

[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:

 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:

Who should we ask for when calling back?

[RB] 1. ENTER 1 TO CONTINUE

FirstName (Appointment) – First name?

SCREEN:

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

First name?

MiddleName (Appointment) – Middle initial?

SCREEN:

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

Middle initial?

LastName (Appointment) – Last name?

SCREEN:

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:

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:

TELEPHONE NUMBER: [PhoneNumber (Appointment)]

Please change the number if needed, area code first.

Extension (Appointment) – What is the extension number?

SCREEN:

TELEPHONE EXTENSION:

What is the extension number?

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

SCREEN:

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:

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:

 MAKE ANY GENERAL APPOINTMENT REMARKS.

LeaveAppt – YOU ARE NOW LEAVING THE APPOINTMENT MODULE.

SCREEN:

 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