72-Month Tracking Survey

InstrumentC_FOS_72 MonthTracking Survey.doc

Family Options Study: Long-Term Follow-up Evaluation

72-Month Tracking Survey

OMB: 2528-0259

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Frame1






Introduction


Hello, my name is [ ]. I work for a company called Abt SRBI. You might remember meeting with me or one of my colleagues back in [MONTH/YEAR of RA or DATE OF LAST INTERVIEW] at [INSERT LOCATION WHERE INTERVIEWER LAST MET WITH RESPONDENT]. At that time I talked to you about a study that we are doing to find out about what kind of housing is best for families who experienced homelessness. This study is often referred to the Family Options Study. Abt SRBI is an independent research company and we are helping the U.S. Department of Housing and Urban Development (HUD) to do this study.


When we talked back in [MONTH/YEAR OF RA/MONTH], I mentioned that I’d be getting in touch with you again to find out about your housing experiences. I’d like to ask you some questions now. The survey will take about 15 minutes to complete. You can stop the interview at any time. You can choose not to answer any question. The information you provide will be kept confidential and only used for this study. The collection of this information has been approved by the Office of Management and Budget. At the end of the interview, you will be paid $25, in appreciation for your time.

Section A: Current Housing, Homelessness since previous interview, housing program participation

First, I’d like to ask about where you are living/staying right now.



  1. Can you please confirm the address of where you are living/staying now? [CAPI: PRE-FILL WITH ADDRESS WHERE INTERVIEW IS TAKING PLACE. INTERVIEWER; CONFIRM THAT INFORMATION IS CORRECT AND UPDATE AS NEEDED. PROBE FOR BUILDING NAME IF APPLICABLE]



A1a. Is there a complex/building name?

A1b. Is there an apartment number?

A1c. What city do you live in?

A1d. What state do you live in?

A1e. What is the zip code?


Refused…………………………….1 (1=checked, 0=not checked)

Don’t Know…………………………1 (1=checked, 0=not checked)



  1. Is [A1 ADDRESS] the best address to reach you at?

YES 1 (SKIP TO A3)

NO 2

REFUSED 7

DON’T KNOW 8



What is the best address to reach you at?

Street Address:


A2a. Is there a complex/building name?

A2b. Is there an apartment number?

A2c. In what city?

A2d. In what state?

A2e. What is the zip code?



A2f. What is your home phone number, starting with the area code?


Telephone # with area code: (_______) ________-________


A2g. What is your cell phone number, starting with the area code?


Telephone # with area code: (_______) ________-________



A2h. Do we have your permission to text you at this number?

YES 1

NO 2

REFUSED 7

DON’T KNOW 8



A2i. What is your email address?




A2j. What is the best way for us to reach you for future data collection efforts?

EMAIL 1

CELL PHONE 2

TEXT 3

CELL PHONE 4

REFUSED 7

DON’T KNOW 8



  1. Which of the following best describes your current living situation?



Would you say you are living/staying in…

CAPI: SKIP TO A4 WHEN YES RESPONSE IS GIVEN

YES

NO

REF

DK

A3a. A house or apartment that you own or rent. THIS DOES NOT INLCUDE YOUR PARENT’S or GUARDIAN’S HOME OR APARTMENT

1

2

7

8

A3b. Your partner’s (boy/girlfriends/fiancé, significant other’s) place.

1

2

7

8

A3c. A friend or relative’s house or apartment, and paying part of the rent [PROBE: THIS INCLUDES YOUR PARENT’S or GUARDIAN’S HOUSE OR APARTMENT OR OTHER FRIEND OR RELATIVE’S APARTMENT]

1

2

7

8

A3d. A friend or relative’s house or apartment, but not paying part of the rent [PROBE: THIS INCLUDES YOUR PARENT’S or GUARDIAN’S HOUSE OR APARTMENT OR OTHER FRIEND OR RELATIVE’S APARTMENT]

1

2

7

8

A3e. A permanent housing program with services to help you keep your housing (on site or coming to you) IF YES: COLLECT NAME OF PROGRAM: <A3E_1_OTHER> _____ __________THEN SKIP TO A4

1

2

7

8

A3f. A transitional housing program IF YES COLLECT NAME OF PROGRAM: <A2F_1_OTHER>

___________________________________ THEN SKIP TO A4

1

2

7

8

A3g. A domestic violence shelter IF YES: SKIP TO A4

1

2

7

8

A3h. An emergency shelter IF YES COLLECT NAME OF PROGRAM: <A3H_1_OTHER>

___________________________________ THEN SKIP TO A4

1

2

7

8

A3i. A voucher hotel or motel IF YES: SKIP TO A4

1

2

7

8

A3j. A hotel or motel you pay for yourself IF YES: SKIP TO A4

1

2

7

8

A3k. A residential drug or alcohol treatment program IF YES: SKIP TO A4

1

2

7

8

A3l. Jail or prison IF YES: SKIP TO A4

1

2

7

8

A3m. A car or other vehicle IF YES: SKIP TO A4

1

2

7

8

A3n. An abandoned building IF YES: SKIP TO A4

1

2

7

8

A3o. Anywhere outside [PROBE: STREETS, PARKS, ETC.] IF YES: SKIP TO A4

1

2

7

8

A3p. OTHER SPECIFY: <A3P_1_OTHER>: ______________________ IF YES, NO, DK OR : SKIP TO A4

1

2

7

8


BASE: ALL

  1. How long have you lived in this place? You can tell me this answer in days, weeks, or months, whichever is easiest for you. [INTERVIEWER/CAPI: RECORD NUMBER OF DAYS, WEEKS, MONTHS. IF 0, RECORD THAT AS WELL.


<A4A1> NUMBER OF DAYS____________

<A4A2> NUMBER OF WEEKS

<A3A3> NUMBER OF MONTHS

REFUSED -2

DON’T KNOW -1


  1. Do you currently receive any governmental housing assistance, such as through public housing, or Section 8 or Housing Choice Voucher? 

YES 1 (SKIP TO A4a)

NO 2

REFUSED 7

DON’T KNOW 8


  1. Are you paying lower rent because the Federal, state, or local government is paying for part of your rent?

YES 1

NO 2 (SKIP TO A7)

REFUSED 7 (SKIP TO A7)

DON’T KNOW 8 (SKIP TO A7)


<A6A> BASE: BASE: A5=1 OR A6=1

A6a. What is the name of the program that provides your housing assistance? This could be the place where you live or the program that helps you with your rent.

RECORD VERBATIM



<A6B> BASE: A5=1 OR A4=1

A6b. Is this assistance a Section 8 or Housing Choice Voucher, or is the building you live in a public housing or a Section 8 project or some other type of assistance?

CAPI: ACCEPT ONE RESPONSE ONLY.


PUBLIC HOUSING 1

A SECTION 8/HOUSING CHOICE VOUCHER 2

A SECTION 8/HCV PROJECT 3

TRANSITIONAL HOUSING 4

LOW INCOME HOUSING 5

HOMEBASE 6

OTHER TYPE OF HOUSING ASSISTANCE 95
(SPECIFY): __<
A6B_95_OTHER> Base: A6B = 95

REFUSED 97

DON’T KNOW 98



  1. Now, I’d like you to think about the last six months—that is, since [MONTH/YEAR SIX MONTHS PRIOR TO INTERVIEW]. Were there any times when you were homeless in the last six months? By homeless, I mean times when you didn’t have a regular place to live and you were living in a homeless shelter or temporarily in an institution because you had nowhere else to go.


Homeless can also include living in a place not typically used for sleeping such as on the street, in a car, in an abandoned building, or in a bus or train station in the past six months.


Please do not include any times when you may have stayed with friends or relatives because you did not have your own place to stay. Please do not include times when you lived in a transitional housing program or permanent housing program.


YES 1

NO 2 (SKIP TO A9)

REFUSED 7 (SKIP TO A9)

DON’T KNOW 8 (SKIP TO A9)


  1. How many times were you homeless in the last six months?

[INTERVIEWER/CAPI: RECORD NUMBER OF TIMES THE PERSON WAS HOMELESS.]


NUMBER OF TIMES ____________________________________

REFUSED -1 (SKIP TO A9)

DON’T KNOW -2 (SKIP TO A9)


BASE: A7≥1

A8a. Thinking about all of the times you have been homeless in the past 6 months], What would you say is the total number of days, weeks, or months that you have been homeless in the past 6 months?

<A8a1>NUMBER OF DAYS____________

<A8A2> NUMBER OF WEEKS

<A8A3> NUMBER OF MONTHS

REFUSED -2

DON’T KNOW -1


  1. Again, please think about the last six months—that is, since [MONTH/YEAR SIX MONTHS PRIOR TO INTERVIEW]. Were there any times when you were living with a friend or relative because you could not find or afford a place of your own?


YES 1

NO 2 (SKIP TO A11)

REFUSED 7 (SKIP TO A11)

DON’T KNOW 8 (SKIP TO A11)


  1. Altogether, how much time in the past six months, would you say you spent living with a friend or relative because you could not find or afford a place of your own? You can tell me this answer in days, weeks, or months, whichever is easiest for you. [INTERVIEWER/CAPI: RECORD NUMBER OF DAYS, WEEKS, MONTHS, YEARS. IF 0, RECORD THAT AS WELL].

<A10a1>NUMBER OF DAYS____________

<A10A2> NUMBER OF WEEKS

<A10A3> NUMBER OF MONTHS

REFUSED -2

DON’T KNOW -1




  1. Again, please think about the past six months —that is, since [MONTH/YEAR SIX MONTHS PRIOR TO INTERVIEW] and today, have you participated in any housing programs other than where you are living now? This could be a housing program where you lived or a program that helped you pay some or all of the rent in your own apartment or house.



YES 1

NO 2 (SKIP TO B1)

REFUSED 7

DON’T KNOW 8










  1. During the past six months, that is between [MONTH/YEAR SIX MONTHS PRIOR TO INTERVIEW] and today, we are interested in knowing if you participated in any of the following types of programs. When answering these questions, please do not include the place you are living now. During the past six months, did you…

  1. Program Type

YES

NO

REFUSED

DON’T KNOW

  1. Spend at least one night in shelter because you did not have your own place to stay?






  1. Participate in a permanent supportive housing program—a program that offered both housing and services?





  1. Spend at least one night in a transitional housing program?





  1. Spend any time living in a place where you received assistance paying your rent with temporary rental assistance. This temporary assistance could be a rapid rehousing or the HPRP program.






  1. Spend any time living in a place where your rent was partially covered by a rent subsidy such as public housing, Section 8 or a Housing Choice Voucher?
















  1. Receive any other form of housing assistance? Please Specify:

_____________









Section B: Family Composition

Now I’d like to ask you about the people in your family. I’ll ask you about people who are living with you now and your spouse/partner or children who are in your family but are not staying with you now.



  1. The last time we talked, [MM/YYYY of RA] [LIST FIRST NAMES AND DOB OF PEOPLE LIVING WITH RESPONDENT AT TIME OF LAST INTERVIEW] were living with you/staying with you: Can you please tell me if each of them are staying with you now? If not, please tell me where they are currently staying, and how long they’ve been staying there.


LINES WILL BE ADDED TO THE TABLE AS NEEDED.


List of family members with Respondent at last interview

  1. Is [B1a…B1e] , who was born in [DOB MO/YR], staying with you now?



<B2_X> (X=1-9)


  1. IF NO TO B2 FOR ANY FAMILY MEMBER ASK: How long has it been since [B1a] lived/stayed with you?


<B3_1_X> Days

<B3_2_X> Weeks

<B3_3_X> Months


(X=1-9)

  1. IF NO TO B2 FOR ANY FAMILY MEMBER ASK: Where is [B1a] living/staying now?

(SINGLE RESPONSE)


NOTE TO FIELD INTERVIEWER: PROBE FOR THE PLACE THE PERSON SPENDS MOST OF THE TIME. 


NOTE TO PROGRAMMER: IF AGE=MISSING/ DK, DISPLAY FULL ANSWER LIST


<HHMAGE_X> Age Calculation (0= less than 1yr, -1=Dk, -2=Ref)


<B4_X> Where living/Staying now?

<B4_6_OTHER_X> How long foster care

<B4_95_OTHER_X> B4 Other Specify

(X=1-9)


B1a

YES (Ask B2A/B2B then SKIP TO NEXT PERSON) 1


NO 2




_____Days

_____Weeks

_____Months


REFUSED -1

DK -2



IF B1d IS AN ADULT >15?

A place of his/her own 1

With friends or relatives 2


IF Bd IS A CHILD <15?

With child’s other parent 3

With your own parents or in-laws 4

With other relatives 5

In foster care 6

how long in foster care? _________


Refused…………………………………….7

Don’t Know………………………………...8


OTHER: _______________ 95


B1b

YES (Ask B2A/B2B then SKIP TO NEXT PERSON) 1


NO 2




_____Days

_____Weeks

_____Months


REFUSED -1

DK -2



IF B1d IS AN ADULT >15?

A place of his/her own 1

With friends or relatives 2


IF Bd IS A CHILD <15?

With child’s other parent 3

With your own parents or in-laws 4

With other relatives 5

In foster care 6

how long in foster care? _________


Refused…………………………………….7

Don’t Know………………………………...8


OTHER: _______________ 95


B1c

YES (Ask B2A/B2B then SKIP TO NEXT PERSON) 1


NO 2



_____Days

_____Weeks

_____Months


REFUSED -1

DK -2



IF B1d IS AN ADULT >15?

A place of his/her own 1

With friends or relatives 2


IF Bd IS A CHILD <15?

With child’s other parent 3

With your own parents or in-laws 4

With other relatives 5

In foster care 6

how long in foster care? _________


Refused…………………………………….7

Don’t Know………………………………...8


OTHER: _______________ 9595


B1d

YES (Ask B2A/B2B then SKIP TO NEXT PERSON) 1

NO 2



_____Days

_____Weeks

_____Months


REFUSED -1

DK -2


IF B1d IS AN ADULT >15?

A place of his/her own 1

With friends or relatives 2


IF Bd IS A CHILD <15?

With child’s other parent 3

With your own parents or in-laws 4

With other relatives 5

In foster care 6

how long in foster care? _________


Refused…………………………………….7

Don’t Know………………………………...8


OTHER: _______________ 95


B1e

YES (Ask B2A/B2B then SKIP TO NEXT PERSON) 1


NO 2



_____Days

_____Weeks

_____Months


REFUSED -1

DK -2




IF B1d IS AN ADULT >15?

A place of his/her own 1

With friends or relatives 2


IF Bd IS A CHILD <15?

With child’s other parent 3

With your own parents or in-laws 4

With other relatives 5

In foster care 6

how long in foster care? _________


Refused…………………………………….7

Don’t Know………………………………...8


OTHER: _______________ 955




We would like to know if there are any other people living with you now, whom we haven’t talked about yet. We are especially interested in people that you consider part of your family. By part of your family, we mean those people who would go with you if you were to move.


B5. <B5> Are there any other people that you consider part of your family, living with you right now whom we haven’t talked about?


YES 1

NO 2 SKIP TO C1

REFUSED 7

DON’T KNOW 8


B5a. How many of the people who we haven’t talked about yet, but are living with you right now are adults, 18 years old or older? How many are children, 17 years old or younger?


<B5A1> NUMBER OF ADULTS ______________

<B5A2> NUMBER OF CHILDREN __________________

REFUSED -2

DON’T KNOW -1



B6. Please tell me the first names of the adults who are living with you now whom we haven’t talked about. By adults I mean people 18 years old or older. Do not include yourself.

<B6_X> (X=1-10)

B6a.

B6b.



B7. Please tell me the first names of the children who are living with you now whom we haven’t talked about. By children I mean people 17 years old or younger. Please do not include children 18 years old or older. .

<B7_X> (X=1-10)


B7a.

B7b.

B7c.

B7d.

Now I have some questions about these family members. Let’s start with the adults. MORE COLUMNS WILL BE ADDED AS NEEDED.THESE ITEMS ARE ONLY COLLECTED FOR FAMILY MEMBERS WHO HAVE JOINED THE FAMILY SINCE THE LAST INTERVIEW (


FAMILY MEMBER 1 (B6a-X)

FAMILY MEMBER 3 (B7a-X)

B8.What is [B6a/B7a]’s relationship to you?


<B8_X> (X=1-7)


Husband or Wife 1

Lover/partner 2

child 3

Step-child 4

Foster child 5

Child of Lover/partner 6

Son- or
Daughter-in-law
7

Mother or Father 8

Step-Parent 9

Mother- or Father-in-law

or partner's parent 10

Grandparent 11

Brother or Sister 12

Brother- or
Sister-in-law
13

Grandchild 14

Other Relative 15

Husband or Wife 1

Lover/partner 2

child 3

Step-child 4

Foster child 5

Child of Lover/partner 6

Son- or
Daughter-in-law
7

Mother or Father 8

Step-Parent 9

Mother- or Father-in-law

or partner's parent 10

Grandparent 11

Brother or Sister 12

Brother- or
Sister-in-law
13

Grandchild 14

Other Relative 15

B9 Is [B6a/B7a] male or female?


<B9_X> (X=1-7)


MALE 1

FEMALE 2

REFUSED 7

DON’T KNOW 8

MALE 1

FEMALE 2

REFUSED 7

DON’T KNOW 8


B10 What is [B6a/B7a]’s Date of Birth?


<B10M_X> Month <B10D_X> Day <B10Y_X> Year

(X=1-7)


<B10AGE_X> Added variable/Used to Calculate age of DOB For B11. (0=less than year, -1=Don’t know, -2 refused)


___/___/_____

MM DD YYYY

___/___/_____

MM DD YYYY

Section C: Employment Status and Internet Usage:

Now I’d like to ask a couple of questions about your current employment.


C1. Last week, did you do any work for pay?

Yes (SKIP TO D1)

No

REF

DK


C2. When was the last time (month/year) that you worked for pay?



C3. Do you have a computer with internet access in in the place you are living now?


YES 1

NO 2

REFUSED 7

DON’T KNOW 8


C4. Do you have access to the internet through your phone or an ipad or tablet device?

YES 1

NO 2

REFUSED 7

DON’T KNOW 8



C5. How often do you access the internet?

Every day 1

4-5 days per week 2

2-3 days per week 3

Once a week 4

Less than once a week 5

Never 6

REFUSED 7

DON’T KNOW 8

Section D: Contact Information

SECONDARY CONTACT


[PROGRAMMER: LOOP THROUGH EXISTING SECONDARY CONTACTS TO CONFIRM CONTACT INFORMATION FOR UP TO THREE SECONDARY CONTACTS. IF INFORMATION CAN’T BE CONFIRMED, IT WILL BE UPDATED. IF LESS THAN THREE CONTACTS ARE AVAILABLE, WE WILL ASK FOR NEW CONTACTS.


To help us be able to get back in touch with you in the future, we would also like to review the names, telephone numbers and addresses of two people we talked about last time we spoke who will always know how to reach you. This information will be kept strictly confidential and will only be used if we are unable to contact you.



  1. When we last spoke on [Last Intvw MMYYYY] you said that [CONTACT X] was a person who would always know where you are and how to reach you. Is [CONTACT#X] still a person who does not live with you and will always know how to contact you?

Yes 1SKIP TO D12

No 2

REFUSED 7

DON’T KNOW 8


SECONDARY CONTACT:

  1. Could you please tell me the name of a person who does not live with you and will always know how to contact you?


Yes 1

No 2 SKIP TO CLOSING

REFUSED 7

DON’T KNOW 8


D11a. What is his/her first name?

D11b. What is his/her middle name?

D11c. What is his/her last name?

D11d. Does his/her name have a suffix?



  1. IF CONTACT #X CONFIRMED ASK: Is [CONTACT #1]’s address still:

DISPLAY FULL INFORMATION FROM THE SAMPLE FOR CONTACT 1


IF CONTACT #1 IS NEW ASK: What is (his/her) street address?


FIELD INTERVIEWER NOTE: PLEASE PROBE TO GET A FULL ADDRESS


Street address:


D12a. Is there a complex/building name?

D12b. Is there an apartment number?

D12c. In what city?

D12d. In what state?

D12e. What is the zip code?


  1. What is (his/her) home phone number, starting with the area code?


Telephone # with area code: (_______) ________-________


    • NO HOME NUMBER AVAILABLE


  1. What is (his/her) cell phone number, starting with the area code?


Telephone # with area code: (_______) ________-________


    • NO CELL NUMBER AVAILABLE



  1. What is (his/her) email address?



    • NO EMAIL ADDRESS AVAILABLE



  1. What is (his/her) relationship to you?


Friend 1

Relative 2

OTHER (SPECIFY______________________________) 95

REFUSED 97

DON’T KNOW 98





Thank you very much for your time today. We will mail your $25 incentive payment. You should receive it within two-four weeks. Remember, we want to be able to reach you again in the future. If you move or change your phone number, please let us know. You can call 1-XXX-XXX-XXXX and leave a message with your PIN [FAMILYID].




File Typeapplication/msword
File TitleHousing quality
AuthorMcinnisD
Last Modified ByFletcher, Anne L
File Modified2016-11-08
File Created2016-11-08

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