Survey 2 Competency Screener

ATTACHMENT A13. SURVEY 2 SCREENER AND CALLBACK SCRIPT
Survey 2 –Screener
S1.

Hello, may I speak with [BENEFICIARY]? [IF NEEDED: I am trying to reach the person who
recently received a letter from the Social Security Administration about a research study]
[IF ASKED, “WHO’S CALLING?”]:
My name is (DATA COLLECTOR) and I am calling from Westat about a Social Security
Administration research study.
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YES/SPEAKING  (GO TO INTRO1)
ANSWERING MACHINE (GO TO ANSWERING MACHINE MESSAGE)
ENTER NEW PHONE NUMBER (GO TO RECORD NEW NUMBER)
CLICK FREDK TAB, CODE RESULT CODE  (GO TO START SCREENER)

ANSWERING MACHINE MESSAGE
(DISPLAY ANSWERING MACHINE MESSAGE ONLY IF ONE HAS NOT BEEN LEFT PREVIOUSLY)
Hello, I’m calling from Westat about a Social Security Administration research study. The study is
voluntary. If you complete the survey, you will receive a Visa pre-paid debit card in the amount of $75.
We will call back within the next few days, or you can call our toll-free number: [INSERT TOLL-FREE
NUMBER]. Thank you.
RECORD A NEW PHONE NUMBER:
(e.g., 301-444-4444)
TELEPHONE NUMBER:
[INTRO1]
Hello, this is (INTERVIEWER) and I’m calling from Westat about a Social Security Administration (SSA)
research study. We spoke to you about 6 months ago. Thank you for your participation in that survey.
We are calling back now to see if you are able to take part in the second survey.
Before I continue, let me review the Privacy Act Statement that was included with the letter you
received in the mail.
Section 1110(a) of the Social Security Act allows us to collect the information you provide, which we will
use for research purposes. Providing this information is voluntary. However, failing to provide all or part
of the information may only affect your eligibility to receive the study participation reimbursement
amount. We may disclose your information as law permits, including to contractors under contract for
the performance of research and statistical activities, and others listed in routine uses in System of
Records Notice 60-0199; available at www.ssa.gov/privacy. Your information may also be used in

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ATTACHMENT A13. SURVEY 2 SCREENER AND CALLBACK SCRIPT
computer matching programs to establish or verify eligibility for Federal benefit programs and debts
under these programs.
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S2.

CONTINUE SCREENER (GO TO S2)

Now, I need to ask a couple questions to make sure I am speaking to the correct person. When
we spoke to you 6 months ago, please tell me if you took that survey with an interviewer over
the telephone or on the internet by yourself.

[INTERVIEWER: COMPARE CURRENT RESPONSE TO NOTES IN BENEFICIARY’S HISTORY BOX.]
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S3.

ACCURATE RESPONSE  (GO TO INTRO2)
INACCCURATE RESPONSE (GO TO S3)
REFUSE  (GO TO S3)
DON’T KNOW/DON’T REMEMBER  (GO TO S3)

Please confirm your date of birth?

[INTERVIEWER: COMPARE CURRENT RESPONSE WITH DATE OF BIRTH LISTED AT THE TOP OF THE
SCREEN.]
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ACCURATE RESPONSE  (GO TO INTRO2)
INACCCURATE RESPONSE  (GO TO THANK1)
REFUSE  (GO TO THANK1)
DON’T KNOW/DON’T REMEMBER  (GO TO THANK1)

[INTRO2—BENEFICIARY CONSENT]
Thank you for that information. I am calling today to invite you to participate in the second survey as
part of the research study being conducted by the Social Security Administration. This survey is very
similar to the first one. It will take about 75 minutes to complete. After you complete the survey, you
will receive a Visa pre-paid debit card in the amount of $75 for your time.
S4.

Do you wish to continue with the study?
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YES  (GO TO S5)
CALLBACK/APPOINTMENT  (GO TO THANK1)
REFUSE  (GO TO THANK1)
DON’T KNOW  (GO TO THANK1)

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ATTACHMENT A13. SURVEY 2 SCREENER AND CALLBACK SCRIPT
S5.

After you have completed Survey 2, we will mail you a Visa pre-paid debit card in the amount of
$75. I would like to confirm that the mailing address we have for you is still correct.
[INTERVIEWER: CHECK BENEFICIARY’S ADDRESS LISTED AT THE TOP OF THE SCREEN].
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S6.

CORRECT ADDRESS  (GO TO S8)
INCORRECT ADDRESS  (GO TO S6)
REFUSE  (GO TO S6)
DON’T KNOW/DON’T REMEMBER  (GO TO S6)

Would you like to give us your current mailing address so that we can send you a Visa pre-paid
debit card in the amount of $75 when you are done with Survey 2 or would you prefer to
complete the survey and not receive a debit card?
 I WILL GIVE MY ADDRESS  (GO TO S7)
 WILL NOT GIVE ADDRESS BUT WILL DO SURVEY  (GO TO S8)
 REFUSE BOTH ADDRESS AND SURVEY  (GO TO THANK1)
 DON’T KNOW  (GO TO THANK1)

S7. What is your correct mailing address?
STREET1:___________________________
STREET 2:______________________________
CITY:_____________________________ STATE:_______________ZIPCODE:_____________
S8.

You have the option of doing the survey now over the telephone or I can schedule the interview
for a different time. You can also go on the Internet to complete the survey on your own. Which
would you prefer?
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S9.

INTERNET  (GO TO S9)
TELEPHONE NOW (GO TO S10)
TELEPHONE LATER (GO TO THANK2)

We will send you an email with an access code and instructions for logging on to the web
survey. Please keep in mind that your access code will expire after 7 days. If you try to log into
the survey more than 7 days from now, your access code will not work. May I please have your
email address?
[NOTE TO INTERVIEWER, RESPONDENT CANNOT DO SURVEY ON INTERNET IF THEY DO NOT
HAVE AN EMAIL ADDRESS OR REFUSE TO PROVIDE AN EMAIL ADDRESS FOR US TO SEND THE
SURVEY LINK.]
E-MAIL ADDRESS ____________________________
CONFIRM E-MAIL ADDRESS ____________________ (GO TO THANK3)

S10.

Survey 2 will take about 75 minutes of your time. If you are ready, let’s begin.

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ATTACHMENT A13. SURVEY 2 SCREENER AND CALLBACK SCRIPT
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CONTINUE TO SURVEY 2  (GO TO SURVEY 2)
DOES NOT WANT TO DO SURVEY 2  (GO TO THANK1)

THANK1.

Thank you, but those are all the questions I have for you. Good-bye. (ADD “NEXT CASE”
BUTTON TO TAKE INTERVIEWER TO THE NEXT BENEFICIARY.)

THANK2.

Thank you for taking the time to answer these questions. We look forward to your
participation in our study. (ADD “NEXT CASE” BUTTON TO TAKE INTERVIEWER TO THE
NEXT BENEFICIARY.)

THANK3.

Thank you for taking the time to answer these questions. You should receive an email
with a link for the web survey soon. We look forward to your participation in our study.
(ADD “NEXT CASE” BUTTON TO TAKE INTERVIEWER TO THE NEXT BENEFICIARY.)

INTERVIEWER SCRIPT FOR “TELEPHONE LATER (S8 ABOVE)” BENEFICIARIES:
Hello, may I speak with {SUBJECT NAME}?
This is {DATA COLLECTOR}. I’m calling back from Westat about a Social Security Administration
Study. We spoke earlier regarding this study and are calling back now to complete the interview.
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YES/SPEAKING  (GO TO INTRO3)
ANSWERING MACHINE  (GO TO ANSWERING MACHINE MESSAGE)
ENTER NEW PHONE NUMBER (GO TO RECORD NEW NUMBER)
CLICK FREDK TAB, CODE RESULT CODE  (GO TO START SCREENER)

[INTRO 3— “TELEPHONE LATER” BENEFICIARY CONSENT]
The purpose of the study is to see if a newly developed set of questions about functioning can improve
the continuing disability review (CDR) process that SSA uses to determine continued eligibility of
program benefits. SSA is working with the survey research company, Westat, to conduct this study. You
can decide if you want to take part in this study or not. The study is voluntary and will not affect your
benefits in any way. The study takes about 75 minutes. When you have completed all of the questions,
you will receive a Visa pre-paid debit card in the amount of $75.
Do you wish to continue?
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THANK1.

YES  (GO TO SURVEY 2)
CALLBACK/APPOINTMENT  (GO TO THANK1)
REFUSE (GO TO THANK1)
DON’T KNOW  (GO TO THANK1)

Thank you, but those are all the questions I have for you. Good-bye.

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ATTACHMENT A13. SURVEY 2 SCREENER AND CALLBACK SCRIPT
Restart Text for Callbacks/Survey Breakoffs
Hello, may I speak with {SUBJECT NAME}?
This is {DATA COLLECTOR}. I’m calling back from Westat about a Social Security Administration
Study. We spoke earlier regarding this study and are calling back now to complete the interview.





YES/SPEAKING  (GO TO INTRO1)
ANSWERING MACHINE  (GO TO ANSWERING MACHINE MESSAGE)
ENTER NEW PHONE NUMBER  (GO TO RECORD NEW NUMBER)
CLICK FREDK TAB, CODE RESULT CODE  (GO TO START SCREENER)

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