Form FF-104-FY-21-100 Long Term Recovery Study 1 Restoration: 6 Months - Phone

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Long Term Recovery Study 1 Restoration 6 months-Phone FF-104-FY-21-100 - 1 PAS-contact

Long Term Recovery Study

OMB: 1660-0130

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LONG TERM RECOVERY SURVEY-RESTORATION: 6 MONTHS - PHONE

QUESTIONNAIRE ONE



OMB Control Number 1660-0130

Expiration: XXX XX, 20XX



PAPERWORK BURDEN DISCLOSURE NOTICE:

FEMA Form 104-FY-21-100

Public reporting burden for this data collection is estimated to average 20 minutes per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting this form. This collection of information is voluntary. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW., Washington, DC 20472-3100, Paperwork Reduction Project (1660-0130) NOTE: Do not send your completed form to this address.


PRIVACY ACT STATEMENT

AUTHORITY: Government Performance and Results Act of 1993 (Pub. L. 103-62), as amended, and the GPRA Modernization Act of 2010 (Pub. L. 111-352); Executive Order (EO) 12862, “Setting Customer Service Standards”; and its March 23, 1995 Memorandum addendum, “Improving Customer Service”; Executive Order 13411 “Improving Assistance for Disaster Victims”; Executive Order 13571 “Streamlining Service Delivery and Improving Customer Service”; and the related June 13, 2011 Memorandum “Implementing Executive Order 13571 on Streamlining Service Delivery and Improving Customer Service.”


PRINCIPAL PURPOSE(S): DHS/FEMA collects this information to measure Individual Assistance applicants’ customer satisfaction with FEMA services.

ROUTINE USES:

This information is used for the principal purpose noted above. Summary and/or aggregate survey results and analysis may be shared with Congress and the Government Accountability Office; however, no Personally Identifiable Information (PII) will be shared externally, except as allowed under the routine uses published in System of Records Notice DHS/FEMA-008 - Disaster Recovery Assistance Files, 78 FR 25282 (April 30, 2013), or as required by law. The Department's system of records notices can be found on the Department's website at http://www.dhs.gov/system-records-notices-sorns.


DISCLOSURE: The disclosure of information on this form is strictly voluntary and will assist FEMA in making improvements to its Individual Assistance program; failure to provide the information requested will not impact an individual’s ability to qualify for or receive FEMA Individual Assistance. Questions regarding this form may be submitted via email to [email protected].

























Introduction


Hello, I'm calling from FEMA, the Federal Emergency Management Agency. My name is ___ and my PIN is _____. May I please speak with [Applicant NAME].


If applicant is not currently available: What would be a better time to call back? Thank you for your time and have a good day/evening. (Enter call back date/time disposition)


(Interviewer note: The FEMA applicant is the only person that can complete this questionnaire. We will schedule and use indefinite call backs when someone other than the applicant answers. Definite call backs will be used if the applicant requests a different date/time. This is a longitudinal survey and we must talk to the same person for each of the 4 interviews.)


If respondent declines to talk or is no longer available for contact: Thank you for your time and have a good day/evening. (Enter decline disposition)


If yes: FEMA is looking for ways to improve disaster recovery services. A long-term recovery study is being conducted over the next 18 months. Understanding how the disaster affected you and continues to impact your household and community will help identify areas where FEMA can improve.


Would you volunteer to participate in today’s interview which will take approximately 15 to 20 minutes and three additional interviews over the next 18 months?


If no: Thank you for your time and have a good day/evening. (Offer call back and enter date and time if appropriate or enter decline disposition.)


If yes: These questions comply with the Privacy Act of 1974 and have been approved by the Office of Management and Budget under number 1660-0130. Your answers will not affect the outcome of your application for FEMA assistance. This call may be monitored and/or recorded for quality assurance.
















OVERALL RECOVERY

This survey is related to the [Disaster Type] that occurred in [Disaster Month, Disaster Year]. Please think about your current circumstances compared to prior to the disaster. Using a scale of 1 (Strongly Disagree) to 5 (Strongly Agree), please indicate your level of agreement with each statement.


1

Strongly Disagree

2

3

4

5

Strongly Agree

Don’t know or No opinion

1. I have a safe and livable place to stay.

2. I have necessary personal property like furniture, appliances, and clothing.

3. My household income is at the same or a higher level than prior to the disaster.

4. My household expenses are at the same level as prior to the disaster.

5. My current stress level is high.

6. Community resources and services are available to me.



Using a scale of 1 (Not at all Recovered) to 5 (Completely Recovered), how would you rate your household’s…


1

Not at all Recovered

2

3

4

5

Completely Recovered

7. Overall level of recovery



SHELTERING AND TEMPORARY HOUSING

The next questions relate to sheltering and temporary housing during the first days and weeks after the disaster.

8. Which one of the following best describes where you stayed immediately after the disaster?

In my home

With family or friends

At a public shelter

In a hotel or motel

In a car

Other (Specify 50 characters)






9. Which one of the following best describes where you are currently living or staying?

Same residence as prior to the disaster

New purchased residence

New rented residence without FEMA-funded rental assistance

New rented residence with FEMA-funded rental assistance

FEMA-provided hotel or motel

FEMA-provided travel trailer or mobile home

Living with family or friends

Institutional setting like a hospital, group home

Homeless as a result of the disaster

Other

(Programmer Note: If Q9 response = Same residence as prior to the disaster go to Q10, if New purchased residence or New rented residence without FEMA rental assistance go to Q13 else go to Q17)

10. Have repairs been completed to make your residence safe and livable?

Yes

No

(Programmer Note: If Q 10 response = Yes go to Q19, If Q10 response = No and Owner Renter UDF = Owner go to Q11, If Q 10 response = No and Owner Renter UDF = Renter go to Q12)


11. Which of the following are primary causes for delays in completing your home repairs? [Select all that apply.] (Homeowners)

  • Lack of money

  • Insurance settlement

  • FEMA financial assistance

  • Lack of time

  • Lack of contractors and/or materials

  • Medical or disability reasons

  • FEMA information and processes were too complicated

(Programmer Note: Go to Q19)

12. Which of the following are primary causes for the repairs not being completed by your landlord? [Select all that apply.] (Renters)

  • Lack of money to make repairs

  • Lack of contractors to do repair work

  • Lack of materials needed for the repairs

  • Landlord does not plan to make repairs

  • Other or don’t know

(Programmer Note: Go to Q16)



13. Is your new permanent residence located in:

The same community where you lived prior to the disaster

A different community but in the same state as you lived prior to the disaster

A different state

(Programmer Note: If Q13 response = The same community where you lived prior to the disaster go to Q16 else go to Q14)


14. Will you be moving back to your pre-disaster community?

Yes

No

(Programmer Note: If Q14 response = No go to Q15 else go to Q16)


15. Why are you not planning to move back to your pre-disaster community? (200 Characters)

Shape1




16. As a result of the disaster, are your current housing costs:

The same

Less or

More than prior to the disaster

(Programmer Note: Go to Q19)



17. Do you expect to have a safe and livable permanent residence in:

Less than two months

Three to four months

Five to six months

More than six months

Don’t know









18. Which of the following are primary causes for the delay in having a permanent residence? [Select all that apply.]

  • Lack of money

  • Insurance settlement denied, delayed or insufficient

  • FEMA financial assistance denied, delayed or insufficient

  • Lack of time

  • Lack of contractors and/or materials

  • Medical or disability reasons

  • Lack of affordable housing

  • Loans from bank or SBA were denied or delayed

  • Lack of access to community services like schools, hospitals, etc.

  • Unable to obtain permits, inspections, zoning

  • Do not need to seek a permanent residence

19. Did you have (If Owner Renter UDF = Owner say [Homeowner’s] or if = Renter say [Renter’s]) insurance in effect at the time of the disaster?

Yes

No

(Programmer Note: Q19 response = No go to Q20 else go to Q22)

20. Which one of following best represents the reason you did not have insurance at the time of the disaster?

Could not afford the premium

Unable to find a company willing to provide coverage

Had coverage but it was cancelled

Didn’t know I needed it

Other (Specify 200 characters)



21. Have you obtained insurance since the disaster?

Yes

No

(Programmer Note: Go to Q26)

Using a scale of 1 (Strongly Disagree) to 5 (Strongly Agree) please indicate your level of agreement with each statement.


1

Strongly Disagree

2

3

4

5

Strongly Agree

22. My insurance covered my losses.

23. The amount paid by insurance was not enough.

24. I received the insurance settlement on time.

25. I did or will update my insurance to improve coverage.

FINANCIAL AND NON-FINANCIAL ASSISTANCE

Using a scale of 1 (Strongly Disagree) to 5 (Strongly Agree) please indicate your level of agreement with each statement.


1

Strongly Disagree

2

3

4

5

Strongly Agree

Not Applicable or No opinion

26. My friends and family were helpful in my recovery.

27. Local community groups and organizations were helpful.

28. My bank and other financial institutions were helpful.

29. I found local community resources to assist me.



Please think about programs or services that helped in your disaster recovery. Using a scale of 1 (Not at all Helpful) to 5 (Very Helpful) please rate the helpfulness of each of the following or respond with Does Not Apply if you did not use.


1

Not at all Helpful

2

3

4

5

Very Helpful

Does Not Apply

30. US Department of Agriculture Disaster Supplemental Nutrition Assistance Program (SNAP)

31. Local food banks

32. Aging services

33. Assistance for individuals with disabilities

34. Animal/pet health services

35. Consumer protection services

36. Women, Infants & Children program (WIC)

37. Disaster legal services

38. Veterans services

39. Crisis counseling



40. Did you need any other types of services, but were unable to find resources?

Yes

No

Programmer Note: If Q40 response = Yes go to Q 41 else go to Q42.)



41. Please briefly describe the type of service you needed, were unable to find. (200 characters)

Shape2



EMOTIONAL RECOVERY

Disasters often create stress and emotional fatigue.

42. Which of the following were the most stressful for you? [Select all that apply.]

  • Financial impact

  • Living conditions

  • Separation from family and friends

  • Health issues

  • Exhaustion

  • Dealing with insurance

  • Dealing with FEMA assistance

  • Loss of, or a decrease in, the ability to live independently

43. After the disaster did you seek crisis counselling from any of the following? [Select all that apply.]

  • FEMA crisis counselling

  • Other government counselling services

  • Community provided counselling

  • Faith-based counselling

  • Financial counselling

  • Other (Specify100 characters)

FEMA SERVICES AND ASSISTANCE

Using a scale of 1 (Strongly Disagree) to 5 (Strongly Agree), please indicate your level of agreement with each statement. FEMA provided:


1

Strongly Disagree

2

3

4

5

Strongly Agree

44. Easy to understand information

45. Easy access to online and telephone services

46. Simple processes and procedures

47. Information in my preferred language

48. Assistance that met my expectations



Using a scale of 1 (Strongly Disagree) to 5 (Strongly Agree), please indicate your level of agreement with each statement. FEMA financial assistance:


1

Strongly Disagree

2

3

4

5

Strongly Agree

49. Arrived in a reasonable amount of time

50. Was an important part of my recovery

51. Helped meet my disaster related needs

Programmer Note: If Q51 response = 1, 2, or 3 go to Q52 else go to Q53.)

52. Which of the following best describes areas where FEMA financial assistance did not meet your disaster related needs? [Select all that apply.]

  • Home repairs

  • Rental financial assistance

  • Personal property

  • Childcare expenses

  • Medical, dental or funeral expenses

  • Disability related repairs or improvements

  • Other (Specify 50 characters)

53. What could FEMA have done to better meet your disaster related needs? (500 characters)

Shape3





COMMUNITY RECOVERY

This section of the survey is about community recovery and uses a scale of 1 (Strongly Disagree) to 5 (Strongly Agree). Please indicate your level of agreement with each statement or you may also respond with Not Applicable or Don’t Know. I now have normal access and availability to:


1

Strongly Disagree

2

3

4

5

Strongly Agree

Not Applicable or Don’t Know

54. Child and day care services

55. Educational institutions like schools, colleges

56. Public transportation







57. Care for pets, service and support animals

58. Businesses like grocery, department stores, pharmacies

59. Medical services, doctors, dentists, hospitals, home healthcare, personal assistance services

60. Senior centers

61. Emergency services like fire, EMS, police

62. Local government offices and services

63. Community organizations and faith-based groups

64. Streets, roads, bridges

65. Entertainment and recreation



66. What additional services and assistance do you need? (300 characters)

Shape4



DEMOGRAPHICS

We are almost finished. The only remaining questions are for demographic purposes.

67. Is your gender…

Female

Male

Other (e.g., transgender, nonbinary, or gender variant)

Prefer not to answer


68. Is your marital status…

Never married

Married or living with partner

Separated

Widowed

Divorced

Prefer not to answer


69. Is your current employment status…

Employed for wages

Self-employed

Unemployed

Homemaker

Student

Retired

Prefer not to answer



70. Which one of the following best describes your highest level of formal education?

Did not complete high school

High school graduate / GED

Some college

Associate degree

Bachelor’s degree

Master’s degree

Doctoral degree

Prefer not to answer





71. Are You Hispanic or Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.)

Yes

No



72. Please select the racial category or categories that you most closely identify with. Select as many as apply.

  • American Indian or Alaska Native

  • Asian

  • Black or African American

  • Native Hawaiian or Other Pacific Islander

  • White

  • Prefer not to answer



CLOSING

The information you provided today is extremely important in helping improve recovery in future disasters. We will check back with you in about six months to see how your recovery is progressing. Thank you for your time.


FF-104-FY-21-100


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