54b Phone Validation Form

Custom MEPS Validation Form Section

Overview

All on-path survey questions will appear in order based on question flow.

If a question is not on path, do not display it.

If displayed, a response is required, unless noted otherwise at question level.

Fills:

Validator Name = User name based on login

Project Fill = "the Medical Expenditure Panel Survey being conducted for the Department of Health and Human Services"

FI Name = Full name of FI who completed the task

Task Date = Date on which the task was completed (M/D/YY)

Phone = {Respondent Phone}

Full Address = Address Line 1, Address Line 2, City, ST, ZIP

Project Name = MEPS

User Interface

Widget Table

Footnote	Name	Requirements
1	VF Intro and Recall	Display/Enable Always Question Text: "Hello, my name is {Validator Name} with {Project Fill}. Recently one of our staff interviewed you. Do you recall the interview?" Response: Yes/No Flow: If Yes, go to VF Begin Survey If No, go to VF FI and Date Prompt
2	VF FI and Date Prompt	Display/Enable Only when VF Intro and Recall = No Question Text: "Our records show that {FI Name} interviewed you on {Task Date}. They would have used a laptop or tablet to record the answers. Do you remember that?" Response: Yes/No Flow: If Yes, go to VF Begin Survey If No, go to VF Verify Phone and Address
3	VF Verify Phone and Address	Display/Enable Only when VF FI and Date Prompt = No Question Text: "[VERIFY THAT YOU HAVE REACHED THE CORRECT TELEPHONE NUMBER AND THAT YOU ARE SPEAKING WITH THE CORRECT RESPONDENT. IF SO, CONTINUE.] Perhaps there is some mistake. Is your telephone number {Phone} and do you live at {Full Address}?" Response: Yes/No Flow: If Yes, go to VF Terminate Survey Comments If No, go to VF Confirm Address
4	VF Confirm Address	Display/Enable Only when VF Verify Phone and Address = No Question Text: "Did you live at {Full Address} on {Task Date}?" Response: Yes/No Flow: If Yes, go to VF Begin Survey If No, go to VF Terminate Survey Comments
5	VF Terminate Survey	Display/Enable Only when Verify Phone and Address = Yes or VF Confirm Address = No If this question is displayed, enable End Interview Button. Question Text: "[COULD THIS BE A HOUSEHOLD SPLIT? ARE THERE OTHER PEOPLE IN THE HOUSEHOLD WHO COULD HAVE ANSWERED THE QUESTIONS? WHAT ABOUT VISITORS? THANK THE RESPONDENT. TERMINATE THE INTERVIEW. ADD ANY PERTINENT NOTES IN THE PHONE VALIDATOR SUMMARY SECTION. REPORT PROBLEMS TO THE VALIDATION MANAGER IMMEDIATELY.] Thank you very much for your time!" Include End Phone Survey Button. On click...display Breakoff Warning Dialog. Collaps section and enable Validator summary in expanded view.
6	End Phone Survey Button	Enable Only if VF Terminate Survey is displayed. On click End Phone survey Button, display Finish Survey Warning Dialog. Once confirmed, store Phone Survey responses collected thus far. Set Phone Survey Call Outcome to Breakoff. Set Phone Validation Status to Call Terminated. Set Final Record of Call with values based on current system date, time and user log in. Enable/Open Phone Validator Summary Screen. Phone Validation Status will be prefilled with "Call Terminated"
7	VF Begin Survey	Display/Enable Only when VF Intro and Recall = Yes or VF FI and Date Prompt = Yes or VF Confirm Address = Yes Question Text: "First, I would like to thank you very much for your participation in this important study. On all our surveys, we routinely re-contact some people who were interviewed to make sure our interviewers are following procedures correctly. I have just a few questions to ask about the interview. according to the information I have, on {Task Date} you live at {Full Address}. Is that correct? Response: Yes/No Flow: If Yes, go to VF Confirm Laptop Use If No, go to VF Correct Respondent Address
8	VF Correct Respondent Address	Display/Enable Only when VF Begin Survey = No Question Text: "What was your address on {Task Date}?" Response: Allow entry of Full Address information in fields for Address Line 1, Address Line 2, City, ST, ZIP Flow: Go to VF Confirm Laptop Use
9	VF Confirm Laptop Use	Display/Enable Only when VF Begin survey = Yes or VF Correct Respondent Address = Not Empty Question Text: "Did the interviewer enter your response into a laptop or tablet?" Response: Yes/No/Don't Know Flow: If Yes or DK, go to VF Task Timing If No, go to VF Reason No Laptop Probe
10	VF Reason No Laptop Probe	Display/Enable Only when VF Confirm Laptop Use = No Question Text: "[IF RESPONDENT SAYS INTERVIEWER DID NOT USE A LAPTOP OR TABLET, PROBE FOR A REASON AND EXPLAIN IN COMMENTS.] Response: Allow entry of up to 500 characters in Comments field. Flow: Go to VF Task Timing
11	VF Task Timing	Display/Enable Only when VF Confirm Laptop Use = Yes/DK or VF Reason No Laptop Probe = Not Empty Question Text: "Approximately how long did the interview take?" [IF RESPONSE IS DON'T KNOW, ENTER DK IN BOTH FIELDS] Response: Allow entry of Hours and Minutes NOTE: If the response was Don't Know, user must enter DK in both fields to move forward. No other text strings are allowed. Flow: Go to VF Confirm Show Cards Use
12	VF Confirm Show Cards Use	Display/Enable Only when VF Task Timing = Not Empty Question Text: "During the interview, the interviewer should have used show cards that included the answer categories to some of the survey questions. These show cards could have been displayed either from a binder or electronically. Did the interviewer use a set of show cards like these?" Response: Yes/No Flow: If Yes, go to VF Confirm Records Use If No, go to VF Reason No Show Cards Probe

Custom MEPS Validation Form cont'd

User Interface

Widget Table

Footnote	Name	Requirements
1	VF Reason No Show Cards Probe	Display/Enable Only when VF Confirm Show Cards Use = No Question Text: "[IF RESPONDENT SAYS INTERVIEWER DID NOT USE SHOW CARDS, PROBE FOR RECALL. FOR EXAMPLE, "THE BINDER MAY HAVE BEEN YELLOW OR RED OR THEY MIGHT HAVE SHOWN YOU A SCREEN WITH RESPONSE OPTIONS." EXPLAIN IN COMMENTS.] Response: Allow entry of up to 500 characters in Comments field. Flow: Go to VF Confirm Records Use
2	VF Confirm Records Use	Display/Enable Only when VF Confirm Show Cards Use = Yes or VF Reason No Show Cards Probe = Not Empty Question Text: "Did the interviewer ask you to refer to records such as a calendar, receipts, or statements during the interview?" Response: Yes/No Flow: Go to VF Confirm Prescription Questions
3	VF Confirm Prescription Questions	Display/Enable Only when VF Confirm Records Use = Not empty Question Text: "Did the interviewer ask about (your/your household's) purchase(s) of prescribed medicines?" Response: Yes/No Flow: Go to VF Confirm Monetary Gift
4	VF Confirm Monetary Gift	Display/Enable Only when VF Confirm Prescription Questions = Not Empty Question Text: "Did you receive a monetary gift from the interviewer?" Response: Yes/No Flow: If Yes, go to VF Confirm Gift Amount If No, go to VF Confirm Interview Location
5	VF Confirm Gift Amount	Display/Enable Only when VF Confirm Monetary Gift = Yes Question Text: "What was the amount?" Response: Yes/No Flow: Go to VF Confirm Interview Location
6	VF Confirm Interview Location	Display/Enable Only when VF Confirm Monetary Gift = No or VF Confirm Gift Amount = Not Empty Question Text: "Was the interview conducted in your home or someplace else?" Response: Yes/No Flow: Go to VF Closing Question
7	VF Closing Question	Display/Enable Only when VF Closing Question = Not Empty Question Text: "That was my last question for you. Do you have any comments?" Response: Yes/No Flow: Go to VF Thank You and Comments
8	VF Thank You and Comments	Display/Enable Only when Question Text: "[RECORD ANY RESPONDENT COMMENTS IN THE FIELD BELOW AND READ THE CLOSING TEXT. ADD YOUR OWN COMMENTS IN THE PHONE VALIDATOR SUMMARY SECTION.] Thank you very much for your time! We appreciate your participation in {Project Name}" Response: Allow entry of up to 500 characters in Comments field. Flow: If Yes, go to If No, go to
9	Save Button	Enable When... On click, No Further Edits Warning Dialog ELSE, if any required values are missing, display Finish Survey Warning Once confirmed save entries. On click Complete Button, Store Phone Survey responses. Set Call Outcome to Survey Complete and Phone Status to Pending. Set Final Record of Call with values based on current system date, time and user log in. Enable/Open Phone Validator Summary Screen. Phone Validation Status will be set to Complete when the Validator Summary questions are answered and submitted.