Part B, Appendix B--Reminder Mailings

PART B. App_B_REMINDER MALINGS.pdf

Consolidated Omnibus Budget Reconciliation Act Health Benefits Subsidy Under the American Recovery and Reinvestment Act of 2009 Evaluation

Part B, Appendix B--Reminder Mailings

OMB: 1291-0001

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1291-0001 can be found here:

2012-12-06 - No material or nonsubstantive change to a currently approved collection

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PART B - APPENDIX B
REMINDER MAILINGS

Mathematica Policy Research

FINAL APPEAL LETTER
[to be printed on DOL Letterhead]

Date
Dear FIRST NAME, LAST NAME:
You have not yet taken the opportunity to call and check your eligibility for a special study about the
health insurance needs of workers and their families after they become unemployed. This study,
which is sponsored by the U.S. Department of Labor (DOL), will help DOL better serve the needs
of people who are unemployed. Mathematica, an independent research company based in Princeton,
New Jersey, is conducting this study on behalf of DOL. I urge you to call and check your
eligibility today! You can check your eligibility for the study in two ways:
1) Complete a brief screening survey using your touchtone telephone. You can call 1-xxx-xxxxxx toll free at your convenience--24 hours a day, seven days a week.
2) Complete a brief screening survey with an interviewer at Mathematica, either by calling
Mathematica toll free at 1-xxx-xxx-xxxx and asking for Carla Smith or by answering the screening
questions when an interviewer from Mathematica calls you.
You will need the following personal identification number (PIN) available when you call:
PIN #: XXXXXXXX
The screening questions will take about two minutes of your time. You will be asked to answer a
few short questions about your job with [fill EMPLOYER NAME] and the health insurance options
that were available to you before that job ended in [fill MONTH, YEAR]. Not everyone will be
selected. If you are selected to participate in the study, you will be asked to complete a telephone
interview with one of Mathematica’s interviewers. This interview will take about 45 minutes to
complete depending on your circumstances. If you are selected for the study and complete the
full interview, Mathematica will send you a payment of $40 as a token of our appreciation.
You can complete the screening interview and the full interview in either English or Spanish.
Your participation is voluntary, but we encourage you to call in to see if you are eligible and to
complete the full survey if you are selected. Any information that we collect from you will be used
for research purposes only and will be kept private to the fullest extent allowed by law.
Thank you for taking the time to consider our request. An information sheet about the study is
enclosed. If you have any questions about the survey, please call Mathematica toll-free at xxx xxx
xxxx, and ask for Carla Smith. You can learn more about Mathematica by visiting our website at
www.mathematica-mpr.com. For more information about the study, please visit the DOL website at
http://www.dol.gov/.
Sincerely,
DOL OFFICIAL

Enclosure

Mathematica is conducting this study for DOL under Contract No. XX-XXXXX-XX-XX and OMB Control No. XXXX-XXXX

B.5

Mathematica Policy Research

INFORMATION SHEET
STUDY ON HEALTH INSURANCE NEEDS AND USE
WHO/WHICH AGENCY IS SPONSORING THE STUDY?
This study is being sponsored by the United States Department of Labor (DOL).
WHO IS CONDUCTING THE STUDY?
Mathematica, an independent research company is conducting the study on behalf of. Mathematica
has more than 40 years of policy research and program evaluation experience. You can learn more
about Mathematica by visiting our website at www.mathematica-mpr.com.
WHAT IS THE PURPOSE OF THE STUDY?
This study will look at how the health insurance status of individuals and their families change after
they become unemployed.
WHO IS ELIGIBLE TO PARTICIPATE IN THE STUDY?
Some people who became unemployed and filed for unemployment insurance benefits between
February 17, 2009 and March 31, 2011.
HOW DID YOU GET MY NAME?
Your name was scientifically selected from among persons in your state who filed for
unemployment insurance compensation benefits between February 17, 2009 and March 31, 2011.
IS THE SURVEY PRIVATE?
Yes. All of the information we collect in the survey will be kept private and will be used for research
purposes only. Your answers will be combined with the answers of other survey participants. Your
name will never be used in any reports. Only members of the study team will have information
about you.
HOW LONG WILL THIS TAKE?
The screening interview to see if you are eligible will take about two minutes to complete. If you are
selected for the full survey, it will take about 45 minutes to complete.
WHO GAVE YOU THE AUTHORITY TO CONDUCT THE STUDY?
This study is being sponsored by DOL and has been approved by the U.S. Office of Management
and Budget under OMB control number XXXX-XXXX. Without this approval DOL would not be
able to conduct this survey.
WHO CAN I CONTACT FOR MORE INFORMATION?
For more information about the study, you can visit the DOL website at http://www.dol.gov/. You
can also contact the study’s project officer, Mr. Jonathan Simonetta of DOL by email at
Simonetta.Jon.A@dol.gov or Mathematica’s Project Director, Dr. Anu Rangarajan at 609-936-2765.
For questions about the survey you can call Mathematica’s Survey Director, Ms. Julita MillinerWaddell at 609-275-2206.
Mathematica is conducting this study for DOL under Contract No. XX-XXXXX-XX-XX and OMB Control No. XXXX-XXXX

B.6

‘

‘
U.S. Department of Labor

U.S. Department of Labor

P.O. Box 2393
Princeton, NJ 08543-2393

RETURN SERVICE REQUESTED

‘

‘
U.S. Department of Labor

U.S. Department of Labor

P.O. Box 2393
Princeton, NJ 08543-2393

RETURN SERVICE REQUESTED

Greetings!

YOU MAY BE ELIGIBLE to participate in a special study about the health
insurance needs of workers and their families after they become
unemployed. The study is being sponsored by the U.S. Department of Labor
(DOL).

You could EARN UP TO $50 if you are eligible and complete the survey.
There are two ways to find out if you are eligible:

1. Complete a brief screening survey using your touchtone telephone. You
can call 1-xxx-xxx-xxx toll free at your convenience—24 hours a day, seven
days a week.

2. Complete the screening survey with an interviewer at Mathematica. You
can call Mathematica toll free at 1-xxx-xxx-xxxx and ask for Carla Smith.

The screening survey takes only 2 minutes to complete! You will need
the following personal identification number (PIN) when you call:

PIN #: XXXXXXXX

Don’t miss this opportunity to share your experiences! Thank you in advance
for your response.

DOL Official Signature

Mathematica is conducting this study for DOL under Contract No. XX-XXXXX-XX-XX and
OMB Control No. XXXX-XXXX.