Tracking Survey

T

OMB# 0970-0388

Expires: 10/1/2015

racking Survey, Internet Version

• Numbering will be made consecutive and font as well as formatting will be made consistent during programming

This collection of information is voluntary and will be used to maintain up-to-date contact information on the participants of the Early Head Start Research and Evaluation Project. Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB number for this information collection is 0970-0388 (Exp. 10/1/15). Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Amy Madigan; ACF / OPRE, 370 L’Enfant Promenade SW, 7th floor West, Washington, DC 20447; Attn: OMB-PRA (0970-0388).

• Please remember that all the information you provide will be shared ONLY with researchers working on the Early Head Start Follow-up Study and kept private to the extent permitted by law.

1. We have your name as (FILL PRIMARYCAREGIVER NAME). Is this correct?

*Q asked if Q1=NO

What is your correct name?

2. We have your child’s name as (FILL CHILD NAME). Is this correct?

*Q asked if Q2=NO

What is your child’s correct name?

3. Are you still (CHILD NAME)’s primary caregiver?

* If NO, Respondent will be skipped to the “New Primary Caregiver” section of the survey

*Q asked if Q5=NO

6. What is the best phone number to reach you on?

10. Do you have any plans to move in the next year?

*Q asked if Q10=YES

Bottom half of above screen:

After your child turns 18, we would like to follow up with him or her directly. If your child is contacted in the future for the study, they can decide at that time whether or not to take part.

12. What is your child’s email address?

 Click this box if they do not have email.

13. What is your child’s cell phone number?

 Click this box if they do not have a Cell Phone

13. Please list any other ways to reach your child directly?

15. Thinking ahead to when your child is 18, where do you think your child will be living?

With you

With another family member

On his/her own or with roommates

In a college dorm

In the military

Somewhere else (specify)

Now we’d like to ask you a few questions about how your child is doing.

16. Will (or did) your child graduate high school or get a GED before Fall 2013?

Yes, Graduated high school

Yes, GED

No

*Q asked if Q16=YES

17. If Yes, will (or does) your child go to college?

Yes

No

18. What school will your child attend in Fall 2013?

 Click this box if the child will not be in school.

School:

City:

19. What grade will your child be in Fall 2013?

Grade:

20. What do you think are the chances your child will graduate from college?

No chance

Some chance

About 50/50

Pretty likely

It will happen

21. What do you think are the chances your child will have a good job by age 30?

No chance

Some chance

About 50/50

Pretty likely

It will happen

22. Has your child ever had any contact with the juvenile justice system? This would include:

• being picked up by the police for breaking the law,

• being found guilty for a crime or a delinquent offense,

• being on probation or court supervision,

• being held at juvenile hall or in jail

Yes

No

Don’t Know

23. Overall, would you describe your child’s health as…

Excellent

Very good

Good

Fair

Poor?

Now a few questions about you.

24. What is the highest grade or year of school that you have completed?

Less than high school

High school or GED

Vocational school or 2 year Associate’s Degree

College or graduate school

25. Which of the following best describes your present work or school situation?

Working full-time (35 hours a week or more)

Working part-time (less than 35 hours per week)

Unemployed and looking for work

Unemployed and not looking for work

Full-time homemaker

In school

Too disabled to work

Some other situation (specify)

26. These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling.

How much of the time during the past 4 weeks...

Have you felt calm and peaceful?

All of the time Most of the time A good bit of the time Some of the time A little of the time None of the time

Did you have a lot of energy?

All of the time Most of the time A good bit of the time Some of the time A little of the time None of the time

Have you felt downhearted and blue?

All of the time Most of the time A good bit of the time Some of the time A little of the time None of the time

* IF R is not current primary caregiver (Q3=NO)

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