Monthly Call Log

Att 3j_Participant Contact Log.docx

Evaluating Locally-Developed HIV Prevention Interventions for African-American MSM in Los Angeles

Monthly Call Log

OMB: 0920-0913

Document [docx]
Download: docx | pdf

Evaluating Locally-Developed HIV Prevention Interventions for African-American MSM in Los Angeles





Attachment 3i


Monthly Calls Log










MONTHLY CALLS LOG*

Month

Name (e.g., Jeff K.)

Contacted by:

New Info? (Y/N)

# of Attempts (Up to 5)

Successful Contact Date:

Address Change?

(Y/N)

Current Email Address:

Current Home Phone#

Current Cell #

Phone

Email

Facebook

1

 





 

 

 

 

 

 

2






 

 

 

 

 

 

3

 





 

 

 

 

 

 

4












5












6












1

 





 

 

 

 

 

 

2

 





 

 

 

 

 

 

3

 





 

 

 

 

 

 

4












5












6












1

 





 

 

 

 

 

 

2

 





 

 

 

 

 

 

3

 





 

 

 

 

 

 

4












5












6












1

 





 

 

 

 

 

 

2

 





 

 

 

 

 

 

3

 





 

 

 

 

 

 

4












5












6












* *If Participant does not wish to be contacted, please write “Do Not Contact” and cross out future contact entries.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
Authorgpo4
File Modified0000-00-00
File Created2021-01-26

© 2024 OMB.report | Privacy Policy