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pdfATTACHMENT J
SURVEY INVITATION LETTERS
J
PROMISE EVALUATION ATTACHMENT D
MATHEMATICA POLICY RESEARCH
D1. Parent invitation mailing
OMB # 0960-0799
OMB Expiration Date: xx/xx/xxxx
Survey Invitation Letter – Parent
[CONSENTING PARENT ADDRESS]
[CONSENTING PARENT CITY, STATE ZIP]
[FILL DATE]
Dear [CONSENTING PARENT / GUARDIAN NAME]:
Thank you for signing up for the [PROMISE PROGRAM NAME] program in [FILL MONTH AND YEAR OF RA]. The evaluation of this
important study, “Promoting Readiness of Minors in Supplemental Security Income” (PROMISE) is paid for by the Social Security
Administration. The study is trying to learn which services or programs help youth and families prepare for life after high school
and assist youth achieve long-term goals.
In the application, you agreed to take part in two interviews with Mathematica Policy Research. We would like to complete the
first one with you and [YOUTH] now. We will ask questions about your educational and employment, health and well-being,
and services you may have received. The interview takes about 35 minutes. You will get a $30 gift card as a thank you for
completing the interview.
If you call us to complete the interview in the next 10 days,
you will get an extra $10, or $40 total. Call us at 800-xxx-xxxx!
The study is voluntary. You can decide to take part in the interview or not. You can also skip any questions you do not wish to
answer or that make you feel uncomfortable. Your decision to take part or not will not impact any benefits your household
receives, now or in the future. This includes SSI benefits.
If you have any questions, or want to begin the interview, please call us at 800-xxx-xxxx. If you have additional questions, you
may also send us an email at: xxxx@mathematica-mpr.com. Please do not include any personally identifiable information (e.g.,
full name, home address, date of birth, etc.) in the email. Thanks again for signing up for PROMISE. We look forward to hearing
from you soon.
Sincerely,
Karen CyBulski – Survey Director for the PROMISE Evaluation
Privacy Act Statement
Section 1110 of the Social Security Act, as amended, authorizes us to request this information. We will use this information to evaluate the impact of services provided to
you (the minor participant or household member) during your participation in the Promoting Readiness of Minors in SSI (PROMISE) project. Providing us this information
is voluntary. Failing to provide us with all or part of the information will not affect the SSI benefits that you, your child, or other household members receive now or in
the future. We may use the information for the administration of our programs, including sharing information:
1. To comply with Federal laws requiring the release of information from our records (e.g., to the Government Accountability Office and the Department of Veterans
Affairs); and, 2. To facilitate audit, investigative, or statistical research activities necessary to assure the integrity and improvement of our programs (e.g., to the Bureau of
Census and to private entities under contract with us).
A complete list of when we may share your information with others, called routine uses, is available in our Privacy Act System of Records Notice entitled, Supplemental
Security Income Studies, Surveys, Records and Extracts (Statistics), 60-0203. Additional information about this and other system of records notices and our programs are
available from our Internet website at www.socialsecurity.gov or at your local Social Security office.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The
valid OMB control number for this information collection is xxxx-xxxx. The time required to complete this information collection is estimated to average 35 minutes per
response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.
D.3
PROMISE EVALUATION ATTACHMENT JD
MATHEMATICA POLICY RESEARCH
Post Card Reminder for Parents
OMB # / Expiration Date: xx/xx/xxxx
Dear Parent / Guardian:
We’re trying to reach you and your child for an important interview! You
and your child each get $30 for being interviewed.
If you call us soon. You will earn a $10 bonus as a thank you - $40 total!
Please call 800-xxx-xxxx.
For more information, go to www.xxx.xxxx. We look forward to hearing
from you!
Sincerely,
Karen CyBulski, Survey Directory
D.4
J
PROMISE EVALUATION ATTACHMENT D
MATHEMATICA POLICY RESEARCH
D2. Youth invitation mailing
OMB # 0960-0799
OMB Expiration Date: xx/xx/xxxx
Survey Invitation Letter – Youth
[ASSENTING YOUTH ADDRESS]
[ASSENTING YOUTH CITY, STATE ZIP]
[FILL DATE]
Dear [ASSENTING YOUTH NAME]:
The evaluation of this important study, “Promoting Readiness of Minors in Supplemental Security Income” (PROMISE) is paid
for by the Social Security Administration. It is trying to learn which services or programs are most helpful to young people as
they prepare for life after high school.
In the application, you agreed to take part in two interviews with Mathematica Policy Research. We would like to complete the
first interview now. We will ask about your education and employment, services you may have received, and your hopes for the
future. The interview takes about 25 minutes. You’ll get a $30 gift card as a thank you for completing the interview.
If you call us in the next 10 days you’ll get an extra $10, or $40 total.
Call us at 800-xxx-xxxx to begin!
The study is voluntary. You can decide to take part in the interview or not. You can also skip any questions you do not wish to
answer or that make you feel uncomfortable. Your decision will not impact any benefits your household receives, now or in the
future.
If you have any questions, or want to begin the interview, please call us at 800-xxx-xxxx. If you have additional questions, you
may also send us an email at: xxxx@mathematica-mpr.com. Please do not include any personally identifiable information (e.g.,
full name, home address, date of birth, etc.) in the email. You may send us an email at: xxxx@mathematica-mpr.com.Thanks
again for signing up for PROMISE. We look forward to hearing from you soon.
Sincerely,
Karen CyBulski
Survey Director for the PROMISE Evaluation
Privacy Act Statement
Section 1110 of the Social Security Act, as amended, authorizes us to request this information. We will use this information to evaluate the impact of services provided to
you (the minor participant or household member) during your participation in the Promoting Readiness of Minors in SSI (PROMISE) project. Providing us this information
is voluntary. Failing to provide us with all or part of the information will not affect the SSI benefits that you, your child, or other household members receive now or in
the future. We may use the information for the administration of our programs, including sharing information:
1. To comply with Federal laws requiring the release of information from our records (e.g., to the Government Accountability Office and the Department of Veterans
Affairs); and, 2. To facilitate audit, investigative, or statistical research activities necessary to assure the integrity and improvement of our programs (e.g., to the Bureau of
Census and to private entities under contract with us).
A complete list of when we may share your information with others, called routine uses, is available in our Privacy Act System of Records Notice entitled, Supplemental
Security Income Studies, Surveys, Records and Extracts (Statistics), 60-0203. Additional information about this and other system of records notices and our programs are
available from our Internet website at www.socialsecurity.gov or at your local Social Security office.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The
valid OMB control number for this information collection is xxxx-xxxx. The time required to complete this information collection is estimated to average 25 minutes per
response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.
D.5
PROMISE EVALUATION ATTACHMENT D
MATHEMATICA POLICY RESEARCH
Post Card Reminder for Youth
OMB # / Expiration Date: xx/xx/xxxx
Hello!
We’re trying to reach you for an important interview. You’ll get $30 for
completing the interview.
Please call 800-xxx-xxxx.
For more information, go to www.xxx.xxxx. We look forward to hearing
from you! Your voice matters!
Sincerely,
Karen CyBulski, Survey Director
D.6
| File Type | application/pdf |
| Author | Forest Crigler |
| File Modified | 2015-04-30 |
| File Created | 2015-04-30 |