Supporting Statement A
For the Paperwork Reduction Act of 1995: Approval for the Participant Tracking, Interim Surveys and Six-Month Follow-up Survey for the Job Search Assistance Strategies Evaluation
Attachment B: Interim Surveys
OMB No. 0970-0440
November 9. 2015
Submitted by:
Office of Planning, Research & Evaluation
Administration for Children & Families
U.S. Department of Health and Human Services
Federal Project Officer
Erica Zielewski
Job Search Assistance Strategies Evaluation Interim Tracking Survey (Draft) OMB Approval Number:
October 22, 2015 Expiration Date:
TEXT IN ALL CAPS AND BRACKETS INDICATE INFORMATION THAT WILL BE INSERTED FROM THE SAMPLE FILE.
PROGRAMMER NOTES ARE IN ALL CAPS, BRACKETS, AND PREFACED WITH “PROGRAMMER:”
Introduction
INTRO. Hello [FNAME]! It is time for your monthly Job Search Assistance Survey. This survey is part of a study of the [TANF/AGENCY NAME] program conducted by an independent research company. This is a study about job search assistance activities provided by the program and the jobs people obtain. This voluntary survey takes 5 minutes and is open for 7 days. Please respond by [PROGRAMMER CALCULATE: SEVEN DAYS FROM TODAY] to earn your $2. Any information you provide to us will be kept private.
Click here for more information about this survey. [PROGRAMMER: INSERT HYPERLINK TO STATIC WEBPAGE THAT IS THE SAME AS THE STUDY BROCHURE – POST ON WEB AS PDF].
OMB CONTROL NUMBER: 0970-0440 EXPIRES: xx/xx/xxxx. [PROGRAMMER: INSERT HYPERLINK TO THIS TEXT: According to the Paperwork Reduction Act (PRA), 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 control number for this collection is 0970-0440 and it expires xx/xx/xxxx. If you have comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, please contact Karin Martinson, Study Project Director, at (301)-652-7322.]
[PROGRAMMER: DISPLAY FOR TEXT SURVEY ONLY:
Text REMAIL to have information about this study re-mailed to your home address.
STAY SAFE: DON’T TEXT AND DRIVE.
Text STOP to opt out of the study, text SKIP to opt out of this month’s survey, or text NEXT to begin the survey. ]
[PROGRAMMER: DISPLAY FOR WEB SURVEY ONLY:
REMAIL. Would you like us to remail the study information to your home address?
Yes [PROGRAMMER: ADDRESS CONFIRM THEN GO TO B1]
No [PROGRAMMER: GO TO B1] ]
Screener/Verification:
B1. First it is important to confirm that the correct person is answering this survey. Please enter the month and day of your date of birth. For example, if your birthday was March 17, please enter 0317.
[PROGRAMMER: IF DOB AGREES WITH THE BIRTH DATE ON THE FILE, SKIP TO C1. IF THERE IS A MISMATCH IN DOB, DISPLAY B2.]
B2. We are sorry but the system is unable to pull up the correct questionnaire. Researchers will re-contact you when the problem is resolved. Thank you for your time.
Employment Status
C1. Are you currently working for pay in a job?
Enter 2 for NO
C2. Are you currently participating in any programs or classes through the [TANF/ AGENCY NAME] program?
Enter 1 for YES
Enter 2 for NO
CONTACT INFORMATION
We want to be sure that if you lose your phone or change plans that we can still reach you.
D1. Have you moved since [RA DATE]?
Enter 1 for YES
Enter 2 for NO
D2. Do you have any plans to move in the next six months?
Enter 1 for YES
Enter 2 for NO
[WEB PROGRAMMER: SHOW THANK1, THANK2, AND INFO1 ON ONE SCREEN]
THANK1. As a reminder, you will be asked to participate in a short survey like this once a month until [6 MONTH/YEAR]. At the end of the five month period, we will send you $2 for each survey you complete as a token of appreciation for your time. THANK2. In order to make sure we can reach you, it is important that we have your current contact information. Your current contact information is important because it helps us keep our records up to date so that we can reach you again next month.INFO1. Please click on the link to confirm or update your contact information and complete the survey. You will need to enter your PIN to access the information we have on file for you: [KEY]. [PROGRAMMER: DISPLAY WEB LINK].
[PROGRAMMER: DISPLAY FOR TEXT SURVEY ONLY:
Or if you prefer you can,
Text TOLLFREE to receive a toll-free number you can call to update your contact information
Text CALL ME to have a member of the research team call you to update or confirm you contact information (within 24 hours)
Text MAILFORM to have an address update form mailed to address provided on XX/XX/XXXX
Text EMAIL to have the link to the online update form emailed to you
If you have any questions, please email [STUDYEMAIL].
[PROGRAMMER: IF RESPONDENT TEXTED TOLLFREE DISPLAY:] Please call 1-888-xxx-xxxx to speak to an interviewer and update your contact information.
[PROGRAMMER: GO TO THANK3]
[PROGRAMMER: IF RESPONDENT TEXTED CALL ME DISPLAY:] A member of the research team will call you from [CALLERID DISPLAY] within 24 hours to update your contact information.
[PROGRAMMER: GO TO THANK3]
[PROGRAMMER: IF RESPONDENT TEXTED MAILFORM DISPLAY:] You should receive a contact update form in the mail within [X days]. Please review the contact information, make any corrections needed, and return the form in the enclosed postage paid envelope.
[PROGRAMMER: GO TO THANK3]
[PROGRAMMER: IF RESPONDENT TEXTED EMAIL DISPLAY:] We will send an email to [EMAIL ADDRESS] inviting you to click a link to the online contact update form. Please follow the link, review the contact information and make any corrections needed.
[PROGRAMMER: GO TO THANK3]
THANK 3. Thank you for completing the monthly survey. You have a total of $[CUMULATIVE TOTAL OF INCENTIVES ACCUMULATED AT TIME OF SURVEY] which you will receive in [6MONTH/YEAR] after the last monthly survey. We will send you the next survey in about a month.
[REVIEWERS: The following information will be displayed when the respondent clicks the link to online contact update form or opts to have an email link emailed to them.]
LOGIN SCREEN Job Search Assistance Strategies Study Please enter your PIN and select NEXT. Enter your PIN here: According to the Paperwork Reduction Act (PRA), 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 control number for this collection is 0970-0440 and it expires xx/xx/xxxx. If you have comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, please contact Karin Martinson, Study Project Director, at (301)-652-7322. NEXT>> |
CONTACT1. Below you will find the last contact information we have for you. Please update any new information and press the SAVE AND CONTINUE button. Check the box if there are no changes. |
Check here if information is correct Check here to update information
First Name/Nombre Last Name/Apellido
Street/Calle
Apartment #/Número de Apt.
City/Ciudad
State/Estado Zip Code/Código Postal
Home Phone/Número de teléfono del hogar
Cell Phone/ Número de teléfono del cellular
Email Address |
SAVE AND CONTINUE |
|
[PROGRAMMER: If sample information was provided for 1 or more alternate contacts, please auto-fill that information so that the respondent can update. If no alternative contact information is available, the respondent should be able to add] CONTACT2. Please take a moment to confirm or update the contact information for these close friends or relatives you told us we can contact in case you move and we cannot easily locate you for the follow-up interview 6 months after you enrolled in the Job Search Assistance Study. |
|
Name/Nombre Phone/Número de teléfono Email address
Check here if information is correct Check here to update information
|
Name/Nombre Phone/Número de teléfono Email address
Check here if information is correct Check here to update information
|
Name/Nombre Phone/Número de teléfono Email address
Check here if information is correct Check here to update information
[PROGRAMMER: If sample information was provided for 1 or more alternate contacts, please auto-fill that information so that the respondent can confirm or update. ] |
CONTACT3. Is there anyone else that you would like us to contact in case you move and we cannot easily locate you for the follow-up interview 6 months after you enrolled in the Job Search Assistance Strategies Study? This could be a relative or friend, who doesn’t live with you but usually knows how to reach you. |
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Name/Nombre Relation to you/Parentesco con usted
Address/Dirección
Apartment #/Número de Apt.
City/Ciudad
State/Estado Zip Code/Código Postal
Phone/Número de teléfono
Email address
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Bethany Boland |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |