OMB Control #0693-0078
Expiration 07/31/2019
Surveyor(s):_________________________________________ Date:________________________________________
Building ID:______________ Wave 2 DS: _____ Repaired in Wave 2?_____ Unit Address:________________________
Building Type: 1, Single family 2, Multi-family, # housing units _______ 3, Mobile home 4, Other, _____________
Comments:_________________________________________________________________________________________
Result/ Completion Codes |
1. Completed interview |
2. Ineligible, no adult or eligible person to answer questions |
3. Bad address, could not locate HU |
||||
4. Incomplete/partial |
5. Not occupied residence, abandoned; home destroyed 6. Ineligible, structure not a residence |
||||||
7. No answer or response, but evidence or confirmed occupied |
8. No access, gated community, fence preventing entry |
||||||
Housing Unit Occupancy status: |
YES: household present interviewed or attempted |
YES, household not present; evidence of habitation |
DK: Indeterminate/ uncertain |
NO: not occupied, appears abandoned |
|||
YES, household not present; occupied confirmed by neighbor |
YES, household not present but occupied, confirmed by management |
NO: not occupied, under repair/ reconstruction. |
NO, damaged and not habitable |
If interview not possible but neighbors, apartment managers, or others can provide information, record here:
Mark type of informant: Neighbor Other: (specify) ________________ |
Was the housing unit occupied at the time of HURRICANE
FLORENCE? |
Is the household still living there? YES NO DK |
If not still living there, do you know when the household left? ____________MM/YY Did household leave because of HURRICANE FLORENCE flooding? YES NO DK |
[The following questions are to be answered upon consent of a household (HH) member over 18 years of age.]
|
Adults (≥ 18) ______ |
Children (< 18) ______ |
IF AFTER SEPT 2018, SKIP TO Q26. |
________________ MM/YY |
|
|
YES NO DK |
|
3a. If YES, how much of your HURRICANE MATTHEW damage was fully repaired at the time of HURRICANE FLORENCE? |
None Some Most All |
|
|
YES NO DK |
|
4a. If YES, how long until it was fully repaired? |
_________ D/WK/MO |
Still not repaired |
The next set of questions are intended to capture the impacts of HURRICANE FLORENCE and the flooding on your HH.
|
YES NO DK* |
If yes, for how long? |
Record in hours or days* ______ Hrs. ______ Dys |
|
|
YES NO DK* |
If yes, for how long? |
Record in hours or days* ______ Hrs. ______ Dys |
|
6b. Did your home lose wastewater/sewer? |
YES NO DK* |
If yes, for how long? |
Record in hours or days* ______ Hrs. ______ Dys |
|
|
YES NO DK* |
If yes, for how long? |
Record hours or days* ______ Hrs. ______ Dys |
|
|
YES NO NA DK* |
If yes, for how long? |
Record hours or days* ______ Hrs. ______ Dys |
|
|
YES NO NA DK* |
If yes, for how long without cell phone service? |
Record hours or days* ______ Hrs. ______ Dys |
|
9. b. Did your Household lose land line phone service? |
YES NO NA DK* |
If yes, for how long without landline phone service? |
Record hours or days* ______ Hrs. ______ Dys |
|
|
YES NO NA DK* |
If yes, for how long without internet service? |
Record hours or days* ______ Hrs. ______ Dys |
|
NA = not appropriate question, did not have this utility DK* = don't know because were out of their home when utility may have been off. If the household evacuated, and never lost cell service, put NO |
*Record hours or days, but not both. Record hour, if utility disruption for less than a day. Record days, to nearest day, if disruption over a day. |
[If YES, continue to a-e. If NO, skip to Q12.] |
YES |
NO |
DK |
a. How long were you and your household dislocated from your home because of the flood following HURRICANE FLORENCE? (insert time range, and circle whether in D, WK, or MO) |
______________ D/WK/MO |
||
b. Did the timing of insurance payout or other financial assistance cause a delay in your household returning home? |
YES |
NO |
DK |
c. Did a closure or change in your place of work cause a delay in your household returning home? |
YES |
NO |
DK |
d. Did a closure or change in your child/ren’s school cause a delay in your household returning home? |
YES |
NO |
DK |
e. Did closure of businesses, such as day care or grocery stores, cause a delay in your household returning home? |
YES |
NO |
DK |
|
YES |
NO |
DK |
|
__________________D/WK |
||
|
_______________________ |
The next set of questions are about assistance you may have received to help with your recovery following HURRICANE FLORENCE.
|
Own |
Rent |
Other, specify_________ |
|
YES NO DK |
||
|
YES NO DK |
||
|
YES NO DK |
||
|
YES NO DK |
If YES to
insurance (Q13a-c), did you receive a payout for
damages from HURRICANE FLORENCE flooding?
[Circle all that apply]
YES, from renters ins. YES, from flood ins. YES, from
homeowner’s ins. NO DK
If YES to
receive payout (Q14), when did you receive your
insurance payout(s)?
(Date MM/YY)_____________________
If YES to
receive payout (Q14), how many of your repairs were
covered by insurance payout(s)?
Very little Some
Almost all/All
If NO to insurance (Q13a-c) before HURRICANE FLORENCE, do you have insurance now?
[Circle all that apply] YES, renters ins. YES, flood ins. YES, homeowner’s ins. NO DK
[Homeowners continue to next question; Renters skip to Q18.]
Now I am going to ask you about seven types of assistance to learn what resources were available to community members. Please answer whether you applied or received any of these types of assistance since the beginning of 2018, considering either HURRICANE MATTHEW or HURRICANE FLORENCE.
|
Wave 2 responses |
Applied? |
Received? |
HM* |
HF* |
If received, when? MM/YY |
|||
|
|
|
|
|
|
|
|||
|
|
|
|
|
|
|
|||
|
|
|
|
|
|
|
|||
|
|
|
|
|
|
|
|||
|
|
|
|
|
|
|
|||
|
|
|
|
|
|
|
|||
|
|
|
|
|
|
|
|||
|
|
|
|
|
|
|
|||
*mark (X) if they applied and/or received from either/both hurricane (HM=Matthew; HF=Florence) |
|||||||||
|
|
|
|
|
|
|
|||
|
YES |
NO |
DK |
||||||
a. |
If NO, how many of your repairs/replacement were covered? |
Very little |
Some |
Almost all/all |
|||||
b. |
If NO, did you and your household personally pay for the rest? |
YES |
NO |
DK |
Now I am going to ask you about your assessment of recovery from HURRICANE MATTHEW and HURRICANE FLORENCE..
|
YES |
NO |
DK |
|
YES |
NO |
DK |
|
YES |
NO |
DK |
|
YES |
NO |
DK |
|
YES |
NO |
DK |
|
YES |
NO |
DK |
|
Somewhere else in Lumberton |
Somewhere else in NC |
Out of State |
[See Q1, if 0 children in household, skip to Q26] Next, I want to ask about the experience of the children in your HH.
Was your child/ren enrolled in a school in Lumberton in the past 12 months? Yes No [If NO, skip to Q26]
When thinking about your child/ren’s educational recovery following both hurricanes, would you say that your child/ren’s educational situation is…
a. Better than it was before the hurricanes
b. Back to where it was before the hurricanes
c. Worse than before the hurricanes
d. Uncertain, things are still changing for you child/ren
e. Other (Please specify)___________________________________________________________
|
Had before Florence |
Have now |
a. Elevate hot water heater and/or HVAC |
Yes No DK |
Yes No DK |
b. Elevate interior contents in preparation for the flood |
Yes No DK |
Yes No DK |
c. Assess the building (structurally) by an engineer |
Yes No DK |
Yes No DK |
d. Re-route ductwork from below floor to attic space |
Yes No DK |
Yes No NA* |
e. Make disaster plan with household members |
Yes No DK |
Yes No DK |
f. Other: |
Yes No DK |
Yes No DK |
g. Other: |
Yes No DK |
Yes No DK |
h. Other: |
Yes No DK |
Yes No DK |
|
Finally, I have four questions about your household in general.
|
High School |
Associate’s degree |
Bachelor’s degree |
Master’s deg. or higher |
||
|
1) White 2) Black or African American 3) American Indian or Native American 4) Asian |
5) Native Hawaiian or other Pacific Islander 6) [If respondent selects >1, surveyor must specify codes] _______________
|
||||
|
1) Not Hispanic or Latino 2) Yes, Hispanic or Latino |
|||||
|
A. $1 to $3,999 B. $4,000 to $5,999 C. $6,000 to $7,999 D. $8,000 to $9,999 E. $10,000 to $11,999 |
F. $12,000 to $14,999 H. $20,000 to $24,999 I. $25,000 to $29,999 J. $30,000 to $39,999 |
K. $40,000 to $49,999 M. $75,000 to $99,999 N. $100,000 to $149,999 O. $150,000+ |
Thank you for your time!
This collection of information contains Paperwork Reduction Act (PRA) requirements approved by the Office of Management and Budget (OMB). Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the PRA unless that collection of information displays a currently valid OMB control number. For this collection, the OMB Control number is:0693-0078 with an expiration date: July 31, 2019. Public reporting burden for this collection is estimated to be 10 minutes per survey, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding this burden estimate or any aspect of this collection of information, including suggestions for reducing this burden, to the National Institute of Standards and Technology, Attn: Dr. Jennifer Helgeson, NIST, 100 Bureau Drive, MS 8603, Gaithersburg, MD 20899-1710, telephone 301-975-6133, or via email:jennifer.helgeson@nist.gov.
Authority: The Paperwork Reduction Act of 1980 (Pub. L. No. 96-511, 94 Stat. 2812, codified at 44 U.S.C. §§ 3501–3521).
Purpose: The National Institute for Standards and Technology (NIST) conducts Community Resilience research and surveys through the Generic Paperwork Reduction Act Clearance, OMB CONTROL NO. 0693-0078 Expiration date: 07/31/2019.
Routine Uses: NIST will use this information to conduct a systematic process evaluation of the NIST Community Resilience Planning Guide implementation. This is not a Privacy Act system of Records, therefore there is no System of Records Notice associated with this collection.
Disclosure: Furnishing this information is voluntary. When you submit the form, you are indicating your voluntary consent for NIST to use of the information you submit for the purpose stated.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Sutley, Elaina J |
File Modified | 0000-00-00 |
File Created | 2021-01-16 |