O MB #: 0970-XXXX
Expiration Date: XX/XX/XXXX
Operation Allies Welcome Survey of Resettled Afghans Questionnaire #2
What language do you prefer to complete the survey?
English
پښتو
دری
Consent Notice
The Office of Refugee Resettlement (ORR), which is part of the U.S. Department of Health and Human Services, invites you to participate in a survey to identify the needs of recently arrived Afghans and the gaps in resettlement services. ORR will use the data from this survey to change or improve its programs to better serve you and other recently arrived Afghans.
This survey is voluntary and should take around 15 minutes to complete. The answers you give will be kept private and anonymous. Once you begin the survey, please do not close the webpage before you answer all the questions in the survey. You will only have one chance to take the survey and will not be able to go back or change your answers.
By clicking “Agree and Next,” you consent to participate in the survey.
Household Composition
Q1. What is your gender?
Male
Female
Q2. How many family members currently live in your household, including yourself?
1
2
3
4
5
6 or more
[If Q2 = “A. 1”, skip to Q4. All other responses proceed to Q3.]
Q3. How many women family members (age 16 and over) live in your household? Include yourself in the count if you are a woman age 16 or over.
0
1
2
3 or more
Q4. What is your marital status?
Now married, spouse living in household
Now married, spouse not living in household
Divorced or separated
Never married
Widowed
Q5. Which of the following does your household need the most help with? (Select up to 3 options to help us understand needs of Afghan families like yours.)
Immigration status
Employment
Housing
Transportation
English language classes
Food
Childcare
Medical
Mental health
School enrollment
Cultural Orientation
Community building and networking
Family reunification
Location/Secondary Migration
Q6. After you left the military base, in what state did you initially resettle? [DROP DOWN LIST OF STATES]
Q7. What state do you live in now? [DROP DOWN LIST OF STATES]
[If Q6 and Q7 responses are the same state, skip to Q8; if 2 states are different, continue to Q7i.]
Q7i. Why did you move to the state you live in now? Please select all answers that apply. [OPTION TO SELECT MULTIPLE]
For better housing options
For employment reasons
To be closer to family
To be closer to an Afghan community
Other
Q8. Do you intend to move to a different state within the United States within the next 12 months?
Yes
No
I don’t know
Housing
Q9. Was your household able to pay your living expenses (rent, food, medical bills, etc.) last month?
Yes
No
Q10. How does your household currently pay for rent? Please select all answers that apply. [OPTION TO SELECT MULTIPLE]
Rental assistance
Income from employment
Family support
Community support
Savings
Other
[If Q10 responses include “A. Rental Assistance” continue to Q10i. If Q10 responses do not include “A. Rental Assistance,” skip to Q11.]
Q10i. Will your household be able to pay the rent next month without any outside assistance?
Yes
No
I don’t know
[If Q10i = “A. Yes” continue to Q10ii. If Q10i response = “B. No” or “C. I don’t know” skip to Q11.]
Q10ii. How will your household pay rent without any assistance? Please select all answers that apply. [OPTION TO SELECT MULTIPLE]
Income from employment
Family support
Community support
Savings
Finding cheaper housing
Other
I don’t know
[CONTINUE TO Q11]
Employment
Q11. What is the highest education level you have completed?
None
Primary
Secondary
Vocational
University or higher
Q12. What best describes your current employment status?
Employed (full-time)
Employed (part-time)
Self-employed (work for yourself, business owner, independent contractor, Uber or Lyft driver, etc.)
Unemployed and not actively looking for a job
[ If Q12 = “D. Unemployed and actively looking for a job”, continue to Q12i.
If Q12 = “A. Employed (full time”, “B. Employed (part-time), or “C. Self-employed”, skip to Q12ii.
If Q12 = “E. Unemployed and not actively looking for a job”, skip to Q13.]
Q12i. What challenges have you faced in finding a job? Please select all answers that apply. [OPTION TO SELECT MULTIPLE]
Childcare or family responsibilities
Transportation challenges
Limited English language skills
Lack of job openings
I don’t know how to find a job
No employment authorization or other documents
Lack of required technical skills, training, or credential/certificate
Employers do not recognize qualifications or work experience from outside the US (professional degree)
Poor health or disability
Other
[CONTINUE TO Q13]
Q12ii. Are you interested in finding a different job?
Yes
No
I don’t know
[ If Q12ii = “A. Yes” or “C. I don’t know”, continue to Q12iii. If Q12ii = “B. No” skip to Q13.]
Q12iii. What kind of assistance do you need to find another job? Please select all answers that apply. [OPTION TO SELECT MULTIPLE]
English language training
Technical certification
Vocational education (job skills class)
Professional degree
Driver’s license
Transportation
Other
I don’t need any assistance
[CONTINUE TO Q13]
Q13. How many family members (16 years and older) in your household, including yourself, are currently employed?
0
1
2
3 or more
[ If Q13 = “A. 0” or Q3 = “A. 0”, skip to Q14. All other responses, continue to Q13i.]
Q13i. How many women family members (16 years and older) in your household are currently employed? Include yourself in the count if you are a woman aged 16 or over.
0
1
2
3 and more
[CONTINUE TO Q14]
Q14. How many family members (16 years and older) within your household, including yourself, are looking for a job?
0
1
2
3 or more
[ If Q14 = “A. 0” or Q3 = “A. 0”, skip to Q15. All other responses, continue to Q14i.]
Q14i. How many women family members (16 years and older) in your household are currently unemployed and looking for a job? Include yourself in the count if you are a woman aged 16 or over.
0
1
2
3 and more
[If Q14i = “A. 0”, skip to Q15.
If Q14i = “B. 1,” “C. 2,” or “D. 3 and more” continue to Q14ii.]
Q14ii. What challenges do women family members (16 years and older) in your household face in finding a job? Please select all answers that apply. [OPTION TO SELECT MULTIPLE]
Childcare or family responsibilities
Transportation challenges
Limited English language skills
Lack of job openings
I don’t know how to find a job
No employment authorization or other documents
Lack of required technical skills, training, or credential/certificate
Employers do not recognize qualifications or work experience from outside the US (professional degree)
Poor health or disability
Other
[CONTINUE TO Q15]
Mental Health
Q15. Have you or any family members in your household had feelings of extreme sadness, have been worrying or thinking too much, have thoughts about the past that kept you from doing things or spending time with others, feeling helpless, or having difficulty sleeping?
Yes
No
[ If Q15 = “A. Yes”, continue to Q15i. If Q15 = “B. No”, skip to Q16.]
Q15i. Have you and/or any family members in your household received help from a professional (psychologist, doctor, etc.) to address those feelings?
Yes, have received help
No, have not received help
[If Q15i = “A. Yes”, skip to Q16. If Q15i = “B. No”, continue to Q15ii.]
Q15ii. Why have you and/or and family members in your household not received help from a professional to address those feelings?
Do not need professional help
Do not know how to access professional help
Cannot afford professional help
[CONTINUE TO Q16]
Legal Services
Q16. Have you applied to modify your immigration status in the United States (asylum, green card, etc.)?
Yes
No
Q17. Do you need immigration assistance?
Yes
No
[If Q17 = “A. Yes”, proceed to Q17i. If Q17 = “B. No”, skip to Q18.]
Q17i: What kind of immigration assistance do you need? Please select all answers that apply. [OPTION TO SELECT MULTIPLE]
Legal orientation on immigration pathways
Referral to lawyer/legal provider
Legal representation
Assistance with completing application
Assistance with interviews or other immigration processes
Cash assistance to pay for legal costs
Other
[CONTINUE TO Q18]
Q18. Have you received any immigration assistance?
Yes
No
[If Q18 = “A. Yes”, proceed to Q18i. If Q18 = “B. No”, proceed to Q18ii.]
Q18i. What kind of immigration assistance have you received? Please select all answers that apply. [OPTION TO SELECT MULTIPLE]
Legal orientation on immigration pathways
Referral to lawyer/legal provider
Legal representation
Assistance with completing application
Assistance with interviews or other immigration processes
Cash assistance to pay for legal costs
Other
[CONTINUE TO Q19]
Q18ii. What has prevented you from receiving immigration assistance? Please select all answers that apply. [OPTION TO SELECT MULTIPLE]
No one has explained the process to me (I do not understand what is needed)
I do not know how to find an immigration attorney.
I am unable to afford an immigration attorney.
Other
[CONTINUE TO Q19]
Q19. Do you wish to reunite with any immediate family members (such as your spouse, child under 21 years old, or parent) located outside of the United States?
Yes
No
[END SURVEY]
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to inform ORR program decisions to better serve the recently arrived Afghan. Public reporting burden for this collection of information is estimated to average 15 minutes per respondent, including any time you needed to collect information to be able to answer our questions. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-XXXX and the expiration date is XX/XX/XXXX. If you have any comments on this collection of information, please contact: asr@acf.hhs.gov.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Wojnar, Elizabeth (ACF) (CTR) |
File Modified | 0000-00-00 |
File Created | 2023-08-27 |