Appendix H - Provider Survey Mailings (r1, R2)

APPENDIX H
RETAIN PROVIDER SURVEY MAILINGS (R1, R2)

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Attachment H

Mathematica

RETAIN: Provider Survey Mailings
Listed below are the provider survey mailings for each round of data collection. We provide an
example of each document in the appendix in the order shown below.
Provider survey mailing

Week of field period

Pre-field notification letter to practice contact

0

Provider advance letter

1

Provider email invitation

1

Provider email: reminder 1

3

Cover letter for the mailed questionnaire (mailing 1)

3

Provider postcard 1

4

Nonresponse email notification 1 to practice contact

4

Provider email reminder 2

5

Cover letter for the mailed questionnaire (mailing 2)

7

Provider postcard 2

8

Provider email reminder 3

11

Nonresponse email notification 2 to practice contact

13

Provider thank-you letter

1–14

The round 2 (R2) mailings follow the same approach shown above, with modifications to make
the text applicable to the R2 effort.

H.1

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OMB No.: XXX
Expiration Date: XX/XX/2023

Provider R1 Survey: Pre-field notification letter to practice contact – Week 0
[PRACTICE ORG NAME]
[ADDRESS 1] [ADDRESS 2]
[PRACTICE CITY], [PRACTICE
STATE] [PRACTICE ZIP]
DATE
Dear [CONTACT FNAME LNAME]:
According to our records, your practice organization, [FILL ORG], is providing care to individuals
enrolled in the “Retaining Employment and Talent After Injury/Illness Network” (RETAIN)
program, funded by the U.S. Department of Labor. RETAIN seeks to test promising early
interventions for adults with recently acquired injuries or disabilities. The goal is to improve labor
force participation and reduce reliance on Social Security disability benefits.
The Social Security Administration is funding an evaluation of RETAIN, which Mathematica will
conduct. As part of this effort, Mathematica will be fielding two surveys of RETAIN service
providers. The first survey begins next week and the second will be conducted one year from
now. The provider survey takes 14 minutes to complete. It asks about the provider’s experience
delivering patient care and their experience with RETAIN. Providers will receive $50 for
completing this voluntary survey. We will send each provider a letter, followed by an email,
inviting them to take part.
The following provider(s) at your practice organization have been selected for the
RETAIN provider survey:
[PROVIDER NAME]

[PROVIDER NAME]

[PROVIDER NAME]

I recognize providers are very busy and may not check emails or postal mail regularly.
Therefore, I extend appreciation in advance for your help in notifying providers about the survey
and encouraging their participation.
If you have questions, or if any of these providers are no longer with your practice organization,
please contact Holly Matulewicz, the survey director at Mathematica, by telephone (XXX)-XXXXXXX) or email XXX@mathematica-mpr.com. We appreciate your support of this important
evaluation.
Sincerely,
FILL NAME, Associate Commissioner of the Office of Research, Demonstration, and
Employment Support, Social Security Administration
More information on RETAIN can be found at: www.xxx.xxx

H.3

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OMB No.: XXX
Expiration Date: XX/XX/2023

Provider R1 Survey: Provider advance letter – Week 1

[PRACTICE ORG NAME]
[ADDRESS 1] [ADDRESS 2]
[PRACTICE CITY], [PRACTICE
STATE] [PRACTICE ZIP]
DATE
Dear [PROVIDER FNAME LNAME]:
According to our records, you are providing care to individuals enrolled in the “Retaining Employment
and Talent After Injury/Illness Network” (RETAIN) program, funded by the U.S. Department of Labor.
RETAIN seeks to test promising early interventions for adults with recently acquired injuries or
disabilities. The goal is to help improve labor force participation and reduce reliance on Social Security
disability benefits. The Social Security Administration is funding an evaluation of RETAIN, which
Mathematica will conduct. As part of this effort, Mathematica will be fielding two surveys with RETAIN
service providers.
I am writing to invite you to take part in the first survey about your experiences with RETAIN.
The next one will take place one year from now.
To complete the survey online, go to: xxxxx
Enter your username [FILL USERNAME] and password [FILL PASSWORD].
Please complete the survey by [FILL +2 WEEKS]. By sharing your experiences, you help us assess the
effectiveness of the program. The survey should take about 15 minutes to complete. As a token of our
appreciation, you will receive $50 for taking part in this survey. We have enclosed $5, and you will receive a
check for $45 after completing the survey.
This survey is voluntary; however, your participation is critical to the success of this study. Neither
your name nor the name of your organization will be used in any report. Moreover, Mathematica will not
share with SSA any survey data that could identify or be linked to your practice organization.

If you have questions, or if you no longer provide patient care at [PRACTICE ORG], please contact Holly
Matulewicz at Mathematica, by telephone ((XXX)-XXX-XXXX) or email (XXX@mathematica-mpr.org).
We appreciate your support of this important evaluation.
Sincerely,
FILL NAME, Associate Commissioner of the Office of Research, Demonstration, and Employment
Support
Social Security Administration
More information on RETAIN can be found at: www.xxx.xxx
H.5

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Provider R1 Survey: Provider email invitation – Week 1
Subject: Retaining Employment and Talent After Injury/Illness Network
Dear [PROVIDER FNAME LNAME]:
According to our records, you are providing care to individuals enrolled in the “Retaining
Employment and Talent After Injury/Illness Network” (RETAIN) program, funded by the U.S.
Department of Labor. RETAIN seeks to test promising early interventions for adults with recently
acquired injuries or disabilities. The goal is to help improve labor force participation and reduce
reliance on Social Security disability benefits. The Social Security Administration (SSA) is
funding an evaluation of RETAIN, which Mathematica will conduct. As part of this effort,
Mathematica is fielding two surveys with RETAIN service providers.
I am writing to invite you to take part in the first survey about your experiences with
RETAIN. The next will take place about one year from now.
To complete the survey, go to: [FILL CUSTOMIZED LINK].
Please complete the survey by [FILL +1.5 WEEKS]. By sharing your experiences, you help us
assess the effectiveness of the program. The survey takes about 15 minutes to complete. As a token
of our appreciation, you will receive a $45 check for completing the survey.
This survey is voluntary; however, your participation is critical to the success of this study.
Neither your name nor the name of your organization will be used in any report. Moreover,
Mathematica will not share with SSA any survey data that could identify or be linked to your practice
organization.

If you have questions, or if you no longer provide patient care at [PRACTICE ORG], please
contact me at Mathematica, by telephone (XXX)-XXX-XXXX) or email. We have attached the
survey invitation letter from SSA. For more information on RETAIN, go to: www.xxx.xxx
Thank you for your support of this important evaluation.
Sincerely,

Holly Matulewicz, Senior Survey Researcher
Mathematica Survey Director for the RETAIN evaluation

H.7

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Provider R1 Survey: Provider email reminders 1, 2 – Weeks 3 and 5
Subject: Reminder - RETAIN program evaluation
Dear [PROVIDER LNAME]:
According to our records, your practice organization, [FILL ORG], is providing care to individuals
enrolled in the “Retaining Employment and Talent After Injury/Illness Network” (RETAIN)
program, funded by the U.S. Department of Labor. RETAIN seeks to test promising early
interventions for adults with recently acquired injuries or disabilities. The Social Security
Administration hired Mathematica to carry out an evaluation of RETAIN.
We have not yet received your completed survey. Your input matters!
To begin the survey, go to: [FILL CUSTOMIZED LINK]
The information you provide about your experiences in providing services to this population is
critical to the success of the evaluation. The questions will take about 15 minutes to answer. We
will mail you a check for $45 after receiving your completed survey. If you are no longer
providing patient care at this practice organization, please reply to this email so we can update
our records.
This survey is voluntary; however, your participation is critical to the success of this
study. Neither your name nor the name of your organization will be used in any report.
Moreover, Mathematica will not share any survey data that could identify or be linked to your
practice organization.
Have questions? Contact me by telephone (XXX)-XXX-XXXX or email.
We appreciate your participation in this important evaluation.
Sincerely,

Holly Matulewicz, Senior Survey Researcher
Mathematica Survey Director for the RETAIN evaluation

H.9

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OMB No.: XXX
Expiration Date: XX/XX/2023

Provider R1 Survey: Cover letter to the paper questionnaire mailing 1 – Week 3.5
[ADDRESS 1 / ADDRESS 2]
[CITY, STATE ZIP]
[DATE (MM/DD/YYYY)]
Dear [FIRST NAME / LAST NAME]:
According to our records, your practice organization, [FILL ORG], is providing care to individuals
enrolled in the “Retaining Employment and Talent After Injury/Illness Network” (RETAIN) program,
funded by the U.S. Department of Labor. RETAIN seeks to test promising early interventions for adults
with recently acquired injuries or disabilities. The goal is to help improve labor force participation and
reduce reliance on Social Security disability benefits. The Social Security Administration (SSA) is
funding an evaluation of RETAIN, which Mathematica will carry out. As part of this effort, Mathematica
is fielding two surveys with RETAIN service providers.
I am writing to invite you to take part in the first survey about your experiences with RETAIN.
The next one will take place about one year from now.
Your input matters! Please complete the enclosed survey.

Mail back the
completed survey

•

Please return the survey to Mathematica by [DATE OF RELEASE + 2.5
WKS]. We have enclosed a postage-paid envelope for you to use.

•

You will receive a $45 check for completing this voluntary survey.

Questions?
Call (XXX)-XXXXXXX

If you prefer to complete the survey online, go to: xxxxx. Input your
username [FILL USERNAME] and password [FILL PASSWORD].

This survey is voluntary; however, your participation is critical to the
success of this study. Neither your name nor the name of your organization will be used in any report.
Moreover, Mathematica will not share with SSA any survey data that could identify or be linked to your
practice organization.
If you have questions, or if you no longer provide patient care at [PRACTICE ORG], please contact
Mathematica by telephone ((XXX)-XXX-XXXX) or email (XXX@mathematica-mpr.org). More
information on RETAIN is available at: www.xxx.xxx.
Thank you for your support of this important evaluation.
Sincerely,
FILL NAME, Associate Commissioner of the Office of Research, Demonstration, and Employment
Support
Social Security Administration
Para información e instrucciones en español, llame (XXX)-XXX-XXXX por favor.

H.11

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Provider R1 Survey: Postcard 1 – Week 4
FRONT OF POSTCARD
SOCIAL SECURITY ADMINISTRATION
50751.XXX
P.O. Box 2393
Princeton, NJ 08543-2393
Return Service Requested

Your input matters!

BACK OF POSTCARD

OMB No.: XXX
Expiration Date: XX/XX/2023

$45

You are invited to take part in a national survey for the Social Security
Administration. We have not yet received your completed survey.
Please call Mathematica at xxx-xxx-xxxx to begin. You will receive
$45 for completing this 15-minute, voluntary survey about the care
you provide at this practice organization.
Your input matters! We look forward to hearing from you.

H.13

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Provider R1 Survey: Nonresponse email to practice contact– Week 4
Subject: RETAIN evaluation – your help is needed
[LOGOS]
Dear [PRI-CONTACT FNAME] [PRI-CONTACTLNAME]:
According to our records, your practice organization is providing care to individuals enrolled in
the “Retaining Employment and Talent After Injury/Illness Network” (RETAIN) program, funded
by the U.S. Department of Labor. The Social Security Administration hired Mathematica to
evaluate this program. As part of this effort, Mathematica is fielding a survey of providers who
are delivering services to RETAIN enrollees.
We are writing to let you know that we have not yet received completed surveys from
providers at your practice organization.
We recognize that providers are very busy and may not check emails or postal mail regularly.
Therefore, we are writing to ask for your help. Could you please reach out to the provider(s)
shown below to encourage their participation?
[PROVIDER NAME]

[PROVIDER NAME]

[PROVIDER NAME]

The survey will take about 15 minutes to complete. It asks about provider experiences with
RETAIN and about the care they delivered to the study population.
If you have questions, or if any of these providers is no longer with your practice organization,
please contact me by phone (XXX)-XXX-XXXX or email.
We appreciate your support of this important evaluation.
Sincerely,

Holly Matulewicz, Senior Survey Researcher
Mathematica Survey Director for the RETAIN evaluation

H.15

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OMB No.: XXX
Expiration Date: XX/XX/2023

Provider R1 Survey: Cover letter for mailed questionnaire, mailing 2 – Week 7
[ADDRESS 1 / ADDRESS 2]
[CITY, STATE ZIP]
[DATE]
Dear [PROVIDER FNAME LNAME]:
I am writing again to ask you to take part in a survey about the Retaining Employment and Talent After
Injury/Illness Network” (RETAIN) program. According to our records, your practice organization, [FILL
ORG], is providing care to individuals enrolled in RETAIN. Funded by the U.S. Department of Labor,
RETAIN seeks to test promising early interventions for adults with recently acquired injuries or
disabilities. The goal is to help improve labor force participation and reduce reliance on Social Security
disability benefits. The Social Security Administration (SSA) is funding an evaluation of RETAIN. SSA
hired Mathematica to conduct the evaluation and field two surveys with RETAIN service providers.
To date, we have not received your completed survey. You will receive a $45 check for completing
this 15-minute survey. It has questions about your experience with RETAIN and about the care you
provide for this patient population.
Your input matters! Please return the survey to Mathematica by [+2.5WKs].
Mail back the
completed
survey
OR
Call (XXX)-XXXXXXX

•

We have enclosed a postage-paid envelope for you to use.

•

If you prefer to complete the survey online, go to: xxxxx. Input your
username [FILL USERNAME] and password [FILL PASSWORD].

This survey is voluntary; however, your participation is critical to the success of this study.
Neither your name nor the name of your organization will be used in any report. Moreover,
Mathematica will not share with SSA any survey data that could identify or be linked to your practice
organization.
If you have questions, or if you no longer provide patient care at [PRACTICE ORG], please contact
Mathematica by telephone ((XXX)-XXX-XXXX) or email (XXX@mathematica-mpr.org). Thank you for
your support of this important evaluation.
Sincerely,
FILL NAME, Associate Commissioner of the Office of Research, Demonstration, and Employment
Support
Social Security Administration
For more information on RETAIN, go to: www.xxx.xxx
Para información e instrucciones en español, llame (XXX)-XXX-XXXX por favor
H.17

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Provider R1 Survey: Provider postcard 2 – Week 8.5

FRONT OF POSTCARD
SOCIAL SECURITY ADMINISTRATION
50751.XXX
P.O. Box 2393
Princeton, NJ 08543-2393
Return Service Requested

Survey ends soon!

BACK OF POSTCARD

OMB No.: XXX
Expiration Date: XX/XX/2023

$45

We invite you to take part in a national survey for the Social Security
Administration. We have not yet received your completed survey.
Please call Mathematica at xxx-xxx-xxxx to begin.
You will receive $45 for completing this 15-minute, voluntary survey
about the care you provide at this practice organization.
The survey ends soon! We look forward to hearing from you.

H.19

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Provider R1 Survey: Provider email reminder 3 – Week 11
Subject: RETAIN evaluation – survey ending soon
Dear [PROVIDER LNAME]:
According to our records, your practice organization, [FILL ORG], is providing care to individuals
enrolled in the “Retaining Employment and Talent After Injury/Illness Network” (RETAIN)
program, which is testing promising early interventions for adults with recently acquired injuries
or disabilities. The Social Security Administration is funding an evaluation of RETAIN, which
Mathematica will carry out.
The survey is ending soon, and we have not yet heard from you. Your answers to
questions about the care you deliver to this patient population are valuable to our assessment of
this program. The questions will take about 15 minutes to answer.
To complete the survey online, go to: [FILL CUSTOMIZED LINK].
We will mail you a check for $45 after receiving your completed survey. If you are no longer
providing patient care at [FILL PRACTICE ORG], please reply to this email so we can update
our records.
This survey is voluntary; however, your participation is critical to the success of this
study. Neither your name nor the name of your organization will be used in any report.
Moreover, Mathematica will not share any survey data that could identify or be linked to your
practice organization.
Have questions? Contact the Mathematica by telephone (XXX)-XXX-XXXX or email. We
appreciate your help with this important evaluation.
Sincerely,

Holly Matulewicz, Senior Survey Researcher
Mathematica Survey Director for the RETAIN evaluation

H.21

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Provider R1 Survey: Nonresponse email notification 2 – Week 13
Subject: RETAIN evaluation – help needed, study ends soon
Dear [PRI-CONTACT FNAME] [PRI-CONTACTLNAME]:
I am writing to follow up about the provider survey for the RETAIN evaluation. According to our
records, your practice organization is providing care to individuals enrolled in the “Retaining
Employment and Talent After Injury/Illness Network” (RETAIN) program, which is testing
promising early interventions for adults with recently acquired injuries or disabilities.
We have not yet received completed surveys from the provider(s) shown below. Would
you please confirm that they are still providing patient care at your practice organization? If they
are not, please contact me so we can update our records.
[PROVIDER NAME]

[PROVIDER NAME]

[PROVIDER NAME]

[PROVIDER NAME]

If they are still providing patient care, may I ask for your help in reaching out to these providers?
The survey is ending soon. Mathematica is happy to answer any questions you or the provider
may have about the survey. Please feel free to contact me at (XXX)-XXX-XXXX or by email.
We appreciate your support of this important evaluation.
Sincerely,

Holly Matulewicz, Senior Survey Researcher
Mathematica Survey Director for the RETAIN evaluation

H.23

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OMB No.: XXX
Expiration Date: XX/XX/2023

Provider R1 Survey: Provider thank-you letter
Dear Provider:
Thank you for participating in the Retaining Employment and Talent After Injury/Illness
Network (RETAIN) provider survey. We appreciate your help and support of the
evaluation.
Enclosed is a check for $45 as a token of our appreciation. We look forward to
connecting with you again for the next survey, to be conducted about one year from
now.
If your contact information changes, please contact Mathematica study team by phone
at xxx-xxx-xxxx or by email (xxxx@mathematica-mpr.org).
Thank you again for your support of this important study.
Best regards,

Holly Matulewicz, Senior Survey Researcher
Mathematica Survey Director for the RETAIN evaluation

More information about RETAIN is available at: www.xxx.xxxxxx

H.25

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OMB No.: XXX
Expiration Date: XX/XX/2023

Provider R2 Survey: Pre-field notification letter to practice contact – Week 0
[PRACTICE ORG NAME]
[ADDRESS 1] [ADDRESS 2]
[PRACTICE CITY], [PRACTICE
STATE] [PRACTICE ZIP]
DATE
Dear [CONTACT FNAME LNAME]:
According to our records, your practice organization, [FILL ORG], is providing care to individuals
enrolled in the “Retaining Employment and Talent After Injury/Illness Network” (RETAIN)
program, funded by the U.S. Department of Labor. RETAIN seeks to test promising early
interventions for adults with recently acquired injuries or disabilities. The goal is to improve labor
force participation and reduce reliance on Social Security disability benefits.
The Social Security Administration is funding an evaluation of RETAIN, which Mathematica will
conduct. As part of this effort, Mathematica is fielding two surveys of RETAIN service providers.
This is the second and final survey. The provider survey takes 14 minutes to complete. It asks
about the provider’s experience delivering patient care and their experience with RETAIN.
Providers will receive $50 for completing this voluntary survey. We will send each provider a
letter, followed by an email, inviting them to take part.
The following provider(s) at your practice organization have been selected for the
RETAIN provider survey:
[PROVIDER NAME]

[PROVIDER NAME]

[PROVIDER NAME]

I recognize providers are very busy and may not check emails or postal mail regularly.
Therefore, I extend appreciation in advance for your help in notifying providers about the survey
and encouraging their participation.
If you have questions, or if any of these providers are no longer with your practice organization,
please contact Holly Matulewicz, the survey director at Mathematica, by telephone (XXX)-XXXXXXX) or email XXX@mathematica-mpr.com. We appreciate your support of this important
evaluation.
Sincerely,
FILL NAME, Associate Commissioner of the Office of Research, Demonstration, and
Employment Support, Social Security Administration
More information on RETAIN can be found at: www.xxx.xxx

H.27

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OMB No.: XXX
Expiration Date: XX/XX/2023

Provider R2 Survey: Provider advance letter – Week 1
[PRACTICE ORG NAME]
[ADDRESS 1] [ADDRESS 2]
[PRACTICE CITY], [PRACTICE
STATE] [PRACTICE ZIP]
DATE
Dear [PROVIDER FNAME LNAME]:
According to our records, you are providing care to individuals enrolled in the “Retaining Employment
and Talent After Injury/Illness Network” (RETAIN) program, funded by the U.S. Department of Labor.
RETAIN seeks to test promising early interventions for adults with recently acquired injuries or
disabilities. The goal is to help improve labor force participation and reduce reliance on Social Security
disability benefits. The Social Security Administration is funding an evaluation of RETAIN, which
Mathematica will conduct. As part of this effort, Mathematica is fielding two surveys with RETAIN
service providers.
I am writing to invite you to take part in the second and final survey about your experiences with
RETAIN.
To complete the survey online, go to: xxxxx
Enter your username [FILL USERNAME] and password [FILL PASSWORD].
Please complete the survey by [FILL +2 WEEKS]. By sharing your experiences, you help us assess
the effectiveness of the program. The survey should take about 15 minutes to complete. As a token of
our appreciation, you will receive $50 for taking part in this survey. We have enclosed $5, and you will
receive a check for $45 after completing the survey.
This survey is voluntary; however, your participation is critical to the success of this study.
Neither your name nor the name of your organization will be used in any report. Moreover,
Mathematica will not share with SSA any survey data that could identify or be linked to your practice
organization.
If you have questions, or if you no longer provide patient care at [PRACTICE ORG], please contact
Holly Matulewicz at Mathematica, by telephone ((XXX)-XXX-XXXX) or email (XXX@mathematicampr.org).
We appreciate your support of this important evaluation.
Sincerely,
FILL NAME, Associate Commissioner of the Office of Research, Demonstration, and Employment
Support
Social Security Administration
More information on RETAIN can be found at: www.xxx.xxx
H.29

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Provider R2 Survey: Provider email invitation – Week 1
Subject: Retaining Employment and Talent After Injury/Illness Network
Dear [PROVIDER FNAME LNAME]:
According to our records, you are providing care to individuals enrolled in the “Retaining
Employment and Talent After Injury/Illness Network” (RETAIN) program, funded by the U.S.
Department of Labor. RETAIN seeks to test promising early interventions for adults with recently
acquired injuries or disabilities. The goal is to help improve labor force participation and reduce
reliance on Social Security disability benefits. The Social Security Administration (SSA) is
funding an evaluation of RETAIN, which Mathematica will conduct. As part of this effort,
Mathematica is fielding two surveys with RETAIN service providers.
I am writing to invite you to take part in the second and final survey about your
experiences with RETAIN.
To complete the survey, go to: [FILL CUSTOMIZED LINK].
Please complete the survey by [FILL +1.5 WEEKS]. By sharing your experiences, you help
us assess the effectiveness of the program. The survey takes about 15 minutes to complete. As
a token of our appreciation, you will receive a $45 check for completing the survey.
This survey is voluntary; however, your participation is critical to the success of this
study. Neither your name nor the name of your organization will be used in any report.
Moreover, Mathematica will not share with SSA any survey data that could identify or be linked
to your practice organization.
If you have questions, or if you no longer provide patient care at [PRACTICE ORG], please
contact me at Mathematica, by telephone (XXX)-XXX-XXXX) or email. We have attached the
survey invitation letter from SSA. For more information on RETAIN, go to: www.xxx.xxx
Thank you for your support of this important evaluation.
Sincerely,

Holly Matulewicz, Senior Survey Researcher
Mathematica Survey Director for the RETAIN evaluation

H.31

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Provider R2 Survey: Provider email reminders 1, 2 – Weeks 3 and 5
Subject: Reminder - RETAIN program evaluation
Dear [PROVIDER LNAME]:
According to our records, your practice organization, [FILL ORG], is providing care to individuals
enrolled in the “Retaining Employment and Talent After Injury/Illness Network” (RETAIN)
program, funded by the U.S. Department of Labor. RETAIN seeks to test promising early
interventions for adults with recently acquired injuries or disabilities. The Social Security
Administration hired Mathematica to carry out an evaluation of RETAIN.
We have not yet received your completed survey. Your input matters!
To begin the survey, go to: [FILL CUSTOMIZED LINK]
The information you provide about your experiences in providing services to this population is
critical to the success of the evaluation. The questions will take about 15 minutes to answer. We
will mail you a check for $45 after receiving your completed survey. If you are no longer
providing patient care at this practice organization, please reply to this email so we can update
our records.
This survey is voluntary; however, your participation is critical to the success of this
study. Neither your name nor the name of your organization will be used in any report.
Moreover, Mathematica will not share any survey data that could identify or be linked to your
practice organization.
Have questions? Contact me by telephone (XXX)-XXX-XXXX or email.
We appreciate your participation in this important evaluation.
Sincerely,

Holly Matulewicz, Senior Survey Researcher
Mathematica Survey Director for the RETAIN evaluation

H.33

This page has been left blank for double-sided copying.

OMB No.: XXX
Expiration Date: XX/XX/2023

Provider R2 Survey: Cover letter to the paper questionnaire mailing 1 – Week 3.5
[ADDRESS 1 / ADDRESS 2]
[CITY, STATE ZIP]
[DATE (MM/DD/YYYY)]
Dear [FIRST NAME / LAST NAME]:
According to our records, your practice organization, [FILL ORG], is providing care to individuals
enrolled in the “Retaining Employment and Talent After Injury/Illness Network” (RETAIN) program,
funded by the U.S. Department of Labor. RETAIN seeks to test promising early interventions for adults
with recently acquired injuries or disabilities. The goal is to help improve labor force participation and
reduce reliance on Social Security disability benefits. The Social Security Administration (SSA) is
funding an evaluation of RETAIN, which Mathematica will carry out. As part of this effort, Mathematica
is fielding two surveys with RETAIN service providers.
I am writing to invite you to take part in the second and final survey about your experiences with
RETAIN.
Your input matters! Please complete the enclosed survey.

Mail back the
completed survey
Questions?
Call (XXX)-XXXXXXX

•

Please return the survey to Mathematica by [DATE OF RELEASE + 2.5
WKS]. We have enclosed a postage-paid envelope for you to use.

•

You will receive a $45 check for completing this voluntary survey.

If you prefer to complete the survey online, go to: xxxxx. Input your
username [FILL USERNAME] and password [FILL PASSWORD].

This survey is voluntary; however, your participation is critical to the
success of this study. Neither your name nor the name of your organization will be used in any report.
Moreover, Mathematica will not share with SSA any survey data that could identify or be linked to your
practice organization.
If you have questions, or if you no longer provide patient care at [PRACTICE ORG], please contact
Mathematica by telephone ((XXX)-XXX-XXXX) or email (XXX@mathematica-mpr.org). More
information on RETAIN is available at: www.xxx.xxx.
Thank you for your support of this important evaluation.
Sincerely,
FILL NAME, Associate Commissioner of the Office of Research, Demonstration, and Employment
Support
Social Security Administration

Para información e instrucciones en español, llame (XXX)-XXX-XXXX por favor.
H.35

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Provider R2 Survey: Postcard 1 – Week 4
FRONT OF POSTCARD
SOCIAL SECURITY ADMINISTRATION
50751.XXX
P.O. BOX 2393
Princeton, NJ 08543-2393
Return Service Requested

Your input matters!

BACK OF POSTCARD

OMB No.: XXX
Expiration Date: XX/XX/2023

$45

You are invited to take part in a national survey for the Social Security
Administration. We have not yet received your completed survey.
Please call Mathematica at xxx-xxx-xxxx to begin. You will receive
$45 for completing this 15-minute, voluntary survey about the care
you provide at this practice organization.
Your input matters! We look forward to hearing from you.

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Provider R2 Survey: Nonresponse email to practice contact – Week 4
Subject: RETAIN evaluation – your help is needed
[LOGOS]
Dear [PRI-CONTACT FNAME] [PRI-CONTACTLNAME]:
According to our records, your practice organization is providing care to individuals enrolled in
the “Retaining Employment and Talent After Injury/Illness Network” (RETAIN) program, funded
by the U.S. Department of Labor. The Social Security Administration hired Mathematica to
evaluate this program. As part of this effort, Mathematica is fielding this survey of providers who
are delivering services to RETAIN enrollees.
We are writing to let you know that we have not yet received completed surveys from
providers at your practice organization.
We recognize that providers are very busy and may not check emails or postal mail regularly.
Therefore, we are writing to ask for your help. Could you please reach out to the provider(s)
shown below to encourage their participation?
[PROVIDER NAME]

[PROVIDER NAME]

[PROVIDER NAME]

The survey will take about 15 minutes to complete. It asks about provider experiences with
RETAIN and about the care they delivered to the study population.
If you have questions, or if any of these providers is no longer with your practice organization,
please contact me by phone (XXX)-XXX-XXXX or email.
We appreciate your support of this important evaluation.
Sincerely,

Holly Matulewicz, Senior Survey Researcher
Mathematica Survey Director for the RETAIN evaluation

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OMB No.: XXX
Expiration Date: XX/XX/2023

Provider R2 Survey: Cover letter for mailed questionnaire, mailing 2 – Week 7
[ADDRESS 1 / ADDRESS 2]
[CITY, STATE ZIP]
[DATE]
Dear [PROVIDER FNAME LNAME]:
I am writing again to ask you to take part in a survey about the Retaining Employment and Talent After
Injury/Illness Network” (RETAIN) program. According to our records, your practice organization, [FILL
ORG], is providing care to individuals enrolled in RETAIN. Funded by the U.S. Department of Labor,
RETAIN seeks to test promising early interventions for adults with recently acquired injuries or
disabilities. The goal is to help improve labor force participation and reduce reliance on Social Security
disability benefits. The Social Security Administration (SSA) is funding an evaluation of RETAIN. SSA
hired Mathematica to conduct the evaluation and field two surveys with RETAIN service providers. This
is the final survey.
To date, we have not received your completed survey. You will receive a $45 check for completing
this 15-minute survey. It has questions about your experience with RETAIN and about the care you
provide for this patient population.
Your input matters! Please return the survey to Mathematica by [+2.5WKs].
Mail back the
completed
survey
OR

•

We have enclosed a postage-paid envelope for you to use.

•

If you prefer to complete the survey online, go to: xxxxx. Input your
username [FILL USERNAME] and password [FILL PASSWORD].

Call (XXX)-XXXXXXX

This survey is voluntary; however, your participation is critical to the success of this study.
Neither your name nor the name of your organization will be used in any report. Moreover,
Mathematica will not share with SSA any survey data that could identify or be linked to your practice
organization.
If you have questions, or if you no longer provide patient care at [PRACTICE ORG], please contact
Mathematica by telephone ((XXX)-XXX-XXXX) or email (XXX@mathematica-mpr.org). Thank you for
your support of this important evaluation.
Sincerely,
FILL NAME, Associate Commissioner of the Office of Research, Demonstration, and Employment
Support
Social Security Administration
For more information on RETAIN, go to: www.xxx.xxx
Para información e instrucciones en español, llame (XXX)-XXX-XXXX por favor

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Provider R2 Survey: Provider postcard 2 – Week 8.5

FRONT OF POSTCARD
SOCIAL SECURITY ADMINISTRATION
50751.XXX
P.O. Box 2393
Princeton, NJ 08543-2393
Return Service Requested

Survey ends soon!

BACK OF POSTCARD

OMB No.: XXX
Expiration Date: XX/XX/2023

$45

We invite you to take part in a national survey for the Social Security
Administration. We have not yet received your completed survey.
Please call Mathematica at xxx-xxx-xxxx to begin.
You will receive $45 for completing this 15-minute, voluntary survey
about the care you provide at this practice organization.
The survey ends soon! We look forward to hearing from you.

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Provider R2 Survey: Provider email reminder 3 – Week 11
Subject: RETAIN evaluation – survey ending soon
Dear [PROVIDER LNAME]:
According to our records, your practice organization, [FILL ORG], is providing care to individuals
enrolled in the “Retaining Employment and Talent After Injury/Illness Network” (RETAIN)
program, which is testing promising early interventions for adults with recently acquired injuries
or disabilities. The Social Security Administration is funding an evaluation of RETAIN, which
Mathematica will carry out.
The survey is ending soon, and we have not yet heard from you. Your answers to
questions about the care you deliver to this patient population are valuable to our assessment of
this program. The questions will take about 15 minutes to answer.
To complete the survey online, go to: [FILL CUSTOMIZED LINK].
We will mail you a check for $45 after receiving your completed survey. If you are no longer
providing patient care at [FILL PRACTICE ORG], please reply to this email so we can update
our records.
This survey is voluntary; however, your participation is critical to the success of this
study. Neither your name nor the name of your organization will be used in any report.
Moreover, Mathematica will not share any survey data that could identify or be linked to your
practice organization.
Have questions? Contact the Mathematica by telephone (XXX)-XXX-XXXX or email.
We appreciate your help with this important evaluation.
Sincerely,

Holly Matulewicz, Senior Survey Researcher
Mathematica Survey Director for the RETAIN evaluation

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Provider R2 Survey: Nonresponse email notification 2 – Week 13
Subject: RETAIN evaluation – help needed, study ends soon
Dear [PRI-CONTACT FNAME] [PRI-CONTACTLNAME]:
I am writing to follow up about the provider survey for the RETAIN evaluation. According to our
records, your practice organization is providing care to individuals enrolled in the “Retaining
Employment and Talent After Injury/Illness Network” (RETAIN) program, which is testing
promising early interventions for adults with recently acquired injuries or disabilities.
We have not yet received completed surveys from the provider(s) shown below. Would
you please confirm that they are still providing patient care at your practice organization? If they
are not, please contact me so we can update our records.
[PROVIDER NAME]

[PROVIDER NAME]

[PROVIDER NAME]

[PROVIDER NAME]

If they are still providing patient care, may I ask for your help in reaching out to these providers?
The survey is ending soon. Mathematica is happy to answer any questions you or the provider
may have about the survey. Please feel free to contact me at (XXX)-XXX-XXXX or by email.
We appreciate your support of this important evaluation.
Sincerely,

Holly Matulewicz, Senior Survey Researcher
Mathematica Survey Director for the RETAIN evaluation

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OMB No.: XXX
Expiration Date: XX/XX/2023

Provider R2 Survey: Provider thank-you letter

Dear Provider:
Thank you for participating in the Retaining Employment and Talent After Injury/Illness
Network (RETAIN) provider survey. We appreciate your help and support of the
evaluation.
Enclosed is a check for $45 as a token of our appreciation.
If you have any questions about the study, please contact Mathematica study team by
phone at xxx-xxx-xxxx or by email (xxxx@mathematica-mpr.org).
Thank you again for your support of this important study.
Best regards,

Holly Matulewicz, Senior Survey Researcher
Mathematica Survey Director for the RETAIN evaluation

More information about RETAIN is available at: www.xxx.xxxxxx

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