Instrument 5_Contact Information Update Request_extension_CLEAN

Instrument 5

Contact Information Update Request

Response to comments February 2023

S
upporting Youth to be Successful in Life (SYSIL) Youth Survey – Contact Information Update

PRIVACY

Thank you for your continued help with this important study! We will be getting in touch at various times during the study to see how you are doing and get the latest information on how to reach you. This update should take you about 5 minutes to complete and you will receive a $5/$10 e-gift card after you complete this update! The information you provide will be used to contact you about future SYSIL surveys to help us understand your experiences and will help shape programs and improve services provided to youth like you.

Note: References to the $5 gift card will NOT be included in outreach to youth in the control group at 9 months, and a reference to the $10 gift card is only for control youth at the 21 month outreach.

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13): Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. 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 number for this information collection is 0970-0574 and the expiration date is XX/XX/XXXX If you have any comments on this collection of information, including estimated time to complete, please contact Dr. M.C. Bradley at Mathematica at 855-888-2092 or by email at: SYSIL@mathematica-mpr.com.

ALL

A1

A1. First, we would like to know how you are doing! How have you generally felt about your wellbeing over the past 3 months?

Select one only

 Excellent 1

 Very good 2

 Good 3

 Fair 4

 Poor 5

NO RESPONSE M

ALL

A2. Now we would like to make sure we have your most up-to-date contact information. What is your current phone number?

Phone number: (STRING 1)

ALL

A3. What is your current email address?

Email address: (STRING 1)

ALL

A4

A4. Where are you currently living?

 With parent(s) 1

 With other relatives 2

 Your own apartment 3

 Hotel or motel 4

 Friend’s apartment or home 5

 Family member’s apartment/home 6

 On the street 7

 Residential treatment facility 8

A4

 Other (specify) 99

Specify (STRING 75)

 Don’t know d

 Choose not to answer R

NO RESPONSE M

SOFT CHECK: IF A4 =99 AND A4 =NO RESPONSE; Please review the question and enter your “other specify” response.

ALL

A5. What is your current address? If you do not have a current residential address, do you have an address where you currently receive mail?

Street Address 1: (STRING 100)

Street Address 2: (STRING 100)

City: (STRING 100)

State: (STRING 50)

Zip: (STRING 50)

MISSING m

SOFT CHECK: IF RESPONDENT DOES NOT ENTER IN street address 1, city, state, or zip; This information will help us to contact you for future surveys. Can you please provide your full address?

ALL

A6. What is the name of one person who could help us reach you for future surveys?

First Name: (STRING 1)

Last Name: (STRING 1)

ALL

A7. What is the contact information for [FIRST NAME FROM A6]?

Phone number: (STRING 1)

Email address: (STRING 1)

Street Address 1: (STRING 100)

Street Address 2: (STRING 100)

City: (STRING 100)

State: (STRING 50)

Zip: (STRING 50)

ALL

A8

A8. We want to make sure we are able to reach you for future surveys! What is the best way to get in touch with you about the study?

Select one only

 Phone call 1

 Text message 2

 Email 3

 In-person contact 4

 Through Navigator/Chafee Worker 5

NO RESPONSE M

ALL

A9. Thank you for providing this update. Please re-enter your email below and we will email you a $5/$10 e-gift card.

Email address: (STRING 100)

Note: References to the $5 gift card will NOT be included in outreach to youth in the control group at 9 months, and a reference to the $10 gift card is only for control youth at the 21 month outreach.