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Appendix B: Telephone Survey of Frontline Workers: Survey Instrument
MPR
ID:|__|__|__|__|__|__|__|__|
SITE ID: |__|__|
SITE ID: |__|__|
| OMB NO. 0970-0300 APPROVAL EXPIRES: 05/31/2009 |
Mathematica Policy Research, Inc. |
U.S. Department of Health and Human Services
Study of Sanctions Policies Survey Instrument 6214-005
November 6, 2006
INTERVIEWER NAME: ____________________________ INTERVIEWER ID#: |__|__|__|__|__| |
| According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0970-0300. The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. |
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