Page 161 - QAP Manual 2020

Questions?
Contact Name
Contact Email
Contact Phone

IN-PERSON SURVEY (IPS) 2020-21

Before you start…

The following are instructions for completing the five parts of this survey.

• Pre-Survey. This information may be useful for scheduling and conducting the face-to-face
surveys. It is not analyzed by HSRI and cannot be downloaded from the Online Data Entry
Survey Application (ODESA).

• Background Information. This information will be analyzed by HSRI and must be collected for
all individuals surveyed. Most states collect this information from case manager or system
records. Some states, however, use surveyors to collect some of this information directly from
the individual, guardian/conservator, or family member; in these cases, the state will specify
the elements to be collected by the surveyor.
• Section I. These questions may only be answered by face-to-face meetings with the person
receiving services and supports. These are subjective, satisfaction-related questions that may
not be answered by anyone else.
• Section II. These questions may be answered by the individual or someone who knows the

person well (proxy respondent)—such as a family member, friend, staff person,
guardian/conservator, or advocate. Service coordinators or case managers are not allowed to
respond to questions in this section. If the individual is answering, the questions need to be
asked face-to-face. If a proxy respondent answers, questions need to be asked face-to-face if at
all possible. Questions for proxy respondents may be asked over the phone only when a face-
to-face meeting is not possible.
• Surveyor Feedback Sheet. This is the last page of the survey. Please fill out one sheet for each

survey you complete.

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