Page 179 - QAP Manual 2020

NCI™ ADULT IN-PERSON SURVEY (IPS) 2020-21

BI-37 Is the person’s residence controlled by a service provider?
(‘Controlled’ means the service provider is also connected to the property by lease or ownership. This
includes foster care or host home settings.)

Check “NO” if the following applies:

• The person owns or rents from a landlord who is not the provider agency and is not
affiliated with the provider agency in any way.
• The person lives in the home of family/friends.
• The person is living in foster care and the foster care/host home is not controlled by a
provider agency, nor is the foster care home under contract to the service provider agency
to deliver foster care services.

Check “YES” if the following applies:
• If the person changed the provider agency providing his/her supports, he/she would need
to move.

□ 1. No
□ 2. Yes

□ 99. Don’t know
□ 98. Not applicable — person is homeless

BI-38 If this person lives in a group home, an Intermediate Care Facility for individuals with I/DD
(ICF/IID) or specialized institutional facility, is it publicly or privately operated? CHECK ONE.
□ 1. Public (staff are employed by a state or local government entity)

□ 2. Private
□ 99. Don’t know
□ 98. Not applicable – person does not live in a group home, ICF/IID, or specialized institutional
facility

BI-39 Is the person named on the lease, deed, or other legally enforceable rental agreement?

□ 1. No
□ 2. Yes, named on lease or deed
□ 3. Yes, named on other legally enforceable rental agreement
□ 99. Don’t know

BI-40 Does the person own his or her own home?

□ 1. No
□ 2. Yes

□ 99. Don’t know

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