Page 185 - QAP Manual 2020
P. 185

NCI™ ADULT IN-PERSON SURVEY (IPS) 2020-21
                                                                            □  1. No      Number of       N/A                   N/A               N/A
                                  BI-48 Unpaid activity in a facility-based
                                  setting                                   □  2. Yes     hours spent at
                                                                            □  99. Don’t   activity in
                                  (e.g., day habilitation, seniors programs,   know       typical two-
                                  drop-in centers)                                        week period:
                                                                                          __ __ __
                                  If the person does more than one activity of
                                  this type, please refer to the activity at which
                                  the person has spent the most time in the
                                  past two weeks.











































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