Page 196 - QAP Manual 2020

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

First, take a few minutes to introduce yourself and make the person feel comfortable. Read or
paraphrase the following introduction. Pause after each statement, making sure the respondent
understands.

“Hi, my name is ____. I'm from _____, and I'm here to ask you some questions about where you live,
where you work, your friends and family, and the people who help you. By answering these questions,
you are helping us figure out how people in California are doing, and how to make supports and
services better.”

“This is not a test, and there are no right or wrong answers to these questions. If you don't understand
a question, let me know and I'll try to explain it. It's okay if you don't know how to answer. Whatever
answers you give, you will not get into trouble and no one will be mad at you.”

“You don't have to answer any questions that you don't want to. Just tell me if you don't want to
answer.”

“I'd like to know your opinions, how you feel about things. Whatever you tell me will be kept private,
so you can be honest.”

AGREEMENT TO PARTICIPATE: Did the person indicate to the surveyor that
they agree to participate in the NCI survey discussion?

□ 2. Yes
□ 1. No

Page 33 of 76