Page 263 - QAP Manual 2020

Cover Sheet

The cover sheet includes information about the scheduling and set-up of the survey meeting. Not all questions are applicable to all states;
surveyors should contact their NCI coordinator to determine what information must be recorded. Among other information, this sheet is used to
help states better understand reasons surveys cannot be completed be used to determine reasons the survey meeting may not take place and
other attributes of the survey meeting.

Cover Sheet
Q# Q Indicator/Intent Other Notes

SC-1 Survey Code Identifies surveys This code will be supplied by the State or contractor. It is
important that the survey code match the appropriate
survey. If HSRI needs to follow up on a particular survey
during data cleaning, the unique survey code is used in
communications with the State/contractor.
SC-2 Survey Status Identifies reasons that a survey States may use this information to update or correct
meeting was not conducted outdated contact information and understand access
issues in the state.
If there were technology-related barriers to administering
remote survey, proceed to Question SC-3

SC-3 Technology related survey Identifies barriers/challenges related
status to technology if survey meeting was
not conducted

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