Page 269 - QAP Manual 2020

Pre-Survey

Q# Q Intent Other Notes
PS-3 Person who can provide Provides contact information for the person Employment information collected in the
information about this who may be able to help answer background background section of the survey is used for
individual’s employment information questions on employment analysis. States should use this question to
(BI-43–BI-48)—for example, a job coach determine the person who can help provide the
most accurate information.

PS-4 Proxy Respondents Provides contact information for individuals Reminder: Proxy respondents may only be used
who may be able to complete some or all of for Section II of the survey, and only if the person
Section II of the survey is unwilling or unable to complete the section on
his/her own; if the person is unwilling to
participate, Section II should only be completed
with a proxy respondent if the person gives
consent.

PS-5 Living Arrangement Provides information on the type of Insert name in question: Q63
residence and names of roommates

PS-6 Support Staff Provides name and contact information for Insert name in questions: Q41-Q43 and Q70
all staff who work directly with the individual
PS-7 Employment Provides the name of the person’s place of Insert name in questions: Q7, Q9, Q66
employment
PS-8 Day Program or Sheltered Provides the name of the person’s day Insert name in questions: Q11 and Q67
Workshop program or workshop

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