Page 413 - QAP Manual 2020

Surveyor Feedback Form
This form is used to get a sense of the survey process. It includes questions about the amount of time it took to complete surveys, how the
survey was administered, and whether the surveyor had difficulties with any questions. This information is useful for states in planning for the
NCI surveys and helps to improve the survey tool itself.

Surveyor Feedback Form
Q# Q Intent Other Notes

1 How long did it take to complete the direct Helps determine approximately If the average time is especially low or high, it may
face-to-face survey(s) (Sections I and II only)? how long the face-to-face indicate a need for additional training or shadowing
meeting takes of surveyors and/or a review of survey protocol.
The average time is around 40 minutes, with a range
to allow for people who need more time to
communicate their answers and complete the survey.

2 How long did it take to complete the entire Helps determine the entire
form, including making phone calls, collecting amount of time surveyors
background information, arranging and should expect to spend per
conducting the face-to-face survey, travel survey
time, etc.?

3 Were there any questions that were Helps identify opportunities to Note: Surveyors should only give information about
problematic? improve the survey; surveyors the questions themselves.
should complete this if there Do not include any identifying information about the
are questions that were
individual surveyed, his/her services, etc.
particularly difficult to ask/have
answered because of wording,
response options, or other
difficulties

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