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Housing Counseling Process Evaluation and Design of ... - HUD User

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Contact Information<br />

Please complete the information below in order to continue.<br />

In case we need to follow up with you to clarify any responses, or contact you in the event there is a <br />

problem that prevents you from completing the survey, please provide the following contact <br />

information for the primary person responsible for completing this survey. <br />

*All fields below are required fields unless otherwise indicated <br />

Prefix: _______ <br />

First Name: _______ <br />

Last Name: _______ <br />

Work Phone Number: _______ <br />

Cell Phone Number (optional): _______<br />

Email: _______ <br />

Confirm Email (please re-type): _______<br />

PROGRAMMING NOTE: Respondents must answer this question to continue.<br />

PAGE BREAK<br />

The following branches are reported as being included in the 9902 data reported by your organization<br />

to <strong>HUD</strong>. For each <strong>of</strong> the branches indicated below, either select ‘Yes – separate survey’, if the<br />

branch submits their own 9902 data <strong>and</strong> should receive a separate survey, or “No”, if the branch’s<br />

information is included in your 9902 data.<br />

PROGRAMMING NOTE: SHOW BRANCES UNDER EACH PARENT AGENCY (IF<br />

APPLICABLE) AND HAVE YES/NO OPTIONS UNDER EACH BRANCH<br />

<br />

<br />

Yes – separate survey<br />

No<br />

PROGRAMMING NOTE: Respondents must have an answer for each branch shown to<br />

continue.<br />

PAGE BREAK<br />

PROGRAMMING NOTE: Before the survey launches, program the following sentence as the<br />

end note to the registration <strong>and</strong> send the survey link to the email address entered in the contact<br />

info. After survey is launched, do not show the following sentence.<br />

Thank you for registering. You will be notified by email when the survey has launched.<br />

PAGE BREAK<br />

Appendix B. Survey <strong>of</strong> <strong>HUD</strong>-Approved <strong>Counseling</strong> Agencies 175

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