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PDF, 3.8 MB - Substance Abuse and Mental Health Services ...

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Exhibit 8.2 2003 NSDUH Field Interviewer Exit Interview<br />

A. Contact Information<br />

Questionnaire ID#:<br />

FI Name:<br />

FI ID:<br />

Hire Date:<br />

Termination Date:<br />

Home Address:<br />

City, State & Zip:<br />

Home Telephone:<br />

Work Telephone:<br />

Field Supervisor:<br />

B. Record of Calls<br />

Date<br />

Day of<br />

Week Time Comments<br />

Result<br />

Code<br />

FI ID<br />

No.<br />

345

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