Office of Disability, Aging and Long-Term Care Policy (DALTCP): LIST OF INSTRUMENTS
This page alphabetically lists instruments, questionnaires, and other survey/project development forms produced through DALTCP-funded research. (Some projects were funded when DALTCP was known as the Office of Social Services Policy or the Office of Family, Community and Long-Term Care Policy.) The instruments are in the HTML and Portable Document Format (PDF). [You will need a copy of the Acrobat Reader in order to view PDF versions.] The project the instrument was developed for is listed after the title.
We will continue working towards putting ALL versions of Full Reports and Instruments online.
Instrumentss are Listed in This Section Alphabetically (by Title):
A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z
A
All Repondents Questionnaire ( ) -- National Board and Care Survey Design
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/AllResp.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/AllResp.pdf (4 PDF pages)
Applicant Screen (December 1981) -- National Long-Term Care Channeling Demonstration
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/1981/AppSc.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/1981/AppSc.pdf (27 PDF pages)
Assisted Living Discharged Resident Proxy Respondent Telephone Interview -- National Study of Assisted Living for the Frail Elderly
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/ALDRPRTI.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/ALDRPRTI.pdf (11 PDF pages)
Assisted Living Discharged Resident Telephone Interview -- National Study of Assisted Living for the Frail Elderly
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/ALDRTI.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/ALDRTI.pdf (15 PDF pages)
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
B
None at this time.
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
C
Client Contact Log ( ) -- National Long-Term Care Channeling Demonstration
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/ClConLog.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/ClConLog.pdf (8 PDF pages)
Client Tracking Form (March 1982) -- National Long-Term Care Channeling Demonstration
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/1982/ClTracFm.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/1982/ClTracFm.pdf (9 PDF pages)
Clinical Assessment and Research Baseline Instrument: Community Version (January 1982) -- National Long-Term Care Channeling Demonstration
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/1982/carbicv.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/1982/carbicv.pdf (98 PDF pages)
Clinical Baseline Assessment Instrument: Community Version (June 1983) -- National Long-Term Care Channeling Demonstration
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/1983/cbaicv.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/1983/cbaicv.pdf (46 PDF pages)
Clinical Baseline Assessment Instrument: Institutional Version (July 1983) -- National Long-Term Care Channeling Demonstration
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/1983/cbaiiv.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/1983/cbaiiv.pdf (50 PDF pages)
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
D
None at this time.
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
E
Exit Proxy Questionnaire (February 1996) -- National Survey Development: Asset and Health Dynamics of the Oldest Old
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/1996/ExProxQ.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/1996/ExProxQ.pdf (161 PDF pages)
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
F
Facility Screening Questionnaire (1998) -- National Study of Assisted Living for the Frail Elderly
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/FacScQ.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/FacScQ.pdf (11 PDF pages)
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
G
None at this time.
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
H
- Health Information Technology Round Two Screener [http://aspe.hhs.gov/daltcp/instruments/HITscreener.pdf] -- Electronic Health Information Technology Systems: Costs and Benefits
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
I
Interagency Councils Questionnaire ( ) -- National Board and Care Survey Design
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/IntCoun.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/IntCoun.pdf (5 PDF pages)
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
J
None at this time.
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
K
None at this time.
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
L
Licensure Questionnaire ( ) -- National Board and Care Survey Design
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/Licensure.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/Licensure.pdf (19 PDF pages)
Local Agency Questionnaire ( ) -- National Board and Care Survey Design
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/LocalAg.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/LocalAg.pdf (18 PDF pages)
Local Ombudsman Questionnaire ( ) -- National Board and Care Survey Design
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/LocalOm.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/LocalOm.pdf (4 PDF pages)
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
M
None at this time.
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
N
None at this time.
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
O
None at this time.
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
P
Participation Questionnaire ( ) -- Personal Assistance Services "Cash and Counseling" Demonstration/Evaluation
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/DecideFm.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/DecideFm.pdf (9 PDF pages)
Payment/Eligibility Questionnaire ( ) -- National Board and Care Survey Design
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/PayElig.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/PayElig.pdf (10 PDF pages)
Public Voucher for Purchases and Services Other Than Personal ( ) -- National Long-Term Care Channeling Demonstration
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/scheduleC.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/scheduleC.pdf (9 PDF pages)
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
Q
None at this time.
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
R
None at this time.
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
S
Screening Identification Sheet (March 1982) -- National Long-Term Care Channeling Demonstration
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/1982/ScrIDSh.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/1982/ScrIDSh.pdf (9 PDF pages)
Site Monthly Caseload Report ( ) -- National Long-Term Care Channeling Demonstration
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/smcr.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/smcr.pdf (9 PDF pages)
Statement of Funds Applied ( ) -- National Long-Term Care Channeling Demonstration
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/scheduleA.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/scheduleA.pdf (8 PDF pages)
Statement of Project Expenses ( ) -- National Long-Term Care Channeling Demonstration
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/scheduleB.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/scheduleB.pdf (10 PDF pages)
Statement of Research Activity ( ) -- National Long-Term Care Channeling Demonstration
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/scheduleD.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/scheduleD.pdf (8 PDF pages)
[A] Study of the Roles and Use of Licensed Social Workers in the United States (2004) -- Report to Congress on Supply and Demand of Social Workers in Long-Term Care: Listening Sessions
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/2004/rulsw.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/2004/rulsw.pdf (10 PDF pages)
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
T
Time Sheet ( ) -- National Long-Term Care Channeling Demonstration
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/TimeSh.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/TimeSh.pdf (8 PDF pages)
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
U
None at this time.
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
V
VISTA Recruitment: A Survey of Recent Applicants ( ) -- Analyses of VISTA Marketing and Recruitment Activities
Full HTML Version: http://aspe.hhs.gov/daltcp/instruments/VISTArec.htm
Full PDF Version: http://aspe.hhs.gov/daltcp/instruments/VISTArec.pdf (10 PDF pages)
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
W
None at this time.
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
X
None at this time.
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
Y
None at this time.
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
Z
None at this time.
| Another Instrument?: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |