Individual/Family Encounter Log

Variable Name Question/Variable Description Value Labels/Format

id Participant ID Sequence ID (i.e., 1, 2, 3. . .)

FormVersion OMB form expiration year YYYY (e.g., 2018)

ProjectNumber Project number

FEMA disaster declaration number (e.g., NJ4086)

ProviderName Provider name Text

ProviderNumber Provider number

Identifier consisting of numbers and/or

letters. The number is system generated.

disaster_ISP Project phase

1 = ISP

2 = ISP Extension

3 = RSP

4 = RSP Extension

DateOfService Date of service MM/DD/YYYY

County County of service County name

employee_number1 First employee number

Identifier consisting of numbers and/or

letters. The format can vary by project.

employee_number2 Second employee number

Identifier consisting of numbers and/or

letters. The format can vary by project.

zipcode ZIP code 5 digit number

visittype_code Visit type code

1 = Individual

2 = Family or household (2 individuals)

3 = Family or household (3 individuals)

4 = Family or household (4 individuals)

5 = Family or household (5 individuals)

6 = Family or household (6 or more 

individuals)

visitnumber_code Visit number code

1 = First visit

2 = Second visit

3 = Third visit

4 = Fourth visit

5 = Fifth visit or later

duration_code Duration code

1 = 15–29 minutes

2 = 30–44 minutes

3 = 45–59 minutes

4 = 60 minutes or more

male_preschool

Number of males, preschool(0–

5 years)

Number (i.e., 1, 2, 3, 4. . .)

male_child

Number of males, child (6–

11years)

Number (i.e., 1, 2, 3, 4. . .)

male_adolescent

Number of males, 

adolescent(12–17 years)

Number (i.e., 1, 2, 3, 4. . .)

male_adult18

Number of males, adult (18–

39years)

Number (i.e., 1, 2, 3, 4. . .)

male_adult40

Number of males, adult (40–

64years)

Number (i.e., 1, 2, 3, 4. . .)
Individual/Family Encounter Log

Variable Name Question/Variable Description Value Labels/Format

male_adult65

Number of males, older 

adult(65 years or older)

Number (i.e., 1, 2, 3, 4. . .)

female_preschool

Number of females,

preschool(0–5 years)

Number (i.e., 1, 2, 3, 4. . .)

female_child

Number of females, child (6–

11years)

Number (i.e., 1, 2, 3, 4. . .)

female_adolescent

Number of females,

adolescent(12–17 years)

Number (i.e., 1, 2, 3, 4. . .)

female_adult18

Number of females, adult(18–

39 years)

Number (i.e., 1, 2, 3, 4. . .)

female_adult40

Number of females, adult(40–

64 years)

Number (i.e., 1, 2, 3, 4. . .)

female_adult65

Number of females, older

adult(65 years or older)

Number (i.e., 1, 2, 3, 4. . .)

transgender_preschool

Number of 

transgender,preschool (0–5 

years)

Number (i.e., 1, 2, 3, 4. . .)

transgender_child

Number of transgender,

child(6–11 years)

Number (i.e., 1, 2, 3, 4. . .)

transgender_adolescent

Number of 

transgender,adolescent (12–17 

years)

Number (i.e., 1, 2, 3, 4. . .)

transgender_adult18

Number of transgender,

adult(18–39 years)

Number (i.e., 1, 2, 3, 4. . .)

transgender_adult40

Number of transgender,

adult(40–64 years)

Number (i.e., 1, 2, 3, 4. . .)

transgender_adult65

Number of transgender,

olderadult (65 years or older)

Number (i.e., 1, 2, 3, 4. . .)

participant_total Number of total participants Number (i.e., 1, 2, 3, 4. . .)

immigrate_yesno_code

Did any of the

participantsimmigrate to the

United States in the past 5 

years?

1 = Yes

2 = No

race_1 American Indian/Alaska Native

1 = Yes

0 = No

race_2 Asian

1 = Yes

0 = No

race_3 Black or African American

1 = Yes

0 = No

race_4 Native Hawaiian/PacificIslander

1 = Yes

0 = No

race_5 White

1 = Yes

0 = No

race_6 Hispanic or Latino

1 = Yes

0 = No
Individual/Family Encounter Log

Variable Name Question/Variable Description Value Labels/Format

primarylanguage_code Primary language code

1 = English

2 = Spanish

3 = Other

primarylanguageother Primary language other Text

disability_1

Physical (mobility, visual,

hearing, medical, etc.)

1 = Yes

0 = No

disability_2

Intellectual/cognitive (learning

disability, developmental delay, 

etc.)

1 = Yes

0 = No

disability_3

Mental health/substance misuse 

(psychiatric,substance 

dependence, etc.)

1 = Yes

0 = No

servicelocation_codes Location of service code

1= School or childcare (all ages through 

college)

2 = Community center

3 = Provider site/mental health agency 

(agency involved with the CCP)

4 = Workplace

5 = Disaster recovery center

6 = Place of worship

7 = Retail

8 = Public place/event (e.g., street, 

sidewalk, town square, fair, festival, sports) 

9 = Temporary home

10 = Temporary home, any children < age 

18 live in the home

11 = Permanent home

12 = Permanent home, any children < age 

18 live in the home

13 = Phone counseling (outbound call to 

participants)

14 = Hotline, helpline, crisis line (inbound 

calls to staff)

15 = Medical center

16 = Other

17 = Virtual

servicelocationother Location of service other Text

risk_01 Family missing/dead

1 = Yes

0 = No

risk_02 Friend missing/dead

1 = Yes

0 = No

risk_03 Pet missing/dead

1 = Yes

0 = No
Individual/Family Encounter Log

Variable Name Question/Variable Description Value Labels/Format

risk_04 Home damaged or destroyed

1 = Yes

0 = No

risk_05 Vehicle or major property loss

1 = Yes

0 = No

risk_06 Other financial loss

1 = Yes

0 = No

risk_07

Disaster un- or

underemployed(self or

household member)

1 = Yes

0 = No

risk_08

Illness, injury, or physical

harm(self or household

member)

1 = Yes

0 = No

risk_09

Life was threatened (self

orhousehold member)

1 = Yes

0 = No

risk_10

Witnessed death/injury (self

orhousehold member)

1 = Yes

0 = No

risk_11

Assisted with

rescue/recovery(self or

household member)

1 = Yes

0 = No

risk_12

Changed schools or

learningformat (e.g., virtual)

1 = Yes

0 = No

risk_13

Prolonged separation fromsocial

network/family, physical 

isolation, or social distancing

1 = Yes

0 = No

risk_14

Evacuated quickly with no

timeto prepare

1 = Yes

0 = No

risk_15

Displaced from home 1 week 

ormore

1 = Yes

0 = No

risk_16

Sheltered in place or

soughtshelter due to

immediate threat of danger

1 = Yes

0 = No

risk_17

Past substance

use/mentalhealth problem

1 = Yes

0 = No

risk_18 Preexisting physical disability

1 = Yes

0 = No

risk_19 Past trauma

1 = Yes

0 = No

risk_20 Disaster-caused food insecurity

1 = Yes

0 = No

risk_21

Reduced or no access toreliable 

information/communication

1 = Yes

0 = No

risk_22

Reduced or no access toreliable

transportation

1 = Yes

0 = No
Individual/Family Encounter Log

Variable Name Question/Variable Description Value Labels/Format

eventparticipant_code Event reaction code

1 = 1 

2 = 2 

3 = 3 

4 = 4 

5 = 5 

6 = 6 or more

behavioral_1 Extreme change in activity level

1 = Yes

0 = No

behavioral_2 Excessive drug or alcohol use

1 = Yes

0 = No

behavioral_3 Isolation/withdrawal

1 = Yes

0 = No

behavioral_4 On guard/hypervigilant

1 = Yes

0 = No

behavioral_5 Agitated/jittery/shaky

1 = Yes

0 = No

behavioral_6 Violent or dangerous behavior

1 = Yes

0 = No

behavioral_7

Acts younger than age (children

or youth)

1 = Yes

0 = No

emotional_1 Sadness, tearful

1 = Yes

0 = No

emotional_2 Irritable, angry

1 = Yes

0 = No

emotional_3 Anxious, fearful

1 = Yes

0 = No

emotional_4 Despair, hopeless

1 = Yes

0 = No

emotional_5 Feelings of guilt/shame

1 = Yes

0 = No

emotional_6 Numb, disconnected

1 = Yes

0 = No

physical_1 Headaches

1 = Yes

0 = No

physical_2 Stomach problems

1 = Yes

0 = No

physical_3

Difficulty falling or staying

asleep

1 = Yes

0 = No

physical_4 Eating problems

1 = Yes

0 = No

physical_5 Worsening of health problems

1 = Yes

0 = No

physical_6 Fatigue, exhaustion

1 = Yes

0 = No
Individual/Family Encounter Log

Variable Name Question/Variable Description Value Labels/Format

cognitive_1 Distressing dreams, nightmares

1 = Yes

0 = No

cognitive_2 Intrusive thoughts, images

1 = Yes

0 = No

cognitive_3 Difficulty concentrating

1 = Yes

0 = No

cognitive_4 Difficulty remembering things

1 = Yes

0 = No

cognitive_5 Difficulty making decisions

1 = Yes

0 = No

cognitive_6

Preoccupied

withdeath/destruction

1 = Yes

0 = No

copingwell Coping well

1 = Yes

0 = No

informationabout_1 Reactions to disaster

1 = Yes

0 = No

informationabout_2 Community resources

1 = Yes

0 = No

informationabout_3 This crisis counseling program

1 = Yes

0 = No

tipsfor_1 Reducing negative thoughts

1 = Yes

0 = No

tipsfor_2

Managing physical

andemotionalreactions(e.g., 

breathing techniques)

1 = Yes

0 = No

tipsfor_3 Doing positive things

1 = Yes

0 = No

tipsfor_4 Problem solving

1 = Yes

0 = No

healthyconnection_1

Mutual support/building

socialnetwork(s)

1 = Yes

0 = No

healthyconnection_2

Participating in

communityaction

1 = Yes

0 = No

focusother Focus of encounter other

1 = Yes

0 = No

materialprovided_yesno_c

ode

Materials provided for

thisencounter

1 = Yes

2 = No

referral_1

Crisis counseling

programservices(e.g., group

counseling, referral to team 

leader, follow- up visit)

1 = Yes

0 = No
Individual/Family Encounter Log

Variable Name Question/Variable Description Value Labels/Format

referral_2

Mental health services (e.g.,

professional, longer-term 

counseling, treatment, 

behavioral, psychiatric services)

1 = Yes

0 = No

referral_3

Substance misuse services (e.g.,

professional, behavioral, 

medicaltreatment,self-help 

groups such as Alcoholics 

Anonymous or Narcotics

Anonymous)

1 = Yes

0 = No

referral_4

Community services (e.g.,

FEMA, loans, housing, 

employment,socialservices)

1 = Yes

0 = No

referral_5

Resources for those

withdisabilities, or other access

or functional needs

1 = Yes

0 = No

referral_6 Other

1 = Yes

0 = No

referralother Referral other Text

noreferral No referral provided

1 = Yes

0 = No

createdby Person who created the record Text

createdon Date the record was created Date

updatedby Person who updated the record Text

updatedon Date the record was updated Date
Group Encounter Log

Variable Name Question/Variable Description Value Labels/Format

id Participant ID Sequence ID (i.e., 1, 2, 3. . .)

FormVersion Form version YYYY (e.g., 2018)

ProjectNumber Project number

FEMA disaster declaration number

(e.g., NJ-4086)

ProviderName Provider name Text

ProviderNumber Provider number

Identifier consisting of numbers

and/or letters. The number is system 

generated.

disaster_ISP Project phase

1 = ISP

2 = ISP Extension

3 = RSP

4 = RSP Extension

DateOfService Date of service MM/DD/YYYY

County County of service County name

employee_number1 First employee number

Identifier consisting of numbers 

and/or letters. The format can vary

by project.

employee_number2 Second employee number

Identifier consisting of numbers

and/or letters. The format can vary 

by project.

zipcode ZIP code 5 digit number

servicetype_code Type of service code

1 = Group counseling

2 = Public education

groupservicelocation_code Location of service code

1 = School or childcare (all ages 

through college)

2 = Community center (e.g., 

recreation club)

3 = Provider site/mental health 

agency (agency involved with the 

CCP)

4 = Workplace (workplace of the 

disastersurvivor or first responder) 

5 = Disaster recovery center (e.g., 

FEMA, American Red Cross)

6 = Place of worship (e.g., church, 

synagogue, mosque)

7 = Home (temporary or permanent)

8 = Retail (e.g., restaurant, mall, 

shopping center, store)

9 = Medical center

10 = Public place/event (e.g., street, 

sidewalk, town square, fair, festival, 

sports)

11 = Other

12 = Virtual

groupservicelocationother Location of service other Text
Group Encounter Log

Variable Name Question/Variable Description Value Labels/Format

sessionnumber_code Session number code

1 = First session of group expected to 

meet once

2 = First session of group expected to 

meet more than once

3 = Second or greater session of

ongoing group

participant18 Number under age 18 Number (i.e., 1, 2, 3, 4. . .)

participant64 Number ages 18–64 Number (i.e., 1, 2, 3, 4. . .)

participant65 Number ages 65 and older Number (i.e., 1, 2, 3, 4. . .)

participanttotal Number of participants total Number (i.e., 1, 2, 3, 4. . .)

duration_code Duration code

1 = 15–29 minutes

2 = 30–44 minutes

3 = 45–59 minutes

4 = 60 minutes or more

identities_code Group identities

1 = Children or youth

2 = Adult survivors

3 = Public safety workers and first 

responders

4 = Other recovery workers

5 = Mixed group, no clear identity

race_1 American Indian/Alaska Native

1 = Yes

0 = No

race_2 Asian

1 = Yes

0 = No

race_3 Black or African American

1 = Yes

0 = No

race_4 Native Hawaiian/Pacific Islander

1 = Yes

0 = No

race_5 White

1 = Yes

0 = No

race_6 Hispanic or Latino

1 = Yes

0 = No

immigrate_yesno_code

Did any of the participants

immigrate to the United States in 

the past 5 years?

1 = Yes

2 = No

disability_1

Physical (mobility, visual, hearing,

medical, etc.)

1 = Yes

0 = No

disability_2

Intellectual/cognitive (learning

disability, developmental delay, etc.)

1 = Yes

0 = No

disability_3

Mental health/substance misuse

(psychiatric,substance dependence, 

etc.)

1 = Yes

0 = No

informationabout_1 Reactions to disaster

1 = Yes

0 = No

informationabout_2 Community resources

1 = Yes

0 = No
Group Encounter Log

Variable Name Question/Variable Description Value Labels/Format

informationabout_3 This crisis counseling program

1 = Yes

0 = No

tipsfor_1 Reducing negative thoughts

1 = Yes

0 = No

tipsfor_2

Managing physical and emotional

reactions(e.g., breathing 

techniques)

1 = Yes

0 = No

tipsfor_3 Doing positive things

1 = Yes

0 = No

tipsfor_4 Problem solving

1 = Yes

0 = No

healthyconnection_1

Mutual support/building social

network(s)

1 = Yes

0 = No

healthyconnection_2 Participating in community action

1 = Yes

0 = No

focusother Focus of group session other Text

materialprovided_yesno_code

Were flyers, brochures, handouts, or

other materials provided to 

participants?

1 = Yes

2 = No

createdby Person who created the record Text

createdon Date the record was created Date

updatedby Person who updated the record Text

updatedon Date the record was updated Date
Weekly Tally Sheet

Variable Name Question/Variable Description Value Labels/Format

id Participant ID Sequence ID (i.e., 1, 2, 3. . .)

FormVersion Form version YYYY (e.g., 2018)

ProjectNumber Project number

FEMA disaster declaration number

(e.g., NJ-4086)

ProviderName Provider name Text

ProviderNumber Provider number

Identifier consisting of numbers 

and/or letters. The number is

system generated.

disaster_ISP Project ISP

1 = ISP

2 = ISP Extension

3 = RSP

4 = RSP Extension

DateOfService Date of service MM/DD/YYYY

County County of service County name

employee_number1 First employee number

Identifier consisting of numbers 

and/or letters. The format can vary

by project.

sunday11

Sunday: In-person or virtual

briefeducational or supportive contact

Number (i.e., 1, 2, 3, 4. . .)

monday11

Monday: In-person or virtual

briefeducational or supportive contact

Number (i.e., 1, 2, 3, 4. . .)

tuesday11

Tuesday: In-person or virtual

briefeducational or supportive contact

Number (i.e., 1, 2, 3, 4. . .)

wednesday11

Wednesday: In-person or virtual

briefeducational or supportive contact

Number (i.e., 1, 2, 3, 4. . .)

thursday11

Thursday: In-person or virtual

briefeducational or supportive contact

Number (i.e., 1, 2, 3, 4. . .)

friday11

Friday: In-person or virtual

briefeducational or supportive contact

Number (i.e., 1, 2, 3, 4. . .)

saturday11

Saturday: In-person or virtual

briefeducational or supportive contact

Number (i.e., 1, 2, 3, 4. . .)

total11

Total: In-person or virtual

briefeducational or supportive contact

Number (i.e., 1, 2, 3, 4. . .)

sunday12

Sunday: Telephone contact by crisis 

counselor (outbound calls 

toparticipants)

Number (i.e., 1, 2, 3, 4. . .)

monday12

Monday: Telephone contact by crisis 

counselor (outbound calls 

toparticipants)

Number (i.e., 1, 2, 3, 4. . .)

tuesday12

Tuesday: Telephone contact by crisis 

counselor (outbound calls 

toparticipants)

Number (i.e., 1, 2, 3, 4. . .)

wednesday12

Wednesday: Telephone contact

bycrisis counselor (outbound calls to 

participants)

Number (i.e., 1, 2, 3, 4. . .)
Weekly Tally Sheet

Variable Name Question/Variable Description Value Labels/Format

thursday12

Thursday: Telephone contact by crisis 

counselor (outbound calls to

participants)

Number (i.e., 1, 2, 3, 4. . .)

friday12

Friday: Telephone contact by crisis 

counselor (outbound calls to

participants)

Number (i.e., 1, 2, 3, 4. . .)

saturday12

Saturday: Telephone contact by crisis 

counselor (outbound calls to

participants)

Number (i.e., 1, 2, 3, 4. . .)

total12

Total: Telephone contact by crisis 

counselor (outbound calls to

participants)

Number (i.e., 1, 2, 3, 4. . .)

sunday13

Sunday: Hotline/helpline/lifeline 

contact (inbound calls from

participants)

Number (i.e., 1, 2, 3, 4. . .)

monday13

Monday: Hotline/helpline/lifeline

contact (inbound callsfrom 

participants)

Number (i.e., 1, 2, 3, 4. . .)

tuesday13

Tuesday: Hotline/helpline/lifeline

contact (inbound callsfrom 

participants)

Number (i.e., 1, 2, 3, 4. . .)

wednesday13

Wednesday: Hotline/helpline/lifeline

contact (inbound callsfrom 

participants)

Number (i.e., 1, 2, 3, 4. . .)

thursday13

Thursday: Hotline/helpline/lifeline

contact (inbound callsfrom 

participants)

Number (i.e., 1, 2, 3, 4. . .)

friday13

Friday: Hotline/helpline/lifeline 

contact (inbound calls from

participants)

Number (i.e., 1, 2, 3, 4. . .)

saturday13

Saturday: Hotline/helpline/lifeline 

contact (inbound calls from

participants)

Number (i.e., 1, 2, 3, 4. . .)

total13

Total: Hotline/helpline/lifeline contact

(inbound calls from participants)

Number (i.e., 1, 2, 3, 4. . .)

sunday14

Sunday: Electronic interaction

(email,text, chat, direct messages, etc.)

Number (i.e., 1, 2, 3, 4. . .)

monday14

Monday: Electronic interaction (email,

text, chat, direct messages, etc.)

Number (i.e., 1, 2, 3, 4. . .)

tuesday14

Tuesday: Electronic interaction (email,

text, chat, direct messages, etc.)

Number (i.e., 1, 2, 3, 4. . .)

wednesday14

Wednesday: Electronic interaction 

(email, text, chat, direct messages,

etc.)

Number (i.e., 1, 2, 3, 4. . .)
Weekly Tally Sheet

Variable Name Question/Variable Description Value Labels/Format

thursday14

Thursday: Electronic interaction 

(email, text, chat, direct messages,etc.)

Number (i.e., 1, 2, 3, 4. . .)

friday14

Friday: Electronic interaction

(email,text, chat, direct messages, etc.)

Number (i.e., 1, 2, 3, 4. . .)

saturday14

Saturday: Electronic interaction(email,

text, chat, direct messages,

Number (i.e., 1, 2, 3, 4. . .)

total14

Total: Electronic interaction

(email,text, chat, direct messages, etc.)

Number (i.e., 1, 2, 3, 4. . .)

sunday15

Sunday: Community networking

andcoalition building

Number (i.e., 1, 2, 3, 4. . .)

monday15

Monday: Community networking

andcoalition building

Number (i.e., 1, 2, 3, 4. . .)

tuesday15

Tuesday: Community networking

andcoalition building

Number (i.e., 1, 2, 3, 4. . .)

wednesday15

Wednesday: Community

networkingand coalition building

Number (i.e., 1, 2, 3, 4. . .)

thursday15

Thursday: Community networking

andcoalition building

Number (i.e., 1, 2, 3, 4. . .)

friday15

Friday: Community networking

andcoalition building

Number (i.e., 1, 2, 3, 4. . .)

saturday15

Saturday: Community networking

andcoalition building

Number (i.e., 1, 2, 3, 4. . .)

total15

Total: Community networking

andcoalition building

Number (i.e., 1, 2, 3, 4. . .)

sunday21 Sunday: Material handed to people Number (i.e., 1, 2, 3, 4. . .)

monday21 Monday: Material handed to people Number (i.e., 1, 2, 3, 4. . .)

tuesday21 Tuesday: Material handed to people Number (i.e., 1, 2, 3, 4. . .)

wednesday21 Wednesday: Material handed topeople

Number (i.e., 1, 2, 3, 4. . .)

thursday21 Thursday: Material handed to people Number (i.e., 1, 2, 3, 4. . .)

friday21 Friday: Material handed to people Number (i.e., 1, 2, 3, 4. . .)

saturday21 Saturday: Material handed to people Number (i.e., 1, 2, 3, 4. . .)

total21 Total: Material handed to people Number (i.e., 1, 2, 3, 4. . .)

sunday22

Sunday: Material emailed, mailed, 

and/or left at a person's

unattendedhome

Number (i.e., 1, 2, 3, 4. . .)

monday22

Monday: Material emailed, mailed, 

and/or left at a person's

unattendedhome

Number (i.e., 1, 2, 3, 4. . .)

tuesday22

Tuesday: Material emailed, mailed, 

and/or left at a person's

unattendedhome

Number (i.e., 1, 2, 3, 4. . .)
Weekly Tally Sheet

Variable Name Question/Variable Description Value Labels/Format

wednesday22

Wednesday: Material emailed, mailed,

and/or left at a person's unattended

home

Number (i.e., 1, 2, 3, 4. . .)

thursday22

Thursday: Material emailed, mailed, 

and/or left at a person's unattended

home

Number (i.e., 1, 2, 3, 4. . .)

friday22

Friday: Material emailed, mailed, 

and/or left at a person's unattended

home

Number (i.e., 1, 2, 3, 4. . .)

saturday22

Saturday: Material emailed, mailed, 

and/or left at a person's unattended

home

Number (i.e., 1, 2, 3, 4. . .)

total22

Total: Material emailed, mailed, 

and/or left at a person's unattended

home

Number (i.e., 1, 2, 3, 4. . .)

sunday23 Sunday: Material left in public places Number (i.e., 1, 2, 3, 4. . .)

monday23 Monday: Material left in public places Number (i.e., 1, 2, 3, 4. . .)

tuesday23 Tuesday: Material left in public places Number (i.e., 1, 2, 3, 4. . .)

wednesday23

Wednesday: Material left in public

places

Number (i.e., 1, 2, 3, 4. . .)

thursday23 Thursday: Material left in public Number (i.e., 1, 2, 3, 4. . .)

friday23 Friday: Material left in public places Number (i.e., 1, 2, 3, 4. . .)

saturday23 Saturday: Material left in public places Number (i.e., 1, 2, 3, 4. . .)

total23 Total: Material left in public places Number (i.e., 1, 2, 3, 4. . .)

sunday24 Sunday: Mass media Number (i.e., 1, 2, 3, 4. . .)

monday24 Monday: Mass media Number (i.e., 1, 2, 3, 4. . .)

tuesday24 Tuesday: Mass media Number (i.e., 1, 2, 3, 4. . .)

wednesday24 Wednesday: Mass media Number (i.e., 1, 2, 3, 4. . .)

thursday24 Thursday: Mass media Number (i.e., 1, 2, 3, 4. . .)

friday24 Friday: Mass media Number (i.e., 1, 2, 3, 4. . .)

saturday24 Saturday: Mass media Number (i.e., 1, 2, 3, 4. . .)

total24 Total: Mass media Number (i.e., 1, 2, 3, 4. . .)

sunday25 Sunday: Social media posts Number (i.e., 1, 2, 3, 4. . .)

monday25 Monday: Social media posts Number (i.e., 1, 2, 3, 4. . .)

tuesday25 Tuesday: Social media posts Number (i.e., 1, 2, 3, 4. . .)

wednesday25 Wednesday: Social media posts Number (i.e., 1, 2, 3, 4. . .)

thursday25 Thursday: Social media posts Number (i.e., 1, 2, 3, 4. . .)

friday25 Friday: Social media posts Number (i.e., 1, 2, 3, 4. . .)

saturday25 Saturday: Social media posts Number (i.e., 1, 2, 3, 4. . .)

total25 Total: Social media posts Number (i.e., 1, 2, 3, 4. . .)

sunday26

Sunday: Social

mediaimpressions/reach

Number (i.e., 1, 2, 3, 4. . .)

monday26

Monday: Social

mediaimpressions/reach

Number (i.e., 1, 2, 3, 4. . .)
Weekly Tally Sheet

Variable Name Question/Variable Description Value Labels/Format

tuesday26

Tuesday: Social media

impressions/reach

Number (i.e., 1, 2, 3, 4. . .)

wednesday26

Wednesday: Social media

impressions/reach

Number (i.e., 1, 2, 3, 4. . .)

thursday26

Thursday: Social media

impressions/reach

Number (i.e., 1, 2, 3, 4. . .)

friday26 Friday: Social media Number (i.e., 1, 2, 3, 4. . .)

saturday26

Saturday: Social media

impressions/reach

Number (i.e., 1, 2, 3, 4. . .)

total26 Total: Social media impressions/reach Number (i.e., 1, 2, 3, 4. . .)

sunday27 Sunday: Social media engagement Number (i.e., 1, 2, 3, 4. . .)

monday27 Monday: Social media engagement Number (i.e., 1, 2, 3, 4. . .)

tuesday27 Tuesday: Social media engagement Number (i.e., 1, 2, 3, 4. . .)

wednesday27 Wednesday: Social media Number (i.e., 1, 2, 3, 4. . .)

thursday27 Thursday: Social media engagement Number (i.e., 1, 2, 3, 4. . .)

friday27 Friday: Social media engagement Number (i.e., 1, 2, 3, 4. . .)

saturday27 Saturday: Social media engagement Number (i.e., 1, 2, 3, 4. . .)

total27 Total: Social media engagement Number (i.e., 1, 2, 3, 4. . .)

createdby Person who created the record Text

createdon Date the record was created Date

updatedby Person who updated the record Text

updatedon Date the record was updated Date
Adult Assessment and Referral Tool

Variable Name Question/Variable Description Value Labels

id Participant ID Sequence ID (e.g., 1, 2, 3. . .)

FormVersion Form version YYYY (e.g., 2018)

ProjectNumber Project number

FEMA disaster declaration number (e.g., NJ4086)

ProviderName Provider name Text

ProviderNumber Provider number

Identifier consisting of numbers and/or letters.

The number is system generated.

disaster_ISP Project phase

1 = ISP

2 = ISP Extension

3 = RSP

4 = RSP Extension

DateOfService Date of service MM/DD/YYYY

County County of service County name

employee_number1 First employee number

Identifier consisting of numbers and/or letters.

The format can vary by project.

employee_number2 Second employee number

Identifier consisting of numbers and/or letters.

The format can vary by project.

zipcode ZIP code 5 digit number

servicelocation_codes Location of service code

1 = School or childcare (all ages through 

college)

2 = Community center (e.g., recreation club)

3 = Provider site/mental health agency (agency 

involved with the CCP)

4 = Workplace

5 = Disaster recovery center

6 = Place of worship (e.g., church, synagogue, 

mosque)

7 = Retail

8 = Public place/event

9 = Temporary home

10 = Temporary home, any children < age 18 

live in the home

11 = Permanent home

12 = Permanent home, any children < age 18 

live in the home

13 = Phone counseling (outbound call to 

participants)

14 = Hotline, helpline, crisis line (inbound calls 

to staff)

15 = Medical center

16 = Other

17 = Virtual

servicelocationother Location of service other Text
Adult Assessment and Referral Tool

Variable Name Question/Variable Description Value Labels

visitnumber_code Visit number code

1 = First visit

2 = Second visit

3 = Third visit

4 = Fourth visit

5 = Fifth visit or later

duration_code Duration of visit

1 = 15–29 minutes

2 = 30–44 minutes

3 = 45–59 minutes

4 = 60 minutes or more

leadpresent_yesno_code

Was the team lead or supervisory

staff present during administering 

this tool?

1 = Yes

0 = No

risk_01 Family missing/dead

1 = Yes

0 = No

risk_02 Friend missing/dead

1 = Yes

0 = No

risk_03 Pet missing/dead

1 = Yes

0 = No

risk_04 Home damaged or destroyed

1 = Yes

0 = No

risk_05 Vehicle or major property loss

1 = Yes

0 = No

risk_06 Other financial loss

1 = Yes

0 = No

risk_07

Disaster un- or underemployed (self

or household member)

1 = Yes

0 = No

risk_08

Illness, injury, or physical harm (self

or household member)

1 = Yes

0 = No

risk_09

Life was threatened (self or

household member)

1 = Yes

0 = No

risk_10

Witnessed death/injury (self or

household member)

1 = Yes

0 = No

risk_11

Assisted with rescue/recovery (self

or household member)

1 = Yes

0 = No

risk_12

Changed schools or learning format

(e.g., virtual)

1 = Yes

0 = No

risk_13

Prolonged separation from social

network/family physical isolation, or 

social distancing

1 = Yes

0 = No

risk_14

Evacuated quickly with no time to

prepare

1 = Yes

0 = No

risk_15

Displaced from home 1 week or

more

1 = Yes

0 = No
Adult Assessment and Referral Tool

Variable Name Question/Variable Description Value Labels

risk_16

Sheltered in place or sought shelter

due to immediate threat of danger

1 = Yes

0 = No

risk_17

Past substance use/mental health

problem

1 = Yes

0 = No

risk_18 Preexisting physical disability

1 = Yes

0 = No

risk_19 Past trauma

1 = Yes

0 = No

risk_20 Disaster-caused food insecurity

1 = Yes

0 = No

risk_21

Reduced or no access to reliable

information/communication

1 = Yes

0 = No

risk_22

Reduced or no access to reliable

transportation

1 = Yes

0 = No

adultage_code Age

1 = Young adult (18–39 years)

2 = Adult (40–64 years)

3 = Older adult (65 years or older)

disability_1

Physical (mobility, visual, hearing,

medical, etc.)

1 = Yes

0 = No

disability_2

Intellectual/cognitive (learning

disability, developmental delay, 

etc.)

1 = Yes

0 = No

disability_3

Mental health/substance misuse

(psychiatric,substance use disorder, 

etc.)

1 = Yes

0 = No

sex_1 Male

1 = Yes

0 = No

sex_2 Female

1 = Yes

0 = No

sex_3 Transgender

1 = Yes

0 = No

sex_4 None of these

1 = Yes

0 = No

primarylanguage_code Primary language code

1 = English

2 = Spanish

3 = Other

primarylanguageother Primary language other Text

race_1 American Indian/Alaska Native

1 = Yes

0 = No

race_2 Asian

1 = Yes

0 = No

race_3 Black or African American

1 = Yes

0 = No
Adult Assessment and Referral Tool

Variable Name Question/Variable Description Value Labels

race_4 Native Hawaiian/Pacific Islander

1 = Yes

0 = No

race_5 White

1 = Yes

0 = No

race_6 Hispanic or Latino

1 = Yes

0 = No

immigrate_yesno_code

Did you immigrate to the United

States in the past 5 years?

1 = Yes

Q1_howmuch_code

How much have you been

bothered by unwanted memories, 

nightmares, or reminders of what 

happened?

1 = Not at all 2 = A little bit

3 = Somewhat 4 = Quite a bit

5 = Very much 6 = N/A

Q2_howmuch_code

How much effort have you made to

avoid thinking or talking about what 

happened or doing things that 

remind you of what happened?

1 = Not at all 2 = A little bit

3 = Somewhat 4 = Quite a bit

5 = Very much 6 = N/A

Q3_howmuch_code

To what extent have you lost

enjoyment in things, kept your 

distance from people, or found it 

difficult to experience feelings 

because of what happened?

1 = Not at all 2 = A little bit

3 = Somewhat 4 = Quite a bit

5 = Very much 6 = N/A

Q4_howmuch_code

How much have you been bothered

by poorsleep, poor concentration, 

jumpiness, irritability, or feeling 

watchful around you because of

what happened?

1 = Not at all 2 = A little bit

3 = Somewhat 4 = Quite a bit

5 = Very much 6 = N/A

Q5_howmuch_code

How down or depressed have you 

been because of what happened?

1 = Not at all 2 = A little bit

3 = Somewhat 4 = Quite a bit

5 = Very much 6 = N/A

Q6_howmuch_code

Has your ability to handle other

stressful events orsituations been 

harmed?

1 = Not at all 2 = A little bit

3 = Somewhat 4 = Quite a bit

5 = Very much 6 = N/A

Q7_howmuch_code

Have your reactions interfered with

how well you take care of your 

physical health? For example, are 

you eating poorly, not getting 

enough rest, smoking more, or 

finding that you have increased

youruse of alcohol or other 

substances?

1 = Not at all 2 = A little bit

3 = Somewhat 4 = Quite a bit

5 = Very much 6 = N/A

Q8_howmuch_code

How distressed or bothered are you 

about your reactions?

1 = Not at all 2 = A little bit

3 = Somewhat 4 = Quite a bit

5 = Very much 6 = N/A
Adult Assessment and Referral Tool

Variable Name Question/Variable Description Value Labels

Q9_howmuch_code

How much have your reactions

interfered with your ability to work 

or carry out your daily activities, 

such as housework or homework?

1 = Not at all 2 = A little bit

3 = Somewhat 4 = Quite a bit

5 = Very much 6 = N/A

Q10_howmuch_code

How much have your reactions

affected your relationships with 

your family or friends or interfered 

with your social, recreational, or 

community activities?

1 = Not at all 2 = A little bit

3 = Somewhat 4 = Quite a bit

5 = Very much 6 = N/A

Q11_howmuch_code

How concerned have you been

about your ability to overcome 

problems you may face without 

further assistance?

1 = Not at all 2 = A little bit

3 = Somewhat 4 = Quite a bit

5 = Very much 6 = N/A

QTotal

Number of responses that were 4 or

5 

Number (i.e., 1, 2, 3, 4. . .)

Q12_yesno_code

I also need to ask: Is there any

possibility that you might hurt or kill 

yourself?

1 = Yes

0 = No

Q12_yesno_code_omb202

In the past month, have you had

thoughts of suicide?

1 = Yes

0 = No

Q13_yesno_code_omb202

Have you ever made a suicide

attempt?

1 = Yes

0 = No

Q14_yesno_code_omb202

If yes to #12 or #13, are you having

thoughts of suicide right now?

1 = Yes

0 = No

referral_1

Other crisis counseling program

services (e.g., group counseling, 

referral to team leader, follow-up 

visit)

1 = Yes

0 = No

referral_2

Mental health services (e.g.,

professional, longer-term 

counseling,treatment, behavioral, 

psychiatric services)

1 = Yes

0 = No

referral_3

Substance misuse services (e.g.,

professional, behavioral, medical 

treatment orself-help groups such 

as Alcoholics Anonymous or

Narcotics Anonymous)

1 = Yes

0 = No

referral_4

Community services (e.g., FEMA,

loans, housing, employment, social 

services)

1 = Yes

0 = No

referral_5

Resources for those with disabilities,

or other access or functional needs

1 = Yes

0 = No

referral_6 Other

1 = Yes

0 = No
Adult Assessment and Referral Tool

Variable Name Question/Variable Description Value Labels

referralother Referral other Text

accept_yesno_code

Did the participant accept one or

more of the referral(s)?

1 = Yes

0 = No

createdby Person who created the record Text

createdon Date the record was created Date

updatedby Person who updated the record Text

updatedon Date the record was updated Date
Child/Youth Assessment and Referral Tool

Variable Name Question/Variable Description Value Labels/Format

id Participant ID Sequence ID (i.e., 1, 2, 3. . .)

FormVersion Form version YYYY (e.g., 2018)

ProjectNumber Project number

FEMA disaster declaration number

(e.g., NJ-4086)

ProviderName Provider name Text

ProviderNumber Provider number

Identifier consisting of numbers

and/or letters. The number is system 

generated.

disaster_ISP Project phase

1 = ISP

2 = ISP Extension

3 = RSP

4 = RSP Extension

DateOfService Date of service MM/DD/YYYY

County County of service County name

employee_number1 First employee number

Identifier consisting of numbers 

and/or letters. The format can vary by

project.

employee_number2 Second employee number

Identifier consisting of numbers

and/or letters. The format can vary by 

project.

zipcode ZIP code 5 digit number

visitnumber_code Visit number code

1 = First visit

2 = Second visit

3 = Third visit

4 = Fourth visit

5 = Fifth visit or later

duration_code Duration of visit

1 = 15–29 minutes

2 = 30–44 minutes

3 = 45–59 minutes

4 = 60 minutes or more

parentpresent_yesno_code

Was a parent or caregiver present during

the visit?

1 = Yes

0 = No

leadpresent_yesno_code

Was the team lead or supervisory staff

present during administering this tool?

1 = Yes

0 = No
Child/Youth Assessment and Referral Tool

Variable Name Question/Variable Description Value Labels/Format

servicelocation_codes Location of service code

1 = School or childcare (all ages 

through college)

2 = Community center (e.g., 

recreation club)

3 = Provider site/mental health

agency (agency involved with the CCP)

4 = Workplace

5 = Disaster recovery center

6 = Place of worship (e.g., church, 

synagogue, mosque)

7 = Retail

8 = Public place/event

9 = Temporary home

10 = Temporary home, any children < 

age 18 live in the home

11 = Permanent home

12 = Permanent home, any children < 

age 18 live in the home

13 = Phone counseling (outbound call 

to participants)

14 = Hotline, helpline, crisisline 

(inbound calls to staff)

15 = Medical center

16 = Other

17 = Virtual

servicelocationother Location of service other Text

risk_01 Family missing/dead

1 = Yes

0 = No

risk_02 Friend missing/dead

1 = Yes

0 = No

risk_03 Pet missing/dead

1 = Yes

0 = No

risk_04 Home damaged or destroyed

1 = Yes

0 = No

risk_05 Vehicle or major property loss

1 = Yes

0 = No

risk_06 Other financial loss

1 = Yes

0 = No

risk_07

Disaster unemployed (self or household

member)

1 = Yes

0 = No

risk_08

Injured or physically harmed (self or

household member)

1 = Yes

0 = No

risk_09

Life was threatened (self or household

member)

1 = Yes

0 = No

risk_10

Witnessed death/injury (self or

household member)

1 = Yes

0 = No
Child/Youth Assessment and Referral Tool

Variable Name Question/Variable Description Value Labels/Format

risk_11

Assisted with rescue/recovery (self or

household member)

1 = Yes

0 = No

risk_12

Had to change schools (for children or

youth)

1 = Yes

0 = No

risk_13 Prolonged separation from family

1 = Yes

0 = No

risk_14

Evacuated quickly with no time to

prepare

1 = Yes

0 = No

risk_15 Displaced from home 1 week or more

1 = Yes

0 = No

risk_16

Sheltered in place or sought shelter due

to immediate threat of danger

1 = Yes

0 = No

risk_17

Past substance use/mental health

problem

1 = Yes

0 = No

risk_18 Preexisting physical disability

1 = Yes

0 = No

risk_19 Past trauma

1 = Yes

0 = No

risk_20 Disaster-caused food insecurity

1 = Yes

0 = No

risk_21

Reduced or no access to reliable

information/communication

1 = Yes

0 = No

risk_22

Reduced or no access to reliable

transportation

1 = Yes

0 = No

childage_code Age

1 = Preschool (0–5 years)

2 = Child (6–11 years)

3 = Adolescent (12–17 years)

gradelevel Grade level in school Number (i.e., 1, 2, 3, 4. . .)

disability_1

Physical (mobility, visual, hearing,

medical, etc.)

1 = Yes

0 = No

disability_2

Intellectual/cognitive (learning disability,

developmental delay, etc.)

1 = Yes

0 = No

disability_3

Mental health/substance misuse

(psychiatric,substance dependence, 

etc.)

1 = Yes

0 = No

sex_1 Male

1 = Yes

0 = No

sex_2 Female

1 = Yes

0 = No

sex_3 Transgender

1 = Yes

0 = No

sex_4 None of these

1 = Yes

0 = No

primarylanguage_code Primary language code

1 = English

2 = Spanish

3 = Other
Child/Youth Assessment and Referral Tool

Variable Name Question/Variable Description Value Labels/Format

primarylanguageother Primary language other Text

race_1 American Indian/Alaska Native

1 = Yes

0 = No

race_2 Asian

1 = Yes

0 = No

race_3 Black or African American

1 = Yes

0 = No

race_4 Native Hawaiian/Pacific Islander

1 = Yes

0 = No

race_5 White

1 = Yes

0 = No

race_6 Hispanic or Latino

1 = Yes

0 = No

immigrate_yesno_code

Did you immigrate to the United States

in the past 5 years?

1 = Yes

Q1_childhowmuch_code

Do you get upset, afraid, or sad when

something makes you think about the 

disaster?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q2_childhowmuch_code

Do you have bad dreams or nightmares 

about what happened?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q3_childhowmuch_code

Do you have upsetting thoughts or

pictures that come into your mind 

about what happened?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q4_childhowmuch_code

Do you try not to think about or talk 

about what happened?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q5_childhowmuch_code

Do you stay away from places, people,

or things that make you remember the 

disaster?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q6_childhowmuch_code

Do you have difficulty falling asleep or

wake up often because of what 

happened?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q7_childhowmuch_code Do you feel jumpy or nervous?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q8_childhowmuch_code

Do you find it harder to concentrate 

orpay attention to things than you

usually do?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q9_childhowmuch_code Do you feel irritable or grouchy?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q10_childhowmuch_code Do you feel sad, down, or depressed?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A
Child/Youth Assessment and Referral Tool

Variable Name Question/Variable Description Value Labels/Format

Q11_childhowmuch_code

Have you had more aches and pains, 

such as stomachaches or headaches?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q12_childhowmuch_code

If in school: Do you find it harder to get 

your schoolwork done?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q13_childhowmuch_code

Do you worry about something else bad

happening to you/your family/your 

friends?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q14_childhowmuch_code

Are you having a harder time getting 

along with family or your friends?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q15_childhowmuch_code

Are you finding it harder to do or enjoy 

activities that you used to enjoy?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q16_childhowmuch_code

Has your child been more clingy or 

worried about separation?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q17_childhowmuch_code

Has your child been more quiet and 

withdrawn?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q18_childhowmuch_code

Has your child talked repeatedly or 

asked questions about the disaster?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q19_childhowmuch_code

Has your child's play been about the 

disaster?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

Q20_childhowmuch_code

Have you noticed changes in your child's

behavior or development (e.g., bedwetting, baby talk, fighting or risk-taking 

behavior, decline in school 

performance)?

0 = Not at all 1 = A little bit

2 = Somewhat 3 = Quite a bit

4 = Very much 5= N/A

QTotal Total number Number (i.e., 1, 2, 3, 4. . .)

hurtingself_yesno_code

Have you had any thoughts or plans

about either hurting or killing yourself?

1 = Yes

0 = No

Q21_yesno_code_omb2020

In the past few weeks, have you wished

you were dead?

1 = Yes

0 = No

Q22_yesno_code_omb2020

In the past few weeks, have you felt that

you or your family would be better off if 

you were dead?

1 = Yes

0 = No

Q23_yesno_code_omb2020

In the past week, have you been having

thoughts about killing yourself?

1 = Yes

0 = No

Q24_yesno_code_omb2020 Have you ever tried to kill yourself?

1 = Yes

0 = No

killingyourself_yesno_code_o

mb2020

Are you having thoughts of killing

yourself now?

1 = Yes

0 = No
Child/Youth Assessment and Referral Tool

Variable Name Question/Variable Description Value Labels/Format

referral_1

Crisis counseling program services (e.g.,

group counseling, referral to team 

leader, follow-up visit)

1 = Yes

0 = No

referral_2

Mental health services (e.g.,

professional, longer-term counseling, 

treatment, behavioral, psychiatric 

services)

1 = Yes

0 = No

referral_3

Substance misuse services (e.g.,

professional, behavioral, medical 

treatment orself-help groups such as 

Alcoholics Anonymous or Narcotics 

Anonymous)

1 = Yes

0 = No

referral_4

Community services (e.g., FEMA, loans,

housing, employment, social services)

1 = Yes

0 = No

referral_5

Resources for those with disabilities, or

other access or functional needs

1 = Yes

0 = No

referral_6 Other

1 = Yes

0 = No

referralother Referral other Text

accept_yesno_code

Did the participant accept one or more

of the referral(s)?

1 = Yes

0 = No

createdby Person who created the record Text

createdon Date the record was created Date

updatedby Person who updated the record Text

updatedon Date the record was updated Date
Provider Feedback Survey

Variable Name Question/Variable Description Value Labels/Format

id Participant ID Sequence ID (i.e., 1, 2, 3. . .)

FormVersion Form version YYYY (e.g., 2018)

ProjectNumber Project number

FEMA disaster declaration number

(e.g., NJ-4086)

disaster_ISP Project ISP

1 = ISP

2 = ISP Extension

3 = RSP 

4 = RSP Extension 

period

How long have you been working for 

the project?

1 = Less than 1 month

2 = 1–3 months

3 = 4–8 months

4 = 9 months or longer

ProviderName Provider name Text

ProviderNumber Provider number

Identifier consisting of numbers

and/or letters. The number is system 

generated.

entrydate Today's date MM/DD/YYYY

Q1_yesno_code_omb2020

Practical skills to engage survivors (e.g.,

hands-on activities, role-play): Have you 

had this training?

1 = Yes

0 = No

Q1_useful_code_omb2020

Practical skills to engage survivors (e.g., 

hands-on activities, role-play): Rate the 

usefulness of this training.

1 = Not at all useful

2 = Slightly useful

3 = Moderately useful

4 = Very useful

5 = Extremely useful

Q2_yesno_code_omb2020

Explaining the normal or expected

reactions to disaster: Have you had this 

training?

1 = Yes

0 = No

Q2_useful_code_omb2020

Explaining the normal or expected 

reactions to disaster: Rate the 

usefulness of this training.

1 = Not at all useful

2 = Slightly useful

3 = Moderately useful

4 = Very useful

5 = Extremely useful

Q3_yesno_code_omb2020

Understanding the CCP outreach to

survivors: Have you had this training?

1 = Yes

0 = No

Q3_useful_code_omb2020

Understanding the CCP outreach to 

survivors: Rate the usefulness of this 

training.

1 = Not at all useful

2 = Slightly useful

3 = Moderately useful

4 = Very useful

5 = Extremely useful

Q4_yesno_code_omb2020

Promoting resilience: Have you had this

training?

1 = Yes

0 = No
Provider Feedback Survey

Variable Name Question/Variable Description Value Labels/Format

Q4_useful_code_omb2020

Promoting resilience: Rate the 

usefulness of this training.

1 = Not at all useful

2 = Slightly useful

3 = Moderately useful

4 = Very useful

5 = Extremely useful

Q5_yesno_code_omb2020

Psychoeducational activities: Have you

had this training?

1 = Yes

0 = No

Q5_useful_code_omb2020

Psychoeducational activities: Rate the 

usefulness of this training.

1 = Not at all useful

2 = Slightly useful

3 = Moderately useful

4 = Very useful

5 = Extremely useful

Q6_yesno_code_omb2020

Resources linkage and identification of

local resources for referral purposes: 

Have you had this training?

1 = Yes

0 = No

Q6_useful_code_omb2020

Resources linkage and identification of 

local resources for referral purposes: 

Rate the usefulness of this training.

1 = Not at all useful

2 = Slightly useful

3 = Moderately useful

4 = Very useful

5 = Extremely useful

Q7_yesno_code_omb2020

Training on how to use the CCP mobile

app for data collection: Have you had 

this training?

1 = Yes

0 = No

Q7_useful_code_omb2020

Training on how to use the CCP mobile 

app for data collection: Rate the 

usefulness of this training.

1 = Not at all useful

2 = Slightly useful

3 = Moderately useful

4 = Very useful

5 = Extremely useful

Q8_yesno_code_omb2020

Training on how to complete the CCP

data collection tools (e.g., encounter 

logs, Weekly Tally Sheet): Have you had 

this training?

1 = Yes

0 = No

Q8_useful_code_omb2020

Training on how to complete the CCP 

data collection tools (e.g., encounter 

logs, Weekly Tally Sheet): Rate the 

usefulness of this training.

1 = Not at all useful

2 = Slightly useful

3 = Moderately useful

4 = Very useful

5 = Extremely useful

Q9_yesno_code_omb2020

Other crisis counseling trainings offered

by the state or your agency (e.g., selfcare, Skills for Psychological Recovery): 

Have you had this training?

1 = Yes

0 = No

Q9_useful_code_omb2020

Other crisis counseling trainings offered 

by the state or your agency (e.g., selfcare, Skills for Psychological Recovery): 

Rate the usefulness of this training.

1 = Not at all useful

2 = Slightly useful

3 = Moderately useful

4 = Very useful

5 = Extremely useful
Provider Feedback Survey

Variable Name Question/Variable Description Value Labels/Format

Q10_howgood_code_omb2022

Quality of the supervision provided to 

you

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good 

5 = Excellent 

Q11_howgood_code_omb2022

Opportunities to interact with other 

staff in supportive ways

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good 

5 = Excellent 

Q12_howgood_code_omb2022

Support and training provided to help 

you avoid compassion fatigue or to 

cope with the stress of listening to and 

helping others

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good 

5 = Excellent 

Q13_howgood_code_omb2022

Opportunitiesfor professional and 

personal growth

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good 

5 = Excellent 

Q14_howgood_code_omb2022

Appropriateness of the workload (e.g., 

neither too much nor too little)

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good 

5 = Excellent 

Q15_howgood_code_omb2020

Adequacy of the resources and tools 

you had available to do your job

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good 

5 = Excellent 

Q16_howgood_code_omb2022

How well you understood how your job 

fit into the bigger picture of your 

community's response to the disaster

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good 

5 = Excellent 

Q17_howgood_code_omb2022

How well data from the evaluation 

were shared with crisis counseling 

teams or used to inform their work

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good 

5 = Excellent 

Q18_howgood_code_omb2022

How well you believe the types of 

services provided by the project 

matched the types of need present in 

the community

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good 

5 = Excellent 
Provider Feedback Survey

Variable Name Question/Variable Description Value Labels/Format

Q19_howgood_code_omb2022

The overall quality of services provided 

by the project

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good 

5 = Excellent 

Q20_howgood_code_omb2022

How likely you would be to recommend 

this project to a friend or family 

member if he or she had the need

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good 

5 = Excellent 

QMobile1_howgood_code

The CCP mobile app is easily used to 

complete forms during and/or after 

encounters

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good 

5 = Excellent 

QMobile2_howgood_code

The CCP mobile app functioned as 

intended for collecting data

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good 

5 = Excellent 

QMobile3_howgood_code

My team leader(s) and program 

management provided adequate 

support and training on the CCP mobile 

app

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good 

5 = Excellent 

QMobile4_howgood_code

The data from the evaluation was 

shared with crisis counseling teams 

and/or was used to inform my work 

efficiently

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good 

5 = Excellent 

MobilePrevention_1 Not applicable; I used the mobile form

1 = Yes

0 = No

MobilePrevention_2 No access to the mobile device

1 = Yes

0 = No

MobilePrevention_3 Did not understand how to use

1 = Yes

0 = No

MobilePrevention_4 Not comfortable with technology

1 = Yes

0 = No

MobilePrevention_5 Privacy concerns

1 = Yes

0 = No

MobilePrevention_6 Other

1 = Yes

0 = No

MobilePrevention_other If other, please specify Text

UnderstandInstructions_yesno_co

de

Were you able to understand the

instructions for filling out the forms?

1 = Yes

0 = No

UnderstandInstructions_other Text
Provider Feedback Survey

Variable Name Question/Variable Description Value Labels/Format

Q21_howmuch_code_omb2022

Have you had difficulty handling other

stressful events orsituations due to 

your crisis counseling work or your 

reactions to it?

1 = Not at all 2 = A little bit 

3 = Somewhat 4 = Quite a bit 

5 = Very much

Q22_howmuch_code_omb2022

Has the crisis counseling work or your

reaction to it interfered with how well 

you take care of your physical health 

(e.g., eating poorly, not getting enough

rest, smoking more, drinking more)?

1 = Not at all 2 = A little bit 

3 = Somewhat 4 = Quite a bit 

5 = Very much

Q23_howmuch_code_omb2022

Has the crisis counseling work or your

reaction to it interfered with your 

ability to work or carry out your other 

daily activities, such as housework or 

schoolwork?

1 = Not at all 2 = A little bit 

3 = Somewhat 4 = Quite a bit 

5 = Very much

Q24_howmuch_code_omb2022

Has your crisis counseling work or your

reaction to it affected your

relationships with your family or friends 

or interfered with your social, 

recreational, or community activities?

1 = Not at all 2 = A little bit 

3 = Somewhat 4 = Quite a bit 

5 = Very much

Q25_howmuch_code_omb2022

Have you been distressed or bothered 

about your reactions?

1 = Not at all 2 = A little bit 

3 = Somewhat 4 = Quite a bit

5 = Very much

workhour_code

How many hours of crisis counseling 

program work do you do in a typical 

week?

1 = Less than 20 hours

2 = 20–29 hours

3 = 30–39 hours

4 = 40 or more hours

workmonth

How many months have you worked

with the crisis counseling program?

Number (i.e., 1, 2, 3, 4. . .)

supervisework_yesno_code

Do you supervise the work of other

crisis counselors?

1 = Yes

0 = No

workcounty

In what county or parish do you

commonly work?

Text

sex_1 Male

1 = Yes

0 = No

sex_2 Female

1 = Yes

0 = No

sex_3 Transgender

1 = Yes

0 = No

sex_4 None of these

1 = Yes

0 = No

birthyear In what year were you born? Number (i.e., 1, 2, 3, 4. . .)
Provider Feedback Survey

Variable Name Question/Variable Description Value Labels/Format

educationdegree_code

What is the highest level of education 

you have completed or degree you 

have received?

1 = No high school

2 = High school diploma

3 = Bachelor's degree

4 = High school, but no diploma or 

GED

5 = Some college, but no degree

6 = Graduate or professional degree 

(e.g., M.A., Ph.D., M.D., J.D.)

7 = GED or other high school 

equivalency

8 = Associate's degree

hispanic_yesno_code Are you Hispanic/Latino?

1 = Yes

0 = No

race5_code

Which of the following best describes 

your race?

1 = American Indian/Alaska Native

2 = Asian

3 = Black or African American

4 = Native Hawaiian/Other Pacific 

Islander

5 = White

disasterimpact_yesno_code

Have you been impacted by the current

disaster?

1 = Yes

0 = No

income_code

What is your household gross annual 

income?

1 = < $10,000

2 = $10,000–$25,000

3 = $25,000–$40,000

4 = $40,000–$51,000

5 = > $51,000

QPreDisaster1_yesno_code

Do you live alone, with a spouse or

partner, other family (e.g., 

children/parents), orroommate?

1 = Yes

0 = No

QPreDisaster2_yesno_code Have employment?

1 = Yes

0 = No

QPreDisaster3_yesno_code Do you own a working car?

1 = Yes

0 = No

QPostDisaster1_yesno_code

Evacuated quickly with no time to

prepare?

1 = Yes

0 = No

QPostDisaster2_yesno_code Home damage?

1 = Yes

0 = No

QPostDisaster3_yesno_code Vehicle or major property loss?

1 = Yes

0 = No

QPostDisaster4_yesno_code

Disaster unemployed (self or household

member)?

1 = Yes

0 = No

QPostDisaster5_yesno_code

Have a change in cohabitation (e.g., live

alone, with spouse/partner, other 

family, roommate)?

1 = Yes

0 = No

QPostDisaster6_yesno_code

Know someone close to you who was

severely injured during the disaster?

1 = Yes

0 = No
Provider Feedback Survey

Variable Name Question/Variable Description Value Labels/Format

QPostDisaster7_yesno_code

Witnessed death/injury (self or

household member)?

1 = Yes

0 = No

QPostDisaster8_yesno_code

Know someone who was severely

injured as a result of the disaster?

1 = Yes

0 = No

QDisplacement_code

Been displaced from your primary

residence?

1 = Yes

0 = No

comments

Do you have any comments you would

like to share?

Text

createdon Date the record was created Date

updatedon Date the record was updated Date
Participant Feedback Survey

Variable Name Question/Variable Description Value Labels

id Participant ID Sequence ID (i.e., 1, 2, 3. . .)

FormVersion Form version YYYY (e.g., 2018)

ProjectNumber Project number

FEMA disaster declaration

number (e.g., NJ-4086)

disaster_ISP Project ISP

1 = ISP

2 = ISP Extension

3 = RSP

4 = RSP Extension

entrydate Today's date MM/DD/YYYY

Q1_howgood_code Treating you with respect?

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good

5 = Excellent

Q2_howgood_code

Respecting your culture, race, ethnicity, or 

religion?

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good

5 = Excellent

Q3_howgood_code Making you feel that asking for help is okay?

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good

5 = Excellent

Q4_howgood_code

Making you feel that you can help yourself 

and your family?

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good

5 = Excellent

Q5_howgood_code Keeping things you said private?

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good

5 = Excellent

Q6_usedservice_yesno_co 

de

One-to-one interaction (with

counselor/outreach worker): Have you used 

this service?

1 = Yes

0 = No

Q6_servicehelpful_yesno_ 

code

One-to-one interaction (with

counselor/outreach worker): Was this service 

helpful?

1 = Yes

0 = No

Q7_usedservice_yesno_co

de

Public education presentation: Have you used

this service?

1 = Yes

0 = No

Q7_servicehelpful_yesno_

code

Public education presentation: Was this

service helpful?

1 = Yes

0 = No

Q8_usedservice_yesno_co

de

Group counseling/support group: Have you

used this service?

1 = Yes

0 = No
Participant Feedback Survey

Variable Name Question/Variable Description Value Labels

Q8_servicehelpful_yesno_

code

Group counseling/support group: Was this

service helpful? 

1 = Yes

0 = No

Q9_usedservice_yesno_co

de

Handouts/materials: Have you used this

service?

1 = Yes

0 = No

Q9_servicehelpful_yesno_

code Handouts/materials: Was this service helpful?

1 = Yes

0 = No

Q10_usedservice_yesno_c

ode

Internet sites (CCP website, Facebook, etc.):

Have you used this service?

1 = Yes

0 = No

Q10_servicehelpful_yesno

_code

Internet sites (CCP website, Facebook, etc.):

Was this service helpful?

1 = Yes

0 = No

Q11_usedservice_yesno_c

ode Other: Have you used this service?

1 = Yes

0 = No

Q11_servicehelpful_yesno

_code Other: Was this service helpful?

1 = Yes

0 = No

Q11_other Other (please specify)

1 = Yes

0 = No

Q12_usedservice_yesno_c

ode

Referral resources: Have you used this

service?

1 = Yes

0 = No

Q12_servicehelpful_yesno

_code Referral resources: Was this service helpful?

1 = Yes

0 = No

referraltype_1 Substance misuse

1 = Yes

0 = No

referraltype_2 Mental health

1 = Yes

0 = No

referraltype_3 CCP services

1 = Yes

0 = No

referraltype_4

Community services (e.g., FEMA, loans,

housing, employment, social services)

1 = Yes

0 = No

referraltype_5

Resources for those with disabilities or other

access or functional needs

1 = Yes

0 = No

referraltype_6 Other referral type

1 = Yes

0 = No

referraltypeother Other referral type (Please specify type) Text

Q13_howgood_code

Helping you to know that your feelings after 

the disaster were the same as many other 

people's feelings?

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good

5 = Excellent

Q14_howgood_code

Helping you to find ways to take care of 

yourself, like eating right and getting enough 

sleep?

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good

5 = Excellent
Participant Feedback Survey

Variable Name Question/Variable Description Value Labels

Q15_howgood_code

Helping you to stay active in things like 

hobbies, sports, church, or volunteer work?

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good

5 = Excellent

Q16_howgood_code

How good was the information you got on 

how people feel after disasters?

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good

5 = Excellent

Q17_howgood_code

How good of an idea is it to tell a friend who 

was upset by the disaster to see this 

counselor or outreach worker?

1 = Extremely poor

2 = Poor

3 = Fair

4 = Good

5 = Excellent

Q18_howmuch_code

How useful was this program in helping 

return things in your life back to the way they 

were before the disaster?

1 = Not at all useful

2 = Slightly useful

3 = Moderately useful

4 = Very useful

5 = Extremely useful

Q19_howmuch_code Overall, how useful was this program to you?

1 = Not at all useful

2 = Slightly useful

3 = Moderately useful

4 = Very useful

5 = Extremely useful

disasterexperience_01 My family member is missing or dead.

1 = Yes

0 = No

disasterexperience_02 My friend is missing or dead.

1 = Yes

0 = No

disasterexperience_03 My pet is missing or dead.

1 = Yes

0 = No

disasterexperience_04 My home is damaged or destroyed.

1 = Yes

0 = No

disasterexperience_05

I had major property loss, such as car/vehicle

loss.

1 = Yes

0 = No

disasterexperience_06 I had other financial loss.

1 = Yes

0 = No

disasterexperience_07

I or a member of my household was injured or

physically harmed.

1 = Yes

0 = No

disasterexperience_08

My life or that of someone in my household

was threatened.

1 = Yes

0 = No

disasterexperience_09

I or a member of my household witnessed

death/injury.

1 = Yes

0 = No

disasterexperience_10

I or a member of my household assisted with

rescue/recovery.

1 = Yes

0 = No
Participant Feedback Survey

Variable Name Question/Variable Description Value Labels

disasterexperience_11

I am or a member of my household is

unemployed because of this disaster.

1 = Yes

0 = No

disasterexperience_12

I was evacuated quickly with no time to

prepare.

1 = Yes

0 = No

disasterexperience_13 I had prolonged separation from family.

1 = Yes

0 = No

disasterexperience_14

I was displaced from my home for 1 week or

longer.

1 = Yes

0 = No

Q20_howmuch_code

Been bothered by bad memories, nightmares, 

or reminders of what happened?

1 = Not at all

2 = A little bit

3 = Somewhat

4 = Quite a bit

5 = Very much

Q21_howmuch_code

Tried NOT to think or talk about what 

happened or to do things that remind you of 

what happened?

1 = Not at all

2 = A little bit

3 = Somewhat

4 = Quite a bit

5 = Very much

Q22_howmuch_code

Been bothered by poor sleep, poor 

concentration, feeling jumpy or angry, or 

being scared that something else bad will 

happen?

1 = Not at all

2 = A little bit

3 = Somewhat

4 = Quite a bit

5 = Very much

Q23_howmuch_code Been down or depressed?

1 = Not at all

2 = A little bit

3 = Somewhat

4 = Quite a bit

5 = Very much

Q24_howmuch_code

Found other stressful things harder to deal 

with because of what happened?

1 = Not at all

2 = A little bit

3 = Somewhat

4 = Quite a bit

5 = Very much

Q25_howmuch_code

Had trouble taking care of your health (e.g., 

eating poorly, not getting enough rest, 

smoking more, drinking more)?

1 = Not at all

2 = A little bit

3 = Somewhat

4 = Quite a bit

5 = Very much

Q26_howmuch_code

Had difficulty getting along or having fun with 

family and friends?

1 = Not at all

2 = A little bit

3 = Somewhat

4 = Quite a bit

5 = Very much
Participant Feedback Survey

Variable Name Question/Variable Description Value Labels

Q27_howmuch_code

Needed help from a counselor to deal with 

your reactions to the disaster?

1 = Not at all

2 = A little bit

3 = Somewhat

4 = Quite a bit

5 = Very much

Q28_feeling_code

Comparing your emotional and mental

wellbeing before the disaster to now, do you 

feel better, worse, or about the same?

1 = Feel better now

2 = Feel about the same

3 = Feel worse now

Q29_takecarehealth_code

Comparing how well you take care of your 

health before the disaster to now, do you 

take care of your health better, worse, or 

about the same?

1 = Take care of your health 

better now

2 = Take care of your health 

about the same now

3 = Take care of your health

worse now

Q30_workingtrouble_code

Comparing how well you work (including a 

job, schoolwork, and housework) before the 

disaster to now, do you have less trouble 

working, more trouble working, or about the

same amount?

1 = Have less trouble working 

now

2 = Have about the same amount 

of trouble working now

3 = Have more trouble working

Q31_active_code

Comparing how active you were in things like

hobbies, sports, church, or volunteer work 

before the disaster to now, are you more 

active, less active, or about the same?

1 = More active now

2 = About the same

3 = Less active now

sex_1 Male

1 = Yes

0 = No

sex_2 Female

1 = Yes

0 = No

sex_3 Transgender

1 = Yes

0 = No

sex_4 None of these

1 = Yes

0 = No

birthyear In what year were you born? Number (i.e., 1, 2, 3, 4. . .)

educationlevel_code

What is the highest level of education you 

have completed or degree you have 

received?

1 = 0–6 years

2 = 7–11 years

3 = 12 years (high school diploma 

or GED)

4 = Some college

5 = College graduate or more

income_code What is your annual gross household income?

1 = < $10,000

2 = $10,000–$25,000

3 = $25,000–$40,000

4 = $40,000–$51,000

5 = > $51,000

livecounty In what county or parish do you currently live?

County name
Participant Feedback Survey

Variable Name Question/Variable Description Value Labels

hispanic_yesno_code Are you Hispanic/Latino?

1 = Yes

0 = No

race2_code

Which of the following best describes your 

race?

1 = American Indian/Alaska 

Native

2 = Asian

3 = Black or African American

4 = Native Hawaiian/Other Pacific 

Islander

5 = White

primarylanguage_code What is your preferred language?

1 = English

2 = Spanish

3 = Other

primarylanguageother Other language Text

disability_1

Physical (mobility, visual, hearing, medical,

etc.)

1 = Yes

0 = No

disability_2

Intellectual/cognitive (learning disability,

mental retardation, etc.)

1 = Yes

0 = No

disability_3

Mental health/substance misuse (psychiatric,

substance dependence, etc.)

1 = Yes

0 = No

createdby Person who created the record Text

createdon Date the record was created Date

updatedby Person who updated the record Text

updatedon Date the record was updated Date