HomeMy WebLinkAboutAgreement A-15-623 with Mathematica Policy Research, Inc..pdfSNAP%E&T%PILOTS%MEMORANDUM%OF%UNDERSTANDING%MATHEMATICA%POLICY%RESEARCH!
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EVALUATION OF SNAP EMPLOYMENT AND TRAINING PILOTS
MEMORANDUM OF UNDERSTANDING
between
MATHEMATICA POLICY RESEARCH, INC.
and
COUNTY OF FRESNO
Memorandum of Understanding No.50064x04602
1. PURPOSE OF AGREEMENT
The purpose of this Memorandum of Understanding (the “Agreement”) is to define the
terms under which the Fresno County Department of Social Services (herein referred to as
“Fresno DSS”), on behalf of the County of Fresno with assistance from Reading and Beyond will
work with Mathematica Policy Research, Inc. (Mathematica) with assistance from subcontractors
MDRC, Insight Policy Research, Koné Consulting, and Decision Information Resources
(hereinafter referred to as the “Mathematica Team”) to strengthen the pilot project design, recruit
participants for the pilot project, conduct random assignment, identify site support and technical
assistance (TA) needs, and provide requisite administrative and other data to answer research
questions. A detailed statement of work is provided in Exhibit A. This MOU also includes a
Data Use Agreement in Exhibit B to provide additional information about the permitted uses,
disclosures, and protections of data provided by Fresno DSS to the Mathematica Team.
2. BACKGROUND AND LEGAL AUTHORITY
The Agriculture Act of 2014 (P.L. 113-79, Section 4022) (the “Act”) authorizes the U.S.
Department of Agriculture (USDA) to enter into cooperative agreements with State agencies to
carry out pilot projects designed to raise employment, increase earnings, and reduce reliance on
public assistance, including the benefits provided by the Supplemental Nutrition Assistance
Program (SNAP) – referred to as “CalFresh”, the name of SNAP in California, for areas of the
MOU specifically referring to the Fresno DSS pilot. Pursuant to the authorizing statute, the
USDA awarded grants to pilot projects in California, Delaware, Georgia, Illinois, Kansas,
Kentucky, Mississippi, Virginia, Vermont, and Washington State.
The Act also directs the USDA to undertake an independent longitudinal evaluation of each
pilot project using statistical methods that can determine differences in employment, earnings,
and public assistance expenditures between those who receive the employment and training
programs and services offered under the pilots and a control group that does not receive such
services. The USDA, Food and Nutrition Services (FNS), has contracted with Mathematica
(under Contract No. AG-3198-B-15-0002/Task Order No. AG-3198-K-15-0003/Task Order No.
AG-3198-K-15-0026) to conduct the Evaluation of the SNAP Employment and Training (E&T)
Pilots. This congressionally-mandated evaluation will rigorously test innovative strategies for
increasing employment and earnings among SNAP participants and reducing their dependence
on SNAP and other public assistance programs. The evaluation includes four components: (1) an
implementation analysis, (2) a random-assignment impact evaluation, (3) a participation
analysis, and (4) a cost-benefit analysis. Data sources will include unemployment insurance
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wage records, SNAP caseload files and other administrative data, service receipt data, baseline
and follow-up household surveys, interviews from site visits and focus groups, and pilot cost
data and frontline staff time-use surveys.
Fresno DSS will complete the specified work under this Agreement as part of the terms and
conditions of the California Department of Social Service’s contract with FNS, under USDA
FNS Pilot Projects to Reduce Dependency and Increase Work Requirements and Work Effort
under the Supplemental Nutrition Assistance Program, Grant CFDA 10.596. Under separate
subcontract agreements with Mathematica, the Mathematica Team members - MDRC, Insight
Policy Research, Koné Consulting, and Decision Information Resources - will assist
Mathematica in the execution of this Agreement by providing guidance and direction to Fresno
DSS to facilitate completion of the statement of work.
This Agreement contains several integral components which are outlined below to provide
an overview of the structure and topics covered, attached hereto, and incorporated into this
Agreement by reference:
Exhibit A: Statement of Work. Exhibit A provides provide background on the evaluation’s
research objectives and components of the study design. Additionally, it outlines the
responsibilities of Fresno DSS and the Mathematica Team, presented separately for each activity
related to the evaluation. Activities related to the evaluation include managing participating
providers and partners, planning and overseeing implementation of the study, obtaining consent
from eligible participants and collecting information through a registration document, conducting
random assignment of participants and maintaining the integrity of random assignment, and
collecting administrative and other data on pilot participants. Finally, the schedule of study
activities provides detail on the responsibilities of Fresno DSS and the Mathematica Team
throughout the phases of the evaluation.
Exhibit B: Data Use Agreement (DUA). Exhibit B details the purpose and variables
needed from three of four data sources required for the evaluation: (1) CalFresh administrative
data files (inclusive of CalWorks and Medi-cal), (2) pilot service receipt data files, and (3) pilot
cost data files. The DUA provides information on secure transmission of these data and the
protections used for maintaining data security and confidentiality, including the Mathematica
Team’s use of these data. The Mathematica Team will acquire employment insurance wage and
employment data from the California State Department of Social Services (CDSS) on pilot study
participants through a separate agreement with Mathematica, Mathematica’s subcontractor
MDRC, and CDSS. CDSS will receive these data from the California Employment Development
Department (EDD).
Attachments: The attachments to this Agreement include: (1) a pilot project flow chart
illustrating Fresno DSS plans for pilot services and point of random assignment, (2) a summary
of target pilot sample enrollment goals by month for the duration of pilot services, (3) a list of
performance targets for the duration of pilot services, (4) the draft registration form required to
enroll each eligible pilot participant in the evaluation, and (5) the draft consent form for pilot
participants.
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3. TERM OF AGREEMENT
This Agreement is effective upon the date of last signature by authorized representatives of
each of Mathematica and Fresno DSS. It will terminate on March 31, 2021 unless otherwise
extended by the mutual written agreement of the parties.
4. POINTS OF CONTACT
The following individuals will serve as the points of contact responsible for managing the
performance of each party’s necessary functions and responsibilities under this Agreement:
MATHEMATICA POLICY RESEARCH, INC.
For administrative/contractual matters:
William (Bill) Farino, CPCM
Sr. Contracts Administrator
Mathematica Policy Research, Inc.
955 Massachusetts Avenue, Suite 801
Cambridge, MA 02139
617-715-6940 (P)
wfarino@mathematica-mpr.com
For technical matters:
James Mabli
Associate Director of Human Services Research
Mathematica Policy Research, Inc.
955 Massachusetts Avenue, Suite 801
Cambridge, MA 02139
617-491-7900 (P)
jmabli@mathematica-mpr.com
COUNTY OF FRESNO
Laura Moreno
Senior Staff Analyst
County of Fresno Department of Social Services
2135 Fresno Street, Fresno, CA 93721
(559) 600-2335
lhaga@co.fresno.ca.us
5. MODIFICATION
Any changes, amendments, or modifications to this Agreement must be made and agreed to
by the parties in writing and any matters of this Agreement may be modified from time to time
by the written consent of all the parties without, in any way, affecting the remainder.
See Attached Signature Page
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EXHIBIT A: STATEMENT OF WORK
This Exhibit A describes the scope of work to be conducted under the Memorandum of
Understanding (the “Agreement”) to which it is attached by County of Fresno Department of
Social Services, herein referred to as “Fresno DSS”, for the Evaluation of SNAP Employment and
Training Pilots project led by Mathematica Policy Research, Inc. (Mathematica) with assistance
from subcontractors MDRC, Insight Policy Research, Koné Consulting, and Decision Information
Resources (hereinafter referred to as the “Mathematica Team”), for the U.S. Department of
Agriculture, Food and Nutrition Service (under Contract No. AG-3198-B-15-0002/Task Order No.
AG-3198-K-15-0003/Task Order No. AG-3198-K-15-0026). As part of this project, Fresno DSS
will work with the Mathematica Team to strengthen the pilot project design, conduct random
assignment, recruit participants for the pilot project, identify site support and technical assistance
needs, and acquire requisite data to answer research questions.
To support evaluation activities, the Mathematica Team will provide evaluation technical
assistance on the pilot and evaluation designs and guidance on providing necessary data for the
evaluation. Fresno DSS will work with FNS and the Mathematica Team to finalize the pilot design,
and will provide the data in accordance with the timeline specified in this Exhibit, in addition to
other activities considered integral to the evaluation.
1. BACKGROUND AND RESEARCH OBJECTIVES
1.1 Background
The national Supplemental Nutrition Assistance Program (SNAP) is a critical work support
for low-income people and families. SNAP benefits help eligible low-income families put food on
the table in times of need. It also supports critical and needed skills and job training so that
recipients can obtain good jobs that lead to self-sufficiency. To help unemployed and
underemployed recipients and their families achieve self-sufficiency, strategies are needed to
impart the skills employers want, and to help address other barriers to employment. Some
participants need assistance developing a resume and accessing job leads, others need education
and training, and still others need help overcoming barriers that prevent them from working
steadily. The SNAP Employment and Training (E&T) program provides assistance to unemployed
and underemployed participants in the form of job search, job skills training, education (basic,
post-secondary, vocational), work experience or training, and workfare, but limited information
exists on what is most effective in connecting these participants to gainful employment.
The Agriculture Act of 2014 (PL 113-79, Section 4022), otherwise known as the 2014 Farm
Bill, authorized grants for up to 10 pilot sites to develop innovative SNAP E&T strategies for
engaging more SNAP work registrants in unsubsidized employment, increasing participants’
earnings, and reducing reliance on public assistance. The pilots’ significant funding can expand
the reach of employment and training services and enable States to experiment with promising
strategies to increase engagement and promote employment. The USDA awarded grants to pilot
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projects in California, Delaware, Georgia, Illinois, Kansas, Kentucky, Mississippi, Virginia,
Vermont, and Washington State.
1.2 Research Objectives
%The Farm Bill also provides funding for rigorous evaluation of the 10 pilots. For each pilot,
the study’s research questions are:
•%How do pilot project services affect SNAP recipients’ employment rates, earnings, and
receipt of public assistance? How do they affect other outcomes such food security, well-
being, health and housing status? What is the effect of these services on subgroups of
recipients defined by participant and program characteristics?
•%What are the characteristics and service paths of pilot project participants? Do the presence
of the pilots and their offer of services or requirements to participate affect whether people
apply to SNAP?
•%How are these services implemented, and how do differences in implementation affect
participants’ employment, earnings, and related outcomes?
•%Are the benefits of these services measured in dollars greater than their costs?
1.3 Study Design
An experimental research design will rigorously test pilot project strategies for increasing
employment and earnings among SNAP participants and reducing their dependence on SNAP
and other public assistance programs. The design includes four primary research components: (1)
an implementation analysis, (2) a random-assignment impact evaluation, (3) a participation
analysis, and (4) a cost-benefit analysis.
(1) An implementation analysis will document the context and operations of each pilot as
well as help to interpret and understand impacts within and across pilots. The Mathematica Team
will conduct three rounds of process study data collection, one visit per year with a specific
focus. Visits will last three to four days and will include interviews with staff at all levels
(grantees/State-level staff, SNAP eligibility staff, E&T provider staff, and DOL staff), structured
observations of SNAP offices and E&T service provider operations, in-depth interviews with
participants, and focus groups with E&T participants and employers. The first round of site visits
will collect data on planning and early implementation and is scheduled after the beginning of
random assignment. The second round of site visits will collect data on operations and is
scheduled for the mid-point of operations. The third will collect data on each pilot’s full
implementation and their pilot close-out processes near the end of operations. These data will be
supplemented with data from participant case files, document reviews, and program
administrative data. The three rounds of site visit data also will be supplemented with data
collected through the TA/monitoring site visits and multiple grantee calls.
(2) A random-assignment impact evaluation will identify what strategies work and for
whom, through estimating program impacts on primary outcomes of employment, earnings, and
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public assistance receipt; and secondary outcomes of food security, health, and housing status. In
each pilot, SNAP participants eligible for the SNAP E&T pilot project services will be randomly
assigned to at least two study groups: one or more control groups that receives no enhanced pilot
intervention services, and one or more treatment groups that receive variations of enhanced pilot
intervention services. Random assignment will typically be conducted at the individual level.
Data sources used to estimate program impacts will include UI wage records, SNAP
administrative data, service receipt data, and baseline and follow-up household surveys.
(3) A participation analysis will examine the characteristics and service paths of pilot
participants to determine if participation varied within and across the pilots. Where feasible, it
also will assess whether the presence of the pilots and their offer of services or requirements to
participate affect whether people apply to SNAP (entry effects). This analysis will use
management information system (MIS) data on service receipt, information from SNAP
administrative records, and baseline and follow up survey data.
(4) A cost-benefit analysis will estimate the return to each dollar invested. All participating
pilots will provide cost data at the completion of the planning period, and then quarterly
thereafter and participate in an annual frontline staff time-use survey. The Mathematica Team
will analyze these data together with outcome and service receipt data to determine the overall
cost-benefit to the individual and to society. Data will be collected and analyzed for pilot
treatment services, and for services provided to the control group under the existing SNAP E&T
program to the extent possible.
2. UNDERSTANDING OF THE RESPONSIBILITIES OF FRESNO DSS AND THE
MATHEMATICA TEAM
2.1 Participating providers and partners
a. Fresno DSS
Fresno DSS will name a primary liaison to work with the evaluation team to support and
ensure efficient program implementation. The primary liaison will participate in program
planning and implementation, supervise all Fresno DSS research activities, and be responsible
for all program site operations. The primary liaison should be authorized to speak for the Fresno
DSS to the Mathematica Team, the Fresno DSS management group, and Fresno DSS research
and site staff.
Fresno DSS also agrees to designate a project!wide Research Liaison who will coordinate all
Fresno DSS research activities. The Liaison will ensure that all site staff implement CalFresh E
& T research procedures as described in this statement of work. The duties of the Research
Liaison include but are not limited to:!
1.%Supervise collection and storage of electronic data and paper documents containing data
collected from study participants;
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2.%Support the Program Manager in serving as a liaison with the Mathematica Team to
manage the secure transmission of paper and electronic data to appropriate evaluation
partners;
3.%Answer questions from staff about research procedures;
4.%Produce aggregate reports separately for pilot activities; transmit electronic files in a
secure manner, according to evaluation partners’ specifications;
5.%Document participant’s consent to participate in the research study according to
procedures developed by the Mathematica Team;
6.%Conduct random assignment using an online assignment tool and database maintained by
the Mathematica Team and ensure individuals are clearly identified by and treated
programmatically according to the research group they have been assigned to;
7.%Ensure that all records (such as study informed consent forms, baseline data, and contact
information) completed by study participants are handled and submitted to the
Mathematica Team according to the guidelines provided;
8.%Participate in required check"in calls with the Mathematica Team;
9.%Ensure that all staff receive required pilot and research training, general and specific to
service operations;
10.%Ensure that staff market each of the programs in a consistent and accurate way;
11.%Ensure that pilot staff implement the program services as described in the Fresno DSS
implementation plan, monitor program performance, and take into account feedback and
technical assistance provided by the Mathematica team.
12.%Supervise all data management, collection and reporting activities and ensure that all staff
adheres to required security protocols, including the proper transmission and storage of
both data and documents.
!
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Fresno DSS will engage with a number of partners, service providers, and other organizations
connected to the pilot in the implementation of the pilot project and the study, in accordance with
the proposal under USDA FNS Grant CFDA 10.596. Fresno DSS will ensure that all service
providers and other partners under the pilot project (defined below) adhere to the responsibilities
outlined in this agreement for the full term of the agreement. Participating entities include:
!%Reading and Beyond (RAB): 4670 E. Butler, Fresno, CA 93702
2.2!Planning and implementation of the study
a. Phases of the study
There are three phases to the study, all involving close collaboration between the Fresno DSS, the
Mathematica Team, and FNS to determine when each phase will transition to the next:
•%Phase I is the planning phase during which the program activities and flow are defined and
the evaluation design is determined. This phase includes training of Fresno DSS staff on
random assignment and research procedures, as well as other aspects of the study.
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•%Phase II is an initial implementation phase of random assignment and pilot activities,
during which the Fresno DSS and the Mathematica Team, in close collaboration with FNS,
will have the opportunity to assess pilot and research activities, discuss and agree upon any
needed changes to either the research or program flows and activities, and assess whether
these activities are sufficiently strong that this Phase II sample will be included in the full
evaluation study. Important performance goals that will be assessed include meeting
sample build-up targets for Phase II, creating a sufficiently large service contrast between
the research groups, and reaching adequate pilot participation rates according to agreed
upon performance goals (see Attachment 3).
•%Phase III is the full evaluation period, including continuing random assignment and
sample build-up, collecting data for monitoring of program performance, and collecting
data for the impact, implementation, participation, and cost studies.
b. Planning and Implementation Responsibilities of Fresno DSS
Fresno DSS agrees to work with the Mathematica Team to implement the study in accordance
with the procedures laid out in this Agreement. Fresno DSS will inform the Mathematica Team
about the pilot project design and specific intervention services. Fresno DSS will work with the
Mathematica Team to determine any changes needed to local computer systems to accommodate
the study, including the web-based information systems detailed below in section 2.4. Fresno DSS
agrees to demonstrate flexibility in working with the Mathematica Team regarding the design and
implementation of the pilot project, including the addition or enhancement of pilot project
activities or services which will serve to strengthen the pilot and/or national evaluation design.
Fresno DSS will collaborate with the Mathematica Team to determine the optimal point in the
program to randomly assign pilot project participants to the treatment group(s) or the control
group. Fresno DSS will implement procedures to ensure legally effective and prospectively
obtained informed consent from pilot participants that is valid for up to six years after the
participants enter the pilot. Fresno DSS will provide and support the interpretation of data on pilot
participants (described in Exhibit B) for up to six years after the participants enter the pilot. Detail
on the pilot project flow specific to Fresno DSS is provided in Attachment 1.
Fresno DSS will support the Mathematica Team in the completion of a State-specific or
provider specific institutional review board (IRB) research applications as needed by facilitating
communications with relevant entities and working to expedite the review process where possible.
Fresno DSS and Reading and Beyond (RAB) will allow time for all staff who will be involved
in the study to be trained by the Mathematica Team, Fresno DSS staff, and/or RAB staff, including
time for new staff trainings and refresher trainings as needed. Fresno DSS will create training
materials and provide training to all Fresno DSS eligibility workers regarding work registrant
(WR) eligibility status, how to screen for it using a WR screening tool that Fresno DSS will
provide, and where to indicate WR status in the CalWin system so the household will be pulled
for the list of potential pilot participants to be contacted by RAB. This training will be completed
in October-November 2015 so that WR households begin to be identified in advance of the pilot
program start. The Fresno DSS policy manual will also be updated to reflect the procedures taught
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in this training. The Mathematica Team will train RAB staff members on the pilot project and
random assignment procedures including how to explain the study to clients, completing the
consent process, administration of the registration form, and completing random assignment. The
Mathematica Team will provide training for whatever RAB staff members are hired at the time of
scheduled training(s) and the RAB team will need to provide the random assignment training to
newly hired staff members moving forward, though the Mathematica Team will be available to
answer questions and help work through any training issues that may arise.
Fresno DSS will collaborate with the Mathematica Team to develop strategies for effective
recruitment of the target population(s) to reach agreed upon research sample targets. (Attachment
2 provides additional detail on sample size targets). During Phase II, Fresno DSS will provide to
the Mathematica Team bi-weekly data on specific performance goals agreed upon by Fresno DSS
and the Mathematica Team. These data will be used by both parties to determine if random
assignment and the program flow are being executed as anticipated. Data include sample build-up
and pilot service receipt. During Phase III, these data will be provided on a monthly basis.
Fresno DSS and their partners will participate as needed in on-site visits conducted by the
Mathematica Team. Fresno DSS will facilitate access to interviews with Fresno DSS staff, RAB
staff, Fresno County Economic Development Corporation staff, and evaluation sample
participants. These visits will include conversations regarding the planning and design of pilot
project services and the evaluation, as well as monitoring of random assignment throughout the
period of random assignment. Fresno DSS will host the Mathematica Team site liaisons and help
arrange for visits during the period of this agreement. During or in preparation for these visits,
Fresno DSS will furnish information requested by the study team.
Fresno DSS agrees to maintain frequent contact with FNS and the Mathematica Team, and to
inform FNS and the Mathematica Team within one week of identifying a challenge which may
impact the program or evaluation design or implementation. Regular standing phone calls between
Fresno DSS, the Mathematica Team and FNS will be set up at a mutually agreeable time.
c. Planning and Implementation Responsibilities of the Mathematica Team
The Mathematica Team will support Fresno DSS in developing a strong pilot project and
evaluation design, through (1) identification of additions or enhancements to pilot project activities
or services and; (2) technical support for developing efficient recruitment strategies, including how
to monitor recruitment, minimize drop off, improve locating the target population(s), and design
strong recruitment messaging. The Mathematica Team will discuss with Fresno DSS the optimal
point in the program to randomly assign participants to the treatment group(s) or the control group
to maximize what can be learned from the evaluation.
The Mathematica Team, in collaboration Fresno DSS, will lead the completion of state or
provider-specific IRB applications.
The Mathematica Team will offer training and training materials to all staff who will be
involved in the study, including how to administer the consent form and registration document,
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how to enter data into the random assignment system (discussed further in sections 2.3 – 2.4
below), and the importance of implementing random assignment correctly. This may include
customized procedure manuals where needed and in-person and web-based trainings on study
procedures.
The Mathematica Team will provide real-time technical assistance and formative feedback as
necessary to Fresno DSS through (1) on-going monitoring of reports and information gathering
visits; (2) targeted technical assistance visits providing feedback on program operations and
research-related practices, as needed; and (3) regular teleconferences with Fresno DSS.
The Mathematica Team will conduct a number of visits to Fresno DSS during the evaluation.
During the period of preparation for the study (Phase I), the Mathematica Team will schedule and
conduct approximately four visits, and during the period of random assignment (including the
Phase II pilot testing of procedures and Phase III full implementation) will schedule and conduct
approximately nine visits. In addition, the Mathematica Team will conduct three rounds of process
study data collection, one round per year with a specific focus. Visits will typically last three to
four days and will include interviews with staff at all levels (grantees/State-level staff, CalFresh
eligibility staff, E&T provider staff, and DOL staff), structured observations of CalFresh offices
and E&T service provider operations, and focus groups with E&T participants and employers. The
first round of site visits will collect data on planning and early implementation and is scheduled
after the beginning of random assignment. The second round of site visits will collect data on
operations and is scheduled for the mid-point of operations. The third will collect data on each
pilot’s full implementation and their pilot close-out processes near the end of operations. These
data will be supplemented with data from participant case files, document reviews, and program
administrative data. Site liaisons will work with Fresno DSS to schedule visits in order to minimize
burden on the site staff. Activities may include (1) interviews with administrators, staff, partner
staff, and participants; (2) observations of program activities; (3) a review of a sample of individual
pilot-participant case files; and (4) a review of program documents. The site liaisons will provide
ongoing feedback to Fresno DSS based on visits, data, and other communications.
The Mathematica Team will maintain frequent contact with Fresno DSS and identify solutions
to challenges presented. Regular standing phone calls between Fresno DSS, the Mathematica
Team and FNS will be set up at a mutually agreeable time.
2.3 Referrals to RAB; RAB completion of consent, administering the registration document,
and initiating random assignment
a. Fresno DSS
Fresno DSS eligibility workers will screen newly certified and existing CalFresh participants
for work registrant (WR) eligibility as part of the application and renewal process. Fresno DSS
workers will identify all eligible WR participants using the newly developed field in CalWin to
denote this status. Using this marker, Fresno DSS will provide RAB with a list of eligible WR
participants on an at least monthly and up to a weekly basis during the pilot project enrollment
period in an electronic format that will be transmitted via email. This weekly list will include the
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following information about each participant: name, phone number, ZIP code, and whether there
are children residing in the household. This list should also include participants in a household
with someone receiving CalWORKS, as long as the participant is considered to be an eligible WR.
Fresno DSS partner, Reading and Beyond (RAB), will describe the evaluation to eligible work
registrants referred to them by Fresno DSS and review the two consent forms with them. For those
individuals granting consent, RAB staff will use the Mathematica Team’s web-based system to (1)
document an individual’s consent to participate in the study and consent to release their UI wage
records to the Evaluation Team, (2) complete the registration document, and (3) initiate random
assignment (RA).
Specifically, once a potential participant is deemed eligible for pilot services, Fresno DSS
partner, RAB, will provide potential participants’ with the evaluation consent form (Attachment
5A) and consent form for the release of their UI wage records (Attachment 5B), describe the
evaluation, and obtain the participant’s consent. Program staff will record consent in the web-
based registration document (see Attachment 4); paper copies of the two signed consent forms will
be provided to the participant and a copy of each form will also be retained and stored by RAB to
comply with CA State IRB and EDD requirements. RAB and MDRC will create a batching and
transmittal process ships the UI wage data release forms to MDRC (MDRC must have possession
of these forms before it can obtain participants’ UI wage data). Participants who do not consent to
participate in the evaluation and release their UI wage records data will be excluded from the study
and will not be eligible to receive any pilot-funded treatment services. These non-consenting
clients are eligible to receive regular CalFresh E&T services subject to their availability.
Once a participant has consented to participate in the study and release its UI wage records
data to the Evaluation Team, the RAB case navigator will administer to the participant a short
registration document, which the case navigator will complete via the Mathematica Team’s web-
based information system (see Attachment 4). The document will collect basic information on each
consenting participant’s demographic and household characteristics; baseline measures of
outcomes such as earnings, employment status, and public assistance program participation; and
how to locate the participant for follow-up data collection. At the end of the form, RAB case
navigators will complete a section that asks them to assess the likelihood that each consenting
individual, if assigned to the treatment group, would receive specific services. Securing consent
and administering the Registration Document will occur prior to random assignment of the
participant to the treatment group or control groups.
Fresno DSS will work with the Mathematica Team to set up a centralized process to optimize
efficiency, accuracy, and timely completion of these activities. Detail on this process specific to
Fresno DSS is provided in Attachment 1.
b. The Mathematica Team
The Mathematica Team will provide access to a web-based information system which RAB
will use to (1) document an individual’s consent to participate in the study and release his or her
UI wage records data, (2) complete the registration document, for all those consenting to
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participate in the pilot, and (3) initiating random assignment (RA). See Attachments 4-9 for drafts
of related documents. The Mathematica Team will provide key demographic information collected
in the Registration Form and transmit this back to RAB in real-time so that RAB will not have to
re-key this information. This transmission will likely involve RAB sending a web request with the
case ID of the newly RA’d participant and a data record will be sent back to RAB that will need
to be further programmed in order to enter it into the appropriate RAB MIS.
The Mathematica Team will obtain and maintain approval of the above forms from the Office
of Management and Budget (OMB) and relevant institutional review boards (California State IRB
and Mathematica’s IRB, the New England IRB).
The Mathematica Team will provide technical support/train RAB case navigators on how to
introduce and complete the documents with study participants, including providing scripts in easy-
to-understand language. The Mathematica Team will provide timely technical support to RAB as
needed in the event of problems involving the web-based system for both the core evaluation as
well as the upfront random assignment experiment to assess effects of incentives on show-up rate
and participation in the pilot.
2.4 Conducting random assignment and maintaining the integrity of random assignment
a. Fresno DSS
Once the registration document is complete, the RAB case navigator will conduct random
assignment through the Mathematica Team’s web-based system. The random assignment system
will validate information as it is entered and indicate any incomplete or duplicate data entries. The
completion of data entry into the random assignment system will occur only after completion of
the consent and registration document.
Once data are entered into the random assignment system, the system will randomly assign
the participant to a research group and assign a unique identifier that will be used to track the
participant throughout the study. The system will indicate the results of random assignment
immediately, and the RAB case navigator will inform the participant of the result. The system will
produce a letter that can be given to the participant that notifies them of their random assignment
result, if Fresno DSS/RAB desires.
On a case-by-case basis, Fresno DSS/RAB can request from the Mathematica Team an
exemption from random assignment. This request will be made only in extraordinary
circumstances and must be made by Fresno DSS/RAB and approved by the Mathematica Team
and national FNS office prior to random assignment.
To ensure a strong random assignment evaluation design, Fresno DSS will recruit a targeted
number of eligible pilot participants so that sample sizes in each research group will be large
enough to produce precise impact estimates. The total target sample sizes for Fresno DSS are 1,500
for the treatment group that receives the expanded CalFresh E&T services (Fresno Bridge
Academy Pilot) denoted the treatment group (T), 500 for the control group that receives the
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“regular” CalFresh E&T services (Control Group C2), and 1,500 for the control group that will
receive only CalFresh benefits (Control Group C1). The services provided in each group are
outlined below:
•%Expanded CalFresh E&T services treatment group: Participants in this group will
receive an expanded employment and training program offered by Reading and Beyond
(Fresno Bridge Academy). This program includes all the components offered in
the “regular” CalFRESH E&T services group, plus additional services and incentives. This
program includes case management services, job search assistance, educational/vocational
training, wrap-around services, enhanced job retention services and incentives, enhanced
job placement services, subsidized employment, incentives for training completion and
program retention, and in-house ABE/GED instruction provided by education navigators.
•%Regular CalFresh E&T services control group: Participants in this group will receive
the standard employment and training program offered by Reading and Beyond. This
program includes case management services, job search assistance, educational/vocational
training, wrap-around services, standard job retention and placement services, and referrals
to outside partner organizations for ABE/GED instruction.
•%No CalFresh E&T services group: Participants in this group will not be eligible to receive
services from the Fresno Bridge Academy for 36 months from the date of enrollment.
However, they are able to seek services from all other employment and training services
available in the community offered by other non-profit organizations and workforce
development agencies. A resource list including contact information for some of these
organizations and agencies will be given to participants.
Employment/Training and Job Retention Incentives. In addition to the primary
randomization in which consenting individuals are assigned to one of the three research groups
described above (T, C1 and C2), the Fresno CA pilot will also randomly assign individuals in the
expanded CalFRESH E&T services group (T) into one of two groups that will receive differential
incentives for completing (1) education and training and (2) job retention program components.
Of the anticipated 1,500 treatment group members, 750 will be randomly assigned to receive
“higher” incentive amounts while 750 will be randomly assigned to receive “lower” incentive
amounts. (The randomization into the three research groups (T, C1 and C2) and within the T group
into the higher versus lower incentives groups is done simultaneously—there is not a 2-step
randomization process.) In the grant application, RAB assumed $315,000 available for enrollment
in skills upgrade courses (up to 12 units for 1,050 participants, $25 per unit) and $315,000 available
for employment retention (up to 12 months for 1,050 participants, $25 per month). RAB assumed
70% of the 1,500 treatment group members would make use of these incentives. The incentives
would accrue in an account maintained by RAB in which the participant could see funds deposited
and would receive in a single lump sum payment at the completion of the pilot program so the
payments would not count toward eligibility determination of CalFRESH benefits.
The Fresno CA pilot will use these resources to support the following ‘test” of varying the
amounts of education/training and employment retention incentives:
Incentives for Skills Upgrades:
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Higher Incentive Group (SUH): $30 per unit, up to 12 units, $360 each for 525 of 750
individuals
Lower Incentive Group (SUL): $20 per unit, up to 12 units, $240 each for 525 of 750
individuals
Incentives for Job Retention:
Higher Incentive Group (JRH): $30 per month, up to 12 months, $360 each for 525 of
750 individuals
Lower Incentive Group (JRL): $20 per month, up to 12 months, $240 each for 525 of 750
individuals
The incentives would accrue in an account maintained by RAB in which the participant could
see funds deposited and would receive in a single lump sum payment at the completion of the pilot
program so the payments would not count toward eligibility determination of CalFRESH benefits.
For example, if a participant assigned to the higher incentive group completed both education and
job retention requirements such that he or she should receive $360 and $360, respectively, then
the participant would receive a single payment of $720 at program completion.
RAB will be responsible for ensuring that members of the treatment group randomly assigned
to the higher and lower incentive groups are offered incentives for the group in which they are
assigned. RAB will monitor treatment group members’ participation in education/training
upgrades and job retention to insure that total incentive payments remain within budget.
Sample Enrollment. The anticipated start date for sample enrollment is January 4, 2016 and
the anticipated end date is June 30, 2017 or until the Phase II and Phase III target samples for each
research group are achieved. Attachment 2 provides additional detail on target sample sizes during
Phases II and III.
RAB will serve eligible WRs through nine offices located within Fresno County. These
offices include: Mosqueda, Lowell, Central, West Fresno, Pinedale, El Dorado, Reedley, Coalinga,
and Kerman. Six offices are in urban locations and three are in rural locations. All offices will
serve enhanced pilot E&T participants, as well as regular E&T participants. The offices vary in
number of staff and hence capacity to serve enhanced E&T and regular E&T participants. Table
2.1 outlines the expected capacity of each RAB location in terms of staff available and the number
of participants that will be served in each group of the pilot. For the treatment group the enrollment
projections are higher than the ultimate target sample size in order to account for expected attrition
of participants. RAB anticipates final samples in the T, C1, and C2 research groups to be 1,500,
1,500 and 500, respectively (the 500 in group C2 is contingent on CA State DSS receiving
additional SNAP E&T funds from FNS and if not received the anticipated size of C2 will be 300).
For the most part, eligible WRs will be steered to a particular office based on the individual’s
residential ZIP code. However, service assignments will be flexible, for example, should a
different office be a better fit because it is located nearby to where the individual attends training
or works.
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Table 2.1. RAB Staffing and Enrollment Projections by Site and Research Group
Location
RAB
Pilot
Staff
RAB
Regula
r Staff
Treatment
Group
Control
Group #1
(No E&T
Services)
Control
Group #2
(Regular
CFET)
Total
Clients in
the
Evaluation
Mosqueda 9 2 420 375 56 851
Lowell 5 1 180 161 56 397
Central 5 1 240 214 56 510
West
Fresno 5 1 240 214 56 510
Pinedale 1 1 60 54 55 169
El Dorado 5 1 240 214 56 510
Reedley 5 1 180 161 55 396
Coalinga 1 1 60 54 55 169
Kerman 1 1 60 54 55 169
TOTALS 37 10 1680 1500 500 3680
Fresno DSS will collaborate with the Mathematica Team to implement and maintain a clear
contrast between the services received by each treatment and control group. In addition, Fresno
DSS will ensure that staff, partners, service providers, and other relevant organizations only
provide pilot-funded services to study participants for which their assigned research group is
eligible. The service embargo period is the time during which participants must stay in the research
group to which they were randomly assigned. Each sample member’s service embargo period is
3 years (36 months) starting from the point he or she was randomly assigned. During this period,
sample members already assigned to a research group may not receive services that are outside of
those permitted for their research group. If program staff are unsure of an individual’s research
status, they can look it up using the Mathematica Team’s random assignment system. In addition,
if an individual re-applies for services and is re-sent for random assignment, the random
assignment system will identify this individual and return the original random assignment result.
b. The Mathematica Team
The Mathematica Team will provide technical support to Fresno DSS to train users on how to
inform participants of their assignment status and explain the types of services they are entitled to
receive given their group assignment, including a script in easy-to-understand language. The
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Mathematica Team will provide technical support to Fresno DSS on the implementation and
maintenance of a strong random assignment evaluation design, including maintaining a clear
contrast between the research treatment group(s) and control group services and developing
adequate sample sizes and/or accelerated sample build-up. The Mathematica Team will review
data from the web-based information system on random assignment to the three research groups
as well as to the two incentive groups and on service receipt (as detailed below in section 2.5 and
in Exhibit B) to validate the accurate execution of the random assignment evaluation design.
Similarly, the Mathematica Team will support random assignment of enrollment incentives and
assist RAB with monitoring of it to ensure accurate execution of randomization into the enrollment
incentive groups. The Mathematica Team will similarly be conducting case file reviews as part of
in-person follow-up visits during pilot testing and full implementation phases to ensure pilot
services and evaluation procedures are implemented correctly.
2.5 Collection of administrative data and other types of data
a. Fresno DSS
Fresno DSS agrees to provide the Mathematica Team with data on pilot activities and
participants in both the treatment and control groups, including (1) CalFresh electronic
administrative data files, (2) electronic pilot service receipt data files, and (3) pilot cost data files.
See Exhibit B, Data Use Agreement for further detail on the data to be provided to the Mathematica
Team.
Fresno DSS will describe existing or new CalFresh, State agency, or other provider data
systems to the Mathematica Team and will connect staff data users, programmers, and experts to
the Mathematica Team to answer questions and to develop a plan for providing data to the
Mathematica Team. Fresno DSS will discuss the optimal way to capture necessary data either in
the MIS with additional data items or through a supplemental data tracking system. Fresno DSS
or other relevant state agency will enter into separate agreement with Mathematica’s subcontractor
MDRC to provide unemployment insurance data. Fresno DSS will transmit these data to the
Mathematica team for all pilot participants in the treatment and control groups until the date
specified in the data use agreement, Exhibit B. Fresno DSS will provide assistance to the
Mathematica Team on data use and systems for up to six years, the term of this agreement.
b. The Mathematica Team
The Mathematica Team will provide guidance to Fresno DSS on data collection needs in each
of the four types of data: (1) CalFresh administrative data, (2) service receipt data for treatment
and control groups, (3) pilot cost data for treatment and control services and (4) unemployment
insurance data (as mentioned, through separate agreement with MDRC). The Mathematica Team
will provide a secure web-based system for the transfer of all data and technical support to Fresno
DSS and other relevant partners. To minimize burden on Fresno DSS, the Mathematica Team will
coordinate the timing of data requests to coincide as much as possible with routine data-related
activities, such as data submissions to the state.
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3. SCHEDULE
The schedule for the activities specified in this agreement is outlined below. These dates are
subject to change and the Mathematica Team and Fresno DSS will come to agreement on any
revisions to the dates below.
Table 3.1. Timeline CalFresh E&T Pilots Program and Evaluation Activities
Activity Expected Completion Date
Phase I
Collaborate with FNS and the
Mathematica Team to develop
program and evaluation design
April 2015 – December
2015
Phase II
Start random assignment of
eligible participants to “pretest”
service delivery and evaluation
processes
January 2016
target:
4-6 months pretest
Phase III
Continue random assignment,
service delivery, and evaluation
processes for Grantees
May 2016 - June 2017
Phase IV
Annual reports to Congress
FNS releases study findings
November of each year
Interim 2019
Final 2021
+ Dates and time commitment estimates are subject to change.
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EXHIBIT B: DATA USE AGREEMENT
THIS DATA USE AGREEMENT (“DUA”) is entered into by and between the County of
Fresno Department of Social Services (herein referred to as “Fresno DSS”) who, with assistance
from Reading and Beyond (RAB), will work with Mathematica Policy Research, Inc.
(Mathematica) with assistance from subcontractors MDRC, Insight Policy Research, Koné
Consulting, and Decision Information Resources (hereinafter referred to as the “Mathematica
Team”) to perform the obligations set forth in the Memorandum of Understanding (the
“Agreement”) to which this Exhibit B is attached. Hereinafter, Fresno DSS and the Mathematica
Team may be referred to singularly as a “Party” and collectively as the “Parties.” This DUA
stipulates the conditions upon which Fresno DSS will provide confidential information to the
Mathematica Team for use in performance of the Evaluation of SNAP Employment and Training
Pilots.
INFORMATION TO BE PROVIDED. Fresno DSS and RAB agree to provide the
Mathematica Team with (1) CalFresh, CalWORKS, and Medi-Cal administrative data files, (2)
pilot service receipt data files, and (3) pilot cost data files. CDSS will provide UI wage records
data (through a separate agreement with Mathematica and Mathematica’s subcontractor MDRC).
The requirements of data files 1-3 are outlined in Tables 1 - 3 below. If a specific data requirement
does not exist in the Fresno DSS or RAB data systems, Fresno DSS and Mathematica will discuss
solutions and alternatives.
(1) CalFresh, CalWORKS, and Medi-Cal administrative data will be used to define primary
outcomes and subgroups for analysis. The data request is for CalFresh unit-level data for both
CalFresh and CalWORKS and individual-level data for pilot participants only for Medi-Cal, and
includes only evaluation sample members (all pilot project participants, each member of treatment
and control), not the full caseload. For each evaluation sample member, the CalFresh, CalWORKS,
and Medi-Cal administrative data request includes the 12 months before random assignment, the
month of random assignment, and each month after random assignment. Fresno DSS will provide
quarterly data files. The data will be provided to Mathematica’s subcontractor, Insight Policy
Research for cleaning and preparation of the analysis file. Fresno DSS will transmit data to Insight
Policy Research through a secure file transfer protocol as agreed upon with Mathematica. Separate
requests for aggregate count data on CalFresh applicants or participants by geographic areas such
as counties may also be made. Table 1 provides further detail on the timeline and variables
requested.
TABLE 1. CALFRESH, CALWORKS, AND MEDI-CAL ADMINISTRATIVE DATA
VARIABLES
Timeline
Monthly data will be collected quarterly (every 3 months) and delivered to Insight in two separate files.
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One file will contain all newly enrolled and randomly assigned participants. This file will provide the 3 months
of data from the current quarter as well as 12 months of historical data.
The second file will contain all continuing pilot participants and will only have three months of data from the
current quarter.
Variables
Basic unit information Unit Benefit amounts for each program for each
month
Case ID – unique identifier of CalFresh unit’s case
Study ID – ID assigned by Mathematica during
random assignment to identify pilot participants
Participant ID – unique individual ID assigned by
Fresno DSS to identify individual CalFresh
participants
Social Security Number – of pilot participant
CalFresh indicator, month X (whether pilot
participant actively participates in a CalFresh unit)
Date of CalFresh certification CalFresh monthly benefit amount, month X
Date of most recent CalFresh recertification Medi-Cal indicator for pilot participant only, month
X
Length of certification period Medi-Cal claims, month X
County where application was processed (FIPS code)
Month of data record
Year of data record
CalWORKS indicator, month X (whether any
CalFresh unit members receive CalWORKS benefits)
CalWORKS total monthly benefit amount for all
members of the CalFresh unit, month X
CalFresh Unit income (as of most recent
certification)
CalFresh Unit’s gross countable monthly income Contact information
CalFresh Unit’s net countable income First and last name of pilot participant or unit head
Presence of earned income Address (residential and mailing)
Presence of unearned income Telephone numbers (include all available numbers on
the file)
Presence of GA income Email
Presence of SSI income
Presence of Social Security income For cases that are closed
Indicator of CalFresh active or closed case
Reason for case closure
Date of case closure
For cases that are open, an indicator for whether
the case is currently under sanction
Notes
Information from the CalWORKS and Medi-Cal systems, including data on each CalFresh participant, will be
obtained for a single outcome measure from integrated systems only.
(2) Pilot service receipt data from Reading and Beyond (RAB) will be used to assess pilot
performance and describe participation and services received by evaluation sample members.
During Phase II, RAB will provide bi-weekly data on specific performance measures and targets
agreed upon by RAB, Fresno DSS and the Mathematica Team. These data will be used by all
parties to determine if random assignment and the program flow are being executed as anticipated.
Data include sample build-up and pilot service receipt. During Phase III, these data will be
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provided on a monthly basis. Performance data will be aggregate reports based on the MIS data
collected by RAB. In addition to the aggregate reports, RAB will provide individual-level data on
service receipt on a quarterly basis. These data will be transmitted to Mathematica through a secure
file transfer protocol as agreed upon with Mathematica. Table 2 provides further detail on the
universe, purpose, timeline, and variables requested.
TABLE 2. PILOT SERVICE RECEIPT DATA VARIABLES
Universe
Each person randomly assigned to the treatment group or one of two control groups as part of the pilot project
Purpose
These data will be used for 1) assessing data fidelity for the evaluation, 2) the participation analysis, and 3) the
cost/benefit analysis.
Timeline
We will work closely with each site to develop a feasible plan for collecting data on service receipt. The data for
monitoring will be needed periodically after the start of the pilot, but data for the participation and cost/benefit
analysis will be required less frequently.
Variables
Demographic information Service receipt information
Unique identifier to link to CalFresh case Service/activity start date (overall and by activity)
Name Service/activity end date (overall and by activity)
Gender Date completed/withdrew by activity
Age Reason for withdrawal by activity
Homeless Cost of training/service
Veteran Amount of subsidy paid for employment
Offender Amount and frequency of support services received
Low-income
Limited English language proficiency
Children in the household
RAB Site Information and Other Provider
Information
Reading and Beyond site assigned to
Provider code—to identify the provider by service
Education Location where each service was provided—RAB
site location
Highest school grade completed at entry/exit
School status at entry Credentials and degree/certifications
Type of credentials/degrees/certifications earned
Type of service received Date earned
Assessments (document outcome Status at program exit (if not complete)
Wrap-around services – referral or ancillary support
Pre-employment support – individualized career
plan, job club workshop, and/or job search
Employment
Vocational training and industry type for training Employment status at entry into program
Case management received/most recent date of
service – number of contacts and number of hours
Occupation type of most recent employment
Subsidized employment placement Employment status at exit from program
Job placement (unsubsidized employment) Occupation type for employment at exit/follow-up
Type of education program in which enrolled – in-
house vs. outside program
Entered training-related employment
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Universe
Post-employment retention services and whether
employment was retained
Notes
For sites that capture the required data within their MIS, or can add needed data elements to their systems, we
will arrange for regular extracts from the existing system. In other sites, where existing systems do not or cannot
capture all of the needed data on service receipt, we will work with the site to develop a supplemental tracking
system that will allow providers to track and submit data consistently and systematically.
(3) Pilot cost data will be used to describe the overall cost of operating the pilot and its
components and services. Additionally, the pilot cost data will be used to conduct a cost benefit
analysis of the pilot project. Fresno DSS will provide cost data from Fresno DSS, RAB, and any
other relevant partners through Mathematica’s customized Excel workbooks immediately
following the planning period and quarterly thereafter for the duration of the pilot. The
Mathematica Team will work with Fresno DSS to determine an efficient process for collecting
cost data quarterly. If possible, RAB will deliver its completed cost data workbooks to Fresno
DSS, and Fresno DSS will submit the cost data workbooks for both RAB and Fresno DSS to
Mathematica according to the quarterly schedule. Fresno DSS will transmit data to Mathematica
through a secure file transfer protocol as agreed upon with Mathematica. Data will be collected
and analyzed for pilot treatment services, and for services provided to the control group under the
existing CalFresh E&T program to the extent possible. Table 3 provides further detail on the
universe, timeline, and variables requested.
TABLE 3. COST DATA VARIABLES
Universe
Collect information on costs from grantee, partner, and provider organizations
Timeline
Administer cost data collection workbooks to collect costs (for treatment and control services) incurred during
start-up/planning phase and each quarter throughout pilot implementation and operations.
Variables
Staff (all those involved in pilot)
General supplies & equipment
Job title and pilot-related job responsibilities Cost of general supplies and equipment used during
the reporting period
Salary and fringe benefits Percentages of cost paid for by grant and other
sources
Hours worked
Percent time worked on pilot during reporting period
Percentages of salary paid for by grant and other
sources
Percentage of time spent on evaluation-related
activities
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Service provider contracts
Indirect and other costs
Amount paid to service providers during the
reporting period
Indirect costs incurred during reporting period
Any travel expenses incurred
Facilities
Cost of facilities (including donated facilities) used
for pilot during the reporting period
Percentages paid for by grant and other sources
Service costs
Payments to vendors for services provided to pilot
participant (for example, tuition, child care)
Payments to participants during the reporting period
(for example, child care, transportation)
Purchase prices of other service-specific supplies (for
example, assessment test booklets and licensing fees)
Percentages paid for by grant and other sources
Notes
Workbooks will be tailored to collect appropriate costs for each grantee and, after first data collection, many
workbook fields will be prepopulated to minimize burden.
Three annual time use surveys of grantee and partner frontline staff (first one administered spring 2016) will
estimate staff costs for pilot services during pilot operations.
USE OF THE DATA PROVIDED. As set forth in the Agreement, Mathematica will use
the data provided by Fresno DSS solely for the purpose of monitoring and analysis activities under
the CalFresh Employment and Training Pilots Evaluation and as otherwise required under
Mathematica’s contract with FNS. Mathematica may publish the data in public use files, provided
that the data are aggregated in a manner that does not reveal the identity of any individual or
employer. Mathematica will also provide restricted use files to FNS.
SPECIFIC USERs. Mathematica specifies the following users of this information, who are
authorized to receive and work with the data received from Fresno DSS:
Mathematica
•%Michael Ponza, Senior Fellow and Associate Director
•%James Mabli, Associate Director
•%Gretchen Rowe, Senior Researcher
•%Peter Schochet, Senior Fellow
•%Nick Beyler, Statistician
•%Linda Rosenberg, Senior Researcher
•%Nora Paxton, Senior Manager
•%Jessica Ziegler, Researcher
•%Lisa Dragoset, Senior Researcher
•%Quinn Moore, Senior Researcher
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•%Dallas Dotter, Researcher
•%Julia Lyskawa, Research Analyst
•%Brittany English, Research Analyst
•%Mary Anne Anderson, Research Analyst
•%Kristen Joyce, Research Analyst
•%Julie Worthington, Research Analyst
•%John Tyler, Program Analyst
MDRC
•%Barbara Goldman, Vice President
•%Gayle Hamilton, Senior Fellow
•%Richard Hendra, Senior Associate
•%Frieda Molina, Senior Operations Associate & Deputy Director
•%Donna Wharton-Fields, Senior Operations Associate
•%Jonathan Bigelow, Research Analyst
•%Keith Olejniczak, Research Assistant
•%Alexandra Pennington, Research Associate
•%David Navarro, Research Associate
•%Kelsey Schaberg, Research Analyst
•%Betsy Tessler, Research Associate
•%Stephen Freedman, Senior Associate
Insight Policy Research
•%Claire Wilson, Executive Director of Research
•%Carole Trippe, Associate Director
•%Brian Estes, Senior Researcher
•%Brittany McGill, Senior Researcher
•%Anne Peterson, Founder and Principal
Koné Consulting
•%Alicia Koné, President
•%Alicia Huguelet, Senior Consultant
•%Sue McGinn, Consultant
TRANSMISSION OF INFORMATION. Fresno DSS agrees to provide the Mathematica
Team with the information specified in this Agreement though a secure online file transfer protocol
(FTP) site or a File Exchange (FX) site, encrypted in transit and at rest, and maintained by
Mathematica.
CONFIDENTIALITY ASSURANCE. The Mathematica Team shall maintain the data
received hereunder in strict confidence and shall only use, access or disclose the data for purposes
of the evaluation. The Mathematica Team shall adhere to all applicable state and federal statutes,
rules, and regulations governing the use and disclosure of information received hereunder.
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Furthermore, Mathematica hereby attests that it has internal security measures sufficient to protect
the confidentiality of this information and to restrict access to the information to only those who
have a valid need to access the information.
PROPRIETORSHIP OF INFORMATION. The data or information provided by this
Agreement remains the property of Fresno DSS, even if Mathematica has paid for its production
or any related production. Fresno DSS retains the right to request that Mathematica return to
Fresno DSS the data or information, in the same form or manner as provided to Mathematica.
Fresno DSS will provide such notice in writing and will afford Mathematica at least thirty (30)
days after receipt of notice to return the data or information. Fresno DSS retains the right to request
any copies or other representations of the information provided under this Agreement made by
Mathematica, its employees or agents, in addition to the original data
DATA DISPOSITION. Upon termination or expiration of the Agreement, regardless of the
reason for such action, the Mathematica Team shall destroy all data received from Fresno DSS
hereunder, certifying in writing to such destruction.
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ATTACHMENTS
ATTACHMENT 1. Pilot project flow
ATTACHMENT 2. Pilot sample build-up goals for Phase II and III by month
ATTACHMENT 3. Pilot performance measures and targets
ATTACHMENT 4. Registration document
ATTACHMENT 5A. Participant consent form for participating in the evaluation
ATTACHMENT 5B. Participant consent form for releasing UI wage records data
ATTACHMENT 6. Focus group participant consent form
ATTACHMENT 7. In-depth participant interview consent form
ATTACHMENT 8. Staff interview consent form
ATTACHMENT 9. Employer interview consent form
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ATTACHMENT 1
FRESNO PILOT PROJECT FLOW
SNAP%E&T%PILOTS%MEMORANDUM%OF%UNDERSTANDING%MATHEMATICA%POLICY%RESEARCH!
%
%
%28%%
Additional)Round)of)Random)Assignment)
(1b))
RAB:%Follows%up%with%phone%
call%to%recruit%into%the%pilot.%
Clients%invited%to%inHperson%
meeting%to%learn%more%about%
the%program.
(1c)%
RAB:)Short%assessment%to%
confirm%interest%and%“predict”%
likely%service%track%(for%
evaluation%purposes)S%Brief%
orientation%to%program.
FBA%Pilot:%%Services,%Placement%and%Retention%
^Higher)Incentives)Treatment)
Group)1AA )(SUH)&)JRH):)
Would%be%eligible%to%receive%higher%level%
of%FBA%participation%incentives%(N=750)%
^Lower)Incentives)Treatment)
Group)1AB )(SU L)&)JRL):)
Would%be%eligible%to%receive%FBA%
regular%participation%incentives%
(N%=%750)%
Phase 1:
WR Screening &
Referrals
)
Internal:))Fresno%DSS%(as%part%of%
eligibility%determination%of%new%
SNAP%applicants%and%reH
certifications)
)
(1a))
Fresno)DSS:%Among%
SNAPHeligible%individuals,%
screen%for%work%registrants%
(WRs)S%Provide%RAB%with%
list%of%WRs .
Phase 2:
%Random
Assignment
Location:
RAB
Control)
Group)#1:
%
Receives%no%
SNAP%E&T%
services
%
(N%=%1,500)
Control)Group)#2:)
%
Receives%current%
(business%as%usual)%
SNAP%E&T%services%
%
(N%=%500)%
Not)engaged:%Do%not%complete%full%
assessment%and%client/family%plan%
(remain%in%Treatment%Group%
evaluation%sample%and%followed)S%
RAB%will%followHup%to%try%to%reH
engage%client%in%program
Client/Family)Plan:%Treatment%group%
members%complete%a%full%intake%
assessment%and%then%develop%a%
Client/Family%Plan%that%includes%goals%for%
employment,%education%/%training,%and%
wraparound%services
(4a))Services)
•Case%Management%
•Soft%skills%
•Digital%literacy%
•Training/Education%
(w/%incentives)%
•Wraparound%
•Children’s%services %
Phase 3:)
Assessment & Develop
Client/Family Plan
)
Location:
RAB
(4b))Placement)
•Enhanced%job%placement%services%
•Subsidized%employment%HORH%
•Unsubsidized%employment%
•Wage%progression%
(4c))Retention )
•Job%retention%(barrier%removal)%
•Participant%incentive%–%continued%education%
•Participant%incentive%H%retention %
Randomly)assigned)to)one)
of)two)control)groups Randomly)assigned)to)
treatment)group!
Treatment)Group:)Receives)offer)to)participate)in)FBA)Pilot)
Enroll%in%FBA%(n%=%1,500)%
Phase 4:
Receipt of Pilot
Services
%
Location:
RAB%and%other%providers
(1d)%
RAB:)Sign%
Informed%Consent%
Form%and%
complete%
Registration
^Phase)2:)Skills)Upgrade)&)Job)
Retention)Incentive)groups)
)
Skills!Upgrades:!!!
•(SUH):%%$30%per%unit,%up%to%12%units,%
$360%each%for%525%of%750%individuals)
•%(SUL):%%$20%per%unit,%up%to%12%units,%
$240%each%for%525%of%750%individuals)
Job!Retention:%
•(JRH):%%$30%per%month,%up%to%12%
months,%$360%each%for%525%of%750%
individuals )
•%(JRL):%%$20%per%month,%up%to%12%
months,%$240%each%for%525%of%750%
individuals )
%
SNAP%E&T%PILOTS%MEMORANDUM%OF%UNDERSTANDING%MATHEMATICA%POLICY%RESEARCH!
%
%
%29%%
ATTACHMENT 2
PILOT SAMPLE BUILD-UP GOALS FOR PHASE II AND III BY MONTH
SNAP%E&T%PILOTS%MEMORANDUM%OF%UNDERSTANDING%MATHEMATICA%POLICY%RESEARCH!
%
%
%30%%
PILOT SAMPLE BUILD-UP GOALS FOR PHASE II AND III BY MONTH
Fresno DSS and RAB agrees to recruit a sufficient number of individuals for the study as
indicated in Table A below. For the treatment group the enrollment projections are higher than
the ultimate target sample size in order to account for expected attrition of participants. RAB
anticipates final samples in the T, C1, and C2 research groups to be 1,500, 1,500 and 500,
respectively (the 500 in group C2 is contingent on CA State DSS receiving additional SNAP
E&T funds from FNS and if not received the anticipated size of C2 will be 300).
TABLE A: MINIMUM RESEARCH SAMPLE REQUIREMENTS
MONTH
Phase II:
Treatment
Group
Phase II:
Control
Group #1
Phase II:
Control
Group #2
Phase III:
Treatment
Group
Phase III:
Control
Group #1
Phase III:
Control
Group #2
January-16 40 40 27
February-16 45 40 27
March-16 50 40 27
April-16 85 80 27
May-16 95 90 28
June-16 105 90 28
July-16 110 95 28
August-16 115 95 28
September-16 115 95 28
October-16 110 95 28
November-16 105 95 28
December-16 105 95 28
January-17 105 95 28
February-17 105 95 28
March-17 100 95 28
April-17 100 90 28
May-17 95 90 28
June-17 95 85 28
TOTALS 220 200 108 1460 1300 392
SNAP%E&T%PILOTS%MEMORANDUM%OF%UNDERSTANDING%MATHEMATICA%POLICY%RESEARCH!
%
%
%31%%
ATTACHMENT 3
PILOT PERFORMANCE MEASURES AND REPORTING
SNAP%E&T%PILOTS%MEMORANDUM%OF%UNDERSTANDING%MATHEMATICA%POLICY%RESEARCH!
%
%
%32%%
PILOT PERFORMANCE MEASURES AND REPORTING
Reading and Beyond (RAB) will provide the following performance measures at an aggregate
level on an ongoing basis in order to assess the performance of the Fresno Bridge Academy pilot
project. These measures will be provided to the Mathematica Team on a bi-weekly basis in an
electronic format. There are three types of performance measures that will be assessed – 1) Pre-
random assignment (RA), 2) RA, and 3) Post-RA – and these measures are outlined in Tables
A3-1, A3-2, and A3-3 below. All measures listed below should be provided for each of the 9
RAB locations, as well as the total for each measure.
Table A3-1. Pre-Random Assignment Pilot Performance Measures
Pre-random
assignment
intake step
Metric
DSS WR
Screening # of individuals DSS identified as eligible for CalFRESH benefits and are WRs
RAB contact
# of individuals who RAB initially call about CalFRESH E&T pilot
# of individuals who RAB reaches via phone
# of individuals who schedule in-person meeting with RAB about CalFRESH E&T pilot
Consent
# of individuals who attend meeting and start consent process for participation in the
CalFRESH E&T Pilot
# of individuals who complete (i.e. sign) informed consent form to participate in the
CalFRESH E&T Pilot
Table A3-2. Random Assignment Pilot Performance Measures
Pilot Site Metric
Offices 1-9
# of individuals randomly assigned to the treatment group
# of individuals randomly assigned to the control group #1
# of individuals randomly assigned to the control group #2
SNAP%E&T%PILOTS%MEMORANDUM%OF%UNDERSTANDING%MATHEMATICA%POLICY%RESEARCH!
%
%
%33%%
Table A3.3 Post-Random Assignment Pilot Performance Measures
SNAP E&T Eligibility Status Metric
Eligibility # of treatment group members
Exit # of treatment group members who ever exited the SNAP E&T
pilot program for any reason.
Exit Reasons
# of treatment group members who ever exited the SNAP E&T
pilot program because: Moved out of the state
# of treatment group members who ever exited the SNAP E&T
pilot program because: Dropped out of program
# of treatment group members who ever exited the SNAP E&T
pilot program because: Other reasons
SNAP E&T Pilot Service Domain Metric
Any SNAP E&T service (support
services, pre-employment services,
education, training, work
experience, placement, or
postemployment services)
# treatment group members who ever started a assessment, wrap-
around service, pre-employment service, case management,
vocational training, education, subsidized employment, job
placement, or post-employment retention services
# treatment group members who ever completed a assessment,
wrap-around service, pre-employment service, case management,
vocational training, education, subsidized employment, job
placement, or post-employment retention services
Assessments
# of treatment group members who ever started any type of
assessment
# of treatment group members who ever completed all
requirements for at least one type of assessment
# of treatment group members who ever started Intake
Assessment
# of treatment group members who ever completed all
requirements for Intake Assessment
# of treatment group members who ever started Quarterly
Assessment – measure at months 3, 6, 9, 12, and 15
# of treatment group members who ever completed Quarterly
Assessment – measure at months 3, 6, 9, 12, and 15
# of treatment group member who ever started Exit Assessment
# of treatment group members who ever completed all
requirements for the Exit Assessment
Wrap-around services: Includes
both outside referrals and
ancillary support funds
# treatment group members who were ever referred to any wrap-
around service
# treatment group members who ever asked/needed ancillary
support funds
# treatment group members who ever received ancillary support
funds
SNAP%E&T%PILOTS%MEMORANDUM%OF%UNDERSTANDING%MATHEMATICA%POLICY%RESEARCH!
%
%
%34%%
Pre-employment services:
Individualized career plan, job
club workshops, and/or job search
# of treatment group members who ever started any type of pre-
employment service
# of treatment group members who ever completed all
requirements for at least one type of pre-employment service
# of treatment group members who ever started individualized
career plan
# of treatment group members who ever completed all
requirements for individualized career plan
# of treatment group members who ever started job club
workshops
# of treatment group members who ever completed all
requirements for job club workshops
# of treatment group members who ever started job search
# of treatment group members who ever completed all
requirements for job search
# of contacts and aggregate hours for all case management for
treatment group members
Case management
# of contacts and aggregate hours for each case management
contact type (email, phone, in-person, home visit) for treatment
group members (tentative – pending data availability)
# of contacts and aggregate hours of case management pertaining
to each “component” including Job Search, Job Retention, and
Education (tentative – pending data availability)
Vocational Training (all types)
# of treatment group members who ever completed first day of
any vocational training program
# of treatment group members who ever completed all
components of any vocational training program
# of treatment group members that obtained an industry-
recognized credential for any vocational training program
Education: Includes GED/HS
diploma via either in-house
services or outside services
# of treatment group members who ever completed first day of
any education program
# of treatment group members who ever completed at least one
subject test for any education program
# of treatment group members who ever completed all
components and received their GED certificate for any education
program
# of treatment group members who ever completed first day of an
in-house education program
# of treatment group members who ever completed at least one
subject test for an in-house education program
# of treatment group members who ever completed all
components and received their GED certificate for an in-house
education program
# of treatment group members who ever completed first day of an
outside education program
SNAP%E&T%PILOTS%MEMORANDUM%OF%UNDERSTANDING%MATHEMATICA%POLICY%RESEARCH!
%
%
%35%%
# of treatment group members who ever completed at least one
subject test for an outside education program
# of treatment group members who ever completed all
components and received their GED certificate for an outside
education program
Subsidized employment: (Level 1,
Level 2 - Higher % subsidy for
jobs over $12/hour vs. lower % for
under $12/hour)
# of treatment group members who ever worked first day of any
subsidized employment
# of treatment group members who ever completed any subsidized
employment placement
# of treatment group members who ever worked first day of Level
1 subsidized employment
# of treatment group members who ever completed Level 1
subsidized employment placement
# of treatment group members who ever worked first day of Level
2 subsidized employment
# of treatment group members who ever completed Level 2
subsidized employment placement
Job Placement (unsubsidized
employment) - started
# of treatment group members who ever started a new job since
random assignment.
Postemployment retention services
- subsidized (includes employee
and employer check-in) and
unsubsidized (employee check-in
only); All check-ins at least monthly
# of treatment group members who ever started any type of post-
employment retention service, while employed
# of treatment group members who retained employment 6
months from start of retention services
# of treatment group members who retained employment 12
months from start of retention services
# of treatment group members who ever started subsidized
employment retention services, while employed
# of treatment group members who retained employment 6
months from start of subsidized employment retention services
# of treatment group members who retained employment 12
months from start of subsidized employment retention services
# of treatment group members who ever started unsubsidized
employment retention services, while employed
# of treatment group members who retained employment 6
months from start of unsubsidized employment retention services
# of treatment group members who retained employment 12
months from start of unsubsidized employment retention services
SNAP%E&T%PILOTS%MEMORANDUM%OF%UNDERSTANDING%MATHEMATICA%POLICY%RESEARCH!
%
%
%36%%
ATTACHMENT 4
REGISTRATION DOCUMENT (ENGLISH)
C.1.2
OMB Control No.: 0584-xxxx
Expiration Date: 00/00/20xx
SNAP E&T Pilots
Registration Document
August 26, 2015
Public Burden Statement
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB
control number for this information collection is 0584-xxxx. The time required to complete this information
collection is estimated to average 12 minutes including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
Send comments regarding this burden estimate to Food and Nutrition Service, U.S. Department of Agriculture,
3101 Park Center Drive, Room 1014, Alexandria, VA 22302.
C.1.3
CONTACT INFO:
1. Participant Name:
First Name:
Middle Initial:
Last Name:
2a. In the past 3 years, have you gone by any other names?
m Yes
.................................................................................................................
1
.................................................................................................................
m No
.................................................................................................................
0
.................................................................................................................
GO TO Q3
2b. Please provide any other names you have been using to identify yourself over the past 3 years
(including Maiden name):
First Name1:
Last Name1:
First Name2:
Last Name2:
3. What is your current address?
Street Address 1:
Street Address 2:
City:
State:
Zip:
C.1.4
m No fixed address/No mailing address
4. What is your date of birth?
MONTH DAY YEAR
5. Social Security Number:
6. Gender:
m Male
.................................................................................................................
1
.................................................................................................................
m Female
.................................................................................................................
2
.................................................................................................................
7. Landline Phone Number:
m None
7a. Under whose name is that phone listed?
m My own
name
.................................................................................................................
1
.................................................................................................................
m Someone else’s name
(SPECIFY)
.................................................................................................................
2
.................................................................................................................
First Name:
Last Name:
8. Cell Phone Number:
m None – GO TO Q9
8a. Do we have your permission to text you to notify you about future surveys?
C.1.5
m Yes
.................................................................................................................
1
.................................................................................................................
m No
.................................................................................................................
0
.................................................................................................................
9. Email Address:
m None
C.1.6
DEMOGRAPHIC AND WELL-BEING INFORMATION:
10. Are you...
m Hispanic or
Latino,
.................................................................................................................
1
.................................................................................................................
m Not Hispanic or
Latino
.................................................................................................................
0
.................................................................................................................
11. Please choose one or more races that you consider yourself to be.
Select all that apply
o American Indian or Alaska
Native
.................................................................................................................
1
.................................................................................................................
o Asian
.................................................................................................................
2
.................................................................................................................
o Black or African
American
.................................................................................................................
3
.................................................................................................................
o Native Hawaiian or Pacific Islander,
or
.................................................................................................................
4
.................................................................................................................
o White
.................................................................................................................
5
.................................................................................................................
12. What is your primary spoken language?
Select one only
m English
.................................................................................................................
1
.................................................................................................................
GO TO Q13
C.1.7
m Spanish
.................................................................................................................
2
.................................................................................................................
m Other
(SPECIFY)
.................................................................................................................
3
.................................................................................................................
12a. How well would you say you speak English? Would you say…
m Very
well
.................................................................................................................
1
m Well
.................................................................................................................
2
.................................................................................................................
m Not well,
or
.................................................................................................................
3
.................................................................................................................
m Not at
all
.................................................................................................................
4
.................................................................................................................
13. Are you currently…
Select one only
m Married
.................................................................................................................
1
.................................................................................................................
m Living with someone as
married,
.................................................................................................................
2
.................................................................................................................
m Separated,
.................................................................................................................
3
.................................................................................................................
m Divorced,
.................................................................................................................
4
.................................................................................................................
C.1.8
m Widowed,
or
.................................................................................................................
5
.................................................................................................................
m Never
married?
.................................................................................................................
6
C.1.9
14. What is the highest grade or degree you have completed?
Select one only:
o Less than 8th
grade
.................................................................................................................
1
.................................................................................................................
o 8th to 12th Grade, no
diploma
.................................................................................................................
2
.................................................................................................................
o High School Diploma or
GED
.................................................................................................................
3
.................................................................................................................
o Adult Basic Education (ABE)
certificate
.................................................................................................................
4
.................................................................................................................
o Some college but no
degree
.................................................................................................................
5
.................................................................................................................
o Vocational/Technical degree or
certificate
.................................................................................................................
6
.................................................................................................................
o Business
degree/certificate
.................................................................................................................
7
.................................................................................................................
o Associates degree
(AA)
.................................................................................................................
8
.................................................................................................................
o Bachelor’s degree or equivalent
(BA/BS)
.................................................................................................................
9
.................................................................................................................
o Master’s degree (MA/MS) or higher (MD,
Ph.D)
.................................................................................................................
C.1.10
10
.................................................................................................................
o Other
(SPECIFY)
.................................................................................................................
11
14a. In general would you say your health is excellent, very good, good, fair or poor?
m Excellent
.................................................................................................................
1
.................................................................................................................
m Very
good
.................................................................................................................
2
.................................................................................................................
m Good
.................................................................................................................
3
.................................................................................................................
m Fair
.................................................................................................................
4
m Poor
.................................................................................................................
5
.................................................................................................................
C.1.11
HOUSEHOLD COMPOSITION:
15. Including yourself, how many people live with you? (Please include babies, small children,
people who are not related to you, and people who are temporarily away.)
(NUMBER OF PEOPLE LIVING WITH YOU, INCLUDING YOU)
16. Do all the people who live with you share the food that is bought for the household?
m Yes
.................................................................................................................
1
.................................................................................................................
GO TO 18
m No
.................................................................................................................
0
.................................................................................................................
17. Including yourself, how many people in your household share the food that is bought for the
household?
(NUMBER OF PEOPLE IN HOUSEHOLD THAT SHARE FOOD WITH YOU,
INCLUDING YOU)
18. And (of those), how many people are children age 18 or younger?
(NUMBER OF CHILDREN AGE 18 OR YOUNGER)
EMPLOYMENT HISTORY:
19. Have you ever worked for pay? Please include self-employment.
m Yes
.................................................................................................................
1
.................................................................................................................
m No
.................................................................................................................
0
.................................................................................................................
GO TO 25a
20. Are you currently self-employed or working at a job for pay?
m Yes
.................................................................................................................
1
.................................................................................................................
GO TO 22
m No
.................................................................................................................
0
.................................................................................................................
C.1.12
21. In what month and year did your last job end?
MONTH YEAR
The next questions are about your current or most recent job. (If you currently have more than one
job or had more than one job recently, give answers about your job with the most hours.)
22. What is the name of the company at which you currently or most recently worked?
m Self-
employed
.................................................................................................................
1
.................................................................................................................
22a. What (is/was) your job title?
23. What are (or were) your main duties at this company? Please be specific.
24. IF RESPONSE AT Q21 IS LESS THAN 5 YEARS: How many hours per week do (or did) you usually
work at your main job?
(HOURS PER WEEK) - GO TO Q25
mVaries/Don’t
know
.................................................................................................................
1
.................................................................................................................
24a. How many hours did you work during the last week you worked?
(HOURS DURING LAST WEEK WORKED)
25. IF RESPONSE AT Q21 IS LESS THAN 5 YEARS: What was your current or most recent rate of
pay, before taxes and deductions at your main job? IF RATE OF PAY VARIES, PROBE FOR
AVERAGE RATE OF PAY
PER
Select one only
m Hour
.................................................................................................................
1
.................................................................................................................
C.1.13
m Week
.................................................................................................................
2
.................................................................................................................
m Every 2
weeks
.................................................................................................................
3
.................................................................................................................
m Twice per
month
.................................................................................................................
4
.................................................................................................................
m Year
.................................................................................................................
5
.................................................................................................................
m Other
(SPECIFY)
.................................................................................................................
6
25a. What is the main reason you (have never worked/are not currently working)?
Select only one.
m Could not find work or lack of jobs available in the
area
.................................................................................................................
1
.................................................................................................................
m Lack necessary schooling, training, skills or
experience
.................................................................................................................
2
.................................................................................................................
m Could not get along with supervisor or co-
workers
.................................................................................................................
3
.................................................................................................................
m Physical or mental health
problems
.................................................................................................................
4
.................................................................................................................
m Alcohol or substance
abuse
.................................................................................................................
5
.................................................................................................................
C.1.14
m Family responsibilities;; caring for children, spouse, or
parents
.................................................................................................................
6
.................................................................................................................
m Attending
school
.................................................................................................................
7
.................................................................................................................
m Transportation issues or problems (no car or no public transportation
available, transportation costs too
much)
.................................................................................................................
8
.................................................................................................................
m Chose not to
work
.................................................................................................................
9
.................................................................................................................
m Other
(SPECIFY)
.................................................................................................................
10
OTHER PROGRAM RECEIPT:
26. Do you currently receive assistance from any of the following programs?
Select all that apply
o SNAP (Food Stamps) also known as
CalFresh
.................................................................................................................
1
.................................................................................................................
o TANF (Temporary Assistance to Needy Families) also known as
CalWorks
.................................................................................................................
2
.................................................................................................................
o Medicaid also known as Medi-
Cal
.................................................................................................................
3
.................................................................................................................
o General
Assistance
.................................................................................................................
C.1.15
4
.................................................................................................................
o Unemployment
Compensation
.................................................................................................................
5
.................................................................................................................
o SSI (Supplemental Security
Income)
.................................................................................................................
6
.................................................................................................................
o Section 8 or Public Housing
Assistance
.................................................................................................................
7
.................................................................................................................
o WIC (Women, Infants, and Children food
program)
.................................................................................................................
8
.................................................................................................................
o Other
(SPECIFY)
.................................................................................................................
9
.................................................................................................................
o None
.................................................................................................................
0
.................................................................................................................
GO TO 28
IF SNAP/CALFRESH NOT SELECTED,
GO TO Q28
27. IF CURRENTLY RECEIVING SNAP (CalFresh): Before you began receiving SNAP (CalFresh)
benefits this most recent time, had you ever participated in SNAP (CalFresh) before?
m Yes
.................................................................................................................
1
.................................................................................................................
m No
.................................................................................................................
0
.................................................................................................................
C.1.16
OTHER CONTACTS:
28. Please provide the name, address, email address, and phone number(s) of two close relatives or
friends who do not live with you but who are likely to know how to contact you in the next year.
We will only contact these people if we cannot reach you directly.
PERSON 1:
Name:
First Name:
Middle Initial:
Last Name:
Address:
Street Address 1:
Street Address 2:
City:
State:
Zip:
Phone number:
(LANDLINE)
(CELL)
Email address:
What is this person’s relationship to you?
m Parent
.................................................................................................................
1
.................................................................................................................
m Grandparent
.................................................................................................................
2
.................................................................................................................
m Brother/Sister
.................................................................................................................
3
.................................................................................................................
C.1.17
m Friend/Neighbor
.................................................................................................................
4
.................................................................................................................
m Employer
.................................................................................................................
5
.................................................................................................................
m Other
(SPECIFY)
.................................................................................................................
6
C.1.18
PERSON 2:
Name:
First Name:
Middle Initial:
Last Name:
Address:
Street Address 1:
Street Address 2:
City:
State:
Zip:
Phone number:
(LANDLINE)
(CELL)
Email address:
What is this person’s relationship to you?
m Parent
.................................................................................................................
1
.................................................................................................................
m Grandparent
.................................................................................................................
2
.................................................................................................................
m Brother/Sister
.................................................................................................................
3
.................................................................................................................
m Friend/Neighbor
.................................................................................................................
4
.................................................................................................................
m Employer
.................................................................................................................
C.1.19
5
.................................................................................................................
m Other
(SPECIFY)
.................................................................................................................
6
C.1.20
FOR RAB CASE NAVIGATOR USE ONLY:
Based on responses to Q12 - Q12a (Ability to speak English) and Q14 (Completed Education) [See Illustrative
Guidance Below], any other information you believe is relevant, and your own intuition, how likely is this
individual to receive the following services:
o ESL/GED/Basic Education Services
Very likely m
Somewhat Likely m
Somewhat Unlikely m
Very Unlikely m
o Vocational Education/Post-Secondary Education Services
Very likely m
Somewhat Likely m
Somewhat Unlikely m
Very Unlikely m
o Employment-Only Services
Very likely m
Somewhat Likely m
Somewhat Unlikely m
Very Unlikely m
Illustrative guidance for completing this section:
IF Q12 = 2-3 (Speak Spanish or another language) AND Q12a = 3-4 (Speaks English not well or not at all) ,
individual would have increased likelihood of being assigned to ESL/GED/Basic ED
IF Q14 = 1-2 (Completed education less than 8th grade or 8th to 12th but no diploma), individual would have
increased likelihood of being assigned to ESL/GED/Basic ED
IF Q14 = 3 – 5 (HS diploma or GED, ABE certificate, or some college no degree), individual would have
increased likelihood of being assigned to Vocational Education/Post-Secondary Education
IF Q14 = 6 – 11 (Vocational/Technical degree or certificate, Business degree/certificate, AA, BA/BS, MA/MS or
higher), individual would have increased likelihood of being assigned to Employment-Only
n Note: IF Q14 = 6 (Vocational/Technical degree or certificate), but date received degree or certificate is a
while ago or individual expresses interest in pursuing a different vocation/technical degree or certificate,
then individual would have high likelihood of being assigned to Vocational Education/Post-Secondary
Education
SNAP%E&T%PILOTS%MEMORANDUM%OF%UNDERSTANDING%MATHEMATICA%POLICY%RESEARCH!
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ATTACHMENT 5A
PARTICIPANT CONSENT FORM TO PARTICIPATE IN THE EVALUATION
D.1.2
FOR COUNSELOR USE ONLY:
Study ID #: | | | | | | | | |
CONSENT TO PARTICIPATE
IN THE EVALUATION OF THE CALFRESH EMPLOYMENT AND TRAINING PROGRAM
The U.S. Department of Agriculture, Food and Nutrition Service is testing new ways to help participants in the CalFresh
Employment and Training (E&T) program. It is also doing a study to find out if these approaches can help people get a job
or get a better job. A team of researchers at Mathematica Policy Research, MDRC, Kone Consulting, Insight Policy
Research, and Decision Information Resources (DIR) will conduct the study. Fresno DSS sent you to us (Reading and
Beyond, RAB) because you get CalFresh and are eligible for employment and training services from CalFresh.
By signing this form, you agree to take part in this important study. In this study, the following will happen:
• About 3,500 CalFresh participants like you will be in the study. A computer will put you in one of three groups. This is a
little like a lottery—it will be decided by chance. Each person has an equal chance of getting into one of the three groups.
Each group will get different kinds of services. The three groups are:
1. Regular CalFresh E&T services group: If you are in this group, you will be able to get services such as case
management, help with your job search, and help to go back to school or training. You will also get help with the
needs of your whole family, and referrals to outside partners for needed tutoring or education.
2. Expanded CalFRESH E&T services group: If you are in this group, you will be able to get the same services as
the regular CalFresh E&T services group. But in addition to those services, you will be able to get incentives to stay in
school and continue working with our program, and chances for direct job placement. Plus you will be able to get in-
house tutors to help you work toward your GED, high school diploma, training certificate, and/or degree.
3. No CalFresh E&T services: If you are in this group, you will not be able to get services from RAB for 36 months
from this date. But you are able to seek employment and training services offered to anyone in the area by other
organizations. A list including contact information for some of these places will be given to you.
• It is up to you to decide to take part in the study. If you do not want to take part, you may only be able to receive regular
CalFresh E&T services subject to their availability.
Information collected as part of the study will include the following:
• During registration, we will ask you to tell us about such things as the number of people in your family including children,
your race/ethnicity, and education. We will ask about employment, use of public assistance, and your health. This
information is required to be part of the study. We will also ask who the research team may talk to who might help them
get in touch with you over the next few years if we cannot reach you by phone. You do not have to answer the questions
about any other names you have gone by or provide information on relatives or friends who may know how to contact
you if we cannot reach you directly. Information you give us will be sent to Mathematica.
• You might be selected to participate in follow-up surveys. Over the next few years, a person from Mathematica or DIR
may ask you to take part in up to 3 telephone surveys up to 60 months after today. Each survey will take about 32
minutes. The survey will ask you about who lives with you, jobs you have held and your earnings;; education and
training, and receipt of public assistance. We will also ask you about whether you and your family have enough food to
eat, housing status, and your physical and mental health. You will receive a letter before each survey to tell you we will
be calling soon. Participation in these surveys is voluntary. You will get a $30 gift card for completing the first survey.
For the second and third surveys, you will get a $40. If you refuse to take part in the survey when we call, someone
from Mathematica will try to call you one last time to ask you about any concerns you may have. This is in hopes that
they can address them and you will complete the survey.
• If we cannot reach you by phone to participate in the surveys, we will try to follow up with you in-person at
your home. If you are home and willing to take part in the survey we will hand you a cell phone to complete the
survey.
• A person from Mathematica may also ask you to do an in-person interview. They may also ask you to be in a focus
group discussion. These could take about 90 minutes each. The focus group will ask you about employment and training
and supportive services you got, what you liked and didn’t like about them, and how difficult it was to participate. The
OMB Control No.: 0584-xxxx
Expiration Date: 00/00/20xx
D.1.3
Public Burden Statement
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0584-xxxx. The time required to complete this information collection is
estimated to average 12 minutes, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding this burden estimate to the Office of Policy Support, Food and Nutrition Service, USDA, 3101 Park Center
Drive, Room 1014, Alexandria, VA 22302.
in-depth interview will ask similar questions plus will learn about some of the things that might make it harder or easier
for you to participate in the program or find employment and how the programs can be made better. Participating in
these activities is voluntary, but are very important for the study. You will be asked to consent to the interview or focus
group. You will get $50 for each interview or focus group you complete.
• Information about your employment and earnings, and government services and benefits you receive (e.g., CalFresh,
CalWorks, and Medi-Cal benefits), will be shared with the research team. This information will be provided by
Unemployment Insurance agencies, Employment Service providers, and agencies that run CalFresh, CalWORKS, and
Medi-Cal. The research team will collect this information for a period that covers up to 7 years, beginning 1-2 years
before today and up to 5 years after today. The research team will hold this information, for study purposes only, for
up to ten years.
• RAB will give the research team information about you and about your participation in employment and training services
they provide (services received, when received, did you complete the programs). This includes information about the
support services (help with transportation or child care, or with cost of uniforms or books) you got, the cost of the
services, and information about jobs you got during and after the program.
• Fresno DSS will give RAB and the evaluation team your name, date of birth, and Social Security Number to be able to
pull together data from CalFresh, UI, and Medi-Cal agencies and RAB. Your identifying information will be removed to
protect your privacy. All identifying information about you will be removed;; your information will be stored on a secure
server with limited access at all times.
• All information the research team gets about you will be used for research only. The information will be kept private
unless the law requires otherwise. Your name will never be used in any reports and no information will be reported in
any way that can identify you.
• Benefits of being in the study: If you take part in the study, you have a chance to get more E&T services than you can
get now. By participating, we will learn if this new program works and that may help you and others like you in the future.
• Possible risks of being in the study: You may feel that some questions asked during the surveys, focus groups, or
interviews are too personal. If you do take part in the study, you do not have to answer any question that you think is
too personal. Taking part in the study will not affect your CalFresh or other benefits. You will still be able to get your
CalFresh or other benefits if you decide not to be in the study. There is also a small risk of the loss of confidentiality of
your data, but procedures are in place to minimize this risk.
• If you agree to take part in the study, and later you wish to leave the study, you can do so at any time by calling the
study toll-free number at 1-800-xxx-xxxx. You can also leave the study by notifying RAB staff who will then notify the
research team. The research team will use any information we get about you before you leave the study only for
research.
o By checking this box, I agree that I have read this consent form (or it has been read to me). I understand the
information provided and voluntarily agree to participate. If I have questions, I can call the study toll-free number
at 1-800-xxx-xxxx.
__________________________________________ | | | | |
NAME SOCIAL SECURITY NUMBER—LAST 4 DIGITS ONLY
__________________________________________
DATE
SNAP%E&T%PILOTS%MEMORANDUM%OF%UNDERSTANDING%MATHEMATICA%POLICY%RESEARCH!
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ATTACHMENT 5B
PARTICIPANT CONSENT FORM FOR RELEASING UI WAGE RECORDS DATA
AUTHORIZATION FOR RELEASE OF RECORDS
To: State of California
Employment Development Department
Information Security Office
PO Box 826880, MIC 33
Sacramento, CA 94280-0001
I, _________________________________________________, authorize the Employment
(TYPE OR PRINT) NAME OF INDIVIDUAL WHOM THE EDD INFORMATION PERTAINS
Development Department (EDD) to release a copy of the following records pertaining to myself:
Unemployment Insurance Payment History
Disability Insurance Payment History
Wages by quarter as reported by my employers
Other __________________________
(SPECIFY TYPE OF RECORD)
covering the period from _______________________ to _______________________
MONTH/DAY/YEAR MONTH/DAY/YEAR
(24 MONTHS PRIOR TO QUARTER OF RA) (60 MONTHS AFTER QUARTER OF RA)
To the following individual or entity:
California Department of Social Services
Victor Simon, Research Program Specialist
Estimates Branch
744 P Street, MS 8-10-100
Sacramento, CA 95814
I authorize the California Department of Social Services to redisclose my records to the SNAP E&T
Pilots Evaluation Team (composed of employees and consultants of Mathematica, MDRC, Insight,
Koné, and DIR). This information will be used by the SNAP E&T Pilots Evaluation Team solely for
research purposes.
This Authorization shall remain in effect until January 31, 2023.
Date: ________________ Signature: ______________________________________
MONTH/DAY/YEAR INDIVIDUAL WHO IS THE SUBJECT OF THE REQUEST
Social Security Number: ___________________
The disclosure of your social security number is voluntary. However, since most EDD records are filed by
social security number, EDD may be unable to locate any or all of the records requested without
disclosure of your social security number.
SNAP%E&T%PILOTS%MEMORANDUM%OF%UNDERSTANDING%MATHEMATICA%POLICY%RESEARCH!
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ATTACHMENT 6
FOCUS GROUP PARTICIPANT CONSENT FORM
INFORMED CONSENT TO PARTICIPATE IN A RESEARCH STUDY
TITLE OF STUDY: Evaluation of the SNAP E&T Pilots
SPONSOR: U.S. Department of Agriculture (USDA), Food and
Nutrition Service (FNS)
RESEARCH TEAM: Mathematica Policy Research, MDRC, Kone Consulting,
Insight Policy Research, and Decision Information
Resources (DIR)
PROJECT DIRECTOR: Michael Ponza, Mathematica Policy Research
PHONE NUMBER: (510) 830-3707
What is the purpose of this form?
You are being asked to participate in a focus group as part of a research study. This form
describes the purpose of the study and how the research will be used. It will also describe
any benefits and risks to you, and your rights as a participant. A member of the research
team will read through this form with you and discuss all the information. You will then
be asked if you agree to take part. If you agree, you will be asked to sign this consent form.
Once you sign it, we will give you a signed and dated copy to keep.
Why is this study being done?
FNS is testing new approaches to help participants in the CalFRESH Employment and
Training (E&T) program. It is doing a study to find out if these approaches can help people
get a job or get a better job. The focus group you have been invited to participate in will
help us learn more about people’s experiences with the CalFRESH E&T program.
What is being studied?
The research team wants to learn about the employment and training and supportive
services you received. They also want to learn what you liked and didn’t like about them,
and how difficult it was to participate. This will help the research team learn what works
well and what can be improved.
You are being asked to participate in this study because you may have views that reflect
the experiences of other people who receive services from the CalFRESH E&T program.
What will happen during the focus group?
By agreeing to participate today, you will participate in one focus group discussion with 6-
9 other participants. There may also be some research team members who are observing
the study to learn about your opinions.
The focus group will last approximately 90 minutes. During that time, the leader will ask
you to talk about your experiences related to the employment and training services and
support services you received from the CalFRESH E&T program. The leader will not ask
you to share anything you do not want to share. We will be recording our discussion for
research purposes and will also be taking notes. Anything you say during the discussions
will remain confidential, meaning we will not use your name in our reports.
Does being in this study provide any benefit?
Participating in the study will provide information about what types of services are most
helpful in helping people get a job or get a better job. It will provide information about
what works well and what can be improved. This may help you and others like you in the
future.
What are the potential risks of being in the study?
There are topics you may feel are too personal to discuss, but you do not have to respond
to any question that you are uncomfortable answering. There is also a small risk of the loss
of confidentiality of your data, but procedures are in place to minimize this risk.
How will you protect my confidentiality?
We will limit the amount of information we collect to only what is needed to answer our
research questions. Only members of the research team will have access to the recordings
and lists of participants. Members of the research team will save the recordings, informed
consent forms, transcribed notes, and participant lists in secure locations with access
restricted to the team members. The list of participant names will be stored in a different
secure location, separate from the recordings. Audio files and transcription files will be
transferred through a secure web portal. All members of the research team have signed
confidentiality agreements and completed training in data security and privacy to protect
human subjects.
Will I receive compensation for my participation?
You will receive a $50 gift card to offset any costs related to participation, such as
transportation.
Do I have to be in this study?
Your participation in this study is voluntary. You can discontinue participation at any time.
Your refusal to participate or your withdrawal from the study will not affect any benefits
you may be receiving.
Who do I contact if I have questions?
If you have questions or concerns about the study, please contact the project director,
Michael Ponza, Mathematica Policy Research, at (510) 830-3707 or
mponza@mathematica-mpr.com. If you have any questions about rights as a research
participant, please contact the California Institutional Review Board at (000) 000-0000.
PARTICIPANT’S STATEMENT
By signing this form, I agree that all of my questions about this study have been answered
to my complete satisfaction.
I am aware that any future questions about this study may be addressed to Michael Ponza
at Mathematica Policy Research. Mathematica, the organization leading this study, is being
paid by the sponsor, U.S Department of Agriculture, Food and Nutrition Service.
My participation in this research project is voluntary. I understand I may excuse myself
from the study at any time without penalty, and the research team may decide at any time
my participation in this study is not necessary.
By signing this form, I agree to participate in this study.
I understand I will receive a copy of this signed and dated form for my records.
__________________________________ ______________
Study Participant (signature) Date
__________________________________
Print Participant’s Name
__________________________________ ______________
Person who explained this study (signature) Date
SNAP%E&T%PILOTS%MEMORANDUM%OF%UNDERSTANDING%MATHEMATICA%POLICY%RESEARCH!
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ATTACHMENT 7
IN-DEPTH PARTICIPANT INTERVIEW CONSENT FORM
INFORMED CONSENT TO PARTICIPATE IN A RESEARCH STUDY
TITLE OF STUDY: Evaluation of the SNAP E&T Pilots
SPONSOR: U.S. Department of Agriculture (USDA), Food and
Nutrition Service (FNS)
RESEARCH TEAM: Mathematica Policy Research, MDRC, Kone Consulting,
Insight Policy Research, and Decision Information
Resources (DIR)
PROJECT DIRECTOR: Michael Ponza, Mathematica Policy Research
PHONE NUMBER: (510) 830-3707
What is the purpose of this form?
You are being asked to participate in an in-depth interview as part of a research study. This
form describes the purpose of the study and how the research will be used. It will also
describe any benefits and risks to you, and your rights as a participant. A member of the
research team will read through this form with you and discuss all the information. You
will then be asked if you agree to take part. If you agree, you will be asked to sign this
consent form. Once you sign it, we will give you a signed and dated copy to keep.
Why is this study being done?
FNS is testing new approaches to help participants in the CalFresh Employment and
Training (E&T) program. It is doing a study to find out if these approaches can help people
get a job or get a better job. The interview you have been invited to participate in will help
us learn more about people’s experiences with the CalFresh E&T program.
What is being studied?
The research team wants to learn about the employment and training and supportive
services you received. They also want to learn what you liked and didn’t like about them,
and how difficult it was to participate. This will help the research team learn what works
well and what can be improved.
You are being asked to participate in this study because you may have views that reflect
the experiences of other people who receive services from the CalFresh E&T program.
What will happen during the interview?
By agreeing to participate today, you will participate in an in-depth interview with a
member of the research team. The interview will last approximately 60 minutes. During
that time, the interviewer will ask you to talk about your experiences related to the
employment and training services and support services you received from the CalFresh
E&T program. You will also be asked about some of the things that might make it harder
or easier for you to participate in the program or find employment and how the programs
can be made better. The leader will not ask you to share anything you do not want to share.
We will be recording our discussion for research purposes and will also be taking notes.
Anything you say during the discussion will remain confidential, meaning we will not use
your name in our reports.
Does being in this study provide any benefit?
Participating in the study will provide information about what types of services are most
helpful in helping people get a job or get a better job. It will provide information about
what works well and what can be improved. This may help you and others like you in the
future.
What are the potential risks of being in the study?
There are topics you may feel are too personal to discuss, but you do not have to respond
to any question that you are uncomfortable answering. There is also a small risk of the loss
of confidentiality of your data, but procedures are in place to minimize this risk.
How will you protect my confidentiality?
We will limit the amount of information we collect to only what is needed to answer our
research questions. Only members of the research team will have access to the recordings.
Members of the research team will save the recordings, informed consent forms, and
transcribed notes in secure locations with access restricted to the team members. Individual
names will be stored in a different secure location, separate from the recordings. Audio
files and transcription files will be transferred through a secure web portal. All members
of the research team have signed confidentiality agreements and completed training in data
security and privacy to protect human subjects.
Will I receive compensation for my participation?
You will receive a $50 gift card to offset any costs related to participation, such as
transportation.
Do I have to be in this study?
Your participation in this study is voluntary. You can discontinue participation at any time.
Your refusal to participate or your withdrawal from the study will not affect any benefits
you may be receiving.
Who do I contact if I have questions?
If you have questions or concerns about the study, please contact the project director,
Michael Ponza, Mathematica Policy Research, at (510) 830-3707 or
mponza@mathematica-mpr.com.
If you have any questions about rights as a research participant, please contact the
California Institutional Review Board at (000) 000-0000.
PARTICIPANT’S STATEMENT
By signing this form, I agree that all of my questions about this study have been answered
to my complete satisfaction.
I am aware that any future questions about this study may be addressed to Michael Ponza
at Mathematica Policy Research. Mathematica, the organization leading this study, is being
paid by the sponsor, U.S Department of Agriculture, Food and Nutrition Service.
My participation in this research project is voluntary. I understand I may excuse myself
from the study at any time without penalty, and the research team may decide at any time
my participation in this study is not necessary.
By signing this form, I agree to participate in this study.
I understand I will receive a copy of this signed and dated form for my records.
__________________________________ ______________
Study Participant (signature) Date
__________________________________
Print Participant’s Name
__________________________________ ______________
Person who explained this study (signature) Date
SNAP%E&T%PILOTS%MEMORANDUM%OF%UNDERSTANDING%MATHEMATICA%POLICY%RESEARCH!
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ATTACHMENT 8
STAFF INTERVIEW CONSENT FORM
INFORMED CONSENT TO PARTICIPATE IN A RESEARCH STUDY
TITLE OF STUDY: Evaluation of the SNAP E&T Pilots
SPONSOR: U.S. Department of Agriculture (USDA), Food and
Nutrition Service (FNS)
RESEARCH TEAM: Mathematica Policy Research, MDRC, Kone Consulting,
Insight Policy Research, and Decision Information
Resources (DIR)
PROJECT DIRECTOR: Michael Ponza, Mathematica Policy Research
PHONE NUMBER: (510) 830-3707
What is the purpose of this form?
You are being asked to participate in an in-depth interview as part of a research study. This
form describes the purpose of the study and how the research will be used. It will also
describe any benefits and risks to you, and your rights as a participant. A member of the
research team will read through this form with you and discuss all the information. You
will then be asked if you agree to take part. If you agree, you will be asked to sign this
consent form. Once you sign it, we will give you a signed and dated copy to keep.
Why is this study being done?
FNS has awarded grants to 10 pilot sites to test new approaches to help participants in the
SNAP Employment and Training (E&T) program (CalFresh in your state). It is conducting
a study to find out if these approaches can help people get a job or get a better job. The
interview you have been invited to participate in will help us learn more about how these
pilots are operating.
What is being studied?
The research team wants to learn how your organization serves the pilot participants. We
are talking with staff like you at other organizations in your State and in other States to
learn first-hand how the pilots are operating on the ground. This information will help us
evaluate what works in these pilots and what could be improved.
What will happen during the interview?
By agreeing to participate today, you will participate in an in-depth interview with a
member of the research team. The interview will last approximately 60 minutes. During
that time, the interviewer will ask you to talk about your organization’s experience
implementing the pilot services to program participants. The interviewer will not ask you
to share anything you do not want to share. We will be recording our discussion for
research purposes and will also be taking notes. Anything you say during the discussion
will remain confidential, meaning we will not use your name in our reports.
Does being in this study provide any benefit?
Participating in the study will provide information about what types of services are most
helpful in helping people get a job or get a better job. It will provide information about
what works well and what can be improved.
What are the potential risks of being in the study?
There are topics you may feel are too personal to discuss, but you do not have to respond
to any question that you are uncomfortable answering. There is also a small risk of the loss
of confidentiality of your data, but procedures are in place to minimize this risk.
How will you protect my confidentiality?
We will limit the amount of information we collect to only what is needed to answer our
research questions. Only members of the research team will have access to the recordings.
Members of the research team will save the recordings, informed consent forms, and
transcribed notes in secure locations with access restricted to the team members. Individual
names will be stored in a different secure location, separate from the recordings. Audio
files and transcription files will be transferred through a secure web portal. All members
of the research team have signed confidentiality agreements and completed training in data
security and privacy to protect human subjects.
Will I receive compensation for my participation?
You will receive a $50 gift card to offset any costs related to participation, such as
transportation.
Do I have to be in this study?
Your participation in this study is voluntary. You can discontinue participation at any time.
Your refusal to participate or your withdrawal from the study will involve no penalty.
Who do I contact if I have questions?
If you have questions or concerns about the study, please contact the project director,
Michael Ponza, Mathematica Policy Research, at (510) 830-3707 or
mponza@mathematica-mpr.com.
If you have any questions about rights as a research participant, please contact the
California Institutional Review Board at (000) 000-0000.
PARTICIPANT’S STATEMENT
By signing this form, I agree that all of my questions about this study have been answered
to my complete satisfaction.
I am aware that any future questions about this study may be addressed to Michael Ponza
at Mathematica Policy Research. Mathematica, the organization leading this study, is being
paid by the sponsor, U.S Department of Agriculture, Food and Nutrition Service.
My participation in this research project is voluntary. I understand I may excuse myself
from the study at any time without penalty, and the research team may decide at any time
my participation in this study is not necessary.
By signing this form, I agree to participate in this study.
I understand I will receive a copy of this signed and dated form for my records.
__________________________________ ______________
Study Participant (signature) Date
__________________________________
Print Participant’s Name
__________________________________ ______________
Person who explained this study (signature) Date
SNAP%E&T%PILOTS%MEMORANDUM%OF%UNDERSTANDING%MATHEMATICA%POLICY%RESEARCH!
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ATTACHMENT 9
EMPLOYER INTERVIEW CONSENT FORM
INFORMED CONSENT TO PARTICIPATE IN A RESEARCH STUDY
TITLE OF STUDY: Evaluation of the SNAP E&T Pilots
SPONSOR: U.S. Department of Agriculture (USDA), Food and
Nutrition Service (FNS)
RESEARCH TEAM: Mathematica Policy Research, MDRC, Kone Consulting,
Insight Policy Research, and Decision Information
Resources (DIR)
PROJECT DIRECTOR: Michael Ponza, Mathematica Policy Research
PHONE NUMBER: (510) 830-3707
What is the purpose of this form?
You are being asked to participate in a focus group as part of a research study. This form
describes the purpose of the study and how the research will be used. It will also describe
any benefits and risks to you, and your rights as a participant. A member of the research
team will read through this form with you and discuss all the information. You will then
be asked if you agree to take part. If you agree, you will be asked to sign this consent form.
Once you sign it, we will give you a signed and dated copy to keep.
Why is this study being done?
FNS is testing new approaches to help participants in the SNAP Employment and Training
(E&T) program, known as CalFresh E&T in your state. It is doing a study to find out if
these approaches can help people get a job or get a better job. The focus group you have
been invited to participate in will help us learn how these new employment and training
services have affected the business community.
What is being studied?
The research team wants to hear about the experiences from employers like you who have
been involved in the pilot program. This will help the research team learn what works well
and what can be improved.
You are being asked to participate in this study because you may have views that reflect
the experiences of other employers who are involved in the pilot programs.
What will happen during the focus group?
By agreeing to participate today, you will participate in one focus group discussion with 6-
9 other participants. There may also be some research team members who are observing
the study to learn about your opinions.
The focus group will last approximately 90 minutes. During that time, the moderator or
leader will ask you to talk about your experiences as an employer involved in the CalFresh
E&T program. The leader will not ask you to share anything you do not want to share. We
will be recording our discussion for research purposes and will also be taking notes.
Anything you say during the discussions will remain confidential, meaning we will not use
your name in our reports.
Does being in this study provide any benefit?
Participating in the study will provide information from an employer perspective about
how the new pilot services are working. It will provide information about what works
well and what can be improved.
What are the potential risks of being in the study?
There are topics you may feel are too personal to discuss, but you do not have to respond
to any question that you are uncomfortable answering. There is also a small risk of the loss
of confidentiality of your data, but procedures are in place to minimize this risk.
How will you protect my confidentiality?
We will limit the amount of information we collect to only what is needed to answer our
research questions. Only members of the research team will have access to the recordings
and lists of participants. Members of the research team will save the recordings, informed
consent forms, transcribed notes, and participant lists in secure locations with access
restricted to the team members. The list of participant names will be stored in a different
secure location, separate from the recordings. Audio files and transcription files will be
transferred through a secure web portal. All members of the research team have signed
confidentiality agreements and completed training in data security and privacy to protect
human subjects.
Will I receive compensation for my participation?
You will receive a $50 gift card to offset any costs related to participation, such as
transportation.
Do I have to be in this study?
Your participation in this study is voluntary. You can discontinue participation at any time.
Your refusal to participate or your withdrawal from the study will involve no penalty.
Who do I contact if I have questions?
If you have questions or concerns about the study, please contact the project director,
Michael Ponza, Mathematica Policy Research, at (510) 830-3707 or
mponza@mathematica-mpr.com.
If you have any questions about rights as a research participant, please contact the
California Institutional Review Board at (xxx) xxx-xxxx.
PARTICIPANT’S STATEMENT
By signing this form, I agree that all of my questions about this study have been answered
to my complete satisfaction.
I am aware that any future questions about this study may be addressed to Michael Ponza
at Mathematica Policy Research. Mathematica, the organization leading this study, is being
paid by the sponsor, U.S Department of Agriculture, Food and Nutrition Service.
My participation in this research project is voluntary. I understand I may excuse myself
from the study at any time without penalty, and the research team may decide at any time
my participation in this study is not necessary.
By signing this form, I agree to participate in this study.
I understand I will receive a copy of this signed and dated form for my records.
__________________________________ ______________
Study Participant (signature) Date
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Print Participant’s Name
__________________________________ ______________
Person who explained this study (signature) Date
1 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and
2 year first hereinabove written.
3 ATTEST:
4 COUNTY OF FRESNO
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Deborah A. Poochigian, Chairm
Board of Supervisors
9 BERNICE E. SEIDEL, Clerk
Board of Supervisors
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By ct~ r bH {'-i:x 11 '1 c I ' . \
APPROVED AS TO LEGAL FORM:
DANIEL C. CEDERBORG, COUNTY COUNSEL
T GFORM:
VICKI CROW, C.P.A., AU OR-CONTROLLER/
TREASURER-TAX COLLECTOR
By __ ~=-~~=---A---~,_ ____ _
REVIEWED AND RECOM
APPROVAL:
Fund/Subclass: 10000
Organization: 56107006
Account/Program: 7870/0
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Fresno, CA