Record Management Section: To Be Completed by Designated Staff Grant ID Baseline Exit Follow-up    S P Service Duration (Select one) Single-session (1 day or less duration)  Study Design Group (Select one) Multiple-session brief (2 duration)  – 29 days’ Intervention Comparison   Multiple-session long (30 days or longer duration)  Participant ID Intervention Name(s) (If the participant is receiving direct services from more than one intervention, please list each intervention below.) Date of Survey Administration 1. / / 2. Month Day Year 3. Interview Type (Select one)
Record Management Section: To Be Completed by Designated Staff Grant ID S P Study Design Group (Select one)  Intervention  Comparison Participant ID Date of Survey Administration / / Month Day Year Interview Type (Select one)  Baseline  Exit  Follow-up Service Duration (Select one)  Single-session (1 day or less duration)  Multiple-session brief (2 – 29 days’ duration)  Multiple-session long (30 days or longer duration) Intervention Name(s) (If the participant is receiving direct services from more than one intervention, please list each intervention below.) 1. 2. 3.