Cover Sheet
This universal cover sheet replaces all previous cover sheets and should be used for all scan forms. Print and complete it.
The cover sheet must be completed in full and included with any scan forms submitted to ODA. Information from the cover sheet allows us to track your forms and aggregate data at various levels (individual, zip code, county, region, and state) and selective time periods.
Important Note: Any survey forms received without the cover sheet or with an incomplete cover sheet are designated “Problem Forms” and placed on hold until a complete cover sheet is submitted. In such cases, ODA will contact the appropriate individual to resolve the issue.