Control Number
Testing Organization
Site
Sampler Code
Test Type
Narrative Requirement
Ad Number
Ad Date (mm/dd/yyyy)
Source Name
City
State
Zip Code (00000)
Type of Approach
Rental Type
Highest Monthly Rent of Available Unit
Number of Bedrooms to Request
Household Composition
Minimum Number of Bedrooms Willing to Accept
Move-in date to request (mm/dd/yyyy)
TC ID Number
Is this test complete?
If NO, why not?
If ad was deemed ineligible, specify:
If other, specify:
TC Comments
RC ID Number
Did test pass quality review?
If no, why not?
If Other, specify
RC Notes
Date of Final Disposition: (mm/dd/yyyy)
If reason approved by UI, specify.
If test was terminated by TC, explain:
If test was not successfully completed by tester(s), explain:
If test forms were not successfully completed by tester(s), explain:
How many units was the control tester told about?
How many units was the protected tester told about?
How tester should refer to their partner/spouse
Based on the FINAL disposition of appointment contact, were both testers able to make an appointment?
How many units did the control tester inspect?
How many units did the protected tester inspect?