[p.1]
FAMILY CORE
Section I -- HEALTH STATUS AND LIMITATION OF ACTIVITIES
Family number: ____________________
(N) No one is available to interview now
FR: ASK IF NECESSARY: With whom am I speaking?
ENTER PERSON NUMBER OF THE RESPONDENT FOR THE FAMILY QUESTIONS FOR THIS FAMILY. IF MORE THAN ONE, ENTER THE NUMBER OF THE ONE YOU CONSIDER TO BE THE MAIN RESPONDENT.
(2) Arrange Callback (CP_BEG)
(3) Noninterview (PRE_ARRAN)
FR: IF ANY PERSONS LISTED BELOW ARE NOT PRESENT, SAY:
FR: ENTER LINE NUMBER(S) OF FAMILY MEMBERS LISTED BELOW THAT ARE CURRENTLY PRESENT. ENTER UP TO 10 NUMBERS.
[ ] FINTRO01
[ ] FINTRO02
[ ] FINTRO03
[ ] FINTRO04
[ ] FINTRO05
[ ] FINTRO06
[ ] FINTRO07
[ ] FINTRO08
[ ] FINTRO09
[ ] FINTRO10
[p.1]
[p.2]
(2) No (FHS.050)
(7) Refused (FHS.050)
(9) DK (FHS.050)
FHS.010
[ ]
[ ]
[ ]
[ ]
[ ]
(7) Refused (FHS.050)
(2) No (FHS.050)
(9) DK (FHS.050)
(7) Refused (FHS.070)
(2) No (FHS.070)
(9) DK (FHS.070)
FHS.060
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FHS.150)
(7) Refused (FHS.150)
(9) DK (FHS.150)
FHS.080
[ ]
[ ]
[ ]
[ ]
[ ]
(1) Yes (FHS.150)
(2) No (FHS.150)
(7) Refused (FHS.150)
(9) DK (FHS.150)
LADRESS Dressing?
LAEAT Eating?
LABED Getting in or out of bed or chairs?
LATOILT Using the toilet, including getting to the toilet?
LAHOME Getting around inside the home?
[p.3]
(2) No (FHS.170)
(7) Refused (FHS.170)
(9) DK (FHS.170)
FHS.160
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FHS.190)
(7) Refused (FHS.190)
(9) DK (FHS.190)
FHS.180
[ ]
[ ]
[ ]
[ ]
[ ]
FHS.190
(2) No (FHS.210)
(7) Refused (FHS.210)
(9) DK (FHS.210)
FHS.200
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FHS.230)
(7) Refused (FHS.230)
(9) DK (FHS.230)
FHS.220
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (Check item FHSCCI2)
(7) Refused (Check item FHSCCI2)
(9) DK (Check item FHSCCI2)
FHS.240
[ ]
[ ]
[ ]
[ ]
[ ]
FHS.250 FHS.260
(2) No (Check item FHSCCI3))
(7) Refused (Check item FHSCCI3
(9) DK (Check item FHSCCI3)
[ ]
[ ]
[ ]
[ ]
[ ]
FHS.270 FHS.271 FHS.272
FR: HAND CARD F2. DO NOT READ. CODE ALL THAT APPLY, UP TO 5, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
2. Hearing problem
3. Speech problem
4. Asthma/breathing problem
5. Birth defect
6. Injury
7. Mental retardation
8. Other developmental problem (e.g. cerebral palsy)
9. Other mental, emotional or behavioral problem
10. Bone, joint, or muscle problem
11. Epilepsy
12. Other impairment/problem
(2) Hearing problem
(3) Speech problem
(4) Asthma/breathing problem
(5) Birth defect
(6) Injury
(7) Mental retardation
(8) Other developmental problem (e.g. cerebral palsy)
(9) Other mental, emotional, or behavioral problem
(10) Bone, joint, or muscle problem
(11) Epilepsy
(12) Other impairment/problem (specify one) (FHS.271)
(13) Other impairment/problem (specify one) (FHS.272)
(97) Refused
(99) DK/not sure
(Goto FHS.280)
(01-94) 1-94 times
(95) 95+
(96) Since birth
(97) Refused
(99) DK
(1) Days(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)
(6) Since Birth
(7) Refused
(9) DK
[Go back to Check item FHSCCI3 for next family member. If no more family members goto FHS.310.]
FR: HAND CARD F3. DO NOT READ. CODE ALL THAT APPLY, UP TO 5, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
2. Hearing problem
3. Arthritis/rheumatism
4. Back or neck problem
5. Fracture, bone/joint injury
6. Other injury
7. Heart problem
8. Stroke problem
9. Hypertension/high blood pressure
10. Diabetes
11. Lung/breathing problem
12. Cancer
13. Birth defect
14. Mental retardation
15. Other developmental problem (e.g. cerebral palsy)
16. Senility
17. Depression/anxiety/emotional problem
18. Weight problem
19. Other impairment/problem
(2) Hearing problem
(3) Arthritis/rheumatism
(4) Back or neck problem
(5) Fractures, bone/joint injury
(6) Other injury
(7) Heart problem
(8) Stroke problem
(9) Hypertension/high blood pressure
(10) Diabetes
(11) Lung/breathing problem
(12) Cancer
(13) Birth defect
(14) Mental retardation
(15) Other developmental problem (e.g. cerebral palsy)
(16) Senility
(17) Depression/anxiety/emotional problem
(18) Weight problem
(19) Other impairment/problem (specify one)(FHS.291)
(20) Other impairment/problem (specify one)(FHS.292)
(97) Refused
(99) DK/not sure
[ ]
[ ]
[ ]
[ ]
[ ]
FHS.291
FHS.292
(01-94) 1-94
(99) DK
(95) 95+
(97) Refused
(96) Since birth
(1) Days(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)
(6) Since Birth
(7) Refused
(9) DK
[Go back to Check item FHSCCI3 for next family member. If no more family members goto FHS.310.]
FHS.310
(2) Very good
(3) Good
(4) Fair
(5) Poor
(7) Refused
(9) DK
(Goto next section--Injuries)
[p.16]
Section III -- HEALTH CARE ACCESS AND UTILIZATION
Part A -- Access To Care
(2) No (FAU.030)
(7) Refused (FAU.030)
(9) DK (FAU.030)
FAU.020
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FAU.050)
(7) Refused (FAU.050)
(9) DK (FAU.050)
FAU.040
[ ]
[ ]
[ ]
[ ]
[ ]
[p.17]
Part B -- Hospital Utilization
[If there is a child lt 1 year old in the family add] Remember to include any new mothers and/or babies who were hospitalized for the baby's birth.
(2) No (FAU.120)
(7) Refused (Check item FAU.120)
(9) DK (Check item FAU.120)
FAU.060
[ ]
[ ]
[ ]
[ ]
[ ]
(997) Refused
(999) DK
(997) Refused
(999) DK
[If FAU.070 lt FAU.110 goto NEXT_HOSP; Else goto FAU.115]
FAU.115
[fill HPNITE_N] is less than the total number of times just reported that {you/subject's name} was in the hospital overnight. PROBE TO CORRECT.
(2) Decrease total number of times [you/subject's name] stayed in hospital (FAU.070)
(3) Proceed without correcting (NEXT_HOSP)
.
[p.18]
Part C -- Health Care Contacts
These next questions are about health care received during the 2 WEEKS outlined on that calendar. Include care from ALL types of medical doctors, such as dermatologists, psychiatrists, ophthalmologists, and general practitioners. Also include care from OTHER health professionals such as nurses, physical therapists, and chiropractors. DO NOT INCLUDE DENTAL CARE.
Do not include care while an overnight patient in a hospital.
[Else, continue to read:]
During those 2 WEEKS, did {you/anyone in the family} receive care AT HOME from a nurse or other health care professional?
(2) No (FAU.150)
(7) Refused (FAU.150)
(9) DK (FAU.150)
FAU.130
[ ]
[ ]
[ ]
[ ]
[ ]
(50) 50+
(97) Refused
(99) DK
(2) No (FAU.180)
(7) Refused (FAU.180)
(9) DK (FAU.180)
FAU.160
PHCPH2W
[ ]
[ ]
[ ]
[ ]
[ ]
(50) 50+
(97) Refused
(99) DK
[p.19]
(2) No (FAU.210)
(7) Refused (FAU.210)
(9) DK (FAU.210)
FAU.190
[ ]
[ ]
[ ]
[ ]
[ ]
(50) 50+
(97) Refused
(99) DK
(2) No (Goto next section -Health Insurance}
(7) Refused (Goto next section - Health Insurance)
(9) DK (Goto next section - Health Insurance}
FAU.220
[ ]
[ ]
[ ]
[ ]
[ ]
Section IV -- HEALTH INSURANCE
(2) No (FHI.020)
(7) Refused (FHI.020)
(9) DK (FHI.020)
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FHI.050)
(7) Refused (FHI.050)
(9) DK (FHI.050)
Check item FHICCI1: If FHI.040 has more than 1 input: show message "FR: PLEASE MARK ONLY ONE RESPONDENT. (1) Back up and make a correction", go back to FHI.040 for correction.
2. Private health insurance plan purchased directly*
3. Medicare
4. Medi-Gap
5. Medicaid
6. Military health care/VA
7. CHAMPUS/TRICARE/CHAMP-VA
8. Indian Health Service
9. State-sponsored health plan
10. Other government program
*EXCLUDE private plans that only provide extra cash while hospitalized or pay for only one type of service (nursing home care, accidents, or dental care).
The next questions are about health insurance.
[If FAVAIL ne (1)]
Since no one else is available to answer these questions, we can just continue. Just give the best answers you can.
{Are you/Is anyone} covered by health insurance or some other kind of health care plan?
FR: READ IF NECESSARY: INCLUDE HEALTH INSURANCE OBTAINED THROUGH EMPLOYMENT OR PURCHASED DIRECTLY AS WELL AS GOVERNMENT PROGRAMS LIKE MEDICARE AND MEDICAID THAT PROVIDE MEDICAL CARE OR HELP PAYMEDICAL BILLS.
(2) No (FHICCI9)
(7) Refused (FHICCI9)
(9) DK (FHICCI9)
FHI.060
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[For members who were not marked in FHI.060, go to FHICCI9; Those family members who were marked in FHI.060, go to FHI.070.]
FR: ENTER EACH NUMBER THAT APPLIES. (Anything else?)
[ ] HIKINDB (02) Private health insurance plan purchased directly
[ ] HIKINDC (03) Medicare
[ ] HIKINDD (04) Medi-Gap
[ ] HIKINDE (05) Medicaid
[ ] HIKINDF (06) Military health care/VA
[ ] HIKINDG (07) CHAMPUS/TRICARE/CHAMP-VA
[ ] HIKINDH (08) Indian Health Service
[ ] HIKINDI (09) State-sponsored health plan
[ ] HIKINDJ (10) Other government program
Check item FHICCI3: (Medicare Coverage) Loop through every non-deleted and non Armed Forces family member roster:
1. If the person in FHI.070 marked 4 and not 3, go to FHI.080.
2. If the person in FHI.070 marked 3, go to FHI.080.
3. If the person in FHI.070 did not mark 3, go to Check item FHICCI4
FR: READ IF NECESSARY: THE PUBLIC HEALTH SERVICE ACT IS TITLE 42, UNITED STATES CODE, SECTION 242K.
MCNO_2 (any characters): -____________
FHI.090
(2) Part B - Medical Only (FHI.100)
(3) Both Part A and Part B (FHI.100)
(4) Card Not Available (FHI.100)
(7) Refused (FHI.100)
(9) DK (FHI.100)
(2) No (FHICCI4)
(7) Refused (FHICCI4)
(9) DK (FHICCI4)
[If answer equals 1, ask: ]
FHI.110
Check item FHICCI4: (Medicaid Coverage) If the person in FHI.070 marked 5 then goto FHI.120; Else goto Check item FHICCI5.
(2) Select from book/list (MACHMD_1)
(3) Doctor is assigned (MACHMD_2)
(7) Refused (FHI.140)
(9) DK (FHI.140)
FHI.130
What is the name of the health plan that provided the book or list?
What is the name of the health plan that assigned the doctor?
[p.23]
(2) No
(7) Refused
(9) DK
(2) No
(7) Refused
(9) DK
When roster exhausted go to Check item FHICCI5.
- Private health insurance plan from employer or workplace (in FHI.070 marked 1 ),
- Private health insurance plan purchased directly (in FHI.070 marked 2),
- Medi-gap (in FHI.070 marked 4),
Then go to Check item FHICCI6; Else go to Check item FHICCI7.
Check item FHICCI6: The next questions are about health insurance plans obtained through work or purchased directly.
We have the following persons listed as being covered by such plans {read names}.
FHI.160
FR: REMIND RESPONDENT IF NECESSARY: Do NOT include plans that only provide extra cash while in the hospital or plans that pay for only one type of service, such as nursing home care, accidents, or dental care.
FR: IF NECESSARY: DO YOU HAVE SOMETHING WITH THE PLAN NAME ON IT?
FHI.170
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FHICCI7)
FHI.172
FHI.173
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FHICCI7)
FHI.175
FHI.176
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FHICCI7)
FHI.178
FHI.179
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FHI.070)
(7) Refused (FHI.070)
(9) DK (FHI.070)
[p.25]
FR: MARK "X" ANY THAT APPLY fill in from FHI.170: HIPNAM, NEXTPNM, NEXTPNM2.
HIVER2_2 [ ]2 [fill NEXTPNM] (if available)
HIVER2_3 [ ]3 [fill NEXTPNM2] (if available)
HIVER2_4 [ ]4 [fill NEXTPNM3] (if available)
HIVER2_5 [ ]5 Some other plan not already mentioned
Check item FHICCI8: [If more plan name (ie. from item HIPNAM), ask:]
Now I am going to ask some questions about the {plan/plans} you just told me about,{/starting with} [fill plan name].
[else]
Next I would like to ask you about [fill plan name].
Enter person #] [ ]
(2) Union
(3) Through workplace, but DK if employer or union
(4) Through workplace, self-employed or professional association
(5) No
(7) Refused
(9) DK
FR: ENTER ALL THAT APPLY. IF GOVERNMENT PROGRAM IS REPORTED, PROBE FOR MEDICARE OR MEDICAID BEFORE ENTERING CODE 6. IF GOVERNMENT IS THE EMPLOYER, ENTER CODE 2.
(2) Employer or Union (FHI.240)
(3) Someone outside the household (FHI.240)
(4) Medicare (FHI.240)
(5) Medicaid (FHI.240)
(6) Government Program (FHI.240)
(7) Refused (FHI.240)
(9) DK (FHI.240)
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[p.26]
FR: HAND CARD F10.
2. $500-$999
3. $1,000 - $1,999
4. $2,000 - $2,999
5. $3,000 or more
(2) $500-$999
(3) $1,000-$1,999
(4) $2,000-$2,999
(5) $3,000 or more
(7) Refused
(9) DK
FR: ACCEPT PPO AS A VALID RESPONSE IF THE RESPONDENT OFFERS IT. ENTER CODE 2 FOR PPO. READ IF NECESSARY: Health Maintenance Organizations, or HMOs, and Individual Practice Associations, or IPAs, are plans whose members are required to use only those doctors who work for or in association with the plan. Sometimes members may choose to go to doctors not associated with the plan, but usually at greater cost to the member. Generally, members do not have to submit claims for costs of medical care services.
(2) PPO
(3) Other
(7) Refused
(9) DK
FHI.250
FR: READ STATE NAME FOR MEDICAID AND STATE SPONSORED HEALTH INSURANCE PROGRAM FROM FLASHCARD PG.19 AND 20.
CHAMPUS or CHAMPVA... or any private insurance?
Alaska . . . Medical Assistance Program
Arizona . . . AHCCCS (Pronounced "Access") OR Acute Care Program OR Long Term Care System (ALTCS)
California . . . Medi-Cal
Connecticut . . . OR ConnecticutAccess (CONNECT CARD)
D.C. . . . OR Medical Assistance
Florida . . . OR MediPass
Georgia . . . OR Better Health Care Program OR Medical Assistance
Hawaii . . . OR Med-QUEST OR Maluhia OR Medical Assistance
Idaho . . . OR Healthy Connections OR Medical Assistance
Illinois . . . OR MediPlan
Indiana . . . OR Hoosier Healthwise
Iowa . . . OR MediPASS (Medical Assistance)
Kansas . . . OR PrimeCare OR Community Care Kansas (CCK) OR HealthConnect
Kentucky . . . OR Kentucky Patient Access and Care System (KenPAC) OR Medical Assistance
Louisiana . . . OR CommunityCARE Progam
Maine . . . OR PrimeCare
Maryland . . . OR Maryland Access to Care (MAC) OR Medical Assistance
Massachusetts . . . MassHealth
Minnesota . . . OR Prepaid Medical Assistance Program (PMAP), Health Care Programs
Mississippi . . . OR HealthMACS
Missouri . . . OR MC Plus
Montana . . . OR Passport to Health
Nebraska . . . OR Primary Care Plus (+) OR Health Connection
Nevada . . . OR MAPnet
New Jersey . . . OR New Jersey Care 2000
New Mexico . . . OR Primary Care Network
New York . . . OR MAX
North Carolina . . . OR Carolina Access
North Dakota . . . OR North Dakota Access to Care (NoDAC)
Ohio . . . OR Accessing Better Care (ABC) Program
Oklahoma . . . OR SoonerCare
Oregon . . . OR Oregon Health Plan (OHP), Kaiser-S/HMO, Medical Assistance
Pennsylvania . . . OR HealthPASS, Family Care Network (FCN), Lancaster Community Health Plan, Blue Card or Green Card, ACCESS
Rhode Island . . . OR Rlte care OR Medical Assistance
South Carolina . . . Or South Carolina Health Access Plan (SCHAP)
South Dakota . . . OR Primary Care Provider Program
Tennessee . . . TennCare
Texas . . . OR LoneSTAR (State of Texas Access Reform)
Vermont . . . OR Dr. Dynosaur, Vermont Health Access Program (VHAP), AIM
Virginia . . . OR Medallion, Options, Medical Assistance
Washington . . . OR Health Access Spokane, Kaiser-S/HMO, Healthy Options
West Virginia . . . OR West Virginia Physician Assured Access System (PAAS)
Wisconsin . . . Medical Assistance Program
California . . . County Medical Services Progam (CMSP), Children's Services (CCS)
Colorado . . . Child Health Plan
Connecticut . . . Healthy Steps, General Assistance Program (GA)
Florida . . . Healthy Kids
Illinois . . . General Assistance Program (State Child and Family Assistance, SCFA or Transitional Assistance, TA)
Iowa . . . Caring Program for Children
Kansas . . . MediKan, Caring Program for Kids
Massachusetts . . . CommonHealth Program, Medical Security Plan (MSP), CenterCare Program, Children's Medical Security Plan
Michigan . . . Wayne County Plus Care Program, Medical Assistance Program, Caring Program for Children
Minnesota . . . MinnesotaCare, Minnesota General Assistance Medical Care Program (GAMC)
Missouri . . . General Relief Medical Assistance
Nebraska, . . . State Disability Program
New Jersey . . . Health Access New Jersey
New York . . . Home Relief, Child Health Plus (CHP)
North Carolina . . . Caring Program for Children
Ohio . . . Ohio Disability Assistance Medical Program
Pennsylvania . . . Children's Health Insurance Program (CHIP), General Assistance Medical Program
Rhode Island . . . General Public Assistance (GPA) Medical Program
Utah . . . Utah Medical Assistance Program (UMAP)
Virginia . . . State and Local Hospitalization (SLH) Program, Caring Program for Children
Washington . . . Basic Health Plan, Children's Health Program, General Assistance Unemployable Program (GA-U)
Wisconsin . . . General Relief Medical
(2) No (FHI.270)
(7) Refused (FHI.270)
(9) DK (FHI.270)
[p.27]
FR: HAND CARD T.
2. More than 6 months, but not more than 1 year ago
3. More than 1 year, but not more than 3 years ago
4. More than 3 years
5. Never
(2) More than 6 months, but not more than 1 year ago (FHI.280)
(3) More than 1 year, but not more than 3 years ago (FHI.280)
(4) More than 3 years (FHI.320)
(5) Never (FHI.320)
(7) Refused (FHI.320)
(9) DK (FHI.320)
FR: HAND CARD F11. ENTER UP TO 5 REASONS. ENTER 'N' FOR NO MORE.
2. Spouse/parent lost job or changed employers
3. Got divorced or separated/death of spouse or parent
4. Became ineligible because of age/left school
5. Employer stopped offering coverage
6. Cut back to part-time/became temporary employee
7. Benefits from employer/former employer ran out
8. Couldn't afford to pay premiums
9. Insurance plan raised cost of premiums
10. Insurance company refused coverage
11. Other
(2) Spouse/parent lost job or changed employers
(3) Got divorced or separated/death of spouse or parent
(4) Became ineligible because of age/left school
(5) Employer stopped offering coverage
(6) Cut back to part-time/became temporary employee
(7) Benefits from employer/former employer ran out
(8) Couldn't afford to pay premiums
(9) Insurance plan raised cost of premiums
(10) Insurance company refused coverage
(11) Other (specify) @SPC
(97) Refused
(99) DK
[ ]
[ ]
[ ]
[ ]
[ ]
(Goto FHI.320)
[p.28]
(2) No (FHI.320)
(7) Refused (FHI.320)
(9) DK (FHI.320)
(97) Refused
(99) DK
FR: HAND CARD F12.
1. Less than $500
2. $500 - $1,999
3. $2,000 - $2,999
4. $3,000 - $4,999
5. $5,000 or more
(1) Less than $500
(2) $500-$1,999
(3) $2,000-$2,999
(4) $3,000-$4,999
(5) $5,000 or more
(7) Refused
(9) DK
Section V -- SOCIO-DEMOGRAPHIC BACKGROUND
(002) Puerto Rico
(003) Outlying Area of the U.S.(American Samoa, Guam, U.S.Virgin Islands, Northern Marianas, Other U.S. Territory)
(004) Canada
(005) Cambodia
(006) China
(007) Colombia
(008) Cuba
(009) Dominican Republic
(010) Ecuador
(011) El Salvador
(012) England
(013) France
(014) Germany
(015) Greece
(016) Guatemala
(017) Guyana
(018) Haiti
(019) Honduras
(020) Hong Kong
(021) Hungary
(022) India
(023) Iran
(024) Ireland/Eire
(025) Italy
(026) Jamaica
(027) Japan
(997) Refused
(999) DK
OTHER COUNTRIES FOR NATIVITY
(029) Mexico
(030) Nicaragua
(031) Peru
(032) Philippines
(033) Poland
(034) Portugal
(035) Russia
(036) Scotland
(037) Korea/South Korea
(038) Taiwan
(039) Thailand
(040) Trinidad and Tobago
(041) Vietnam
(042) Yugoslavia
(200) Afghanistan
(375) Argentina
(185) Armenia
(102) Austria
(501) Australia
(130) Azores
(333) Bahamas
(202) Bangladesh
(334) Barbados
(310) Belize
(103) Belgium
(300) Bermuda
(376) Bolivia
(377) Brazil
(205) Burma
(378) Chile
(311) Costa Rica
(155) Czech Republic
(105) Czechoslovakia
(106) Denmark
(338) Dominica
(415) Egypt
(417) Ethiopia
(507) Fiji
OTHER COUNTRIES FOR NATIVITY
(138) Great Britain
(340) Grenada
(126) Holland
(211) Indonesia
(213) Iraq
(214) Israel
(216) Jordan
(427) Kenya
(183) Latvia
(222) Lebanon
(184) Lithuania
(108) Finland
(436) Morocco
(128) Netherlands
(514) New Zealand
(440) Nigeria
(142) Northern Ireland
(127) Norway
(229) Pakistan
(253) Palestine
(317) Panama
(132) Romania
(233) Saudi Arabia
(234) Singapore
(156) Slovakia/Slovak Rep.
(224) Malaysia
(449) South Africa
(134) Spain
(136) Sweden
(137) Switzerland
(237) Syria
(240) Turkey
(195) Ukraine
(387) Uruguay
(180) USSR
(388) Venezuela
(353) Caribbean
(318) Central America
(304) North America
(148) Europe
(252) Middle East
(468) North Africa
(527) Pacific Islands
(555) Elsewhere
(462) Other Africa
(245) Asia
If PLBORN=1 goto FSD.005; all others goto FSDCCI1.
FSD.006 FSD.007
(2) No (FSD.007)
(7) Refused (FSD.007)
(9) DK (FSD.007)
(2) No
(7) Refused
(9) DK
Enter highest level of school:
FR: HAND CARD F13.
1. 1st grade
2. 2nd grade
3. 3rd grade
4. 4th grade
5. 5th grade
6. 6th grade
7. 7th grade
8. 8th grade
9. 9th grade
10. 10th grade
11. I lth grade
12. 12th grade, no diploma
13. HIGH SCHOOL GRADUATE
14. GED or equivalent
15. Some college, no degree
16. Associate degree: occupational, technical, or vocational program
17. Associate degree: academic program
18. Bachelor's degree (Example: BA, AB, BS, BBA)
19. Master's degree (Example: MA, MS, MEng, MEd, MBA)
20. Professional School degree (Example: MD, DDS, DVM, JD)
21. Doctoral degree (Example: PhD, EdD)
(01) 1st grade
(02) 2nd grade
(03) 3rd grade
(04) 4th grade
(05) 5th grade
(06) 6th grade
(07) 7th grade
(08) 8th grade
(09) 9th grade
(10) 10th grade
(11) 11th grade
(12) 12th grade, no diploma
(13) HIGH SCHOOL GRADUATE
(14) GED or equivalent
(15) Some college, no degree
(16) Associate degree: occupational, technical, or vocational program
(17) Associate degree: academic program
(18) Bachelor's degree (Example: BA, AB, BS, BBA)
(19) Master's degree (Example: MA, MS, Meng, Med, MBA)
(20) Professional School degree (Example: MD, DDS, DVM, JD)
(21) Doctoral degree (Example: PhD, EdD)
(22) Child under 5 years old
(97) Refused
(99) Don't know
[p.31]
FR: SERVICE IN NATIONAL GUARD OR RESERVES IS NOT CONSIDERED ACTIVE DUTY
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FSD.050
(2) With a job or business but not at work (FSD.060)
(3) Looking for work (FSD.060)
(4) Not working at a job or business (FSD.090)
(7) Refused (FSD.060)
(9) DK (FSD.060)
FSD.060
(2) No (if FSD.050=3 Goto FSD.100;ELSE FSD.090)
(7) Refused (FSD.100)
(9) DK (FSD.100)
(95) 95+ (FSD.110)
(97) Refused (FSD.080)
(99) DK (FSD.080)
(2) No
(7) Refused
(9) DK
What is the main reason {you/subject's name} did not work last week?
[Else, ask:]
What is the main reason {you/subject's name} did not have a job or business last week?
(2) Going to school
(3) Retired
(4) Unable to work for health reasons
(5) On layoff
(6) Other
(7) Refused
(9) DK
[p.32]
Did {you/he/she} work for pay at any time in {last year in 4 digit format}?
[Else, ask:]
Although you reported that {you/subject's name} did not work at any time in the LAST week, did {you/he/she} work for pay at any time in {last year in 4 digit format}?
(2) No (Check item FSDCCI3)
(7) Refused (Check item FSDCCI3)
(9) DK (Check item FSDCCI3)
FR: IF LESS THAN ONE MONTH, ENTER (1).
(97) Refused
(99) DK
FR: ENTER 999,995 IF THE REPORTED INCOME IS GREATER THAN $999,995.
(999995) $999,995+
(999997) Refused
(999999) DK
FSD.130
(2) No
(7) Refused
(9) DK
Section VI -- INCOME AND ASSETS
Part A -- Sources of Income
The next questions are about {your/your combined family} income.
Are you knowledgeable about your family's finances?
(2) No (FIN.011)
(7) Refused (FIN.011)
(9) DK (FIN.011)
[ ] PINWHO_2
[ ] PINWHO_3
[ ] PINWHO_4
[ ] PINWHO_5
(2) No (Check item FINCCI1)
(7) Refused (Check item FINCCI1)
(9) DK (Check item FINCCI1)
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FIN.030
Since no one else is available to answer these questions, we can just continue. Just give the best answers you can.
[If one person family, ask:]
Did you receive income in {last year in 4 digit format} from... Wages and Salaries?
[else, ask:]
Did any family members 18 and older, that is (READ NAMES) receive income in {last year in 4 digit format} from... Wages and Salaries?
(2) No (FIN.050)
(7) Refused (FIN.050)
(9) DK (FIN.050)
FIN.040
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Did you receive income from... self-employment including business and farm income?
[else, ask:]
Did they (FR: READ NAMES AGAIN IF NECESSARY) receive income from...self-employment including business and farm income?
(2) No (FIN.070)
(7) Refused (FIN.070)
(9) DK (FIN.070)
FIN.060
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(2) No (FIN.090)
(7) Refused (FIN.090)
(9) DK (FIN.090)
FIN.080
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(2) No (FIN.110)
(7) Refused (FIN.110)
(9) DK (FIN.110)
FIN.100
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(2) Yes - some people but not everybody (FIN.120)
(3) No (FIN.130)
(7) Refused (FIN.130)
(9) DK (FIN.130)
FIN.120
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(2) Yes - some people but not everybody (FIN.140)
(3) No (FIN.150)
(7) Refused (FIN.150)
(9) DK (FIN.150)
FIN.140
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(2) Yes - some people but not everybody (FIN.160)
(3) No (FIN.170)
(7) Refused (FIN.170)
(9) DK (FIN.170)
FIN.160
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(2) No (FIN.190)
(7) Refused (FIN.190)
(9) DK (FIN.190)
FIN.180
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or mutual funds, or net rental income from property, royalties, estates or trusts?
(2) No (FIN.210)
(7) Refused (FIN.210)
(9) DK (FIN.210)
FIN.200
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[p.36]
(2) No (FIN.230)
(7) Refused (FIN.230)
(9) DK (FIN.230)
FIN.220
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(2) No (FIN.250)
(7) Refused (FIN.250)
(9) DK (FIN.250)
FIN.240
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[p.37]
Part B -- Amounts and Home Ownership
that amount before taxes?
FR: IF NECESSARY REMIND RESPONDENT THAT TOTAL COMBINED FAMILY INCOME IS THEIR INCOME PLUS THE INCOME OF ALL FAMILY MEMBERS INCLUDING COHABITING PARTNERS AND ARMED FORCES MEMBERS LIVING AT HOME BEFORE TAXES.
(999996) 999,995+ dollars (FIN.280)
(999997) Refused (FIN.260)
(999999) DK (FIN.260)
FIN.260
(2) Less than $20,000 (FIN.270)
(7) Refused (FIN.280)
(9) DK (FIN.280)
FR: IF ANSWER FOR FIN.260 EQUALS 1, HAND CARD F14.IF ANSWER FOR FIN.260 EQUALS 2, HAND CARD F15.READ IF NECESSARY: INCOME IS IMPORTANT IN ANALYZING THE HEALTH INFORMATION WE COLLECT. FOR EXAMPLE, THIS INFORMATION HELPS USTO LEARN WHETHER PERSONS IN ONE INCOME GROUP USE CERTAIN TYPES OF MEDICAL SERVICES OR HAVE CERTAIN CONDITIONS MORE OR LESS OFTEN THAN THOSE IN ANOTHER GROUP.
v. $21,000 - $21,999
w. $22,000 - $22,999
x. $23,000 - $23,999
y. $24,000 - $24,999
z. $25,000 - $25,999
AA. $26,000 - $26,999
BB. $27,000 - $27,999
CC. $28,000 - $28,999
DD: $29,000 - $29,999
EE. $30,000 - $30,999
FF. $31,000 - $31,999
GG. $32,000 - $32,999
HH. $33,000 - $33,999
II. $34,000 - $34,999
JJ. $35,000 - $39,999
KK. $40,000 - $44,999
LL. $45,000 - $49,999
MM. $50,000 - $54,999
NN. $55,000 - $59,999
00. $60,000 - $64,999
PP. $65,000 - $69,999
QQ. $70,000 - $74,999
RR. $75,000 and over
FIN.270
(01) B
(02) C
(03) D
(04) E
(05) F
(06) G
(07) H
(08) I
(09) J
(10) K
(11) L
(12) M
(13) N
(14) O
(15) P
(16) Q
(17) R
(18) S
(19) T
(20) U
(21) V
(22) W
(23) X
(24) Y
(25) Z
(26) AA
(27) BB
(28) CC
(29) DD
(30) EE
(31) FF
(32) GG
(33) HH
(34) II
(35) JJ
(36) KK
(37) LL
(38) MM
(39) NN
(40) OO
(41) PP
(42) QQ
(43) RR
(97) Refused
(99) DK
(2) Being bought
(3) Rented
(4) Other arrangement
(7) Refused
(9) DK
[p.38]
Part C -- Program Participation
FIN.290
(2) No
(7) Refused
(9) DK
FIN.300 FIN.310
(2) No (FIN.320)
(7) Refused (FIN.320)
(9) DK (FIN.320)
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(2) No
(7) Refused
(9) DK
FIN.330 FIN.340
(2) No
(7) Refused
(9) DK
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FR: IF LESS THAN 1 MONTH, ENTER (1).
(12) 12 months or all
(97) Refused
(99) DK
FR: AN AUTHORIZED PERSON IS ONE WHOSE NAME APPEARS ON A CERTIFICATION CARD
(2) No (next section)
(7) Refused (next section)
(9) DK (next section)
FIN.370
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FR: IF LESS THAN 1 MONTH, ENTER (1).
(12)12 months or all
(97) Refused
(99) DK