[p. 1]
FAMILY CORE
Section I--FAMILY RELATIONSHIPS and VERIFICATION OF DEMOGRAPHIC INFORMATION
(N) No one is available to interview now. (Go to FID.035)
FR: READ IF NECESSARY:
I would like to speak with {you/name}. {Are/Is} {you/he/she} available?
[If multi-person family]
FR: READ IF NECESSARY:
I would like to speak with someone in this family, preferably an adult who is knowledgeable about the family's health, to complete the interview for their family.
Is {READ NAMES FROM ROSTER} available?
(2) No,arrange a callback (FID.035)
What date and time would be best?
FR: TODAY IS {day and date in words}. ENTER CALLBACK DATE AND TIME, OR ENTER (A) FOR ANYDAY/ANYTIME, OR ENTER (N) IF CALLBACK BEFORE CLOSEOUT IS NOT POSSIBLE.
(Go to FIDCCI1)
[p. 2]
[Enter Person #] [ ]
Is this correct?
(2) No, select another person (FID.045--RELSRESP1)
(2) No, select another person (FID.050--FAMREF_B)
(2) No, select another person (FID.050--FAMREF_A)
What is {PX-name's/your} relationship to {FRP-name/you}?
3. Unmarried Partner
4. Child (biological/adoptive/in-law/step/foster)
5. Child of Partner
6. Grandchild
7. Parent (biological/adoptive/in-law/step/foster)
8. Brother/sister (biological/adoptive/in-law/step/foster)
9. Grandparent (Grandmother/Grandfather)
10. Aunt/Uncle
11. Niece/Nephew
14. Roomer/Boarder
15. Other nonrelative
16. Legal guardian
17. Ward
(3) Unmarried partner (FID.064)
(4) Child (biological/adoptive/in-law/step/foster) (FID.070)
(5) Child of partner (Check item)
(6) Grandchild (Check item)
(7) Parent (biological/adoptive/in-law/step/foster) (FID.080)
(8) Brother/sister(biological/adoptive/ in-law/step/foster) (FID.090)
(9) Grandparent (grandmother/father) (Check item)
(10) Aunt/uncle (Check item)
(11) Niece/nephew (Check item)
(12) Other relative (Check item)
(13) Housemate/Roommate (Check item)
(14) Roomer/Boarder (Check item)
(15) Other nonrelative (Check item)
(16) Legal guardian (Check item)
(17) Ward (Check item)
(97) Refused (Check item)
(99) DK (Check item)
FID.063
(2) No, they are not relatives (HHC.100)
Earlier I recorded {name of 1st spouse/partner} was {FRP name}'s spouse or partner. You have just reported {fill name 2nd spouse/partner} is also {FRP name}'s spouse or partner.
Which is correct?
(2) {2nd spouse/partner} is the correct spouse/partner. Change relationship entry of {1st spouse/partner}. (FID.068)
CHANGE RELATIONSHIP TO FAMILY REFERENCE PERSON. WHEN
FINISHED, PRESS F3 TO JUMP FORWARD.
(2) Adoptive [fill son/daughter]
(3) Step [fill son/daughter]
(4) Foster [fill son/daughter]
(5) [fill son/daughter]-in-law
(7) Refused
(9) Don't know
FID.075
(2) No, change relationship (FID.070)
FID.080
(2) Adoptive [fill mother/father]
(3) Step [fill mother/father]
(4) Foster [fill mother/father]
(5)[fill mother/father]-in-law
(7) Refused
(9) Don't know
[p. 4]
(2) Half [fill brother/sister]
(3) Adopted [fill brother/sister]
(4) Step [fill brother/sister]
(5) Foster [fill brother/sister]
(6) [fill brother/sister]-in-law
(7) Refused
(9) Don't know
Sex ____ {SEX}
Age ____ {AGE}
DOB ____ {BMONTH/BDAY/BYEAR}
Race:{RACE}
Origin: {Non-hispanic/HISPAN}
FR: VERIFY THE ABOVE INFORMATION WITH THE RESPONDENT AND MAKE CORRECTIONS IF NECESSARY.
(2) No correction/no more corrections for this person (FID.110)
FR: ENTER EACH NUMBER THAT APPLIES. IF A WRONG CHOICE, TYPE THAT CHOICE AGAIN. ENTER (N) FOR NO MORE.
CWHAT__1 (1) Name
CWHAT__2 (2) Age or DOB
CWHAT__3 (3) Sex
CWHAT__4 (4) National origin
CWHAT__5 (5) Race
If CWHAT__2 eq (X) [go to FID.180]; If CWHAT__4 eq (X) [go to FID.190]
If CWHAT__3 eq (X) [go to FID.220]; If CWHAT2 eq (X) [go to FID.110];
When all change-needed items are corrected or changed, go to FID.100 for the next
family member. When no more eligible persons in the family, go to FIDCCI3.
THE ORIGINAL INFORMATION. ENTER "D." or "R." FOR INITIAL.
IF NECESSARY ASK:
What is {name}'s correct name?
CHG_NAM2 MIDDLE NAME: _____________________________
CHG_NAM3 LAST NAME: _____________________________
FID.125
(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't know
CHG_AG02 ________Time Period
(2) Week(s)
(3) Month(s)
(4) Year(s)
DOB_MMONTH: ______________________
DOB_BDAY DAY: ______________________
DOB_Y_PYEAR: ______________________
Check item CHG_AGECAL1: C_AGE1 takes information entered in CHG_AG01 and CHG_AG02 and calculates an age.
C_AGE2 takes the date-of birth information entered in FID.125 and calculates an
age.
C_AGE3 = current year - birth year -1, C_AGE4 = C_AGE3 + 1. If not enough
DOB information was given to calculate an age, "D" will be assigned to C_AGE2.
calculated.
If C_AGE1 eq (D) and C_AGE2 ne (D), set AGE = C_AGE2, go to FID.190
If C_AGE1 eq (D) and C_AGE2 eq (D), and C_AGE3 eq blank, go to FID.145
If C_AGE1 eq (D) and C_AGE2 eq (D), and C_AGE3 ne blank, go to FID.140
If C_AGE1 ne (D) and C_AGE2 ne (D), and C_AGE1 eq C_AGE2, go to FID.190
If C_AGE1 ne (D) and C_AGE2 ne (D), and C_AGE1 ne C_AGE2, and CHG_DOBV eq lt or gt, go to FID.130.
If C_AGE1 ne (D) and C_AGE2 ne (D), and C_AGE1 ne C_AGE2, and CHG_DOBV ne lt or gt, set AGE=C_AGE2, got to FID. 190
If C_AGE1 ne (D) and C_AGE2 = (D), and (C_AGE1 = C_AGE3 or C_AGE1 = C_AGE4); set AGE = C_AGE1; go to FID.190
If C_AGE1 ne C_AGE3 and C_AGE1 ne C_AGE4 and birth year eq blank, go to FID.140
If C_AGE1 ne C_AGE3 and C_AGE1 ne C_AGE4 and birth year ne lt or gt; set AGE = C_AGE1, go to FID.190
FID.130
(2) No (Go to FID.135)
FID.135
FR: OLD DATE of BIRTH = {BMONTH/BDAY/BYEAR} ASK IF NECESSARY:
(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't know
DOB_BDAY DAY: ____________
DOB_B_PYEAR: ____________
FID.140
(2) [fill C_AGE4] year(s) old? (Go to CHG_LOOP)
(N) Neither is correct (Go to FID.145)
(7) Refused (Go to FID.145)
(9) Don't Know (Go to FID.145)
[If answer is (1,2), update AGE accordingly; go to CHG_LOOP.]
FID.145
FR: IF THE RESPONDENT DOES NOT KNOW THE AGE, ENTER YOUR BEST ESTIMATE OF THE PERSON'S AGE. ENTER (C) FOR COMPUTE IF THE RESPONSE IS A RANGE OF AGES.
CHG_AG08 [equiv AGEGES12] ____ Time Period
(4) Year(s) (Check item)
(6) Compute from range (FID.165)
(7) Refused (FID.150)
(9) DK (FID.150)
FID.150
(2) 18 or older (FID.160)
(7) Refused ( FID.160)
(9) DK (FID.160)
FID.155
ENTER "0" IF LESS THAN 1 YEAR OLD.
FID.160
FID.165
First/lower:
CHG_AG12 [equiv AGERNG_3] Time Period ____________
(4) Year(s)
Last/higher
CHG_AG13[equiv AGERNG_4] Time Period ____________
(4) Year(s)
(Go to CHG_LOOP)
[Set AGE = (CHG_AG10 + CHG_AG11) /2]
FID.170
(2) [fill with 4-digit BYEAR2]
(N) either is correct
(7) Refused
(9) Don't Know
(Go to CHG_LOOP)
[p. 9]
I recorded {your/name's} sex as [fill SEX].
What is {your/name's} correct sex?
(2) Female
FID.190
[List all mentioned origin in HISPAN@1 to HISPAN@5; fill other specify description (SPECH_1 and/or SPECH_2) if HISPAN@1 to HISPAN@5 = 8 or 9]
Is that correct?
(2) No, not correct origin (FID.200)
(3) No, NOT Hispanic (CHG_LOOP)
FID.200
IF A NONHISPANIC GROUP IS NAMED, PRESS "F1" TO RETURN TO
CHG_NATO AND CHANGE THE ANSWER TO (3). ENTER THE NUMBER FOR EACH GROUP MENTIONED, ENTER (N) FOR NO MORE.
2. Cuban
3. Cuban American
4. Mexican/Mexicano
5. Mexican American
6. Chicano
7. Hispanic
8. Other Latin American
(1) Puerto Rican
(2) Cuban
(3) Cuban American
(4) Mexican/Mexicano
(5) Mexican American
(6) Chicano
(7) Hispanic
(8) Other Latin American (CHIS_SP1)
(9) Other Spanish or Hispanic (CHIS_SP2)
(97) Refused
(99) DK
[ ] CHG_HIS1 [ ] CHG_HIS2 [ ] CHG_HIS3 [ ]CHG_HIS 4 [ ] CHG_HIS5
[Equiv HISPAN_1 to HISPAN_5]
FID.210
FID.215
FID.220
ENTER THE NUMBER FOR EACH RACE MENTIONED, ENTER (N) FOR NO MORE
I recorded that {your/name's} race is [CAPI: List all mentioned race in RACE@1 to
RACE@5; fill other specify description (RAC_SP1 and/or RAC_SP2) if RACE@1 to
RACE @ 5 = 15 or 16]
What race {does/do} {name/you} consider {himself/herself/yourself} to be?
2. Black/African American
3. Indian (American)
4. Eskimo
5. Aleut
6. Chinese
7. Filipino
8. Hawaiian
9. Korean
10. Vietnamese
11. Japanese
12. Asian Indian
13. Samoan
14. Guamanian
15. Other Asian/Pacific Islander
(2) Black/African American
(3) Indian (American)
(4) Eskimo
(5) Aleut
(6) Chinese
(7) Filipino
(8) Hawaiian
(9) Korean
(10) Vietnamese
(11) Japanese
(12) Asian Indian
(13) Samoan
(14) Guamanian
(15) Other Asian, Pacific Islander (CHG_RAC6)
(16) Some other race (CHG_RAC7)
(97) Refused
(99) Don't know
[ ] CHG_RAC1 [ ] CHG_RAC2 [ ] CHG_RAC3 [ ] CHG_RAC4 [ ] CHG_RAC5
[Equiv RACE1 - RACE5]
FID.230
FID.235
FID.240
FID.250
(Are/Is} {you/PX-name} now married, widowed, divorced, separated, never married, or living with a partner?
(2) Widowed (FIDCCI4)
(3) Divorced (FIDCCI4)
(4) Separated (FIDCCI4)
(5) Never married (FIDCCI4)
(6) Living with a partner (FID.280)
(7) Refused (FIDCCI4)
(9) Don't Know (FIDCCI4)
Is {your/PX-name's} spouse living in the household?
(2) No (FIDCCI4)
(7) Refused (FIDCCI4)
(9) Don't Know (FIDCCI4)
(97) Refused
(99) Don't know
(Go to FIDCCI4)
(2) No (FIDCCI4)
(7) Refused (FIDCCI4)
(9) Don't Know (FIDCCI4)
FID.290
(2) Widowed
(3) Divorced
(4) Separated
(7) Refused
(9) DK
(97) Refused
(99) Don't know
For Reference person's child:
If Reference person's spouse is male, go to FID.305
If Reference person's spouse is female, go to FID.315
For Reference person's partner's child:
If Reference person's partner is male, go to FID.305
If Reference person's partner is female, go to FID.315
(2) Adoptive child
(3) Step child
(4) Foster child
(5){Son/daughter}-in-law
(7) Refused
(9) Don't know
(2) No, Change relationship (DEGREE4)
(2) Adoptive child
(3) Step child
(4) Foster child
(5) {son/daughter}-in-law
(7) Refused
(9) Don't know
(2) No, Change relationship (DEGREE5)
Is {PX-name's/your} mother a household member? (Include Mother-in-law)
ENTER THE LINE NUMBER OF THE MOTHER OR MOTHER-IN-LAW.
IF THE MOTHER OR MOTHER-IN-LAW IS NOT A HOUSEHOLD MEMBER, ENTER "00".
(01-30) Person number (FID.330)
(96) No parent in household;has legal guardian (FID.360)
(97) Refused (Go to FIDCCI5)
(99) Don't Know (Go to FIDCCI5)
(2) Adoptive mother
(3) Step mother
(4) Foster mother
(5) Mother-in-law
(7) Refused
(9) Don't know
[If MOTHERC1 eq (1); If (AGE(MOTHER) - AGE(PX)) lt (12) display:]
You said that {name(MOTHER@)} is the BIOLOGICAL MOTHER of {PX-name}.
There is only {age difference} years age difference between them, is this relationship
correct?
(2) No, select different person as MOTHER (FID.325)
(3) No, change relationship (FID.330--MOTHERC1)
ENTER THE LINE NUMBER OF THE FATHER. IF THE FATHER IS NOT A HOUSEHOLD MEMBER, ENTER "00". IF THE PERSON HAS NO PARENTS PRESENT BUT HAS A LEGAL GUARDIAN, ENTER "96".
(01-30) Person number (FID.350)
(96) No Parent in Household; Has legal guardian (FID.360)
(97) Refused (FIDCCI6)
(99) Don't Known (FIDCCI6)
(2) Adoptive father
(3) Step father
(4) Foster father
(5) Father-in-law
(7) Refused
(9) Don't know
[If FATHERC1 eq (1); If (AGE(FATHER) - AGE(PX)) lt (12) display:]
You said that {name(FATHER@)} is the BIOLOGICAL FATHER of {PX-name}, there
is only {age difference} years difference between them, is this relationship correct?
(2) No, select different person as FATHER (FID.340)
(3) No, change relationship (FID.350--FATHERC1)
FR: PROBE AS NECESSARY AND ENTER THE PERSON NUMBER OF {px-name's} GUARDIAN. IF THE GUARDIAN IS NOT A HOUSEHOLD MEMBER, ENTER "00".
(01-30) Person number (FIDCCI6)
(97) Refused (FIDCCI6)
(99) Don't Know (FIDCCI6)
FID.370 .
(1) If a person is 14-17 years of age and married or cohabiting; or
(2) If a person is 14-17 years old and no other adults present in the family.
Go to SASEL
If no persons in this sorted group, GO TO SCSEL.
If one person only in this sorted group, flag with "S" and GO TO SCSEL.
Else, GO TO step 2.
2. Generate a random number from 1 to N (number of persons in sort).
Set HHSTAT4 of the person whose person number corresponding to the random
number to (S) (Sample Adult); GO TO SCSEL.
Check item SCSEL: 1. Sort all children (AGE lt 18) of the same FX and NOT flagged "A" or "D" or "E" in descending age order -- from the oldest to the youngest. If no persons in this sort and more than 1 person in family, Go to SAID. If one person only in this sort, set the person's HHSTAT4 to (C), go to SAID;
Else continue with step2.
2. Generate a random number from 1 to N (number of persons in sort).
Set HHSTAT4 of the person whose person number corresponding to the random number to (C) (Sample Child); Go to SAID.
[fill "S" flagged person name] IS SELECTED AS THE SAMPLE ADULT
FOR FAMILY [fill FX].
[endif]
[IF there is a sample child selected]
[fill "C" flagged person name] IS SELECTED AS THE SAMPLE CHILD
FOR FAMILY [fill FX]
Who in the family would you say knows about the health of all the family members?
FR: ENTER THE NUMBER FOR EACH PERSON MENTIONED (UP TO 3).
[KNOW = 'x' for each person mentioned.]
FR: ENTER THE LINE NUMBER FOR EACH PERSON MENTIONED (UP TO 3 PERSONS). [KNOWSC = 'x' for each person mentioned.]
(Go to next section -- Family Health Status and Limitation)
[p. 16]
FAMILY CORE
Section II-- HEALTH STATUS AND LIMITATION OF ACTIVITIES
We would like to have all adult family members who are at home take part in the interview. Are (READ NAMES BELOW) at home now? IF YES, ASK: Could they join us? (ALLOW TIME)
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
[ ] FINTRO010
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.
Check item FHSCCI1: If any family member is less than 5 years old go to FHS.005; If any family member is greater than 4 and less than 18 years old go to FHS.050; If all family members are greater than 17 go to FHS.070.
(2) No (FHS.050)
(7) Refused (FHS.050)
(9) DK (FHS.050)
FHS.010
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FHS.050)
(7) Refused (FHS.050)
(9) DK (FHS.050)
[p. 17]
(2) No (FHS.070)
(7) Refused (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?
(2) No (FHS.170)
(7) Refused (FHS.170)
(9) DK (FHS.170)
FHS.160
[ ]
[ ]
[ ]
[ ]
[ ]
[p. 18]
(2) No (FHS.190)
(7) Refused (FHS.190)
(9) DK (FHS.190)
FHS.180
[ ]
[ ]
[ ]
[ ]
[ ]
(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
If AGE is less than 18 go to FHS.270; Else go to FHS.290. If none with entry in
FHS.010 through FHS.260, or the family roster is exhausted go to FHS.310.
FR: SHOW CARD F1. 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
[ ]
[ ]
[ ]
[ ]
[ ]
(Go to FHS.280)
[p. 20]
(01-94) 1-94 times
(95) 95+ times
(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 go to FHS.310.]
FR: SHOW 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. 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
[ ]
[ ]
[ ]
[ ]
[ ]
[If item (19) mentioned, go to FSH.291; If item (20) mentioned go to FHS.292; Else go to FHS.300.]
FHS.291
FHS.292
(01-94)1-94
(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 go to FHS.310.]
Would you say {subject's name} health in general is excellent, Very good, good, fair, or poor?
(2) Very good
(3) Good
(4) Fair
(5) Poor
(7) Refused
(9) DK
Section IV -- HEALTH CARE ACCESS AND UTILIZATION
Part A -- Access To Care
DURING THE PAST 12 MONTHS, has medical care been delayed for {you/anyone in the family} because of worry about the cost?
(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. 32]
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 (FAU.120)
(9) DK (FAU.120)
FAU.060
[ ]
[ ]
[ ]
[ ]
[ ]
(997) Refused
(999) DK
(997) Refused
(999) DK
[If FAU.070 lt FAU.110 go to NEXT_HOSP; Else go to 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)
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?
[Exclude children born during interview week]
(2) No (FAU.150)
(7) Refused (FAU.150)
(9) DK (FAU.150)
FAU.130
[ ]
[ ]
[ ]
[ ]
[ ]
(50) 50+ Visits
(97) Refused
(99) DK
[Exclude children born during interview week]
(2) No (FAU.180)
(7) Refused (FAU.180)
(9) DK (FAU.180)
FAU.160
[ ]
[ ]
[ ]
[ ]
[ ]
(50)50+ Calls
(97) Refused
(99) DK
[p. 34]
[Exclude children born during interview week]
(2) No (FAU.210)
(7) Refused (FAU.210)
(9) DK (FAU.210)
FAU.190
[ ]
[ ]
[ ]
[ ]
[ ]
(50)50+ Times
(97) Refused
(99) DK
(2) No (Go to next section - Health Insurance}
(7) Refused (Go to next section - Health Insurance)
(9) DK (Go to next section - Health Insurance}
FAU.220
[ ]
[ ]
[ ]
[ ]
[ ]
Section V -- HEALTH INSURANCE
Are you familiar with the family's health care coverage?
(2)No (FHI.020)
(7)Refused (FHI.020)
(9)DK (FHI.020)
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FHI.050)
(7) Refused (FHI.050)
(9) DK (FHI.050)
[ ]
FHI.050
[If FAVAIL eq (1)]
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 PAY MEDICAL BILLS.
2. Private health insurance plan purchased directly*
3. Private health insurance plan through a state or local government program or community
4. Medicare
5. Medi-Gap
6. Medicaid
7. Military health care/VA
8.CHAMPUS/TRICARE/CHAMP-VA
9. Indian Health Service
10.State-sponsored health plan
11. 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).
(2) No (FHICCI9)
(7) Refused (FHICCI9)
(9) DK (FHICCI9)
[p. 36]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[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: SHOW CARD F9.
MARK "X" ALL THAT APPLY.
2. Private health insurance plan purchased directly*
3. Private health insurance plan through a state or local government program or community
4. Medicare
5. Medi-Gap
6. Medicaid
7. Military health care/VA
8.CHAMPUS/TRICARE/CHAMP-VA
9. Indian Health Service
10.State-sponsored health plan
11. 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).
[ ]HIKINDB (02) Private health insurance plan purchased directly
[ ]HIKINDC (03) Private health insurance plan through a State or local government program or community program
[ ]HIKINDD (04) Medicare
[ ]HIKINDE (05) Medi-GAP
[ ]HIKINDF (06) Medicaid
[ ]HIKINDG (08) Military health care/VA
[ ]HIKINDH (09) CHAMPUS/TRICARE/CHAMP-VA
[ ]HIKINDI (10) Indian Health Service
[ ]HIKINDJ (11) State-sponsored health plan
[ ]HIKINDK (12) 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 5 and not 4, mark HIKINDD=X and go to FHI.080.
2. If the person in FHI.070 marked 4, go to FHI.080.
3. If the person in FHI.070 did not mark 4, go to Check item FHICCI4
anyone, including any other government agency. Providing the Health Insurance Claim Number is voluntary and collected under the authority of the Public Health Service Act. Whether the number is given or not, there will be no effect on your benefits. This number will be held in strict confidence.
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)
that is, a Health Maintenance Organization? (With an HMO, you must generally receive care from HMO doctors, otherwise the expense is not covered unless you were referred by the HMO
or there was a medical emergency).
(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 6 then go to FHI.120; Else go to
Check item FHICCI5.
The next questions are about Medicaid coverage. In this State it is also called (state name). {You/subject's name} {are/is} listed as having Medicaid coverage. Can {you/subject's name} go to ANY doctor who will accept Medicaid or MUST {you/he/she} choose from a book or list of doctors or is a doctor assigned?
(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?
[If answer equals 3, ask:]
What is the name of the health plan that assigned the doctor?
Card F10
(Note: OR indicates that the state also has the name "state name medicaid" such as "Iowa Medicaid")
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
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, Health Choice
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
doctors, or certain clinic which {you/he/she} must go to for all of {your/his/her} routine care?
(Do not include emergency care or care from a specialist {you/he/she} was referred to).
(2) No
(7) Refused
(9) DK
(2) No
(7) Refused
(9) DK
[When roster exhausted go to Check item FHICCI5.]
If any person with -
- Private health insurance plan from employer or workplace (in FHI.070 marked 1),
- Private health insurance plan purchased directly (in FHI.070 marked 2),
- Private health iinsurance plan through a State or local government program or
community program (in FHI.070 marked 3)
- Medi-gap (in FHI.070 marked 5),
Then go to Check item FHICCI6; Else go to Check item FHICCI7.
Check item FHICCI6: The next questions are about private health insurance plans obtained through work, purchased directly, or through a State or local government or community program.
[If more than 1 person has private insurance plan say:]
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. 40]
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: FHI.200-FHI.246 are repeated for each health plan.
Now I am going to ask some questions about the {plan/plans} you just told me about,{/starting with} [fill plan name].
[else read]
Next I would like to ask you about [fill plan name].
[Read to everyone]
Health insurance plans are usually obtained in one person's name even if other family members are covered. That person is called the policyholder. In whose name is this plan?
FR: ENTER (0) FOR POLICYHOLDER OUTSIDE OF FAMILY.
(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)or community program (FHI.240)
(4) Medicare (FHI.240)
(5) Medicaid (FHI.240)
(6) State or local government
(7) Refused (FHI.240)
(9) DK (FHI.240)
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[p. 41]
FR: SHOW CARD F12.
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) POS
(4) Other
(7) Refused
(9) DK
(2) Select from group/list (FJI.246)
(7) Refused (FHICCI9)
(9) DK (FHICCI9)
(2) No
(7) Refused
(9) DK
(2) No
(7) Refused
(9) DK
Check item FHICCI9: Loop through each non-deleted family member: If any member is in a family with a family member in the armed forces, go to FHI.320; Else if any member with no entry marked in FHI.060 , go to FHI.260; Else if any member marked FHI.070 with 10 or 11 go to FHI.250; Else go to FHI.300.
FR: READ STATE NAME FOR MEDICAID AND STATE SPONSORED HEALTH INSURANCE PROGRAM FROM CARDS F10 AND F11.
CHAMPUS or CHAMPVA... or any private insurance?
(2) No (FHI.270)
(7) Refused (FHI.270)
(9) DK (FHI.270)
Card F10
(Note: OR indicates that the state also has the name "state name medicaid" such as "Iowa Medicaid")
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
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, Health Choice
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
Arizona - Medically Indigent Program
California - County Medical Services Progam (CMSP), Children's Services (CCS), AIM (Access for Infants and Mothers), California's children's health
Colorado - Child Health Plan, Children's Health Plan
Connecticut - Healthy Steps, General Assistance Program (GA)
Delaware - Nemours Child Program
Florida - Healthy Kids
Hawaii - Hawaii HealthQUEST
Illinois - General Assistance Program (State Child and Family Assistance, SCFA or Transitional Assistance, TA)
Iowa - Caring Program for Children, Iowa coverage for unemployed workers
Kansas - MediKan, Caring Program for Kids, Kansas Caring Program for kids
Maine - Maine Health Program
Maryland - AIDS Insurance Assistance Program
Massachusetts - CommonHealth Program, Medical Security Plan (MSP), CenterCare Program, Children's Meidcal Security Plan, Healthy Kids
Michigan - Wayne County Plus Care Program, Medical Assistance Program, Caring Program for Children
Minnesota - MinnesotaCare, Minnesota General Assitance Medical Care Program (GAMC)
Mississippi - Mississippi subsidized insurance coverage
Missouri - General Relief Medical Assistance
Nebraska - State Disability Program
New Hampshire - Healthy Kids
New Jersey - Health Access New Jersey, New Jersey's coverage for pregnant women
New York - Home Relief, Child Health Plus (CHP), New York's subsidized insurance
North Carolina - Caring Program for Children
Ohio - Ohio Disability Assistance Medical Program, Children's Health Care Program
Oregon - Oregon Health PLan
Pennsylvania - Children's Health Insurance Program (CHIP), General Assistance Medical Program
Rhode Island - General Public Assistance (GPA) Medical Program
Tennessee - TennCare
Utah - Utah Medical Assistance Program (UMAP), Rite Care
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), Children's Health Plan
Wisconsin - General Relief Medical
FHI.270
FR: SHOW CARD 13.
(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
(7) Refused
(9) DK
FR: SHOW CARD F14.
2. Got divorced or separated/death of spouse or parent
3. Became ineligible because of age/left school
4. Employer does not offer coverage/or not eligible for coverage
5. Cost is too High
6. Insurance company refused coverage
7. Medicaid/Medical plan stopped after pregnancy
8. Lost Medicaid/Medical plan because of new job or increase in income
9. Lost Medicaid (other)
10. Other (specify)
(2) Got divorced or separated/death of spouse or parent
(3) Became ineligible because of age/left school
(4) Employer does not offer coverage/Or not eligible for coverage
(5) Cost is too high
(6) Insurance company refused coverage
(7) Medicaid/Medical plan stopped after pregnancy
(8) Lost Medicaid/Medical plan because of new job or increase in income
(9) Lost Medicaid (other)
(10) Other (specify) ____________
(97) Refused
(99) DK
[ ]
[ ]
[ ]
[ ]
(Go to FHI.320)
(2) No (FHI.320)
(7) Refused (FHI.320)
(9) DK (FHI.320)
[p. 43]
(97) Refused
(99) DK
FR: SHOW CARD F15.
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 VI -- SOCIO-DEMOGRAPHIC BACKGROUND
FSD.001
(002) Puerto Rico
(003) Outlying Area of the U.S. (American Samoa, Guam, US, Virgin Islands, Northern Mariana, Other US 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
(421) Ghana
(138) Great Britain
(340) Grenada
(126) Holland
(211) Indonesia
(213) Iraq
(214) Israel
(216) Jordan
(427) Kenya
(183) Latvia
(222) Lebanon
(184) Lithuania
(224) Malaysia
(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.
(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 go to FSD.002; all others go to FSD.003
Earlier I recorded {your/subject's name] date of birth as {fill in date of birth}.
In what year did {you/subject's name} come to the United States to stay?
(1900-1998) 1900-1998 years (FSD.005)
(9997) Refused (FSD.004)
(9999) DK(FSD.004)
FSD.004
Earlier I recorded that {you/subject's name} {are/is} _____years old.
About how long {have/has} {you/subject's name} been in the United States?
FR: ENTER 95 FOR 95 OR MORE YEARS. IF LESS THAN 1 YEAR, GIVEN AS A RESPONSE, CODE THE ANSWER AS ?".
(1-94) years
(95) 95+ years
(97) Refused
(99) DK
[p. 46]
{Are/Is} { you/subject's name} a CITIZEN of the United States?
2. Yes, born in Puerto Rico, Guam, American Virgin Islands, or U.S. territory
3. Yes, born abroad to American parents
4. Yes, U.S. citizen by naturalization
5. No, not a citizen of the United
(2) Yes, born in Puerto Rico, Guam, American Virgin Islands, or other U.S. territory
(3) Yes, born aboard to American parent(s)
(4) Yes, U.S. citizen by naturalization
(5) No, not a citizen of the United States
(7) Refused
(9) DK
FSD.006 FSD.007
(2) No (FSD.007)
(7) Refused (FSD.007)
(9) DK (FSD.007)
(2) No
(7) Refused
(9) DK
FR: SHOW CARD F17.
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. 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)
(01) 1st grade
(02) 2nd gradetechnical, or vocational program
(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,
(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. 47]
FR: SERVICE IN NATIONAL GUARD OR RESERVES IS NOT CONSIDERED ACTIVE DUTY
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
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 Go to FSD.100; ELSE FSD.090)
(7) Refused (FSD.100)
(9) DK (FSD.100)
(01-94) 1-94 hours (FSD.080)
(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. 48]
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 VII -- INCOME AND ASSETS
Part A -- Sources of Income
The next questions are about {your/your combined family} income. Each income question refers to income received in {last calendar year}.
Are you knowledgeable about your family's finances?
(2) No (FIN.011)
(7) Refused (FIN.011)
(9) DK (FIN.011)
[ ]
[ ]
[ ]
[ ]
(2) No (Check item FINCCI1)
(7) Refused (Check item FINCCI1)
(9) DK (Check item FINCCI1)
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
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
[ ]
[ ]
[ ]
[ ]
[ ]
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
[ ]
[ ]
[ ]
[ ]
[ ]
FR: READ IF NECESSARY:
Social Security checks are either automatically deposited in the bank or mailed to arrive on the 3rd of every month. If mailed, they are sent in a yellow/gold colored envelope.
(2) No (FIN.090)
(7) Refused (FIN.090)
(9) DK (FIN.090)
FIN.080
[ ]
[ ]
[ ]
[ ]
[ ]
FIN.082 FIN.084
(2) No (FIN.090)
(7) Refused (FIN.090)
(9) DK (FIN.090)
ENTER APPLICABLE LINE NUMBER(S).
ENTER (N) FOR NO MORE AFTER THE LAST NUMBER.
Who received Social Security or Railroad Retirement as a disability benefit? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No
(7) Refused
(9) DK
(2) No (FIN.102)
(7) Refused
(9) DK
FIN.100
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FIN.110)
(7) Refused (FIN.110)
(9) DK (FIN.110)
FIN.104
ENTER APPLICABLE LINE NUMBER(S)
ENTER (N) FOR NO MORE AFTER THE LAST NUMBER.
Who received this? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
[p. 52]
FR: READ IF NECESSARY:
Federal SSI checks are either automatically deposited in the bank or mailed to arrive on the first of every month. If mailed, they are sent in a blue colored envelope.
(2) No (FIN.150)
(7) Refused (FIN.150)
(9) DK (FIN.150)
FIN.120
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No
(7) Refused
(9) DK
(2) No (FIN.162)
(7) Refused (FIN.162)
(9) DK (FIN.162)
FIN.160
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No
(7) Refused
(9) DK
(2) No (FIN.170)
(7) Refused (FIN.170)
(9) DK (FIN.170)
FIN.166
[ ]
[ ]
[ ]
[ ]
[ ]
[p. 53]
(2) No (FIN.190)
(7) Refused (FIN.190)
(9) DK (FIN.190)
FIN.180
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FIN.210)
(7) Refused (FIN.210)
(9) DK (FIN.210)
FIN.200
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FIN.230)
(7) Refused (FIN.230)
(9) DK (FIN.230)
FIN.220
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FIN.250)
(7) Refused (FIN.250)
(9) DK (FIN.250)
FIN.240
[ ]
[ ]
[ ]
[ ]
[ ]
[p. 54]
Part B -- Amounts and Home Ownership
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, SHOW CARD F18.
IF ANSWER FOR FIN.260 EQUALS 2, SHOW CARD F19.
READ IF NECESSARY: INCOME IS IMPORTANT IN ANALYZING THE HEALTH INFORMATION WE COLLECT. FOR EXAMPLE, THIS INFORMATION HELPS US TO 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
OO. $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. 55]
Part C -- Program Participation
(2) No (FIN.330)
(7) Refused (FIN.330)
(9) DK (FIN.330)
FIN.310
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FINCCI3)
(7) Refused (FINCCI3)
(9) DK (FINCCI3
FIN.340
[ ]
[ ]
[ ]
[ ]
[ ]
FIN.350
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 questionnaire)
(7) Refused (next questionnaire)
(9) DK (next questionnaire)
FIN.370
[ ]
[ ]
[ ]
[ ]
[ ]
[p. 56]
FR: IF LESS THAN 1 MONTH, ENTER (1).
(12)12 months or all
(97) Refused
(99) DK