What are the names of all persons living or staying here?
Start with the name of the person, or one of the persons, who owns or rents this home.
[Else]
What is the name of the next person living or staying here?

NAME_FNA FIRST NAME:___________________________
NAME_MNA MIDDLE NAME : ________________________
NAME_LNA LAST NAME:____________________________

Check item: If NAME_FNA or NAME_LNA is (D,R) go to HHC.015; Else go to HHC.020.

How shall I refer to {you/this person} for the rest of the interview?

ALIAS Name: ______________________

{Do/Does} {you/name} usually live here?

(1) Yes (HHC.040)
(2) No (HHC.030)
(7) Refused (HHC.030)
(9) Don't know (HHC.030)

{Do/Does} {you/name} have some other place where you/he/she usually lives?

(1) Yes (HHC.035)
(2) No (HHC.040)
(7) Refused (HHC.040)
(9) Don't know (HHC.040)

FR:IF THE PERSON DOES NOT USUALLY LIVE AT THIS ADDRESS AND HAS ANOTHER RESIDENCE WHERE HE/SHE DOES USUALLY LIVE, HE/SHE WILL BE FLAGGED WITH "D" FOR DELETED AND NOT INCLUDED IN THIS INTERVIEW.

FR:ASK IF NECESSARY.
Is anyone else living or staying here now?

(1) Yes (Check Item HHCCCI1)
(2) No (HHC.050)
(7) Refused (HHC.050)
(9) Don't know (HHC.050)

FR:READ FIRST TIME ONLY:
I have listed living here (READ NAMES).
(1) Yes
(2) No
(7) Refused
(9) Don't know

Have I missed -

MISPERS1 - Any babies or small children?
MISPERS2 - Any lodgers, boarders, or persons you employ who live here?
MISPERS3 - Anyone who USUALLY lives here, but is now away from home traveling or in a hospital?
MISPERS4 - Anyone else staying here?

[If any of MISPERS1 -MISPERS4 is yes; go to Check Item HHCCCI1; Else, go to Check Item HHCCCI2.]

Check item HHCCCI1: If total number of household members is less than 30 go to HHC.010; Else go to HHC.055.

FR:A MAXIMUM OF 30 PEOPLE MAY BE INTERVIEWED IN ANY HOUSEHOLD. THE LIMIT HAS BEEN REACHED, NO QUESTIONS WILL BE ASKED FOR ANY ADDITIONAL PEOPLE.

Check item HHCCCI2:_ If all the household members are flagged with "D" (=URE or unusual residence elsewhere), then OUTCOME=225 and ACTION=31, go to END; Else go to HHC.060

Do all the persons I have listed live AND eat together?
FR:READ NAMES IF NECESSARY.

(1) Yes (HHC.090)
(2) No (HHC.070)
(7) Refused (HHC.090)
(9) Don't Know (HHC.090)

Do the people who do not live and eat here have direct access from the outside or through a common hallway to a separate living quarters?

(1) Yes (HHC.080)
(2) No (HHC.090)
(7) Refused (HHC.090)
(9) Don't know (HHC.090)

FR:ENTER THE LINE NUMBER OF EACH PERSON WHO DOES NOT LIVE AND EAT WITH THIS HOUSEHOLD.

[ ] TABX_1
[ ] TABX_2
[ ] TABX_3
[ ] TABX_4
[ ] TABX_5
[ ] TABX_6
[ ] TABX_7
[ ] TABX_8
[ ] TABX_9
[ ] TABX_10

(Go to HHC.090)

Check item HHC04: Cycle the roster, for each person number entered in TABX_1 to TABX_10: Set HHSTAT = (D)
At end, go to HHC.095/OTHLIV.

Do members of any other household on the property live and eat with members of this household?

(1) Yes (HHC.095)
(2) No (HHC.100)
(7) Refused (HHC.100)
(9) Don't know (HHC.100)

FR:THIS UNIT (HOUSEHOLD) INCLUDES THE SPACE OCCUPIED BY ALL PERSONS WHO LIVE AND EAT TOGETHER.

(Go to HHC.040)

FR:ASK IF NECESSARY
With whom am I speaking?

ENTER LINE NUMBER OF THE RESPONDENT.
IF MORE THAN ONE, ENTER THE NUMBER OF THE ONE YOU CONSIDER TO BE THE MAIN RESPONDENT.

HHRESP [Enter Person #]

Check item HHCCCI3:_Cycle the roster and ask questions on SEX, AGE, DOB, ETHNICITY, RACE, and NOWAF of all un-deleted household members. At end go to Check Item HHCCCI6

FR:ASK IF NOT APPARENT:
{Are/Is} {you/name} male or female?

IF DON'T KNOW OR REFUSED ENTER YOUR BEST GUESS

(1) Male
(2) Female

What is {your/name} age and date of birth? Please give month, day, and year for the date of birth.

(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

AGEDOB_1 ________Age/ Number
AGEDOB_2 [ ]Time Period

(1) Day(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)

Date of Birth:

DOB_MMONTH: ______________________
DOB_BDAY DAY:______________________
DOB_Y_PYEAR:______________________

Check item AGECAL: AGE1 takes information entered in AGEDOB_1 and AGEDOB_2 and calculates an age.

AGE2 takes the date-of-birth information entered in AGEDOB and calculates an age.

AGE3 = current year - birth year -1, AGE4 = AGE3 + 1. If not enough DOB
information was given to calculate an age, "D" will be assigned to AGE2.

Check item AGECK:AGECK compares the two ages calculated in AGE1 and AGE2. AGE1 and AGE2 will either contain an age, or "D" if an age could not be calculated.
If AGE1 =(D) and AGE2 ne (D), set AGE = AGE2, go to HHC.170
If AGE1 =(D) and AGE2 = (D), and AGE3 = blank, go to HHC.150
If AGE1 =(D) and AGE2 = (D), and AGE3 ne lt gt, go to HHC.130
If AGE1 ne (D) and AGE2 ne (D), and AGE1 = AGE2, go to HHC.170
If AGE1 ne (D) and AGE2 ne (D), and AGE1 ne AGE2, and
HHC.124/DOBVER = lt gt , go to HHC.124
If AGE1 ne (D) and AGE2 ne (D), and AGE1 ne AGE2 and HHC.124/DOBVER
ne lt gt; set AGE=AGE2, go to HHC.170
If AGE1 ne (D) and AGE2 = (D), and (AGE1 = AGE3 or AGE1 = AGE4); set AGE =
AGE1; go to HHC.170
If AGE1 ne AGE3 and AGE1 ne AGE4 and birth year = blank, go to HHC.130
If AGE1 ne AGE3 and AGE1 ne AGE4 and birth year ne lt gt; set AGE = AGE1, go to
HHC.170

There is a difference between the age the computer calculated from {your/name's} date-of-birth and the age that you gave me. I recorded {your/name's} date-of-birth as{DOB_M/DOB_BDAY/DOB_Y_P}. Is that {your/name's} correct date-of-birth?

(1) Yes (HHC.170)
(2) No (HHC.128)
(7) Refused (HHC.170)
(9) Don't know (HHC.170)

FR:OLD DATE OF BIRTH = {DOB_M/DOB_BDAY/DOB_Y_P}
ASK IF NECESSARY:

What is {your/name's} correct date-of-birth?

(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_M MONTH: ______________
DOB_B DAY DAY:______________
DOB_Y_P YEAR:______________

[If valid birthdate is given, update AGE accordingly. If (D,R)is given for the birthdate,
set AGE = AGE1, go to HHC.170]

{Are you/Would you say} {your/name's} is
[If AGE3 = (0)]

(1) Less than 1 year old? (HHC.170)

[Else]
(1) {AGE3} year(s) old? (HHC.170)
(2) {AGE4} year(s) old? (HHC.170)
(N) Neither is correct (HHC.150)
(7) Refused (HHC.150)
(9) Don't know (HHC.150)
[If answer is (1, 2); update AGE accordingly, go to HHC.170]

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.

What is your best guess of {your/name's} age?

AGEGES11 [ ] Number
AGEGES12 [ ] Time Period

(3) Month(s) (Check item)
(4) Year(s) (Check item)
(C) Compute from range (HHC.160)
(7) Refused (HHC.152)
(9) Don't Know (HHC.152)

Check item: _If AGEGES12 is (3) then AGE = (AGEGES11/12); If AGEGES12 is (4) then AGE =(AGEGES11). If DOB_Y_P = (D, R); set BYY1 = (current year-AGE1-1) and BYY2 = (current year- AGE) go to HHC.165; If DOB_Y_P ne (D, R); set AGE = (AGE1), go to HHC.170. If AGEGES12 = (D, R), go to HHC.152

Certain sections of this interview depend on knowing if a person is 18 years old or older. Could you please tell me if {you/name} {are/is} at least 18 years old?

(1) Less than 18 (HHC.154)
(2) 18 or older (HHC.154)
(7) Refused (HHC.156)
(9) Don't know (HHC.156)

FR:ENTER YOUR BEST ESTIMATE OF {your/name's} AGE.
ENTER "0" IF LESS THAN 1 YEAR OLD.

LESS18 Age: ________________

(Go to HHC.170)

FR:ENTER YOUR BEST ESTIMATE OF {your/name's} AGE.

GREAT18 Age:____________ (Enter age 18 or greater)

(Go to HHC.170)

FR:ENTER FIRST AND LAST AGES OF THE RANGE.

First/lower:

AGERNG_1 [ ] Number
AGERNG_3 [ ] Time period

(3) Month (s)
(4) Year (s)

Last/higher

AGERNG_2 [ ] Number
AGERNG_4 [ ] Time period

(3) Month (s)
(4) Year (s)

(Go to HHC.170)

[Convert AGERNG_1 and AGERNG_2 into year, Set AGE = (AGERNG_1 + AGERNG_2) /2]

Would you say that {you/name} {were/was} born in:

(1) [fill with 4-digit BYY1]
(2) [fill with 4-digit BYY2]
(N) Neither is correct
(7) Refused
(9) Don't Know

FR:SHOW CARD H1.
{Do/Does} (you/name's) consider {yourself/himself/herself} to be Hispanic or Latino?

FR:READ IF NECESSARY:

1. Puerto Rican
2. Cuban/Cuban American
3. Dominican (Republic)
4. Mexican
5. Mexican American
6. Central or South American
7. Other Latin American
8. Other Hispanic/Latino

Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American
Other Latin American
Other Hispanic/Latino

(Where did {your/name's} ancestors come from?)

(1) Yes (HHC.180)
(2) No (HHC.200)
(7) Refused (HHC.200)
(9) Don't know (HHC.200)

FR:SHOW CARD H1.
Please give me the number of the group that represents {your/name's} Hispanic origin or ancestry.

FR: _IF A NONHISPANIC GROUP IS NAMED, PRESS "F1" TO RETURN TO
HHC.170/ORIGIN AND CHANGE THE ANSWER FROM "YES" TO "NO".
ENTER EACH NUMBER THAT APPLY. IF A WRONG CHOICE, TYPE THAT CHOICE AGAIN. ENTER (N) FOR NO MORE.

1. Puerto Rican
2. Cuban/Cuban American
3. Dominican (Republic)
4. Mexican
5. Mexican American
6. Central or South American
7. Other Latin American
8. Other Hispanic/Latino

(1) Puerto Rican (HHC.200)
(2) Cuban/Cuban American (HHC.200)
(3) Dominican (Republic) (HHC.200)
(4) Mexican (HHC.200)
(5) Mexican American (HHC.200)
(6) Central or South American (HHC.200)
(7) Other Latin American (HHC.190)
(8) Other Hispanic/Latino (HHC.195)
(97) Refused (HHC.200)
(99) Don't know (HHC.200)

[ ] HISPAN_1
[ ] HISPAN_2
[ ] HISPAN_3
[ ] HISPAN_4
[ ] HISPAN_5

FR:PROBE FOR THE COUNTRY.

FR: IF ANY OF THE FOLLOWING ARE MENTIONED, PRESS F1 TO RETURN
TO HHC.180/HISPAN AND CORRECT ENTRY.

Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American

FR:SPECIFY THE OTHER LATIN AMERICAN

HIS_SP2 Other Latin American: _____________________________

FR:PROBE FOR THE COUNTRY.
FR: IF ANY OF THE FOLLOWING ARE MENTIONED, PRESS F1 TO RETURN TO HHC.180/HISPAN AND CORRECT ENTRY.

Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American

FR:SPECIFY THE OTHER HISPANIC OR LATINO

HIS_SP3 Other Hispanic or Latino: __________________________

FR:SHOW CARD H2

1. White
2. Black/African American
3. Indian (American)
4. Alaska Native
5. Native Hawaiian
6. Guamanian
7. Samoan
8. Other Pacific Islander
9. Asian Indian
10. Chinese
11. Filipino
12. Japanese
13. Korean
14. Vietnamese
15. Other Asian
16. Some Other Race

What race {do/does} {you/name} consider {yourself/himself/herself} to be? Please select 1 or more of these categories.
(1) White
(2) Black/African American
(3) Indian (American)
(4) Alaska Natives
(5) Native Hawaiian
(6) Guamanian
(7) Samoan
(8) Other Pacific Islander (HHC.210)
(9) Asian Indian
(10) Chinese
(11) Filipino
(12) Japanese
(13) Korean
(14) Vietnamese
(15) Other Asian (HHC.212)
(16) Some other race (HHC.214)
(97) Refused (Check Item HHCCCI4)
(99) Don't know (Check Item HHCCCI4)

[ ] RACE1
[ ] RACE2
[ ] RACE3
[ ] RACE4
[ ] RACE5

(Go to Check Item HHCCCI4)

FR: IF ANY OF THE FOLLOWING ARE MENTIONED, PRESS F1 TO RETURN
TO RACE AND CORRECT ENTRY.
White
Black/African American
Indian (American)
Alaska Native
Native Hawaiian
Guamanian
Samoan
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese

FR:SPECIFY OTHER PACIFIC ISLANDER

RACSPY1Other Pacific Islander: _________(Go to Check Item HHCCCI4)

FR:IF ANY OF THE FOLLOWING ARE MENTIONED, PRESS F1 TO RETURN
TO RACE AND CORRECT ENTRY.

White
Black/African American
Indian (American)
Alaska Native
Native Hawaiian
Guamanian
Samoan
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese

FR:SPECIFY THE OTHER ASIAN

RACSPY2 Other Asian: _________(Go to Check Item HHCCCI4)

FR:IF ANY OF THE FOLLOWING ARE MENTIONED, PRESS F1 TO RETURNTO RACE AND CORRECT ENTRY.

White
Black/African American
Indian (American)
Alaska Native
Native Hawaiian
Guamanian
Samoan
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese

FR:SPECIFY THE OTHER RACE

RACSPY3 Other race: ______________(Go to Check Item HHCCCI4)

Check item HHCCCI4: If multiple entries in HHC.200/ RACE go to HHC.220; Else go to Check Item HHCCCI5.

Which one of these groups, that is (FR: READ GROUPS) would you say BEST represents {your/name's} race?

[List all mentioned race codes and descriptions in Race_1 - Race_5; If Race_1

(01-16) Race number
(97) Refused
(99) Don't know

Check item HHCCCI5: If a household member's age is 18-64 and not a deleted person go to HHC.230; Else go to Check Item HHCCCI6.

{Is/Are} {name/you} now on full-time active duty with the armed forces?

(1) Yes
(2) No
(7) Refused
(9) Don't know

(Go to Check Item HHCCCI6)

Check item HHCCCI6: If all the household members are flagged with "A" or "D", set OUTCOME=223 and ACTION=31 go to HHC.240; If SCR_STAT = 2 (interviewed household), or SCR_STAT = 1 (screened household) and where anyone is Black or Hispanic, go to HHC.250. If SCR_STAT = 1 and no one in the household is Black or Hispanic; go to HHC.240

Not every household in our survey is asked all questions. I have all the information about I your household that need at this time. Thank you for your assistance.

FR: {You/Name} {HAVE/HAS} BEEN SELECTED AS THE HOUSEHOLD
REFERENCE PERSON. IS THIS HOUSEHOLD MEMBER AN APPROPRIATE CHOICE? PREFERABLY A CIVILIAN ADULT?

(1) Yes, accept this person (Check Item HHCCCI3)
(2) No, select another person (HH_REF)

HH_REF Enter the line number of the Household Reference person: ____

[If HHREF_A = 1, store Reference Person's person number in HH_REF]

Check item: If the person listed in HHC.250/HH_REF is 14-17 years old, go to HHC.255; Else store the Reference Person's person number in HH_REF; go to check item RPREL_CK.

You have selected a person less than 18 years old. Is it correct?

(1) Yes, continue the interview (RPREL_CK)
(2) No, select another (HHREF_A)

Check item RPREL_CK: Obtain the relationship of each non-deleted HH member to the HH reference person (get information on RPREL, DEGREE1, DEGREE2, DEGREE3). After exhausting all the HH members go to Check Item HHCCCI8.

FR:SHOW CARD H3.
What is {your/PX-name's} relationship to {you/RP-name}?

2. Spouse (husband/wife)
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
12. Other relative
13. Housemate/roommate
14. Roomer/Boarder
15. Other nonrelative
16. Legal guardian
17. Ward

(2) Spouse (husband/wife)
(3) Unmarried partner
(4) Child (biological/ adoptive/in-law/ step/ foster) (HHC.270)
(5) Child of partner
(6) Grandchild
(7) Parent (biological/ adoptive/in-law/ step/ foster) (HHC.280)
(8) Brother/sister (biological/adoptive/ in-law/ step/ foster) (HHC.290)
(9) Grandparent (grandmother/grandfather)
(10) Aunt/uncle
(11) Niece/nephew
(12) Other relative
(13) Housemate/Roommate
(14) Roomer/Boarder
(15) Other nonrelative
(16) Legal guardian
(17) Ward
(97) Refused
(99) Don't know

[Go to HHC.260 for obtaining the relationship of next person in the household. If no more persons in the household, go to Check Item HHCCC18]

FR:READ IF NECESSARY:

I have recorded that:
Line #NAME.
Are {your/} spouses or unmarried partners { /of Reference Person name}.
Which one is correct?

SPOUSCK_______________(Go to HHC.260)

{Are/Is} {you/PX-name} {your/RP-name}'s biological (natural), adoptive, step, foster {son/daughter} or {son/daughter}-in-law?

(1) Biological (natural) {son/daughter}
(2) Adoptive {son/daughter}
(3) Step {son/daughter}
(4) Foster {son/daughter}
(5) {son/daughter}-in-law
(7) Refused
(9) Don't know

Check item: If HHC.270 = 1 and (AGE (Reference Person)-AGE(PX) lt (12)) go to BIOCK1; If there are no more persons go to Check Item HHCCC18; Else go to HHC.260 for the next person in the HH.

You said that {you are/{name's} is} {subject name}'s biological {mother/father}.
There are only {1-11} years age difference between {you/them}. Is this relationship correct?

(1) Yes, continue the interview (HHC.260)
(2) No, change relationship (HHC.270)

{Are/Is} {you/PX-name} {your/RP-name}'s biological (natural), adoptive, step,
or foster {mother/father} or {mother/father}-in-law?

(1) Biological (natural) {mother/father}
(2) Adoptive {mother/father}
(3) Step {mother/father}
(4) Foster {mother/father}
(5) {mother/father}-in-law
(7) Refused
(9) Don't know

Check item: If HHC.280 = 1 and (AGE(Reference Person)-AGE(PX) lt (12)) go to BIOCK2; If there are no more persons go to Check Item HHCCC18; Else go to HHC.260 for the next person in the HH.

You said that {subject's name} is {your/ PX's name}'s biological {mother/father}. There are only {1-11} years age difference between {you/them}. Is this relationship correct?

(1) Yes, continue the interview (HHC.260)
(2) No, change relationship (HHC.280)

{Are/Is} {you/PX-name} {your/RP-name}'s full, half, adoptive, step, or foster
{brother/sister} or {brother/sister}-in-law?

(1) Full {brother/sister}
(2) Half {brother/sister}
(3) Adopted {brother/sister}
(4) Step {brother/sister}
(5) Foster {brother/sister}
(6) {brother/sister}-in-law
(7) Refused
(9) Don't know

Check item: Roster all members in the HH, If two persons in a household with RPREL=2 or 3, go to HHC.264. If no more persons, go to Check Item HHCCCI8; Else go to HHC.260 for the next person in the HH.

Check item HHCCCI8: If more than 1 unrelated person in a HH, go to HHC.300; Else go to END_HHC.

FR:PROBE AS NECESSARY TO ESTABLISH RELATIONSHIPS OF PERSON(S) NOT RELATED TO THE REFERENCE PERSON.

FR:DO NEW FAMILY NUMBERS NEED TO BE ASSIGNED TO ANY
HOUSEHOLD MEMBERS?

(1) Yes, additional numbers (HHC.310)
(2) No, all are in family "2" (END_HHC)

FR: CHANGE THE FAMILY NUMBER AS NECESSARY.
Line # NameFamily #

FAMNUM2 [fill PX][fill NAME]

[Store new family # in FMX (family number)]

Check item END_HHC:_ Count the Number of Families in the Household.
Count the number of persons in each family.

(Go to next section -- Family Relationship and Verification of Demographic Information).

FR: VERIFY OR ASK IF NAME IS MISSING OR WAS REFUSED OR NOT KNOWN. ENTER (D) OR (R) FOR ANY PARTS OF NAME REFUSED OR NOT KNOWN. IF THERE IS NO MIDDLE INITIAL, LEAVE BLANK.

NAMVER_F First name of {subject's name} is: ______________
NAMVER_M Middle initial of {subject's name}: _____________
NAMVER_L Last name of {subject's name}: ________________

FR: MARK FIRST CATEGORY THAT APPLIES FOR {subject's name}.

(1) Present for all questions
(2) Present for some questions
(3) Not present

Does {subject's name} usually go by another first name?

(1) Yes (RCI.040)
(2) No (Check item RCICCI1)
(7) Refused (Check item RCICCI1)
(9) Don't know (Check item RCICCI1)

What is this other first name?

NCNAME Name: _____________

(7) Refused
(9) Don't know

Check item RCICCI1 : If HHC.040 = 1, 7, or 9 go to RCI.060; Else if HHC.040 = 2 and HHC.460 = 5 or AGE less than 14 go to RCI.060; Else if HHC.040 = 2 and HHC.460 = 6 and HHC.490 not = 1 go to RCI.060; Else go to RCI.050.

What is {subject's name}'s maiden name?

(S) Same as CURRENT last name (displayed above)
(7) Refused
(9) Don't know

What is {subject's name}'s FATHER'S last name?

(S) Same as CURRENT last name (displayed above)
(7) Refused
(9) Don't know

FR: READ TO RESPONDENT(S):
We also need {subject's name}'s Social Security Number. The National Center for Health Statistics will use {subject's name}'s Social Security Number to conduct health-related research by linking your survey data with vital statistics and other records. We may also use it if we need to recontact you or your family. Except for these purposes, the National Center for Health Statistics will not release {subject's name}'s SSN to anyone, including any government agency. Providing this information is voluntary and is collected under the authority of the Public Health Service Act. There will be no effect on {subject's name}'s benefits if you do not provide it.

FR: READ IF NECESSARY:
The Public Health Service Act is title 42, United States Code, section 242k.

What is {subject's name}'s Social Security Number?
Social Security Number : _____ - ____ -______ (RCI.080)
(999999997) Refused (RCI.075)
(999999999) Don't know (RCI.075)

FR: DO NOT READ TO RESPONDENTS(S): YOU MIGHT WANT TO ENTER (H) TO READ SSN HELP SCREEN

Have you now convinced the respondent to give you the SSN?
(1) Yes (RCI.070)
(2) No (Check item RCICCI2)

FR: ENTER HOW SOCIAL SECURITY NUMBER WAS REPORTED

(1) from Memory
(2) from Records

FR: SELECT ONE CATEGORY BELOW TO INDICATE REPORTING OF SOCIAL SECURITY NUMBER

(1) Self - in person
(2) Self - telephone
(3) Proxy - in person
(4) Proxy - telephone

Check item RCICCI2: Return to RCI.020 for next non-deleted person until the family roster is exhausted. When family roster is exhausted go to Check item RCICCI3.
Check item RCICCI3: If TELENUM = N go to RCI.096; If TELENUM = R or D go to
RCI.092; Else go to RCI.091. (Note: Telephone number, TELENUM, obtained at beginning of interview)

Earlier I recorded the telephone number as {fill TELENUM}.Is this {your/your family's} telephone number?

(1) Yes (RCI.093)
(2) No (RCI.092
(7) Refused (RCI.096)
(9) Don't know (RCI.096)

What is {your/your family's} telephone number? (____)_____-________

(1000000000- 9999999999)1000000000-9999999999 (RCI.093)
(999999997)Refused (RCI.096)
(999999999)Don't know (RCI.096)

How is this phone number listed in the telephone directory? (What is the relationship of the person listed in the telephone directory to {fill Family Respondent}?

NAME: ________________________
RELATIONSHIP: ________________
(7) Refused
(9) Don't know

{Do/Does} {you/your family} expect to move at any time in the next year?

(1) Yes (RCI.097)
(2) No (RCI.100)
(7) Refused (RCI.100)
(9) Don't know (RCI.100)

Approximately when do you think that will happen?

MONTH: ____________
YEAR: ______________
(7) Refused
(9) Don't know

Where do you expect to move?

Number, Street, Apartment Number: ____________________
City: ___________________
State: __________________
Zip: ___________________
(7) Refused
(9) Don't know

Please give me the names, addresses, and telephone numbers of TWO relatives or friends who would know where you could be reached in case we have trouble reaching you. (Please give me the names of persons not currently living in the household.)

FIRST CONTACT PERSON'S NAME:

CP1NAME1 First Name: _________________
CP1NAME2 Middle Initial: _______________
CP1NAME3 Last Name: _________________

What is this person's address?

CP1ADDR1 Number and street: _________________________
CP1ADDR2
CP1ADDR3 City : ____________________
CP1ADDR4 State: ____________________
CP1ADDR5 Zip: _____________________
CP1ADDR6 Zip: _____________________

What is this person's telephone number, beginning with the area code?

CP1TELNO (____)_____-________

(1000000000 - 9999999999)1000000000-9999999999
(9999999996) Does not have a telephone
(9999999997) Refused
(9999999999) Don't know

What is the relationship of this contact person to [fill CP1NAME]?

(1) Spouse (Husband or wife)/ex-spouse not living in HH
(2) Unmarried partner not living in HH
(3) Child
(4) Grandchild
(5) Parent (mother or father)
(6) Brother or sister
(7) Grandparent
(8) Other relative
(9) Legal Guardian
(10) Friend
(11) Co-worker
(12) Neighbor
(13) Other
(97) Refused
(99) Don't know

Please give us the name, address, and telephone number of the second relative or friend who would also know where you could be reached in case we have trouble reaching you. Again, this should be someone who is not currently living in the household.

SECOND CONTACT PERSON'S NAME:

CP2NAME1 First Name: ___________________
CP2NAME2 Middle Initial: _________________
CP2NAME3 Last Name: ___________________

What is this person's address?

CP2ADDR1 Number and street: _________________
CP2ADDR2
CP2ADDR3 City : __________________
CP2ADDR4 State: __________________
CP2ADDR5 Zip: ___________________
CP2ADDR6 Zip: ___________________

What is this person's telephone number, beginning with the area code?

CP2TELNO(_____)_____-__________

(1000000000-9999999999) 10000000000-9999999999
(9999999996) Does not have a telephone
(9999999997) Refused
(9999999999) Don't know

What is the relationship of this contact person to [fill CP2NAME]?

(1) Spouse (Husband or wife)/ex-spouse not living in HH
(2) Unmarried partner not living in HH
(3) Child
(4) Grandchild
(5) Parent (mother or father)
(6) Brother or sister
(7) Grandparent
(8) Other relative
(9) Legal Guardian
(10) Friend
(11) Co-worker
(12) Neighbor
(13) Other
(97) Refused
(99) Don't know

If we need to contact you again, when are the best times to call or visit?

CINFO1 __________________________
CINFO2 __________________________
CINFO3 __________________________
CINFO4 __________________________

Check item RCICCI4: Go to child questionnaire, adult questionnaire, or next family.