[First person]
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?

[endif]

FR: PROBE FOR MIDDLE NAME OR MIDDLE INITIAL IF NOT REPORTED. INITIALS MAY BE ENTERED FOR EACH FIELD BUT MUST BE FOLLOWED BY "." PRESS (ENTER) TO SKIP TO LAST NAME IF NO MIDDLE NAME.

[If not the first person]

FR: IF LAST NAME IS THE SAME AS DISPLAYED, PRESS (ENTER), OTHERWISE, ENTER THE NEW LAST NAME.

[endif]

[If NAME_FNA or NAME_LNA is (D,R) go to HHC.015; Else go to HHC.020]

NAME_FNA FIRST NAME: __________________________________
NAME_MNA MIDDLE NAME: __________________________________
NAME_LNA LAST NAME:__________________________________

[If person is gt 1, prefill previous NAME_LNAME]

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: READ IF NECESSARY:

Since (you/name) (do/does) not usually live here and (have/has) another residence elsewhere, (you/he/she) will not be included in this interview.

PRESS (P) TO PROCEED TO THE NEXT PERSON.

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.

ENTER (P) TO PROCEED.

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.

ENTER "N" FOR NO MORE.



(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 OTHLIV/HHC.090.

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)

ADDOTH All such persons should be included in this interview.

FR: ENTER "P" TO ADD THE ADDITIONAL PERSON(S) TO THE HOUSEHOLD ROSTER.

(Go to HHC.010)

FR: ASK IF NECESSARY

With whom am I speaking?

FR: 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. IF DON'T KNOW OR REFUSED ENTER YOUR BEST GUESS:

{Are/Is} {you/name} male or female?

(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

Age:

[ ] Number

[ ] Time Period

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

Date of Birth:
DOB_M MONTH: ______________________
DOB_BDAY DAY:______________________
DOB_Y_P YEAR: ______________________

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 Check item INTWKCK1.
If AGE1 =(D) and AGE2 = (D), and AGE3 = blank, go to HHC.150
If AGE1 =(D) and AGE2 = (D), and AGE3 ne ( ), go to HHC.130
If AGE1 ne (D) and AGE2 ne (D), and AGE1 = AGE2, go to Check item INTWKCK1.
If AGE1 ne (D) and AGE2 ne (D), and AGE1 ne AGE2, and HHC.124/DOBVER = ( ), go to HHC.124
If AGE1 ne (D) and AGE2 ne (D), and AGE1 ne AGE2 and HHC.124/DOBVER ne ( ); set AGE=AGE2, go to Check item INTWKCK1
If AGE1 ne (D) and AGE2 = (D), and (AGE1 = AGE3 or AGE1 = AGE4); set AGE = AGE1; go to Check item INTWKCK1
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 ( ); set AGE = AGE1, go to Check item INTWKCK1

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 (Check item INTWKCK1)
(2) No (HHC.128)
(7) Refused (Check item INTWKCK1)
(9) Don't know (Check item INTWKCK1)

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_BDAY 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? (Check item INTWKCK1)

[Else]
(1) {AGE3} year(s) old? (Check item INTWKCK1)
[endif]

(2) {AGE4} year(s) old? (Check item INTWKCK1)
(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?

[ ] Number

[ ] 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 Check item INTWKCK1. 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 {name's} AGE.
ENTER "0" IF LESS THAN 1 YEAR OLD.

LESS18 Age:____________(Enter age 0 to 17)

(Go to Check item INTWKCK1)

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

GREAT18 Age:____________(Enter age 18 or greater)

(Go to Check item INTWKCK1)

FR: ENTER FIRST AND LAST AGES OF THE RANGE.

First/lower:

[ ]Number

[ ] Time period

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

Last/higher:

[ ] Number

[ ] Time period

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

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

(Go to Check item INTWKCK1)

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

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

Check item INTWKCK1: If a child and child's birthdate is given and birthdate is greater than STARTDATE, go to CHILDEV/HHC.168. If child's exact birthdate is not known, go to INTWKCK/HHC.167. Else go to HHC.170.

Was {name} born on or after {STARTDATE date}?

(1) Yes (HHC.168)
(2) No (HHC.170)

For statistical reasons, children born on or after {STARTDATE} will not be included in this interview. No more questions will be asked about {name}.

Enter (P) to proceed.

(Go to Check item HHCCCI5)

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 ORIGIN AND CHANGE THE ANSWER FROM "YES" TO "NO".
ENTER EACH NUMBER THAT APPLIES. ENTER (N) FOR NO MORE.

(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)

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

[ ] 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 HISPAN SCREEN 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: _____________________________

(Go to HHC.200)

FR: PROBE FOR THE COUNTRY.
FR: IF ANY OF THE FOLLOWING ARE MENTIONED, PRESS F1 TO RETURN TO HISPAN SCREEN 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: __________________________

(Go to HHC.200)

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.

FR: ENTER (N) FOR NO MORE.

(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 IndianHHCCCI4)
(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
(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

RACSPY1 Other 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 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 RACE

RACSPY3 Other race: _______________________________

(Go to Check Item HHCCCI4)

Check item HHCCCI4:If multiple entries in RACE/HHC.200 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 RACE1 - RACE5; If RACE1 - RACE5 = 8,15,16 fill RACSPY1 and/or RACSPY2 and/or RACSPY3 IN THE ORDER IN WHICH THE RESPONDENT GAVE THEM]

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

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

[If total number of adults aged 18 to 64 gt (1)]
Is anyone in the household now on full-time active duty with the armed forces?

[else]
[If total number of adults aged 18 to 64 eq (1) and a HH respondent]
Are you now on full-time active duty with the Armed Forces?

[else]
Is {name} now on full-time active duty with the Armed Forces?

(1) Yes (HHC.232)
(2) No (HHC.240)
(7) Refused (HHC.240)
(9) Don't know (HHC.240)

Who is this? (Anyone else?)

FR: ENTER LINE NUMBERS AS APPROPRIATE. ENTER (N) FOR NO MORE.

NOWAF2_B ___________________________

(Go to Check item SREEN_1)

Check item SCREEN 1: If all the household members are active duty in the armed forces or deleted persons, 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 your household that I need at this time. Thank you for your assistance.

ENTER (P) TO PROCEED.

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

PRESS SHIFT F1 TO SEE FULL ROSTER INFORMATION.

(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]

Check item: If two persons in a household with RPREL = 2 or 3, go to HHC.264.

FR: READ IF NECESSARY:

I have recorded that:

Line #NAME.

Are {your/} spouses or unmarried partners { /of Reference Person name}.
Which is correct?

SPOUSCK ________________________________(Go to HHC.260)

{Are/Is} {you/PX-name} {your/Reference Person-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/Reference Person-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(PX)-AGE(Reference Person) 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 #
Name
Family #

[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 7 or 9 FOR ANY PARTS OF NAME REFUSED OR NOT KNOWN.
IF THERE IS NO MIDDLE INITIAL, LEAVE BLANK.

NAMVER_F First name of {subject name} is :
NAMVER_M Middle initial of {subject name}:
NAMVER_L Last name of {subject name}:

(7) Refused
(9) Don't know

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

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

Does {subject 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?

Name: _______________________________________
(7) Refused
(9) Don't Know

Check item RCICCI1: If male, then go to RCI.060.
If female and (never married or age is under 14), then go to RCI.060.

What is {subject name}'s maiden name?

Name: ________________________________________
(S) Same as current last name (displayed above)
(7) Refused
(9) Don't Know

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

Name: _______________________________________
(S) Same as current last name (displayed above)
(7) Refused
(9) Don't Know

FR: READ TO RESPONDENT(S):
We also need {subject name}'s Social Security Number. The National Center for Health Statistics will use {subject 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 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 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 name}'s Social Security Number?

FR: ENTER (N) IF NO SOCIAL SECURITY NUMBER.

Social Security Number : _____ - ____ -______(RCI.080)
(999999997) Refused
(999999999) Don't Know

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 SOCIAL SECURITY NUMBER?

(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.

FR: READ TO RESPONDENT:

The United States Public Health Service may wish to contact {you/your family} again to obtain additional health related information.

Check item RCICCI3:If TELENUM = N go to RCI.096; If TELENUM = 7 or 9 go to RCI.092. (Note: Telephone number TELENUM was 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)
(7) Refused (RCI.096)
(9) 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 {Reference Person}?

FR: SPECIFY NAME AND RELATIONSHIP AND/OR OTHER VERBATIM RESPONSE. RECORD UP TO FOUR LINES OF INFORMATION. ENTER (N) WHEN ALL ENTRIES HAVE BEEN MADE.

TELST_A____________________________________
TELST_B____________________________________
TELST_C____________________________________
TELST_D____________________________________

(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?

FR: PROBE FOR MONTH AND YEAR.

MVTIME_M MONTH:______________
MVTIME_Y YEAR:___________

(7) Refused
(9) Don't Know

Where do you expect to move?

FR: PROBE FOR AS MUCH DETAIL AS RESPONDENT CAN PROVIDE - LOCATION, SPECIFIC ADDRESS IF POSSIBLE (STREET ADDRESS, APT #, CITY, STATE, ZIP]. RECORD UP TO FOUR LINES OF ADDRESS INFORMATION. ENTER (N) WHEN ALL ENTRIES HAVE BEEN MADE.

MVINFO_A ___________________________________________________
MVINFO_B ___________________________________________________
MVINFO_C ___________________________________________________
MVINFO_D ___________________________________________________

(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/your family} 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:

CP1NAME_F First Name: ________________________________________
CP1NAME_M Middle Initial: _____________________________________
CP1NAME_L Last Name: ________________________________________

(7) Refused
(9) Don't Know

Check item: If CPINAME_L = 7 or 9 go to RCI.172.

What is this person's address?

FR: READ IF NECCESSARY:

If there is more than one address, please give us the address used most often.

CP1ADDR1 Number and street: ____________________________________
CP1ADDR2 ____________________________________________________
CP1ADDR3 City : _______________________________________________
CP1ADDR4 State: ____
CP1ADDR5 Zip:________ -
CP1ADDR6 Zip:______

(7) Refused
(9) Don't Know

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

FR: ENTER THE AREA CODE AND THE NUMBER OR ENTER (N) IF NO PHONE.

CP1TELN1 ( _____ ) _____ - ______
CP1TELN2 ______

(9999999996) Does not have a telephone
(9999999997) Refused
(9999999999) Don't Know

What is the relationship of this contact person to [Reference Person]?

(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

FR: READ TO RESPONDENT:

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:

CP2NAME_F First Name: ________________________________________
CP2NAME_M Middle Initial: _____________________________________
CP2NAME_L Last Name: ________________________________________

(7) Refused
(9) Don't Know

Check item: If CP2NAME_L = 7 or 9 go to RCI.172.

What is this person's address?

FR: READ IF NECESSARY:

If there is more than one address, please give us the address used most often.

CP2ADDR1 Number and street: ___________________________________
CP2ADDR1 ____________________________________________________
CP2ADDR3 City : _______________________________________________
CP2ADDR4 State: ____
CP2ADDR5 Zip:_______ -
CP2ADDR6 Zip:______
(7) Refused

(7) Refused
(9) Don't Know

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

FR: ENTER THE AREA CODE AND THE NUMBER OR ENTER (N) IF NO PHONE.

CP2TELN1 ( _____ ) _____ - ______
CP2TELN2_______

(9999999996) Does not have a telephone
(9999999997) Refused
(9999999999) Don't Know

What is the relationship of this contact person to [Reference Person]?

(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/your family} again, when are the best times to call or visit?

_____________
_____________
_____________
_____________
(7) Refused
(9) Don't Know

Check item END_CP: Roster end PERSONS

Go to next section -- Child section, or Adult section, or next family.