[p.1]
FAMILY CORE
Section I--FAMILY RELATIONSHIPS and VERIFICATION OF DEMOGRAPHIC INFORMATION
[Questions FID.020--FID.090 asked only of multi-family households. Single family households begin at FID.100.]
(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?
[Else]
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.
(N) Callback before closeout is not possible
(7) Refused
(9) Don't Know
[If a callback cannot be arranged at FID.035 = (N), go to FID.040; Else go to FID.020]
[p.2]
(Go to Check Item FIDCCI1)
[Enter Person #] [ ]
[If RELRESP1 is 14-17 years old]
You have selected a person less than 18 years old.
Is this correct?
(2) No, select another person (FID.045/RELRESP1)
(2) No, select another person (FID.050/FAMREF_B)
[If FAMREF_A = 2]
[If FAMREF_B is 14 to 17 years old display]
You have selected a person less than 18 years old. Is this correct?
(2) No, select another person (FID.050/FAMREF_A)
[p. 3]
What is {PX-name's/your} relationship to {Family Reference Person 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
12. Other relative
13. Housemate/Roommate
14. Roomer/Boarder
15. Other nonrelative
16. Legal Guardian
17. Ward
(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/father)
(10) Aunt/uncle
(11) Niece/nephew
(12) Other relative
(13) House-mate / Roommate
(14) Roomer/Boarder
(15) Other nonrelative
(16) Legal guardian
(17) Ward
(97) Refused
(99) Don't know
(Go to Check Item FIDCCI2)
[If FID.060 = 4 go to FID.070, If FID.060= 7 go to FID.080, If FID.060 = 8 go to FID.090, If FID.060 = 13-15 go to FID.063; if there are no more persons, go to Check Item FIDCCI2; Else go to FID.060.]
FID.063
(2) No, they are not relatives
(Go to FID.060)
FID.070
(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
[If the age difference between the parent and child is less than 12, go to FID.075. If there are no more persons, go to FID.100; Else go to FID.060 for the next person in the family.]
FID.075
You said that {you/PX-name} {are/is} {Family Reference Person name}=s biological {mother/father}.
There are only {1-11} years age difference between {you/them}. Is this relationship correct?
[If age difference eq (0)]
You said that {you/PX-name} {are/is} {Family Reference Person name}=s biological {mother/father}.
However, {you and Family Reference Person-name} are the same age. Is this relationship correct?
[If age difference lt (0)]
You said that {you/PX-name} {are/is} {Family Reference Person name}=s biological {mother/father}.
However, {you/PX-name} {are/is} {1-11} years younger than {Family Reference Person name}. Is this relationship correct?
(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
[If the age difference between the parent and child is less than 12, go to FID.085. If there are no more persons, go to FID.100; Else go to FID.060 for the next person in the family.]
FID.085
You said that {you/PX-name} {are/is} {Family Reference Person name}=s biological {mother/father}.
There are only {1-11} years age difference between {you/them}. Is this relationship correct?
[If age difference eq (0)]
You said that {you/PX-name} {are/is} {Family Reference Person name}=s biological {mother/father}.
However, {you and Family Reference Person-name} are the same age. Is this relationship correct?
[If age difference lt (0)]
You said that {you/PX-name} {are/is} {Family Reference Person name}=s biological {mother/father}.
However, {you/PX-name} {are/is} {1-11} years younger than {Family Reference Person name}. Is this relationship correct?
(2) No, change the relationship (FID.080)
(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
[If there are no more persons, go to FID.100; Else go to FID.060 for the next person in the family.]
Line #
Name
are the spouses or unmarried partners of {Family Reference Person Name/You}
Which one is correct?
(7) Refused
(9) Don't know
[p. 6]
What is {PX-name's/your} relationship to {Family Reference Person 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
12. Other relative
13. Housemate/Roommate
14. Roomer/Boarder
15. Other nonrelative
16. Legal Guardian
17. Ward
(5) Child of partner
(6) Grandchildren
(7) Parent (biological/adoptive/in-law/step/foster)
(8) Brother/sister (biological/adoptive/in-law/step/foster)
(9) Grandparent (grandmother/father)
(10) Aunt/uncle
(11) Niece/nephew
(12) Other relative
(13) Housemate/Roommate (FID.093)
(14) Roomer/Boarder (FID.093)
(15) Other nonrelative (FID.093)
(16) Legal guardian
(17) Ward
(Go to Check item FIDCCI1B)
(2) No, they are not relatives (Check item FIDCCI1B)
Is this information correct?
(2) No, Correction(s) needed/ more corrections needed (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
[p. 7]
FR: PROBE FOR MIDDLE NAME OR MIDDLE INITIAL IF NOT REPORTED. INITIALS MAY BE ENTERED FOR EACH FIELD BUT MUST BE FOLLOWED BY A@PRESS (ENTER) TO SKIP TO LAST NAME IF NO MIDDLE NAME.
[If PX gt 1]
FR: IF LAST NAME IS THE SAME AS DISPLAYED, PRESS (ENTER), OTHERWISE, ENTER THE NEW LAST NAME.
CHG_NAM2 [equiv NAME_MNA] MIDDLE NAME: _________________
CHG_NAM3 [equiv NAME_LNA] LAST NAME: ____________________
[p. 8]
(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
[ ] Number
(1) Day(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)
DOB_BDAY DAY: ______________________
DOB_Y_P YEAR: ______________________
C_AGE3 = current year - birth year -1, C_AGE4 = C_AGE3 + 1. If not enough DOB information was given to calculate an age,AD@ will be assigned to C_AGE2.
Check item CHG_AGECK: CHG_AGECK compares the two ages calculated in C_AGE1 and C_AGE2. C_AGE1 and C_AGE2 will either contain an age, orAD@ if an age could not be calculated.
If C_AGE1 =AD@ and C_AGE2 not =AD@, set AGE = C_AGE2, go to Check item CHG_LOOP
If C_AGE1 =AD@ and C_AGE2 =AD@, and C_AGE3 = blank, go to FID.145
If C_AGE1 =AD@and C_AGE2 =AD@, and C_AGE3 not = blank, go to FID.140
If C_AGE1 not =AD@ and C_AGE2 not =AD@, and C_AGE1 = C_AGE2, go to Check item CHG_LOOP
If C_AGE1 not =AD@ and C_AGE2 not =AD@, and C_AGE1 not = C_AGE2, and CHG_DOBV = (), go to FID.130
If C_AGE1 not =AD@ and C_AGE2 not =AD@, and C_AGE1 not = C_AGE2, and CHG_DOBV not = (), set AGE = C_AGE2, go to Check item CHG_LOOP
If C_AGE1 not =AD@ and C_AGE2 = AD@, and (C_AGE1 = C_AGE3 or C_AGE1 = C_AGE4); set AGE = C_AGE1; go to Check item CHG_LOOP
If C_AGE1 not = C_AGE3 and C_AGE1 not = C_AGE4 and birth year = blank, go to FID.140 If C_AGE1 not = C_AGE3 and C_AGE1 not = C_AGE4 and birth year not = (); set AGE = C_AGE1, go to Check item CHG_LOOP.
FID.130
I recorded {your/name's} date-of-birth as {Birth month in words}/{BDAY/BYEAR}. Is that {your/name's} correct date-of-birth?
(2) No (FID.135)
(7) Refused(Check item CHG_LOOP)
(9) Don't know(Check item CHG_LOOP)
FID.135
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
CHG_DOB2 [equiv DOB_BDAY] DAY:____________
CHG_DOB3 [equiv DOB_Y_P] YEAR: ____________
FID.140
Are you
[Else]
Would you say {name} is
(2) [fill C_AGE4] year(s) old? (Check item CHG_LOOP)
(N) Neither is correct (FID.145)
(7) Refused (FID.145)
(9) Don't Know (FID.145)
[If answer is 1 or 2 update AGE accordingly; go to CHG_LOOP.]
FID.145
What is your best guess of {name's} age?
(3) Month(s) (Check item)
(4) Year(s) (Check item)
(C) Compute from range (FID.165)
(7) Refused (FID.150)
(9) Don't know (FID.150)
If CHG_AG08 is 4 then AGE = (CHG_AG07). Go to Check item CHG_LOOP.
If birth year is unknown; set BYY1 = (current year-AGE-1) and BYY2 = (current year- AGE) go to FID.170;
FID.150
(2) 18 or older (FID.160)
(9) Don't know (FID.160)
(7) Refused (FID.160)
FID.155
ENTER "0" IF LESS THAN 1 YEAR OLD.
FID.160
FID.165
First/lower:
(0-120) 0-120
(03-04) 3-4
(3) Month(s)
(4) Year(s)
Last/higher
(0-120) 0-120
(03-04) 3-4
(3) Month(s)
(4) Year(s)
(Go to CHG_LOOP)
[Convert AGERNG_1 and AGERNG_2 into year, set AGE = (AGERNG_1 + AGERNG_2)/2]
FID.170
(2) [fill BYY2](9) Don't Know
(N) Neither is correct
FID.180
{Are/Is} {you/name} male or female?
(2) Female
{Do/Does} {you/name's} consider {yourself/himself/herself} to be Hispanic or Latino?
FR: READ IF NECESSARY:
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?)
You may choose more than one
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
(2) No
(7) Refused
(9) Don't know
(Go to Check item CHG_LOOP)
FID.200
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 CHG_NATOR/FID.190 AND CHANGE THE ANSWER FROM "YES" TO "NO".
ENTER EACH NUMBER THAT APPLIES. ENTER (N) FOR NO MORE.
You may choose more than one
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
(02) Cuban/Cuban American
(03) Dominican
(04) Mexican
(05) Mexican American
(06) Central or South America
(07) Other Latin American
(08) Other Hispanic/Latino
(97) Refused
(99) Don't know
[ ] CHG_HIS1
[ ] CHG_HIS2
[ ] CHG_HIS3
[ ] CHG_HIS4
[ ] CHG_HIS5
[Equiv HISPAN_1 to HISPAN_5]
[If FID.200 = (07) go to FID.210; Else if FID.200 = (08) go to FID.215; Else go to Check Item CHG_ LOOP]
FID.210
FR: IF ANY OF THE FOLLOWING ARE MENTIONED, PRESS F1 TO RETURN TO HISPAN SCREEN AND CORRECT THE ENTRY.
Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American
FR: SPECIFY THE OTHER LATIN AMERICAN
FID.215
FR: IF ANY OF THE FOLLOWING ARE MENTIONED, PRESS F1 TO RETURN TO HISPAN SCREEN AND CORRECT THE ENTRY.
Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American
FR: SPECIFY THE OTHER LATIN AMERICAN
What race {does/do} {name/you} consider {himself/herself/yourself} to be? Please select 1 or more of these categories.
FR: ENTER (N) FOR NO MORE
(01) White
(02) Black/African American
(03) Indian (American)
(04) Alaska Native
(05) Native Hawaiian
(06) Guamanian
(07) Samoan
(08) Other Pacific Islander
(09) Asian Indian
(10) Chinese
(11) Filipino
(12) Japanese
(13) Korean
(14) Vietnamese
(15) Other Asian
(16) Some other race
(97) Refused
(99) Don't know
You may choose more than one.
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
[ ] CHG_RACE2
[ ] CHG_RACE3
[ ] CHG_RACE4
[ ] CHG_RACE5
[If FID.220 = (08) go to FID.230; If FID.220 = (15) go to FID.232; If FID.220 = (16) go to FID.234; If multiple entries in FID.220 go to FID.240; Else go to Check Item CHG_LOOP]
FID.230
White
Black/African American
Indian (American)
Alaska Native
Native Hawaiian
Guamanian
Samoan
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
FR: SPECIFY THE OTHER PACIFIC ISLANDER
FID.232
White
Black/African American
Indian (American)
Alaska Native
Native Hawaiian
Guamanian
Samoan
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
FR: SPECIFY THE OTHER ASIAN
FID.234
White
Black/African American
Indian (American)
Alaska Native
Native Hawaiian
Guamanian
Samoan
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
FR: SPECIFY THE OTHER RACE
FID.240
[List all mentioned race in RACE1 to RACE5/FID.220.
Fill other specify descriptions if RACE1 to RACE5 = 15 or 16.]
If a screened household with no one with ORIGIN = (1) or RACE = (2), then set outcome = (236) (screened out household)
For all persons in the family, if AGE ge (14) and FID.250 = ( ) (not pre-filled)go to FID.250; at end, go to Check Item FIDCCI4.
(Are/Is} {you/PX-name} now married, widowed, divorced, separated, never married, or living with a partner?
(2) Widowed (Check item FIDCCI4)
(3) Divorced (Check item FIDCCI4)
(4) Separated (Check item FIDCCI4)
(5) Never married (Check item FIDCCI4)
(6) Living with a partner (FID.280)
(7) Refused (Check item FIDCCI4)
(9) Don't Know (Check item FIDCCI4)
Is {your/PX-name's} spouse living in the household?
(2) No (Check Item FIDCCI4)
(9) Don't Know (Check Item FIDCCI4)
(7) Refused (Check Item FIDCCI4)
(97)Don't know
(98)Refused
(Go to Check Item FIDCCI4)
(2) No
(7) Refused
(9) Don't Know
FID.290
(2) Widowed
(3) Divorced
(4) Separated
(7) Refused
(9) Don't know
(97) Refused
(99) Don't know
(Go to Check Item FIDCCI4)
[p. 17]
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
Else go to Check Item FIDCCI4A.
(2) Adoptive child
(3) Step child
(4) Foster child
(5){Son/daughter}-in-law
(7) Refused
(9) Don't know
[If DEGREE4 = 1 and if (father's age - child's age) less than 12, go to FID.310; Else go to Check Item FIDCCI6.]
(2) No, Change relationship (FID.305)
(2) Adoptive child
(3) Step child
(4) Foster child
(5) {son/daughter}-in-law
(7) Refused
(9) Don't know
[If DEGREE5 = 1 and if (mother's age - child's age) less than 12, go to FID.320; Else go to Check Item FIDCCI6.]
(2) No, Change relationship (FID.315)
Is {PX-name's/your} mother a household member? (Include Mother-in-law)
FR: 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". IF THE PERSON HAS NO PARENTS PRESENT BUT HAS A LEGAL GUARDIAN, ENTER "96."
(96) Legal Guardian (FID.360)
(00) Person not a household member (Check item FIDCCI5)
(01-30) Person number (FID.330)
(97) Refused (Check item FIDCCI5)
(99) Don't Know (Check item FIDCCI5)
FR: CHOOSE MOTHER OVER MOTHER-IN-LAW IF BOTH ARE PRESENT.
(2) Adoptive mother
(3) Step mother
(4) Foster mother
(5) Mother-in-law
(7) Refused
(9) Don't know
[If the age difference between the mother and child is less than 12 years at MOTHERCI, go to MOTHERC2; Else go to Check Item FIDCCI5.]
[If MOTHERC1 = 1 and if (AGE(MOTHER) - AGE(PX)) lt 12 display:]
You said that {name(MOTHER)} is the BIOLOGICAL MOTHER of {PX-name}. There is only less than 12 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)
Is {PX-name's/your} father a household member? (Include father-in-law).
FR: ENTER THE LINE NUMBER OF THE FATHER OR FATHER-IN-LAW. IF THE FATHER IS NOT A HOUSEHOLD MEMBER, ENTER "00". IF THE PERSON HAS NO PARENTS PRESENT BUT HAS A LEGAL GUARDIAN, ENTER "96".
(96) Legal Guardian (FID.360)
(00) Person not a household member (Check Item FIDCCI6)
(01-30) Person number (FID.350)
(97) Refused (Check Item FIDCCI6)
(99) Don't Know (Check Item FIDCCI6)
FR: CHOOSE FATHER OVER FATHER-IN-LAW IF BOTH PRESENT
(2) Adoptive father
(3) Step father
(4) Foster father
(5) Father-in-law
(7) Refused
(9) Don't know
[If the age difference between the Father and child is less than 12 years at FATHERC1, go to FATHERC2; Else go to Check Item FIDCCI6.]
[If FATHERC1 = 1 and if (AGE(FATHER) - AGE(PX) lt 12, display:]
You said that {name(FATHER)} is the BIOLOGICAL FATHER of {PX-name}, there is less than 12 years difference between them, is this relationship correct?
(2) No, select different person as FATHER (FID.340)
(3) No, change relationship (FID.350--FATHERC1)
(00) Person number
(01-30) Person number
(97) Refused
(99) Don't Know
(Go to Check item 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 adult present in the family. Go to SASEL.
1. Sort all adults (AGE gt or =18) of the same FX and NOT flagged AA@ or AD@ in descending age order C from the oldest to the youngest. If no persons in this sorted group, GO TO SCSEL. If one person only in this sorted group, flag with AS@ 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 AA@ AD@ or AE@ in descending age order C 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.
{Sample Adult name} IS SELECTED AS THE SAMPLE ADULT FOR FAMILY
{family number}.
[Else]
NO SAMPLE ADULT IS SELECTED FOR FAMILY {family number}
[If a sample child was selected]
{Sample Child name} IS SELECTED AS THE SAMPLE CHILD FOR THIS FAMILY.
[Else]
NO SAMPLE CHILD WAS SELECTED FOR THIS FAMILY.
FR: SELECT ALL THAT APPLY. TO SELECT A PERSON, ENTER THE NUMBER NEXT TO THE PERSON'S NAME. TO UNSELECT A PERSON, RE-ENTER THE NUMBER: ENTER (N) FOR NO MORE.
[Store gt X' in KNOW for each person mentioned]
[If the family has a sample child, go to FID.630; Else go the next section- Family Health Status and Limitation.]
[p. 21]
FR: SELECT UP TO THREE PERSONS. TO SELECT A PERSON, ENTER THE NUMBER NEXT TO THE PERSON'S NAME. TO UNSELECT A PERSON, RE-ENTER THE NUMBER: ENTER (N) FOR
NO MORE.
[Store gt X= in KNOWSC for each person mentioned]
(Go to next section -- Family Health Status and Limitation)
[p. 22]
FAMILY CORE
Section II-- HEALTH STATUS AND LIMITATION OF ACTIVITIES
IF YES, ASK:
Could they join us? (ALLOW TIME). IF NO ENTER (N).
FR: ENTER LINE NUMBER(S) OF FAMILY MEMBERS LISTED BELOW THAT ARE CURRENTLY PRESENT. ENTER UP TO 10 NUMBERS. ENTER (N) FOR NO MORE.
[ ] FINTRO_1
[ ] FINTRO_2
[ ] FINTRO_3
[ ] FINTRO_4
[ ] FINTRO_5
[ ] FINTRO_6
[ ] FINTRO_7
[ ] FINTRO_8
[ ] FINTRO_9
[ ] FINTRO_10
With whom am I speaking?
ENTER THE LINE NUMBER OF THE PERSON YOU CONSIDER TO BE THE MAIN RESPONDENT FOR THIS FAMILY'S HEALTH QUESTIONS.
I am now going to ask about {your/the} general health {names of family members} and the effects of any physical, mental, or emotional health problems.
(P) Proceed
(R) Refused
(2) No (FHS.050)
(7) Refused (FHS.050)
(9) Don't know (FHS.050)
FHS.010
Who is this? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No
(7) Refused
(9) Don't know
(2) No (FHS.070)
(7) Refused (FHS.070)
(9) Don't know (FHS.070)
If one person family AND FSPEDEIS eq (1); go to FHS.065
FHS.060
Who is this? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No
(7) Refused
(9) Don't know
FR: DO NOT INCLUDE FAMILY MEMBERS UNDER 3 YEARS OLD. IF AGE LESS THAN 3, GO TO FHS.210.
(2) No (FHS.150)
(7) Refused (FHS.150)
(9) Don't know (FHS.150)
FHS.080
Who is this? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
(1) Yes
(2) No
(7) Refused
(9) Don't know
LADRESSDressing?
LAEATEating?
LABEDGetting in or out of bed or chairs?
LATOILTUsing the toilet, including getting to the toilet?
LAHOMEGetting around inside the home?
FR: DO NOT INCLUDE FAMILY MEMBERS UNDER 18 YEARS OLD. IF AGE LESS THAN 18, GO TO FHS.210.
(2) No (FHS.170)
(7) Refused (FHS.170)
(9) Don't know (FHS.170)
If one person family AND FLAIADL eq (1); go to FHS.170
FHS.160
Who is this? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FHS.190)
(7) Refused (FHS.190)
(9) Don't know (FHS.190)
If one person family AND FLAWKNOW eq (1); go to FHS.190
FHS.180
Who is this? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FHS.210)
(7) Refused (FHS.210)
(9) Don't know (FHS.210)
If one person family AND FLAWKLIM eq (1); go to FHS.210
FHS.200
Who is this? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FHS.230)
(7) Refused (FHS.230)
(9) Don't know (FHS.230)
If one person family AND FLAWALK eq (1); go to FHS.230
FHS.220
Who is this? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (Check item FHSCCI2)
(7) Refused (Check item FHSCCI2)
(9) Don't know (Check item FHSCCI2)
If one person family AND FLAREMEM eq (1); go to FHSCCI2.
FHS.240
Who is this? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
FHS.250 FHS.260
(2) No (Check item FHSCCI3)
(7) Refused (Check item FHSCCI3
(9) Don't know (Check item FHSCCI3)
If one person family AND FLIMANY eq (1); gotoFHSCCI3
Who is this? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
FHS.270
FR: SHOW FLASHCARD F1. DO NOT READ. MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
You may choose more than one.
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 or seizures
12. Learning disability
13. Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
Other impairment/problem
LAHCC2 (2) Hearing problem
LAHCC3 (3) Speech problem
LAHCC4 (4) Asthma / breathing problem
LAHCC5 (5) Birth defect
LAHCC6 (6) Injury
LAHCC7 (7) Mental retardation
LAHCC8 (8) Other developmental problem (e.g. cerebral palsy)
LAHCC9 (9) Other mental, emotional, or behavioral problem
LAHCC10 (10) Bone, joint, or muscle problem
LAHCC11 (11) Epilepsy or seizures
LAHCC12 (12) Learning disability
LAHCC13 (13) Attention deficit/Hyperactivity disorder (ADD/ADHD)
LAHCC14 (14) Other impairment (specify one) (LAHCC@S1)
LAHCC15 (15) Other impairment (specify one) (LAHCC@S2)
FR: ENTER NUMBER, PRESS RETURN, AND ENTER TIME PERIOD.
(01-94) 1-94
(95) 95+
(97) Refused
(99) Don't know
(96) Since birth
(1) Days(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)
(6) Since Birth
(7) Refused
(9) Don't know
[Go back to Check item FHSCCI3 for next family member. If no more family members go to FHS.310]
[p. 28]
FR: SHOW FLASHCARD F2. DO NOT READ. MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
You may choose more than one.
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 (e.g., asthma and emphysema)
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
Other impairment/problem
LAHCA2 (2) Hearing problem
LAHCA3 (3) Arthritis / rheumatism
LAHCA4 (4) Back or neck problem
LAHCA5 (5) Fracture, bone / joint injury
LAHCA6 (6) Other injury
LAHCA7 (7) Heart problem
LAHCA8 (8) Stroke problem
LAHCA9 (9) Hypertension / high blood pressure
LAHCA10 (10) Diabetes
LAHCA11 (11) Lung / breathing problem (e.g. asthma and emphysema)
LAHCA12 (12) Cancer
LAHCA13 (13) Birth defect
LAHCA14 (14) Mental retardation
LAHCA15 (15) Other developmental problem (e.g. cerebral palsy)
LAHCA16 (16) Senility
LAHCA17 (17) Depression / anxiety / emotional problem
LAHCA18 (18) Weight problem
(97) Refused
(99) Don't know/not sure
FHS.290
FR: MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (N) FOR NO MORE
(19) Missing limbs (fingers, toes or digits), amputee
(20) Kidney, bladder or renal problems
(21) Circulation problems (including blood clots)
(22) Benign tumors, cysts
(23) Fibromyalgia, lupus
(24) Osteoporosis, tendinitis
(25) Epilepsy, seizures
(26) Multiple sclerosis (MS), Muscular Dystrophy (MD)
(27) Polio (my elitis), paralysis, para/quadriplegia
(28) Parkinson's disease, other tremors
(29) Other nerve damage, including carpal tunnel syndrome
(30) Hernia
(31) Ulcer
(32) Varicose veins, hemorrhoids
(33) Thyroid problems, Graves disease, gout
(34) Knee problems (not arthritis (03), not joint injury (05)
(35) Migraine headaches (not just headaches)
(36) Other impairment/problem (Specify one) (LAHCA@S1)
(37) Other impairment/problem (Specify one) (LAHCA@S2)
(B) Back-up to previous screen
FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
[p. 30]
FR: ENTER NUMBER, PRESS RETURN, AND ENTER TIME PERIOD.
(01-94) 1-94
(95) 95+
(96) Since birth
(97) Refused
(99) Don't know
(1) Days(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)
(6) Since Birth
(7) Refused
(9) Don't know
[Go back to Check item FHSCCI3 for next family member. If no more family members go to FHS.310]
Would you say {your/subject name's} health in general is excellent, very good, good, fair, or poor?
(2) Very good
(3) Good
(4) Fair
(5) Poor
(7) Refused
(9) Don't know
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) Don't know (FAU.030)
FAU.020
For which family member was medical care delayed? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FAU.050)
(7) Refused (FAU.050)
(9) Don't know (FAU.050)
FAU.040
Who didn't get needed care? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[p. 42]
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) Don't know (FAU.120)
FAU.060
Who was in a hospital overnight? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
(997) Refused
(999) Don't Know
[If HOSPNO gt 10]
FR: DO NOT READ.
{HOSPNO} is an unusually large number. Verify entry. DO NOT PROBE. Make corrections if necessary.
(2) Proceed
(997) Refused
(999) Don't know
[If HPNITE gt 50]
R:DO NOT READ.
{HPNITE} is an unusually large number. Verify entry. DO NOT PROBE. Make corrections if necessary.
(2) Proceed
FAU.115
[fill HPNITE_N} is less than the total number of times just reported that [fill F_DTEMPNAME] was in the hospital overnight. PROBE TO CORRECT.
(2) Decrease total number of times [fill F_TEMPNAME] stayed in hospital (FAU.070)
(3) Proceed without correcting (Check item 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. During those 2 WEEKS, did {you/anyone in the family} receive care AT HOME from a nurse or other health care professional?
(2) No (FAU.150)
(7) Refused (FAU.150)
(9) Don't know (FAU.150)
FAU.130
Who received care at home? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
(50) 50+ visits
(97) Refused
(99) Don't know
[If PHCHMN2W gt 14]
FR: DO NOT READ.
{PHCHMN2W} is an unusually large number. Verify entry. DO NOT PROBE. Make corrections if necessary.
(2) Proceed
FAU.150
FAU.160
Do not include phone calls to make appointments, for billing questions or for prescription refills.
(2) No (FAU.180)
(7) Refused (FAU.180)
(9) Don't know (FAU.180)
Who was the phone call about? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[If single person family]
did you make?
[else]
were made about {subject's name}?
(50) 50+ calls
(97) Refused
(99) Don't know
[If PHCPHN2W gt 14]
FR: DO NOT READ.
{PHCPHN2W} is an unusually large number. Verify entry. DO NOT PROBE. Make corrections if necessary.
(2) Proceed
(2) No (FAU.210)
(7) Refused (FAU.210)
(9) Don't know (FAU.210)
FAU.190
Who received care? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[p. 46]
(50)50+ Times
(97) Refused
(99) Don't know
[If PHCDVN2W gt 14]
FR: DO NOT READ.
{PHCDVN2W} is an unusually large number. Verify entry. DO NOT PROBE. Make corrections if necessary.
(2) Proceed
(2) No (FHI.010)
(7) Refused (FHI.010)
(9) Don't know (FHI.010)
FAU.220
Who received care 10 or more times (exclude telephone calls)? (Anyone else?)
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
Section V -- HEALTH INSURANCE
The next questions are about health insurance.
{Are you/Is anyone} covered by any kind of 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.
You may choose more than one.
2. Private health insurance plan purchased directly*
3. Private health insurance plan through a state or local government program or community program
4. Medicare
5. Medi-Gap
6. Medicaid
7. CHIP (Children's Health Insurance Program)
8. Military health care/VA
9. TRICARE/CHAMPUS/CHAMP-VA
10. Indian Health Service
11. State-sponsored health plan
12. Other government program
13. Single service plan (e.g., dental, vision, prescriptions)
14. No coverage of any type
*EXCLUDE private plans that only provide extra cash while hospitalized.
(2) No
(7) Refused (FHI.075)
(9) Don't know (FHI.075)
If (2) mark HIKIND_N = (X) for all persons in family then go to FHI.075
FR: ENTER (N) FOR NO MORE ENTER EACH NUMBER THAT APPLIES. PLEASE REFER TO FLASHCARDS F9 AND F10 FOR YOUR STATE.
You may choose more than one.
2. Private health insurance plan purchased directly*
3. Private health insurance plan through a state or local government program or community program
4. Medicare
5. Medi-Gap
6. Medicaid
7. CHIP (Children's Health Insurance Program)
8. Military health care/VA
9. TRICARE/CHAMPUS/CHAMP-VA
10. Indian Health Service
11. State-sponsored health plan
12. Other government program
13. Single service plan (e.g., dental, vision, prescriptions)
14. No coverage of any type
*EXCLUDE private plans that only provide extra cash while hospitalized.
[ ] HIKINDB (02) Private health insurance plan purchased directly
[ ] HIKINDC (03) Private health insurance plan through a state or local government or community program
[ ] HIKINDD (04) Medicare
[ ] HIKINDE (05) Medi-Gap
[ ] HIKINDF (06) Medicaid
[ ] HIKINDG (07) CHIP (Children's Health Insurance Program)
[ ] HIKINDH (08) Military health care/VA
[ ] HIKINDI (09) TRICARE/CHAMPUS/CHAMP-VA
[ ] HIKINDJ (10) Indian Health Service
[ ] HIKINDK (11) State-sponsored health plan
[ ] HIKINDL (12) Other government program
[ ] HIKINDM (13) Single Service Plan (e.g. dental, vision, prescriptions)
[ ] HIKINDN (14) No coverage of any type
[p. 48]
Is this correct?
(2) No (Go to FHI.070 and make corrections)
(7) Refused (Check item FHICCI3)
(9) Don't know (Check item FHICCI3)
1. If the person in FHI.070 marked 5 and not 4, mark HIKINDD=X and go to Check item FHICCI35.
2. If the person in FHI.070 marked 4, go to Check item FHICCI35.
3. If the person in FHI.070 did not mark 4, go to Check item FHICCI4
Check item FHICCI35:If person with Medicare is the family respondent go to FHI.080; else go to FHI.090
FR: ENTER THE NUMBERS AND LETTERS.
This number is needed to allow Medicare records of the centers for Medicare and Medicaid services to be easily and accurately located and identified for statistical or research purposes. We may also need to link it with other records in order to re-contact you. Except for these purposes, NCHS will not release your Health Insurance Claim Number to 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): -
(7) Refused
(9) Don't know
FHI.090
Earlier I recorded that {you/subject name} {are/is} covered by Medicare. May I please see {your/subject name} Medicare card to determine the type of coverage?
[ELSE]
FR: FILL IN APPROPRIATE COVERAGE TYPE BELOW
(2) Part B - Medical Only (FHI.095)
(3) Both Part A and Part B (FHI.095)
(4) Card Not Available (FHI.095)
(7) Refused (FHI.095)
(9) Don't know (FHI.095)
(2) No
(7) Refused
(9) Don't know
{Are/Is} {You/subject name} under a Medicare managed care arrangement, such as an HMO, 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 (FHI.114)
(7) Refused (FHI.114)
(9) Don't know (FHI.114)
What is the name of the HMO?
(2) No
(7) Refused
(9) Don't know
(2) No
(7) Refused
(9) Don't know
[p. 50]
FHI.120
REFER TO FLASHCARD F10 FOR STATE MEDICAID NAMES
The next questions are about Medicaid coverage. In this State it is also called (state name). {You/subject 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 (FHI.130)
(3) Doctor is assigned (FHI.130)
(7) Refused (FHI.140)
(9) Don't know (FHI.140)
[If MACHMD eq (2)]
[flashcards associated with FHI.120]
Card F10-AL
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called"Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Alabama
Medicaid: Patient 1st; BAY Health Plan or BAY Program; SOBRA
CHIP: AL-Kids; ALL KIDS
State/Other: Children's Rehabilitation Service; Alabama Health Insurance Plan
[p. 23]
Card F10-AK
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Alaska
Medicaid: Medical Assistance Program
CHIP: Denali KidCare; AKChip
State/Other: Chronic and Acute Medical Assistance (CAMA); Health Care Program for Children with Special Health Care Needs (HCP-CSN); Alaska Comprehensive Health Insurance Association (ACHIA)
[p. 24]
Card F10-AZ
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called"Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below off additionalnames for the public health insurance programsfor each State.
Arizona
Medicaid: AHCCCS; Arizona Health Care Cost Containment System
CHIP: KidsCare
State/Other: Medically Indigent-Medically Needy Program (MI/MN); Office for Children with Special Health Care Needs; Premium Sharing Program; Young Adults Transitional Insurance
[p. 25]
Card F10-AR
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Arkansas
Medicaid: Connectcare
CHIP: ARKids First; Child Health lnsurance Program
State/Other: Arkansas Comprehensive Health Insurance Plan; Children's Medical Services
[p. 26]
Card F10-CA
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
California
Medicaid: Medi-Cal; Medi-Cal Managed Care; The Two-Plan Model
CHIP: Healthy Families Program (HFP)
State/Other: Access for Infants and Mothers (AIM); County Medical Services Program (CMSP); Children's Services (CCS); Managed Risk Medical Insurance Program (MRMIP); California Children's Services; CARE Health Insurance Premium Payment Program
[p. 27]
Card F10-CO
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Colorado
Medicaid: Primary Care Physician Program (PCPP); BabyCare/KidsCare
CHIP: Child Health Plan Plus (CHP+)
State/Other: Health Care Program for Children with Special Health Care Needs; CUHlP - Colorado Uninsurable Health Insurance Plan; CoverColorado; Colorado Indigent Care Program (CICP)
[p. 28]
Card F10-CT
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Connecticut
Medicaid: Connecticut Access; HUSKY Part A
CHIP: The HUSKY Plan; HUSKY PLUS; HUSKY Part B
State/Other: General Assistance Medical Aid; Refugee Medical Asistance; Children with Special Health Care Needs; Connecticut Health Reinsurance Association
[p. 29]
Card F10-DE
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Delaware
Medicaid: Diamond State Health Plan; GA Healthfirst
CHIP: The Delaware Healthy Children Program (DHCP)
State/Other: Nemours Child Plan; Children with Special Health Care Needs; Disabled Children's Program
[p. 30]
Card F10-DC
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
District of Columbia
Medicaid: Medical Assistance
CHIP: DC Healthy Families; Healthy DC Kids
State/Other: Medical Charities Program; Health Services for Children with Special Needs
[p. 31]
Card F10-FL
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Florida
Medicaid: Medipass; Children's Medical Services (CMS) Network
CHIP: KidCare; MediKids; Florida Healthy Kids
State/Other: AIDS Insurance Continuation Program (AICP); Florida Comprehensive Health Insurance Plan; Children's Medical Services
[p. 32]
Card F10-GA
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Georgia
Medicaid: Georgia Better Health Care; Right from the Start
CHIP: Peachcare for Kids
State/Other: Children's Medical Services; Indigent Care Trust Fund (ICTF)
[p. 33]
Card F10-HI
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Hawaii
Medicaid: Hawaii-QUEST
CHIP: Hawaii CHIP
State/Other: QUEST-Net; HCOBRA; Children with Special Health Needs
[p. 34]
Card F10-ID
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Idaho
Medicaid: Healthy Connections; Medical Assistance
CHIP: Children's Health Insurance Program
State/Other: Catastrophic Fund; Children's Special Health Program
[p. 35]
Card F10-IL
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Illinois
Medicaid: Medical Assistance; Healthy Start; Parent Assist
CHIP: KidCare
State/Other: Comprehensive Health Insurance Plan (ICHIP); Specialized Care for Children; Kidcare Moms and Babies
[p. 36]
Card F10-IN
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Indiana
Medicaid: Hoosier Healthwise; Primestep; Risk Based Managed Care
CHIP: Hoosier Healthwise for Children
State/Other: ICHIA; Health Insurance Assistance Program (HIAP); Children's Special Health Care Services; Comprehensive Health Insurance Association
[p. 37]
Card F10-IA
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Iowa
Medicaid: Medical Assistance; Health Insurance Premium Payment (HIPP); MediPASS
CHIP: Health and Well Kids in Iowa (HAWK-I)
State/Other: Children's Health Specialty Clinics; Iowa Comprehensive Health Association; AIDSMIV Health Insurance Premium Payment
[p. 38]
Card F10-KS
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Kansas
Medicaid: HealthConnect; Prime Connect Kansas; PrimeCare Kansas; Medical Assistance; KANBE Healthy
CHIP: HealthWave
State/Other: Medi-KAN; Services for Children with Special Health Care Needs (CSHSN); Kansas Uninsurable Health Insurance Plan; Kansas Health Insurance Association (KHIA)
[p. 39]
Card F10-KY
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Kentucky
Medicaid: Kentucky Patient Access and Care System (KenPAC); The Partnership Program Plan
CHIP: Kentucky Children's Health Insurance Program (KCHIP)
State/Other: HIV Health Insurance Assistance; Commission for Children with Special Health Care Needs; Kentucky Access
[p. 40]
Card F10-LA
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Louisiana
Medicaid: CommunityCARE
CHIP: LACHIP
State/Other: Louisiana Health Plan; Children's Special Health Services; Louisiana Health Insurance Association; Health Insurance Purchase Option
[p. 41]
Card F10-ME
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Maine
Medicaid: Medical Assistance; Primecare
CHIP: Cub Care
State/Other: Maine State Health Insurance Program (SHIP); Coordinated Care Services for Children with Special Health Care Needs Program (CSHNP)
[p. 42]
Card F10-MD
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Maryland
Medicaid: Medical Assistance Program; Healthchoice; REM Program
CHIP: Maryland Children's Health Program (MCHP)
State/Other: AIDS Insurance Assistance Program (MAIAP); Maryland Primary Care (MPC); Children's Medical Services
[p. 43]
Card F10-MA
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Massachusetts
Medicaid: MassHealth; Elder Service Plans; PACE
CHIP: MassHealth; Family Assistance Plan
State/Other: Children's Medical Security Plan (CMSP); Commonhealth; Medical Security Family Assistance Plan (MSP); Special KidsISpecial Care Insurance Partnership
[p. 44]
Card F10-MI
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Michigan
Medicaid: MICHOICE Comprehensive Health Care Program (CHCP); Medical Assistance Program
CHIP: MIChild Program
State/Other: Children's Special Health Care Services; Trust Fund for Children with Special Health Care Needs
[p. 45]
Card F10-MN
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Minnesota
Medicaid: Medical Assistance; Prepaid Medical Assistance Program (PMAP) or PMAP+
CHIP: Children's Health lnsurance Program
State/Other: Minnesota Care; Minnesota General Assistance Medical Care Program (GAMC); HIV/AIDS Insurance Continuation Program; Children with Special Health Care Needs; Minnesota Comprehensive Health Association (MCHA)
[p. 46]
Card F10-MS
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Mississippi
Medicaid: HealthMACS; Medical Assistance
CHIP: Mississippi Children's Health Insurance Program (CHIP); Title XXI
State/Other: Mississippi Comprehensive Health Insurance Risk Pool Association (MCHIRPA); Infant Survival Program; Children with Special Health Care Needs
[p. 47]
Card F10-MO
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Missouri
Medicaid: Managed Care Plus (MC+); MCPlus; Sarah Lopez Waiver
CHIP: MC+ for Kids
State/Other: General Relief Medical Assistance; Children with Special Health Care Needs; Missouri Health Insurance Pool (MHIP)
[p. 48]
Card F10-MT
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Montana
Medicaid: Passport to Health
CHIP: Montana's CHIP
State/Other: Montana Comprehensive Health Insurance Association (MCHA); Health Insurance Continuum of Coverage Program (HICCP); Special Health Services
[p. 49]
Card F10-NE
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Nebraska
Medicaid: Medical Assistance Program; Nebraska Health Connection (NHC)
CHIP: Kids Connection
State/Other: Medically Handicapped Children's Program; Comprehensive Health Association
[p. 50]
Card F10-NV
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Nevada
Medicaid: Nevada Medicaid
CHIP: Nevada T Check Up
State/Other: Family Health Services Bureau
[p. 51]
Card F10-NH
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
New Hampshire
Medicaid: Medical Assistance Program
CHIP: Healthy Kids Gold; Healthy Kids Silver
State/Other: Bureau of Special Medical Services
[p. 52]
Card F10-NJ
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
New Jersey
Medicaid: New Jersey Care 2000+; Managed Charity Care Demonstration (MCCD)
CHIP: New Jersey KidCare or NJ KidCare Plan
State/Other: AIDS Community Care Alternatives (ACCAP); Health Access; Health Insurance Continuation Program (HICP); Special Child Adult and Early Intervention Services
[p. 53]
Card F10-NM
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
New Mexico
Medicaid: SALUD!
CHIP: New MexiKids
State/Other: Comprehensive Health Insurance Pool; Insurance Assistance Program; Children's Medical Services
[p. 54]
Card F10-NY
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
New York
Medicaid: Medical Assistance Program (MAP); The Partnership Plan
CHIP: Child Health Plus (CHPlus)
State/Other: Family Health Plus; Healthy New York; Physically Handicapped Children's Program; Children with Special Health Care Needs
[p. 55]
Card F10-NC
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
North Carolina
Medicaid: Carolina Access; Health Care Connection Access II
CHIP: NC CHlP Program; NC Health Choice for Children
State/Other: Children Special Health Services (CHS)
[p. 56]
Card F10-ND
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
North Dakota
Medicaid: Medical Services; North Dakota Access and Care Program (NoDAC)
CHIP: Healthy Steps Program
State/Other: Comprehensive Health Association of North Dakota; Children's Special Health Services
[p. 57]
Card F10-OH
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Ohio
Medicaid: OhioCare; Premiercare
CHIP: Healthy Start
State/Other: HIV Health lnsurance Premium Payment Program; Hemophilia lnsurance Pilot Program; Bureau for Children with Medical Handicaps (BCMH); Healthy Families
[p. 58]
Card F10-OK
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Oklahoma
Medicaid: Soonercare
CHIP: Oklahoma CHIP
State/Other: Children with Special Health Care Needs; Oklahoma Health Insurance High Risk Pool
[p. 59]
Card F10-OR
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Oregon
Medicaid: Oregon Health Plan (OHP)
CHIP: Oregon SCHIP
State/Other: CareAssist; Oregon Services for Children with Special Health Needs; Oregon Medical Insurance Pool; Family Health Insurance Assistance Program; Insurance Purchasing Cooperative
[p. 60]
Card F10-PA
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Pennsylvania
Medicaid: Medical Assistance; Access Card; Family Care Network; Healthchoices
CHIP: Pa CHIP
State/Other: Division of Special Health Care Programs
[p. 61]
Card F10-RI
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Rhode Island
Medicaid: RIte Care; RI Medical Assistance
CHIP: RIte Care
State/Other: Subsidy for Health Insurance for Center-Based Child-Care Providers; Children with Special Health Care Needs
[p. 62]
Card F10-SC
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
South Carolina
Medicaid: Healthy Options Program; Physicians Enhanced Program
CHIP: Partners for Healthy Children
State/Other: South Carolina Health Insurance Pool; Children's Rehabilitative Services
[p. 63]
Card F10-SD
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
South Dakota
Medicaid: PRIME
CHIP: Children's Health Insurance Program (CHIP)
State/Other: Catastrophic County-Poor Relief Program (CCPR); Continuation of Health Insurance; Childrens Special Health Services
[p. 64]
Card F10-TN
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Tennessee
Medicaid: TennCare
CHIP: TennCare for Children
State/Other: Childrens Special Health Services (CSS)
[p. 65]
Card F10-TX
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Texas
Medicaid: State of Texas Access Reform (STAR); Star Plus
CHIP: Texas CHIP; TexCare Partnership
State/Other: Texas Health Insurance Risk Pool; State Kid Insurance Program; Children with Special Health Care Needs Services
[p. 66]
Card F10-UT
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Utah
Medicaid: Medicaid
CHIP: Children's Health Insurance Program
State/Other: Utah Medical Assistance Program (UMAP); Custody Medical Care Program; Premium Payment Program; Children with Special Health Care Needs; Comprehensive Health Insurance Pool
[p. 67]
Card F10-VT
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Vermont
Medicaid: Medicaid
CHIP: Dr. Dynasaur
State/Other: Vermont Health Access Plan (VHAP); HIV Insurance Continuation Program; Children with Special Health Care Needs
[p. 68]
Card F10-VA
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Virginia
Medicaid: Virginia Medallion
CHIP: Children's Medical Security Insurance Plan (CMSIP); Family Access to Medical Ilnsurance Security Plan (FAMIS)
State/Other: State and Local Hospitalization (SLH) Program; Children's Specialty Services
[p. 69]
Card F10-WA
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Washington
Medicaid: Healthy Options; Basic Health Plus
CHIP: Children's Health Insurance Program
State/Other: Basic Health; AIDS CARE Access Project; Children with Special Health Care Needs; Washington State Health Insurance Pool
[p. 70]
Card F10-WV
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
West Virginia
Medicaid: Medical Assistance; Mountain Health Trust (MHT); Physician Assured Access System (PAAS)
CHIP: Children's Health Insurance Program (CHIP)
State/Other: Children with Special Health Care Needs
[p. 71]
Card F10-WI
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Wisconsin
Medicaid: Medical Assistance; MA; Healthy Start
CHIP: Badgercare for Working Families
State/Other: Health lnsurance Risk Sharing Program; Wisconsin AIDS/HIV Health lnsurance Premium Subsidy Program; Children with Special Health Care Needs
[p. 72]
Card F10-WY
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Wyoming
Medicaid: Wyoming Medicaid
CHIP: Wyoming Kid Care; KCCV
State/Other: Wyoming Health Insurance Pool; Basic Foster Care Program; Minimum Medical Program (MMP); Childrens Special Health Services
What is the name of the health plan that provided the book or list?
What is the name of the health plan that assigned the doctor?
FHI.132
[This question is only of the FR]
(2) No
(Do not include emergency care or care from a specialist {you/he/she} was referred to).
(2) No
(7) Refused
(9) Don't know
(2) No
(7) Refused
(9) Don't know
[p. 51]
FHI.156
What type of service or care do {your/subject name} single service plan or plans pay for? (Mark all that apply)
You may choose more than one
2. AIDS care
3. Cancer treatment
4. Catastrophic care
5. Dental care
6. Disability insurance (cash payments when unable to work for health reasons)
7. Hospice care
8. Hospitalization only
9. Long-term care (nursing home care)
10. Prescriptions
11. Vision care
12. Other
(2) AIDS care
(3) Cancer treatment
(4) Catastrophic care
(5) Dental care
(6) Disability Insurance (cash payments when unable to work for health reasons)
(7) Hospice care
(8) Hospitalization only
(9) Long-term care (nursing home care)
(10) Prescriptions
(11) Vision care
(12) Other (FHI.157)
(97) Refused
(99) Don't know
(Go to Check Item FHICCI5)
FHI.157
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 insurance 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 program or community program.
We have the following persons listed as being covered by such plans:
FR: READ NAMES.
FR: PRESS (P) TO PROCEED.
What is the COMPLETE name of the first plan?
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: READ: DO YOU HAVE YOUR HEALTH PLAN CARD OR SOMETHING WITH THE PLAN NAME ON IT?
FHI.160.1
(2) No
FHI.170
FR: MARK "X" ALL THAT APPLY.
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
Are there any more health insurance plans?
[fill HIPNAM_N]
(2) No (Check Item FHICCI7)
FHI.172
FHI.172.1
(2) No
FHI.173
FR: MARK "X" ALL THAT APPLY.
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
Are there any more health insurance plans in addition to those already mentioned?
[fill HIPNAM_N]
[fill NEXTPNM_N]
(2) No (Check Item FHCCI7)
FHI.175
FHI.175.1
(2) No
FHI.176
FR: MARK "X" ALL THAT APPLY.
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
Are there any more health insurance plans in addition to those already mentioned?
[fill HIPNAM_N]
[fill NEXTPNM_N]
[fill NEXTPNM2_N]
(2) No (Check Item FHICCI7)
FHI.178
FHI.178.1
(2) No
FHI.179
FR: MARK "X" ALL THAT APPLY.
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No (FHI.070)
(7) Refused (FHI.070)
(9) Don't know (FHI.070)
FR: MARK "X" ANY THAT APPLY [fill FHI.170: HIPNAM, NEXTPNM, NEXTPNM2.].
HIVER2_2 [ ]2 [fill NEXTPNM] (if available)
HIVER2_3 [ ]3 [fill NEXTPNM2] (if available)
HIVER2_4 [ ]4 [fill NEXTPNM3] (if available)
HIVER2_5 [ ]5 Some other plan not already mentioned
Check item FHICCI8 : [If the first plan name (ie. from item HIPNAM/FHI.170)]
Now I am going to ask some questions about the {plan/plans} you just told me about, {starting with} [fill plan name].
[else]
Next I would like to ask about [fill plan name]
If anyone in the family has private health insurance, loop through all the private plans entered; [Else go to Check item FHICCI95]
[p. 55]
FR: ENTER LINE NUMBER OF FAMILY MEMBER (FROM LIST BELOW). IN WHOSE NAME THIS PLAN IS HELD.
(0)Policyholder outside of family
(7) Refused
(9) Don't know
FR: IF "YES" PROBE FOR EMPLOYER OR UNION.
(2) Union
(3) Through workplace, but don't know if employer or union
(4) Through workplace, self-employed or professional association
(5) No
(7) Refused
(9) Don't know
FR: ENTER ALL THAT APPLY. ENTER (N) FOR NO MORE. IF GOVERNMENT PROGRAM IS REPORTED, PROBE FOR MEDICARE OR MEDICAID OR CHIP BEFORE ENTERING CODE 7. IF GOVERNMENT IS THE EMPLOYER, ENTER CODE 2.
(2) Employer or Union (FHI.240)
(3) Someone outside the household (FHI.240)
(4) Medicare (FHI.240)
(5) Medicaid (FHI.240)
(6) CHIP (Children's Health Insurance Program) (FHI.240)
(7) State or local government or community program (FHI.240)
(97) Refused (FHI.230)
(99) Don't know (FHI.230)
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[p. 56]
(1-9,999) $1-$9,999
(99,997) Refused
(99,999) Don't know
(1) Once a week
(2) Once every two weeks
(3) Once a month
(4) Twice a month
(5) Every 2 months
(6) Quarterly (Every 3 months)
(7) Once a year
(8) Twice a year
(97) Refused
(99) Don't know
(2) PPO
(3) POS
(4) Fee-for-service/indemnity
(5) Other
(7) Refused
(9) Don't know
(2) Select from group/list (FHI.246)
(7) Refused (FHI.248)
(9) Don't know (FHI.248)
(2) No
(7) Refused
(9) Don't know
(Go to FHI.248)
(2) No
(7) Refused
(9) Don't know
[p. 57]
(2) No
(7) Refused
(9) Don't know
FHI.250
Earlier I recorded that {you/subject name} {are/is} covered by CHIP, a state-sponsored or other public program (other than Medicaid) that pays for health care. What is the name of the plan?
Check item FHICCI97:Loop through each non-deleted family member. If HIKIND/FHI.070 = 14 or only = to 13 then go to FHI.270; else go to FHI.300.
[flashcards associated with FHI.250]
Card F10-AL
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called"Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Alabama
Medicaid: Patient 1st; BAY Health Plan or BAY Program; SOBRA
CHIP: AL-Kids; ALL KIDS
State/Other: Children's Rehabilitation Service; Alabama Health Insurance Plan
[p. 23]
Card F10-AK
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Alaska
Medicaid: Medical Assistance Program
CHIP: Denali KidCare; AKChip
State/Other: Chronic and Acute Medical Assistance (CAMA); Health Care Program for Children with Special Health Care Needs (HCP-CSN); Alaska Comprehensive Health Insurance Association (ACHIA)
[p. 24]
Card F10-AZ
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called"Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below off additionalnames for the public health insurance programsfor each State.
Arizona
Medicaid: AHCCCS; Arizona Health Care Cost Containment System
CHIP: KidsCare
State/Other: Medically Indigent-Medically Needy Program (MI/MN); Office for Children with Special Health Care Needs; Premium Sharing Program; Young Adults Transitional Insurance
[p. 25]
Card F10-AR
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Arkansas
Medicaid: Connectcare
CHIP: ARKids First; Child Health lnsurance Program
State/Other: Arkansas Comprehensive Health Insurance Plan; Children's Medical Services
[p. 26]
Card F10-CA
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
California
Medicaid: Medi-Cal; Medi-Cal Managed Care; The Two-Plan Model
CHIP: Healthy Families Program (HFP)
State/Other: Access for Infants and Mothers (AIM); County Medical Services Program (CMSP); Children's Services (CCS); Managed Risk Medical Insurance Program (MRMIP); California Children's Services; CARE Health Insurance Premium Payment Program
[p. 27]
Card F10-CO
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Colorado
Medicaid: Primary Care Physician Program (PCPP); BabyCare/KidsCare
CHIP: Child Health Plan Plus (CHP+)
State/Other: Health Care Program for Children with Special Health Care Needs; CUHlP - Colorado Uninsurable Health Insurance Plan; CoverColorado; Colorado Indigent Care Program (CICP)
[p. 28]
Card F10-CT
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Connecticut
Medicaid: Connecticut Access; HUSKY Part A
CHIP: The HUSKY Plan; HUSKY PLUS; HUSKY Part B
State/Other: General Assistance Medical Aid; Refugee Medical Asistance; Children with Special Health Care Needs; Connecticut Health Reinsurance Association
[p. 29]
Card F10-DE
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Delaware
Medicaid: Diamond State Health Plan; GA Healthfirst
CHIP: The Delaware Healthy Children Program (DHCP)
State/Other: Nemours Child Plan; Children with Special Health Care Needs; Disabled Children's Program
[p. 30]
Card F10-DC
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
District of Columbia
Medicaid: Medical Assistance
CHIP: DC Healthy Families; Healthy DC Kids
State/Other: Medical Charities Program; Health Services for Children with Special Needs
[p. 31]
Card F10-FL
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Florida
Medicaid: Medipass; Children's Medical Services (CMS) Network
CHIP: KidCare; MediKids; Florida Healthy Kids
State/Other: AIDS Insurance Continuation Program (AICP); Florida Comprehensive Health Insurance Plan; Children's Medical Services
[p. 32]
Card F10-GA
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Georgia
Medicaid: Georgia Better Health Care; Right from the Start
CHIP: Peachcare for Kids
State/Other: Children's Medical Services; Indigent Care Trust Fund (ICTF)
[p. 33]
Card F10-HI
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Hawaii
Medicaid: Hawaii-QUEST
CHIP: Hawaii CHIP
State/Other: QUEST-Net; HCOBRA; Children with Special Health Needs
[p. 34]
Card F10-ID
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Idaho
Medicaid: Healthy Connections; Medical Assistance
CHIP: Children's Health Insurance Program
State/Other: Catastrophic Fund; Children's Special Health Program
[p. 35]
Card F10-IL
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Illinois
Medicaid: Medical Assistance; Healthy Start; Parent Assist
CHIP: KidCare
State/Other: Comprehensive Health Insurance Plan (ICHIP); Specialized Care for Children; Kidcare Moms and Babies
[p. 36]
Card F10-IN
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Indiana
Medicaid: Hoosier Healthwise; Primestep; Risk Based Managed Care
CHIP: Hoosier Healthwise for Children
State/Other: ICHIA; Health Insurance Assistance Program (HIAP); Children's Special Health Care Services; Comprehensive Health Insurance Association
[p. 37]
Card F10-IA
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Iowa
Medicaid: Medical Assistance; Health Insurance Premium Payment (HIPP); MediPASS
CHIP: Health and Well Kids in Iowa (HAWK-I)
State/Other: Children's Health Specialty Clinics; Iowa Comprehensive Health Association; AIDSMIV Health Insurance Premium Payment
[p. 38]
Card F10-KS
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Kansas
Medicaid: HealthConnect; Prime Connect Kansas; PrimeCare Kansas; Medical Assistance; KANBE Healthy
CHIP: HealthWave
State/Other: Medi-KAN; Services for Children with Special Health Care Needs (CSHSN); Kansas Uninsurable Health Insurance Plan; Kansas Health Insurance Association (KHIA)
[p. 39]
Card F10-KY
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Kentucky
Medicaid: Kentucky Patient Access and Care System (KenPAC); The Partnership Program Plan
CHIP: Kentucky Children's Health Insurance Program (KCHIP)
State/Other: HIV Health Insurance Assistance; Commission for Children with Special Health Care Needs; Kentucky Access
[p. 40]
Card F10-LA
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Louisiana
Medicaid: CommunityCARE
CHIP: LACHIP
State/Other: Louisiana Health Plan; Children's Special Health Services; Louisiana Health Insurance Association; Health Insurance Purchase Option
[p. 41]
Card F10-ME
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Maine
Medicaid: Medical Assistance; Primecare
CHIP: Cub Care
State/Other: Maine State Health Insurance Program (SHIP); Coordinated Care Services for Children with Special Health Care Needs Program (CSHNP)
[p. 42]
Card F10-MD
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Maryland
Medicaid: Medical Assistance Program; Healthchoice; REM Program
CHIP: Maryland Children's Health Program (MCHP)
State/Other: AIDS Insurance Assistance Program (MAIAP); Maryland Primary Care (MPC); Children's Medical Services
[p. 43]
Card F10-MA
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Massachusetts
Medicaid: MassHealth; Elder Service Plans; PACE
CHIP: MassHealth; Family Assistance Plan
State/Other: Children's Medical Security Plan (CMSP); Commonhealth; Medical Security Family Assistance Plan (MSP); Special KidsISpecial Care Insurance Partnership
[p. 44]
Card F10-MI
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Michigan
Medicaid: MICHOICE Comprehensive Health Care Program (CHCP); Medical Assistance Program
CHIP: MIChild Program
State/Other: Children's Special Health Care Services; Trust Fund for Children with Special Health Care Needs
[p. 45]
Card F10-MN
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Minnesota
Medicaid: Medical Assistance; Prepaid Medical Assistance Program (PMAP) or PMAP+
CHIP: Children's Health lnsurance Program
State/Other: Minnesota Care; Minnesota General Assistance Medical Care Program (GAMC); HIV/AIDS Insurance Continuation Program; Children with Special Health Care Needs; Minnesota Comprehensive Health Association (MCHA)
[p. 46]
Card F10-MS
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Mississippi
Medicaid: HealthMACS; Medical Assistance
CHIP: Mississippi Children's Health Insurance Program (CHIP); Title XXI
State/Other: Mississippi Comprehensive Health Insurance Risk Pool Association (MCHIRPA); Infant Survival Program; Children with Special Health Care Needs
[p. 47]
Card F10-MO
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Missouri
Medicaid: Managed Care Plus (MC+); MCPlus; Sarah Lopez Waiver
CHIP: MC+ for Kids
State/Other: General Relief Medical Assistance; Children with Special Health Care Needs; Missouri Health Insurance Pool (MHIP)
[p. 48]
Card F10-MT
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Montana
Medicaid: Passport to Health
CHIP: Montana's CHIP
State/Other: Montana Comprehensive Health Insurance Association (MCHA); Health Insurance Continuum of Coverage Program (HICCP); Special Health Services
[p. 49]
Card F10-NE
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Nebraska
Medicaid: Medical Assistance Program; Nebraska Health Connection (NHC)
CHIP: Kids Connection
State/Other: Medically Handicapped Children's Program; Comprehensive Health Association
[p. 50]
Card F10-NV
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Nevada
Medicaid: Nevada Medicaid
CHIP: Nevada T Check Up
State/Other: Family Health Services Bureau
[p. 51]
Card F10-NH
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
New Hampshire
Medicaid: Medical Assistance Program
CHIP: Healthy Kids Gold; Healthy Kids Silver
State/Other: Bureau of Special Medical Services
[p. 52]
Card F10-NJ
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
New Jersey
Medicaid: New Jersey Care 2000+; Managed Charity Care Demonstration (MCCD)
CHIP: New Jersey KidCare or NJ KidCare Plan
State/Other: AIDS Community Care Alternatives (ACCAP); Health Access; Health Insurance Continuation Program (HICP); Special Child Adult and Early Intervention Services
[p. 53]
Card F10-NM
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
New Mexico
Medicaid: SALUD!
CHIP: New MexiKids
State/Other: Comprehensive Health Insurance Pool; Insurance Assistance Program; Children's Medical Services
[p. 54]
Card F10-NY
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
New York
Medicaid: Medical Assistance Program (MAP); The Partnership Plan
CHIP: Child Health Plus (CHPlus)
State/Other: Family Health Plus; Healthy New York; Physically Handicapped Children's Program; Children with Special Health Care Needs
[p. 55]
Card F10-NC
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
North Carolina
Medicaid: Carolina Access; Health Care Connection Access II
CHIP: NC CHlP Program; NC Health Choice for Children
State/Other: Children Special Health Services (CHS)
[p. 56]
Card F10-ND
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
North Dakota
Medicaid: Medical Services; North Dakota Access and Care Program (NoDAC)
CHIP: Healthy Steps Program
State/Other: Comprehensive Health Association of North Dakota; Children's Special Health Services
[p. 57]
Card F10-OH
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Ohio
Medicaid: OhioCare; Premiercare
CHIP: Healthy Start
State/Other: HIV Health lnsurance Premium Payment Program; Hemophilia lnsurance Pilot Program; Bureau for Children with Medical Handicaps (BCMH); Healthy Families
[p. 58]
Card F10-OK
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Oklahoma
Medicaid: Soonercare
CHIP: Oklahoma CHIP
State/Other: Children with Special Health Care Needs; Oklahoma Health Insurance High Risk Pool
[p. 59]
Card F10-OR
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Oregon
Medicaid: Oregon Health Plan (OHP)
CHIP: Oregon SCHIP
State/Other: CareAssist; Oregon Services for Children with Special Health Needs; Oregon Medical Insurance Pool; Family Health Insurance Assistance Program; Insurance Purchasing Cooperative
[p. 60]
Card F10-PA
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Pennsylvania
Medicaid: Medical Assistance; Access Card; Family Care Network; Healthchoices
CHIP: Pa CHIP
State/Other: Division of Special Health Care Programs
[p. 61]
Card F10-RI
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Rhode Island
Medicaid: RIte Care; RI Medical Assistance
CHIP: RIte Care
State/Other: Subsidy for Health Insurance for Center-Based Child-Care Providers; Children with Special Health Care Needs
[p. 62]
Card F10-SC
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
South Carolina
Medicaid: Healthy Options Program; Physicians Enhanced Program
CHIP: Partners for Healthy Children
State/Other: South Carolina Health Insurance Pool; Children's Rehabilitative Services
[p. 63]
Card F10-SD
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
South Dakota
Medicaid: PRIME
CHIP: Children's Health Insurance Program (CHIP)
State/Other: Catastrophic County-Poor Relief Program (CCPR); Continuation of Health Insurance; Childrens Special Health Services
[p. 64]
Card F10-TN
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Tennessee
Medicaid: TennCare
CHIP: TennCare for Children
State/Other: Childrens Special Health Services (CSS)
[p. 65]
Card F10-TX
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Texas
Medicaid: State of Texas Access Reform (STAR); Star Plus
CHIP: Texas CHIP; TexCare Partnership
State/Other: Texas Health Insurance Risk Pool; State Kid Insurance Program; Children with Special Health Care Needs Services
[p. 66]
Card F10-UT
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Utah
Medicaid: Medicaid
CHIP: Children's Health Insurance Program
State/Other: Utah Medical Assistance Program (UMAP); Custody Medical Care Program; Premium Payment Program; Children with Special Health Care Needs; Comprehensive Health Insurance Pool
[p. 67]
Card F10-VT
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Vermont
Medicaid: Medicaid
CHIP: Dr. Dynasaur
State/Other: Vermont Health Access Plan (VHAP); HIV Insurance Continuation Program; Children with Special Health Care Needs
[p. 68]
Card F10-VA
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Virginia
Medicaid: Virginia Medallion
CHIP: Children's Medical Security Insurance Plan (CMSIP); Family Access to Medical Ilnsurance Security Plan (FAMIS)
State/Other: State and Local Hospitalization (SLH) Program; Children's Specialty Services
[p. 69]
Card F10-WA
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Washington
Medicaid: Healthy Options; Basic Health Plus
CHIP: Children's Health Insurance Program
State/Other: Basic Health; AIDS CARE Access Project; Children with Special Health Care Needs; Washington State Health Insurance Pool
[p. 70]
Card F10-WV
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
West Virginia
Medicaid: Medical Assistance; Mountain Health Trust (MHT); Physician Assured Access System (PAAS)
CHIP: Children's Health Insurance Program (CHIP)
State/Other: Children with Special Health Care Needs
[p. 71]
Card F10-WI
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Wisconsin
Medicaid: Medical Assistance; MA; Healthy Start
CHIP: Badgercare for Working Families
State/Other: Health lnsurance Risk Sharing Program; Wisconsin AIDS/HIV Health lnsurance Premium Subsidy Program; Children with Special Health Care Needs
[p. 72]
Card F10-WY
State names for Medicaid, CHIP, State-/Local-sponsored, and other health insurance programs
Please find your State.
Note: Some Medicaid programs are called "Medical Assistance Program" or "{State}Medicaid," such as "Alabama Medicaid." CHIP or S-CHIP programs can also be under "Title XXI Program" or "{State} CHIP," such as "PennsylvaniaCHIP." The names provided below offer additional names for the public health insurance programs for each State.
Wyoming
Medicaid: Wyoming Medicaid
CHIP: Wyoming Kid Care; KCCV
State/Other: Wyoming Health Insurance Pool; Basic Foster Care Program; Minimum Medical Program (MMP); Childrens Special Health Services
Not including Single Service Plans, about how long has it been since {subject name} last had health care coverage?
2. More than 6 months, but not more than 1 year ago
3. More than 1 year, but not more than 3 years ago
4. More than 3 years
5. Never
(2) More than 6 months, but not more than 1 year ago
(3) More than 1 year, but not more than 3 years ago
(4) More than 3 years
(5) Never
(7) Refused
(9) Don't know
[p. 58]
Which of these are reasons {you/subject name} stopped being covered or {do/does} not have health insurance?
FR: ENTER UP TO 5 REASONS. ENTER (N) FOR NO MORE.
You may choose more than one
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) @SPC
(97) Refused
(99) Don't know (other)
[ ]
[ ]
[ ]
[ ]
[ ]
(Go to FHI.320)
(2) No (FHI.320)
(7) Refused (FHI.320)
(9) Don't know (FHI.320)
FR: IF LESS THAN 1 MONTH, ENTER (1).
(97)Refused
(99)Don't know
READ EACH CATEGORY IF TELEPHONE INTERVIEW.
During the PAST 12 MONTHS, about how much did {you/your family} spend for medical care, including dental care? Do NOT include the cost of health insurance premiums, over the counter remedies, or any costs for which you expect to be reimbursed.
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) Don't know
Section VI -- SOCIO-DEMOGRAPHIC BACKGROUND
[FSD.001 to FSD.130 are asked for each person in the family.]
(2) Alaska
(3) Arizona
(4) Arkansas
(5) California
(6) Colorado
(7) Connecticut
(8) Delaware
(9) Dist. of Columbia
(10) Florida
(11) Georgia
(12) Hawaii
(13) Idaho
(14) Illinois
(15) Indiana
(16) Iowa
(17) Kansas
(18) Kentucky
(19) Louisiana
(20) Maine
(21) Maryland
(22) Massachusetts
(23) Michigan
(24) Minnesota
(25) Mississippi
(26) Missouri
(27) Montana
(28) Nebraska
(29) Nevada
(30) New Hampshire
(31) New Jersey
(32) New Mexico
(33) New York
(34) North Carolina
(35) North Dakota
(36) Ohio
(37) Oklahoma
(38) Oregon
(39) Pennsylvania
(40) Rhode Island
(41) South Carolina
(42) South Dakota
(43) Tennessee
(44) Texas
(45) Utah
(46) Vermont
(47) Virginia
(48) Washington
(49) West Virginia
(50) Wisconsin
(51) Wyoming
(57) United States (state unknown)
(99) NOT IN THE U.S.
[If 99 go to POB_FOREIGN (FSD.002); if 1-51 or 57 go to Check item FSDCCI1]
FSD.002
[@]
(A) [go to A_LIST]
(B) [go to B_LIST]
(C) [go to C_LIST]
(D) [go to D_LIST]
(E) [go to E_LIST]
(F) [go to F_LIST]
(G) [go to G_LIST]
(H) [go to H_LIST]
(I) [go to I_LIST]
(J) [go to J_LIST]
(K) [go to K_LIST]
(L) [go to L_LIST]
(M) [go to M_LIST]
(N) [go to N_LIST]
(O) [go to O_LIST]
(P) [go to P_LIST]
(Q) [go to Q_LIST]
(R) [go to R_LIST]
(S) [go to S_LIST]
(T) [go to T_LIST]
(U) [go to U_LIST]
(V) [go to V_LIST]
(W) [go to W_LIST]
(Y) [go to Y_LIST]
(Z) [go to Z_LIST]
(X) [clear out entry box, and display error message "FR: THERE ARE NO COUNTRIES LISTED BEGINNING WITH THIS LETTER, PLEASE ENTER ANOTHER ANSWER"]
(100) ABROAD
(101) ABU DHABI
(102) ADEN
(103) AFGHANISTAN
(104) AFRICA
(105) ALBANIA
(106) ALBERTA
(107) ALGERIA
(108) ALGIERS
(109) ALSACE-LORRAINE
(060) AMERICAN SAMOA
(061) AM SAMOA
(110) AMSTERDAM
(111) ANEGADA
(112) ANGOLA
(113) ANGUILLA
(114) ANGUILLA BWI
(115) ANOJOUAN
(116) ANTARCTICA
(117) ANTIGUA
(118) ANTIGUA and BARBUDA
(119) ANTIGUA WI
(120) ANTILLES
(121) ARAB PALESTINE
(122) ARABIA
(123) ARGENTINA
(124) ARMENIA
(125) ARUBA
(126) ARUBA DWI
(127) ARUBA NETHERLANDS
(128) ASCENSION ISLAND
(129) ASIA
(130) ASIA MINOR
(131) ASSAM
(132) AT SEA
(133) AUSTRALIA
(134) AUSTRIA
(135) AUSTRIA-HUNGARY
(136) AZERBAIJAN
(137) AZORES ISLANDS
(688) ANDORRA
(138) BAHAMAS
(139) BAHAMAS UK
(140) BAHRAIN
(141) BAJA CAL
(142) BAJA CAL SUR
(062) BAKER ISLAND
(143) BALBOA
(144) BANGLADESH
(145) BARBADOS
(146) BARBUDA
(147) BAVARIA
(148) BELARUS
(149) BELFAST
(150) BELGIAN CONGO
(151) BELGIUM
(152) BELIZE
(153) BENIN
(154) BERLIN
(155) BERMUDA
(156) BESSARABIA
(157) BHUTAN
(158) BOHEMIA
(159) BOLIVIA
(160) BONAIRE
(161) BORNEO
(162) BOSNIA
(163) BOSNIA and HERZEGOVINA
(164) BOTSWANA
(165) BRASIL
(166) BRAZIL
(167) BRAZZAVILLE
(168) BREMEN
(169) BRITAIN
(170) BRITISH COLUMBIA
(171) BRITISH EAST AFRICA
(172) BRITISH GUIANA
(173) BRITISH GUYANA
(174) BRITISH HONDURAS
(175) BRITISH HONG KONG
(176) BRITISH ISLES
(177) BRITISH VI
(178) BRITISH VIRGIN IS
(179) BRITISH WEST INDIES
(180) BRITISH WI
(181) BRUNEI
(182) BULGARIA
(183) BURKINA FASO
(184) BURMA
(185) BURUNDI
(186) BWI
(187) BYELARUS
(188) BYELORUSSIA
(689) BRITISH INDIAN OCEAN TERRITORY
(189) CAICOS ISLANDS
(190) CAM PHA
(191) CAM RANH
(192) CAMBODIA
(193) CAMEROON
(194) CAN THO
(195) CANADA
(196) CANAL ZONE
(197) CANARY ISLANDS
(198) CANTON and ENDERBURY IS
(199) CANTON ISLAND
(200) CAPE VERDE
(201) CARIBBEAN
(202) CAYMAN ISLANDS
(203) CENTRAL AFRICA
(204) CENTRAL AFRICAN REP
(205) CENTRAL AMERICA
(206) CEYLON
(207) CHAD
(208) CHANNEL ISLANDS
(209) CHIAPAS
(210) CHIHUAHUA
(211) CHILE
(212) CHINA
(213) CHINA HONG KONG
(214) CHRISTMAS ISLAND
(215) CHRISTMAS ISLAND, INDIAN OCEAN
(216) COAHUILA
(217) COLIMA
(218) COLOMBIA
(219) COMOROS
(220) CONGO
(221) COOK ISLANDS
(222) CORAL SEA ISLANDS
(223) CORK
(224) CORSICA
(225) COSTA RICA
(226) COTE D'IVORIE
(227) CRETE
(228) CRIMEA
(229) CRISTOBAL
(230) CROATIA
(231) CUBA
(232) CURACAO
(233) CYPRUS
(234) CZ
(235) CZECH REPUBLIC
(236) CZECHOSLOVAKIA
(237) DA LAT
(238) DA NANG
(239) DAKAR
(240) DANZIG
(241) DELHI
(242) DEMO PEOPLE'S REP OF KOREA
(243) DEMO REP OF CONGO
(244) DENMARK
(245) DISTRITO FEDERAL
(246) DJIBOUTI
(247) DOM REP
(248) DOMINICA
(249) DOMINICA BWI
(250) DOMINICA WI
(251) DOMINICAN REPUBLIC
(252) DUBAI
(253) DUBLIN
(254) DURANGO
(255) DUTCH EAST INDIES
(256) DUTCH GUIANA
(257) DUTCH INDONESIA
(258) DUTCH NEW GUINEA
(690) DEUTSCHLAND
(259) EAST PAKISTAN
(260) EAST PRUSSIA
(261) EASTER ISLAND
(262) EASTERN AFRICA
(263) ECUADOR
(264) EGYPT
(265) EIRE
(266) EL SALVADOR
(267) ENGLAND
(268) EQUATORIAL GUINEA
(269) ERITREA
(270) ESPANA
(271) ESTONIA
(272) ETHIOPIA
(273) EUROPA ISLAND
(274) EUROPE
(275) FALKLAND ISLANDS
(276) FAROE ISLANDS
(277) FEDERAL DISTRICT
(278) FEDERAL REPUBLIC OF YUGOSLAVIA
(279) FEDERATED STATES OF MICRONESIA
(280) FIJI
(281) FILIPINES
(282) FINLAND
(283) FOREIGN COUNTRY
(284) FORMOSA
(285) FRANCE
(286) FRANKFURT
(287) FRENCH GUIANA
(288) FRENCH MOROCCO
(289) FRENCH POLYNESIA
(691) FRENCH SOUTHERN AND ANTARCTIC LANDS
(290) GABON
(291) GALAPAGOS ISLANDS
(292) GALWAY
(293) GAMBIA
(294) GAZA STRIP
(295) GEORGIA
(296) GERMANY
(297) GHANA
(298) GIA DINH
(299) GIBRALTER
(300) GLORIOSO ISLANDS
(301) GOA
(302) GRAND BAHAMA
(303) GRAND CAYMAN
(304) GRAND TURK
(305) GREAT BRITAIN
(306) GREAT COMORE
(307) GREECE
(308) GREENLAND
(309) GRENADA
(310) GUADALAJARA
(311) GUADELOUPE
(063) GUAM
(312) GUANAJUATO
(313) GUATEMALA
(314) GUERNSEY
(315) GUERRERO
(316) GUIANA
(317) GUINEA
(318) GUINEA -BISSAU
(319) GUYANA
(692) GRENADINES, THE
(320) HA DONG
(321) HAI PHONG
(322) HAITI
(323) HAMBURG
(324) HANOI
(325) HANOVER
(326) HAVANA
(327) HEARD and MCDONALD ISLANDS
(328) HERZEGOVINA
(329) HESSE
(330) HIDALGO
(331) HIGH SEAS
(332) HOLLAND
(333) HONDURAS
(334) HONG KONG
(064) HOWLAND ISLAND
(335) HUNGARY
(336) HYDERABAD
(337) ICELAND
(338) INDIA
(339) INDONESIA
(340) INTERNATIONAL WATERS
(341) IRAN
(342) IRAQ
(343) IRELAND
(344) IRIAN JAYA
(345) IRISH REPUBLIC
(346) ISLE OF MAN
(347) ISRAEL
(348) ITALY
(349) IVORY COAST
(350) JALISCO
(351) JAMAICA
(352) JAN MEYAN
(353) JAPAN
(065) JARVIS ISLAND
(354) JAVA
(355) JERSEY
(356) JIBUTI
(066) JOHNSTON ATOLL
(357) JORDAN
(358) JUAN DE NOVA ISLAND
(359) JUGOSLAVIA
(360) KALININGRAD
(361) KAMPUCHEA
(362) KASHMIR
(363) KAZAKHSTAN
(364) KENYA
(365) KHANH HUNG
(067) KINGMAN REEF
(366) KINSHASA
(367) KIRIBATI
(368) KOREA
(369) KORO ISLAND
(370) KUWAIT
(371) KWAJALEIN
(372) KWANTUNG
(373) KYRGYZSTAN
(693) KOSOVO
(374) LABRADOR
(375) LABUAN
(376) LAOS
(377) LATAKIA
(378) LATIN AMERICA
(379) LATVIA
(380) LEBANON
(381) LEEWARD ISLANDS
(382) LESOTHO
(383) LIBERIA
(384) LIBYA
(385) LIECHTENSTEIN
(386) LITHUANIA
(387) LOAS
(388) LONDONDERRY
(389) LONG XUYEN
(390) LORRAINE
(391) LUBECK
(392) LUXEMBOURG
(393) MACAO
(394) MACAU
(395) MACEDONIA
(396) MADAGASCAR
(397) MADEIRA ISLANDS
(398) MAINLAND CHINA
(399) MAJORCA
(400) MALAGASY REPUBLIC
(401) MALAWI
(402) MALAYSIA
(403) MALDIVES
(404) MALI
(405) MALLORCA
(406) MALTA
(407) MACHURIA
(408) MANICA
(409) MANILA
(410) MANITOBA
(068) MANUA ISLANDS
(411) MARSHALL ISLANDS
(412) MARTINIQUE
(413) MAURITANIA
(414) MAURITIUS
(415) MAYOTTE ISLAND
(416) MELANESIA
(417) MEXICO
(418) MICHOACAN
(419) MICRONESIA
(420) MIDDLE EAST
(069) MIDWAYISLANDS
(421) MOLDAVIA
(422) MOLDOVA
(423) MONACO
(424) MONAGAS
(425) MONGOLIA
(426) MONTENEGRO
(427) MONTSERRAT
(428) MORELOS
(429) MOROCCO
(430) MOZAMBIQUE
(431) MY THO
(694) MYANMAR
(432) N. IRELAND
(433) NAM DINH
(434) NAMIBIA
(435) NAURU
(070) NAVASSA ISLAND
(436) NAYARIT
(437) NEPAL
(438) NETHERLANDS
(439) NETH. ANTILLES
(440) NETH. EAST INDIES
(441) NEVIS ISLAND
(442) NEW BRUNSWICK
(443) NEW CALEDONIA
(444) NEW GUINEA
(445) NEW HEBRIDES
(446) NEW SOUTH WALES
(447) NEW ZEALAND
(448) NEWFOUNDLAND
(449) NHA TRANG
(450) NICARAGUA
(451) NIGER
(452) NIGERIA
(453) NIUE ISLAND
(454) NORFOLK ISLAND
(455) NORTH AFRICA
(456) NORTH AMERICA
(457) NORTH KOREA
(458) NORTH VIETNAM
(459) NORTHERN IRELAND
(071) NORTHERN MARIANAS
(460) NORTHERN TERRITORY
(461) NORWAY
(462) NOVA SCOTIA
(463) NUEVO LEON
(695) NORTHWEST TERRITORY
(696) NUNAVUT TERRITORY
(464) OAXACA
(465) OCEANIA
(466) OKINAWA
(467) OMAN
(468) ONTARIO
(469) OVERSEAS
(470) PAKISTAN
(471) PALAU
(472) PALESTINE
(072) PALMYRA ATOLL
(473) PANAMA
(474) PANAMA CANAL ZONE
(475) PAPUA NEW GUINEA
(476) PARACEL ISLANDS
(477) PARAGUAY
(478) PELAGOSA
(479) PEOPLE'S REP. OF CHINA
(480) PEOPLE'S REP. OF CONGO
(481) PERSIA
(482) PERU
(483) PHAN THIET
(484) PHILIPPINES
(485) PITCAIRN ISLAND
(486) POLAND
(487) POLYNESIA
(488) PONAPE
(489) PORTUGAL
(490) PORTUGUESE INDIA
(491) PRINCE EDWARD ISLAND
(492) PRINCIPE ISLAND
(493) PROVIDENCIA
(494) PRUSSIA
(495) PUEBLA
(073) PUERTO RICO
(496) PUNJAB
(497) PUNJAB, INDIA
(498) PUNJAB, PAKISTAN
(499) QATAR
(500) QUANG LONG
(501) QUEBEC
(502) QUEENSLAND
(503) QUERETARO
(504) QUI NHON
(505) RACH GIA
(506) RAJASTHAN
(507) RED CHINA
(508) REPUBLIC OF CHINA
(509) REPUBLIC OF CYPRUS
(510) REPUBLIC OF IRELAND
(511) REPUBLIC OF KOREA
(512) REPUBLIC OF PANAMA
(513) REP. OF PHILIPPINES
(514) REP. OF SOUTH AFRICA
(515) REPUBLICA DOMINICANA
(516) REUNION ISLAND
(517) RHODESIA
(518) ROC
(519) ROK
(520) ROMANIA
(074) ROTA
(521) ROTTERDAM
(522) RUMANIA
(523) RUSSIA
(524) RUSSIAN FEDERATION
(525) RWANDA
(526) SAIGON
(075) SAIPAN
(527) SALVADOR
(528) SAMOA
(529) SAN ANDRES
(530) SAN LUIS POTOSI
(531) SAN MARINO
(532) SAN SALVADOR
(076) SAND ISLAND
(533) SAO TOME ISLAND
(534) SAO TOME and PRINCIPE
(535) SARAWAK
(536) SASKATCHEWAN
(537) SAUDI ARABIA
(566) SOUTHEAST ASIA
(567) SOUTHERN AFRICA
(568) SOUTHERN RHODESIA
(569) SOVIET UNION
(570) SPAIN
(571) SPRATLEY ISLANDS
(572) SRI LANKA
(573) ST BARTHELEMY
(574) ST BARTS
(575) ST CHRISTOPHER
(576) ST CHRISTOPHER-NEVIS
(077) ST CROIX
(538) SAXONY
(539) SCOTLAND
(540) SENEGAL
(541) SEOUL
(542) SERBIA
(543) SEYCHELLES
(544) SHANGHAI
(545) SHARJAH
(546) SIBERIA
(547) SICILY
(548) SIERRA LEONE
(549) SIKKIM
(550) SINALOA
(551) SINGAPORE
(577) ST EUSTATIUS
(578) ST HELENA
(078) ST JOHN
(579) ST KITTS
(580) ST KITTS-NEVIS
(581) ST LUCIA
(582) ST MAARTEN
(583) ST MARTIN
(584) ST PIERRE and MIQUELON
(079) ST THOMAS
(585) ST VINCENT
(586) ST VINCENT and THE GRENADINES
(552) SLAVONIA
(553) SLOVAK REPUBLIC
(554) SLOVAKIA
(555) SLOVENIA
(556) SOLOMAN ISLANDS
(557) SOMALIA
(558) SONORA
(559) SOUTH AFRICA
(560) SOUTH AMERICA
(561) SOUTH AUSTRALIA
(562) SOUTH KOREA
(563) SOUTH VIETNAM
(564) SOUTH WALES
(565) SOUTH YEMEN
(587) SUDAN
(588) SUMATRA
(589) SURINAM
(590) SURINAME
(591) SVALBARD
(592) SWAZILAND
(593) SWEDEN
(594) SWITZERLAND
(595) SYRIA
(596) SYRIAN ARAB REP
(597) TABASCO
(598) TADZHIK
(599) TAHITI
(600) TAIWAN
(601) TAIWAN ROC
(602) TAJIKISTAN
(603) TAMAULIPAS
(604) TANGANYIKA
(605) TANGIER
(606) TANZANIA
(607) TASMANIA
(608) THAILAND
(609) THANH HOA
(610) THE GRENADINES
(611) TIBET
(612) TIJUANA
(080) TINIAN
(613) TLAXCALA
(614) TOBAGO
(615) TOGO
(616) TOGOLAND
(617) TOKELAU
(618) TONGA
(619) TORTOISE ISLANDS
(620) TORTOLA
(621) TRANSVAAL
(622) TRANSYLVANIA
(623) TRIESTE
(624) TRINIDAD
(625) TRINIDAD and TOBAGO
(626) TRIPOLI
(627) TROMELIN ISLAND
(628) TRUK
(629) TUNIS
(630) TUNISIA
(631) TURKEY
(632) TURKMENISTAN
(633) TURKS and CAICOS IS
(634) TURK ISLANDS
(635) TUVALU
(636) TUY HOA
(637) UGANDA
(638) UK
(639) UKRAINE
(640) UKRAINIA
(641) UNION ISLANDS
(642) UNION OF SOUTH AFRICA
(643) UNION OF SOVIET SOCIALIST REPUBLICS
(644) UNITED ARAB EMIRATES
(645) UNITED KINGDOM
(646) UPPER VOLTA
(647) URUGUAY
(081) US OUTLYING AREA
(082) US VIRGIN ISLANDS
(648) USSR
(083) USVI
(649) USBEKISTAN
(650) VANCOUVER
(651) VANUATU
(652) VATICAN CITY
(653) VENEZUELA
(654) VERACRUZ
(655) VICTORIA
(656) VIETNAM
(657) VINH LONG
(084) VIRGIN ISLANDS
(658) VUNG TAU
(085) WAKE ISLAND
(659) WALES
(660) WALLIS and FUTUNA ISLANDS
(661) WEST AFRICA
(662) WEST BANK
(663) WEST BENGAL
(664) WEST INDIES
(665) WEST PAKISTAN
(666) WESTERN AUSTRALIA
(667) WESTERN SAHARA
(668) WESTERN SAMOA
(669) WHITE RUSSIA
(670) WINDWARD ISLANDS
(671) WINNIPEG
(672) WURZBERG
(673) YAP
(674) YAR
(675) YEMEN
(676) YEMEN ARAB REPUBLIC
(677) YEREVAN
(678) YUCATAN
(679) YUGOSLAVIA
(680) YUKON TERRITORY
(681) ZACATECAS
(682) ZADAR
(683) ZAIRE
(684) ZAMBIA
(685) ZANZIBAR
(686) ZIMBABWE
(687) ZURICH
(997) Refused
(998) Not ascertained
(999) Don't know
Earlier I recorded {your/subject name's] date of birth as {month in words, 2-digit day, 4-digit year}.
In what year did {you/subject name} come to the United States to stay?
(9997) Refused (FSD.004)
(9999) Don't know (FSD.004)
FSD.004
FR: READ IF NECESSARY:
Earlier I recorded that {you/subject name} {are/is} {AGE} years old.
FR: ENTER 95 FOR 95 OR MORE YEARS. IF LESS THAN 1 YEAR GIVEN AS A RESPONSE, CODE THE ANSWER AS "0".
(95) 95+ years
(97) Refused
(99) Don't know
[p. 71]
{Are/Is} {you/subject name} a CITIZEN of the United States?
2. Yes, born in Puerto Rico, Guam, American Virgin Islands, or other US. territory
3. Yes, born abroad to American parent(s)
4. Yes, US. citizen by naturalization
5. No, not a citizen of the United States
(2) Yes, born in Puerto Rico, Guam, American Virgin Islands, or other 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 States
(7) Refused
(9) Don't know
FSD.006 FSD.007
(2) No (FSD.007)
(7) Refused (FSD.007)
(9) Don't know (FSD.007)
(2) No
(7) Refused
(9) Don't know
[p. 72]
What is the HIGHEST level of school {you/subject name} {have/has} completed or the highest degree {you/subject name} {have/has} received? Please tell me the number from the card.
FR: ENTER HIGHEST LEVEL OF SCHOOL:
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. 10thgrade
11. 11thgrade
12. 12th grade, no diploma
13. GED or equivalent
14. HIGH SCHOOL GRADUATE
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)
(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) GED or equivalent
(14) HIGH SCHOOL GRADUATE
(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 (Exa mple: PhD, EdD)
(97) Refused
(99) Don't know
(0 -21, 97, 99) goto FSD.041
FR: ENTER UP TO SEVEN LINE NUMBERS.
ENTER "N" AFTER THE LAST ONE, OR IF NONE. 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.100)
(4) Working, but not for pay, at a job or business (FSD.070)
(5) Not working at a job or business AND not looking for work (FSD.060)
(7) Refused (FSD.100)
(9) Don't know (FSD.100)
What is the main reason {you/subject name} did not work last week?
[Else, display]
What is the main reason {you/subject name} did not have a job or business last week?
(2) Going to school (FSD.100)
(3) Retired (FSD.100)
(4) On a planned vacation from work (FSD.070)
(5) On family or maternity leave (FSD.070)
(6) Temporarily unable to work for health reasons (FSD.070)
(7) On layoff (FSD.100)
(8) Disabled (FSD.100)
(9) Have job/contract; off-season (FSD.100)
(10) Other (FSD.100)
(97) Refused (FSD.100)
(99) Don't know (FSD.100)
NOTE: Information from the ASD section is used to create DOINGLW1 (from DOINGLW) and WHYNOWK1 (from WHYNOWRK).
How many hours did {you/subject name} work LAST WEEK at ALL jobs or businesses?
[Else, display]
How many hours {do/does} {you/subject name} USUALLY work at all jobs or businesses?
FR: ENTER 95 IF THE REPORTED HOURS ARE GREATER THAN OR EQUAL TO 95 HOURS.
(95) 95 hours +
(97) Refused
(99) Don't know
[p. 74]
(2) No
(7) Refused
(9) Don't know
(2) No (Check item FSDCCI3)
(7) Refused (Check item FSDCCI3)
(9) Don't know (Check item FSDCCI3)
FR: IF LESS THAN ONE MONTH, ENTER (1).
(97) Refused
(99) Don't know
FSD.120
FR: ENTER 999,995 IF THE REPORTED INCOME IS GREATER THAN $999,995.
(999995) $999,995+
(999997) Refused
(999999) Don't know
FSD.130
(2) No
(7) Refused
(9) Don't know
Section VII -- INCOME AND ASSETS
Part A -- Sources of Income
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, display]
Did you receive income in {last year in 4 digit format} from... Wages and Salaries?
[else, display]
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
(7) Refused
(9) Don't know
[Else go to FIN.040]
FIN.040
Who received this? (Anyone else?)
FR: INDICATE EACH FAMILY MEMBER WITH THIS INCOME.
[ ]
[ ]
[ ]
[ ]
[ ]
Did you receive income in {last year in 4 digit format} from... self-employment including business and farm income?
[else, display]
Did any family member 18 and older, that is (READ NAMES) receive income in {last year in 4 digit format} from ... self-employment including business and farm income?
(2) No (FIN.070)
(7) Refused (FIN.070)
(9) Don't know (FIN.070)
[Else go to FIN.060]
FIN.060
Who received this? (Anyone else?)
FR: INDICATE EACH FAMILY MEMBER WITH THIS INCOME.
[ ]
[ ]
[ ]
[ ]
[ ]
FR: READ IF NECESSARY:
Social Security checks are either automatically deposited in the bank or mailed to arrive on the 3rdof every month. If mailed, they are sent in a yellow/gold colored envelope.
(2) No
(7) Refused
(9) Don't know
[If one person family and FSSRR eq (1)] go to FINCCI2;
[Else if FSSRR eq (2,7,9)] go to FIN.090;
[Else go to FIN.080]
FIN.080
Who received this? (Anyone else?)
FR: INDICATE EACH FAMILY MEMBER WITH THIS INCOME.
[ ]
[ ]
[ ]
[ ]
[ ]
FIN.082
(2) No
(7) Refused
(9) Don't know
[If one person family and FSSRRD eq (1), go to FIN.086]
[If FSSRRD eq (2,7,9), go to FIN.090]
[Else go to FIN.084]
FIN.084
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) Don't know
(2) No
(7) Refused
(9) Don't know
[Else go to FIN.100]
FIN.100
ENTER (N) FOR NO MORE AFTER THE LAST NUMBER.
Who received this? (Anyone else?)
FR: INDICATE EACH FAMILY MEMBER WITH THIS INCOME.
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No
(7) Refused
(9) Don't know
[(If one person family and FOPENS eq (1)) or FOPENS eq (2,7,9)] go to FIN.110;
[Else go to FIN.104]
FIN.104
ENTER (N) FOR NO MORE AFTER THE LAST NUMBER.
Who received this? (Anyone else?)
FR: INDICATE EACH FAMILY MEMBER WITH THIS INCOME.
[ ]
[ ]
[ ]
[ ]
[ ]
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
(7) Refused
(9) Don't know
[If one person family and FSSI eq (1), go to FIN.122];
[Else if FSSI eq (2,7,9), go to FIN.150];
[Else go to FIN.120]
FIN.120
ENTER (N) FOR NO MORE AFTER THE LAST NUMBER.
Who in the family received this? (Anyone else?)
FR: INDICATE EACH FAMILY MEMBER WITH THIS INCOME.
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No
(7) Refused
(9) Don't know
[p. 79]
FR: SHOW CARD F17. PLEASE DO NOT INCLUDE FOOD STAMPS, SSI, ENERGY ASSISTANCE, OR MEDICAL ASSISTANCE PAYMENTS.
(2) No
(7) Refused
(9) Don't know
[(If one person family and FTANF eq (1)) or FTANF eq (2,7,9)] go to FIN.164;
[Else go to FIN.160]
[Flashcards associated with FIN.150]
Card F17-AL
Note: Where there is more than one program, an asterisk* denotes which most resembles TANF.
Alabama
Family Assistance (FA) Program*
JOBS
[Blank Page]
[p. 80]
Card F17-AK
Alaska
Alaska Temporary Assistance Program (ATAP)
[p. 81]
Card F17-AZ
Arizona
Employing and Moving People Off Welfare and Encouraging Responsibility (EMPOWER)
[p. 82]
Card F17-AR
Arkansas
Transitional Employment Assistance (TEA)
[p. 83]
Card F17-CA
California
California Work Opportunity and Responsibility to Kids (CalWorks)
[p. 84]
Card F17-CO
Colorado
Colorado Works
[p. 85]
Card F17-CT
Connecticut
Jobs First
[p. 86]
Card F17-DE
Delaware
A Better Chance (ABC)
[p. 87]
Card F17-DC
District of Columbia
Temporary Assistance for Needy Families (TANF)
[p. 88]
Card F17-FL
Florida
Work and Gain Economic Self-Sufficiency (WAGES)
[p. 89]
Card F17-GA
Georgia
Temporary Assistance for Needy Families (TANF)
[p. 90]
Card F17-HI
Hawaii
Temporary Assistance for Needy Families (TANF)
[p. 91]
Card F17-ID
Idaho
Temporary Assistance for Families in Idaho (TAFI)
[p. 92]
Card F17-IL
Illinois
Temporary Assistance for Needy Families (TANF)
[p. 93]
Card F17-IN
Note: Where there is more than one program, an asterisk* denotes which most resembles TANF.
Indiana
Temporary Assistance for Needy Families (TANF)*
Indiana Manpower Placement and Comprehensive Training (IMPACT)
[p. 94]
Card F17-IA
Note: Where there is more than one program, an asterisk* denotes which most resembles TANF.
Iowa
Family Investment Program (FIP)*
PROMISE JOBS
[p. 95]
Card F17-KS
Note: Where there is more than one program, an asterisk* denotes which most resembles TANF.
Kansas
Temporary Assistance for Families (TAF)*
KansasWorks
[p. 96]
Card F17-KY
Kentucky
Transitional Assistance Program (K-TAP)
[p. 97]
Card F17-LA
Note: Where there is more than one program, an asterisk* denotes which most resembles TANF.
Louisiana
Family Independence Temporary Assistance Program (FITAP)*
Family Independence Work Program (FIND Work)
[p. 98]
Card F17-ME
Note: Where there is more than one program, an asterisk* denotes which most resembles TANF.
Maine
Temporary Assistance for Needy Families (TANF)*
Additional Support for People in Retraining and Employment (ASPIRE)
[p. 99]
Card F17-MD
Maryland
Family Investment Program (FIP)
[p. 100]
Card F17-MA
Note: Where there is more than one program, an asterisk* denotes which most resembles TANF.
Massachusetts
Transitional Aid to Families with Dependent Children (TAFDC)*
Employment Services Program (ESP)
[p. 101]
Card F17-MI
Michigan
Family Independence Program (FIP)
[p. 102]
Card F17-MN
Note: Where there is more than one program, an asterisk* denotes which most resembles TANF.
Minnesota
Minnesota Family Investment Program (MFIP)*
Minnesota Works 95- WorkFIRST
[p. 103]
Card F17-MS
Mississippi
Temporary Assistance for Needy Families (TANF)
[p. 104]
Card F17-MO
Missouri
Beyond Welfare
[p. 105]
Card F17-MT
Note: Where there is more than one program, an asterisk* denotes which most resembles TANF.
Montana
Families Achieving Independence in Montana (FAIM)*
- Pathways
- Community Services Program (CSP)
Demonstration JOBS
[p. 106]
Card F17-NE
Nebraska
Employment First
[p. 107]
Card F17-NV
Note: Where there is more than one program, an asterisk* denotes which most resembles TANF.
Nevada
Temporary Assistance for Needy Families (TANF)*
New Employees of Nevada (NEON)
[p. 108]
Card F17-NH
Note: Where there is more than one program, an asterisk* denotes which most resembles TANF.
New Hampshire
Family Assistance Program (FAP)*
New Hampshire Employment Program (NHEP)
[p. 109]
Card F17-NJ
New Jersey
Work First New Jersey (WFNJ)
[p. 110]
Card F17-NM
New Mexico
NM Works
[p. 111]
Card F17-NY
New York
Family Assistance (FA) Program
[p. 112]
Card F17-NC
North Carolina
Work First
[p. 113]
Card F17-ND
North Dakota
Training, Employment, Education Management(TEEM)
[p. 114]
Card F17-OH
Ohio
Ohio Works First (OWF)
[p. 115]
Card F17-OK
Oklahoma
Temporary Assistance for Needy Families (TANF)
[p. 116]
Card F17-OR
Oregon
Job Opportunities and Basic Skills Program (JOBS)
[p. 117]
Card F17-PA
Pennsylvania
Pennsylvania TANF
[p. 118]
Card F17-RI
Rhode Island
Family Independence Program (FIP)
[p. 119]
Card F17-SC
South Carolina
Family Independence Program
[p. 120]
Card F17-SD
South Dakota
Temporary Assistance for Needy Families (TANF)
[p. 121]
Card F17-TN
Tennessee
Families First
[p. 122]
Card F17-TX
Texas
Texas Works (Department of Human Services)
[p. 123]
Card F17-UT
Utah
Family Employment Program (FEP)
[p. 124]
Card F17-VT
Note: Where there is more than one program, an asterisk* denotes which most resembles TANF.
Vermont
Aid to Needy Families with Children (ANFC)*
Reach UP
[p. 125]
Card F17-VA
Note: Where there is more than one program, an asterisk* denotes which most resembles TANF.
Virginia
Virginia Independence Program (VIP)*
Virginia Initiative for Employment Not Welfare (VIEW)
[p. 126]
Card F17-WA
Washington
WorkFirst
[p. 127]
Card F17-WV
West Virginia
West Virginia Works
[p. 128]
Card F17-WI
Wisconsin
Wisconsin Works (W-2)
[p. 129]
Card F17-WY
Wyoming
Personal Opportunities with Employment Responsibility (POWER)
FIN.160
Who in the family received this? (Anyone else?)
FR: INDICATE EACH FAMILY MEMBER WITH THIS INCOME.
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No
(7) Refused
(9) Don't know
[(If one person family and FOWBEN eq (1)) or FOWBEN eq (2,7,9)] go to FIN.170;
[Else go to FIN.166]
FIN.166
Who received this? (Anyone else?)
FR: INDICATE EACH FAMILY MEMB ER WITH THIS INCOME.
[ ]
[ ]
[ ]
[ ]
[ ]
[p. 80]
FR: DO NOT INCLUDE DIVIDENDS.
(2) No
(7) Refused
(9) Don't know
[Else go to FIN.180]
FIN.180
Who received this? (Anyone else?)
FR: INDICATE EACH FAMILY MEMBER WITH THIS INCOME.
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No
(7) Refused
(9) Don't know
[(If one person family and FDIVD eq (1)) or FDIVD eq (2,7,9)] go to FIN.210;
[Else go to FIN.200]
FIN.200
Who received this? (Anyone else?)
FR: INDICATE EACH FAMILY MEMBER WITH THIS INCOME.
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No
(7) Refused
(9) Don't know
[(If one person family and FCHLDSP eq (1)) or FCHLDSP eq (2,7,9)] go to FIN.230;
[Else go to FIN.220]
FIN.220
Who received this? (Anyone else?)
FR: ENTER LINE NUMBERS OF CHILDREN FOR WHOM CHILD SUPPORT WAS RECEIVED. IF THAT CHILD IS NO LONGER RESIDING WITH THIS FAMILY, ENTER LINE NUMBER OF CUSTODIAL PARENT. ENTER (N) FOR NO MORE.
[ ]
[ ]
[ ]
[ ]
[ ]
(2) No
(7) Refused
(9) Don't know
[(If one person family and FINCOT eq (1)) or FINCOT eq (2,7,9)] go to FIN.250;
[Else go to FIN.240]
FIN.240
Who received this? (Anyone else?)
FR: INDICATE EACH FAMILY MEMBER WITH THIS INCOME.
[ ]
[ ]
[ ]
[ ]
[ ]
[p. 82]
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.
FR: ENTER 999,996 IF THE REPORTED INCOME IS GREATER THAN $999,995
(999996) 999,995+ dollars (FIN.280)
(999997) Refused (FIN.260)
(999999) Don't know (FIN.260)
FIN.260
(2) Less than $20,000 (FIN.270)
(7) Refused (FIN.280)
(9) Don't know (FIN.280)
FR: IF ANSWER FOR FIN.260 = 1, SHOW CARD F18.
IF ANSWER FOR FIN.260 = 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
B. $1,000 - $1,999
C. $2,000 - $2,999
D. $3,000 - $3,999
E. $4,000 - $4,999
F. $5,000 - $5,999
G. $6,000 - $6,999
H. $7,000 - $7,999
I. $8,000 - $8,999
J. $9,000 - $9,999
K. $10,000 - $10,999
L. $11,000 - $11,999
M. $12,000 - $12,999
N. $13,000 - $13,999
O. $14,000 - $14,999
P. $15,000 - $15,999
Q. $16,000 - $16,999
R. $17,000 - $17,999
S. $18,000 - $18,999
T. $19,000 - $19,999
FIN.270
FR: ENTER NUMBER CORRESPONDING TO TOTAL COMBINED FAMILY INCOME.
(01) B. $1,000 - $1,999
(02) C. $2,000 - $2,999
(03) D. $3,000 - $3,999
(04) E. $4,000 - $4,999
(05) F. $5,000 - $5,999
(06) G. $6,000 - $6,999
(07) H. $7,000 - $7,999
(08) I. $8,000 - $8,999
(09) J. $9,000 - $9,999
(10) K. $10,000 - $10,999
(11) L. $11,000 - $11,999
(12) M. $12,000 - $12,999
(13) N. $13,000 - $13,999
(14) O. $14,000 - $14,999
(15) P. $15,000 - $15,999
(16) Q. $16,000 - $16,999
(17) R. $17,000 - $17,999
(18) S. $18,000 - $18,999
(19) T. $19,000 - $19,999
(20) U. $20,000 - $20,999
(21) V. $21,000 - $21,999
(22) W. $22,000 - $22,999
(23) X$ 23,000 - $23,999
(24) Y. $24,000 - $24,999
(25) Z. $25,000 - $25,999
(26) AA. $26,000 - $26,999
(27) BB. $27,000 - $27,999
(28) CC. $28,000 - $28,999
(29) DD. $29,000 - $29,999
(30) EE. $30,000 - $30,999
(31) FF. $31,000 - $31,999
(32) GG. $32,000 - $32,999
(33) HH. $33,000 - $33,999
(34) II. $34,000 - $34,999
(35) JJ. $35,000 - $39,999
(36) KK. $40,000 - $44,999
(37) LL. $45,000 - $49,999
(38) MM. $50,000 - $54,999
(39) NN. $55,000 - $59,999
(40) OO. $60,000 - $64,999
(41) PP. $65,000 - $69,999
(42) QQ. $70,000 - $74,999
(43) RR. $75,000 and over
(97) Refused
(99) Don't know
(2) Rented (FIN.282)
(3) Other arrangement (FINCCI3)
(7) Refused (FINCCI3)
(9) Don't know (FINCCI3)
(2) No
(7) Refused
(9) Don't know
[p. 84]
Part C -- Program Participation
FIN.300
Have you EVER applied for Supplemental Security Income or SSI, even if the claim was denied?
[Else, display]
Have any family members living here EVER applied for Supplemental Security Income, or SSI? This includes people who applied for benefits, even if the claim was denied.
(2) No
(7) Refused
(9) Don't know
[(If one person family and FSSAPL eq (1)) or FSSAPL eq (2,7,9)] go to FIN.330;
[Else go to FIN.310]
FIN.310
ENTER (N) FOR NO MORE AFTER THE LAST NUMBER.
Who in the family applied for it? (Anyone else?)
FR: INDICATE EACH FAMILY MEMBER WHO APPLIED FOR SSI BENEFITS.
[ ]
[ ]
[ ]
[ ]
[ ]
Have you EVER APPLIED for disability benefits from Social Security, even if the claim was denied?
[Else, display]
Have any family members living here EVER APPLIED for disability benefits from Social Security?
This includes people who applied for benefits, even if the claim was denied.
(2) No
(7) Refused
(9) Don't know
[(If one person family and FSSAPL eq (1)) or FSSAPL eq (2,7,9)] go to FINCCI4;
[Else go to FIN.340]
FIN.340
FR: INDICATE EACH FAMILY MEMBER WHO APPLIED FOR SOCIAL SECURITY DISABILITY BENEFITS. ENTER (N) FOR NO MORE AFTER THE LAST SUMMER.
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FIN.350
FR: IF LESS THAN 1 MONTH, ENTER (1).
(12)12 months or all
(97) Refused
(99) Don't know
FR: AN AUTHORIZED PERSON IS ONE WHOSE NAME APPEARS ON A CERTIFICATION CARD.
(2) No
(7) Refused
(9) Don't know
[Else if FFSTIP eq (2,7,9)] go to FINCCI5;
[Else go to FIN.370]
FIN.370
ENTER (N) FOR NO MORE AFTER THE LAST NUMBER.
Who was authorized to receive Food Stamps? (Anyone else?)
FR: INDICATE FAMILY MEMBERS WHO WERE AUTHORIZED TO RECEIVE FOOD STAMPS.
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FR: IF LESS THAN 1 MONTH, ENTER (1).
(12) 12 months or all
(97) Refused
(99) Don't know
[p. 86]
FIN.384
(2) No
(7) Refused
(9) Don't know
[(If one person family and FINWIC eq (1)) or FINWIC eq (2,7,9)] go to end of section;
[Else go to FIN.385]
FIN.385
Who received this? (Anyone else?)
FR: INDICATE FAMILY MEMBERS WHO WERE AUTHORIZED TO RECEIVE WIC BENEFITS.
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