fam

[p.1]

2007 NHIS Questionnaire - Family
Family Identification

Document Version Date: 28 - May-08

Question ID: FID.100_00.000

Instrument Variable Name: HHCHANGE
Question Text:

I have recorded that [your name is {fill fullname}, you are /fill ALIAS is] [fill sex], [fill age] years old, born on [fill birthdate]. [His/Her] national origin is [fill Hispanic origin], and [his/her] race is [fill race]:
Is this information correct?

1 Yes, this information is correct
2 No, correction(s) needed/more corrections needed

Universe Text: All nondeleted family members
Skip Instructions:

(1) if no additional PX remain
if SCREENIN = 0 and I_SCRN_STATUS = S [goto EXIT(HHC)]
else [goto FIDCC13]
(2) [goto CWHAT2]

Question ID: FID.110_00.000

Instrument Variable Name: CWHAT2
Question Text:

* Change(s) needed for [ALIAS].
* Enter each number that applies. If a wrong choice, type that choice again.
1 Name
2 Age or DOB
3 Sex
4 National origin
5 Race

Universe Text: HHCHANGE = 2 (No, not correct)
Skip Instructions:

(1) [goto CHG_NAME_FNAME]
(2) [goto CHG_AGEDOB_1]
(3) [goto CHG_SEX]
(4) [goto CHG_NATOR]
(5) [goto CHG_RACE]

Question ID: FID.245_00.000

Instrument Variable Name: HHCHANGE_1
Question Text:

I have recorded that {your name is/ALIAS is} {fill full name}, age is {fill age}, date of birth is {fill birthdate}, {his/her} national origin is {fill Hispanic origin}, and {his/her} {fill race} is:
Is this information correct?

1 Yes, information is correct_
2 No, correction(s) needed/more corrections needed

Universe Text: All nondeleted family members with a change made to their demographic information
Skip Instructions:

(1) if no additional PX remain
if SCREENIN = 0 and I_SCRN_STATUS = S, GOTO EXIT(HHC)
else GOTO FIDCC13
(2) GOTO ERR_HHCHANGE_1

[p.2]

Question ID: FID.250_00.000

Instrument Variable Name: MARITAL
Question Text:

* ASK OR VERIFY
[fill: Are you/Is ALIAS] now married, widowed, divorced, separated, never married, or living with a partner?

1 Married
2 Widowed
3 Divorced
4 Separated
5 Never Married
6 Living with partner
7 Refused
9 Don't know

Universe Text: All persons, 14 and older, who don't have a marital status yet
Skip Instructions:

(1) [goto SPFLAG]
(2-5, R, D) [goto FIDCCI3]
(6) if LINTAL[FAMINT] = 1 [goto FIDCCI4]
else [goto COHAB1]

Question ID: FID.250_03.000

Instrument Variable Name: MARVER_FLG
Question Text:

1 Yes
2 No
7 Refused
9 Don't know

Universe Text:
Skip Instructions:

Question ID: FID.260_00.000

Instrument Variable Name: SPOUS
Question Text:

* ASK OR VERIFY
Is [fill: your/ALIAS's] spouse living in the household?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: A potential spouse lives in the unit.
Skip Instructions:

(1) If SPOUS2[PX] = null [goto SPOUS2]
else [goto FIDCCI3]
(2,R,D) [goto FIDCCI3]

[p.3]

Question ID: FID.270_00.000

Instrument Variable Name: SPOUS2
Question Text:

* Probe as necessary and enter the line number of the spouse.
[Display all possible spouse candidates]
01-25 Person # of spouse

Universe Text: Person has an unidentified spouse in the household.
Skip Instructions:

Do not allow line number of the subject to be entered. If so [goto ERR_SPOUS2]
(1-25,R,D) [goto FIDCCI3]

Question ID: FID.280_00.000

Instrument Variable Name: COHAB1
Question Text:

[fill: Have you/Has ALIAS] ever been married?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Marital status is "living with a partner."
Skip Instructions:

(1) [goto COHAB2]
(2,R,D) if COHAB3[PX] = null [goto COHAB3]
else [goto FIDCCI3]

Question ID: FID.290_00.000

Instrument Variable Name: COHAB2
Question Text:

What is [fill: your/ALIAS's] current legal marital status?

1 Married
2 Widowed
3 Divorced
4 Separated
7 Refused
9 Don't know

Universe Text: Person has been married.
Skip Instructions:

(1-4,R,D) If COHAB3[PX] = null [goto COHAB3]
else [goto FIDCCI3]

Question ID: FID.300_00.000

Instrument Variable Name: COHAB3
Question Text:

* Probe as necessary and enter the line number of the cohabiting partner.
[Display all possible cohabitation candidates]
01-25 Person number

Universe Text: Co-habitating partner has yet to be identified.
Skip Instructions:

If line number of the subject is entered [goto ERR_COHAB3]
(1-25,R,D) [goto FIDCCI3]

[p.4 ]

Question ID: FID.322_00.000

Instrument Variable Name: DEGREE4
Question Text:

I noted that [father's fullname] is the father of [child's fullname]. Is [child's fullname] his biological, adoptive, step, foster, or [fill: son/daughter] in law?

1 Biological
2 Adoptive
3 Step
4 Foster
5 -in-law
7 Refused
9 Don't know

Universe Text: When the reference person is the person in question's parent.
Skip Instructions:

(1) if AGEDIFF (12 [goto ERR_DEGREE4]
if ERR_DEGREE4 = 1 [goto FIDCCI4B]
else reset DEGREE4 [goto DEGREE4] endif
else [goto FIDCCI4B]
(2-5,R,D) [goto FIDCCI4B]

Question ID: FID.324_00.000

Instrument Variable Name: DEGREE5
Question Text:

I noted that [mother's fullname] is the mother of [child's fullname]. Is [child's fullname] her biological, adoptive, step, foster, or [fill: son/daughter] in law?

1 Biological
2 Adoptive
3 Step
4 Foster
5 -in-law
7 Refused
9 Don't know

Universe Text: When the reference person is the person in question's parent.
Skip Instructions:

(1) if AGEDIFF (12 [goto ERR_DEGREE5]
if yes, continue the interview [goto FIDCCI4B]
else, reset DEGREE5 [goto DEGREE5] endif
else [goto FIDCCI4B]
(2-5,R,D) [goto FIDCCI4B]

[p.5 ]

Question ID: FID.326_00.000

Instrument Variable Name: MOTHER
Question Text:

* Ask or verify Is [fill: your/ALIAS's] mother a household member? (Include biological (natural), adoptive, step, or foster mother or mother-in-law)
* Enter the line number of the mother or mother-in-law.
If the mother or mother-in-law is not a household member, enter "0".
If the person has no parents present but has a legal guardian, enter "96".
* Choose mother over mother-in-law if both are present.

00 Mother not a household member
01-25 Person number of mother
96 Has legal guardian
97 Refused
99 Don't know

Universe Text: Potential mother in the Family, mother not already identified
Skip Instructions:

(01-25) [goto MOTHERCK_A]
(0,R,D) [goto FIDCCI5]
(96) [goto GUARD]

Question ID: FID.330_01.000

Instrument Variable Name: MOTHERCK_A
Question Text:

[fill1: Are you/Is ALIAS] [fill2: ALIAS's/your] biological (natural), adoptive, step, or foster mother or mother-in-law?

1 Biological mother
2 Adoptive mother
3 Step mother
4 Foster mother
5 Mother-in-law
7 Refused
9 Don't know

Universe Text: Mother is in the immediate family.
Skip Instructions:

(1) If AGEDIFF (12 [goto ERR_MOTHERCK_A]
if (1) [goto FIDCCI5]
elseif (2) [goto MOTHER]
elseif (3), reset MOTHERCK_A [goto MOTHERCK_A]
else [goto FIDCCI5]
(2-5,R,D) [goto FIDCCI5]

[p.6]

Question ID: FID.330_02.000

Instrument Variable Name: MOM_CKFG
Question Text:

[fill1: Are you/Is ALIAS] [fill2: ALIAS's/your] biological (natural), adoptive, step, or foster mother or mother-in-law?
1 Relationship is correct

Universe Text: Mother is in the immediate family.
Skip Instructions:

(1) If AGEDIFF (12 [goto ERR_MOTHERCK_A]
if (1) [goto FIDCCI5]
elseif (2) [goto MOTHER]
elseif (3), reset MOTHERCK_A [goto MOTHERCK_A]
else [goto FIDCCI5]
(2-5,R,D) [goto FIDCCI5]

Question ID: FID.340_00.000

Instrument Variable Name: FATHER
Question Text:

* Ask or verify
Is [fill: your/ALIAS's] father a household member? (Include biological (natural), adoptive, step, or foster father or father-
in-law).
* Enter the line number of the father or father-in-law.
* If the father is not a household member, enter '0'.
* If the person has no parents present but has a legal guardian, enter '96'.
* Choose father over father-in-law if both are present.

00 Father not in household
01-25 Person # of father
96 Has legal guardian
97 Refused
99 Don't know

Universe Text: Potential Father in Family, not already identified
Skip Instructions:

(1-25) [goto FATHERCK_A]
(0,R,D) [goto FIDCCI4]
(96) [goto GUARD]

[p.7]

Question ID: FID.350_01.000

Instrument Variable Name: FATHERCK_A
Question Text:

[fill1: Are you/Is ALIAS]

[fill2: ALIAS's/your] biological (natural), adoptive, step, or foster father or father-in-law?

1 Biological father
2 Adoptive father
3 Step father
4 Foster father
5 Father-in-law
7 Refused
9 Don't know

Universe Text: Father has been identified
Skip Instructions:

(1) If AGEDIFF (12 [goto ERR_FATHERCK_A]
if ERRFATHERCK_A = (1) [goto FIDCCI4]
elseif (2) [goto FATHER]
elseif (3) reset FATHERCK_A
[goto FATHERCK_A] endif
else [goto FIDCCI4]
(2-5,R,D) [goto FIDCCI4]

Question ID: FID.350_02.000

Instrument Variable Name: DAD_CKFG
Question Text:

[fill1: Are you/Is ALIAS] [fill2: ALIAS's/your] biological (natural), adoptive, step, or foster father or father-in-law?
1 Relationship is correct

Universe Text: Father has been identified
Skip Instructions:

Question ID: FID.360_01.000

Instrument Variable Name: GUARD
Question Text:

Who is [fill: your/ALIAS's ] legal guardian?
* Enter the line number of [fill1: your/ALIAS's] gu a rdian.
* If the guardian is not a household member, enter '0'.

00 Guardian not a household member
01-25 Person # of guardian
97 Refused
99 Don't know

Universe Text: Child identified as a guard at mother or father or, at the FIDCCI5 procedure, it's determined that the child
(AGE(14) has no mother or father in the family.
Skip Instructions:

(0-25,R,D) [goto FIDCCI4]

[p.8 ]

Question ID: FID.380_00.000

Instrument Variable Name: KNOW2
Question Text:

* Verify or ask
Who in the family would you say knows about the health of all the family members?
[Display all family members who not deleted and ) 17 or emancipated minors.]
* Mark all that apply, separate with commas.

1 Yes, knows family members' health_
2 No, does not know family member's health_
7 Refused
9 Don't know

Universe Text: More than one adult
Skip Instructions:

(1-25,R,D)
if SCSEL = 0 [goto FINTRO2]
else [goto KNOWSC2]

Question ID: FID.390_03.000

Instrument Variable Name: FINTRO2
Question Text:

* Enter line number(s) of family members listed that are currently present. Enter up to 10 numbers, separate with commas.
[Display all family members who are not deleted and )17 or emancipated minors]
* If any persons listed are not present, say:
We would like to have all adult family members who are at home take part in the interview. Are (READ NAMES) at_
home now?
* If yes, ask: Could they join us?
* If nobody is presently available, enter "96" to proceed to a callback screen.

1 Present
2 Not present

Universe Text: All nondeleted persons )17 or emancipated minors
Skip Instructions:

(96) [goto FCALLBK1]
if only one PX selected [goto HLTH_BEG]
else [goto FAMRESP]

Question ID: FID.390_04.000

Instrument Variable Name: FAMRESP
Question Text:

* Ask if necessary: 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.

01-25 Person # of Family Respondent

Universe Text: More than 1 adult present.
Skip Instructions:

goto HLTH_BEG

[p.1]

2007 NHIS Questionnaire - Family
Family Health Status and Limitations

Document Version Date: 28 - May-08

Question ID: FHS.005_00.000

Instrument Variable Name: FLAPLYLM
Question Text:

(book)? [F1]
[fill1: Are/Is]
* Read names
(fill roster of persons age 0-4)
limited in the kind or amount of play activities [fill2: they/he/she] can do because of a physical, mental, or emotional
problem?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with one or more persons less than 5 years of age
Skip Instructions:

(1) [if only one child less than 5 years of age, store the person number in PLAPLYLM and goto PLAPLYUN;
else, goto PLAPLYLM]
(2,R,D) [goto FSPEDEIS]

Question ID: FHS.010_00.000

Instrument Variable Name: PLAPLYLM
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons less than five years of age and at least one is limited in play activities
Skip Instructions:

goto PLAPLYUN
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FHS.020_00.000

Instrument Variable Name: PLAPLYUN
Question Text:

Is [fill: ALIAS] able to take part AT ALL in the usual kinds of play activities done by most children [fill: ALIAS]'s age?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons less than 5 years of age who are limited in play activities
Skip Instructions:

repeat this question for all persons listed at PLAPLYLM, then goto FSPEDEIS

[p.2 ]

Question ID: FHS.050_00.000

Instrument Variable Name: FSPEDEIS
Question Text:

(book) ? [F1]
[fill: Do you/Does/Do any of these family members,
* Read names
(fill roster of persons less than age 18)]
receive Special Educational or Early Intervention Services?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with one or more persons less than 18 years of age
Skip Instructions:

(1) [if only one person less than 18 years of age, store the person number in PSPEDEIS and goto PSPEDEM;
else, goto PSPEDEIS]
(2,R,D) [goto FLAADL]

Question ID: FHS.060_00.000

Instrument Variable Name: PSPEDEIS
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)

1 Yes
2 No
7 Refused
9 Don't know

Universe Text:
All families with two or more persons less than 18 years of age and at least one receives Special Educational or _
Early Intervention Services_
Skip Instructions:

goto PSPEDEM
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: : FHS.065_00.000

Instrument Variable Name: PSPEDEM
Question Text:

[fill: Do you/Does ALIAS] receive these services because of an emotional
or behavioral problem?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who receive Special Educational or Early Intervention Services
Skip Instructions:

repeat this question for all persons listed at PSPEDEIS, then goto FLAADL

[p.3]

Question ID: FHS.070_00.000

Instrument Variable Name: FLAADL
Question Text:

(book)? [F1]
Because of a physical, mental, or emotional problem, [fill1: do you/does anyone in the family] need the help of other
persons with PERSONAL CARE NEEDS, such as eating, bathing, dressing, or getting around inside this home?
[fill2: Do not include family members age 2 and under.]

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with one or more persons 3 years of age or older
Skip Instructions:

(1) [if a single-person family, store the person number in PLAADL and goto LABATH; else, goto PLAADL]
(2,R,D) [goto FLAIADL]

Question ID: FHS.080_00.000

Instrument Variable Name: PLAADL
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons 3 years of age or older and at least one needs the help of other persons with
personal care needs
Skip Instructions:

goto LABATH
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FHS.090_01.000

Instrument Variable Name: LABATH
Question Text:

[fill: Do you/Does ALIAS] need the help of other persons with...
Bathing or showering?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons 3 years of age or older who need help with personal care needs
Skip Instructions:

goto LADRESS

[p.4 ]

Question ID: FHS.090_02.000

Instrument Variable Name: LADRESS
Question Text:

* Read lead-in if necessary.
[fill: Do you/Does ALIAS] need the help of other persons with...
Dressing?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons 3 years of age or older who need help with personal care needs
Skip Instructions:

goto LAEAT

Question ID: FHS.090_03.000

Instrument Variable Name: LAEAT
Question Text:

* Read lead-in if necessary.
[fill: Do you/Does ALIAS] need the help of other persons with...
Eating?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons 3 years of age or older who need help with personal care needs
Skip Instructions:

goto LABED

Question ID: FHS.090_04.000

Instrument Variable Name: LABED
Question Text:

* Read lead-in if necessary.
[fill: Do you/Does ALIAS] need the help of other persons with...
Getting in or out of bed or chairs?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons 3 years of age or older who need help with personal care needs
Skip Instructions:

goto LATOILT

[p.5]

Question ID: FHS.090_05.000

Instrument Variable Name: LATOILT
Question Text:

* Read lead-in if necessary.
[fill: Do you/Does ALIAS] need the help of other persons with...
Using the toilet, including getting to the toilet?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons 3 years of age or older who need help with personal care needs
Skip Instructions:

goto LAHOME

Question ID: FHS.090_06.000

Instrument Variable Name: LAHOME
Question Text:

* Read lead-in if necessary.
[fill: Do you/Does ALIAS] need the help of other persons with...
Getting around inside the home?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons 3 years of age or older who need help with personal care needs_
Skip Instructions:

goto LABATH for the next persons listed at PLAADL; else, goto FLAIADL_

Question ID: FHS.150_00.000

Instrument Variable Name: FLAIADL
Question Text:

(book)? [F1]
Because of a physical, mental, or emotional problem, do [fill: you/any of these family members
* Read names
(fill roster of persons age 18 or older)]
need the help of other persons in handling ROUTINE NEEDS, such as everyday household chore s, doing necessary
business, shopping, or getting around for other purposes?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with one or more persons 18 years of age or older
Skip Instructions:

(1) [if only one person 18 years of age or older, store the person number in PLAIADL and goto FLAWKNOW;
else, goto PLAIADL]
(2,R,D) [goto FLAWKNOW]

Question ID: FHS.160_00.000

Instrument Variable Name: PLAIADL
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons 18 years of age or older and at least one needs the help of other persons in
handling routine needs
Skip Instructions:

goto FLAWKNOW
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FHS.170_00.000

Instrument Variable Name: FLAWKNOW
Question Text:

(book)? [F1]
Does a physical, mental, or emotional problem NOW keep [fill: you/any of these family members
* Read names
(fill roster of persons age 18 or older)]
from working at a job or business?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with one or more persons 18 years of age or older
Skip Instructions:

(1) [if only one person 18 years of age or older, store the person number in PLAWKNOW and goto FLAWALK;
else, goto PLAWKNOW]
(2,R,D) [goto FLAWKLIM]

Question ID: FHS.180_00.000

Instrument Variable Name: PLAWKNOW
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons 18 years of age or older and at least one is unable to work due to a physical, mental, or emotional problem
Skip Instructions:

all persons selected goto FLAWALK; else, goto FLAWKLIM
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FHS.190_00.000

Instrument Variable Name: FLAWKLIM
Question Text:

(book)? [F1]
[fill: Are you limited in the kind OR amount of work you/ Is ALIAS limited in the kind OR amount of work he/she/ Are
any of these family members,
* Read names
(fill roster of persons age 18 or older)]
limited in the kind OR amount of work they] can do because of a physical, mental or emotional problem?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with one or more persons 18 years of age or older not listed as being unable to work due to a physical,
mental, or emotional problem
Skip Instructions:

(1) [if only one person 18 years of age or older not selected at PLAWKNOW, store person number in _
PLAWKLIM and goto FLAWALK; else, goto PLAWKLIM]
(2,R,D) [goto FLAWALK]

Question ID: FHS.200_00.000

Instrument Variable Name: PLAWKLIM
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)

0 Unable to work
1 Limited in work
2 Not limited in work
7 Refused
9 Don't know

Universe Text: All families with two or more persons 18 years of age or older able to work and at least one is limited in the kind
or amount of work he/she can do
Skip Instructions:

goto FLAWALK
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FHS.210_00.000

Instrument Variable Name: FLAWALK
Question Text:

(book) ? [F1]
Because of a health problem, [fill: do you/does anyone in the family]
have difficulty walking without using any special equipment?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in PLAWALK and goto FLAREMEM; else, goto PLAWALK]
(2,R,D) [goto FLAREMEM]

Question ID: FHS.220_00.000

Instrument Variable Name: PLAWALK
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one has difficulty walking without using special equipment
Skip Instructions:

goto FLAREMEM
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

[p.9 ]

Question ID: FHS.230_00.000

Instrument Variable Name: FLAREMEM
Question Text:

(book)? [F1]
[fill1: Are you/Is anyone in the family] LIMITED IN ANY WAY because of difficulty remembering or because
[fill2: you/they] experience periods of confusion?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store person number in PLAREMEM and goto LAHCC; else, goto PLAREMEM]
(2,R,D) [goto FLIMANY]

Question ID: FHS.240_00.000

Instrument Variable Name: PLAREMEM
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one is limited due to difficulty remembering or periods of confusion
Skip Instructions:

goto FLIMANY
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FHS.250_00.000

Instrument Variable Name: FLIMANY
Question Text:

(book)? [F1]
[fill: Are you/ Is ALIAS/ Are any family members
* Read names
(fill roster of applicable persons)]
LIMITED IN ANY WAY in any activities because of physical, mental or emotional problems?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with one or more family members not previously mentioned as having a limitation
Skip Instructions:

(1) [if a one-person family or the respondent is the only person NOT previously mentioned as having a limitation, store person number in PLIMANY and goto LAHCC; else goto PLIMANY]
(2,R,D) [goto LAHCC]

Question ID: FHS.260_00.000

Instrument Variable Name: PLIMANY
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)

0 Limitation previously mentioned
1 Yes, limited in some other way
2 Not limited in any way
7 Refused
9 Don't know

Universe Text: All families with two or more persons not previously mentioned as having a limitation
Skip Instructions:

goto LAHCC
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

[p.11 ]

Question ID: FHS.270_00.000

Instrument Variable Name: LAHCC
Question Text:

(book) F1 ? [F1]
What conditions or health problems cause [fill: ALIAS]'s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.

01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Mental retardation
08 Other developmental problem (e.g., cerebral palsy)
09 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)
90 Other impairment/problem (specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure

Universe Text: All persons less than 18 years of age who have at least one reported limitation
Skip Instructions:

(1-4,6-13) [goto appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
(5) [fill "96" in LHCL05N and fill "6" in LHCL05T]
(90) [goto LAHCC_S1]
(91) [goto LAHCC_S2]
(R,D) [repeat this question for the next person less than 18 years of age with a reported limitation; if no more _
persons less than 18 years of age with a reported limitation, goto LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.

Question ID: FHS.271_90.000

Instrument Variable Name: LAHCC_S1
Question Text:

* Read if necessary.
What is the other impairment or problem?
Verbatim Verbatim Response
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

goto LHCL90N

Question ID: FHS.271_91.000

Instrument Variable Name: LAHCC_S2
Question Text:

* Read if necessary.
What is the other impairment or problem?
Verbatim Verbatim Response
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

goto LHCL91N

Question ID: FHS.280_01.000

Instrument Variable Name: LHCL01N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a vision problem or problem seeing?
* Enter number for time with a vision problem or problem seeing.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to a vision problem or problem seeing
Skip Instructions:

(1-95,D) [goto LHCL01T]
(96) [fill "6" in LHCL01T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL01T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]

Question ID: FHS.280_02.000

Instrument Variable Name: LHCL01T
Question Text:

2 of 2
* Enter time period for time with vision problem or problem seeing.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to a vision problem or problem seeing and 1-95, D
was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(6) [goto ERR2_LHCL01T]
if (LHCL01T = 4 and LHCL01N ) AGE) or (LHCL01T = 3 and LHCL01N ) AGE in months) or (LHCL01T = 2 and LHCL01N ) AGE in weeks), goto ERR1_LHCL01T

Question ID: FHS.282_01.000

Instrument Variable Name: LHCL02N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a hearing problem?
* Enter number for time with a hearing problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to a hearing problem
Skip Instructions:

(1-95,D) [goto LHCL02T]
(96) [fill "6" in LHCL02T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
(R) [store "R" in LHCL02T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]

Question ID: FHS.282_02.000

Instrument Variable Name: LHCL02T
Question Text:

2 of 2
* Enter time period for time with hearing problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to a hearing problem and 1-95, D was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(6) [goto ERR2_LHCL02T] if (LHCL02T = 4 and LHCL02N ) AGE) or (LHCL02T = 3 and LHCL02N ) AGE in months) or (LHCL02T = 2
and LHCL02N ) AGE in weeks), goto ERR1_LHCL02T

Question ID: FHS.284_01.000

Instrument Variable Name: LHCL03N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a speech problem?
* Enter number for time with a speech problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to a speech problem
Skip Instructions:

(1-95,D) [goto LHCL03T]
(96) [fill "6" in LHCL03T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL03T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]

Question ID: FHS.284_02.000

Instrument Variable Name: LHCL03T
Question Text:

2 of 2
* Enter time period for time with speech problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to a speech problem and 1-95, D was entered for
the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(6) [goto ERR2_LHCL03T] if (LHCL03T = 4 and LHCL03N ) AGE) or (LHCL03T = 3 and LHCL03N ) AGE in months) or (LHCL03T = 2
and LHCL03N ) AGE in weeks), goto ERR1_LHCL03T

Question ID: FHS.286_01.000

Instrument Variable Name: LHCL04N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had asthma or a breathing problem?
* Enter number for time with an asthma or breathing problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to asthma/breathing problem
Skip Instructions:

(1-95,D) [goto LHCL04T]
(96) [fill "6" in LHCL04T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL04T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]

Question ID: FHS.286_02.000

Instrument Variable Name: LHCL04T
Question Text:

2 of 2
* Enter time period for time with asthma or a breathing problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to asthma/breathing problem and 1-95, D was
entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA] (6) [goto ERR2_LHCL04T] if (LHCL04T = 4 and LHCL04N ) AGE) or (LHCL04T = 3 and LHCL04N ) AGE in months) or (LHCL04T = 2 and LHCL04N ) AGE in weeks), goto ERR1_LHCL04T

Question ID: FHS.288_01.000

Instrument Variable Name: LHCL06N
Question Text:

1 of 2
How long [fill1: have you/has ALIAS] had the injury that caused [fill2:your/his/her] limitation?
* Enter number for time with the injury.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to an injury
Skip Instructions:

(1-95,D) [goto LHCL06T]
(96) [fill "6" in LHCL06T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL06T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]

Question ID: FHS.288_02.000

Instrument Variable Name: LHCL06T
Question Text:

2 of 2
* Enter time period for time with the injury that caused [fill: your/his/her] limitation.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to an injury and 1-95, D was entered for the
"number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA] (6) [goto ERR2_LHCL06T] if (LHCL06T = 4 and LHCL06N ) AGE) or (LHCL06T = 3 and LHCL06N ) AGE in months) or (LHCL06T = 2 and LHCL06N ) AGE in weeks), goto ERR1_LHCL06T

Question ID: FHS.290_01.000

Instrument Variable Name: LHCL07N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had mental retardation?
* Enter number for time with mental retardation.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to mental retardation
Skip Instructions:

(1-95,D) [goto LHCL07T]
(96) [fill "6" in LHCL07T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL07T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]

Question ID: FHS.290_02.000

Instrument Variable Name: LHCL07T
Question Text:

2 of 2
* Enter time period for time with mental retardation.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to mental retardation and 1-95, D was entered for
the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA] (6) [goto ERR2_LHCL07T] if (LHCL07T = 4 and LHCL07N ) AGE) or (LHCL07T = 3 and LHCL07N ) AGE in months) or (LHCL07T = 2 and LHCL07N ) AGE in weeks), goto ERR1_LHCL07T

Question ID: FHS.292_01.000

Instrument Variable Name: LHCL08N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a developmental problem (e.g. cerebral palsy)?
* Enter number for time with a developmental problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to some other developmental problem
Skip Instructions:

(1-95,D) [goto LHCL08T]
(96) [fill "6" in LHCL08T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL08T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]

Question ID: FHS.292_02.000

Instrument Variable Name: LHCL08T
Question Text:

2 of 2
* Enter time period for time with developmental problem (e.g. cerebral palsy).

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to some other developmental problem and 1-95, D
was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA] (6) [goto ERR2_LHCL08T] if (LHCL08T = 4 and LHCL08N ) AGE) or (LHCL08T = 3 and LHCL08N ) AGE in months) or (LHCL08T = 2 and LHCL08N ) AGE in weeks), goto ERR1_LHCL08T

Question ID: FHS.294_01.000

Instrument Variable Name: LHCL09N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a mental, emotional, or behavioral problem?
* Enter number for time with a mental, emot ional, or behavioral problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to a mental, emotional, or behavioral problem
Skip Instructions:

(1-95,D) [goto LHCL09T]
(96) [fill "6" in LHCL09T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL09T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]

Question ID: FHS.294_02.000

Instrument Variable Name: LHCL09T
Question Text:

2 of 2
* Enter time period for time with mental, emotional, or behavioral problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to a mental, emotional, or behavioral problem and
1-95, D was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA] (6) [goto ERR2_LHCL09T] if (LHCL09T = 4 and LHCL09N ) AGE) or (LHCL09T = 3 and LHCL09N ) AGE in months) or (LHCL09T = 2 and LHCL09N ) AGE in weeks), goto ERR1_LHCL09T

Question ID: FHS.296_01.000

Instrument Variable Name: LHCL10N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a bone, joint, or muscle problem?
* Enter number for time with a bone, joint, or muscle problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to a bone, joint, or muscle problem
Skip Instructions:

(1-95,D) [goto LHCL10T]
(96) [fill "6" in LHCL10T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL10T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]

Question ID: FHS.296_02.000

Instrument Variable Name: LHCL10T
Question Text:

2 of 2
* Enter time period for time with bone, joint, or muscle problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to a bone, joint, or muscle problem and 1-95, D
was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA] (6) [goto ERR2_LHCL10T] if (LHCL10T = 4 and LHCL10N ) AGE) or (LHCL10T = 3 and LHCL10N ) AGE in months) or (LHCL10T = 2 and LHCL10N ) AGE in weeks), goto ERR1_LHCL10T

Question ID: FHS.298_01.000

Instrument Variable Name: LHCL11N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had epilepsy or seizures?
* Enter number for time with epileplsy or seizures.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to epilepsy or seizures
Skip Instructions:

(1-95,D) [goto LHCL11T]
(96) [fill "6" in LHCL11T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL11T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]

Question ID: FHS.298_02.000

Instrument Variable Name: LHCL11T
Question Text:

2 of 2
* Enter time period for time with epilepsy or seizures.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to epilepsy or seizures and 1-95, D was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA] (6) [goto ERR2_LHCL11T] if (LHCL11T = 4 and LHCL11N ) AGE) or (LHCL11T = 3 and LHCL11N ) AGE in months) or (LHCL11T = 2 and LHCL11N ) AGE in weeks), goto ERR1_LHCL11T

Question ID: FHS.300_01.000

Instrument Variable Name: LHCL12N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a learning disability?
* Enter number for time with a learning disability.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to a learning disability
Skip Instructions:

(1-95,D) [goto LHCL12T]
(96) [fill "6" in LHCL12T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
(R) [store "R" in LHCL12T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]

Question ID: FHS.300_02.000

Instrument Variable Name: LHCL12T
Question Text:

2 of 2
* Enter time period for time with learning disability.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to a learning disability and 1-95, D was entered for
the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA] (6) [goto ERR2_LHCL12T] if (LHCL12T = 4 and LHCL12N ) AGE) or (LHCL12T = 3 and LHCL12N ) AGE in months) or (LHCL12T = 2 and LHCL12N ) AGE in weeks), goto ERR1_LHCL12T

Question ID: FHS.302_01.000

Instrument Variable Name: LHCL13N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had attention deficit/hyperactivity disorder?
* Enter number for time with attention deficit/hyperactivity disorder.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to Attention Deficit/Hyperactivity Disorder
Skip Instructions:

(1-95,D) [goto LHCL13T]
(96) [fill "6" in LHCL13T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL13T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]

Question ID: FHS.302_02.000

Instrument Variable Name: LHCL13T
Question Text:

2 of 2
* Enter time period for time with attention deficit/hyperactivity disorder.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to Attention Deficit/Hyperactivity Disorder and 1-
95, D was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA] (6) [goto ERR2_LHCL13T] if (LHCL13T = 4 and LHCL13N ) AGE) or (LHCL13T = 3 and LHCL13N ) AGE in months) or (LHCL13T = 2 and LHCL13N ) AGE in weeks), goto ERR1_LHCL13T

Question ID: FHS.304_01.000

Instrument Variable Name: LHCL90N
Question Text:

1 of 2
How long [fill1: have you/has ALIAS] had [fill2: problem in LAHCC_S1]?
* Enter number for time with [fill1: problem in LAHCC_S1]?
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to the problem entered at LAHCC_S1
Skip Instructions:

(1-95,D) [goto LHCL90T]
(96) [fill "6" in LHCL90T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA] (R) [store "R" in LHCL90T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]

Question ID: FHS.304_02.000

Instrument Variable Name: LHCL90T
Question Text:

2 of 2
* Enter time period for time with [fill: problem in LAHCC_S1].

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to the problem entered at LAHCC_S1 and 1-95, D
was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC
for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(6) [goto ERR2_LHCL90T]
if (LHCL90T = 4 and LHCL90N ) AGE) or (LHCL90T = 3 and LHCL90N ) AGE in months) or (LHCL90T = 2
and LHCL90N ) AGE in weeks), goto ERR1_LHCL90T

Question ID: FHS.306_01.000

Instrument Variable Name: LHCL91N
Question Text:

1 of 2
How long [fill1: have you/has ALIAS] had [fill2: problem in LAHCC_S2]?
* Enter number for time with [fill1: problem in LAHCC_S2].
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to the problem entered at LAHCC_S2
Skip Instructions:

(1-95,D) [goto LHCL91T]
(96) [fill "6" in LHCL91T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
(R) [store "R" in LHCL91T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]

Question ID: FHS.306_02.000

Instrument Variable Name: LHCL91T
Question Text:

2 of 2
* Enter time period for time with [fill: problem in LAHCC_S2].

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to the problem entered at LAHCC_S2 and 1-95, D
was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC
for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(6) [goto ERR2_LHCL91T]
if (LHCL91T = 4 and LHCL91N ) AGE) or (LHCL91T = 3 and LHCL91N ) AGE in months) or (LHCL91T = 2
and LHCL91N ) AGE in weeks), goto ERR1_LHCL91T

[p.27 ]

Question ID: FHS.350_00.000

Instrument Variable Name: LAHCA
Question Text:

(book) F2
What conditions or health problems cause [fill: your/ALIAS's] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.

01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 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
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(myelitis), 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, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure

Universe Text: All persons 18 years of age or older who have at least one reported limitation
Skip Instructions:

(1-12,14-35) [goto appropriate follow-up questions: LHAL01N - LHAL12N, LHAL14N - LHAL35N]
(13) [fill "96" in LHAL13N and fill "6" in LHAL13T]
(90) [goto LAHCA_S1]
(91) [goto LAHCA_S2]
(R,D) [repeat this question for the next person 18 years of age or older with a reported limitation; if no more
persons 18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of
age or older with a reported limitation. The instrument then proceeds to PHSTAT.

Question ID: FHS.351_90.000

Instrument Variable Name: LAHCA_S1
Question Text:

* Read if necessary.
What is the other impairment or problem?

Verbatim Verbatim Response
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

goto LHAL90N

Question ID: FHS.351_91.000

Instrument Variable Name: LAHCA_S2
Question Text:

* Read if necessary.
What is the other impairment or problem?

Verbatim Verbatim Response
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

goto LHAL91N

[p.29 ]

Question ID: FHS.360_01.000

Instrument Variable Name: LHAL01N
Question Text:

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a vision problem or problem seeing
Skip Instructions:

(1-95,D) [goto LHAL01T]
(96) [fill "6" in LHAL01T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL01T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.360_02.000

Instrument Variable Name: LHAL01T
Question Text:

2 of 2
* Enter time period for time with vision problem or problem seeing.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a vision problem or problem seeing and 1-95, D
was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL01T]
if LHAL01T = 4 and LHAL01N ) AGE, goto ERR1_LHAL01T

[p.30 ]

Question ID: FHS.362_01.000

Instrument Variable Name: LHAL02N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a hearing problem?
* Enter number for time with a hearing problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a hearing problem
Skip Instructions:

(1-95,D) [goto LHAL02T]
(96) [fill "6" in LHAL02T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL02T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.362_02.000

Instrument Variable Name: LHAL02T
Question Text:

2 of 2
* Enter time period for time with hearing problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a hearing problem and 1-95, D was entered for
the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL02T]
if LHAL02T = 4 and LHAL02N ) AGE, goto ERR1_LHAL02T

[p.31 ]

Question ID: FHS.364_01.000

Instrument Variable Name: LHAL03N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had arthritis or rheumatism?
* Enter number for time with arthritis or rheumatism.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to arthritis/rheumatism
Skip Instructions:

(1-95,D) [goto LHAL03T]
(96) [fill "6" in LHAL03T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL03T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.364_02.000

Instrument Variable Name: LHAL03T
Question Text:

2 of 2
* Enter time period for time with arthritis or rheumatism.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to arthritis/rheumatism and 1-95, D was entered for
the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL03T]
if LHAL03T = 4 and LHAL03N ) AGE, goto ERR1_LHAL03T

[p.32 ]

Question ID: FHS.366_01.000

Instrument Variable Name: LHAL04N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a back or neck problem?
* Enter number for time with a back or neck problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a back or neck problem
Skip Instructions:

(1-95,D) [goto LHAL04T]
(96) [fill "6" in LHAL04T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL04T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.366_02.000

Instrument Variable Name: LHAL04T
Question Text:

2 of 2
* Enter time period for time with back or neck problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a back or neck problem and 1-95, D was entered
for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL04T]
if LHAL04T = 4 and LHAL04N ) AGE, goto ERR1_LHAL04T

[p.33 ]

Question ID: FHS.368_01.000

Instrument Variable Name: LHAL05N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a fracture, bone, or joint injury?
* Enter number for time with a fracture, bone or joint injury.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a fracture or bone/joint injury
Skip Instructions:

(1-95,D) [goto LHAL05T]
(96) [fill "6" in LHAL05T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL05T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.368_02.000

Instrument Variable Name: LHAL05T
Question Text:

2 of 2
* Enter time period for time with fracture, bone, or joint injury.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a fracture or bone/joint injury and 1-95, D was
entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL05T]
if LHAL05T = 4 and LHAL05N ) AGE, goto ERR1_LHAL05T

[p.34 ]

Question ID: FHS.370_01.000

Instrument Variable Name: LHAL06N
Question Text:

1 of 2
How long [fill1: have you/has ALIAS] had the other injury that caused [fill2: your/his/her] limitation?
* Enter number for time with the injury.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to some "other" injury
Skip Instructions:

(1-95,D) [goto LHAL06T]
(96) [fill "6" in LHAL06T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL06T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.370_02.000

Instrument Variable Name: LHAL06T
Question Text:

2 of 2
* Enter time period for time with other injury that caused [fill: your/his/her] limitation.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to some "other" injury and 1-95, D was entered for
the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL06T]
if LHAL06T = 4 and LHAL06N ) AGE, goto ERR1_LHAL06T

[p.35 ]

Question ID: FHS.372_01.000

Instrument Variable Name: LHAL07N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a heart problem?
* Enter number for time with a heart problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a heart problem
Skip Instructions:

(1-95,D) [goto LHAL07T]
(96) [fill "6" in LHAL07T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL07T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.372_02.000

Instrument Variable Name: LHAL07T
Question Text:

2 of 2
* Enter time period for time with heart problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a heart problem and 1-95, D was entered for the
"number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL07T]
if LHAL07T = 4 and LHAL07N ) AGE, goto ERR1_LHAL07T

[p.36 ]

Question ID: FHS.374_01.000

Instrument Variable Name: LHAL08N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a stroke problem?
* Enter number for time with a stroke problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a stroke problem
Skip Instructions:

(1-95,D) [goto LHAL08T]
(96) [fill "6" in LHAL08T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL08T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.374_02.000

Instrument Variable Name: LHAL08T
Question Text:

2 of 2
* Enter time period for time with stroke problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a stroke problem and 1-95, D was entered for the
"number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL08T]
if LHAL08T = 4 and LHAL08N ) AGE, goto ERR1_LHAL08T

[p.37 ]

Question ID: FHS.376_01.000

Instrument Variable Name: LHAL09N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had hypertension or high blood pressure?
* Enter number for time with hypertension or high blood pressure.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to hypertension/high blood pressure
Skip Instructions:

(1-95,D) [goto LHAL09T]
(96) [fill "6" in LHAL09T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL09T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.376_02.000

Instrument Variable Name: LHAL09T
Question Text:

2 of 2
* Enter time period for time with hypertension or high blood pressure.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to hypertension/high blood pressure and 1-95, D
was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL09T]
if LHAL09T = 4 and LHAL09N ) AGE, goto ERR1_LHAL09T

[p.38 ]

Question ID: FHS.378_01.000

Instrument Variable Name: LHAL10N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had diabetes?
* Enter number for time with diabetes.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to diabetes
Skip Instructions:

(1-95,D) [goto LHAL10T]
(96) [fill "6" in LHAL10T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL10T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.378_02.000

Instrument Variable Name: LHAL10T
Question Text:

2 of 2
* Enter time period for time with diabetes.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to diabetes and 1-95, D was entered for the
"number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL10T]
if LHAL10T = 4 and LHAL10N ) AGE, goto ERR1_LHAL10T

[p.39 ]

Question ID: FHS.380_01.000

Instrument Variable Name: LHAL11N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a lung problem or breathing problem (e.g., asthma and emphysema)?
* Enter number for time with a lung problem or breathing problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a lung/breathing problem
Skip Instructions:

(1-95,D) [goto LHAL11T]
(96) [fill "6" in LHAL11T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL11T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.380_02.000

Instrument Variable Name: LHAL11T
Question Text:

2 of 2
* Enter time period for time with lung problem or breathing problem (e.g., asthma and emphysema).

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a lung/breathing problem and 1-95, D was _
entered for the "number" part of this two-part question_
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL11T]
if LHAL11T = 4 and LHAL11N ) AGE, goto ERR1_LHAL11T

[p.40 ]

Question ID: FHS.382_01.000

Instrument Variable Name: LHAL12N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had cancer?
* Enter number for time with cancer.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to cancer
Skip Instructions:

(1-95,D) [goto LHAL12T]
(96) [fill "6" in LHAL12T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL12T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.382_02.000

Instrument Variable Name: LHAL12T
Question Text:

2 of 2
* Enter time period for time with cancer.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to cancer and 1-95, D was entered for the "number"
part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL12T]
if LHAL12T = 4 and LHAL12N ) AGE, goto ERR1_LHAL12T

[p.41 ]

Question ID: FHS.384_01.000

Instrument Variable Name: LHAL14N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had mental retardation?
* Enter number for time with mental retardation.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to mental retardation
Skip Instructions:

(1-95,D) [goto LHAL14T]
(96) [fill "6" in LHAL14T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL14T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.384_02.000

Instrument Variable Name: LHAL14T
Question Text:

2 of 2
* Enter time period for time with mental retardation.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to mental retardation and 1-95, D was entered for
the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL14T]
if LHAL14T = 4 and LHAL14N ) AGE, goto ERR1_LHAL14T

[p.42 ]

Question ID: FHS.386_01.000

Instrument Variable Name: LHAL15N
Question Text:

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to some other developmental problem
Skip Instructions:

(1-95,D) [goto LHAL15T]
(96) [fill "6" in LHAL15T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL15T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.386_02.000

Instrument Variable Name: LHAL15T
Question Text:

2 of 2
* Enter time period for time with developmental problem (e.g. cerebral palsy).

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to some other developmental problem and 1-95, D
was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL15T]
if LHAL15T = 4 and LHAL15N ) AGE, goto ERR1_LHAL15T

[p.43]

Question ID: FHS.388_01.000

Instrument Variable Name: LHAL16N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had senility?
* Enter number for time with senility.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to senility
Skip Instructions:

(1-95,D) [goto LHAL16T]
(96) [fill "6" in LHAL16T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL16T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.388_02.000

Instrument Variable Name: LHAL16T
Question Text:

2 of 2
* Enter time period for time with senility.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to senility and 1-95, D was entered for the
"number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL16T]
if LHAL16T = 4 and LHAL16N ) AGE, goto ERR1_LHAL16T

[p.44 ]

Question ID: FHS.390_01.000

Instrument Variable Name: LHAL17N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had depression, anxiety, or an emotional problem?
* Enter number for time with depression, an xiety or an emotional problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to depression/anxiety/emotional problem
Skip Instructions:

(1-95,D) [goto LHAL17T]
(96) [fill "6" in LHAL17T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL17T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.390_02.000

Instrument Variable Name: LHAL17T
Question Text:

2 of 2
* Enter time period for time with depression, anxiety, or an emotional problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to depression/anxiety/emotional problem and 1-95,
D was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL17T]
if LHAL17T = 4 and LHAL17N ) AGE, goto ERR1_LHAL17T

[p.45]

Question ID: FHS.392_01.000

Instrument Variable Name: LHAL18N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a weight problem?
* Enter number for time with a weight problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a weight problem
Skip Instructions:

(1-95,D) [goto LHAL18T]
(96) [fill "6" in LHAL18T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL18T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.392_02.000

Instrument Variable Name: LHAL18T
Question Text:

2 of 2
* Enter time period for time with weight problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a weight problem and 1-95, D was entered for the
"number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL18T]
if LHAL18T = 4 and LHAL18N ) AGE, goto ERR1_LHAL18T

[p.46 ]

Question ID: FHS.394_01.000

Instrument Variable Name: LHAL19N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a missing limb (finger, toe, or digit)?
* Enter number for time with a missing limb.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to missing limbs
Skip Instructions:

(1-95,D) [goto LHAL19T]
(96) [fill "6" in LHAL19T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL19T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.394_02.000

Instrument Variable Name: LHAL19T
Question Text:

2 of 2
* Enter time period for time with missing limb (finger, toe, or digit).

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to missing limbs and 1-95, D was entered for the
"number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL19T]
if LHAL19T = 4 and LHAL19N ) AGE, goto ERR1_LHAL19T

[p.47 ]

Question ID: FHS.396_01.000

Instrument Variable Name: LHAL20N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a kidney, bladder or renal problem?
* Enter number for time with a kidney, bladder or renal problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a kidney, bladder, or renal problem
Skip Instructions:

(1-95,D) [goto LHAL20T]
(96) [fill "6" in LHAL20T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL20T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.396_02.000

Instrument Variable Name: LHAL20T
Question Text:

2 of 2
* Enter time period for time with kidney, bladder or renal problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a kidney, bladder, or renal problem and 1-95, D
was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL20T]
if LHAL20T = 4 and LHAL20N ) AGE, goto ERR1_LHAL20T

[p.48 ]

Question ID: FHS.398_01.000

Instrument Variable Name: LHAL21N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a circulation problem (including blood clots)?
* Enter number for time with a circulation problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to circulation problems
Skip Instructions:

(1-95,D) [goto LHAL21T]
(96) [fill "6" in LHAL21T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL21T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.398_02.000

Instrument Variable Name: LHAL21T
Question Text:

2 of 2
* Enter time period for time with circulation problem (including blood clots).

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to circulation problems and 1-95, D was entered for
the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL21T]
if LHAL21T = 4 and LHAL21N ) AGE, goto ERR1_LHAL21T

[p.49 ]

Question ID: FHS.400_01.000

Instrument Variable Name: LHAL22N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had benign tumors or cysts?
* Enter number for time with benign tumors or cysts.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to benign tumors or cysts
Skip Instructions:

(1-95,D) [goto LHAL22T]
(96) [fill "6" in LHAL22T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL22T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.400_02.000

Instrument Variable Name: LHAL22T
Question Text:

2 of 2
* Enter time period for time with benign tumors or cysts.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to benign tumors or cysts and 1-95, D was entered
for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL22T]
if LHAL22T = 4 and LHAL22N ) AGE, goto ERR1_LHAL22T

[p.50 ]

Question ID: FHS.402_01.000

Instrument Variable Name: LHAL23N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had fibromyalgia or lupus?
* Enter number for time with fibromyalgia or lupus.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to fibromyalgia or lupus
Skip Instructions:

(1-95,D) [goto LHAL23T]
(96) [fill "6" in LHAL23T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL23T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.402_02.000

Instrument Variable Name: LHAL23T
Question Text:

2 of 2
* Enter time period for time with fibromyalgia or lupus.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to fibromyalgia or lupus and 1-95, D was entered
for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL23T]
if LHAL23T = 4 and LHAL23N ) AGE, goto ERR1_LHAL23T

[p.51] 51 of 65

Question ID: FHS.404_01.000

Instrument Variable Name: LHAL24N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had osteoporosis or tendinitis?
* Enter number for time with osteoporosis or tendinitis.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to osteoporosis or tendinitis
Skip Instructions:

(1-95,D) [goto LHAL24T]
(96) [fill "6" in LHAL24T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL24T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.404_02.000

Instrument Variable Name: LHAL24T
Question Text:

2 of 2
* Enter time period for time with osteoporosis or tendinitis.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to osteoporosis or tendinitis and 1-95, D was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL24T] if LHAL24T = 4 and LHAL24N ) AGE, goto ERR1_LHAL24T

[p.52 ]

Question ID: FHS.406_01.000

Instrument Variable Name: LHAL25N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had epilepsy or seizures?
* Enter number for time with epilepsy or seizures.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to epilepsy or seizures
Skip Instructions:

(1-95,D) [goto LHAL25T]
(96) [fill "6" in LHAL25T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL25T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.406_02.000

Instrument Variable Name: LHAL25T
Question Text:

2 of 2
* Enter time period for time with epilepsy or seizures.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to epilepsy or seizures and 1-95, D was entered for
the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT] (6) [goto ERR2_LHAL25T] if LHAL25T = 4 and LHAL25N ) AGE, goto ERR1_LHAL25T

[p.53 ]

Question ID: FHS.408_01.000

Instrument Variable Name: LHAL26N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had multiple sclerosis (MS) or muscular dystrophy (MD)?
* Enter number for time with multiple sclero sis (MS) or muscular dtstrophy (MD)?
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to multiple sclerosis or muscular dystrophy
Skip Instructions:

(1-95,D) [goto LHAL26T]
(96) [fill "6" in LHAL26T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL26T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.408_02.000

Instrument Variable Name: LHAL26T
Question Text:

2 of 2
* Enter time period for time with multiple sclerosis (MS) or muscular dystrophy (MD).

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to multiple sclerosis or muscular dystrophy and 1-
95, D was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL26T]
if LHAL26T = 4 and LHAL26N ) AGE, goto ERR1_LHAL26T

[p.54 ]

Question ID: FHS.410_01.000

Instrument Variable Name: LHAL27N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had polio(myelitis), paralysis or para/quadriplegia?
* Enter number for time with polio (myelitis ) paralysis or para/quadriplegia.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to polio, paralysis, or para/quadriplegia
Skip Instructions:

(1-95,D) [goto LHAL27T]
(96) [fill "6" in LHAL27T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL27T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.410_02.000

Instrument Variable Name: LHAL27T
Question Text:

2 of 2
* Enter time period for time with polio(myelitis), paralysis or para/quadriplegia.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to polio, paralysis, or para/quadriplegia and 1-95, D
was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT] (6) [goto ERR2_LHAL27T] if LHAL27T = 4 and LHAL27N ) AGE, goto ERR1_LHAL27T

[p.55 ]

Question ID: FHS.412_01.000

Instrument Variable Name: LHAL28N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had Parkinson's disease or tremors?
* Enter number for time with Parkinson's disease or tremors.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to Parkinson's disease or other tremors
Skip Instructions:

(1-95,D) [goto LHAL28T]
(96) [fill "6" in LHAL28T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL28T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.412_02.000

Instrument Variable Name: LHAL28T
Question Text:

2 of 2
* Enter time period for time with Parkinson's disease or tremors.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to Parkinson's disease or other tremors and 1-95, D
was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL28T]
if LHAL28T = 4 and LHAL28N ) AGE, goto ERR1_LHAL28T

[p.56 ]

Question ID: FHS.414_01.000

Instrument Variable Name: LHAL29N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had nerve damage (including carpal tunnel syndrome)?
* Enter number for time with nerve damage.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to other nerve damage, including carpal tunnel
syndrome
Skip Instructions:

(1-95,D) [goto LHAL29T]
(96) [fill "6" in LHAL29T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL29T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.414_02.000

Instrument Variable Name: LHAL29T
Question Text:

2 of 2
* Enter time period for time with nerve damage (including carpal tunnel syndrome).

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to other nerve damage, including carpal tunnel
syndrome, and 1-95, D was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT] (6) [goto ERR2_LHAL29T] if LHAL29T = 4 and LHAL29N ) AGE, goto ERR1_LHAL29T

[p.57]

Question ID: FHS.416_01.000

Instrument Variable Name: LHAL30N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a hernia?
* Enter number for time with a hernia.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a hernia
Skip Instructions:

(1-95,D) [goto LHAL30T]
(96) [fill "6" in LHAL30T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL30T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.416_02.000

Instrument Variable Name: LHAL30T
Question Text:

2 of 2
* Enter time period for time with hernia.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to a hernia and 1-95, D was entered for the
"number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL30T]
if LHAL30T = 4 and LHAL30N ) AGE, goto ERR1_LHAL30T

[p.58 ]

Question ID: FHS.418_01.000

Instrument Variable Name: LHAL31N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had an ulcer?
* Enter number for time with an ulcer.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to an ulcer
Skip Instructions:

(1-95,D) [goto LHAL31T]
(96) [fill "6" in LHAL31T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL31T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.418_02.000

Instrument Variable Name: LHAL31T
Question Text:

2 of 2
* Enter time period for time with ulcer.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to an ulcer and 1-95, D was entered for the
"number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL31T]
if LHAL31T = 4 and LHAL31N ) AGE, goto ERR1_LHAL31T

[p.59]

Question ID: FHS.420_01.000

Instrument Variable Name: LHAL32N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had varicose veins or hemorrhoids?
* Enter number for time with varicose veins or hemorrhoids.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to varicose veins or hemorrhoids
Skip Instructions:

(1-95,D) [goto LHAL32T]
(96) [fill "6" in LHAL32T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL32T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.420_02.000

Instrument Variable Name: LHAL32T
Question Text:

2 of 2
* Enter time period for time with varicose veins or hemorrhoids.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to varicose veins or hemorrhoids and 1-95, D was
entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL32T]
if LHAL32T = 4 and LHAL32N ) AGE, goto ERR1_LHAL32T

[p.60 ]

Question ID: FHS.422_01.000

Instrument Variable Name: LHAL33N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a thyroid problem, Grave's disease or gout?
* Enter number for time with a thyroid problem, Grave's disease or gout.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to thyroid problems, Grave's disease, or gout
Skip Instructions:

(1-95,D) [goto LHAL33T]
(96) [fill "6" in LHAL33T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL33T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.422_02.000

Instrument Variable Name: LHAL33T
Question Text:

2 of 2
* Enter time period for time with thyroid problem, Grave's disease or gout.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to thyroid problems, Grave's disease, or gout and 1-
95, D was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL33T]
if LHAL33T = 4 and LHAL33N ) AGE, goto ERR1_LHAL33T

[p.61 ]

Question ID: FHS.424_01.000

Instrument Variable Name: LHAL34N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had a knee problem?
* Enter number for time with a knee problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to knee problems
Skip Instructions:

(1-95,D) [goto LHAL34T]
(96) [fill "6" in LHAL34T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL34T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.424_02.000

Instrument Variable Name: LHAL34T
Question Text:

2 of 2
* Enter time period for time with knee problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to knee problems and 1-95, D was entered for the
"number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL34T]
if LHAL34T = 4 and LHAL34N ) AGE, goto ERR1_LHAL34T

[p.62]

Question ID: FHS.426_01.000

Instrument Variable Name: LHAL35N
Question Text:

1 of 2
How long [fill: have you/has ALIAS] had migraine headaches?
* Enter number for time with migrane headaches.
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to migraine headaches
Skip Instructions:

(1-95,D) [goto LHAL35T]
(96) [fill "6" in LHAL35T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL35T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.426_02.000

Instrument Variable Name: LHAL35T
Question Text:

2 of 2
* Enter time period for time with migraine headaches.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to migraine headaches and 1-95, D was entered for
the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT] (6) [goto ERR2_LHAL35T] if LHAL35T = 4 and LHAL35N ) AGE, goto ERR1_LHAL35T

[p.63]

Question ID: FHS.450_01.000

Instrument Variable Name: LHAL90N
Question Text:

1 of 2
How long [fill1: have you/has ALIAS] had [fill2: LAHCA_S1]?
* Enter number for time with [fill1: LAHCA_S1].
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to the problem entered at LAHCA_S1
Skip Instructions:

(1-95,D) [goto LHAL90T]
(96) [fill "6" in LHAL90T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL90T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.450_02.000

Instrument Variable Name: LHAL90T
Question Text:

2 of 2
* Enter time period for time with [fill: LAHCA_S1].

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to the problem entered at LAHCA_S1 and 1-95, D
was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL90T]
if LHAL90T = 4 and LHAL90N ) AGE, goto ERR1_LHAL90T

[p.64]

Question ID: FHS.452_01.000

Instrument Variable Name: LHAL91N
Question Text:

1 of 2
How long [fill1: have you/has ALIAS] had [fill2: LAHCA_S2]?
* Enter number for time with [fill1: LAHCA_S2].
* Enter '95' for 95 or more.
* Enter '96' if since birth.

01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to the problem entered at LAHCA_S2
Skip Instructions:

(1-95,D) [goto LHAL91T]
(96) [fill "6" in LHAL91T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL91T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]

Question ID: FHS.452_02.000

Instrument Variable Name: LHAL91T
Question Text:

2 of 2
* Enter time period for time with [fill: LAHCA_S2].

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who have a limitation due to the problem entered at LAHCA_S2 and 1-95, D
was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL91T]
if LHAL91T = 4 and LHAL91N ) AGE, goto ERR1_LHAL91T

[p.65 ]

Question ID: FHS.500_00.000

Instrument Variable Name: PHSTAT
Question Text:

Would you say [fill: your/ALIAS's] health in general is excellent, very good, good, fair, or poor?

1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
7 Refused
9 Don't know

Universe Text: All persons
Skip Instructions:

repeat for all persons in the family, goto FINJ3M

[p. 1]

2007 NHIS Questionnaire - Family
Family Access to Health Care and Utilization

Question ID: FAU.010_00.000

Instrument Variable Name: FDMED12M
Question Text:

? [F1]
The following questions are about the use of health care. Do not include dental care.
DURING THE PAST 12 MONTHS, [fill: have you delayed seeking medical care/has medical care been delayed for
anyone in the family] because of worry about the cost?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in PDMED12M and goto FNMED12M; else, goto PDMED12M]
(2,R,D) [goto FNMED12M]

Question ID: FAU.020_00.000

Instrument Variable Name: PDMED12M
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
For which family member was medical care delayed?
(Anyone else?)

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one had medical care delayed due to worry about the cost during
the past 12 months
Skip Instructions:

goto FNMED12M
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FAU.030_00.000

Instrument Variable Name: FNMED12M
Question Text:

(book) ? [F1]
DURING THE PAST 12 MONTHS, was there any time when [fill1: you/someone in the family] needed medical care, but
did not get it because [fill2: you/the family] couldn't afford it?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in PNMED12M and goto FHOSPYR; else, goto _PNMED12M]
(2,R,D) [goto FHOSPYR]

Question ID: FAU.040_00.000

Instrument Variable Name: PNMED12M
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who didn't get needed care?
(Anyone else?)

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one didn't get medical care due to cost during the past 12 months
Skip Instructions:

goto FHOSPYR
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FAU.050_00.000

Instrument Variable Name: FHOSPYR
Question Text:

?[F1]
[fill1: were you/Including all infants born in a hospital, has anyone in the family] been hospitalized OVERNIGHT in the past 12 months? Do not include an overnight stay in the emergency room.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in PHOSPYR and goto HOSPNO; else, goto PHOSPYR] (2,R,D) [goto FHCHM2W]

Question ID: FAU.060_00.000

Instrument Variable Name: PHOSPYR
Question Text:

*Ask or verify. Enter applicable line number(s), separate with commas.
Who was in a hospital overnight?
(Anyone else?)

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one was a patient overnight during the past 12 months
(excluding ER)
Skip Instructions:

goto HOSPNO
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

[p.3 ]

Question ID: FAU.070_00.000

Instrument Variable Name: HOSPNO
Question Text:

(book) ? [F1]
How many different times did [fill: you/ALIAS] stay in any hospital overnight or longer DURING THE PAST 12 MONTHS?

001-365 1-365 times
997 Refused
999 Don't know

Universe Text: All persons who had an overnight hospital stay during the past 12 months (excluding ER)
Skip Instructions:

(1-10) [goto HPNITE]
(11-365) [goto ERR_HOSPNO]
(R,D) [goto HPNITE]

Question ID: FAU.110_00.000

Instrument Variable Name: HPNITE
Question Text:

(book) ? [F1]
Altogether how many nights [fill: were you/was ALIAS] in the hospital DURING THE PAST 12 MONTHS?

001-365 1-365 nights
997 Refused
999 Don't know

Universe Text: All persons who had an overnight hospital stay during the past 12 months (excluding ER)
Skip Instructions:

(1-50,R,D) [goto next person selected at PHOSPYR; if no more persons, goto FHCM2W] (51-365) [goto ERR1_HPNITE]
if HOSPNO gt HPNITE, goto ERR2_HPNITE

[p.4 ]

Question ID: FAU.120_00.000

Instrument Variable Name: FHCHM2W
Question Text:

(book) ? [F1]
* Hand calendar card.
These next questions are about health care received during the 2 WEEKS outlined on that calendar. Include care from
ALL types of medical doctors, such as dermatologists, psychiatrists, ophthalmologists, and general practitioners. Also include care from OTHER health professionals such as nurses, physical therapists, and chiropractors.
Do not include dental care. Do not include care while an overnight patient in a hospital.
During those 2 WEEKS, did [fill: you/anyone in the family] receive care AT HOME from a nurse or other health care professional?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in PHCHM2W and goto PHCHMN2W; else, goto PHCHM2W] (2,R,D) [goto FHCPH2W]

Question ID: FAU.130_00.000

Instrument Variable Name: PHCHM2W
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received care at home?
(Anyone else?)

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received care at home from a health care professional during
the past 2 weeks (excluding dental care)
Skip Instructions:

goto PHCHMN2W
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

[p.5 ]

Question ID: FAU.140_00.000

Instrument Variable Name: PHCHMN2W
Question Text:

How many home visits did [fill: you/ ALIAS] receive during those 2 WEEKS?
* Enter '50' for 50 or more visits.

01-50 1-50 home visits
97 Refused
99 Don't know

Universe Text: All persons who received care at home from a health care professional during the past 2 weeks (excluding dental
care)
Skip Instructions:

(1-14,R,D) [repeat for all eligible persons, then goto FHCPH2W]
(15-50) [goto ERR_PHCPHMN2W]

Question ID: FAU.150_00.000

Instrument Variable Name: FHCPH2W
Question Text:

During those 2 WEEKS, did [fill: you/anyone in the family] get any medical advice or test results over the PHONE from a
doctor, nurse, or other health care professional?
Do not include phone calls to make appointments, for billing questions or for prescription refills.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in PHCPH2W and goto PHCPHN2W; else, goto _
PHCPH2W]
(2,R,D) [goto FHCDV2W]

Question ID: FAU.160_00.000

Instrument Variable Name: PHCPH2W
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who was the phone call about?
(Anyone else?)

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received medical advice or test results over the phone
during the past 2 weeks (excluding calls for appointments, billing questions, or prescription medicines)
Skip Instructions:

goto PHCPHN2W
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

[p.6 ]

Question ID: FAU.170_00.000

Instrument Variable Name: PHCPHN2W
Question Text:

During those 2 WEEKS, how many telephone calls [fill: did you make/were made about ALIAS]?
* Enter '50' for 50 or more phone calls.

01-50 1-50 calls
97 Refused
99 Don't know

Universe Text: All persons for whom medical advice or test results were received over the phone from a health care professional
during the past 2 weeks (excluding calls for appointments, billing questions, or prescription refills)
Skip Instructions:

(1-14,R,D) [repeat for all eligible persons, then goto FHCDV2W]
(15-50) [goto ERR_PHCPHN2W]

Question ID: FAU.180_00.000

Instrument Variable Name: FHCDV2W
Question Text:

During those 2 WEEKS, did [fill1: you/anyone in the family] see a doctor or other health care professional at a doctor's OFFICE, a clinic, an emergency room, or some other place? [fill2: Do not include times during an overnight hospital stay.]

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in PHCDV2W and goto PHCDVN2W; else, goto _PHCDV2W]
(2,R,D) [goto F10DVYR]

Question ID: FAU.190_00.000

Instrument Variable Name: PHCDV2W
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received care?
(Anyone else?)

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one saw a health care professional in an office, clinic,
emergency room, or some other place during the past 2 weeks (excluding visits during overnight hospital stays)
Skip Instructions:

goto PHCDVN2W
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

[p.7 ]

Question ID: FAU.200_00.000

Instrument Variable Name: PHCDVN2W
Question Text:

How many times did [fill: you/ALIAS] visit a doctor or other health care professional during those 2 WEEKS?
* Enter '50' for 50 or more visits.

01-50 1-50 times
97 Refused
99 Don't know

Universe Text: All persons who visited a health care professional during the past 2 weeks (excluding overnight hospital stays)
Skip Instructions:

(1-14,R,D) [repeat for all eligible persons, then goto F10DVYR]
(15-50) [goto ERR_PHCDVN2W]

Question ID: FAU.210_00.000

Instrument Variable Name: F10DVYR
Question Text:

During the past 12 MONTHS did [fill: you/any member of the family] receive care from doctors or other health care professionals 10 or more times? Do not include telephone calls.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in P10DVYR and goto FHICOV; else, goto P10DVYR] (2,R,D) [goto FHICOV]

Question ID: FAU.220_00.000

Instrument Variable Name: P10DVYR
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received care 10 or more times? (Anyone else?)

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received care 10 or more times from a health care
professional during the past 12 months (excluding telephone calls)
Skip Instructions:

goto FHICOV
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

[p.1 ]

2007 NHIS Questionnaire - Family
Family Health Insurance

Question ID: FHI.050_00.000

Instrument Variable Name: FHICOV
Question Text:

(book) F12 and (book) F14
The next questions are about health insurance. 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.
[fill:Are you/Is anyone in the family] covered by any kind of health insurance or some other kind of health care plan?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1,R,D) [goto HIKIND]
(2) [if AGE ge 65, goto MCAREPRB; else, goto MCAIDPRB]

Question ID: FHI.070_00.000

Instrument Variable Name: HIKIND
Question Text:

(book) F12 and (book) F14 ? [F1]
What kind of health insurance or health care coverage [fill: do you/does ALIAS] have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care). EXCLUDE private plans that only provide extra cash while hospitalized.
* Enter all that apply, separate with commas.

01 Private health insurance
02 Medicare
03 Medi-Gap
04 Medicaid
05 SCHIP (CHIP/Children's Health Insurance Program)
06 Military health care (TRICARE/VA/CHAMP-VA)
07 Indian Health Service
08 State-sponsored health plan
09 Other government program
10 Single service plan (e.g., dental, vision, prescriptions)
11 No coverage of any type
97 Refused
99 Don't know

Universe Text: All persons in families where FHICOV= yes, don't know, or refused
Skip Instructions:

(R,D) [goto HCSPFYR]
(1-10) [if AGE ge 65 and HIKIND ne 2, goto MCAREPRB; else, if HIKIND ne 10 goto SINCOV; else, goto _HICHANGE]
(11) [if HIKIND = 1-10, goto ERR_HIKIND; else, if AGE ge 65 goto MCAREPRB; else, goto MCAIDPRB]

[p.2 ]

Question ID: FHI.072_00.000

Instrument Variable Name: MCAREPRB
Question Text:

(book) F13
People covered by Medicare have a card that looks like this.
[fill: Are you/Is ALIAS] covered by Medicare?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons 65 years of age or older in families not covered by health insurance or Medicare was not selected for
those persons at HIKIND
Skip Instructions:

if HIKIND ne 10, goto SINCOV; else, goto HICHANGE

Question ID: FHI.073_00.000

Instrument Variable Name: MCAIDPRB
Question Text:

(book F14)
* Refer to flashcard F14 for state Medicaid names.
There is a program called Medicaid that pays for health care for persons in need. In this State it is also called (* fill State name). [fill: Are you/Is ALIAS] covered by Medicaid?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons less than 65 years of age with no insurance coverage of any type
Skip Instructions:

goto SINCOV

Question ID: FHI.074_00.000

Instrument Variable Name: SINCOV
Question Text:

[fill: Do you/Does ALIAS] have any type of insurance that pays for only one type of service such as dental, vision, or prescriptions?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons in families not covered by health insurance or single service plan was not selected for those persons at
HIKIND
Skip Instructions:

goto HICHANGE

[p.3 ]

Question ID: FHI.075_00.000

Instrument Variable Name: HICHANGE
Question Text:

I have recorded [fill1: you are/ALIAS is] [fill 2: covered by:
fill3: ^HIKIND] / not covered by health insurance.] Is this correct?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons
Skip Instructions:

(1,R,D) [repeat for all eligible persons, then goto MCPART]
(2) [goto ERR_HICHANGE]

Question ID: FHI.090_00.000

Instrument Variable Name: MCPART
Question Text:

{if subject ne respondent}:
Earlier I recorded that ALIAS is covered by Medicare. May I please see ALIAS's Medicare card to determine the type of
coverage?
{if subject eq respondent}:
* Read if necessary.
What type of Medicare coverage do you have? Is it Part A - hospital insurance, Part B - medical insurance, or both?
* Fill in appropriate coverage type below.

1 Part A - Hospital only
2 Part B - Medical only
3 Both Part A and Part B
7 Refused
9 Don't know

Universe Text: All persons with Medicare
Skip Instructions:

(1-3) [goto MCCARD]
(R,D) [prefill MCCARD with a "2" and goto MCCHOICE]

Question ID: FHI.092_00.000

Instrument Variable Name: MCCARD
Question Text:

* Do not read. Was the type of coverage obtained from a Medicare card or some other form of documentation?

1 Yes
2 No

Universe Text: All persons with Part A Medicare coverage, Part B Medicare coverage, or both
Skip Instructions:

if MCPART = 1, goto MCPARTD; else, goto MCCHOICE

[p.4 ]

Question ID: FHI.095_00.000

Instrument Variable Name: MCCHOICE
Question Text:

(book) ? [F1]
Medicare Advantage is the new name for Medicare Plus Choice plans. [fill: Are you/Is ALIAS] enrolled in a Medicare
Advantage plan?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with Medicare who signed up for part B coverage or for whom it is unknown if they signed up for Part
B coverage
Skip Instructions:

goto MCHMO

Question ID: FHI.100_00.000

Instrument Variable Name: MCHMO
Question Text:

(book) ? [F1]
[fill: Are you/Is ALIAS] 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).

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with Medicare who signed up for part B coverage or for whom it is unknown if they signed up for Part
B coverage
Skip Instructions:

(1) [goto MCNAME]
(2,R,D) [goto MCREF]

Question ID: FHI.110_00.000

Instrument Variable Name: MCNAME
Question Text:

(book) ? [F1]
What is the name of the HMO?
* Read if necessary: Do you have a health plan card or something with the plan name on it?

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text: All persons with Medicare who signed up for part B coverage or for whom it is unknown if they signed up for part
B coverage, and are enrolled under a Medicare managed care arrangement
Skip Instructions:

goto MCREF

[p.5 ]

Question ID: FHI.114_00.000

Instrument Variable Name: MCREF
Question Text:

(book)
? [F1]
Under [fill1: your/ALIAS's] Medicare plan, if [fill2: you need/he needs/she needs] to go to a different doctor or place for
special care, [fill3: do you/does he/does she] need approval or a referral? Do not include emergency care.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with Medicare who signed up for part B coverage or for whom it is unknown if they signed up for Part
B coverage
Skip Instructions:

goto MCPAYPRE

Question ID: FHI.116_00.000

Instrument Variable Name: MCPAYPRE
Question Text:

Besides [fill1: your/ALIAS's] Medicare insurance, [fill2: are you/is ALIAS] paying an additional monthly or yearly
premium to receive a more comprehensive health benefit plan?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with Medicare who signed up for part B coverage or for whom it is unknown if they signed up for Part
B coverage
Skip Instructions:

goto MCPARTD

Question ID: FHI.118_00.000

Instrument Variable Name: MCPARTD
Question Text:

[Fill 1: Are you/Is ALIAS] enrolled in Medicare Part D, also known as the Medicare Prescription Drug Plan?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with Medicare
Skip Instructions:

(1,2,7,9) [goto MCPART for next person with Medicare; else goto MACHMD]

[p.6 ]

Question ID: FHI.120_00.000

Instrument Variable Name: MACHMD
Question Text:

(book F14) ? [F1]
* Refer to flashcard F14 for state Medicaid names.
The next questions are about Medicaid coverage. In this State it is also called (* fill State Name). [fill1: You are/ALIAS
is] listed as having Medicaid coverage. Can [fill2: you/ALIAS] go to ANY doctor who will accept Medicaid or MUST
[fill3: you/he/she] choose from a book or list of doctors or is a doctor assigned?

1 Any doctor
2 Select from book/list
3 Doctor is assigned
7 Refused
9 Don't know

Universe Text: All persons with Medicaid
Skip Instructions:

(1,R,D) [goto MAPCMD]
(2) [goto MACHMD1]
(3) [goto MACHMD2]

Question ID: FHI.130_00.000

Instrument Variable Name: MACHMD1
Question Text:

* Ask or verify.
What is the name of the health plan that provided the book or list?
*Read if necessary: Do you have a health plan card or something with the plan name on it?

Verbatim Verbatim Response
7 Refused
9 Don't know

Universe Text: All persons with Medicaid who must select a doctor from a book or list of doctors
Skip Instructions:

goto MANAM

Question ID: FHI.131_00.000

Instrument Variable Name: MACHMD2
Question Text:

* Ask or verify.
What is the name of the health plan that assigned the doctor?
*Read if necessary: Do you have a health plan card or something with the plan name on it?

Verbatim Verbatim Response
7 Refused
9 Don't know

Universe Text: All persons with Medicaid for whom a doctor is assigned
Skip Instructions:

goto MANAM

Question ID: FHI.132_00.000

Instrument Variable Name: MANAM
Question Text:

(book) ? [F1]
* Do not read. Was the Health Plan name obtained from a Health Plan Card or something with the Health Plan name on it?

1 Yes
2 No

Universe Text: All persons with Medicaid who must select a doctor from a book or list or for whom a doctor is assigned
Skip Instructions:

goto MAPCMD_

Question ID: FHI.140_00.000

Instrument Variable Name: MAPCMD
Question Text:

[fill1: Are you/Is ALIAS] required to sign up with a certain primary care doctor, group of doctors, or certain clinic which
[fill2: you/he/she] must go to for all of [fill3: your/his/her] routine care? Do not include emergency care or care from a
specialist [fill4: you were/he was/she was] referred to.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with Medicaid
Skip Instructions:

goto MAREF

Question ID: FHI.150_00.000

Instrument Variable Name: MAREF
Question Text:

? [F1]
Under [fill1: your/ALIAS's] Medicaid plan, if [fill2: you need/he needs/she needs] to go to a different doctor or place for
special care, [fill3: do you/does he/does she] need approval or a referral? Do not include emergency care.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with Medicaid
Skip Instructions:

goto MACHMD for the next person with Medicaid; else, goto SSTYPE2

[p.8 ]

Question ID: FHI.156_00.000

Instrument Variable Name: SSTYPE2
Question Text:

(book) F15
* Enter all that apply, separate with commas.
You mentioned that [fill1: you have/ALIAS has] a single-service plan - that is, an insurance plan that provides one specific type of coverage. What type of service or care does [fill2: your/ALIAS's] single service plan or plans pay for?

01 Accidents
02 AIDS care
03 Cancer treatment
04 Catastrophic care
05 Dental care
06 Disability insurance
07 Hospice care
08 Hospitalization only
09 Long-term care
10 Prescriptions
11 Vision care
12 Other (specify)
97 Refused
99 Don't know

Universe Text: All persons with single service plans
Skip Instructions:

(1-11,R,D) [repeat for all eligible persons, then goto FHICCI6]
(12) [goto SSOTHER]

Question ID: FHI.157_00.000

Instrument Variable Name: SSOTHER
Question Text:

* Other type of single-service plan

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text: All persons with an "other" single service plan
Skip Instructions:

goto SSTYPE2 for the next person with a single service plan; else, goto FHICCI6

[p.9 ]

Question ID: FHI.158_00.000

Instrument Variable Name: FHICCI6
Question Text:

The next questions are about private health insurance plans [fill1: /including Medi-Gap]. These plans can be obtained
through work, purchased directly, or through a state or local government program or community program.
[fill2: We have the following persons listed as being covered by such plans:
* Read names.
(display roster of eligible persons)]
* Enter 1 to continue
1 Continue

Universe Text: All families with at least one person covered by private health insurance_
Skip Instructions:

goto HIPNAM1

Question ID: FHI.160_00.000

Instrument Variable Name: HIPNAM1
Question Text:

It is important that we record the complete and accurate name of each health insurance plan. What is the COMPLETE
name of the first plan?
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.
* Read if necessary: Do you have your health plan card or something with the plan name on it?

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text: All families with at least one person covered by private health insurance
Skip Instructions:

(verbatim) [goto PCARD1]
(R,D) [prefill PCARD1 with a "2" and goto HIPNAM1B]

Question ID: FHI.160_01.000

Instrument Variable Name: PCARD1
Question Text:

* Do not read. Was the health plan name obtained from a health plan card or something with the health plan name on it?

1 Yes
2 No

Universe Text: All private health insurance plans where the plan name was entered at HIPNAM1
Skip Instructions:

goto HIPNAM1B

Question ID: FHI.170_00.000

Instrument Variable Name: HIPNAM1B
Question Text:

* Ask or verify. Enter all that apply, separate with commas.
Which family members are covered by this plan?
* Indicate each family member covered by this plan.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with a private health insurance plan and the plan name, refused, or don't know was entered at
HIPNAM1
Skip Instructions:

(R,D) [if HIPNAM1= R or D, goto STNAME]
goto MORPLAN NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FHI.171_00.000

Instrument Variable Name: MORPLAN
Question Text:

* Ask if necessary
Are there any more private health insurance plans?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families where a private health insurance plan name was entered at HIPNAM1 or a person number was entered
at HIPNAM1B
Skip Instructions:

(1) [goto HIPNAM2]
(2,R,D) [if no persons selected at HIPNAM1B, goto FHICCI8; else, if persons selected at HIPNAM1B, but not all persons with HIKIND = 1 or 3 selected at HIPNAM1B, goto HIVER1]

Question ID: FHI.172_00.000

Instrument Variable Name: HIPNAM2
Question Text:

What is the name of the next plan?
*Read if necessary: Do you have a health plan card or something with the plan name on it?

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text: All families with a second private health insurance plan
Skip Instructions:

(verbatim) [goto PCARD2]
(R,D) [prefill PCARD2 with a "2" and goto HIPNAM2B]

Question ID: FHI.172_01.000

Instrument Variable Name: PCARD2
Question Text:

* Do not read. Was the health plan name obtained from a health plan card or something with the health plan name on it?

1 Yes
2 No

Universe Text: All private health insurance plans where the plan name was entered at HIPNAM2
Skip Instructions:

goto HIPNAM2B

Question ID: FHI.173_00.000

Instrument Variable Name: HIPNAM2B
Question Text:

* Ask or verify. Enter all that apply, separate with commas.
Which family members are covered by that plan?
* Indicate each family member covered by this plan.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with a second private health insurance plan and the plan name, refused, or don't know was entered at
HIPNAM2
Skip Instructions:

(R,D) [if HIPNAM2 eq R or D and persons selected at HIPNAM1B, but not all persons with HIKIND eq 1 or 3 selected at HIPNAM1B, goto HIVER1; else, if HIPNAM2 eq R or D and persons selected at HIPNAM1B, and all persons with HIKIND eq 1 or 3 selected at HIPNAM1B, goto FHICCI8; else, if HIPNAM2 eq R or D and persons not selected at HIPNAM1B, goto FHICCI8; else, if a health plan name recorded in HIPNAM2, goto MORPLAN2] goto MORPLAN2

Question ID: FHI.174_00.000

Instrument Variable Name: MORPLAN2
Question Text:

* Ask if necessary
Are there any more private health insurance plans?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families where a private health insurance plan name was entered at HIPNAM2 or a person number was entered
at HIPNAM2B
Skip Instructions:

(1) [goto HIPNAM3]
(2,R,D) [if persons selected at HIPNAM2B or HIPNAM1B, but not all persons with HIKIND eq 1 or 3 selected at HIPNAM2B or HIPNAM1B, goto HIVER1; else, goto FHICCI8]

[p.12]

Question ID: FHI.175_00.000

Instrument Variable Name: HIPNAM3
Question Text:

What is the name of the next plan?
*Read if necessary: Do you have a health plan card or something with the plan name on it?

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text: All families with a third private health insurance plan
Skip Instructions:

(verbatim) [goto PCARD3]
(R,D) [prefill PCARD3 with a "2" and goto HIPNAM3B]

Question ID: FHI.175_01.000

Instrument Variable Name: PCARD3
Question Text:

* Do not read. Was the health plan name obtained from a health plan card or something with the health plan name on it?

1 Yes
2 No

Universe Text: All private health insurance plans where the plan name was entered at HIPNAM3_
Skip Instructions:

goto HIPNAM3B_

Question ID: FHI.176_00.000
Instrument Variable Name: HIPNAM3B
Question Text:

* Ask or verify. Enter all that apply, separate with commas.
Which family members are covered by that plan?
* Indicate each family member covered by this plan.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with a third private health insurance plan and the plan name, refused, or don't know was entered at
HIPNAM3
Skip Instructions:

(R,D) [if HIPNAM3 eq R or D and persons selected at HIPNAM1B or HIPNAM2B, but not all persons with
HIKIND eq 1 or 3 selected at HIPNAM1B or HIPNAM2B, goto HIVER1; else, if HIPNAM3 eq R or D and persons selected at HIPNAM1B or HIPNAM2B, and all persons with HIKIND eq 1 or 3 selected at HIPNAM1B or HIPNAM2B, goto FHICCI8; else, if HIPNAM3 eq R or D and persons not selected at HIPNAM1B and HIPNAM2B, goto FHICCI8; else, if the health plan name was entered at HIPNAM3, goto ORPLAN3]
goto MORPLAN3

[p.13 ]

Question ID: FHI.177_00.000

Instrument Variable Name: MORPLAN3
Question Text:

* Ask if necessary
Are there any more private health insurance plans?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families where a private health insurance plan name was entered at HIPNAM3 or a person number was entered
at HIPNAM3B
Skip Instructions:

(1) [goto HIPNAM4]
(2,R,D) [if persons selected at HIPNAM1B or HIPNAM2B or HIPNAM3B, but not all persons with HIKIND eq 1 or 3 selected at HIPNAM1B or HIPNAM2B or HIPNAM3B, goto HIVER1; else, goto FHICCI8]

Question ID: FHI.178_00.000

Instrument Variable Name: HIPNAM4
Question Text:

What is the name of the next plan?
*Read if necessary: Do you have a health plan card or something with the plan name on it?

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text: All families with a fourth private health insurance plan
Skip Instructions:

(verbatim) [goto PCARD4]
(R,D) [prefill PCARD4 with a "2" and goto HIPNAM4B]

Question ID: FHI.178_01.000

Instrument Variable Name: PCARD4
Question Text:

* Do not read. Was the health plan name obtained from a health plan card or something with the health plan name on it?

1 Yes
2 No

Universe Text: All private health insurance plans where the plan name was entered at HIPNAM4
Skip Instructions:

goto HIPNAM4B

[p.14] 14 of 29

Question ID: FHI.179_00.000

Instrument Variable Name: HIPNAM4B
Question Text:

* Ask or verify. Enter all that apply, separate with commas.
Which family members are covered by that plan?
* Indicate each family member covered by this plan.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with a fourth private health insurance plan and the plan name, refused, or don't know was entered at
HIPNAM4
Skip Instructions:

(R,D) [if HIPNAM4 eq R or D and persons selected at HIPNAM1B or HIPNAM2B or HIPNAM3B, but not all persons with HIKIND eq 1 or 3 selected at HIPNAM1B or HIPNAM2B or HIPNAM3B, goto HIVER1; else, goto FHICCI8] goto FHICCI8

Question ID: FHI.180_00.000

Instrument Variable Name: HIVER1
Question Text:

? [F1]
[fill1: You are/ALIAS is] listed as having private insurance but [fill2: were/was] not mentioned as being covered by any
of the plans we just discussed. [fill3: Are you/Is ALIAS] covered by private insurance?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons who have private health insurance coverage, but were not mentioned as being covered by any of the
reported plans
Skip Instructions:

(1) [ goto HIVER2]
(2,R,D) [goto ERR_HIVER1]

[p.15 ]

Question ID: FHI.190_00.000

Instrument Variable Name: HIVER2
Question Text:

? [F1]
* Enter all that apply, separate with commas.
Is [fill: your/ALIAS's] health insurance plan the same as one of those already mentioned?

1 1st plan mentioned (^HIPNAM1)
2 2nd plan mentioned (^HIPNAM2)
3 3rd plan mentioned (^HIPNAM3)
4 4th plan mentioned (^HIPNAM4)
5 Some other plan not already mentioned
7 Refused
9 Don't know

Universe Text: All persons for whom it was verified they have private health insurance coverage, but were not mentioned as being
covered by any of the reported plans
Skip Instructions:

(1-4) [update responses for HIPNAM1B/HIPNAM2B/HIPNAM3B/HIPNAM4B and goto FHICCI8] (5) [if 4 plans were reported, ignore this 5th plan and goto FHICCI8; else, goto HIPNAM2, or HIPNAM3, or _HIPNAM4 accordingly to enter information on this plan] (R,D) [goto FHICCI8]

Question ID: FHI.195_01.000

Instrument Variable Name: FHICCI8
Question Text:

[fill1: Now I am going to ask some questions about the [fill2: plan/plans] you just told me about [fill3: /,starting with [fill4: ^HIPNAM1/Plan1]]./Next I would like to ask you about [fill5: ^HIPNAM2/^HIPNAM3/^HIPNAM4/Plan 2/Plan 3/Plan 4]].
* Enter 1 to continue
1 Continue

Universe Text: All families where a private health insurance plan was reported
Skip Instructions:

goto FHI200
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a
family. Information on up to 4 plans per family is collected.

[p.16 ]

Question ID: FHI.200_01.000

Instrument Variable Name: FHI200
Question Text:

? [F1]
Health insurance plans are usually obtained in one person's name even if other family members are covered. That person
is called the policyholder. In whose name is this plan?
* Enter line number of family member (from list below) in whose name this plan is held.
* Enter 0 if the policyholder is not on the family roster."

00 Policyholder not on family roster
01-25 Two-digit person number
97 Refused
99 Don't know

Universe Text: All private health insurance plans
Skip Instructions:

goto PLNWRK
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.

Question ID: FHI.210_01.000

Instrument Variable Name: PLNWRK
Question Text:

(book) F16 ? [F1]
Which one of these categories best describes how this plan was obtained?

01 Through employer
02 Through union
03 Through workplace, but don't know if employer or union
04 Through workplace, self-employed or professional association
05 Purchased directly
06 Through a state/local government or community program
07 Other, specify
97 Refused
99 Don't know

Universe Text: All private health insurance plans
Skip Instructions:

(1-6,R,D) [goto PLNPAY]
(7) [goto PLNWKSP] NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.

Question ID: FHI.211_01.000

Instrument Variable Name: PLNWKSP
Question Text:

*Read if necessary.
How was this plan obtained?

Verbatim Verbatim Response
7 Refused
9 Don't know

Universe Text:All private health insurance plans where the plan was obtained through an "other" source
Skip Instructions:

goto PLNPAY NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.

Question ID: FHI.220_10.000

Instrument Variable Name: PLNPAY
Question Text:

? [F1]
* Enter all that apply, separate with commas.
Who pays for this health insurance plan?
* If government program is reported, probe for Medicare or Medicaid or SCHIP before entering code 7. If government is
the employer, enter code 2.

01 Self or family (living in the household)
02 Employer or union
03 Someone outside the household
04 Medicare
05 Medicaid
06 Children's Health Insurance Program (CHIP/SCHIP)
07 State or local government or community program
97 Refused
99 Don't know

Universe Text: All private health insurance plans
Skip Instructions:

(1) [goto HICOSTN]
(2-7,R,D) [if PLNPAY=1, goto HICOSTN; else, goto PLNMGD]
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.

[p.18 ]

Question ID: FHI.230_11.000

Instrument Variable Name: HICOSTN
Question Text:

1 of 2 ? [F1]
How much [fill1: do you/does your family] currently spend for health insurance premiums for [fill2: ^HIPNAM1/^HIPNAM2/^HIPNAM3/^HIPNAM4/Plan 1/Plan 2/Plan 3/Plan 4]? Please include payroll deductions for premiums.
*Enter dollar amount for premium payments.

00001-99995 $1-$99,995
99997 Refused
99999 Don't know

Universe Text: All private health insurance plans payed for by self or family
Skip Instructions:

(1-99995) [goto HICOSTT]
(R) [store "R" in HICOSTT and goto PLNMGD]
(D) [store "D" in HICOSTT and goto PLNMGD]
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.

Question ID: FHI.230_12.000

Instrument Variable Name: HICOSTT
Question Text:

2 of 2 ? [F1]
* Enter time period for premium payments.

01 Once a week
02 Once every 2 weeks
03 Once a month
04 Twice a month
05 Every 2 months
06 Quarterly (every 3 months)
07 Once a year
08 Twice a year
97 Refused
99 Don't know

Universe Text: All private health insurance plans with a valid response to HICOSTN
Skip Instructions:

goto PLNMGD
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.

[p.19 ]

Question ID: FHI.240_01.000

Instrument Variable Name: PLNMGD
Question Text:

? [F1]
Is [fill: ^HIPNAM1/^HIPNAM2/^HIPNAM3/^HIPNAM4/Plan 1/Plan 2/Plan 3/Plan 4] an HMO (Health Maintenance
Organization), an IPA (Individual Practice Association), a PPO (Preferred Provider Organization), a POS (Point-Of-
Service), fee-for-service, or indemnity or is it some other kind of plan?

1 HMO/IPA
2 PPO
3 POS_
4 Fee-for-service/indemnity
5 Other
7 Refused
9 Don't know

Universe Text: All private health insurance plans
Skip Instructions:

goto HDHP
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.

Question ID: FHI.241_01.000

Instrument Variable Name: HDHP
Question Text:

?[F1]
[If only one person covered by this plan:]
Is the annual deductible for medical care for this plan less than $1,100 or $1,100 or more? If there is a separate deductible
for prescription drugs, hospitalization, or out-of-network care, do not include those deductible amounts here.
[If two or more persons in the family are covered by this plan:]
Is the family annual deductible for medical care for this plan less than $2,200 or $2,200 or more? If there is a separate
deductible for prescription drugs, hospitalization, or out-of-network care, do not include those deductible amounts here.

1 Less than [$1,100/$2,200]
2 [$1,100/$2,200] or more
7 Refused
9 Don't know

Universe Text: All private health insurance plans
Skip Instructions:

1,R,D [goto MGCHMD]
2 [goto HSAHRA]
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a
family. Information on up to 4 plans per family is collected.

[p.20

Question ID: FHI.242_01.000

Instrument Variable Name: HSAHRA
Question Text:

?[F1]
With this plan, is there a special account or fund that can be used to pay for medical expenses? The accounts are
sometimes referred to as Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs), Personal Care
accounts, Personal Medical funds, or Choice funds, and are different from Flexible Spending Accounts.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All high deductible private health plans
Skip Instructions:

1,2,R,D [goto MGCHMD]
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.

Question ID: FHI.243_01.000

Instrument Variable Name: MGCHMD
Question Text:

Under this plan, can [fill1:you/ALIAS/the family members with this plan] choose ANY doctor or MUST [fill2:you/he/she/they] choose one from a specific group or list of doctors?

1 Any doctor
2 Select from group/list
7 Refused
9 Don't know

Universe Text: All private health insurance plans
Skip Instructions:

(1) [goto MGPRMD]
(2) [goto MGPYMD]
(R,D) [goto MGPREF]
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a
family. Information on up to 4 plans per family is collected.

Question ID: FHI.244_01.000

Instrument Variable Name: MGPRMD
Question Text:

[fill: Do you/Does ALIAS/Do the family members with this plan] have the option of choosing a doctor from a preferred or
select list at a lower cost?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All private health insurance plans where covered persons can choose any doctor
Skip Instructions:

goto MGPREF
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a
family. Information on up to 4 plans per family is collected.

[p.21 ]

Question ID: FHI.246_01.000

Instrument Variable Name: MGPYMD
Question Text:

If [fill1: you select/ALIAS selects/the family members with this plan select] a doctor who is not in the plan, will [fill2:
^HIPNAM1/^HIPNAM2/^HIPNAM3/^ HIPNAM4/Plan 1/Plan 2/Plan 3/Plan 4] pay for any or part of the cost?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All private health insurance plans where covered persons must select from a group or list of doctors
Skip Instructions:

goto MGPREF
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a
family. Information on up to 4 plans per family is collected.

Question ID: FHI.248_01.000

Instrument Variable Name: MGPREF
Question Text:

? [F1]
When [fill1: you need/ALIAS needs/the family members with this plan need] to go to a different doctor or place for
special care, [fill2: do you/does ALIAS/do they] need approval or a referral? Do not include emergency care.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All private health insurance plans
Skip Instructions:

goto PRRXCOV
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a
family. Information on up to 4 plans per family is collected.

Question ID: FHI.249_01.000

Instrument Variable Name: PRRXCOV
Question Text:

Does [fill1: ^HIPNAM1/^HIPNAM2/^HIPNAM3/^HIPNAM4/Plan 1/Plan 2/Plan 3/Plan 4] pay for any of the costs for
medicines prescribed by a doctor?
* Read if necessary: Does this plan have a drug benefit?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All private health insurance plans
Skip Instructions:

goto FHICCI8 for the next private health insurance plan; else, goto STNAME1
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.

[p.22 ]

Question ID: FHI.250_00.000

Instrument Variable Name: STNAME1
Question Text:

Earlier I recorded that [fill: you are/ALIAS is] covered by the Children's Health Insurance Program (CHIP/SCHIP). What
is the name of the plan?
* Read if necessary: Do you have a health plan card or something with the plan name on it?

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text: All persons with SCHIP
Skip Instructions:

goto STDOC1

Question ID: FHI.251_00.000

Instrument Variable Name: STDOC1
Question Text:

Under the [fill1:^STNAME1/SCHIP plan] can [fill2: you/ALIAS] go to ANY doctor who will accept this plan or MUST
[fill3: you/he/she] choose from a book or list of doctors or is the doctor assigned?

1 Any doctor
2 Select from book/list
3 Doctor is assigned
7 Refused
9 Don't know

Universe Text: All persons with SCHIP
Skip Instructions:

goto STPCMD1

Question ID: FHI.252_00.000

Instrument Variable Name: STPCMD1
Question Text:

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with SCHIP
Skip Instructions:

goto STREF1

[p.23 ]

Question ID: FHI.253_00.000

Instrument Variable Name: STREF1
Question Text:

? [F1]
Under [fill1: ^STNAME1/this SCHIP plan], if [fill2: you need/ALIAS needs] to go to a different doctor or place for
special care, [fill3: do you/does he/does she] need approval or a referral? Do not include emergency care.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with SCHIP
Skip Instructions:

goto STNAME1 for the next person with SCHIP; else, goto STNAME2

Question ID: FHI.257_00.000

Instrument Variable Name: STNAME2
Question Text:

Earlier I recorded that [fill: you are/ALIAS is] covered by a state sponsored health plan. What is the name of the plan?
* Read if necessary: Do you have a health plan card or something with the plan name on it?

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text: All persons covered by a state sponsored health plan
Skip Instructions:

goto STDOC2

Question ID: FHI.258_00.000

Instrument Variable Name: STDOC2
Question Text:

Under the [fill1:^STNAME2/state sponsored plan] can [fill2: you/ALIAS] go to ANY doctor who will accept this plan or
MUST [fill3: you/he/she] choose from a book or list of doctors or is the doctor assigned?

1 Any doctor
2 Select from book/list
3 Doctor is assigned
7 Refused
9 Don't know

Universe Text: All persons covered by a state sponsored health plan
Skip Instructions:

goto STPCMD2

[p.24 ] 24 of 29

Question ID: FHI.259_00.000

Instrument Variable Name: STPCMD2
Question Text:

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons covered by a state sponsored health plan
Skip Instructions:

goto STREF2

Question ID: FHI.260_00.000

Instrument Variable Name: STREF2
Question Text:

? [F1]
Under [fill1:^STNAME2/this state sponsored plan], if [fill2: you need/ALIAS needs] to go to a different doctor or place
for special care, [fill3: do you/does he/does she] need approval or a referral? Do not include emergency care.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons covered by a state sponsored health plan
Skip Instructions:

goto STNAME2 for the next person with a state sponsored health plan; else, goto STNAME3

Question ID: FHI.264_00.000

Instrument Variable Name: STNAME3
Question Text:

Earlier I recorded that [fill: you are/ALIAS is] covered by an other government program. What is the name of the plan?
* Read if necessary: Do you have a health plan card or something with the plan name on it?

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text: All persons covered by an "other" government plan
Skip Instructions:

goto STDOC3

[p.25 ]

Question ID: FHI.265_00.000

Instrument Variable Name: STDOC3
Question Text:

Under the [fill1:^STNAME3/other government plan] can [fill2: you/ALIAS] go to ANY doctor who will accept this plan
or MUST [fill3:you/he/she] choose from a book or list of doctors or is the doctor assigned?

1 Any doctor
2 Select from book/list
3 Doctor is assigned
7 Refused
9 Don't know

Universe Text: All persons covered by an "other" government plan
Skip Instructions:

goto STPCMD3

Question ID: FHI.266_00.000

Instrument Variable Name: STPCMD3
Question Text:

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons covered by an "other" government plan
Skip Instructions:

goto STREF3

Question ID: FHI.267_00.000

Instrument Variable Name: STREF3
Question Text:

? [F1]
Under [fill1:^ STNAME3/this other government plan], if [fill2: you need/ALIAS needs] to go to a different doctor or
place for special care, [fill3: do you/does he/does she] need approval or a referral? Do not include emergency care.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons covered by an "other" government plan
Skip Instructions:

goto STNAME3 for the next person with an "other" government plan; else, goto MILSPC

[p.26 ]

Question ID: FHI.270_00.000

Instrument Variable Name: MILSPC
Question Text:

? [F1]
* Enter all that apply, separate with commas.
Earlier I recorded that [fill1: you are/ALIAS is] covered by military health care. What types of military health care [fill2:
are you/is ALIAS] covered by?

1 TRICARE
2 VA
3 CHAMP-VA
4 Other military coverage (specify)
7 Refused
9 Don't know

Universe Text: All persons with military health care
Skip Instructions:

(1) [goto MILMAN]
(2,3,R,D) [repeat question for next person with military health care; else, goto HILAST]
(4) [goto MILSPCOT]

Question ID: FHI.271_00.000

Instrument Variable Name: MILSPCOT
Question Text:

* Other military coverage

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text: All persons with "other" military coverage
Skip Instructions:

if MILSPC eq 1, goto MILMAN; else, goto MILSPC for the next person with military health care; else, goto HILAST

Question ID: FHI.275_00.000

Instrument Variable Name: MILMAN
Question Text:

? [F1]
Is [fill: your/ALIAS's] TRICARE plan, TRICARE prime, TRICARE Extra, TRICARE Standard or TRICARE for Life?

1 TRICARE Prime
2 TRICARE Extra
3 TRICARE Standard
4 TRICARE for life
5 TRICARE other (specify)
7 Refused
9 Don't know

Universe Text: All persons with TRICARE coverage
Skip Instructions:

(1-4,R,D) [goto MILSPC for the next person with military health care; else, goto HILAST] (5) [goto MILMANOT]

Question ID: FHI.276_00.000

Instrument Variable Name: MILMANOT
Question Text:

* Other type of TRICARE coverage

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text: All persons with "other" type of TRICARE coverage
Skip Instructions:

goto MILSPC for the next person with military health care; else, goto HILAST

Question ID: FHI.280_00.000

Instrument Variable Name: HILAST
Question Text:

(book) F17 ? [F1]
Not including Single Service Plans, about how long has it been since [fill: you/ALIAS] last had health care coverage?

1 6 months or less
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

Universe Text: All persons without known health insurance or with only single service plans
Skip Instructions:

goto HISTOP

Question ID: FHI.290_00.000

Instrument Variable Name: HISTOP
Question Text:

(book) F18
[fill1: Which of these are reasons [fill2: you/ALIAS] stopped being covered?/Which of these are reasons [fill3:you
do/ALIAS does] not have health insurance?]
* Enter up to 5 reasons, separate with commas.

01 Person in family with health insurance lost job or changed employers
02 Got divorced or separated/death of spouse or parent
03 Became ineligible because of age/left school
04 Employer does not offer coverage/or not eligible for coverage
05 Cost is too high
06 Insurance company refused coverage
07 Medicaid/Medical plan stopped after pregnancy
08 Lost Medicaid/Medical plan because of new job or increase in income
09 Lost Medicaid (other)
10 Other (specify)
97 Refused
99 Don't know

Universe Text: All persons without known health insurance or with only single service plans
Skip Instructions:

(1-9,R,D) [goto HCSPFYR]
(10) [goto HISTOPOT]

Question ID: FHI.291_00.000

Instrument Variable Name: HISTOPOT
Question Text:

? [F1]
* Other reason for not having coverage

Verbatim Verbatim Response
7 Refused
9 Don't know

Universe Text: All persons without known health insurance and an "other" reason for stopping or not having coverage
Skip Instructions:

goto HISTOP for the next person without known health insurance coverage or only single service plans; else, goto HCSPFYR

Question ID: FHI.300_00.000

Instrument Variable Name: HINOTYR
Question Text:

In the PAST 12 MONTHS, was there any time when [fill: you/ALIAS] did NOT have ANY health insurance or coverage?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with known health insurance coverage except single service plans
Skip Instructions:

(1) [goto HINOTMYR]
(2,R,D) [goto HCSPFYR]

Question ID: FHI.310_00.000

Instrument Variable Name: HINOTMYR
Question Text:

In the PAST 12 MONTHS, about how many months [fill: were you/was ALIAS] without coverage?
* If less than 1 month, enter '1'.

01-12 1-12 months
97 Refused
99 Don't know

Universe Text: All persons with known health insurance coverage, but did not have health insurance for some period of time in
the past 12 months
Skip Instructions:

goto HINOTYR for the next person with known health insurance coverage, except single service plans; else, goto
HCSPFYR

[p. 29]

Question ID: FHI.320_00.000

Instrument Variable Name: HCSPFYR
Question Text:

(book) F19
The next question is about money that [fill1: you have/your family has] spent out of pocket on medical care. We do NOT
want you to count health insurance premiums, over the counter drugs, or costs that you will be reimbursed for. In the
PAST 12 MONTHS, about how much did [fill2: you/your family] spend for medical care and dental care?

0 Zero_
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

Universe Text: All families
Skip Instructions:

goto FSA

Question ID: FHI.330_00.000

Instrument Variable Name: FSA_
Question Text:

[fill 1: Do you/Does anyone in your family] have a Flexible Spending Account for health expenses? These accounts are
offered by some employers to allow employees to set aside pre-tax dollars of their own money for their use throughout the
year to reimburse themselves for their out-of-pocket expenses for health care. With this type of account, any money
remaining in the account at the end of the year, following a short grace period, is lost to the employee.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All Families
Skip Instructions:

goto PLBORN

[p.1 ]

2007 NHIS Questionnaire - Family
Family Socio-Demographic

Question ID: FSD.001_00.000

Instrument Variable Name: PLBORN
Question Text:

[fill: Were you/Was ALIAS] born in the United States?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons
Skip Instructions:

(1) [store "1" in CITIZEN and goto PLBORN1]
(2) [goto PLBORN2]
(R,D) [goto CITIZEN]

[p.2]

Question ID: FSD.002_00.000

Instrument Variable Name: PLBORN1
Question Text:

In what state [fill: were you/was ALIAS] born?

01 Alabama
02 Alaska
03 Arizona
04 Arkansas
05 California
06 Colorado
07 Connecticut
08 Delaware
09 District 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

[p.3 ]

48 Washington
49 West Virginia
50 Wisconsin
51 Wyoming
57 United States (state unknown)

Universe Text: All persons born in the United States
Skip Instructions:

(1-51,57) [goto HEADST]

[p.4 ]

Question ID: FSD.003_00.000

Instrument Variable Name: PLBORN2
Question Text:

In what country [fill: were you/was ALIAS] born?
* Please record country of birth. If country not found, type "ZZ"

06 0 AMERICAN SAMOA
06 1 AM SAMOA
06 2 BAKER ISLAND
06 3 GUAM
06 4 HOWLAND ISLAND
06 5 JARVIS ISLAND
06 6 JOHNSTON ATOLL
06 7 KINGMAN REEF
06 8 MANUA ISLANDS
06 9 MIDWAY ISLANDS
07 0 NAVASSA ISLAND
07 1 NORTHERN MARIANAS
07 2 PALMYRA ATOLL
07 3 PUERTO RICO
07 4 ROTA
07 5 SAIPAN
07 6 SAND ISLAND
07 7 ST CROIX
07 8 ST JOHN
07 9 ST THOMAS
08 0 TINIAN
08 1 US OUTLYING AREA
08 2 US VIRGIN ISLANDS
08 3 USVI
08 4 VIRGIN ISLANDS
08 5 WAKE ISLAND
10 0 ABROAD
10 1 ABU DHABI
10 2 ADEN
10 3 AFGHANISTAN
10 4 AFRICA
10 5 ALBANIA
10 6 ALBERTA
10 7 ALGERIA
10 8 ALGIERS
10 9 ALSACE-LORRAINE
11 0 AMSTERDAM
11 1 ANEGADA
11 2 ANGOLA
11 3 ANGUILLA
11 4 ANGUILLA BWI
11 5 ANOJOUAN
11 6 ANTARCTICA
11 7 ANTIGUA
11 8 ANTIGUA and BARBUDA
11 9 ANTIGUA WI

[p.5]

12 0 ANTILLES
12 1 ARAB PALESTINE
12 2 ARABIA
12 3 ARGENTINA
12 4 ARMENIA
12 5 ARUBA
12 6 ARUBA DWI
12 7 ARUBA NETHERLANDS
12 8 ASCENSION ISLAND
12 9 ASIA
13 0 ASIA MINOR
13 1 ASSAM
13 2 AT SEA
13 3 AUSTRALIA
13 4 AUSTRIA
13 5 AUSTRIA-HUNGARY
13 6 AZERBAIJAN
13 7 AZORES ISLANDS
13 8 BAHAMAS
13 9 BAHAMAS UK
14 0 BAHRAIN
14 1 BAJA CAL
14 2 BAJA CAL SUR
14 3 BALBOA
14 4 BANGLADESH
14 5 BARBADOS
14 6 BARBUDA
14 7 BAVARIA
14 8 BELARUS
14 9 BELFAST
15 0 BELGIAN CONGO
15 1 BELGIUM
15 2 BELIZE
15 3 BENIN
15 4 BERLIN
15 5 BERMUDA
15 6 BESSARABIA
15 7 BHUTAN
15 8 BOHEMIA
15 9 BOLIVIA
16 0 BONAIRE
16 1 BORNEO
16 2 BOSNIA
16 3 BOSNIA and HERZEGOVINA
16 4 BOTSWANA
16 5 BRASIL
16 6 BRAZIL
16 7 BRAZZAVILLE
16 8 BREMEN
16 9 BRITAIN
17 0 BRITISH COLUMBIA
17 1 BRITISH EAST AFRICA

[p.6 ]

17 2 BRITISH GUIANA
17 3 BRITISH GUYANA
17 4 BRITISH HONDURAS
17 5 BRITISH HONG KONG
17 6 BRITISH ISLES
17 7 BRITISH VI
17 8 BRITISH VIRGIN IS
17 9 BRITISH WEST INDIES
18 0 BRITISH WI
18 1 BRUNEI
18 2 BULGARIA
18 3 BURKINA FASO
18 4 BURMA
18 5 BURUNDI
18 6 BWI
18 7 BYELARUS
18 8 BYELORUSSIA
18 9 CAICOS ISLANDS
19 0 CAM PHA
19 1 CAM RANH
19 2 CAMBODIA
19 3 CAMEROON
19 4 CAN THO
19 5 CANADA
19 6 CANAL ZONE
19 7 CANARY ISLANDS
19 8 CANTON and ENDERBURY IS
19 9 CANTON ISLAND
20 0 CAPE VERDE
20 1 CARIBBEAN
20 2 CAYMAN ISLANDS
20 3 CENTRAL AFRICA
20 4 CENTRAL AFRICAN REP
20 5 CENTRAL AMERICA
20 6 CEYLON
20 7 CHAD
20 8 CHANNEL ISLANDS
20 9 CHIAPAS
21 0 CHIHUAHUA
21 1 CHILE
21 2 CHINA
21 3 CHINA HONG KONG
21 4 CHRISTMAS ISLAND
21 5 CHRISTMAS ISLAND, INDIAN OCEAN
21 6 COAHUILA
21 7 COLIMA
21 8 COLOMBIA
21 9 COMOROS
22 0 CONGO
22 1 COOK ISLANDS
22 2 CORAL SEA ISLANDS
22 3 CORK

[p.7 ] 7 of 22

22 4 CORSICA
22 5 COSTA RICA
22 6 COTE D'IVORIE
22 7 CRETE
22 8 CRIMEA
22 9 CRISTOBAL
23 0 CROATIA
23 1 CUBA
23 2 CURACAO
23 3 CYPRUS
23 4 CZ
23 5 CZECH REPUBLIC
23 6 CZECHOSLOVAKIA
23 7 DA LAT
23 8 DA NANG
23 9 DAKAR
24 0 DANZIG
24 1 DELHI
24 2 DEMO PEOPLE'S REP OF KOREA
24 3 DEMO REP OF CONGO
24 4 DENMARK
24 5 DISTRITO FEDERAL
24 6 DJIBOUTI
24 7 DOM REP
24 8 DOMINICA
24 9 DOMINICA BWI
25 0 DOMINICA WI
25 1 DOMINICAN REPUBLIC
25 2 DUBAI
25 3 DUBLIN
25 4 DURANGO
25 5 DUTCH EAST INDIES
25 6 DUTCH GUIANA
25 7 DUTCH INDONESIA
25 8 DUTCH NEW GUINEA
25 9 EAST PAKISTAN
26 0 EAST PRUSSIA
26 1 EASTER ISLAND
26 2 EASTERN AFRICA
26 3 ECUADOR
26 4 EGYPT
26 5 EIRE
26 6 EL SALVADOR
26 7 ENGLAND
26 8 EQUATORIAL GUINEA
26 9 ERITREA
27 0 ESPANA
27 1 ESTONIA
27 2 ETHIOPIA
27 3 EUROPA ISLAND
27 4 EUROPE
27 5 FALKLAND ISLANDS

[p.8]

27 6 FAROE ISLANDS
27 7 FEDERAL DISTRICT
27 8 FEDERAL REPUBLIC OF YUGOSLAVIA
27 9 FEDERATED STATES OF MICRONESIA
28 0 FIJI
28 1 FILIPINES
28 2 FINLAND
28 3 FOREIGN COUNTRY
28 4 FORMOSA
28 5 FRANCE
28 6 FRANKFURT
28 7 FRENCH GUIANA
28 8 FRENCH MOROCCO
28 9 FRENCH POLYNESIA
29 0 GABON
29 1 GALAPAGOS ISLANDS
29 2 GALWAY
29 3 GAMBIA
29 4 GAZA STRIP
29 5 GEORGIA
29 6 GERMANY
29 7 GHANA
29 8 GIA DINH
29 9 GIBRALTER
30 0 GLORIOSO ISLANDS
30 1 GOA
30 2 GRAND BAHAMA
30 3 GRAND CAYMAN
30 4 GRAND TURK
30 5 GREAT BRITAIN
30 6 GREAT COMORE
30 7 GREECE
30 8 GREENLAND
30 9 GRENADA
31 0 GUADALAJARA
31 1 GUADELOUPE
31 2 GUANAJUATO
31 3 GUATEMALA
31 4 GUERNSEY
31 5 GUERRERO
31 6 GUIANA
31 7 GUINEA
31 8 GUINEA-BISSAU
31 9 GUYANA
32 0 HA DONG
32 1 HAI PHONG
32 2 HAITI
32 3 HAMBURG
32 4 HANOI
32 5 HANOVER
32 6 HAVANA
32 7 HEARD and MCDONALD ISLANDS

[p.9

32 8 HERZEGOVINA
32 9 HESSE
33 0 HIDALGO
33 1 HIGH SEAS
33 2 HOLLAND
33 3 HONDURAS
33 4 HONG KONG
33 5 HUNGARY
33 6 HYDERABAD
33 7 ICELAND
33 8 INDIA
33 9 INDONESIA
34 0 INTERNATIONAL WATERS
34 1 IRAN
34 2 IRAQ
34 3 IRELAND
34 4 IRIAN JAYA
34 5 IRISH REPUBLIC
34 6 ISLE OF MAN
34 7 ISRAEL
34 8 ITALY
34 9 IVORY COAST
35 0 JALISCO
35 1 JAMAICA
35 2 JAN MEYAN
35 3 JAPAN
35 4 JAVA
35 5 JERSEY
35 6 JIBUTI
35 7 JORDAN
35 8 JUAN DE NOVA ISLAND
35 9 JUGOSLAVIA
36 0 KALININGRAD
36 1 KAMPUCHEA
36 2 KASHMIR
36 3 KAZAKHSTAN
36 4 KENYA
365 KHANH HUNG
36 6 KINSHASA
36 7 KIRIBATI
36 8 KOREA
36 9 KORO ISLAND
37 0 KUWAIT
37 1 KWAJALEIN
37 2 KWANTUNG
37 3 KYRGYZSTAN
37 4 LABRADOR
37 5 LABUAN
37 6 LAOS
37 7 LATAKIA
37 8 LATIN AMERICA
37 9 LATVIA

[p.10]

38 0 LEBANON
38 1 LEEWARD ISLANDS
38 2 LESOTHO
38 3 LIBERIA
38 4 LIBYA
38 5 LIECHTENSTEIN
38 6 LITHUANIA
38 7 LOAS
38 8 LONDONDERRY
38 9 LONG XUYEN
39 0 LORRAINE
39 1 LUBECK
39 2 LUXEMBOURG
39 3 MACAO
39 4 MACAU
39 5 MACEDONIA
39 6 MADAGASCAR
39 7 MADEIRA ISLANDS
39 8 MAINLAND CHINA
39 9 MAJORCA
40 0 MALAGASY REPUBLIC
40 1 MALAWI
40 2 MALAYSIA
40 3 MALDIVES
40 4 MALI
40 5 MALLORCA
40 6 MALTA
40 7 MACHURIA
40 8 MANICA
40 9 MANILA
41 0 MANITOBA
41 1 MARSHALL ISLANDS
41 2 MARTINIQUE
41 3 MAURITANIA
41 4 MAURITIUS
41 5 MAYOTTE ISLAND
41 6 MELANESIA
41 7 MEXICO
41 8 MICHOACAN
41 9 MICRONESIA
42 0 MIDDLE EAST
42 1 MOLDAVIA
42 2 MOLDOVA
42 3 MONACO
42 4 MONAGAS
42 5 MONGOLIA
42 6 MONTENEGRO
42 7 MONTSERRAT
42 8 MORELOS
42 9 MOROCCO
43 0 MOZAMBIQUE
43 1 MY THO

[p.11 ]

43 2 N. IRELAND
43 3 NAM DINH
43 4 NAMIBIA
43 5 NAURU
43 6 NAYARIT
43 7 NEPAL
43 8 NETHERLANDS
43 9 NETH. ANTILLES
44 0 NETH. EAST INDIES
44 1 NEVIS ISLAND
44 2 NEW BRUNSWICK
44 3 NEW CALEDONIA
44 4 NEW GUINEA
44 5 NEW HEBRIDES
44 6 NEW SOUTH WALES
44 7 NEW ZEALAND
44 8 NEWFOUNDLAND
44 9 NHA TRANG
45 0 NICARAGUA
45 1 NIGER
45 2 NIGERIA
45 3 NIUE ISLAND
45 4 NORFOLK ISLAND
45 5 NORTH AFRICA
45 6 NORTH AMERICA
45 7 NORTH KOREA
45 8 NORTH VIETNAM
45 9 NORTHERN IRELAND
46 0 NORTHERN TERRITORY
46 1 NORWAY
46 2 NOVA SCOTIA
46 3 NUEVO LEON
46 4 OAXACA
46 5 OCEANIA
46 6 OKINAWA
46 7 OMAN
46 8 ONTARIO
46 9 OVERSEAS
47 0 PAKISTAN
47 1 PALAU
47 2 PALESTINE
47 3 PANAMA
47 4 PANAMA CANAL ZONE
47 5 PAPUA NEW GUINEA
47 6 PARACEL ISLANDS
47 7 PARAGUAY
47 8 PELAGOSA
47 9 PEOPLE'S REP. OF CHINA
48 0 PEOPLE'S REP. OF CONGO
48 1 PERSIA
48 2 PERU
48 3 PHAN THIET

[p.12 ]

48 4 PHILIPPINES
48 5 PITCAIRN ISLAND
48 6 POLAND
48 7 POLYNESIA
48 8 PONAPE
48 9 PORTUGAL
49 0 PORTUGUESE INDIA
49 1 PRINCE EDWARD ISLAND
49 2 PRINCIPE ISLAND
49 4 PRUSSIA
49 5 PUEBLA
49 6 PUNJAB
49 7 PUNJAB, INDIA
49 8 PUNJAB, PAKISTAN
49 9 QATAR
50 0 QUANG LONG
50 1 QUEBEC
50 2 QUEENSLAND
50 3 QUERETARO
50 4 QUI NHON
50 5 RACH GIA
50 6 RAJASTHAN
50 7 RED CHINA
50 8 REPUBLIC OF CHINA
50 9 REPUBLIC OF CYPRUS
51 0 REPUBLIC OF IRELAND
51 1 REPUBLIC OF KOREA
51 2 REPUBLIC OF PANAMA
51 3 REP. OF PHILIPPINES
51 4 REP. OF SOUTH AFRICA
51 5 REPUBLICA DOMINICANA
51 6 REUNION ISLAND
51 7 RHODESIA
51 8 ROC
51 9 ROK
52 0 ROMANIA
52 1 ROTTERDAM
52 2 RUMANIA
52 3 RUSSIA
52 4 RUSSIAN FEDERATION
52 5 RWANDA
52 6 SAIGON
52 7 SALVADOR
52 8 SAMOA
52 9 SAN ANDRES
53 0 SAN LUIS POTOSI
53 1 SAN MARINO
53 2 SAN SALVADOR
53 3 SAO TOME ISLAND
53 4 SAO TOME and PRINCIPE
53 5 SARAWAK
53 6 SASKATCHEWAN

[p.13]

53 7 SAUDI ARABIA
53 8 SAXONY
53 9 SCOTLAND
54 0 SENEGAL
54 1 SEOUL
54 2 SERBIA
54 3 SEYCHELLES
54 4 SHANGHAI
54 5 SHARJAH
54 6 SIBERIA
54 7 SICILY
54 8 SIERRA LEONE
54 9 SIKKIM
55 0 SINALOA
55 1 SINGAPORE
55 2 SLAVONIA
55 3 SLOVAK REPUBLIC
55 4 SLOVAKIA
55 5 SLOVENIA
55 6 SOLOMAN ISLANDS
55 7 SOMALIA
55 8 SONORA
55 9 SOUTH AFRICA
56 0 SOUTH AMERICA
56 1 SOUTH AUSTRALIA
56 2 SOUTH KOREA
56 3 SOUTH VIETNAM
56 4 SOUTH WALES
56 5 SOUTH YEMEN
56 6 SOUTHEAST ASIA
56 7 SOUTHERN AFRICA
56 8 SOUTHERN RHODESIA
56 9 SOVIET UNION
57 0 SPAIN
57 1 SPRATLEY ISLANDS
57 2 SRI LANKA
57 3 ST BARTHELEMY
57 4 ST BARTS
57 5 ST CHRISTOPHER
57 6 ST CHRISTOPHER-NEVIS
57 7 ST EUSTATIUS
57 8 ST HELENA
57 9 ST KITTS
58 0 ST KITTS-NEVIS
58 1 ST LUCIA
58 2 ST MAARTEN
58 3 ST MARTIN
58 4 ST PIERRE and MIQUELON
58 5 ST VINCENT
58 6 ST VINCENT and THE GRENADINES
58 7 SUDAN
58 8 SUMATRA

[p.14 ]

58 9 SURINAM
59 0 SURINAME
59 1 SVALBARD
59 2 SWAZILAND
59 3 SWEDEN
59 4 SWITZERLAND
59 5 SYRIA
59 6 SYRIAN ARAB REP
59 7 TABASCO
59 8 TADZHIK
59 9 TAHITI
60 0 TAIWAN
60 1 TAIWAN ROC
60 2 TAJIKISTAN
60 3 TAMAULIPAS
60 4 TANGANYIKA
60 5 TANGIER
60 6 TANZANIA
60 7 TASMANIA
60 8 THAILAND
60 9 THANH HOA
61 0 THE GRENADINES
61 1 TIBET
61 2 TIJUANA
61 3 TLAXCALA
61 4 TOBAGO
61 5 TOGO
61 6 TOGOLAND
61 7 TOKELAU
61 8 TONGA
61 9 TORTOISE ISLANDS
62 0 TORTOLA
62 1 TRANSVAAL
62 2 TRANSYLVANIA
62 3 TRIESTE
62 4 TRINIDAD
62 5 TRINIDAD and TOBAGO
62 6 TRIPOLI
62 7 TROMELIN ISLAND
62 8 TRUK
62 9 TUNIS
63 0 TUNISIA
63 1 TURKEY
63 2 TURKMENISTAN
63 3 TURKS and CAICOS IS
63 4 TURK ISLANDS
63 5 TUVALU
63 6 TUY HOA
63 7 UGANDA
63 8 UK
63 9 UKRAINE
64 0 UKRAINIA

[p.15 ]

64 1 UNION ISLANDS
64 2 UNION OF SOUTH AFRICA
64 3 UNION OF SOVIET SOCIALIST REPUBLICS
64 4 UNITED ARAB EMIRATES
64 5 UNITED KINGDOM
64 6 UPPER VOLTA
64 7 URUGUAY
64 8 USSR
64 9 USBEKISTAN
65 0 VANCOUVER
65 1 VANUATU
65 2 VATICAN CITY
65 3 VENEZUELA
65 4 VERACRUZ
65 5 VICTORIA
65 6 VIETNAM
65 7 VINH LONG
65 8 VUNG TAU
65 9 WALES
66 0 WALLIS and FUTUNA ISLANDS
66 1 WEST AFRICA
66 2 WEST BANK
66 3 WEST BENGAL
66 4 WEST INDIES
66 5 WEST PAKISTAN
66 6 WESTERN AUSTRALIA
66 7 WESTERN SAHARA
66 8 WESTERN SAMOA
66 9 WHITE RUSSIA
67 0 WINDWARD ISLANDS
67 1 WINNIPEG
67 2 WURZBERG
67 3 YAP
67 4 YAR
67 5 YEMEN
67 6 YEMEN ARAB REPUBLIC
67 7 YEREVAN
67 8 YUCATAN
67 9 YUGOSLAVIA
68 0 YUKON TERRITORY
68 1 ZACATECAS
68 2 ZADAR
68 3 ZAIRE
68 4 ZAMBIA
68 5 ZANZIBAR
68 6 ZIMBABWE
68 7 ZURICH
68 8 ANDORRA
68 9 BRITISH INDIAN OCEAN TERRITORY
69 0 DEUTSCHLAND
69 1 FRENCH SOUTHERN AND ANTARCTIC LANDS
69 2 GRENADINES, THE

[p.16 ]

69 3 KOSOVO
69 4 MYANMAR
69 5 NORTHWEST TERRITORY
69 6 NUNAVUT TERRITORY
996 Country not listed
997 Refused
999 Don't know

Universe Text: All persons not born in the United States
Skip Instructions:

(60-85) [store "2" in CITIZEN and goto USYR]
(100-696,996,R,D) [goto USYR]

Question ID: FSD.004_00.000

Instrument Variable Name: USYR
Question Text:

* Read if necessary.
Earlier I recorded [fill1: your/ALIAS's] date of birth as [fill2: AGEDOB@3(text version) AGEDOB@4, AGEDOB@5].
In what year did [fill3: you/ALIAS] come to the United States to stay?
1880-Current 1880-Current Year

Year
9997 Refused
9999 Don't know

Universe Text: All persons not born in the United States
Skip Instructions:

(1880-Current Year) [if USYR lt AGEDOB@5, goto ERR2_USYR; else, goto CITIZEN]
(R,D) [goto USLONG]
NOTE: The "*Read if necessary...Earlier I recorded..." portion of this question is included for persons with
complete date of birth information.

Question ID: FSD.005_00.000

Instrument Variable Name: USLONG
Question Text:

About how long [fill1: have you/has ALIAS] been in the United States?
* Read if necessary: Earlier I recorded that [fill2: you are/ALIAS is] [fill3: AGE] years old.
*Enter '95' for 95 or more years.
*If less than 1 year given as a response, code the answer as '0'.

00-94 00-94 years
95 95+ years
97 Refused
99 Don't know

Universe Text: All persons not born in the United States and refused or don't know was reported for USYR
Skip Instructions:

(0-95) [if USLONG gt AGE, goto ERR_USLONG; else, goto CITIZEN]
(R,D) [goto CITIZEN]

[p.17 ]

Question ID: FSD.006_00.000

Instrument Variable Name: CITIZEN
Question Text:

(book) F20 ?[F1]
[fill: Are you/Is ALIAS] a CITIZEN of the United States?

1 Yes, born in one of the 50 United States or the District of Columbia
2 Yes, born in Puerto Rico, Guam, American Virgin Islands, or other U.S. territory
3 Yes, born abroad to American parent(s)
4 Yes, U.S. citizen by naturalization
5 No, not a citizen of the United States
7 Refused
9 Don't know

Universe Text: All persons not born in the United States or a United States territory
Skip Instructions:

(1) [if PLBORN eq 2, goto ERR1_CITIZEN; else, if PLBORN eq R, goto ERR3_CITIZEN; else, goto HEADST]
(2) [if (PLBORN eq 2 or PLBORN eq R), goto ERR2_CITIZEN; else, goto HEADST]
(R,D) [goto HEADST]

Question ID: FSD.007_00.000

Instrument Variable Name: HEADST
Question Text:

?[F1]
Is [fill: ALIAS] now attending Head Start?

1 Yes
2 No
7 Refused
9 Don't know

Text: All persons less than 7 years of age
Skip Instructions:

(1) [if no more persons less than 7 years of age, goto EDUC; else, repeat this question for the next eligible person]
(2,R,D) [ goto HEADSTEV]

Question ID: FSD.008_00.000

Instrument Variable Name: HEADSTEV
Question Text:

Has [fill: ALIAS] ever attended Head Start?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age and not currently enrolled in Head Start
Skip Instructions:

if no more persons less than 7 years of age, goto EDUC; else, goto HEADST for the next eligible person

[p.18 ]

Question ID: FSD.010_00.000

Instrument Variable Name: EDUC
Question Text:

(book) F21 ?[F1]
What is the HIGHEST level of school [fill: you have/ALIAS has] completed or the highest degree [fill: you have/ALIAS
has] received? Please tell me the number from the card.
* Enter highest level of school completed.

00 Never attended/kindergarten only
01 1st grade
02 2nd grade
03 3rd grade
04 4th grade
05 5th grade
06 6th grade
07 7th grade
08 8th grade
09 9th grade
10 10th grade
11 11th grade
12 12th grade, no diploma
13 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)
96 Child under 5 years old
97 Refused
99 Don't know

Universe Text: All persons 5 years of age or older
Skip Instructions:

repeat for all eligible persons, then goto FMILTRY

[p.19 ]

Question ID: FSD.041_00.000

Instrument Variable Name: FMILTRY
Question Text:

[fill: Have you/Has any family member, that is
*Read names
(fill roster of people ge 18 years of age)]
ever been hono rably discharged from active duty in the U.S. Army, Navy, Air Force, Marine Corps, or Coast Guard?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with persons 18 years of age or older
Skip Instructions:

(1) [if only one person 18 years of age or older, store the person number in PMILTRY and goto DOINGLW; else,
goto PMILTRY]
(2,R,D) [goto DOINGLW]

Question ID: FSD.042_00.000

Instrument Variable Name: PMILTRY
Question Text:

* Ask or verify. Enter all that apply, separate with commas.
Who was this?
* Indicate each family member with honorable discharge.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons 18 years of age or older and at least one was honorably discharged from
active duty in the U.S. Army, Navy, Air Force, Marine Corps, or Coast Guard
Skip Instructions:

goto DOINGLW
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

[p.20 ]

Question ID: FSD.050_00.000

Instrument Variable Name: DOINGLW
Question Text:

(book) F22 ? [F1]
The next few questions are about employment status.
Which of the following [fill: were you/was ALIAS] doing last week?
* Read answer categories.

1 Working for pay at a job or business_
2 With a job or business but not at work
3 Looking for work
4 Working, but not for pay, at a family-owned job or business_
5 Not working at a job or business and not looking for work
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older
Skip Instructions:

(1,4) [goto WRKHRS]
(2,5) [goto WHYNOWRK]
(3,R,D) [goto WRKLYR]
NOTE: A flashcard was added to this question in quarter 3 of 2005.

Question ID: FSD.060_00.000

Instrument Variable Name: WHYNOWRK
Question Text:

?[F1]
What is the main reason [fill1: you/ALIAS] did not [fill2: work last week/have a job or business last week]?

01 Taking care of house or family
02 Going to school
03 Retired
04 On a planned vacation from work
05 On family or maternity leave
06 Temporarily unable to work for health reasons
07 Have job/contract and off-season
08 On layoff
09 Disabled
10 Other
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who were either with a job or business but not at work, or not working at a job
or business and not looking for work
Skip Instructions:

(1-3,8-10,R,D) [goto WRKLYR]
(4-7) [goto WRKHRS]

[p.21 ] 21 of 22

Question ID: FSD.070_00.000

Instrument Variable Name: WRKHRS1
Question Text:

?[F1]
How many hours [fill: did you work LAST WEEK at ALL jobs or businesses/did ALIAS work LAST WEEK at ALL jobs
or businesses/do you USUALLY work at ALL jobs or businesses/does ALIAS USUALLY work at ALL jobs or
businesses]?

001-168 1-168 hours
997 Refused
999 Don't know

Universe Text: All persons 18 years of age or older who were working for pay at a job or business, or working, but not for pay, at
a job or business last week, or on a planned vacation from work, or on family or maternity leave, or temporarily
unable to work for health reasons, or have a job/contract and off-season
Skip Instructions:

(1-34,R,D) [goto WRKFTALL]
(35-94) [goto WRKLYR]
(95-168) [goto ERR1_WRKHRS]

Question ID: FSD.080_00.000

Instrument Variable Name: WRKFTALL
Question Text:

?[F1]
[fill: Do you/Does ALIAS] USUALLY work 35 hours or more per week in total at ALL jobs or businesses?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who worked less than 35 hours last week or did not know/refused to answer
how many hours they worked last week
Skip Instructions:

[goto WRKLYR]
NOTE ON QUESTIONNAIRE FLOW: The instrument cycles through the appropriate questions from DOINGLW
to WRKFTALL for each eligible person, then proceeds to WRKLYR.

Question ID: FSD.100_00.000

Instrument Variable Name: WRKLYR
Question Text:

?[F1]
Did [fill1: you/ALIAS] work for pay at any time in [fill2: last calendar year in 4-digit format]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older
Skip Instructions:

(1) [goto WRKMYR]
(2,R,D) [goto HIEMPOF]

[p.22 ]

Question ID: FSD.110_00.000

Instrument Variable Name: WRKMYR
Question Text:

How many months in [fill1: last calendar year in 4-digit format] did [fill2: you/ALIAS] have at least one job or business?
* If less than one month, enter '1'.

01 1 month or less
02-12 2-12 months
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who worked last year
Skip Instructions:

goto ERNYR

Question ID: FSD.120_00.000

Instrument Variable Name: ERNYR
Question Text:

?[F1]
What is your best estimate of [fill1: your/ALIAS's] earnings before taxes and deductions from ALL jobs and businesses in
[fill2: last calendar year in 4-digit format]?
Include hourly wages, salaries, tips and commissions.
* Enter '999,995' if the reported income is greater than $999,995.

0 00001-999994 $1-$999,994
999995 $999,995+
999997 Refused
999999 Don't know

Universe Text: All persons 18 years of age or older who worked last year
Skip Instructions:

goto HIEMPOF

Question ID: FSD.130_00.000

Instrument Variable Name: HIEMPOF
Question Text:

Regarding [fill1: your/ALIAS's] job or work last week, was health insurance offered to [fill2: you/ALIAS] through [fill1:
your/ALIAS's] workplace?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who were working for pay at a job or business, or with a job or business, but
not at work, or working, but not for pay, at a family-owned job or business
Skip Instructions:

goto INTROINC
NOTE ON QUESTIONNAIRE FLOW: The instrument cycles through the appropriate questions from WRKLYR
to HIEMPOF for each eligible person, then proceeds to INTROINC.

[p.1 ]

2007 NHIS Questionnaire - Family
Family Income

Question ID: FIN.010_00.000

Instrument Variable Name: FINCINT
Question Text:

* Read the following.
The next questions are about [fill1: your total/your total family] income in [fill2: last calendar year in 4-digit format]
BEFORE TAXES.
Income is important in analyzing the health information we collect. For example, with this information, we can learn
whether persons in one income group use certain types of medical services more or less often than those in another group.
Please be assured that, like all other information you have provided, these answers will be kept strictly confidential.
1 Enter 1 to continue

Universe Text: All families
Skip Instructions:

goto FSAL

Question ID: FIN.030_00.000

Instrument Variable Name: FSAL
Question Text:

? [F1]
[fill1: Did you receive income in [fill2: last calendar year in 4-digit format] from wages and salaries?]
[fill3: When answering these questions, please remember that by "combined ," I mean your income PLUS
the income of all family members living in this household (including cohabiting partners, and armed forces members
living at home).
Did any family members 18 and older, that is * Read names
(fill roster of people ge 18 years of age)
receive income in [fill2: last calendar year in 4-digit format] from...wages and salaries?]

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with one or more persons 18 years of age or older
Skip Instructions:

(1) [if a single-person family, store the person number in PSAL and goto FSEINC; else, goto PSAL]
(2,R,D) [goto FSEINC]

Question ID: FIN.040_00.000

Instrument Variable Name: PSAL
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons 18 years of age or older and at least one received income from wages and
salaries in the last calendar year
Skip Instructions:

goto FSEINC
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.050_00.000

Instrument Variable Name: FSEINC
Question Text:

[fill1: Did you receive income in [fill2: last calendar year in 4-digit format] from self-employment including business and
farm income?/ Did ALIAS receive income in [fill2: last calendar year in 4-digit format] from self-employment including
business and farm income?/Did any family members 18 and older, that is
*Read names
(fill roster of people ge 18 years of age)
receive income in [fill2: last calendar year in 4-digit format] from...self-employment including business and farm income?]

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with one or more persons 18 years of age or older
Skip Instructions:

(1) [if a single-person family, store the person number in PSEINC and goto FSSRR; else, goto PSEINC]
(2,R,D) [goto FSSRR]

Question ID: FIN.060_00.000

Instrument Variable Name: PSEINC
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons 18 years of age or older and at least one received income from self-
employment in the last calendar year
Skip Instructions:

goto FSSRR
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.070_00.000

Instrument Variable Name: FSSRR
Question Text:

? [F1]
Did [fill1: you/any family members living here] receive income in [fill2: last calendar year in 4-digit format] from Social
Security or Railroad Retirement?
* Read if necessary: Social Security checks are either automatically deposited in the bank or mailed to arrive on the third
of every month.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in PSSRR and goto FSSRRD; else, goto PSSRR]
(2,R,D) [goto FPENS]

Question ID: FIN.080_00.000

Instrument Variable Name: PSSRR
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received income from Social Security or Railroad
Retirement in the last calendar year
Skip Instructions:

goto FSSRRD
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.082_00.000

Instrument Variable Name: FSSRRD
Question Text:

Was [fill: your/any family member's *Read names (fill roster of all persons selected at PSSRR and AGE LE 64)]
Social Security or Railroad Retirement income received as a disability benefit?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with persons less than 65 years of age who received Social Security or Railroad Retirement income in
the last calendar year
Skip Instructions:

(1) [if only one person less than 65 years of age received Social Security or Railroad Retirement income, fill the
person number in PSSRRDB and goto PSSRRD; else, goto PSSRRDB]
(2,R,D) [goto FPENS]

Question ID: FIN.084_00.000

Instrument Variable Name: PSSRRDB
Question Text:

*Ask or verify. Enter applicable line number(s), separate with commas.
Who received Social Security or Railroad Retirement as a disability benefit?
(Anyone else?)

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons less than 65 years of age who received income from Social Sceurity or
Railroad Retirement in the last calendar year and at least one received the income as a disability benefit
Skip Instructions:

goto PSSRRD
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.086_00.000

Instrument Variable Name: PSSRRD
Question Text:

Did [fill1: you/ALIAS] receive this benefit because [fill2: you are/he is/she is] disabled?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons less than 65 years of age who received Social Security or Railroad Retirement income as a disability
benefit in the last calendar year
Skip Instructions:

repeat for all eligible persons, then goto FPENS

Question ID: FIN.090_00.000

Instrument Variable Name: FPENS
Question Text:

Did [fill1: you/any family members living here] receive income in [fill2: last calander year in 4-digit format] from any
disability pension [fill3: other than Social Security or Railroad Retirement]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in PPENS and goto FOPENS; else, goto PPENS]
(2,R,D) [goto FOPENS]

Question ID: FIN.100_00.000

Instrument Variable Name: PPENS
Question Text:

*Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
*Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received income from a disability pension (other than Social
Security or Railroad Retirement) in the last calendar year
Skip Instructions:

goto FOPENS
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.102_00.000

Instrument Variable Name: FOPENS
Question Text:

Did [fill1: you/any family members living here] receive income from any retirement or survivor pension other [fill2: than
Social Security or Railroad Retirement/than a disability pension/than Social Security, Railroad Retirement, or a disability
pension]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in POPENS and goto FSSI; else, goto POPENS]
(2,R,D) [goto FSSI]

Question ID: FIN.104_00.000

Instrument Variable Name: POPENS
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received income from a retirement or survivor pension in
the last calendar year
Skip Instructions:

goto FSSI
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

[p.7 ]

Question ID: FIN.110_00.000

Instrument Variable Name: FSSI
Question Text:

? [F1]
Did [fill: you/any family members] receive Supplemental Security Income (SSI)?
* Read if necessary: Federal SSI checks are either automatically deposited in the bank or mailed to arrive on the first of
every month.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, fill the person number in PSSI and goto PSSID; else, goto PSSI]
(2,R,D) [goto FTANF]

Question ID: FIN.120_00.000

Instrument Variable Name: PSSI
Question Text:

*Ask or verify. Enter applicable line number(s), separate with commas.
Who in the family received this?
(Anyone else?)
*Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received Supplemental Security Income (SSI) in the last
calendar year
Skip Instructions:

goto PSSID
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.122_00.000

Instrument Variable Name: PSSID
Question Text:

Did [fill1: you/ALIAS] receive SSI because [fill2: you have/he has/she has] a disability?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons who received SSI in the last calendar year
Skip Instructions:

repeat for all eligible persons, then goto FTANF

[p.8 ]

Question ID: FIN.150_00.000

Instrument Variable Name: FTANF
Question Text:

*(book) F23 ? [F1]
At any time during [fill1: last calendar year in 4-digit format], even for one month, did [fill2: you/any family members
living here] receive any CASH assistance from a state or county welfare program, such as (* fill specific program name)?
* Please do not include food stamps, SSI, energy assistance, or medical assistance payments.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in PTANF and goto FOWBEN; else, goto PTANF]
(2,R,D) [goto FOWBEN]

Question ID: FIN.160_00.000

Instrument Variable Name: PTANF
Question Text:

*Ask or verify. Enter applicable line number(s), separate with commas.
Who in the family received this?
(Anyone else?)
*Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received cash assistance from a state or county welfare
program in the last calendar year
Skip Instructions:

goto FOWBEN
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.164_00.000

Instrument Variable Name: FOWBEN
Question Text:

At any time during [fill1: last calander year in 4-digit format], did [fill2: you/any family members living here] receive any
OTHER kind of welfare assistance such as help with getting a job, placement in education or job training programs, or
help with transportation or child care?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in POWBEN and goto FINTRST; else, goto POWBEN]
(2,R,D) [goto FINTRST]

Question ID: FIN.166_00.000

Instrument Variable Name: POWBEN
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received income from some "other" kind of welfare
assistance in the last calendar year
Skip Instructions:

goto FINTRST
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.170_00.000

Instrument Variable Name: FINTRST
Question Text:

Did [fill: you/any family members living here] receive income from interest bearing checking accounts, savings accounts,
IRAs or certificates of deposit, money market funds, treasury notes, bonds, or any other investments that earn interest?
* Do not include dividends

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in PINTRST and goto FDIVD; else, goto PINTRST]
(2,R,D) [goto FDIVD]

Question ID: FIN.180_00.000

Instrument Variable Name: PINTRST
Question Text:

*Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received interest income in the last calendar year
Skip Instructions:

goto FDIVD
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

[p.10 ] 10 of 17

Question ID: FIN.190_00.000

Instrument Variable Name: FDIVD
Question Text:

Did [fill: you/any family members living here] receive income from dividends from stocks or mutual funds, or net rental
income from property, royalties, estates or trusts?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in PDIVD and goto FCHLDSP; else, goto PDIVD]
(2,R,D) [goto FCHLDSP]

Question ID: FIN.200_00.000

Instrument Variable Name: PDIVD
Question Text:

* Ask or verify. Enter applicable line number(s). Separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received dividend or net rental income in the last calendar
year
Skip Instructions:

goto FCHLDSP
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.210_00.000

Instrument Variable Name: FCHLDSP
Question Text:

? [F1]
Did [fill: you/any family members living here] receive income from child support?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in PCHLDSP and goto FINCOT; else, goto PCHLDSP]
(2,R,D) [goto FINCOT]

Question ID: FIN.220_00.000

Instrument Variable Name: PCHLDSP
Question Text:

*Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate which child in the family this is for. If that child is no longer residing with this family, enter line number of
custodial parent.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least received income from child support in the last calendar year
Skip Instructions:

goto FINCOT
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.230_00.000

Instrument Variable Name: FINCOT
Question Text:

Did [fill: you/any family members living here] receive income from any other source such as alimony, contributions from
family/others, VA payments, Worker's Compensation, or unemployment compensation?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in PINCOT and goto FINCTOT; else, goto PINCOT]
(2,R,D) [goto FINCTOT]

Question ID: FIN.240_00.000

Instrument Variable Name: PINCOT
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received some "other" source of income in the last calendar
year
Skip Instructions:

goto FINCTOT
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

[p.12 ]

Question ID: FIN.250_00.000

Instrument Variable Name: FINCTOT
Question Text:

[fill1: When answering this next question, please remember to include your income PLUS the income of all family
members living in this household.]
What is your best estimate of [fill2: your total income/the total income of all family members] from all sources, before
taxes, in [fill3: last calendar year in 4 digit format]?
* Enter ?999,995' if the reported income is greater than $999,995.

000000 -999994 $0-$999,994
999995 $999,995+
999997 Refused
999999 Don't know

Universe Text: All families
Skip Instructions:

(0-999) goto ERR1_FINCTOT_
(1000-250000) goto HOUSEOWN _
(250001-999995) goto ERR2_FINCTOT_
(D,R) goto FINC50_

Question ID: FIN.255_00.000

Instrument Variable Name: FINC50
Question Text:

Was your total [fill: family] income from all sources less than $50,000 or $50,000 or more?

1 Less than $50,000
2 $50,000 or more
7 Refused
9 Don't know

Universe Text: Respondents who don't know or refuse their income
Skip Instructions:

(1) [goto FINC35]
(2) [goto FINC100]
(R,D) [HOUSEOWN]

Question ID: FIN.260_00.000

Instrument Variable Name: FINC35
Question Text:

Was your total [fill: family] income from all sources less than $35,000 or $35,000 or more?

1 Less than $35,000
2 $35,000 or more
7 Refused
9 Don't know

Universe Text: The respondent answered Less than $50,000
Skip Instructions:

(1) [goto FINCPOV]
(2,R,D) [goto HOUSEOWN]

Question ID: FIN.265_00.000

Instrument Variable Name: FINCPOV
Question Text:

Was your total [fill1: family] income from all sources less than [fill2: fill based on poverty threshold] or [fill2: fill based
on poverty threshold] or more?

1 Less than [$9,500/$12,000/$15,000/$19,000/$22,500/$25,500/$29,000]
2 [$9,500/$12,000/$15,000/$19,000/$22,500/$25,500/$29,000] or more
7 Refused
9 Don't know

Universe Text: The respondent answered Less than $35,000
Skip Instructions:

(1,2,R,D) [HOUSEOWN]

Question ID: FIN.270_00.000

Instrument Variable Name: FINC100
Question Text:

Was your total [fill: family] income from all sources less than $100,000 or $100,000 or more?

1 Less than $100,000
2 $100,000 or more
7 Refused
9 Don't know

Universe Text: The respondent answered More than $50,000
Skip Instructions:

(1) [goto FINC75] (2,R,D) [goto HOUSEOWN]

Question ID: FIN.275_00.000

Instrument Variable Name: FINC75
Question Text:

Was your total [fill: family] income from all sources less than $75,000 or $75,000 or more?

1 Less than $75,000
2 $75,000 or more
7 Refused
9 Don't know

Universe Text: The respondent answered Less than $100,000
Skip Instructions:

(1,2,R,D) [goto HOUSEOWN]

Question ID: FIN.280_00.000

Instrument Variable Name: HOUSEOWN
Question Text:

Is this house/apartment owned or being bought, rented, or occupied by some other arrangement by you [fill: /or someone
in your family]?

1 Owned or being bought
2 Rented
3 Other arrangement
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1,3,R,D) [goto FSSAPL]
(2) [goto FGAH]

[p.14 ]

Question ID: FIN.282_00.000

Instrument Variable Name: FGAH
Question Text:

? [F1]
[fill: Are you/Is anyone in your family] paying lower rent because the Federal, State, or local government is paying part of
the cost?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families that rent their house/apartment
Skip Instructions:

goto FSSAPL

Question ID: FIN.300_00.000

Instrument Variable Name: FSSAPL
Question Text:

[fill: Have you EVER applied for Supplemental Security Income or SSI, even if the claim was denied?/Have any family
members living here EVER applied for Supplemental Security Income (SSI)? This includes people who applied for
benefits, even if the claim was denied.]

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in PSSAPL and goto FSDAPL; else, goto PSSAPL]
(2,R,D) [goto FSDAPL]

Question ID: FIN.310_00.000

Instrument Variable Name: PSSAPL
Question Text:

*Ask or verify. Enter applicable line number(s), separate with a comma.
Who in the family applied for it?
(Anyone else?)
* Indicate each family member who applied for SSI benefits.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one applied for SSI
Skip Instructions:

goto FSDAPL
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

[p. 15]

Question ID: FIN.330_00.000

Instrument Variable Name: FSDAPL
Question Text:

[fill: Have you EVER APPLIED for disability benefits from Social Security even if the claim was denied?/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.]

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All Families
Skip Instructions:

(1) [if a single-person family, store the person number in PSDAPL and goto TANFMYR; else, goto PSDAPL]
(2,R,D) [goto TANFMYR]

Question ID: FIN.340_00.000

Instrument Variable Name: PSDAPL
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who in the family applied for it?
(Anyone else?)
* Indicate each family member who applied for Social Security Disability benefits.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one applied for Social Security Disability benefits
Skip Instructions:

goto TANFMYR
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.350_00.000

Instrument Variable Name: TANFMYR
Question Text:

? [F1]
Earlier I recorded that [fill1: you/ALIAS] received cash assistance from programs such as welfare or public assistance in
[fill2: last calendar year in 4-digit format]. During [fill2: last calendar year in 4-digit format], about how many months
did [fill1: you/ALIAS] receive this assistance?
*Enter '1' if less than one month.

01-12 1-12 months
97 Refused
99 Don't know

Universe Text: All persons who received cash assistance from public assistance programs in the last calendar year
Skip Instructions:

repeat for all eligible persons, then goto FFSTIP

[p.16 ]

Question ID: FIN.360_00.000

Instrument Variable Name: FFSTIP
Question Text:

? [F1]
[fill1: Were you/Was anyone in the family] authorized to receive food stamps (which includes a food stamp card or
voucher, or cash grants from the state for food) at anytime during [fill2: last calendar year in 4-digit format]?
*An authorized person is one whose name appears on a certification card.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, store the person number in PFSTP and goto FSTPMYR; else, goto PFSTP]
(2,R,D) [goto FINWIC]

Question ID: FIN.370_00.000

Instrument Variable Name: PFSTP
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who was authorized to receive food stamps?
* Indicate family members who were authorized to receive food stamps.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one was authorized to receive food stamps in the last calendar
year
Skip Instructions:

goto FSTPMYR
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.380_00.000

Instrument Variable Name: FSTPMYR
Question Text:

During [fill1: last calendar year in 4-digit format], about how many months [fill2: were you/was ALIAS] authorized to
receive food stamps?
* Enter '1' if less than 1 month

01-12 1-12 months
97 Refused
99 Don't know

Universe Text: All persons authorized to receive food stamps in the last calendar year
Skip Instructions:

goto FINWIC

[p.17 ]

Question ID: FIN.384_00.000

Instrument Variable Name: FINWIC
Question Text:

? [F1]
At any time during [fill1: last calendar year in 4-digit format] did [fill2: you/anyone in your family] receive benefits from
the WIC program, that is, the Women, Infants and Children program?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with females 12-55 years of age or children 0-5 years of age
Skip Instructions:

(1) [if a single-person family, store the person number in PWIC and goto FMSSN; else, goto PWIC]
(2,R,D) [goto FMSSN]

Question ID: FIN.385_00.000

Instrument Variable Name: PWIC
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who in the family received this?
(Anyone else?)
* Indicate family members who were authorized to receive WIC benefits.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons who are female and between the ages of 12-55 or children between the ages
of 0-5, and at least one received WIC benefits in the last calendar year
Skip Instructions:

goto FMSSN
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

[p.1 ]

2007 NHIS Questionnaire - Family
Coverage

Document Version Date: 28 - May-08

Question ID: COV.330_00.000

Instrument Variable Name: TELENUM
Question Text:

What is the telephone number here?
* Enter the area code and the number, or enter "N" if no phone.

2000000000-9999999996 Phone number
9999999997 Refused
9999999999 Don't know
N No phone

Universe Text: All families
Skip Instructions:

(2000000000 - 9999999999, D, R) store in HPHONE1, GOTO INSIDE_
(0-1999999999) GOTO ERR_TELENUM_
(N) GOTO HOWLONG_1

Question ID: COV.331_00.000

Instrument Variable Name: CURWRK
Question Text:

?[F1]
Is there at least one telephone INSIDE your home that is currently working and is not a cell phone?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with a phone
Skip Instructions:

(1,Refused,Don't know) go to RNOSERV
(2) goto RH1LNGDY_1

Question ID: COV.332_00.000

Instrument Variable Name: RNOSERV
Question Text:

Not including cell phones, have you or your family been without telephone service for one week or more DURING THE
PAST 12 MONTHS? Do not include interruptions of phone service due to weather or natural disasters.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: No phone in home that is working and not a cellular phone (or refused to provide or said don't know this
information)
Skip Instructions:

(1) goto RH1LNGDY_1
(2, Refused, Don't know) goto TELCEL

[p.2]

Question ID: COV.333_01.000

Instrument Variable Name: RH1LNGDY_1
Question Text:

?[F1]
Not including cell phones, how long were you or your family without telephone service in the PAST 12 MONTHS?
* Enter number for time without telephone service.
* If less than one week, enter '0'.

000 Less than 1 week
001-365 1-365
997 Refused
999 Don't know

Universe Text: Respondents with no phone or who have no working land-line phone or who have been without land-line phone
service for one week or more during the past 12 months.
Skip Instructions:

(1-365) goto RH1LNGDY_2
(0,Refused, Don't know) goto TELCEL

Question ID: COV.333_02.000

Instrument Variable Name: RH1LNGDY_2
Question Text:

?[F1]
* Enter time period for time without telephone service.

1 Day(s)
2 Week(s)
3 Months(s)
7 Refused
9 Don't know

Universe Text: Gave number at RH1LNGDY_1
Skip Instructions:

(1) if RH1LNGDY_1 lt '7' goto ERR1_RH1LNGDY_2 else goto TELCEL
(2) if RH1LNGDY_1 gt '52' goto ERR2_RH1LNGDY_2 else goto TELCEL
(3) if RH1LNGDY_1 gt '12' goto ERR3_RH1LNGDY_2 else goto TELCEL

Question ID: COV.334_00.000

Instrument Variable Name: TELCEL
Question Text:

Do you or anyone in your family have a working cell phone?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) goto WRKCEL
(2, Refused, Don't know) if CURWRK = '1' and RNOSERV = '1'
goto CELLOUT
elseif POS2 = '0'
goto hhc.NAME_FNAME
else
goto hhc.ADC

[p.3]

Question ID: COV.335_00.000

Instrument Variable Name: WRKCEL
Question Text:

How many working cell phones do you or people in your family have?

01- 10 1-10 phones
97 Refused
99 Don't know

Universe Text: Families with a working cell phone
Skip Instructions:

(1-10, Refused, Don't know) if CURWRK = '1' and RNOSERV = '1'
goto CELLOUT
elseif CURWRK = '1' and RNOSERV = '2', 'Refused', or 'Don't know'
goto PHONEUSE
elseif POS2 = '0'
goto hhc.NAME_FNAME
else
goto hhc.ADC

Question ID: COV.336_00.000

Instrument Variable Name: CELLOUT
Question Text:

During the most recent time you or your family were without telephone service, did you have a working cell phone?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Families with no cell phone, or Refused or Don't know whether they had working cell phone and have a current
working land-line that was out of service in the past 12 months, or who have a least one working cell phone or
Refused or Don't know number of working cell phones and have current working land-line that was out of service
in the past 12 months
Skip Instructions:

(1, 2, Refused, Don't know) if TELCEL = '1'_goto PHONEUSE
elseif POS2 = '0' goto hhc.NAME_FNAME
else goto hhc.ADC

[p.4]

Question ID: COV.337_00.000

Instrument Variable Name: PHONEUSE
Question Text:

Of all the telephone calls that you or your family receives, are...
*Read categories below.

1 All or almost all calls received on cell phones
2 Some received on cell phones and some on regular phones
3 Very few or none on cell phones
7 Refused
9 Don't know

Universe Text: Working cell phone and working land-line in family
Skip Instructions:

(1-3, Refused, Don't know) if POS2 = '0'
goto hhc.NAME_FNAME else goto hhc.ADC

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