Document Version Date: 30-May-12
Questionnaire File Name: Family

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]

Instrument Variable Name: CWHAT2
QuestionText: * 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

UniverseText: HHCHANGE = 2 (No, not correct)
SkipInstructions:

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

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?

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
Hard Edit: ERR_HHCHANGE_1
* Press enter to go back to change some demographic information or arrow down and press enter to change your answer.
Default Goto should be CWHAT2

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
SkipInstructions:

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

Instrument Variable Name: SPOUS
QuestionText:

* 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]

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]
Hard Edit: ERR1_SPOUS2
*Person can't be his or her own spouse.
*Please correct.

Soft Edit: ERR2_SPOUS2

*If [ALIAS (SPOUS2(PX)] is [ALIAS (PX)]'s spouse, [ALIAS (SPOUS2(PX))]'s RPREL value should be '02'.
*Correct relationship code at RPREL or change answer at SPOUS2.
*First GOTO is to change Relationship code of [ALIAS (SPOUS2(PX))]
*Second GOTO is to choose different spouse at SPOUS2
Questions involved Value
RPREL: Relationship to Ref Person RPREL(SPOUS2(PX))
SPOUS2 ALIAS (SPOUS2(PX))
ERR3_SPOUS2
*Do not read this message to the respondent.
*The married couple [ALIAS (SPOUS2(PX))] and [ALIAS (PX)] are both [SEX(PX)].
*Suppress message if correct.
*Otherwise, correct SEX of either person or choose different spouse.
*First GOTO is to choose different spouse at SPOUS2
*Second GOTO is to change SEX of spouse [ALIAS (SPOUS2(PX))]
*Third GOTO is to change SEX of [ALIAS(PX)]
Questions involved Value
SPOUS2 ALIAS (SPOUS2(PX))
SEX SEX (SPOUS2(PX))
SEX SEX (PX)
ERR4_SPOUS2
*Age difference between spouses is greater than or equal to 30 years.
I have recorded [ALIAS (PX)] is [AGE(PX)] years old and [fill: his/her] spouse [ALIAS(SPOUS2(PX))] is
[AGE(SPOUS2(PX))] years old. Are these ages and relationships correct?
*First GOTO is to choose different spouse at SPOUS2
*Second GOTO is to change AGE of spouse [ALIAS (SPOUS2(PX))]
*Third GOTO is to change AGE of [ALIAS(PX)]
Questions involved Value
SPOUS2 ALIAS (SPOUS2(PX))
AGE AGE (SPOUS2(PX))
AGE AGE (PX)

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]

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 is currently cohabiting and has been married.
Skip Instructions:

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

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: Cohabiting 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]
Hard Edit: ERR1_COHAB3
* Person can't be his or her own partner.
* Please correct.
ERR2_COHAB3
Soft Edit:
*If [ALIAS (COHAB3(PX))] is [ALIAS (PX)]'s cohabiting partner, [ALIAS (COHAB3(PX))]'s RPREL value
should be '03'.
*Correct relationship code at RPREL or change answer at COHAB3.
*First GOTO is to change Relationship code of [ALIAS (COHAB3(PX))]
*Second GOTO is to choose different cohabiting partner at COHAB3
Questions involved Value
RPREL: Relationship to Ref Person RPREL(COHAB3 (PX))
COHAB3 ALIAS (COHAB3 (PX))
ERR3_COHAB3
*If [ALIAS (COHAB3(PX))] and [ALIAS (PX)] are cohabiting partners, it is not possible for both to have RPREL
codes equal to '04' for 'Child'. One of their RPREL codes should equal '12' for 'Other relative'.
*Correct relationship code at RPREL or change answer at COHAB3.
*First GOTO is to change Relationship code of [ALIAS (COHAB3(PX))]
*Second GOTO is to change Relationship code of [ALIAS (PX)]
*Third GOTO is to choose different cohabiting partner at COHAB3
Questions involved Value
RPREL: Relationship to Ref Person Child
RPREL: Relationship to Ref Person Child
COHAB3 ALIAS (COHAB3 (PX))
ERR4_ COHAB3
*Age difference between cohabiting partners is greater than or equal to 20 years.
I have recorded [ALIAS (PX)] is [AGE(PX)] years old and [fill: his/her] cohabiting partner
[ALIAS(COHAB3(PX))] is [AGE(COHAB3(PX))] years old. Are these ages and relationships correct?
*First GOTO is to choose different cohabiting partner at COHAB3
*Second GOTO is to change AGE of cohabiting partner [ALIAS (COHAB3(PX))]
*Third GOTO is to change AGE of [ALIAS(PX)]
Questions involved Value
COHAB3 ALIAS (COHAB3 (PX))
AGE AGE (COHAB3 (PX))
AGE AGE (PX)

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:
Skip Instructions:

Hard Edit:
Soft Edit:
2011 NHIS Questionnaire - Family
Family Identification
When the reference person is the person in question's parent.
(1) if AGEDIFF LT12 [goto ERR_DEGREE4]
if ERR_DEGREE4 = 1 [goto FIDCCI4B]
else reset DEGREE4 [goto DEGREE4] endif
else [goto FIDCCI4B]
(2-5,R,D) [goto FIDCCI4B]
ERR2_DEGREE4
*Age difference between father and child is [AGEDIFF] years.
I have recorded [ALIAS (X2)] is [AGE(X2)] years old and his child [ALIAS(PX)] is [AGE(PX)] years old.
Are these ages and relationships correct?
* Please correct relationship code or age.
*First GOTO is to change Relationship code of [ALIAS(X2)]
*Second GOTO is to change Relationship code of [ALIAS(PX)]
*Third GOTO is to change AGE of father [ALIAS(X2)]
*Fourth GOTO is to change AGE of child [ALIAS(PX)]
Questions involved Value
RPREL: Relationship to Ref Person Spouse (husband) or Unmarried Partner
RPREL: Relationship to Ref Person Child or Child of Partner
AGE AGE (X2)
AGE AGE(PX)
ERR1_DEGREE4
*Age difference between father and child is only [AGEDIFF] years.
I have recorded [ALIAS (X2)] is [AGE(X2)] years old and his child [ALIAS(PX)] is [AGE(PX)] years old. Are
these ages and relationships correct?
*First GOTO is to change Relationship code of [ALIAS(X2)]
*Second GOTO is to change Relationship code of [ALIAS(PX)]
*Third GOTO is to change AGE of father [ALIAS(X2)]
*Fourth GOTO is to change AGE of child [ALIAS(PX)]
Questions involved Value
RPREL: Relationship to Ref Person Spouse (husband) or Unmarried Partner
RPREL: Relationship to Ref Person Child or Child of Partner
AGE AGE (X2)
AGE AGE(PX)
If suppressed and additional persons remain, GOTO FIDCCI4
else GOTO FIDCCI4B, endif
ERR3_DEGREE4
*Age difference between father and child is greater than or equal to 50 years.
I have recorded [ALIAS (X2)] is [AGE(X2)] years old and his child [ALIAS(PX)] is [AGE(PX)] years old. Are
these ages and relationships correct?
*First GOTO is to change Relationship code of [ALIAS(X2)]
*Second GOTO is to change Relationship code of [ALIAS(PX)]
*Third GOTO is to change AGE of father [ALIAS(X2)]
*Fourth GOTO is to change AGE of child [ALIAS(PX)]
Questions involved Value
RPREL: Relationship to Ref Person Spouse (husband) or Unmarried Partner
RPREL: Relationship to Ref Person Child or Child of Partner
AGE AGE (X2)
AGE AGE(PX)
If suppressed and additional persons remain, GOTO FIDCCI4
else GOTO FIDCCI4B, endif

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]

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 fatherin-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]

Instrument Variable Name: GUARD
Question Text:

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

00 Guardian not a household member
01-25 Person No. of guardian
97 Refused
99 Don't know

Universe Text: Mother or father was identified as legal guardian of child or, at the FIDCCI5 procedure, it's determined that the child (AGELT14) has no mother or father in the family.
Skip Instructions:

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

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 GT 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]

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 GT17 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 GT17 or emancipated minors
Skip Instructions:

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

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.
SkipInstructions:

goto HLTH_BEG

Instrument Variable Name: FLAPLYLM
Question Text:

? [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 emotionalproblem?

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]

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.

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

Instrument Variable Name: FSPEDEIS
Question Text: ? [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]

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:

go to 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.

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 go to FLAADL

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

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

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

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

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

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

Instrument Variable Name: FLAIADL
Question Text: ? [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 chores, 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]

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.

Instrument Variable Name: FLAWKNOW
Question Text: ? [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]

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.

Instrument Variable Name: FLAWKLIM
Question Text:

? [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]

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:

go to 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.

Instrument Variable Name: FLAWALK
Question Text:

? [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]

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:

go to 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.

Instrument Variable Name: FLAREMEM
Question Text:

? [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]

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: go to 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.

Instrument Variable Name: FLIMANY
Question Text:

? [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]

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.

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 Intellectual disability, also known as mental retardation
08 Other developmental problem (for example, 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.

Instrument Variable Name: LAHCC_S1
Question Text: * Read if necessary.

What is the other impairment or problem?

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

Instrument Variable Name: LAHCC_S2
Question Text:

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

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

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
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]

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, go to 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 GT AGE) or (LHCL01T = 3 and LHCL01N GT AGE in months) or (LHCL01T = 2
and LHCL01N GT AGE in weeks), goto ERR1_LHCL01T

Hard Edit: ERR1_LHCL01T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL01T
* "6" not selectable.

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
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]

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
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]

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 GT AGE) or (LHCL03T = 3 and LHCL03N GT AGE in months) or (LHCL03T = 2
and LHCL03N GT AGE in weeks), goto ERR1_LHCL03T

Hard Edit: ERR1_LHCL03T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL03T
* "6" not selectable.

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
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]

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 GT AGE) or (LHCL04T = 3 and LHCL04N GT AGE in months) or (LHCL04T = 2
and LHCL04N GT AGE in weeks), goto ERR1_LHCL04T

Hard Edit: ERR1_LHCL04T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL04T
* "6" not selectable.

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]

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 GT AGE) or (LHCL06T = 3 and LHCL06N GT AGE in months) or (LHCL06T = 2
and LHCL06N GT AGE in weeks), goto ERR1_LHCL06T

Hard Edit: ERR1_LHCL06T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL06T
* "6" not selectable.

Instrument Variable Name: LHCL07N
Question Text: 1 of 2

How long [fill: have you/has ALIAS] had intellectual disability, also known as mental retardation?
* Enter number for time with intellectual disability/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 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]

Instrument Variable Name: LHCL07T
Question Text: 2 of 2

* Enter time period for time with intellectual disability/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 GT AGE) or (LHCL07T = 3 and LHCL07N GT AGE in months) or (LHCL07T = 2 and LHCL07N GT AGE in weeks), goto
Hard Edit: ERR1_LHCL07T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL07T
* "6" not selectable.

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]

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 GT AGE) or (LHCL08T = 3 and LHCL08N GT AGE in months) or (LHCL08T = 2 and LHCL08N GT AGE in weeks), goto

Hard Edit: ERR1_LHCL08T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL08T
* "6" not selectable.

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* Enter '95' for 95 or more.
* Enter '96' if since birth.
ional, or behavioral problem.

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]

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
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]

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 epilepsy or seizures.
* 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 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]

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 GT AGE) or (LHCL11T = 3 and LHCL11N GT AGE in months) or (LHCL11T = 2 and LHCL11N GT AGE in weeks), goto

Hard Edit :ERR1_LHCL11T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL11T
* "6" not selectable.

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
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]

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 GT AGE) or (LHCL12T = 3 and LHCL12N GT AGE in months) or (LHCL12T = 2 and LHCL12N GT AGE in weeks), goto

Hard Edit: ERR1_LHCL12T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL12T
* "6" not selectable.

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 195,
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 GT AGE) or (LHCL13T = 3 and LHCL13N GT AGE in months) or (LHCL13T = 2 and LHCL13N GT AGE in weeks), goto ERR1_LHCL13T

Hard Edit: ERR1_LHCL13T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL13T
* "6" not selectable.

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
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]

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 GT AGE) or (LHCL90T = 3 and LHCL90N GT AGE in months) or (LHCL90T = 2
and LHCL90N GT AGE in weeks), goto ERR1_LHCL90T

Hard Edit: ERR1_LHCL90T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL90T
* "6" not selectable.

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
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]

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 GT AGE) or (LHCL91T = 3 and LHCL91N GT AGE in months) or (LHCL91T = 2 and LHCL91N GT AGE in weeks), goto ERR1_LHCL91T

Hard Edit: ERR1_LHCL91T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL91T
* "6" not selectable.

Instrument Variable Name: LAHCA Family
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(for example, asthma and emphysema)
12 Cancer
13 Birth defect
14 Intellectual disability, also known as mental retardation
15 Other developmental problem (for example 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.

Instrument Variable Name: LAHCA_S1
Question Text: * Read if necessary.

What is the other impairment or problem?

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

Instrument Variable Name: LAHCA_S2
Question Text: * Read if necessary.

What is the other impairment or problem?

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

Instrument Variable Name: LHAL01N
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
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]

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 GT AGE, goto ERR1_LHAL01T
Hard Edit: ERR1_LHAL01T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL01T
* "6" not selectable.

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
95 95+
96 Since birth
97 Refused
99 Unknown

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]

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 GT AGE, goto ERR1_LHAL02T

Hard Edit: ERR1_LHAL02T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL02T
* "6" not selectable.

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
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]

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 GT AGE, goto ERR1_LHAL03T

Hard Edit: ERR1_LHAL03T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL03T
* "6" not selectable.

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
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]

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 GT AGE, goto ERR1_LHAL04T

Hard Edit: ERR1_LHAL04T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL04T
* "6" not selectable.

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
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]

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 GT AGE, goto ERR1_LHAL05T

Hard Edit: ERR1_LHAL05T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL05T
* "6" not selectable.

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]

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 GT AGE, goto ERR1_LHAL06T

Hard Edit: ERR1_LHAL06T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL06T
* "6" not selectable.

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
95 95+
96 From 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]

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 GT AGE, goto ERR1_LHAL07T
Hard Edit: ERR1_LHAL07T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL07T
* "6" not selectable.

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
95 95+
96 Since birth
97 Refused
99 Unknown

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]

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 GT AGE, goto ERR1_LHAL08T

Hard Edit: ERR1_LHAL08T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL08T
* "6" not selectable.

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
95 95+
96 Since birth
97 Refused
99 Unknown

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

(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]

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 Unknown

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 GT AGE, goto ERR1_LHAL09T

Hard Edit: ERR1_LHAL09T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL09T
* "6" not selectable.

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
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]

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 Unknown

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 GT AGE, goto ERR1_LHAL10T

Hard Edit: ERR1_LHAL10T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL10T
* "6" not selectable.

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
SkipInstructions:

(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]

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 GT AGE, goto ERR1_LHAL11T

Hard Edit: ERR1_LHAL11T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL11T
* "6" not selectable.

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
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]

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 GT AGE, goto ERR1_LHAL12T

Hard Edit: ERR1_LHAL12T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL12T
* "6" not selectable.

Instrument Variable Name: LHAL14N
Question Text: 1 of 2

How long [fill: have you/has ALIAS] had intellectual disability, also known as mental retardation?
* Enter number for time with intellectual disability/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]

Instrument Variable Name: LHAL14T
Question Text: 2 of 2

* Enter time period for time with intellectual disability/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 GT AGE, goto ERR1_LHAL14T

Hard Edit: ERR1_LHAL14T

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL14T
* "6" not selectable.

Instrument Variable Name: LHAL15N
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
95 95+
96 Since birth
97 Refused
99 Don't know
01-94

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]

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 GT AGE, goto ERR1_LHAL15T
Hard Edit: ERR1_LHAL15T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL15T
* "6" not selectable.

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
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]

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 GT AGE, goto ERR1_LHAL16T
Hard Edit: ERR1_LHAL16T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL16T
* "6" not selectable.

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* 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 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]

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 GT AGE, goto ERR1_LHAL17T
Hard Edit: ERR1_LHAL17T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL17T
* "6" not selectable.

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
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]

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 GT AGE, goto ERR1_LHAL18T
Hard Edit: ERR1_LHAL18T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL18T
* "6" not selectable.

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]

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 GT AGE, goto ERR1_LHAL19T
Hard Edit: ERR1_LHAL19T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL19T
* "6" not selectable.

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
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]

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 GT AGE, goto ERR1_LHAL20T
Hard Edit: ERR1_LHAL20T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL20T
* "6" not selectable.

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]

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 GT AGE, goto ERR1_LHAL21T
Hard Edit: ERR1_LHAL21T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL21T
* "6" not selectable.

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
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]

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 GT AGE, goto ERR1_LHAL22T
Hard Edit: ERR1_LHAL22T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL22T
* "6" not selectable.

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
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]

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 GT AGE, goto ERR1_LHAL23T
Hard Edit: ERR1_LHAL23T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL23T
* "6" not selectable.

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 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 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]

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 GT AGE, goto ERR1_LHAL24T
Hard Edit: ERR1_LHAL24T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL24T
* "6" not selectable.

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
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]

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 GT AGE, goto ERR1_LHAL25T
Hard Edit: ERR1_LHAL25T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL25T
* "6" not selectable.

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* 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 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]

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 195,
D was entered for the "number" part of this two-part question
SkipInstructions:

(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 GT AGE, goto ERR1_LHAL26T
Hard Edit: ERR1_LHAL26T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL26T
* "6" not selectable.

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* 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 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]

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 GT AGE, goto ERR1_LHAL27T
Hard Edit: ERR1_LHAL27T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL27T
* "6" not selectable.

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
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]

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 GT AGE, goto ERR1_LHAL28T
Hard Edit: ERR1_LHAL28T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL28T
* "6" not selectable.

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
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]

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 GT AGE, goto ERR1_LHAL29T
Hard Edit: ERR1_LHAL29T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL29T
* "6" not selectable.

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
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]

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 GT AGE, goto ERR1_LHAL30T
Hard Edit: ERR1_LHAL30T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL30T
* "6" not selectable.

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
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]

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 GT AGE, goto ERR1_LHAL31T
Hard Edit: ERR1_LHAL31T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL31T
* "6" not selectable.

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]

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 GT AGE, goto ERR1_LHAL32T
Hard Edit: ERR1_LHAL32T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL32T
* "6" not selectable.

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 probl* 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 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]

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 195, 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 GT AGE, goto ERR1_LHAL33T
Hard Edit: ERR1_LHAL33T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL33T
* "6" not selectable.

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
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]

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 GT AGE, goto ERR1_LHAL34T
Hard Edit: ERR1_LHAL34T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL34T
* "6" not selectable.

Instrument Variable Name: LHAL35N
Question Text: 1 of 2

How long [fill: have you/has ALIAS] had migraine headaches?
* Enter number for time with migraine headaches.
* 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 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]

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 GT AGE, goto ERR1_LHAL35T
Hard Edit: ERR1_LHAL35T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL35T
* "6" not selectable.

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
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]

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 GT AGE, goto ERR1_LHAL90T
Hard Edit: ERR1_LHAL90T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL90T
* "6" not selectable.

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
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]

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
SkipInstructions:

(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 GT AGE, goto ERR1_LHAL91T
Hard Edit: ERR1_LHAL91T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL91T
* "6" not selectable.

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

Instrument Variable Name: FSRUNOUT
Question Text:

These next questions are about whether you were always able to afford the food you needed in the last 30 days. I'm going to read you several statements that people have made about their food situation. For these statements, please tell me whether the statement was often true, sometimes true, or never true for [fill 1: you/your family] in the last 30 days.

The first statement is "[fill 2: I/We] worried whether [fill 3: my/our] food would run out before [fill 4: I/we] got money to buy more." Was that often true, sometimes true, or never true for [fill 1: you/your family] in the last 30 days?

1 Often true
2 Sometimes true
3 Never true
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1-3,R,D) goto FSLAST

Instrument Variable Name: FSLAST
Question Text:

"The food that [fill 1: I/we] bought just didn't last, and [fill 1: I/we] didn't have money to get more." Was that often true, sometimes true, or never true for [fill 2: you/your family] in the last 30 days?

1 Often true
2 Sometimes true
3 Never true
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1-3,R,D) goto FSBALANC

Instrument Variable Name: FSSKIP
Question Text:

In the last 30 days, did [fill 1: you/you or other adults in your family] ever cut the size of your meals or skip meals because there wasn't enough money for food?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Families for whom it was often or sometimes true in the last 30 days that they worried that food would run out
before they got money to buy more, or that food that was bought didn't last and they didn't have money to get more, or they couldn't afford to eat balanced meals
Skip Instructions:

(1) [goto FSSKDAYS]
(2,R,D) [goto FSLESS]

Instrument Variable Name: FSSKDAYS
Question Text:

In the last 30 days, how many days did this happen?

01-30 Days
97 Refused
99 Don't know

Universe Text: Adults in the family cut the size of their meals or skipped meals in the last 30 days because there wasn't enough
money for food
Skip Instructions:

(1-30,R,D) [goto FSLESS]

Instrument Variable Name: FSLESS
Question Text:

In the last 30 days, did you ever eat less than you felt you should because there wasn't enough money for food?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Families for whom it was often or sometimes true in the last 30 days that they worried that food would run out
before they got money to buy more, or that food that was bought didn't last and they didn't have money to get more, or they couldn't afford to eat balanced meals
SkipInstructions:

(1,2,R,D) [goto FSHUNGRY]

Instrument Variable Name: FSHUNGRY
Question Text:

In the last 30 days, were you ever hungry but didn't eat because there wasn't enough money for food?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Families for whom it was often or sometimes true in the last 30 days that they worried that food would run out
before they got money to buy more, or that food that was bought didn't last and they didn't have money to get more, or they couldn't afford to eat balanced meals
Skip Instructions:

(1,2,R,D) [goto FSWEIGHT]

Instrument Variable Name: FSWEIGHT
Question Text:

In the last 30 days, did you lose weight because there wasn't enough money for food?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Families for whom it was often or sometimes true in the last 30 days that they worried that food would run out
before they got money to buy more, or that food that was bought didn't last and they didn't have money to get more, or they couldn't afford to eat balanced meals
Skip Instructions:

(1) [goto FSNOTEAT]
(2,R,D) [if FSSKIP=1 or FSLESS=1 or FSHUNGRY=1, goto FSNOTEAT; else goto FINJ3M]

Instrument Variable Name: FSNOTEAT
Question Text:

In the last 30 days, did [fill 1: you/you or other adults in your family] ever not eat for a whole day because there wasn't enough money for food?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families where adult(s) cut the size of meals or meals were skipped, ate less than they felt they should, were
hungry but didn't eat, or lost weight in the last 30 days because there wasn't enough money for food
Skip Instructions:

(1) [goto FSNEDAYS]
(2,R,D) [goto FINJ3M]

Instrument Variable Name: FSNEDAYS
Question Text:

In the last 30 days, how many days did this happen?

01-30 Days
97 Don't know
99 Refused

Universe Text:All families where the adult(s) did not eat for a whole day, in the last 30 days, because there wasn't enough money for food
Skip Instructions:

(1-30,R,D) [goto FINJ3M]

Instrument Variable Name: FDMED12M
QuestionText: ? [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]

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.

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]

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.

Instrument Variable Name: HOSPNO
QuestionText: ? [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]
ERR_HOSPNO
Soft Edit:
* [fill: HOSPNO] is unusually high.
* Verify entry.
* Make corrections if necessary.

Instrument Variable Name: HPNITE
Question Text: ? [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
ERR1_HPNITE
Soft Edit:
* [fill: HPNITE] is unusually high.
* Verify entry.
* Make corrections if necessary.
ERR2_HPNITE
* Do not read.
* [fill: HPNITE] night(s) is less than the total number of times in the hospital overnight.
* Please verify.
Note: If edit suppressed, store S in HPNITE_FLG

Instrument Variable Name: FHCHM2W
Question Text: ?[F1]

These next questions are about health care received DURING THE LAST 2 WEEKS. Include care from ALL types of medical doctors, such as dermatologists, psychiatrists, ophthalmologists (AHF-thal-MOL-oh-jists), 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 THE LAST 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]

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.

Instrument Variable Name: PHCHMN2W
Question Text:

How many home visits did [fill: you/ Alias] receive DURING THE LAST 2 WEEKS?
* Enter '50' for 50 or more visits.

01-50 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]
ERR_PHCHMN2W
Soft Edit:
* [fill: PHCHMN2W] is unusually high.
* Verify entry.
* DO NOT PROBE. Make corrections if necessary.

Instrument Variable Name: FHCPH2W
Question Text:

DURING THE LAST 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]

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.

Instrument Variable Name: PHCPHN2W
Question Text:

DURING THE LAST 2 WEEKS, how many telephone calls
[fill1: did you make?]
[fill2: were made about [fill: Alias]?
* Enter '50' for 50 or more phone calls.

01-50 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]
ERR_PHCPHN2W
Soft Edit:
* [fill: PHCPHN2W] is unusually high.
* Verify that all calls were within the two week period.
* Make corrections if necessary.

Instrument Variable Name: FHCDV2W
Question Text:

DURING THE LAST 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]

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.

Instrument Variable Name: PHCDVN2W
Question Text:

How many times did [fill: you/ Alias] visit a doctor or other health care professional DURING THE LAST 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]
ERR_PHCDVN2W
Soft Edit:
* [fill: PHCDVN2W] is unusually high.
* Verify that all visits were within the two week reference period.
* Make corrections if necessary.

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]

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.

Instrument Variable Name: FHICOV
QuestionText: (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]

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]
Hard Edit: ERR_HIKIND
* Cannot mark "No coverage of any kind" and another type.
* Please correct.

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

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

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

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]
Hard Edit: ERR_HICHANGE
*Press enter to go back to HIKIND and update coverage.

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]

Instrument Variable Name: MCCHOICE
QuestionText: ? [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

Instrument Variable Name: MCHMO
Question Text: ? [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 MCANAME]
(2,R,D) [if MCCHOICE=1, goto MCANAME; else if MCCHOICE=2,R,D, goto MCREF]

Instrument Variable Name: MCANAME
Question Text: ? [F1]

What is the name of [fill 1: your/ALIAS's] Medicare Advantage or Medicare HMO plan?
* Read if necessary: Do you have a health plan card or something with the plan name on it?

Verbatim response
7 Refused
9 Don't know

Universe Text: All persons that had either a Medicare Advantage plan or a Medicare HMO plan
Skip Instructions:

(allow 80,R,D) goto MCPREM

Instrument Variable Name: MCPREM
Question Text:

Besides [fill 1: your/ALIAS's] Medicare Part B payment, [fill 2: are you/is ALIAS] paying a premium for [fill 3: your/his/her] Medicare Advantage or Medicare HMO plan?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons that had either a Medicare Advantage plan or a Medicare HMO plan
Skip Instructions:

(1,2,R,D) goto MCREF

Instrument Variable Name: MCREF
Question Text: ? [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:

(1,2,R,D) goto MCPARTD

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]

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]

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 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

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 response
7 Refused
9 Don't know

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

goto MANAM

Instrument Variable Name: MANAM
Question Text: ? [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

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

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

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]

Instrument Variable Name: SSOTHER
Question Text:

* Other type of single-service plan

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

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

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 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]

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

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.

Instrument Variable Name: MORPLAN
QuestionText:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:All families where a private health insurance plan name was entered at HIPNAM1 or a person number was entered
at HIPNAM1B
SkipInstructions:

(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]

Instrument Variable Name: HIPNAM2
QuestionText:

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

UniverseText: All families with a second private health insurance plan
SkipInstructions:

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

Instrument Variable Name: PCARD2
QuestionText:

* 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

UniverseText: All private health insurance plans where the plan name was entered at HIPNAM2
SkipInstructions:

goto HIPNAM2B

Instrument Variable Name: HIPNAM2B
QuestionText:

* 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

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

(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

Instrument Variable Name: MORPLAN2
QuestionText:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: All families where a private health insurance plan name was entered at HIPNAM2 or a person number was entered at HIPNAM2B
SkipInstructions:

(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]

Instrument Variable Name: HIPNAM3
QuestionText:

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

UniverseText: All families with a third private health insurance plan
SkipInstructions:

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

Instrument Variable Name: PCARD3
QuestionText:

* 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

UniverseText: All private health insurance plans where the plan name was entered at HIPNAM3.
SkipInstructions:

goto HIPNAM3B

Instrument Variable Name: HIPNAM3B
QuestionText:

* 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

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

(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 MORPLAN3]
goto MORPLAN3

Instrument Variable Name: MORPLAN3
QuestionText:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: All families where a private health insurance plan name was entered at HIPNAM3 or a person number was entered at HIPNAM3B
SkipInstructions:

(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]

Instrument Variable Name: HIPNAM4
QuestionText:

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

UniverseText: All families with a fourth private health insurance plan
SkipInstructions:

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

Instrument Variable Name: PCARD4
QuestionText:

* 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

UniverseText: All private health insurance plans where the plan name was entered at HIPNAM4
SkipInstructions:

goto HIPNAM4B

Instrument Variable Name: HIPNAM4B
QuestionText:

* 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

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

(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

Instrument Variable Name: HIVER1
QuestionText:

? [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

UniverseText: All persons who have private health insurance coverage, but were not mentioned as being covered by any of the reported plans
SkipInstructions:

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

Hard Edit: ERR_HIVER1

*Press ENTER to go back to HIKIND to update health insurance coverage.

Instrument Variable Name: HIVER2
QuestionText:

? [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

UniverseText: 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
SkipInstructions:

(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]

Instrument Variable Name: HIVER2
QuestionText:

UniverseText:
SkipInstructions:

Instrument Variable Name: HIVER2
QuestionText:
UniverseText:
SkipInstructions:

Instrument Variable Name: HIVER2
QuestionText:
UniverseText:
SkipInstructions:

Instrument Variable Name: HIVER2
QuestionText:
UniverseText:
SkipInstructions:

Instrument Variable Name: HIVER2
QuestionText:
UniverseText:
SkipInstructions:

Instrument Variable Name: FHICCI8
QuestionText:

[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

UniverseText: All families where a private health insurance plan was reported
SkipInstructions:

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.

Instrument Variable Name: FHI200
QuestionText:

? [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

UniverseText: All private health insurance plans
SkipInstructions:

if (00) [ goto PRPOLH]
(01 to 25) [go to PRCOOH]
(R, D) [go to PLNWRK]

Instrument Variable Name: PRCOOH
QuestionText:

Does this plan cover anyone who does not live here?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: All private health insurance plans with policyholder on family roster
SkipInstructions:

(1) [goto PRCTOH]
(2,R,D) [goto PLNWRK]

Instrument Variable Name: PRCTOH
QuestionText:

How many people does this plan cover who live somewhere else?

01-30 persons
97 Refused
99 Don't know

UniverseText: All private health insurance plans with policyholder on family roster that cover someone outside the family roster
SkipInstructions:

(1-30) [goto PRRELOH]
(R,D) [goto PLNWRK]

Instrument Variable Name: PRRELOH
QuestionText:

What [fill 1: is the relationship of this person/ are the relationships of these persons] to the policyholder?

*Read if Necessary: Children includes adult children.
*Enter all that apply, separate with commas.

1 Child (including stepchild)
2 Spouse
3 Former spouse
4 Some other relationship
7 Refused
9 Don't know

UniverseText: All private health insurance plans with policyholder on family roster that cover someone outside the family roster
SkipInstructions:

(1) [goto PRCNUM]
(2-4,R,D) [goto PLNWRK]

Instrument Variable Name: PRCNUM
QuestionText:

How many children of the policyholder are covered who live elsewhere?
*Read if Necessary: Children includes adult children.
*If more than 10 children, enter '10'.

01-10
97
99
01-10 children
Refused
Don't know

UniverseText: All private health insurance plans with policyholder on family roster that cover a child or children not on the roster
SkipInstructions:

(01-10) if [PRCNUM GT PRCTOH goto ERR1_PRCNUM]
else goto PRAGEOH
(R,D) [goto PLNWRK]
if PRCNUM GT PRCTOH

Hard Edit:

*Number of children, [fill 1], exceeds the total number who live elsewhere, [fill 2].

Instrument Variable Name: PRAGEOH
QuestionText:

How old is {fill1: this child/the first child/ the next child}?

000-100 years
997 Refused
999 Don't know

Universe Text: All private health insurance plans with policyholder on family roster that cover one or more children not on the roster
SkipInstructions:

(000-100,R,D)if [AGE GTE 50 years goto ERR1_PRAGEOH]
else if PRCNUM GE 2 [goto PRAGEOH up to 9 more times]
else [goto PLNWRK]
Soft Edit: If AGE GTE 50 years
*Respondent said the child is [fill: PRAGEOH] years old. Please verify.

Instrument Variable Name: PLNWRK
QuestionText:

(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

UniverseText: All private health insurance plans
SkipInstructions:

(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.

Instrument Variable Name: PLNWKSP
QuestionText:

*Read if necessary.
How was this plan obtained?
Verbatim

7 Refused
9 Don't know

UniverseText: All private health insurance plans where the plan was obtained through an "other" source
SkipInstructions:

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.

Instrument Variable Name: PLNPAY
QuestionText:

? [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

UniverseText: All private health insurance plans
SkipInstructions:

(1) [goto HICOSTN]
(2) [goto EMPPAY]
(3-7,D,R) [goto PLNMGD]
(if both 1 and 2 chosen, go to HICOSTN first and then EMPPAY)
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.

Instrument Variable Name: HICOSTN
QuestionText:

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

UniverseText: All private health insurance plans paid for by self or family
SkipInstructions:

if gt 9999, [goto ERR_HICOSTN]
(1-9999) [goto HICOSTT]
(D) [store (D) in HICOSTT, goto EMPPAY if PLNPAY=2; else goto PLNMGD]
(R) [store (R) in HICOSTT, goto EMPPAY if PLNPAY=2; 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.

Soft Edit: ERR_HICOSTN

* [fill # from HICOSTN] is unusually high. Please verify.
Make corrections if necessary.

Instrument Variable Name: HICOSTT
QuestionText:

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

UniverseText: All private health insurance plans with a valid response to HICOSTN
SkipInstructions:

(1-8,R,D) if PLNPAY=2 [goto EMPPAY]; 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.

Instrument Variable Name: EMPPAY
QuestionText:

Do you know how much the employer or union is paying for [fill1: plan1/plan2/plan3/plan4]?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: All private health insurance plans paid for by employer or union
SkipInstructions:

(1) [goto EMPCOSTN] (2,R,D) [goto PLNMGD]

Instrument Variable Name: EMPCOSTN
QuestionText:

1 of 2
How much does the employer or union currently pay for health insurance premiums for [fill1: Plan 1/Plan 2/Plan 3/Plan 4]?
*Enter dollar amount for premium payments.
*Enter 'ZZ' to go to percentage format.

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

UniverseText: All private health insurance plans where amount of premium employer/union pays is known
SkipInstructions:

(1-99995) [goto EMPCOSTT]
(R) [store "R" in EMPCOSTT and goto PLNMGD] (D) [store "D" in EMPCOSTT and goto PLNMGD] (P)
[goto EMPCOSTP]

Soft Edit: ERR_EMPCOSTN

* [fill # from EMPCOSTN] is unusually high. Please verify.
Make corrections if necessary.

Instrument Variable Name: EMPCOSTT
QuestionText:

2 of 2
* 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

UniverseText: All private health insurance plans with a valid response to EMPCOSTN
SkipInstructions:

goto PLNMGD

Instrument Variable Name: EMPCOSTP
QuestionText:

What percent of the premiums does the employer or union pay for [fill1: Plan 1/Plan 2/Plan 3/Plan 4]?

001-100 001-100 percent
997 Refused
999 Don't know

UniverseText: All private health insurance plans paid for by employer or union where respondent wanted to report percentage of premium paid.
SkipInstructions:

(1-100,R,D) [goto PLNMGD]

Instrument Variable Name: PLNMGD
QuestionText:

? [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

UniverseText: All private health insurance plans
SkipInstructions:

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.

Instrument Variable Name: HDHP
QuestionText:

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

[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 $2,400 or $2,400 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 [$1,200/$2,400]
2 [$1,200/$2,400] or more
7 Refused
9 Don't know

UniverseText: All private health insurance plans
SkipInstructions:

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.

Instrument Variable Name: HSAHRA
QuestionText:

?[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

UniverseText: All high deductible private health plans
SkipInstructions:

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.

Instrument Variable Name: MGCHMD
QuestionText:

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

UniverseText: All private health insurance plans
SkipInstructions:

(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.

Instrument Variable Name: MGPRMD
QuestionText:

[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

UniverseText: All private health insurance plans where covered persons can choose any doctor
SkipInstructions:

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.

Instrument Variable Name: MGPYMD
QuestionText:

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

UniverseText: All private health insurance plans where covered persons must select from a group or list of doctors
SkipInstructions:

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.

Instrument Variable Name: MGPREF
QuestionText:

? [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

UniverseText: All private health insurance plans
SkipInstructions:

goto PCPREQ

Instrument Variable Name: PCPREQ
QuestionText:

Does this plan REQUIRE [fill1: you/ALIAS/the family members with this plan] to have a primary care doctor or group of doctors for all routine care?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Asked of all private health insurance plans
SkipInstructions:

(1,2,R,D) [goto PRRXCOV]

Instrument Variable Name: PRRXCOV
QuestionText:

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

UniverseText: All private health insurance plans
SkipInstructions:

goto PRDNCOV
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.

Instrument Variable Name: PRDNCOV
QuestionText:

Does [fill 1: ^HIPNAM1 or ^HIPNAM2, or ^HIPNAM3, or ^HIPNAM4 or Plan 1 or Plan 2 or Plan 3 or Plan 4] pay for any of the costs for dental care?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: All private health insurance plans
SkipInstructions:

goto FHICCI8 for the next private health insurance plan; else, goto FCOVCONF

Instrument Variable Name: FCOVCONF
QuestionText:

If [fill1: you/your family] had to buy a health plan on [fill 2: your/its] own with no help from [fill 3: your/an] employer, how confident are you that [fill 1: you/your family] would be able to obtain affordable coverage Would you say...
*Read categories below.

1 Very confident
2 Somewhat confident
3 Not too confident
4 Not confident at all
7 Refused
9 Don't know

UniverseText: All families with an employer-based health plan
SkipInstructions:

(1-4,R,D) goto STNAME1 or STNAME2 or STNAME3 or MILSPC or HILAST or HINOTYR

Instrument Variable Name: STNAME1
QuestionText:

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

UniverseText: All persons with SCHIP
SkipInstructions:

goto STDOC1

Instrument Variable Name: STDOC1
QuestionText:

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

UniverseText: All persons with SCHIP
SkipInstructions:

goto STPCMD1

Instrument Variable Name: STPCMD1
QuestionText:

[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

UniverseText: All persons with SCHIP
SkipInstructions:

goto STREF1

Instrument Variable Name: STREF1
QuestionText:

? [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

UniverseText: All persons with SCHIP
SkipInstructions:

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

Instrument Variable Name: STNAME2
QuestionText:

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

UniverseText: All persons covered by a state sponsored health plan
SkipInstructions:

goto STDOC2

Instrument Variable Name: STDOC2
QuestionText:

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

UniverseText: All persons covered by a state sponsored health plan
SkipInstructions:

goto STPCMD2

Instrument Variable Name: STPCMD2
QuestionText:

[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

UniverseText: All persons covered by a state sponsored health plan
SkipInstructions:

goto STREF2

Instrument Variable Name: STREF2
QuestionText:

? [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

UniverseText: All persons covered by a state sponsored health plan
SkipInstructions:

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

Instrument Variable Name: STNAME3
QuestionText:

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

UniverseText: All persons covered by an "other" government plan
SkipInstructions:

goto STDOC3

Instrument Variable Name: STDOC3
QuestionText:

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

UniverseText: All persons covered by an "other" government plan
SkipInstructions:

goto STPCMD3

Instrument Variable Name: STPCMD3
QuestionText:

[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

UniverseText: All persons covered by an "other" government plan
SkipInstructions:

goto STREF3

Instrument Variable Name: STREF3
QuestionText:

? [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

UniverseText: All persons covered by an "other" government plan
SkipInstructions:

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

Instrument Variable Name: MILSPC
QuestionText:

? [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

UniverseText: All persons with military health care
SkipInstructions:

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

Instrument Variable Name: MILSPCOT
QuestionText:

* Other military coverage

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: All persons with "other" military coverage
SkipInstructions:

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

Instrument Variable Name: MILMAN
QuestionText:

? [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

UniverseText: All persons with TRICARE coverage
SkipInstructions:

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

Instrument Variable Name: MILMANOT
QuestionText:

* Other type of TRICARE coverage

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: All persons with "other" type of TRICARE coverage
SkipInstructions:

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

Instrument Variable Name: HILAST
QuestionText:

(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

UniverseText: All persons without known health insurance or with only single service plans
SkipInstructions:

goto HISTOP

Instrument Variable Name: HISTOP
QuestionText:

(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

UniverseText: All persons without known health insurance or with only single service plans
SkipInstructions:

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

(10) [goto HISTOPOT]

Instrument Variable Name: HISTOPOT
QuestionText:

? [F1]
* Other reason for not having coverage

7 Refused
9 Don't know

UniverseText: All persons without known health insurance and an "other" reason for stopping or not having coverage
SkipInstructions:

goto HISTOP for the next person without known health insurance coverage or only single service plans; else, goto HCSPFYR

Instrument Variable Name: HINOTYR
QuestionText:

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

UniverseText: All persons with known health insurance coverage except single service plans
SkipInstructions:

(1) [goto HINOTMYR] (2,R,D) [goto FHICHNG]

Instrument Variable Name: HINOTMYR
QuestionText:

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 01-12 months
97 Refused
99 Don't know

UniverseText: All persons with known health insurance coverage, but did not have health insurance for some period of time in
the past 12 months
SkipInstructions:

goto HINOTYR for the next person with known health insurance coverage, except single service plans; else, goto
HCSPFYR

Instrument Variable Name: FHICHNG
QuestionText:

Did [fill1: you/ALIAS] have [fill2: type of health insurance coverage] for the past 12 months?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: All persons who are currently insured who were continuously covered in the past year
SkipInstructions:

(1,R,D) [goto HCSPFYR]
(2) [goto FHIKDB]

Instrument Variable Name: FHIKDB
QuestionText:

(book) F12 and (book) F14
If person is currently uninsured:
{Think about the last time [fill1: you/ALIAS] had health insurance or health care coverage. What type did [fill1: you/ALIAS] have?}

If person had a period without coverage in the past year:
{I recorded that [fill1: you/ALIAS] had a period without health insurance in the past year. What type of health insurance or coverage did [fill1: you/ALIAS] have before this period?}

If person had a change in coverage type in the past year:
{What other types of health insurance or health care coverage did [fill1: you/ALIAS] have?}

*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

UniverseText: All persons except those with continuous coverage who are currently uninsured for more than 1 year with no changes
SkipInstructions:

(1) [goto PWRKB]
(2-11,R,D) [goto HCSPFYR]

Instrument Variable Name: PWRKB
QuestionText:

Which one of these categories best describes how [fill1: your/ALIAS's] private health insurance 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

UniverseText: All persons who had private health insurance previously
SkipInstructions:

(1-6,R,D) [goto HCSPFYR] (7) [goto PWRKBSP]

Instrument Variable Name: PWRKBSP
QuestionText:

*Enter how private health insurance was obtained.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: All persons who had private health insurance obtained from other source previously
SkipInstructions:

(Allow 75 characters) [goto HCSPFYR]

Instrument Variable Name: HCSPFYR
QuestionText:

(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

UniverseText: All families
SkipInstructions:

goto MEDBILL

Instrument Variable Name: MEDBILL
QuestionText:

In the past 12 months did [fill1: you/anyone in the family] have problems paying or were unable to pay any medical bills?
Include bills for doctors, dentists, hospitals, therapists, medication, equipment, nursing home or home care.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: All families
SkipInstructions:

(1,2,7,9) [goto MEDBPAY]

Instrument Variable Name: MEDBPAY
QuestionText:

[fill 1: Do you/Does anyone in your family] currently have any medical bills that are being paid off over time? This could include medical bills being paid off with a credit card, through personal loans, or bill paying arrangements with hospitals or other providers. The bills can be from earlier years as well as this year.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: All families
SkipInstructions:

(1,2,7,9) if MEDBILL=2 [goto FSA]; else [goto MEDBNOP]

Instrument Variable Name: MEDBNOP
QuestionText:

[fill 1: Do you/Does anyone in your family] currently have any medical bills that you are unable to pay at all?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: All families but those who said they don't have problems paying their medical bills
SkipInstructions:

(1,2,7,9) [goto FSA]

Instrument Variable Name: FSA
QuestionText:

[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

UniverseText: All Families
SkipInstructions:

goto PLBORN

Instrument Variable Name: PLBORN
QuestionText:

[fill: Were you/Was ALIAS] born in the United States?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: All persons
SkipInstructions:

(1) [store "1" in CITIZEN and goto PLBORN1]
(2) [goto PLBORN2]
(R,D) [goto CITIZEN]

Instrument Variable Name: PLBORN1
QuestionText:

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
Washington 48
West Virginia 49
Wisconsin 50
Wyoming 51
United States (state unknown) 57

UniverseText: All persons born in the United States
SkipInstructions:

(1-51,57) [goto HEADST]

Instrument Variable Name: PLBORN2
QuestionText:

In what country [fill: were you/was ALIAS] born?
* Please record country of birth. If country not found, type "ZZ"

060 AMERICAN SAMOA
061 AM SAMOA
062 BAKER ISLAND
063 GUAM
064 HOWLAND ISLAND
065 JARVIS ISLAND
066 JOHNSTON ATOLL
067 KINGMAN REEF
068 MANUA ISLANDS
069 MIDWAY ISLANDS
070 NAVASSA ISLAND
071 NORTHERN MARIANAS
072 PALMYRA ATOLL
073 PUERTO RICO
074 ROTA
075 SAIPAN
076 SAND ISLAND
077 ST CROIX
078 ST JOHN
079 ST THOMAS
080 TINIAN
081 US OUTLYING AREA
082 US VIRGIN ISLANDS
083 USVI
084 VIRGIN ISLANDS
085 WAKE ISLAND
100 ABROAD
101 ABU DHABI
102 ADEN
103 AFGHANISTAN
104 AFRICA
105 ALBANIA
106 ALBERTA
107 ALGERIA
108 ALGIERS
109 ALSACE-LORRAINE
110 AMSTERDAM
111 ANEGADA
112 ANGOLA
113 ANGUILLA
114 ANGUILLA BWI
115 ANOJOUAN
116 ANTARCTICA
117 ANTIGUA
118 ANTIGUA and BARBUDA
119 ANTIGUA WI
120 ANTILLES
121 ARAB PALESTINE
122 ARABIA
123 ARGENTINA
124 ARMENIA
125 ARUBA
126 ARUBA DWI
127 ARUBA NETHERLANDS
128 ASCENSION ISLAND
129 ASIA
130 ASIA MINOR
131 ASSAM
132 AT SEA
133 AUSTRALIA
134 AUSTRIA
135 AUSTRIA-HUNGARY
136 AZERBAIJAN
137 AZORES ISLANDS
138 BAHAMAS
139 BAHAMAS UK
140 BAHRAIN
141 BAJA CAL
142 BAJA CAL SUR
143 BALBOA
144 BANGLADESH
145 BARBADOS
146 BARBUDA
147 BAVARIA
148 BELARUS
149 BELFAST
150 BELGIAN CONGO
151 BELGIUM
152 BELIZE
153 BENIN
154 BERLIN
155 BERMUDA
156 BESSARABIA
157 BHUTAN
158 BOHEMIA
159 BOLIVIA
160 BONAIRE
161 BORNEO
162 BOSNIA
163 BOSNIA and HERZEGOVINA
164 BOTSWANA
165 BRASIL
166 BRAZIL
167 BRAZZAVILLE
168 BREMEN
169 BRITAIN
170 BRITISH COLUMBIA
171 BRITISH EAST AFRICA
172 BRITISH GUIANA
173 BRITISH GUYANA
174 BRITISH HONDURAS
175 BRITISH HONG KONG
176 BRITISH ISLES
177 BRITISH VI
178 BRITISH VIRGIN IS
179 BRITISH WEST INDIES
180 BRITISH WI
181 BRUNEI
182 BULGARIA
183 BURKINA FASO
184 BURMA
185 BURUNDI
186 BWI
187 BYELARUS
188 BYELORUSSIA
189 CAICOS ISLANDS
190 CAM PHA
191 CAM RANH
192 CAMBODIA
193 CAMEROON
194 CAN THO
195 CANADA
196 CANAL ZONE
197 CANARY ISLANDS
198 CANTON and ENDERBURY IS
199 CANTON ISLAND
200 CAPE VERDE
201 CARIBBEAN
202 CAYMAN ISLANDS
203 CENTRAL AFRICA
204 CENTRAL AFRICAN REP
205 CENTRAL AMERICA
206 CEYLON
207 CHAD
208 CHANNEL ISLANDS
209 CHIAPAS
210 CHIHUAHUA
211 CHILE
212 CHINA
213 CHINA HONG KONG
214 CHRISTMAS ISLAND
215 CHRISTMAS ISLAND, INDIAN OCEAN
216 COAHUILA
217 COLIMA
218 COLOMBIA
219 COMOROS
220 CONGO
221 COOK ISLANDS
222 CORAL SEA ISLANDS
223 CORK
224 CORSICA
225 COSTA RICA
226 COTE D'IVORIE
227 CRETE
228 CRIMEA
229 CRISTOBAL
230 CROATIA
231 CUBA
232 CURACAO
233 CYPRUS
234 CZ
235 CZECH REPUBLIC
236 CZECHOSLOVAKIA
237 DA LAT
238 DA NANG
239 DAKAR
240 DANZIG
241 DELHI
242 DEMO PEOPLE'S REP OF KOREA
243 DEMO REP OF CONGO
244 DENMARK
245 DISTRITO FEDERAL
246 DJIBOUTI
247 DOM REP
248 DOMINICA
249 DOMINICA BWI
250 DOMINICA WI
251 DOMINICAN REPUBLIC
252 DUBAI
253 DUBLIN
254 DURANGO
255 DUTCH EAST INDIES
256 DUTCH GUIANA
257 DUTCH INDONESIA
258 DUTCH NEW GUINEA
259 EAST PAKISTAN
260 EAST PRUSSIA
261 EASTER ISLAND
262 EASTERN AFRICA
263 ECUADOR
264 EGYPT
265 EIRE
266 EL SALVADOR
267 ENGLAND
268 EQUATORIAL GUINEA
269 ERITREA
270 ESPANA
271 ESTONIA
272 ETHIOPIA
273 EUROPA ISLAND
274 EUROPE
275 FALKLAND ISLANDS
276 FAROE ISLANDS
277 FEDERAL DISTRICT
278 FEDERAL REPUBLIC OF YUGOSLAVIA
279 FEDERATED STATES OF MICRONESIA
280 FIJI
281 FILIPINES
282 FINLAND
283 FOREIGN COUNTRY
284 FORMOSA
285 FRANCE
286 FRANKFURT
287 FRENCH GUIANA
288 FRENCH MOROCCO
289 FRENCH POLYNESIA
290 GABON
291 GALAPAGOS ISLANDS
292 GALWAY
293 GAMBIA
294 GAZA STRIP
295 GEORGIA
296 GERMANY
297 GHANA
298 GIA DINH
299 GIBRALTER
300 GLORIOSO ISLANDS
301 GOA
302 GRAND BAHAMA
303 GRAND CAYMAN
304 GRAND TURK
305 GREAT BRITAIN
306 GREAT COMORE
307 GREECE
308 GREENLAND
309 GRENADA
310 GUADALAJARA
311 GUADELOUPE
312 GUANAJUATO
313 GUATEMALA
314 GUERNSEY
315 GUERRERO
316 GUIANA
317 GUINEA
318 GUINEA-BISSAU
319 GUYANA
320 HA DONG
321 HAI PHONG
322 HAITI
323 HAMBURG
324 HANOI
325 HANOVER
326 HAVANA
327 HEARD and MCDONALD ISLANDS
328 HERZEGOVINA
329 HESSE
330 HIDALGO
331 HIGH SEAS
332 HOLLAND
333 HONDURAS
334 HONG KONG
335 HUNGARY
336 HYDERABAD
337 ICELAND
338 INDIA
339 INDONESIA
340 INTERNATIONAL WATERS
341 IRAN
342 IRAQ
343 IRELAND
344 IRIAN JAYA
345 IRISH REPUBLIC
346 ISLE OF MAN
347 ISRAEL
348 ITALY
349 IVORY COAST
350 JALISCO
351 JAMAICA
352 JAN MEYAN
353 JAPAN
354 JAVA
355 JERSEY
356 JIBUTI
357 JORDAN
358 JUAN DE NOVA ISLAND
359 JUGOSLAVIA
360 KALININGRAD
361 KAMPUCHEA
362 KASHMIR
363 KAZAKHSTAN
364 KENYA
365 KHANH HUNG
366 KINSHASA
367 KIRIBATI
368 KOREA
369 KORO ISLAND
370 KUWAIT
371 KWAJALEIN
372 KWANTUNG
373 KYRGYZSTAN
374 LABRADOR
375 LABUAN
376 LAOS
377 LATAKIA
378 LATIN AMERICA
379 LATVIA
380 LEBANON
381 LEEWARD ISLANDS
382 LESOTHO
383 LIBERIA
384 LIBYA
385 LIECHTENSTEIN
386 LITHUANIA
387 LOAS
388 LONDONDERRY
389 LONG XUYEN
390 LORRAINE
391 LUBECK
392 LUXEMBOURG
393 MACAO
394 MACAU
395 MACEDONIA
396 MADAGASCAR
397 MADEIRA ISLANDS
398 MAINLAND CHINA
399 MAJORCA
400 MALAGASY REPUBLIC
401 MALAWI
402 MALAYSIA
403 MALDIVES
404 MALI
405 MALLORCA
406 MALTA
407 MACHURIA
408 MANICA
409 MANILA
410 MANITOBA
411 MARSHALL ISLANDS
412 MARTINIQUE
413 MAURITANIA
414 MAURITIUS
415 MAYOTTE ISLAND
416 MELANESIA
417 MEXICO
418 MICHOACAN
419 MICRONESIA
420 MIDDLE EAST
421 MOLDAVIA
422 MOLDOVA
423 MONACO
424 MONAGAS
425 MONGOLIA
426 MONTENEGRO
427 MONTSERRAT
428 MORELOS
429 MOROCCO
430 MOZAMBIQUE
431 MY THO
432 N. IRELAND
433 NAM DINH
434 NAMIBIA
435 NAURU
436 NAYARIT
437 NEPAL
438 NETHERLANDS
439 NETH. ANTILLES
440 NETH. EAST INDIES
441 NEVIS ISLAND
442 NEW BRUNSWICK
443 NEW CALEDONIA
444 NEW GUINEA
445 NEW HEBRIDES
446 NEW SOUTH WALES
447 NEW ZEALAND
448 NEWFOUNDLAND
449 NHA TRANG
450 NICARAGUA
451 NIGER
452 NIGERIA
453 NIUE ISLAND
454 NORFOLK ISLAND
455 NORTH AFRICA
456 NORTH AMERICA
457 NORTH KOREA
458 NORTH VIETNAM
459 NORTHERN IRELAND
460 NORTHERN TERRITORY
461 NORWAY
462 NOVA SCOTIA
463 NUEVO LEON
464 OAXACA
465 OCEANIA
466 OKINAWA
467 OMAN
468 ONTARIO
469 OVERSEAS
470 PAKISTAN
471 PALAU
472 PALESTINE
473 PANAMA
474 PANAMA CANAL ZONE
475 PAPUA NEW GUINEA
476 PARACEL ISLANDS
477 PARAGUAY
478 PELAGOSA
479 PEOPLE'S REP. OF CHINA
480 PEOPLE'S REP. OF CONGO
481 PERSIA
482 PERU
483 PHAN THIET
484 PHILIPPINES
485 PITCAIRN ISLAND
486 POLAND
487 POLYNESIA
488 PONAPE
489 PORTUGAL
490 PORTUGUESE INDIA
491 PRINCE EDWARD ISLAND
492 PRINCIPE ISLAND
494 PRUSSIA
495 PUEBLA
496 PUNJAB
497 PUNJAB, INDIA
498 PUNJAB, PAKISTAN
499 QATAR
500 QUANG LONG
501 QUEBEC
502 QUEENSLAND
503 QUERETARO
504 QUI NHON
505 RACH GIA
506 RAJASTHAN
507 RED CHINA
508 REPUBLIC OF CHINA
509 REPUBLIC OF CYPRUS
510 REPUBLIC OF IRELAND
511 REPUBLIC OF KOREA
512 REPUBLIC OF PANAMA
513 REP. OF PHILIPPINES
514 REP. OF SOUTH AFRICA
515 REPUBLICA DOMINICANA
516 REUNION ISLAND
517 RHODESIA
518 ROC
519 ROK
520 ROMANIA
521 ROTTERDAM
522 RUMANIA
523 RUSSIA
524 RUSSIAN FEDERATION
525 RWANDA
526 SAIGON
527 SALVADOR
528 SAMOA
529 SAN ANDRES
530 SAN LUIS POTOSI
531 SAN MARINO
532 SAN SALVADOR
533 SAO TOME ISLAND
534 SAO TOME and PRINCIPE
535 SARAWAK
536 SASKATCHEWAN
537 SAUDI ARABIA
538 SAXONY
539 SCOTLAND
540 SENEGAL
541 SEOUL
542 SERBIA
543 SEYCHELLES
544 SHANGHAI
545 SHARJAH
546 SIBERIA
547 SICILY
548 SIERRA LEONE
549 SIKKIM
550 SINALOA
551 SINGAPORE
552 SLAVONIA
553 SLOVAK REPUBLIC
554 SLOVAKIA
555 SLOVENIA
556 SOLOMAN ISLANDS
557 SOMALIA
558 SONORA
559 SOUTH AFRICA
560 SOUTH AMERICA
561 SOUTH AUSTRALIA
562 SOUTH KOREA
563 SOUTH VIETNAM
564 SOUTH WALES
565 SOUTH YEMEN
566 SOUTHEAST ASIA
567 SOUTHERN AFRICA
568 SOUTHERN RHODESIA
569 SOVIET UNION
570 SPAIN
571 SPRATLEY ISLANDS
572 SRI LANKA
573 ST BARTHELEMY
574 ST BARTS
575 ST CHRISTOPHER
576 ST CHRISTOPHER-NEVIS
577 ST EUSTATIUS
578 ST HELENA
579 ST KITTS
580 ST KITTS-NEVIS
581 ST LUCIA
582 ST MAARTEN
583 ST MARTIN
584 ST PIERRE and MIQUELON
585 ST VINCENT
586 ST VINCENT and THE GRENADINES
587 SUDAN
588 SUMATRA
589 SURINAM
590 SURINAME
591 SVALBARD
592 SWAZILAND
593 SWEDEN
594 SWITZERLAND
595 SYRIA
596 SYRIAN ARAB REP
597 TABASCO
598 TADZHIK
599 TAHITI
600 TAIWAN
601 TAIWAN ROC
602 TAJIKISTAN
603 TAMAULIPAS
604 TANGANYIKA
605 TANGIER
606 TANZANIA
607 TASMANIA
608 THAILAND
609 THANH HOA
610 THE GRENADINES
611 TIBET
612 TIJUANA
613 TLAXCALA
614 TOBAGO
615 TOGO
616 TOGOLAND
617 TOKELAU
618 TONGA
619 TORTOISE ISLANDS
620 TORTOLA
621 TRANSVAAL
622 TRANSYLVANIA
623 TRIESTE
624 TRINIDAD
625 TRINIDAD and TOBAGO
626 TRIPOLI
627 TROMELIN ISLAND
628 TRUK
629 TUNIS
630 TUNISIA
631 TURKEY
632 TURKMENISTAN
633 TURKS and CAICOS IS
634 TURK ISLANDS
635 TUVALU
636 TUY HOA
637 UGANDA
638 UK
639 UKRAINE
640 UKRAINIA
641 UNION ISLANDS
642 UNION OF SOUTH AFRICA
643 UNION OF SOVIET SOCIALIST REPUBLICS
644 UNITED ARAB EMIRATES
645 UNITED KINGDOM
646 UPPER VOLTA
647 URUGUAY
648 USSR
649 USBEKISTAN
650 VANCOUVER
651 VANUATU
652 VATICAN CITY
653 VENEZUELA
654 VERACRUZ
655 VICTORIA
656 VIETNAM
657 VINH LONG
658 VUNG TAU
659 WALES
660 WALLIS and FUTUNA ISLANDS
661 WEST AFRICA
662 WEST BANK
663 WEST BENGAL
664 WEST INDIES
665 WEST PAKISTAN
666 WESTERN AUSTRALIA
667 WESTERN SAHARA
668 WESTERN SAMOA
669 WHITE RUSSIA
670 WINDWARD ISLANDS
671 WINNIPEG
672 WURZBERG
673 YAP
674 YAR
675 YEMEN
676 YEMEN ARAB REPUBLIC
677 YEREVAN
678 YUCATAN
679 YUGOSLAVIA
680 YUKON TERRITORY
681 ZACATECAS
682 ZADAR
683 ZAIRE
684 ZAMBIA
685 ZANZIBAR
686 ZIMBABWE
687 ZURICH
688 ANDORRA
689 BRITISH INDIAN OCEAN TERRITORY
690 DEUTSCHLAND
691 FRENCH SOUTHERN AND ANTARCTIC LANDS
692 GRENADINES, THE
KOSOVO 693
MYANMAR 694
NORTHWEST TERRITORY 695
NUNAVUT TERRITORY 696
Country not listed 996
Refused997
Don't know 999