fam
1

2012 NHIS Questionnaire: Family
Family Identification

Question ID:FID.100_00.000

Instrument Variable Name:HHCHANGE
Question Text:

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

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

Universe Text All nondeleted family members
Skip Instructions:

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

Question ID:FID.110_00.000

Instrument Variable Name: CWHAT2
Question Text:

* Change(s) needed for [ALIAS].
* Enter each number that applies. If a wrong choice, type that choice again.

1 Name
2 Age or DOB
3 Sex
4 National origin
5 Race

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

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

Question ID:FID.245_00.000

Instrument Variable Name: HHCHANGE_1
Question Text:

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

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) GO TO 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 Go to should be CWHAT2

Question ID:FID.250_00.000

Instrument Variable Name: MARITAL
Question Text:

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

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

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

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

Question ID:FID.260_00.000

Instrument Variable Name: SPOUS
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FID.270_00.000

Instrument Variable Name: SPOUS2
Question Text:

* Probe as necessary and enter the line number of the spouse.
[Display all possible spouse candidates]

01-25 Person # of spouse

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

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

ERR1_SPOUS2

Hard Edit:

*Person can't be his or her own spouse.
*Please correct.

ERR2_SPOUS2

Soft Edit:

*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 GO TO is to change Relationship code of [ALIAS (SPOUS2(PX))]
*Second GO TO 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 GO TO is to choose different spouse at SPOUS2
*Second GO TO is to change SEX of spouse [ALIAS (SPOUS2(PX))]
*Third GO TO 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 GO TO is to choose different spouse at SPOUS2
*Second GO TO is to change AGE of spouse [ALIAS (SPOUS2(PX))]
*Third GO TO is to change AGE of [ALIAS(PX)]

Questions involved Value
SPOUS2 ALIAS (SPOUS2(PX))
AGE AGE (SPOUS2(PX))
AGE AGE (PX)

Question ID:FID.280_00.000

Instrument Variable Name: COHAB1
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FID.290_00.000

Instrument Variable Name: COHAB2
Question Text:

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

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

Universe Text Person is currently cohabiting and has been married.
Skip Instructions:

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

Question ID:FID.300_00.000

Instrument Variable Name: COHAB3
Question Text:

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

01-25
Person number

Universe Text 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]

ERR1_COHAB3

Hard Edit:

* 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 GO TO is to change Relationship code of [ALIAS (COHAB3(PX))]
*Second GO TO 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 GO TO is to change Relationship code of [ALIAS (COHAB3(PX))]
*Second GO TO is to change Relationship code of [ALIAS (PX)]
*Third GO TO 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 GO TO is to choose different cohabiting partner at COHAB3
*Second GO TO is to change AGE of cohabiting partner [ALIAS (COHAB3(PX))]
*Third GO TO is to change AGE of [ALIAS(PX)]

Questions involved Value
COHAB3 ALIAS (COHAB3 (PX))
AGE AGE (COHAB3 (PX))
AGE AGE (PX)

Question ID:FID.322_00.000

Instrument Variable Name: DEGREE4
Question Text:

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

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

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

(1) if AGEDIFF LT12 [go to ERR_DEGREE4]
if ERR_DEGREE4 = 1 [go to FIDCCI4B]
else reset DEGREE4 [go to DEGREE4] endif
else [go to FIDCCI4B]
(2-5,R,D) [go to FIDCCI4B]

Hard Edit:

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 GO TO is to change Relationship code of [ALIAS(X2)]
*Second GO TO is to change Relationship code of [ALIAS(PX)]
*Third GO TO is to change AGE of father [ALIAS(X2)]
*Fourth GO TO 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 GO TO is to change Relationship code of [ALIAS(X2)]
*Second GO TO is to change Relationship code of [ALIAS(PX)]
*Third GO TO is to change AGE of father [ALIAS(X2)]
*Fourth GO TO 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, GO TO FIDCCI4
else GO TO FIDCCI4B, endif

Soft Edit:

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 GO TO is to change Relationship code of [ALIAS(X2)]
*Second GO TO is to change Relationship code of [ALIAS(PX)]
*Third GO TO is to change AGE of father [ALIAS(X2)]
*Fourth GO TO 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, GO TO FIDCCI4
else GO TO FIDCCI4B, endif

Question ID:FID.324_00.000

Instrument Variable Name: DEGREE5
Question Text:

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

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

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

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

Hard Edit:

ERR2_DEGREE5
*Age difference between mother and child is [AGEDIFF] years.
I have recorded [ALIAS (X2)] is [AGE(X2)] years old and her child [ALIAS(PX)] is [AGE(PX)] years old.
Are these ages and relationships correct?

* Please correct relationship code or age.

*First GO TO is to change Relationship code of [ALIAS(X2)]
*Second GO TO is to change Relationship code of [ALIAS(PX)]
*Third GO TO is to change AGE of mother [ALIAS(X2)]
*Fourth GO TO is to change AGE of child [ALIAS(PX)]

Questions involved Value
RPREL: Relationship to Ref Person Spouse (wife) or Unmarried Partner
RPREL: Relationship to Ref Person Child or Child of Partner
AGE AGE (X2)
AGE AGE(PX)
ERR1_DEGREE5

*Age difference between mother and child is only [AGEDIFF] years.
I have recorded [ALIAS (X2)] is [AGE(X2)] years old and her child [ALIAS(PX)] is [AGE(PX)] years old. Are
these ages and relationships correct?

*First GO TO is to change Relationship code of [ALIAS(X2)]
*Second GO TO is to change Relationship code of [ALIAS(PX)]
*Third GO TO is to change AGE of mother [ALIAS(X2)]
*Fourth GO TO is to change AGE of child [ALIAS(PX)]

Questions involved Value
RPREL: Relationship to Ref Person Spouse (wife) 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 GO TO FIDCCI4B, endif

Soft Edit:

ERR3_DEGREE5
*Age difference between mother and child is greater than or equal to 50 years.
I have recorded [ALIAS (X2)] is [AGE(X2)] years old and her child [ALIAS(PX)] is [AGE(PX)] years old. Are these ages and relationships correct?

*First GO TO is to change Relationship code of [ALIAS(X2)]
*Second GO TO is to change Relationship code of [ALIAS(PX)]
*Third GO TO is to change AGE of mother [ALIAS(X2)]
*Fourth GO TO is to change AGE of child [ALIAS(PX)]

Questions involved Value
RPREL: Relationship to Ref Person Spouse (wife) 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

Question ID:FID.326_00.000

Instrument Variable Name: MOTHER
Question Text:

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

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

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

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

Question ID:FID.330_01.000

Instrument Variable Name: MOTHERCK_A
Question Text:

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

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

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

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

Hard Edit:

ERR2_MOTHERCK_A
*Age difference between mother and child is [AGEDIFF] years.
I have recorded [ALIAS (LNMOM[PX])] is [AGE(LNMOM[PX])] years old and her child [ALIAS(PX)] is
[AGE(PX)] years old. Are these ages and relationships correct?

* Please correct relationship code or age.

*First GO TO is to change code at MOTHER
*Second GO TO is to change AGE of mother [ALIAS (LNMOM[PX])]
*Third GO TO is to change AGE of child [ALIAS(PX)]

Questions involved Value
MOTHER ALIAS (MOTHER [PX])
AGE AGE(LNMOM[PX])
AGE AGE(PX)

Soft Edit:

ERR1_MOTHERCK_A
*Age difference between mother and child is only [AGEDIFF] years.
I have recorded [ALIAS (LNMOM[PX])] is [AGE(LNMOM[PX])] years old and her child [ALIAS(PX)] is
[AGE(PX)] years old. Are these ages and relationships correct?

*First GO TO is to change code at MOTHER
*Second GO TO is to change AGE of mother [ALIAS (LNMOM[PX])]
*Third GO TO is to change AGE of child [ALIAS(PX)]

Questions involved Value
MOTHER ALIAS (MOTHER [PX])
AGE AGE(LNMOM[PX])
AGE AGE(PX)

if suppressed go to FIDCCI5

ERR3_MOTHERCK_A
*Age difference between mother and child is greater than or equal to 50 years.
I have recorded [ALIAS (LNMOM[PX])] is [AGE(LNMOM[PX])] years old and her child [ALIAS(PX)] is
[AGE(PX)] years old. Are these ages and relationships correct?

*First GOTO is to change code at MOTHER
*Second GOTO is to change AGE of mother [ALIAS (LNMOM[PX])]
*Third GOTO is to change AGE of child [ALIAS(PX)]

Questions involved Value
MOTHER ALIAS (MOTHER [PX])
AGE AGE(LNMOM[PX])
AGE AGE(PX)

if suppressed go to FIDCCI5

Question ID:FID.330_02.000

Instrument Variable Name: MOM_CKFG
Question Text:

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

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

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

Question ID:FID.340_00.000

Instrument Variable Name: FATHER
Question Text:

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

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

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

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

Question ID:FID.350_01.000

Instrument Variable Name: FATHERCK_A
Question Text:

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

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

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

(1) If AGEDIFF LT 12 [go to ERR_FATHERCK_A]
if ERRFATHERCK_A = (1) [go to FIDCCI4]
elseif (2) [go to FATHER]
elseif (3) reset FATHERCK_A
[go to FATHERCK_A] endif
else [go to FIDCCI4]
(2-5,R,D) [go to FIDCCI4]
Hard Edit:

ERR2_FATHERCK_A
*Age difference between father and child is [AGEDIFF] years.
I have recorded [ALIAS(LNDAD[PX])] is [AGE(LNDAD[PX])] 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 GO TO is to change code at FATHER
*Second GO TO is to change AGE of father [ALIAS (LNDAD[PX])]
*Third GO TO is to change AGE of child [ALIAS(PX)]

Questions involved Value
FATHER ALIAS(FATHER [PX])
AGE AGE(LNDAD[PX])
AGE AGE(PX)

Soft Edit:

ERR1_FATHERCK_A
*Age difference between father and child is only [AGEDIFF] years.
I have recorded [ALIAS(LNDAD[PX])] is [AGE (LNDAD[PX])] years old and his child [ALIAS(PX)] is
[AGE(PX)] years old. Are these ages and relationships correct?

*First GO TO is to change code at FATHER
*Second GO TO is to change AGE of father [ALIAS (LNDAD[PX])]
*Third GO TO is to change AGE of child [ALIAS(PX)]

Questions involved Value
FATHER ALIAS(FATHER [PX])
AGE AGE(LNDAD[PX])
AGE AGE(PX)

if suppressed go to FIDCCI4

ERR3_FATHERCK_A
*Age difference between father and child is greater than or equal to 50 years.
I have recorded [ALIAS(LNDAD[PX])] is [AGE (LNDAD[PX])] years old and his child [ALIAS(PX)] is
[AGE(PX)] years old. Are these ages and relationships correct?

*First GO TO is to change code at FATHER
*Second GO TO is to change AGE of father [ALIAS (LNDAD[PX])]
*Third GO TO is to change AGE of child [ALIAS(PX)]

Questions involved Value
FATHER ALIAS(FATHER [PX])
AGE AGE(LNDAD[PX])
AGE AGE(PX)

if suppressed go to FIDCCI4

Question ID:FID.350_02.000

Instrument Variable Name: DAD_CKFG
Question Text:

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

Universe Text Father has been identified
Skip Instructions:

Question ID:FID.360_01.000

Instrument Variable Name: GUARD
Question Text:

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

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

Universe Text Mother or father was identified as legal guardian of child or, at the FIDCCI5 procedure, it's determined that the
child (AGE LT14) has no mother or father in the family.
Skip Instructions:

(0-25,R,D) [go to FIDCCI4]

Question ID:FID.380_00.000

Instrument Variable Name: KNOW2
Question Text:

* Verify or ask Who in the family would you say knows about the health of all the family members?
[Display all family members who not deleted and 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 [go to FINTRO2]
else [go to KNOWSC2]

Question ID:FID.390_03.000

Instrument Variable Name: FINTRO2
Question Text:

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

1 Present
2 Not present

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

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

Question ID:FID.390_04.000

Instrument Variable Name: FAMRESP
Question Text:

* Ask if necessary: With whom am I speaking?
* Enter the line number of the person you consider to be the main respondent for this family's health questions.

01-25 Person # of Family Respondent

Universe Text More than 1 adult present.
Skip Instructions:

go to HLTH_BEG

Question ID:FHS.005_00.000

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 emotional problem?

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHS.010_00.000

Instrument Variable Name: PLAPLYLM
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHS.020_00.000

Instrument Variable Name: PLAPLYUN
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHS.050_00.000

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 go to PSPEDEM; else, go to PSPEDEIS]
(2,R,D) [go to FLAADL]

Question ID:FHS.060_00.000

Instrument Variable Name: PSPEDEIS
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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.

Question ID:FHS.065_00.000

Instrument Variable Name: PSPEDEM
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHS.070_00.000

Instrument Variable Name: FLAADL
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHS.080_00.000

Instrument Variable Name: PLAADL
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHS.090_01.000

Instrument Variable Name: LABATH
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

go to LADRESS

Question ID:FHS.090_02.000

Instrument Variable Name: LADRESS
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

go to LAEAT

Question ID:FHS.090_03.000

Instrument Variable Name: LAEAT
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

go to LABED

Question ID:FHS.090_04.000

Instrument Variable Name: LABED
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

go to LATOILT

Question ID:FHS.090_05.000

Instrument Variable Name: LATOILT
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

go to LAHOME

Question ID:FHS.090_06.000

Instrument Variable Name: LAHOME
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

go to LABATH for the next persons listed at PLAADL; else, go to FLAIADL

Question ID:FHS.150_00.000

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 go to FLAWKNOW;
else, go to PLAIADL]
(2,R,D) [go to FLAWKNOW]

Question ID:FHS.160_00.000

Instrument Variable Name: PLAIADL
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHS.170_00.000

Instrument Variable Name: FLAWKNOW
Question Text:

? [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 go to FLAWALK; else, go to PLAWKNOW]
(2,R,D) [go to FLAWKLIM]

Question ID:FHS.180_00.000

Instrument Variable Name: PLAWKNOW
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHS.190_00.000

Instrument Variable Name: FLAWKLIM
Question Text:

? [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 go to FLAWALK; else, go to PLAWKLIM]
(2,R,D) [go to FLAWALK]

Question ID:FHS.200_00.000

Instrument Variable Name: PLAWKLIM
Question Text:

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

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

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

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.

Question ID:FHS.210_00.000

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 go to FLAREMEM; else, go to PLAWALK]
(2,R,D) [go to FLAREMEM]

Question ID:FHS.220_00.000

Instrument Variable Name: PLAWALK
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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.

Question ID:FHS.230_00.000

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 go to LAHCC; else, go to PLAREMEM]
(2,R,D) [go to FLIMANY]

Question ID:FHS.240_00.000

Instrument Variable Name: PLAREMEM
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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.

Question ID:FHS.250_00.000

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 ? please see note on PLIMANY
Skip Instructions:

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

Question ID:FHS.260_00.000

Instrument Variable Name: PLIMANY
Question Text:

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

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

Universe Text All families ? please see note on PLIMANY
Skip Instructions:

go to LAHCC NOTE: In 2012, PLIMANY/FLIMANY was asked of two different sample groups. See the Survey Description Document and Variable Layout for more information. In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing

Question ID:FHS.270_00.000

Instrument Variable Name: LAHCC
Question Text:

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

01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 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) [go to appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
(5) [fill "96" in LHCL05N and fill "6" in LHCL05T]
(90) [go to LAHCC_S1]
(91) [go to 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, go to LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.

Question ID:FHS.271_90.000

Instrument Variable Name: LAHCC_S1
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

go to LHCL90N

Question ID:FHS.271_91.000

Instrument Variable Name: LAHCC_S2
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

go to LHCL91N

Question ID:FHS.280_01.000

Instrument Variable Name: LHCL01N
Question Text:

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

01-94 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) [go to LHCL01T]
(96) [fill "6" in LHCL01T and go to 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, go to LAHCA]
(R) [store "R" in LHCL01T and go to 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, go to LAHCA]

Question ID:FHS.280_02.000

Instrument Variable Name: LHCL01T
Question Text:

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

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

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

(1-4,R,D) [go to 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, go to LAHCA]
(6) [go to 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), go to ERR1_LHCL01T

ERR1_LHCL01T

Hard Edit:

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

Question ID:FHS.282_01.000

Instrument Variable Name: LHCL02N
Question Text:

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

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

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

(1-95,D) [go to LHCL02T]
(96) [fill "6" in LHCL02T and go to 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, go to LAHCA]
(R) [store "R" in LHCL02T and go to 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, go to LAHCA]

Question ID:FHS.282_02.000

Instrument Variable Name: LHCL02T
Question Text:

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

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

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

(1-4,R,D) [go to 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, go to LAHCA]
(6) [go to ERR2_LHCL02T] if (LHCL02T = 4 and LHCL02N GT AGE) or (LHCL02T = 3 and LHCL02N GT AGE in months) or (LHCL02T = 2 and LHCL02N GT AGE in weeks), go to ERR1_LHCL02T

ERR1_LHCL02T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL02T
* "6" not selectable.

Question ID:FHS.284_01.000

Instrument Variable Name: LHCL03N
Question Text:

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

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

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

(1-95,D) [go to LHCL03T]
(96) [fill "6" in LHCL03T and go to 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, go to LAHCA]
(R) [store "R" in LHCL03T and go to 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, go to LAHCA]

Question ID:FHS.284_02.000

Instrument Variable Name: LHCL03T
Question Text:

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

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

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

(1-4,R,D) [go to 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, go to LAHCA]
(6) [go to 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), go to ERR1_LHCL03T

ERR1_LHCL03T

Hard Edit:

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

Question ID:FHS.286_01.000

Instrument Variable Name: LHCL04N
Question Text:

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

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

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

(1-95,D) [go to LHCL04T]
(96) [fill "6" in LHCL04T and go to 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, go to LAHCA]
(R) [store "R" in LHCL04T and go to 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, go to LAHCA]

Question ID:FHS.286_02.000

Instrument Variable Name: LHCL04T
Question Text:

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

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

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

(1-4,R,D) [go to 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, go to LAHCA]
(6) [go to 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), go to ERR1_LHCL04T

ERR1_LHCL04T

Hard Edit:

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

Question ID:FHS.288_01.000

Instrument Variable Name: LHCL06N
Question Text:

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

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

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

(1-95,D) [go to LHCL06T]
(96) [fill "6" in LHCL06T and go to 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, go to LAHCA]
(R) [store "R" in LHCL06T and go to 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, go to LAHCA]

Question ID:FHS.288_02.000

Instrument Variable Name: LHCL06T
Question Text:

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

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

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

(1-4,R,D) [go to 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, go to LAHCA]

(6) [go to 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), go to ERR1_LHCL06T

ERR1_LHCL06T

Hard Edit:

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

Question ID:FHS.290_01.000

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 intellectual disability/mental retardation
Skip Instructions:

(1-95,D) [go to LHCL07T]
(96) [fill "6" in LHCL07T and go to 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, go to LAHCA]
(R) [store "R" in LHCL07T and go to 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, go to LAHCA]

Question ID:FHS.290_02.000

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 intellectual disability/mental retardation and 195, D was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [go to 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, go to LAHCA]
(6) [go to 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), go to ERR1_LHCL07T

ERR1_LHCL07T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL07T
* "6" not selectable.

Question ID:FHS.292_01.000

Instrument Variable Name: LHCL08N
Question Text:

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

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

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

(1-95,D) [go to LHCL08T]
(96) [fill "6" in LHCL08T and go to 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, go to LAHCA]
(R) [store "R" in LHCL08T and go to 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,
go to LAHCA]

Question ID:FHS.292_02.000

Instrument Variable Name: LHCL08T
Question Text:

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

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

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

(1-4,R,D) [go to 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, go to LAHCA]
(6) [go to 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), go to ERR1_LHCL08T

ERR1_LHCL08T

Hard Edit:

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

Question ID:FHS.294_01.000

Instrument Variable Name: LHCL09N
Question Text:

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

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

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

(1-95,D) [go to LHCL09T]
(96) [fill "6" in LHCL09T and go to 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, go to LAHCA]
(R) [store "R" in LHCL09T and go to 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, go to LAHCA]

Question ID:FHS.294_02.000

Instrument Variable Name: LHCL09T
Question Text:

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

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

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

(1-4,R,D) [go to 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, go to LAHCA]
(6) [go to ERR2_LHCL09T] if (LHCL09T = 4 and LHCL09N GT AGE) or (LHCL09T = 3 and LHCL09N GT AGE in months) or (LHCL09T = 2 and LHCL09N GT AGE in weeks), go to ERR1_LHCL09T

ERR1_LHCL09T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL09T
* "6" not selectable.

Question ID:FHS.296_01.000

Instrument Variable Name: LHCL10N
Question Text:

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

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

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

(1-95,D) [go to LHCL10T]
(96) [fill "6" in LHCL10T and go to 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, go to LAHCA]
(R) [store "R" in LHCL10T and go to 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, go to LAHCA]

Question ID:FHS.296_02.000

Instrument Variable Name: LHCL10T
Question Text:

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

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

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

(1-4,R,D) [go to 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, go to LAHCA]
(6) [go to ERR2_LHCL10T] if (LHCL10T = 4 and LHCL10N GT AGE) or (LHCL10T = 3 and LHCL10N GT AGE in months) or (LHCL10T = 2 and LHCL10N GT AGE in weeks), go to ERR1_LHCL10T

ERR1_LHCL10T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL10T
* "6" not selectable.

Question ID:FHS.298_01.000

Instrument Variable Name: LHCL11N
Question Text:

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

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

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

(1-95,D) [go to LHCL11T]
(96) [fill "6" in LHCL11T and go to 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, go to LAHCA]
(R) [store "R" in LHCL11T and go to 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, go to LAHCA]

Question ID:FHS.298_02.000

Instrument Variable Name: LHCL11T
Question Text:

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

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

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

(1-4,R,D) [go to 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, go to LAHCA]
(6) [go to 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), go to ERR1_LHCL11T

ERR1_LHCL11T

Hard Edit:

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

Question ID:FHS.300_01.000

Instrument Variable Name: LHCL12N
Question Text:

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

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

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

(1-95,D) [go to LHCL12T]
(96) [fill "6" in LHCL12T and go to 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, go to LAHCA]
(R) [store "R" in LHCL12T and go to 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, go to LAHCA]

Question ID:FHS.300_02.000

Instrument Variable Name: LHCL12T
Question Text:

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

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

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

(1-4,R,D) [go to 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, go to LAHCA]
(6) [go to 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), go to ERR1_LHCL12T

ERR1_LHCL12T

Hard Edit:

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

Question ID:FHS.302_01.000

Instrument Variable Name: LHCL13N
Question Text:

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

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

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

(1-95,D) [go to LHCL13T]
(96) [fill "6" in LHCL13T and go to 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, go to LAHCA]
(R) [store "R" in LHCL13T and go to 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, go to LAHCA]

Question ID:FHS.302_02.000

Instrument Variable Name: LHCL13T
Question Text:

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

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

Universe Text All persons less than 18 years of age who have a limitation due to Attention Deficit/Hyperactivity Disorder and 195, D was entered for the "number" part of this two-part question
Skip Instructions:

(1-4,R,D) [go to 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, go to LAHCA]
(6) [go to 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), go to ERR1_LHCL13T

ERR1_LHCL13T

Hard Edit:

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

Question ID:FHS.304_01.000

Instrument Variable Name: LHCL90N
Question Text:

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

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

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

(1-95,D) [go to LHCL90T]
(96) [fill "6" in LHCL90T and go to 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, go to LAHCA]
(R) [store "R" in LHCL90T and go to 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, go to LAHCA]

Question ID:FHS.304_02.000

Instrument Variable Name: LHCL90T
Question Text:

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

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

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

(1-4,R,D) [go to 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, go to LAHCA]
(6) [go to 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), go to ERR1_LHCL90T

ERR1_LHCL90T

Hard Edit:

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

Question ID:FHS.306_01.000

Instrument Variable Name: LHCL91N
Question Text:

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

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

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

(1-95,D) [go to LHCL91T]
(96) [fill "6" in LHCL91T and go to 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, go to LAHCA]
(R) [store "R" in LHCL91T and go to 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, go to LAHCA]

Question ID:FHS.306_02.000

Instrument Variable Name: LHCL91T
Question Text:

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

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

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

(1-4,R,D) [go to 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, go to LAHCA]
(6) [go to 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), go to ERR1_LHCL91T

ERR1_LHCL91T

Hard Edit:

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

Question ID:FHS.350_00.000 QuestionnaireFileName:

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

Question ID:FHS.351_90.000

Instrument Variable Name: LAHCA_S1
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

go to LHAL90N

Question ID:FHS.351_91.000

Instrument Variable Name: LAHCA_S2
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

go to LHAL91N

Question ID:FHS.360_01.000

Instrument Variable Name: LHAL01N
Question Text:

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

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

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

Question ID:FHS.360_02.000

Instrument Variable Name: LHAL01T
Question Text:

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

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

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

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

ERR1_LHAL01T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL01T
* "6" not selectable.

Question ID:FHS.362_01.000

Instrument Variable Name: LHAL02N
Question Text:

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

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

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

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

Question ID:FHS.362_02.000

Instrument Variable Name: LHAL02T
Question Text:

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

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

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

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

ERR1_LHAL02T

Hard Edit:

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

Question ID:FHS.364_01.000

Instrument Variable Name: LHAL03N
Question Text:

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

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

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

(1-95,D) [go to LHAL03T]

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

Question ID:FHS.364_02.000

Instrument Variable Name: LHAL03T
Question Text:

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

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

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

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

ERR1_LHAL03T

Hard Edit:

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

Question ID:FHS.366_01.000

Instrument Variable Name: LHAL04N
Question Text:

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

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

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

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

Question ID:FHS.366_02.000

Instrument Variable Name: LHAL04T
Question Text:

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

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

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

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

ERR1_LHAL04T

Hard Edit:

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

Question ID:FHS.368_01.000

Instrument Variable Name: LHAL05N
Question Text:

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

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

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

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

Question ID:FHS.368_02.000

Instrument Variable Name: LHAL05T
Question Text:

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

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

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

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

ERR1_LHAL05T

Hard Edit:

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

Question ID:FHS.370_01.000

Instrument Variable Name: LHAL06N
Question Text:

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

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

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

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

Question ID:FHS.370_02.000

Instrument Variable Name: LHAL06T
Question Text:

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

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

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

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

ERR1_LHAL06T

Hard Edit:

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

Question ID:FHS.372_01.000

Instrument Variable Name: LHAL07N
Question Text:

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

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

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

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

Question ID:FHS.372_02.000

Instrument Variable Name: LHAL07T
Question Text:

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

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

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

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

ERR1_LHAL07T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL07T
* "6" not selectable.

Question ID:FHS.374_01.000

Instrument Variable Name: LHAL08N
Question Text:

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

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

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

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

Question ID:FHS.374_02.000

Instrument Variable Name: LHAL08T
Question Text:

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

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

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

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

ERR1_LHAL08T

Hard Edit:

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

Question ID:FHS.376_01.000

Instrument Variable Name: LHAL09N
Question Text:

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

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

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

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

Question ID:FHS.376_02.000

Instrument Variable Name: LHAL09T
Question Text:

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

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

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

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

ERR1_LHAL09T

Hard Edit:

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

Question ID:FHS.378_01.000

Instrument Variable Name: LHAL10N
Question Text:

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

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

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

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

Question ID:FHS.378_02.000

Instrument Variable Name: LHAL10T
Question Text:

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

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

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

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

ERR1_LHAL10T

Hard Edit:

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

Question ID:FHS.380_01.000

Instrument Variable Name: LHAL11N
Question Text:

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

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

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

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

Question ID:FHS.380_02.000

Instrument Variable Name: LHAL11T
Question Text:

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

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

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

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

ERR1_LHAL11T

Hard Edit:

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

Question ID:FHS.382_01.000

Instrument Variable Name: LHAL12N
Question Text:

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

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

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

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

Question ID:FHS.382_02.000

Instrument Variable Name: LHAL12T
Question Text:

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

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

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

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

ERR1_LHAL12T

Hard Edit:

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

Question ID:FHS.384_01.000

Instrument Variable Name: LHAL14N
Question Text:

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

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

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

Question ID:FHS.384_02.000

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 intellectual disability/mental retardation and 195, D was entered for the "number" part of this two-part question
Skip Instructions:

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

ERR1_LHAL14T

Hard Edit:

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

Question ID:FHS.386_01.000

Instrument Variable Name: LHAL15N
Question Text:

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

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

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

Question ID:FHS.386_02.000

Instrument Variable Name: LHAL15T
Question Text:

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

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

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

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

ERR1_LHAL15T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL15T
* "6" not selectable.

Question ID:FHS.388_01.000

Instrument Variable Name: LHAL16N
Question Text:

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

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

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

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

Question ID:FHS.388_02.000

Instrument Variable Name: LHAL16T
Question Text:

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

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

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

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

ERR1_LHAL16T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL16T
* "6" not selectable.

Question ID:FHS.390_01.000

Instrument Variable Name: LHAL17N
Question Text:

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

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

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

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

Question ID:FHS.390_02.000

Instrument Variable Name: LHAL17T
Question Text:

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

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

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

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

ERR1_LHAL17T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL17T
* "6" not selectable.

Question ID:FHS.392_01.000

Instrument Variable Name: LHAL18N
Question Text:

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

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

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

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

Question ID:FHS.392_02.000

Instrument Variable Name: LHAL18T
Question Text:

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

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

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

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

ERR1_LHAL18T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL18T
* "6" not selectable.

Question ID:FHS.394_01.000

Instrument Variable Name: LHAL19N
Question Text:

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

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

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

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

Question ID:FHS.394_02.000

Instrument Variable Name: LHAL19T
Question Text:

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

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

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

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

ERR1_LHAL19T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL19T
* "6" not selectable.

Question ID:FHS.396_01.000

Instrument Variable Name: LHAL20N
Question Text:

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

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

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

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

Question ID:FHS.396_02.000

Instrument Variable Name: LHAL20T
Question Text:

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

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

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

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

ERR1_LHAL20T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL20T
* "6" not selectable.

Question ID:FHS.398_01.000

Instrument Variable Name: LHAL21N
Question Text:

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

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

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

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

Question ID:FHS.398_02.000

Instrument Variable Name: LHAL21T
Question Text:

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

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

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

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

ERR1_LHAL21T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL21T
* "6" not selectable.

Question ID:FHS.400_01.000

Instrument Variable Name: LHAL22N
Question Text:

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

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

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

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

Question ID:FHS.400_02.000

Instrument Variable Name: LHAL22T
Question Text:

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

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

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

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

ERR1_LHAL22T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL22T
* "6" not selectable.

Question ID:FHS.402_01.000

Instrument Variable Name: LHAL23N
Question Text:

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

01-94 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) [go to LHAL23T]
(96) [fill "6" in LHAL23T and go to follow-up questions for next condition selected at LAHCA; if no more conditions, go to LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, go to PHSTAT]
(R) [store "R" in LHAL23T and go to follow-up questions for next condition selected at LAHCA; if no more conditions, go to LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, go to PHSTAT]

Question ID:FHS.402_02.000

Instrument Variable Name: LHAL23T
Question Text:

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

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

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

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

ERR1_LHAL23T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL23T
* "6" not selectable.

Question ID:FHS.404_01.000

Instrument Variable Name: LHAL24N
Question Text:

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

01-94 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) [go to LHAL24T]
(96) [fill "6" in LHAL24T and go to follow-up questions for next condition selected at LAHCA; if no more conditions, go to LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, go to PHSTAT]
(R) [store "R" in LHAL24T and go to follow-up questions for next condition selected at LAHCA; if no more conditions, go to LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, go to PHSTAT]

Question ID:FHS.404_02.000

Instrument Variable Name: LHAL24T
Question Text:

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

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

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

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

ERR1_LHAL24T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL24T
* "6" not selectable.

Question ID:FHS.406_01.000

Instrument Variable Name: LHAL25N
Question Text:

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

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

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

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

Question ID:FHS.406_02.000

Instrument Variable Name: LHAL25T
Question Text:

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

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

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

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

ERR1_LHAL25T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL25T
* "6" not selectable.

Question ID:FHS.408_01.000

Instrument Variable Name: LHAL26N
Question Text:

1 of 2 How long [fill: have you/has ALIAS] had multiple sclerosis (MS) or muscular dystrophy (MD)?
* Enter number for time with multiple sclerosis (MS) or muscular dystrophy (MD)?
* 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 multiple sclerosis or muscular dystrophy
Skip Instructions:

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

Question ID:FHS.408_02.000

Instrument Variable Name: LHAL26T
Question Text:

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

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

Universe Text All persons 18 years of age or older who have a limitation due to multiple sclerosis or muscular dystrophy and 195, D was entered for the "number" part of this two-part question
Skip Instructions:

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

ERR1_LHAL26T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL26T
* "6" not selectable.

Question ID:FHS.410_01.000

Instrument Variable Name: LHAL27N
Question Text:

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

01-94 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) [go to LHAL27T]
(96) [fill "6" in LHAL27T and go to follow-up questions for next condition selected at LAHCA; if no more conditions, go to LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, go to PHSTAT]
(R) [store "R" in LHAL27T and go to follow-up questions for next condition selected at LAHCA; if no more conditions, go to LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID:FHS.410_02.000

Instrument Variable Name: LHAL27T
Question Text:

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

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

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

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

ERR1_LHAL27T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL27T
* "6" not selectable.

Question ID:FHS.412_01.000

Instrument Variable Name: LHAL28N
Question Text:

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

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

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

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

Question ID:FHS.412_02.000

Instrument Variable Name: LHAL28T
Question Text:

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

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

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

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

ERR1_LHAL28T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL28T
* "6" not selectable.

Question ID:FHS.414_01.000

Instrument Variable Name: LHAL29N
Question Text:

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

01-94 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) [go to LHAL29T]
(96) [fill "6" in LHAL29T and go to follow-up questions for next condition selected at LAHCA; if no more conditions, go to LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, go to PHSTAT]
(R) [store "R" in LHAL29T and go to follow-up questions for next condition selected at LAHCA; if no more conditions, go to LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, go to PHSTAT]

Question ID:FHS.414_02.000

Instrument Variable Name: LHAL29T
Question Text:

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

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

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

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

ERR1_LHAL29T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL29T
* "6" not selectable.

Question ID:FHS.416_01.000

Instrument Variable Name: LHAL30N
Question Text:

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

01-94 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) [go to LHAL30T]
(96) [fill "6" in LHAL30T and go to follow-up questions for next condition selected at LAHCA; if no more conditions, go to LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, go to PHSTAT]
(R) [store "R" in LHAL30T and go to follow-up questions for next condition selected at LAHCA; if no more conditions, go to LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, go to PHSTAT]

Question ID:FHS.416_02.000

Instrument Variable Name: LHAL30T
Question Text:

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

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

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

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

ERR1_LHAL30T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL30T
* "6" not selectable.

Question ID:FHS.418_01.000

Instrument Variable Name: LHAL31N
Question Text:

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

01-94 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) [go to LHAL31T]
(96) [fill "6" in LHAL31T and go to follow-up questions for next condition selected at LAHCA; if no more conditions, go to LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, go to PHSTAT]
(R) [store "R" in LHAL31T and go to follow-up questions for next condition selected at LAHCA; if no more conditions, go to LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, go to PHSTAT]

Question ID:FHS.418_02.000

Instrument Variable Name: LHAL31T
Question Text:

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

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

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

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

ERR1_LHAL31T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL31T
* "6" not selectable.

Question ID:FHS.420_01.000

Instrument Variable Name: LHAL32N
Question Text:

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

01-94 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) [go to LHAL32T]
(96) [fill "6" in LHAL32T and go to follow-up questions for next condition selected at LAHCA; if no more conditions, go to LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, go to PHSTAT]
(R) [store "R" in LHAL32T and go to follow-up questions for next condition selected at LAHCA; if no more conditions, go to LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, go to PHSTAT]

Question ID:FHS.420_02.000

Instrument Variable Name: LHAL32T
Question Text:

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

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

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

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

ERR1_LHAL32T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL32T
* "6" not selectable.

Question ID:FHS.422_01.000

Instrument Variable Name: LHAL33N
Question Text:

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

01-94 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) [go to LHAL33T]
(96) [fill "6" in LHAL33T and go to follow-up questions for next condition selected at LAHCA; if no more conditions, go to LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, go to PHSTAT]
(R) [store "R" in LHAL33T and go to follow-up questions for next condition selected at LAHCA; if no more conditions, go to LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, go to PHSTAT]

Question ID:FHS.422_02.000

Instrument Variable Name: LHAL33T
Question Text:

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

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

Universe Text All persons 18 years of age or older who have a limitation due to thyroid problems, Grave's disease, or gout and 195, D was entered for the "number" part of this two-part question
Skip Instructions:

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

ERR1_LHAL33T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL33T
* "6" not selectable.

Question ID:FHS.424_01.000

Instrument Variable Name: LHAL34N
Question Text:

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

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

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

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

Question ID:FHS.424_02.000

Instrument Variable Name: LHAL34T
Question Text:

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

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

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

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

ERR1_LHAL34T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL34T
* "6" not selectable.

Question ID:FHS.426_01.000

Instrument Variable Name: LHAL35N
Question Text:

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

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

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

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

Question ID:FHS.426_02.000

Instrument Variable Name: LHAL35T
Question Text:

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

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

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

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

ERR1_LHAL35T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL35T
* "6" not selectable.

Question ID:FHS.450_01.000

Instrument Variable Name: LHAL90N
Question Text:

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

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

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

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

Question ID:FHS.450_02.000

Instrument Variable Name: LHAL90T
Question Text:

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

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

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

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

ERR1_LHAL90T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL90T
* "6" not selectable.

Question ID:FHS.452_01.000

Instrument Variable Name: LHAL91N
Question Text:

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

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

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

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

Question ID:FHS.452_02.000

Instrument Variable Name: LHAL91T
Question Text:

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

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

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

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

ERR1_LHAL91T

Hard Edit:

* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL91T
* "6" not selectable.

Question ID:FHS.500_00.000

Instrument Variable Name: PHSTAT
Question Text:

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

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

Universe Text All persons
Skip Instructions:

repeat for all persons in the family, go to FINJ3M

Question ID:FFS.010_00.000

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) go to FSLAST

Question ID:FFS.020_00.000

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) go to FSBALANC

Question ID:FFS.030_00.000

Instrument Variable Name: FSBALANC
Question Text:

"[fill 1: I/We] couldn't afford to eat balanced meals." 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:

(1,2) [go to FSSKIP]
(3,D,R) [if FSRUNOUT in(1,2) or FSLAST in(1,2), go to FSSKIP; else go to FINJ3M]

Question ID:FFS.040_00.000

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) [go to FSSKDAYS]
(2,R,D) [go to FSLESS]

Question ID:FFS.050_00.000

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) [go to FSLESS]

Question ID:FFS.060_00.000

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

(1,2,R,D) [go to FSHUNGRY]

Question ID:FFS.070_00.000

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

(1,2,R,D) [go to FSWEIGHT]

Question ID:FFS.080_00.000

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

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

Question ID:FFS.090_00.000

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) [go to FSNEDAYS]
(2,R,D) [go to FINJ3M]

Question ID:FFS.100_00.000

Instrument Variable Name: FSNEDAYS
Question Text:

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

01-30 Days
97 Refused
99 Don't know

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) [go to FINJ3M]

Question ID:FIJ.010_00.000

Instrument Variable Name: FINJ3M
Question Text:

? [F1] The next set of questions is about INJURIES AND POISONINGS. People can be injured or poisoned unexpectedly, accidentally or on purpose. They may have hurt themselves or others may have caused them to be hurt.
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: did you/did you or anyone in your family] have an injury where any part of [fill3: your/the] body was hurt, for example, with a [fill4: (random set of injury examples)]?

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 WFINJ3M and goto TFINJ3M; else, go to WFINJ3M]
(2,R,D) [go to FPOI3M]

Question ID:FIJ.012_00.000

Instrument Variable Name: WFINJ3M
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who was 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 person was injured during the past 3 months
Skip Instructions:

(R,D) [go to FPOI3M] else, go to TFINJ3M
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID:FIJ.014_00.000

Instrument Variable Name: TFINJ3M
Question Text:

? [F1] DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] injured?

01-91 1-91 times
97 Refused
99 Don't know

Universe Text All persons injured during the past 3 months
Skip Instructions:

(1-10,D) [go to MFINJ3M]
(R) [go to TFINJ3M for the next person with a reported injury episode; if no more persons with an injury episode, go to FPOI3M]
(11-91) [go to ERR_TFINJ3M]

ERR_TFINJ3M

Soft Edit:

* ^TFINJ3M is unusually high. Please verify.

(Suppress) [go to MFINJ3M]
(Close) [reset TFINJ3M for new entry]
(Go to) [reset TFINJ3M for new entry]

Question ID:FIJ.016_00.000

Instrument Variable Name: MFINJ3M
Question Text:

? [F1]
Did [fill1: you /ALIAS] talk to or see a medical professional about [fill2: any of these injuries//this injury/your injury or injuries/his injury or injuries/ her injury or injuries]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons with at least one or an unknown number of injury episodes during the past 3 months
Skip Instructions:

(1) [if TFINJ3M eq 1, fill "1" in MTFINJ3M and go to IPDATEM; else, go to MTFINJ3M]
(2,R,D) [go to TFINJ3M for the next person with a reported injury episode; if no more persons with an injury episode, go to FPOI3M]

Question ID:FIJ.018_00.000

Instrument Variable Name: MTFINJ3M
Question Text:

? [F1] Of [fill1: the ^TFINJ3M/all the] times that [fill2: you were/ALIAS was] injured, how many of those times was the injury serious enough that a medical professional was consulted?

01-91 1-91 times
97 Refused
99 Don't know

Universe Text All persons who consulted a medical professional for their injury episode(s)
Skip Instructions:

(1-91) [If MTFINJ3M gt TFINJ3M, go to ERR1_MTFINJ3M; else, if MTFINJ3M gt 3 and TFINJ3M eq D, go to ERR2_MTFINJ3M; else, go to IPDATEM]
(R,D) [go to TFINJ3M for the next person with a reported injury episode; if no more persons with an injury episode, go to FPOI3M]

ERR1_MTFINJ3M

Hard Edit:

[If (MTIFNJ3M gt TFINJ3M), display ERR1_MTFINJ3M]:

[^MTFINJ3M] is greater than the total number of times you said [you were/ALIAS was] injured, which is [^TFINJ3M]. For this question, we are asking about the number of times [you were/ALIAS was] injured and a medical professional was consulted. For example, if you were injured three different times but only sought medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical professional more than once about that injury event.

Go to
Close

ERR2_MTFINJ3M

Soft Edit:

[If (TFINJ3M = 99 and MTFINJ3M gt 3), display ERR2_MTFINJ3M]:

^MTFINJ3M is an unusually high number of injuries for which a medical professional was consulted. Please verify.

*Read if necessary.

For this question, we are asking about the number of times [you were/ALIAS was] injured and a medical professional was consulted. For example, if you were injured three different times, but only sought medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical professional more than once about that injury event.

Suppress
Go to
Close

Question ID:FIJ.020_00.000

Instrument Variable Name: FPOI3M
Question Text:

? [F1] DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: were you/ were you or anyone in your family] poisoned by swallowing or breathing in a harmful substance such as bleach, carbon monoxide, or too many pills or drugs? Do not include food poisoning, sun poisoning, or poison ivy rashes.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

(1) [if single-person family, store person number in WFPOI3M and go to TFPOI3M; else,
go to WFPOI3M]
(2,DK,R) [go to next section]

Question ID:FIJ.022_00.000

Instrument Variable Name: WFPOI3M
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who was 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 person was poisoned during the past 3 months
Skip Instructions:

(1-25) [All family members. Avoid duplicate; go to TFPOI3M]
(DK,R) [go to next section]

Question ID:FIJ.024_00.000

Instrument Variable Name: TFPOI3M
Question Text:

? [F1] DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] poisoned? Do not include food poisoning, sun poisoning, or poison ivy rashes.

01-91 1-91 times
97 Refused
99 Don't know

Universe Text All persons poisoned during the past 3 months
Skip Instructions:

(01-10, DK) [go to MFPOI3M]
(R) [go to TFPOI3M for next person with reported poisoning; if no more persons with a poisoning, go to next section]
(11-91) [go to ERR_TFPOI3M]

ERR_TFPOI3M

Soft Edit:

[If TFPOI3M gt 10, display ERR_TFPOI3M]

* ^TFPOI3M is unusually high. Please verify.

(Suppress) [go to MFPOI3M]
(Close) [go to TFPOI3M for new entry]
(Go to) [go to TFPOI3M for new entry]

Question ID:FIJ.026_00.000

Instrument Variable Name: MFPOI3M
Question Text:

? [F1] Did [fill1: you /ALIAS] talk to or see a medical professional about [fill2: any of these poisonings/this poisoning/your poisoning or poisonings/his poisoning or poisonings/her poisoning or poisonings]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons with at least one or an unknown number of poisoning episodes during the past 3 months
Skip Instructions:

(1) [if TFPOI3M eq 1, fill "1" in MTFPOI3M and go to IPDATEM; else go to MTFPOI3M]
(2,DK,R) [go to TFPOI3M for next person with reported poisoning; if no more persons with a poisoning, go to next section]

Question ID:FIJ.028_00.000

Instrument Variable Name: MTFPOI3M
Question Text:

? [F1] Of [fill1: the ^TFPOI3M/all the] times that [fill2: you were/ALIAS was] poisoned, how many of those times was the poisoning serious enough that a medical professional was consulted?

01-91 1-91 times
97 Refused
99 Don't know

Universe Text All persons who consulted a medical professional for their poisoning episode(s)
Skip Instructions:

(01-91) [If MTFPOI3M gt TFPOI3M, go to ERR1_MTFPOI3M; else, go to IPDATEM]
(DK, R) [go to TFPOI3M for next person with reported poisoning; if no more persons with a
poisoning, go to next section]

If ((MTFPOI3M gt TFPOI3M) or (TFPOI3M eq DK and MTFPOI3M gt 3)), display ERR_MTFPOI3M]:

ERR1_MTFPOI3M

Hard Edit:

[If (MTFPOI3M gt TFPOI3M), display ERR1_MTFPOI3M]:

[^MTFPOI3M] is greater than the total number of times you said [you were/ALIAS was] poisoned, which is [^TFPOI3M]. For this question, we are asking about the number of times [you were/ALIAS was] poisoned and a medical professional was consulted. For example, if you were poisoned three different times but only sought medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical professional more than once about that poisoning event.

(Close) [go to MTFPOI3M for new entry]

(Go to) [go to TFPOI3M or MTFPOI3M for new entry]

ERR2_MTFPOI3M

Soft Edit:

[If TFPOI3M = 99 and MTFPOI3M gt 3), display ERR2_MTFINJ3M]:

* ^MTFINJ3M is an unusually high number.

For this question, we are asking about the number of times [you were/ALIAS was]
poisoned and a medical professional was consulted. For example, if you were poisoned three different times but only sought medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical professional more than once about that poisoning event.

Suppress
Go to
Close

Question ID:FIJ.050_01.000

Instrument Variable Name: IPDATEM
Question Text:

1 of 3 * Please hand the calendar card to the respondent. {if only 1 injury/poisoning episode for the person}
When did [fill1: your/ALIAS's] [fill2: injury/poisoning] happen for which a medical professional was consulted?
{first of multiple injury/poisoning episodes for the person} Now I'm going to ask a few questions about the [fill3: ^MTFINJ3M/^MTFPOI3M] times [fill4: you were/ALIAS was]
[fill5: injured/poisoned] for which a medical professional was consulted. Starting with the most recent time, when did this [fill2: injury/poisoning] happen?
{second plus of multiple injury/poisoning episodes for the person} You just told me about [fill1: your/ALIAS's] [fill6: (month, day of previous event)] [fill7:most recent/second most recent/third most recent/fourth most recent][fill2: injury/poisoning]. What was the date of the [fill2: injury/poisoning] before that for which a medical professional was consulted?
* Enter month.

01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know

Universe Text All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:

(1-12) [go to IPDATED]
(R) [go to IPHOW]
(D) [go to IPDATENO]

Question ID:FIJ.050_02.000

Instrument Variable Name: IPDATED
Question Text:

2 of 3 * Enter day.

01-31 1-31
97 Refused
99 Don't know

Universe Text All injury/poisoning episodes where a valid month of episode was entered
Skip Instructions:

(1-31) [go to IPDATEY]
(R) [go to IPHOW]
(D) [go to IPDATEMT]

ERR_IPDATED

Hard Edit:

[fill1: IPDATED] is not a valid day for [fill2: IPDATEM ].

(Close) [reset IPDATED for new entry]
(Go to) [reset IPDATED for new entry]

Question ID:FIJ.050_03.000

Instrument Variable Name: IPDATEY
Question Text:

3 of 3 * Enter year.

Year Year
9997 Refused
9999 Don't know

Universe Text All injury/poisoning episodes where a valid day of episode was entered
Skip Instructions:

if IPDATEM, IPDATED and IPDATEY result in a future date; goto ERR_IPDATEY; else, if IPDATEM, IPDATED and IPDATEY result in a date prior to the start date of the 91 day reference period, go to ERR1_IPDATEY; else, go to IPHOW

Hard Edit: ERR_IPDATEY

* Future date invalid.
* Please correct.

(Close) [reset IPDATED for new entry]
(Go to) [reset IPDATED for new entry]
ERR1_IPDATEY

Soft Edit:

* The reported date, [^IPDATEM(text)^IPDATED(numeric)^IPDATEY(4-digit year)], falls outside the reference period beginning [fill date used in FIJ.010].
*Please verify the date and make any corrections.

ERR2_IPDATEY
*The reported date, [^IPDATEM(text)^IPDATED(numeric)^IPDATEY(4-digit year)], falls outside the reference period beginning [fill date used in FIJ.010]. NOTE: The start of the reference period falls in the [beginning/middle/end] of [month used in FIJ.010].

*Please verify the date and make any corrections.
ERR3_IPDATEY

* The reported date, [^IPDATEM(text)^IPDATEY(4-digit year)], falls outside the reference period beginning [fill date used in FIJ.010].

*Please verify the date and make any corrections.

Question ID:FIJ.051_01.000

Instrument Variable Name: IPDATENO
Question Text:

1 of 2 Can you tell me approximately how long ago [fill1: your/ALIAS's] [fill2: injury/poisoning] happened?
*Enter number for time since event.

001-096 1-96
997 Refused
999 Don't know

Universe Text All injury/poisoning episodes where don't know was entered for month of episode
Skip Instructions:

(1-91) [go to IPDATETP]
(R,D) [go to IPHOW]

Question ID:FIJ.051_02.000

Instrument Variable Name: IPDATETP
Question Text:

2 of 2 *Enter number for time period since event.
^IPDATENO?

1 Days
2 Weeks
3 Months
7 Refused
9 Don't know

Universe Text All injury/poisoning episodes where don't know was entered for month of episode and 1-91 was entered for the "number" part of this two-part question
Skip Instructions:

go to IPHOW

Hard Edit: If IPDATENO GT 91 days (1) or IPDATENO GT 13 weeks (2) or
IPDATENO GT 4 months (3) then go to ERR_IPDATETP

ERR_IPDATETP
defaul blaise message for now "Out of range"

ERR1_IPDATETP

Soft Edit:

*The approximate date falls outside the reference period beginning [fill date used in FIJ.010].
*Please verify and make any corrections.

Question ID:FIJ.052_00.000

Instrument Variable Name: IPDATEMT
Question Text:

(book) F3 ? [F1] Was this in the beginning of [fill: ^IPDATEM (text)], the middle of [fill: ^IPDATEM (text)], or the end of [fill: ^IPDATEM (text)]?

1 Beginning
2 Middle
3 End
7 Refused
9 Don't know

Universe Text All injury/poisoning episodes where don't know was entered for day of episode
Skip Instructions:

go to IPHOW

Question ID:FIJ.060_00.000

Instrument Variable Name: IPHOW
Question Text:

? [F1] [fill1: How did [fill2: your/ALIAS's] [fill3: injury/poisoning] on [fill4: ^IPDATEM ^IPDATED (starting with most recent if multiple)] happen?/How did this [fill3: injury/poisoning] happen?] Please describe fully the circumstances or events leading to the [fill3: injury/poisoning], and any objects, substances, or other people involved.
* Enter the verbatim response, probing for as much detail as possible, including specifically what the person was doing at the time and all circumstances surrounding the event. Record all volunteered information.

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:

(verbatim) [if an injury episode, go to ICAUS; else, if a poisoning episode, go to PPCC]
(R) [if an injury episode, fill "R" in ICAUS and go to IJBODY; else, if a poisoning episode, go to PPCC]
(D) [if an injury episode, fill "D" in ICAUS and go to IJBODY; else, if a poisoning episode, go to PPCC]

Question ID:FIJ.065_00.000

Instrument Variable Name: ICAUS
Question Text:

? [F1]
* Do not read. * Enter the number which best describes the cause of the person's injury from the list below.

01 In a motor vehicle
02 On a bike, scooter, skateboard, skates, skis, horse, etc.
03 Pedestrian who was struck by a vehicle such as a car or bicycle
04 In a boat, train, or plane
05 Fall
06 Burned or scalded by substances such as hot objects or liquids, fire, or chemicals
07 Other
97 Refused
99 Don't know

Universe Text All injury episodes for which a medical professional was consulted and don't know or refused was not entered at IPHOW
Skip Instructions:

go to IJBODY

Question ID:FIJ.070_00.000

Instrument Variable Name: IJBODY
Question Text:

(book) F4 * Enter up to 4 responses, separate with commas.
* Ask or verify. In this injury, what parts of [fill: your/ALIAS's] body were hurt?

01 Ankle
02 Back
03 Buttocks
04 Chest
05 Ear
06 Elbow
07 Eye
08 Face
09 Finger/thumb
10 Foot
11 Forearm
12 Groin
13 Hand
14 Head (not face)
15 Hip
16 Jaw
17 Knee
18 Lower leg
19 Mouth
20 Neck
21 Nose
22 Shoulder
23 Stomach
24 Teeth
25 Thigh
26 Toe
27 Upper arm
28 Wrist
29 Other, specify
97 Refused
99 Don't know

Universe Text All injury episodes for which a medical professional was consulted
Skip Instructions:

(1-28) [go to IJTYPE1]
(29) [go to IJBODYOS]
(R,D) [go to IPEV]

Question ID:FIJ.071_00.000

Instrument Variable Name: IJBODYOS
Question Text:

*Read if necessary. What other parts of the body were hurt?

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text All injury episodes where some "other" part of the body was hurt
Skip Instructions:

go to IJTYPE1

Question ID:FIJ.072_00.000

Instrument Variable Name: IJTYPE1
Question Text:

(book) F5
*Enter up to 2 responses, separate with a comma.
* Ask or verify. In what way was [fill1: your/ALIAS's] [fill2: first entry--^IJBODY (text) or ^IJBODYOS] hurt?

01 Broken bone or fracture
02 Sprain, strain, or twist
03 Cut
04 Scrape
05 Bruise
06 Burn
07 Insect bite
08 Animal bite
09 Other, specify
97 Refused
99 Don't know

Universe Text All injury episodes where at least one part of the body was hurt
Skip Instructions:

(1-8,D) [go to IJTYPE2 for next body part entered at IJBODY; if no more body parts, go to IPEV]
(9) [go to IJTYP1OS]
(R) [go to IPEV]

Question ID:FIJ.073_00.000

Instrument Variable Name: IJTYP1OS
Question Text:

? [F1] * Read if necessary. How was [fill1: your/ALIAS's] [fill2: first entry -- ^IJBODY (text) or ^IJBODYOS] hurt?

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text All injury episodes where the first body part was hurt in some "other" way
Skip Instructions:

go to IJTYPE2 for next body part; if no more body parts, go to IPEV

Question ID:FIJ.074_00.000

Instrument Variable Name: IJTYPE2
Question Text:

(book) F5
*Enter up to 2 responses, separate with a comma.
* Ask or verify. In what way was [fill1: your/ALIAS's] [fill2: second entry--^IJBODY (text) or ^IJBODYOS] hurt?

01 Broken bone or fracture
02 Sprain, strain, or twist
03 Cut
04 Scrape
05 Bruise
06 Burn
07 Insect bite
08 Animal bite
09 Other, specify
97 Refused
99 Don't know

Universe Text All injury episodes where at least two body parts were hurt and the type of injury or don't know was entered for the first body part at IJTYPE1
Skip Instructions:

(1-8,D) [go to IJTYPE3 for next body part entered at IJBODY; if no more body parts, go to IPEV]
(9) [go to IJTYP2OS]
(R) [go to IPEV]

Question ID:FIJ.075_00.000

Instrument Variable Name: IJTYP2OS
Question Text:

* Read if necessary. How else was [fill1: your/ALIAS's] [fill2: second entry -- ^IJBODY (text) or ^IJBODYOS] hurt?

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text All injury episodes where the second body part was hurt in some "other" way
Skip Instructions:

go to IJTYPE3 for next body part; if no more body parts, go to IPEV

Question ID:FIJ.076_00.000

Instrument Variable Name: IJTYPE3
Question Text:

(book) F5
*Enter up to 2 responses, separate with a comma.
* Ask or verify. In what way was [fill1: your/ALIAS's] [fill2: third entry--^IJBODY (text) or ^IJBODYOS] hurt?

01 Broken bone or fracture
02 Sprain, strain, or twist
03 Cut
04 Scrape
05 Bruise
06 Burn
07 Insect bite
08 Animal bite
09 Other, specify
97 Refused
99 Don't know

Universe Text All injury episodes where at least three body parts were hurt and type of injury or don't know was entered for the second body part at IJTYPE2
Skip Instructions:

(1-8,D) [go to IJTYPE4 for next body part entered at IJBODY; if no more body parts, go to IPEV]
(9) [go to IJTYP3OS]
(R) [go to IPEV]

Question ID:FIJ.077_00.000

Instrument Variable Name: IJTYP3OS
Question Text:

* Read if necessary. How else was [fill1: your/ALIAS's] [fill2: third entry -- ^IJBODY (text) or ^IJBODYOS] hurt?

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text All injury episodes where the third body part was hurt in some "other" way
Skip Instructions:

go to IJTYPE4 for next body part; if no more body parts, go to IPEV

Question ID:FIJ.078_00.000

Instrument Variable Name: IJTYPE4
Question Text:

(book) F5
*Enter up to 2 responses, separate with a comma.
* Ask or verify. In what way was [fill1: your/ALIAS's] [fill2: fourth entry--^IJBODY (text) or ^IJBODYOS] hurt?

01 Broken bone or fracture
02 Sprain, strain, or twist
03 Cut
04 Scrape
05 Bruise
06 Burn
07 Insect bite
08 Animal bite
09 Other, specify
97 Refused
99 Don't know

Universe Text All injury episodes where four body parts were hurt and type of injury or don't know was entered for the third body part at IJTYPE3
Skip Instructions:

(1-8,R,D) [go to IPEV]
(9) [go to IJTYP4OS]

Question ID:FIJ.079_00.000

Instrument Variable Name: IJTYP4OS
Question Text:

* Read if necessary. How else was [fill1: your/ALIAS's] [fill2: fourth entry -- ^IJBODY (text) or ^IJBODYOS] hurt?

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text All injury episodes where the fourth body part was hurt in some "other" way
Skip Instructions:

if a poisoning episode, go to PPCC; else, go to IPEV

Question ID:FIJ.080_01.000

Instrument Variable Name: PPCC
Question Text:

Did [fill: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this poisoning from.. A phone call to a poison control center?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All poisoning episodes for which a medical professional was consulted
Skip Instructions:

(1,2,D) [go to IPEV]
(R) [go to IPHOSP]

Question ID:FIJ.080_02.000

Instrument Variable Name: IPEV
Question Text:

* Read lead-in if necessary. Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2: injury/poisoning]? An emergency vehicle, such as an ambulance or fire truck

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:

(1,2,D) [go to IPER]
(R) [go to IPHOSP]

Question ID:FIJ.080_03.000

Instrument Variable Name: IPER
Question Text:

* Read lead-in if necessary. Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2: injury/poisoning]? A visit to an emergency room

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:

(1,2,D) [go to IPDO]
(R) [go to IPHOSP]

Question ID:FIJ.080_04.000

Instrument Variable Name: IPDO
Question Text:

? [F1]
* Read lead-in if necessary. Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2: injury/poisoning]? A visit to a doctor's office or other health clinic

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:

(1,2,D) [go to IPPCHCP]
(R) [go to IPHOSP]

Question ID:FIJ.080_05.000

Instrument Variable Name: IPPCHCP
Question Text:

? [F1]
* Read lead-in if necessary. Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2: injury/poisoning]? A phone call to a doctor, nurse, or other health care professional

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:

(1,2,D) [go to IPOTH]
(R) [go to IPHOSP]

Question ID:FIJ.080_06.000

Instrument Variable Name: IPOTH
Question Text:

* Read lead-in if necessary. Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2: injury/poisoning]? Any place else?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:

(1) [go to IPOTHOS] if [MTFINJ3M= 01-91 and IPEV=2] go to IPVER
(2) [if poisoning and episode and PPCC eq 2 and IPEV eq 2 and IPER eq 2 and IPDO eq 2 and IPPCHCP eq 2, go to IPVER; else if an injury episode and IPEV eq 2 and IPER eq 2 and IPDO eq 2 and IPPCHCP eq 2, goto IPVER; else go to IPHOSP]
(R,D) [go to IPHOSP]

Question ID:FIJ.081_00.000

Instrument Variable Name: IPOTHOS
Question Text:

* Read lead-in if necessary. Where else did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2: injury/poisoning]?

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text All injury/poisoning episodes where medical advice, treatment, or follow-up care was received from some "other" place
Skip Instructions:

go to IPHOSP

Question ID:FIJ.082_00.000

Instrument Variable Name: IPVER
Question Text:

* Please verify. [fill1: You/ALIAS] DID NOT receive any medical advice, treatment, or follow-up for this [fill2: injury/poisoning]. Is that correct?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All injury/poisoning episodes for which a medical professional was consulted, but no source of medical advice, treatment, or follow-up care was selected
Skip Instructions:

(1) [If the subject HAS more injury/poisoning episodes, then go to FIJ.050_1for that subject. If the subject DOES NOT HAVE more injury/poisoning episodes, then go to FIJ.014/FIJ.024 for next person with an injury/poisoning. If no more family members with an injury/poisoning, go to next section.]
(2) [if poisoning, go to PPCC for new entries; else if injury, go to IPEV for new entries]

Hard Edit: ERR_IPVER

Question ID:FIJ.090_00.000

Instrument Variable Name: IPHOSP
Question Text:

? [F1]
[fill1: Were you/Was ALIAS] hospitalized for at least one night as a result of this [fill2: injury/poisoning]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:

(1) [go to IPIHNO]
(2,R,D) [if an injury episode, go to IMTRAF; if a poisoning episode, go to PPOIS]

Question ID:FIJ.091_00.000

Instrument Variable Name: IPIHNO
Question Text:

? [F1]
How many nights [fill: were you/was ALIAS] in the hospital?
* If still in hospital, ask how many nights up to today.
* Enter '95' for 95 or more nights.

01-94 1-94 nights
95 95+ nights
97 Refused
99 Don't know

Universe Text All injury/poisoning episodes for which a medical professional was consulted and resulted in hospitalization
Skip Instructions:

(1-60,R,D) [if ICAUS eq 1-3, go to IMTRAF; else, if ICAUS eq 4-7,R,D, go to IPWHAT; else, if ICAUS eq 5, go to IFALL; if a poisoning episode, go to PPOIS]
(61-95) [go to ERR_IPIHNO]

Soft Edit: [if IPIHNO gt 60, display ERR_IPIHNO]
* ^IPIHNO is unusually high. Please verify.

Suppress
Go to
Close

(Supress) [if ICAUS eq 01 or 02 or 03, go to IMTRAF]
if ICAUS eq 04 or 06 or 07 or 97, or 99, go to IPWHAT]
if ICAUS eq 05, go to IFALL]]
(Close, Go to) [reset IPIHNO for new entry]

Question ID:FIJ.109_00.000

Instrument Variable Name: IMTRAF
Question Text:

? [F1]
* Ask or verify. Did this accident occur on a public highway, street, or road?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All medically-consulted injury episodes that occurred while in a motor vehicle; on a bike, scooter, skateboard, skates, skis, horse, etc.; or as a pedestrian who was struck by a vehicle such as a car or bicycle
Skip Instructions:

go to IMVWHO

Question ID:FIJ.110_00.000

Instrument Variable Name: IMVWHO
Question Text:

*Read all categories.
* Ask or verify. [fill: Were you/Was ALIAS] injured as:
* Read answer categories.

1 The driver of a motor vehicle
2 A passenger in a motor vehicle
3 A pedestrian
4 A bicycle rider or tricycle rider
5 The rider of a scooter, skateboard, skates, or other non-motorized vehicle
7 Refused
9 Don't know

(1,2) [go to IMVTYP]
(4,5) [go to IHELMT]
(3,R,D0 [go to IPWHAT]

Question ID:FIJ.111_00.000

Instrument Variable Name: IMVTYP
Question Text:

(book) F6 ? [F1]
* Ask or verify. What type of vehicle [fill: were you/was ALIAS] in?

01 Passenger car
02 Passenger truck, such as a pickup truck, van, or SUV
03 Bus
04 Large commercial truck, such as a semi-truck, big rig, or 18 wheeler
05 Motorcycle (including mopeds and minibikes)
06 All terrain vehicle or ski/snow-mobile
07 Farm equipment (such as a tractor)
08 Industrial or construction vehicle
09 Other
97 Refused
99 Don't know

Universe Text All medically-consulted injury episodes that occurred while a driver or passenger of a vehicle
Skip Instructions:

(1,2,4) [go to ISBELT]
(5,6) [go to IHELMT]
(3,7,8,9,R,D) [go to IPWHAT]

Question ID:FIJ.112_00.000

Instrument Variable Name: ISBELT
Question Text:

? [F1]
* Ask or verify. [fill: Were you/Was ALIAS] restrained at the time of the accident?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All medically-consulted injury episodes that occurred while a driver or passenger of a car or truck
Skip Instructions:

go to IPWHAT

Question ID:FIJ.113_00.000

Instrument Variable Name: IHELMT
Question Text:

? [F1]
* Ask or verify. [fill: Were you/Was ALIAS] wearing a helmet at the time of the accident?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All medically-consulted injury episodes that occurred while riding a bicycle, tricycle, scooter, skateboard, skates, or other nonmotorized vehicle; a motorcycle; or an all terrain vehicle or ski/snow-mobile
Skip Instructions:

go to IPWHAT

Question ID:FIJ.130_00.000

Instrument Variable Name: IFALL
Question Text:

(book) F7 * Enter up to 2 responses, separate with a comma.
* Ask or verify. How did [fill: you/ALIAS] fall? Anything else?

01 Stairs, steps, or escalator
02 Floor or level ground
03 Curb (including sidewalk)
04 Ladder or scaffolding
05 Playground equipment
06 Sports field, court, or rink
07 Building or other structure
08 Chair, bed, sofa, or other furniture
09 Bathtub, shower, toilet, or commode
10 Hole or other opening
11 Other
97 Refused
99 Don't know

Universe Text All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:

go to IFALLWHY

Question ID:FIJ.131_00.000

Instrument Variable Name: IFALLWHY
Question Text:

(book) F8
* Ask or verify. What caused [fill: you/ALIAS] to fall?

1 Slipping or tripping
2 Jumping or diving
3 Bumping into an object or another person
4 Being shoved or pushed by another person
5 Losing balance or having dizziness (becoming faint or having a seizure)
6 Other
7 Refused
9 Don't know

Universe Text All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:

go to IPWHAT

Question ID:FIJ.140_00.000

Instrument Variable Name: PPOIS
Question Text:

(book) F9 ? [F1]
* Ask or verify. What did [fill: your/ALIAS's] poisoning result from?

1 Swallowing a drug or medical substance mistakenly or in overdose
2 Swallowing or touching a harmful solid or liquid substance
3 Inhaling harmful gases or vapors
4 Eating a poisonous plant or other substance mistaken for food
5 Being bitten by a poisonous animal
6 Other, please specify
7 Refused
9 Don't know

Universe Text All poisoning episodes for which a medical professional was consulted
Skip Instructions:

(1-5,R,D) [go to IPWHAT]
(6) [go to PPOISOS]

Question ID:FIJ.141_00.000

Instrument Variable Name: PPOISOS
Question Text:

* Read if necessary. How did [fill: your/ALIAS's] poisoning occur?

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text All medically-consulted poisoning episodes where the poisoning resulted from some "other" reason
Skip Instructions:

go to IPWHAT

Question ID:FIJ.150_00.000

Instrument Variable Name: IPWHAT
Question Text:

(book) F10 ? [F1]
* Enter up to 2 responses, separate with a comma.
* Ask or verify. What activity [fill1: were you/was ALIAS] involved in at the time of the [fill2: injury/poisoning]?

01 Driving or riding in a motor vehicle
02 Working at a paid job
03 Working around the house or yard
04 Attending school
05 Unpaid work (such as volunteer work)
06 Sports and exercise
07 Leisure activity (excluding sports)
08 Sleeping, resting, eating, or drinking
09 Cooking
10 Being cared for (hands-on care from other person)
11 Other, please specify
97 Refused
99 Don't know

Universe Text All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:

(1-10,R,D) [go to IPWHER]
(11) [go to IPWHATOT]

Question ID:FIJ.151_00.000

Instrument Variable Name: IPWHATOT
Question Text:

* Read if necessary.
What other activity [fill1: were you/was ALIAS] involved in at the time of the [fill2: injury/poisoning]?

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text All medically-consulted injury/poisoning episodes that occurred in some "other" place
Skip Instructions:

go to IPWHER

Question ID:FIJ.160_00.000

Instrument Variable Name: IPWHER
Question Text:

(book) F11 ? [F1] * Enter up to 2 responses, separate with a comma.
* Ask or verify. Where [fill1: were you/was ALIAS] when the [fill2: injury/poisoning] happened?

01 Home (inside)
02 Home (outside)
03 School (not residential)
04 Child care center or preschool
05 Residential institution (excluding hospital)
06 Health care facility (including hospital)
07 Street or highway
08 Sidewalk
09 Parking lot
10 Sport facility, athletic field, or playground
11 Shopping center, restaurant, store, bank, gas station, or other place of business
12 Farm
13 Park or recreation area (include bike or jog path)
14 River, lake, stream, or ocean
15 Industrial or construction area
16 Other public building
17 Other
97 Refused
99 Don't know

Universe Text All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:

(01-17,R,DK) [If AGE lt 5 and person HAS more injury/poisoning episodes, go to IPDATEM for that person; else if AGE lt 5 and person DOES NOT HAVE more injury/poisoning episodes, go to TFINJ3M/TFPOI3M for next person with an injury/poisoning; else if AGE lt 5 and no more family members with an injury/poisoning, go to FPOI3M/next section; Else [if AGE ge 13, go to IPEMP; else if AGE ge 5 and AGE le 12, go to IPSTU]

Question ID:FIJ.170_00.000

Instrument Variable Name: IPEMP
Question Text:

? [F1] At the time of this [fill1: injury/poisoning], [fill2: were you/was ALIAS] employed full-time, part-time, or not employed?

1 Full-time
2 Part-time
3 Not employed
7 Refused
9 Don't know

Universe Text All medically-consulted injury/poisoning episodes for persons 13 years of age or older
Skip Instructions:

(1,2) [go to IPWKLS]
(3,R,D) [go to IPSTU]

Question ID:FIJ.171_00.000

Instrument Variable Name: IPWKLS
Question Text:

As a result of this [fill1: injury/poisoning], how many days of work did [fill2: you/ALIAS] miss?

1 None
2 Less than one day
3 One to five days
4 Six or more days
7 Refused
9 Don't know

Universe Text All medically-consulted injury/poisoning episodes for persons 13 years of age or older who were employed at the time of the episode
Skip Instructions:

go to IPSTU

Question ID:FIJ.180_00.000

Instrument Variable Name: IPSTU
Question Text:

At the time of this [fill1: injury/poisoning], [fill2: were you/was ALIAS] a full-time student, part-time student or not a student?

1 Full-time
2 Part-time
3 Not a student
7 Refused
9 Don't know

Universe Text All medically-consulted injury/poisoning episodes for persons 5 years of age or older
Skip Instructions:

(1,2) [go to IPSCLS]
(3,R,DK) [If person HAS more injury/poisoning episodes, go to IPDATEM for that person; else if person DOES NOT HAVE more injury/poisoning episodes, go to TFINJ3M/TFPOI3M for next person with an injury/poisoning; else if no more family members with an injury/poisoning, go to next section]

Question ID:FIJ.181_00.000

Instrument Variable Name: IPSCLS
Question Text:

As a result of this [fill1: injury/poisoning], how many days of school did [fill2: you/ALIAS] miss?

1 None
2 Less than one day
3 One to five days
4 Six or more days
7 Refused
9 Don't know

Universe Text All medically-consulted injury/poisoning episodes for persons 5 years of age or older who were students at the time of the episode
Skip Instructions:

(1-4,R,DK) [If person HAS more injury/poisoning episodes, go to IPDATEM for that person; else if person DOES NOT HAVE more injury/poisoning episodes, go to TFINJ3M/TFPOI3M for next person with an injury/poisoning; else if no more family members with an injury/poisoning, go to next section]

Question ID:FAU.010_00.000

Instrument Variable Name: FDMED12M
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

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

Question ID:FAU.020_00.000

Instrument Variable Name: PDMED12M
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

go to FNMED12M

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

Question ID:FAU.030_00.000

Instrument Variable Name: FNMED12M
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe TextAll families
Skip Instructions:

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

Question ID:FAU.040_00.000

Instrument Variable Name:PNMED12M
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

go to FHOSPYR

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

Question ID:FAU.050_00.000

Instrument Variable Name: FHOSPYR
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

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

Question ID:FAU.060_00.000

Instrument Variable Name: PHOSPYR
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

go to 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.

Question ID:FAU.070_00.000

Instrument Variable Name: HOSPNO
Question Text:

? [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) [go to HPNITE]
(11-365) [go to ERR_HOSPNO]
(R,D) [go to HPNITE]

Soft Edit: ERR_HOSPNO

* [fill: HOSPNO] is unusually high.
* Verify entry.
* Make corrections if necessary.

Question ID:FAU.110_00.000

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) [go to next person selected at PHOSPYR; if no more persons, go to FHCM2W]
(51-365) [go to ERR1_HPNITE]

if HOSPNO gt HPNITE, goto ERR2_HPNITE

Soft Edit: ERR1_HPNITE

* [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

Question ID:FAU.120_00.000

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 go to PHCHMN2W; else, go to PHCHM2W]
(2,R,D) [go to FHCPH2W]

Question ID:FAU.130_00.000

Instrument Variable Name: PHCHM2W
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

go to 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.

Question ID:FAU.140_00.000

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

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

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

Soft Edit: ERR_PHCHMN2W

* [fill: PHCHMN2W] is unusually high.
* Verify entry.
* DO NOT PROBE. Make corrections if necessary.

Question ID:FAU.150_00.000

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 go to PHCPHN2W; else, go to PHCPH2W]
(2,R,D) [go to FHCDV2W]

Question ID:FAU.160_00.000

Instrument Variable Name: PHCPH2W
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

go to 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.

Question ID:FAU.170_00.000

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 1-50 calls
97 Refused
99 Don't know

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

(1-14,R,D) [repeat for all eligible persons, then go to FHCDV2W]
(15-50) [go to 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.

Question ID:FAU.180_00.000

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 go to PHCDVN2W; else, go to PHCDV2W]
(2,R,D) [go to F10DVYR]

Question ID:FAU.190_00.000

Instrument Variable Name: PHCDV2W
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

go to 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.

Question ID:FAU.200_00.000

Instrument Variable Name: PHCDVN2W
Question Text:

How many times did [fill: you/ Alias] visit a doctor or other health care professional DURING 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 go to F10DVYR]
(15-50) [go to ERR_PHCDVN2W]

Soft Edit: ERR_PHCDVN2W

* [fill: PHCDVN2W] is unusually high.
* Verify that all visits were within the two week reference period.
* Make corrections if necessary.

Question ID:FAU.210_00.000

Instrument Variable Name: F10DVYR
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

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

Question ID:FAU.220_00.000

Instrument Variable Name: P10DVYR
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

go to 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.

Question ID:FHI.050_00.000

Instrument Variable Name: FHICOV
Question Text:

(book) F12 and (book) F14 The next questions are about health insurance. Include health insurance obtained through employment or purchased directly as well as government programs like Medicare and Medicaid that provide Medical care or help pay medical bills. [fill: Are you/Is anyone in the family] covered by any kind of health insurance or some other kind of health care plan?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

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

Question ID:FHI.070_00.000

Instrument Variable Name: HIKIND
Question Text:

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

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

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

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

Hard Edit: ERR_HIKIND:

* Cannot mark "No coverage of any kind" and another type.
* Please correct.

Question ID:FHI.072_00.000

Instrument Variable Name: MCAREPRB
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

if HIKIND ne 10, g oto SINCOV; else, go to HICHANGE

Question ID:FHI.073_00.000

Instrument Variable Name: MCAIDPRB
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

go to SINCOV

Question ID:FHI.074_00.000

Instrument Variable Name: SINCOV
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

go to HICHANGE

Question ID:FHI.075_00.000

Instrument Variable Name: HICHANGE
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons
Skip Instructions:

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

Hard Edit: ERR_HICHANGE

*Press enter to go back to HIKIND and update coverage.

Question ID:FHI.090_00.000

Instrument Variable Name: MCPART
Question Text:

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

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

Universe Text All persons with Medicare
Skip Instructions:

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

Question ID:FHI.092_00.000

Instrument Variable Name: MCCARD
Question Text:

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

1 Yes
2 No

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

if MCPART = 1, go to MCPARTD; else, g oto MCCHOICE

Question ID:FHI.095_00.000

Instrument Variable Name: MCCHOICE
Question Text:

? [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:

go to MCHMO

Question ID:FHI.100_00.000

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, go to MCANAME; else if MCCHOICE=2,R,D, go to MCREF]

Question ID:FHI.112_00.000

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 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) go to MCPREM

Question ID:FHI.113_00.000

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) go to MCREF

Question ID:FHI.114_00.000

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) go to MCPARTD

Question ID:FHI.118_00.000

Instrument Variable Name: MCPARTD
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons with Medicare
Skip Instructions:

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

Question ID:FHI.120_00.000

Instrument Variable Name: MACHMD
Question Text:

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

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

Universe Text All persons with Medicaid
Skip Instructions:

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

Question ID:FHI.130_00.000

Instrument Variable Name: MACHMD1
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

go to MANAM

Question ID:FHI.131_00.000

Instrument Variable Name: MACHMD2
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

go to MANAM

Question ID:FHI.132_00.000

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:

go to MAPCMD

Question ID:FHI.140_00.000

Instrument Variable Name: MAPCMD
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons with Medicaid
Skip Instructions:

go to MAREF

Question ID:FHI.150_00.000

Instrument Variable Name: MAREF
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons with Medicaid
Skip Instructions:

go to MACHMD for the next person with Medicaid; else, go to SSTYPE2

Question ID:FHI.156_00.000

Instrument Variable Name: SSTYPE2
Question Text:

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

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

Universe Text All persons with single service plans
Skip Instructions:

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

Question ID:FHI.157_00.000

Instrument Variable Name: SSOTHER
Question Text:

* Other type of single-service plan

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Question ID:FHI.158_00.000

Instrument Variable Name: FHICCI6
Question Text:

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

1 Continue

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

go to HIPNAM1

Question ID:FHI.160_00.000

Instrument Variable Name: HIPNAM1
Question Text:

It is important that we record the complete and accurate name of each health insurance plan. What is the COMPLETE name of the first plan? Do NOT include plans that only provide extra cash while in the hospital or plans that pay for only one type of service, such as nursing home care, accidents, or dental care.
* Read if necessary: Do you have your health plan card or something with the plan name on it?

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Question ID:FHI.160_01.000

Instrument Variable Name: PCARD1
Question Text:

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

1 Yes
2 No

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

go to HIPNAM1B

Question ID:FHI.170_00.000

Instrument Variable Name: HIPNAM1B
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

(R,D) [if HIPNAM1= R or D, go to STNAME]
go to MORPLAN

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

Question ID:FHI.171_00.000

Instrument Variable Name: MORPLAN
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

Skip Instructions:

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

Question ID:FHI.172_00.000

Instrument Variable Name: HIPNAM2
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Question ID:FHI.172_01.000

Instrument Variable Name: PCARD2
Question Text:

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

1 Yes
2 No

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

go to HIPNAM2B

Question ID:FHI.173_00.000

Instrument Variable Name: HIPNAM2B
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHI.174_00.000

Instrument Variable Name: MORPLAN2
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

(1) [go to 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, go to HIVER1; else, go to FHICCI8]

Question ID:FHI.175_00.000

Instrument Variable Name: HIPNAM3
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Question ID:FHI.175_01.000

Instrument Variable Name: PCARD3
Question Text:

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

1 Yes
2 No

Universe Text All private health insurance plans where the plan name was entered at HIPNAM3
Skip Instructions:

go to HIPNAM3B

Question ID:FHI.176_00.000

Instrument Variable Name: HIPNAM3B
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHI.177_00.000

Instrument Variable Name: MORPLAN3
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

(1) [go to 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, go to HIVER1; else, go to FHICCI8]

Question ID:FHI.178_00.000

Instrument Variable Name: HIPNAM4
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Question ID:FHI.178_01.000

Instrument Variable Name: PCARD4
Question Text:

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

1 Yes
2 No

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

go to HIPNAM4B

Question ID:FHI.179_00.000

Instrument Variable Name: HIPNAM4B
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHI.180_00.000

Instrument Variable Name: HIVER1
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

(1) [ go to HIVER2]
(2,R,D) [go to ERR_HIVER1]
Hard Edit: ERR_HIVER1

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

Question ID:FHI.190_00.000

Instrument Variable Name: HIVER2
Question Text:

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

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

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

(1-4) [update responses for HIPNAM1B/HIPNAM2B/HIPNAM3B/HIPNAM4B and go to FHICCI8]
(5) [if 4 plans were reported, ignore this 5th plan and go to FHICCI8; else, go to HIPNAM2, or HIPNAM3, or HIPNAM4 accordingly to enter information on this plan]
(R,D) [go to FHICCI8]

Question ID:FHI.195_01.000

Instrument Variable Name: FHICCI8
Question Text:

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

1 Continue

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

go to 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.

Question ID:FHI.200_01.000

Instrument Variable Name: FHI200
Question Text:

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

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

Universe Text All private health insurance plans
Skip Instructions:

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

Question ID:FHI.202_01.010

Instrument Variable Name: PRPOLH
Question Text:

How [fill1:are you/is ALIAS] related to the policyholder for [fill2: plan1/plan2/plan3/plan4]?
*Read if Necessary? [fill3:You are/ALIAS is} the policyholder's?

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

Universe Text All persons on each plan where the policyholder is outside of the family roster
Skip Instructions:

(1-4,R,D) [go to PLNWRK]

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

Question ID:FHI.204_01.010

Instrument Variable Name: PRCOOH
Question Text:

Does this plan cover anyone who does not live here?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All private health insurance plans with policyholder on family roster
Skip Instructions:

(1) [go to PRCTOH]
(2,R,D) [go to PLNWRK]

Question ID:FHI.205_01.010

Instrument Variable Name: PRCTOH
Question Text:

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

01-30 1-30 persons
97 Refused
99 Don't know

Universe Text All private health insurance plans with policyholder on family roster that cover someone outside the family roster
Skip Instructions:

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

Question ID:FHI.206_10.010

Instrument Variable Name: PRRELOH
Question Text:

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

Universe Text All private health insurance plans with policyholder on family roster that cover someone outside the family roster
Skip Instructions:

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

Question ID:FHI.207_01.010

Instrument Variable Name: PRCNUM
Question Text:

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 1-10 children
97 Refused
99 Don't know

Universe Text All private health insurance plans with policyholder on family roster that cover a child or children not on the roster
Skip Instructions:

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

Hard Edit: if PRCNUM GT PRCTOH

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

Question ID:FHI.208_01.010

Instrument Variable Name: PRAGEOH
Question Text:

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

000-100 0-100 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
Skip Instructions:

(000-100,R,D)if [AGE GTE 50 years go to ERR1_PRAGEOH] else if PRCNUM GE 2 [go to PRAGEOH up to 9 more times] else [go to PLNWRK]

Soft Edit: If AGE GTE 50 years

*Respondent said the child is [fill: PRAGEOH] years old. Please verify.

Question ID:FHI.210_01.000

Instrument Variable Name: PLNWRK
Question Text:

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

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

Universe Text All private health insurance plans
Skip Instructions:

(1-6,R,D) [go to PLNPAY]
(7) [go to PLNWKSP]

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

Question ID:FHI.211_01.000

Instrument Variable Name: PLNWKSP
Question Text:

*Read if necessary. How was this plan obtained?

Verbatim Verbatim response
7 Refused
9 Don't know

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

go to PLNPAY

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

Question ID:FHI.220_10.000

Instrument Variable Name: PLNPAY
Question Text:

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

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

Universe Text All private health insurance plans
Skip Instructions:

(1) [go to HICOSTN]
(2) [go to EMPPAY]
(3-7,D,R) [go to 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.

Question ID:FHI.230_11.000

Instrument Variable Name: HICOSTN
Question Text:

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

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

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

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

Question ID:FHI.230_12.000

Instrument Variable Name: HICOSTT
Question Text:

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

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

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

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

Question ID:FHI.235_01.010

Instrument Variable Name: EMPPAY
Question Text:

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

Universe Text All private health insurance plans paid for by employer or union
Skip Instructions:

(1) [go to EMPCOSTN]
(2,R,D) [go to PLNMGD]

Question ID:FHI.237_01.010

Instrument Variable Name: EMPCOSTN
Question Text:

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

Universe Text All private health insurance plans where amount of premium employer/union pays is known
Skip Instructions:

(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.

Question ID:FHI.237_02.020

Instrument Variable Name: EMPCOSTT
Question Text:

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

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

go to PLNMGD

Question ID:FHI.237_02.030

Instrument Variable Name: EMPCOSTP
Question Text:

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

001-100 1-100 percent
997 Refused
999 Don't know

Universe Text All private health insurance plans paid for by employer or union where respondent wanted to report percentage of premium paid
Skip Instructions:

(1-100,R,D) [go to PLNMGD]

Question ID:FHI.240_01.000

Instrument Variable Name: PLNMGD
Question Text:

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

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

Universe Text All private health insurance plans
Skip Instructions:

go to HDHP

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

Question ID:FHI.241_01.000

Instrument Variable Name: HDHP
Question Text:

?[F1] [If only one person covered by this plan:] Is the annual deductible for medical care for this plan less than $1,200 or $1,200 or more? If there is a separate deductle 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

Universe Text All private health insurance plans
Skip Instructions:

1,R,D [go to MGCHMD]
2 [go to 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.

Question ID:FHI.242_01.000

Instrument Variable Name: HSAHRA
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All high deductible private health plans
Skip Instructions:

1,2,R,D [go to MGCHMD]

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

Question ID:FHI.243_01.000

Instrument Variable Name: MGCHMD
Question Text:

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

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

Universe Text All private health insurance plans
Skip Instructions:

(1) [go to MGPRMD]
(2) [go to MGPYMD]
(R,D) [go to MGPREF]

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

Question ID:FHI.244_01.000

Instrument Variable Name: MGPRMD
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

go to MGPREF

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

Question ID:FHI.246_01.000

Instrument Variable Name: MGPYMD
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHI.248_01.000

Instrument Variable Name: MGPREF
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All private health insurance plans
Skip Instructions:

go to PCPREQ

Question ID:FHI.248_05.000

Instrument Variable Name: PCPREQ
Question Text:

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

Universe Text Asked of all private health insurance plans
Skip Instructions:

(1,2,R,D) [go to PRRXCOV]

Question ID:FHI.249_01.010

Instrument Variable Name: PRRXCOV
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All private health insurance plans
Skip Instructions:

go to 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.

Question ID:FHI.249_02.010

Instrument Variable Name: PRDNCOV
Question Text:

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

Universe Text All private health insurance plans
Skip Instructions:

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

Question ID:FHI.249_03.000

Instrument Variable Name: FCOVCONF
Question Text:

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

Universe Text All families with an employer-based health plan
Skip Instructions:

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

Question ID:FHI.250_00.000

Instrument Variable Name: STNAME1
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text All persons with SCHIP
Skip Instructions:

go to STDOC1

Question ID:FHI.251_00.000

Instrument Variable Name: STDOC1
Question Text:

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

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

Universe Text All persons with SCHIP
Skip Instructions:

go to STPCMD1

Question ID:FHI.252_00.000

Instrument Variable Name: STPCMD1
Question Text:

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons with SCHIP
Skip Instructions:

go to STREF1

Question ID:FHI.253_00.000

Instrument Variable Name: STREF1
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons with SCHIP
Skip Instructions:

go to STNAME1 for the next person with SCHIP; else, go to STNAME2

Question ID:FHI.257_00.000

Instrument Variable Name: STNAME2
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

go to STDOC2

Question ID:FHI.258_00.000

Instrument Variable Name: STDOC2
Question Text:

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

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

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

go to STPCMD2

Question ID:FHI.259_00.000

Instrument Variable Name: STPCMD2
Question Text:

1 Yes
2 No
7 Refused
9 Don't know

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

go to STREF2

Question ID:FHI.260_00.000

Instrument Variable Name: STREF2
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHI.264_00.000

Instrument Variable Name: STNAME3
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

go to STDOC3

Question ID:FHI.265_00.000

Instrument Variable Name: STDOC3
Question Text:

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

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

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

go to STPCMD3

Question ID:FHI.266_00.000

Instrument Variable Name: STPCMD3
Question Text:

1 Yes
2 No
7 Refused
9 Don't know

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

go to STREF3

Question ID:FHI.267_00.000

Instrument Variable Name: STREF3
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHI.270_00.000

Instrument Variable Name: MILSPC
Question Text:

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

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

Universe Text All persons with military health care
Skip Instructions:

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

Question ID:FHI.271_00.000

Instrument Variable Name: MILSPCOT
Question Text:

* Other military coverage

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Question ID:FHI.275_00.000

Instrument Variable Name: MILMAN
Question Text:

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

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

Universe Text All persons with TRICARE coverage
Skip Instructions:

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

Question ID:FHI.276_00.000

Instrument Variable Name: MILMANOT
Question Text:

* Other type of TRICARE coverage

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Question ID:FHI.280_00.000

Instrument Variable Name: HILAST
Question Text:

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

1 6 months or less
2 More than 6 months, but not more than 1 year ago
3 More than 1 year, but not more than 3 years ago
4 More than 3 years
5 Never
7 Refused
9 Don't know

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

go to HISTOP

Question ID:FHI.290_00.000

Instrument Variable Name: HISTOP
Question Text:

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

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

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

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

Question ID:FHI.291_00.000

Instrument Variable Name: HISTOPOT
Question Text:

? [F1] * Other reason for not having coverage

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Question ID:FHI.300_00.000

Instrument Variable Name: HINOTYR
Question Text:

In the PAST 12 MONTHS, was there any time when [fill: you/ALIAS] did NOT have ANY health insurance or coverage?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons with known health insurance coverage except single service plans
Skip Instructions:

(1) [go to HINOTMYR]
(2,R,D) [go to FHICHNG]

Question ID:FHI.310_00.000

Instrument Variable Name: HINOTMYR
Question Text:

In the PAST 12 MONTHS, about how many months [fill: were you/was ALIAS] without coverage?
* If less than 1 month, enter '1'.

01-12 1-12 months
97 Refused
99 Don't know

Universe Text All persons with known health insurance coverage, but did not have health insurance for some period of time in the past 12 months
Skip Instructions:

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

Question ID:FHI.312_00.010

Instrument Variable Name: FHICHNG
Question Text:

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

Universe Text All persons who are currently insured who were continuously covered in the past year
Skip Instructions:

(1,R,D) [go to HCSPFYR]
(2) [go to FHIKDB]

Question ID:FHI.315_00.010

Instrument Variable Name: FHIKDB
Question Text:

(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.

Universe Text All persons except those with continuous coverage who are currently uninsured for more than 1 year with no
changes
Skip Instructions:

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

Question ID:FHI.316_00.010

Instrument Variable Name: PWRKB
Question Text:

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

Universe Text All persons who had private health insurance previously
Skip Instructions:

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

Question ID:FHI.317_00.010

Instrument Variable Name: PWRKBSP
Question Text:

*Enter how private health insurance was obtained.

7 Refused
9 Don't know
Verbatim Verbatim response

Universe Text All persons who had private health insurance obtained from other source previously
Skip Instructions:

(Allow 75 characters) [go to HCSPFYR]

Question ID:FHI.320_00.000

Instrument Variable Name: HCSPFYR
Question Text:

(book) F19 The next question is about money that [fill1: you have/your family has] spent out of pocket on medical care. We do NOT want you to count health insurance premiums, over the counter drugs, or costs that you will be reimbursed for. In the PAST 12 MONTHS, about how much did [fill2: you/your family] spend for medical care and dental care?

0 Zero
1 Less than $500
2 $500 - $1,999
3 $2,000 - $2,999
4 $3,000 - $4,999
5 $5,000 or more
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

go to MEDBILL

Question ID:FHI.325_00.010

Instrument Variable Name: MEDBILL
Question Text:

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

Universe Text All families
Skip Instructions:

(1,2,7,9) [go to MEDBPAY]

Question ID:FHI.327_00.010

Instrument Variable Name: MEDBPAY
Question Text:

[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

Universe Text All families
Skip Instructions:

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

Question ID:FHI.327_00.020

Instrument Variable Name: MEDBNOP
Question Text:

[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

Universe Text All families but those who said they don't have problems paying their medical bills
Skip Instructions:

(1,2,7,9) [go to FSA]

Question ID:FHI.330_00.000

Instrument Variable Name: FSA
Question Text:

[fill 1: Do you/Does anyone in your family] have a Flexible Spending Account for health expenses? These accounts are offered by some employers to allow employees to set aside pre-tax dollars of their own money for their use throughout the year to reimburse themselves for their out-of-pocket expenses for health care. With this type of account, any money remaining in the account at the end of the year, following a short grace period, is lost to the employee.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All Families
Skip Instructions:

go to PLBORN

Question ID:FSD.001_00.000

Instrument Variable Name: PLBORN
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons
Skip Instructions:

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

Question ID:FSD.002_00.000

Instrument Variable Name: PLBORN1
Question Text:

In what state [fill: were you/was ALIAS] born?

01 Alabama
02 Alaska
03 Arizona
04 Arkansas
05 California
06 Colorado
07 Connecticut
08 Delaware
09 District of Columbia
10 Florida
11 Georgia
12 Hawaii
13 Idaho
14 Illinois
15 Indiana
16 Iowa
17 Kansas
18 Kentucky
19 Louisiana
20 Maine
21 Maryland
22 Massachusetts
23 Michigan
24 Minnesota
25 Mississippi
26 Missouri
27 Montana
28 Nebraska
29 Nevada
30 New Hampshire
31 New Jersey
32 New Mexico
33 New York
34 North Carolina
35 North Dakota
36 Ohio
37 Oklahoma
38 Oregon
39 Pennsylvania
40 Rhode Island
41 South Carolina
42 South Dakota
43 Tennessee
44 Texas
45 Utah
46 Vermont
47 Virginia
48 Washington
49 West Virginia
50 Wisconsin
51 Wyoming
57 United States (state unknown)

Universe Text All persons born in the United States
Skip Instructions:

(1-51,57) [go to HEADST]

Question ID:FSD.003_00.000

Instrument Variable Name: PLBORN2
Question Text:

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

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
693 KOSOVO
694 MYANMAR
695 NORTHWEST TERRITORY
696 NUNAVUT TERRITORY
996 Country not listed
997 Refused
999 Don't know

Universe Text All persons not born in the United States
Skip Instructions:

(60-85) [store "2" in CITIZEN and go to USYR]
(100-696,996,R,D) [go to USYR]

Question ID:FSD.004_00.000

Instrument Variable Name: USYR
Question Text:

* Read if necessary. Earlier I recorded [fill1: your/ALIAS's] date of birth as [fill2: AGEDOB@3(text version) AGEDOB@4, AGEDOB@5]. In what year did [fill3: you/ALIAS] come to the United States to stay?

1880-Current Year 1880-Current Year
9997 Refused
9999 Don't know

Universe Text All persons not born in the United States
Skip Instructions:

(1880-Current Year) [if USYR lt AGEDOB@5, go to ERR2_USYR; else, go to CITIZEN]
(R,D) [go to USLONG]

NOTE: The "*Read if necessary?Earlier I recorded?" portion of this question is included for persons with
complete date of birth information.

Hard Edit: ERR1_USYR

*Future year invalid: [fill: USYR]. Please correct.

ERR2_USYR: * [fill year from USYR] is prior to the person's birth year.
*Please correct.

Question ID:FSD.005_00.000

Instrument Variable Name: USLONG
Question Text:

About how long [fill1: have you/has ALIAS] been in the United States?
* Read if necessary: Earlier I recorded that [fill2: you are/ALIAS is] [fill3: AGE] years old.
*Enter '95' for 95 or more years.
*If less than 1 year given as a response, code the answer as '0'.

00-94 00-94 years
95 95+ years
97 Refused
99 Don't know

Universe Text All persons not born in the United States and refused or don't know was reported for USYR
Skip Instructions:

(0-95) [if USLONG gt AGE, go to ERR_USLONG; else, go to CITIZEN]
(R,D) [go to CITIZEN]

Hard Edit: ERR_LONG: * In US longer than alive!

* Please correct.

Question ID:FSD.006_00.000

Instrument Variable Name: CITIZEN
Question Text:

(book) F20 ?[F1] [fill: Are you/Is ALIAS] a CITIZEN of the United States?

1 Yes, born in one of the 50 United States or the District of Columbia
2 Yes, born in Puerto Rico, Guam, American Virgin Islands, or other U.S. territory
3 Yes, born abroad to American parent(s)
4 Yes, U.S. citizen by naturalization
5 No, not a citizen of the United States
7 Refused
9 Don't know

Universe Text All persons not born in the United States or a United States territory
Skip Instructions:

(1) [if PLBORN eq 2, go to ERR1_CITIZEN; else, if PLBORN eq R, go to ERR3_CITIZEN; else, go to HEADST]
(2) [if (PLBORN eq 2 or PLBORN eq R), go to ERR2_CITIZEN; else, go to HEADST]
(R,D) [go to HEADST]

Hard Edit: ERR1_CITIZEN

*Already indicated birth outside the United States.
*Please correct.

ERR2_CITIZEN
*Already indicated birth outside United States territory.
*Please correct.

Soft Edit: ERR3_CITIZEN: Refused

Previously, you refused to say if [you/ALIAS] were/was born in the United States.
Would you like to change your answer to the question?

ERR4_CITIZEN: Don't Know
Previously, you didn't know if [you/ALIAS] were/was born in the United States.
Would you like to change your answer to the question?

Question ID:FSD.007_00.000

Instrument Variable Name: HEADST
Question Text:

?[F1] Is [fill: ALIAS] now attending Head Start?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons less than 7 years of age
Skip Instructions:

(1) [if no more persons less than 7 years of age, go to EDUC; else, repeat this question for the next eligible person]
(2,R,D) [ go to HEADSTEV]

Question ID:FSD.008_00.000

Instrument Variable Name: HEADSTEV
Question Text:

Has [fill: ALIAS] ever attended Head Start?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons less than 18 years of age and not currently enrolled in Head Start
Skip Instructions:

if no more persons less than 7 years of age, go to EDUC; else, go to HEADST for the next eligible person

Question ID:FSD.010_00.000

Instrument Variable Name: EDUC
Question Text:

(book) F21 ?[F1] What is the HIGHEST level of school [fill: you have/ALIAS has] completed or the highest degree [fill: you have/ALIAS has] received? Please tell me the number from the card.
* Enter highest level of school completed.

00 Never attended/kindergarten only
01 1st grade
02 2nd grade
03 3rd grade
04 4th grade
05 5th grade
06 6th grade
07 7th grade
08 8th grade
09 9th grade
10 10th grade
11 11th grade
12 12th grade, no diploma
13 GED or equivalent
14 High School Graduate
15 Some college, no degree
16 Associate degree: occupational, technical, or vocational program
17 Associate degree: academic program
18 Bachelor's degree (Example: BA, AB, BS, BBA)
19 Master's degree (Example: MA, MS, MEng, MEd, MBA)
20 Professional School degree (Example: MD, DDS, DVM, JD)
21 Doctoral degree (Example: PhD, EdD)
96 Child under 5 years old
97 Refused
99 Don't know

Universe Text All persons 5 years of age or older
Skip Instructions:

repeat for all eligible persons, then go to ARMFVER

Question ID:FSD.020_00.000

Instrument Variable Name: ARMFVER
Question Text:

Earlier [fill1: you said/it was said] [fill2: you/alias] [fill3: were/was] on full-time active duty with the Armed Forces. Is this correct?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with a person age 18 or older who were said to be on active duty in the armed forces in the HHC section
Skip Instructions:

(1) [go to ARMFFC]
(2,R,D) [go to ARMFEV]

Question ID:FSD.021_00.000

Instrument Variable Name: ARMFEV
Question Text:

[fill1: Have you/Has alias] ever served on active duty in the U.S. Armed Forces, military Reserves, or National Guard?
*Read if necessary. Active duty does not include training for the Reserves or National Guard, but DOES include activation, for example, for service in the US or in a foreign country, in support of military or humanitarian operations.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with a person age 18 or older who is not currently on active duty or said R,D to active duty question
Skip Instructions:

(1) [go to ARMFFC]
(2,R,D) [go to DOINGLW]

Question ID:FSD.022_00.000

Instrument Variable Name: ARMFFC
Question Text:

Did [fill1: you/alias] ever serve in a foreign country during a time of armed conflict or on a humanitarian or peacekeeping mission?
*Read if necessary. This would include National Guard or reserve or active duty monitoring or conducting peace keeping operations in Bosnia Kosovo, in the Sinai between Egypt and Israel, or in response to the 2004 tsunami, or Haiti in 2010.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with a person age 18 or older who has ever served in the armed forces
Skip Instructions:

(1,2,R,D) [go to ARMFTMP]

Question ID:FSD.023_00.000

Instrument Variable Name: ARMFTMP
Question Text:

When did [fill1: you/alias] serve on ACTIVE DUTY in the U.S. Armed Forces?
*Enter all that apply, separate with commas.
*Enter all periods in which this person served. Enter the item even if the person served for just part of that period.

01 Sept 2001 or later
02 August 1990 to August 2001 (including Persian Gulf War)
03 September 1980 to July 1990
04 May 1975 to August 1980
05 Vietnam era (August 1964 to April 1975)
06 March 1961 to July 1964
07 February 1955 to February 1961
08 Korean War (July 1950 to January 1955)
09 January 1947 to June 1950
10 World War II (December 1941 to December 1946)
11 November 1941 or earlier
97 Refused
99 Don't know

Universe Text All families with a person age 18 or older who has ever served in the armed forces
Skip Instructions:

(1,3-11,R,D) [go to DOINGLW]
(2) [go to ARMFDS]

Hard Edit: If gray answer code is selected please display:
That selection is not valid at this time.
Please correct.

Question ID:FSD.024_00.000

Instrument Variable Name: ARMFDS
Question Text:

Did [fill1: you/alias] serve in the Persian Gulf during Operation Desert Shield or Operation Desert Storm between August 1990 and April 1991?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with a person age 18 or older who served from August 1990 to August 2001
Skip Instructions:

(1,2,R,D) [go to DOINGLW]

Question ID:FSD.050_00.000

Instrument Variable Name: DOINGLW
Question Text:

(book) F22 ? [F1] The next few questions are about employment status. Which of the following [fill: were you/was ALIAS] doing last week?
* Read answer categories.

1 Working for pay at a job or business
2 With a job or business but not at work
3 Looking for work
4 Working, but not for pay, at a family-owned job or business
5 Not working at a job or business and not looking for work
7 Refused
9 Don't know

Universe Text All persons 18 years of age or older
Skip Instructions:

(1,4) [go to WRKHRS]
(2,5) [go to WHYNOWRK]
(3,R,D) [go to WRKLYR]

NOTE: A flashcard was added to this question in quarter 3 of 2005.

Question ID:FSD.060_00.000

Instrument Variable Name: WHYNOWRK
Question Text:

?[F1] What is the main reason [fill1: you/ALIAS] did not [fill2: work last week/have a job or business last week]?

01 Taking care of house or family
02 Going to school
03 Retired
04 On a planned vacation from work
05 On family or maternity leave
06 Temporarily unable to work for health reasons
07 Have job/contract and off-season
08 On layoff
09 Disabled
10 Other
97 Refused
99 Don't know

Universe Text All persons 18 years of age or older who were either with a job or business but not at work, or not working at a job or business and not looking for work
Skip Instructions:

(1-3,8-10,R,D) [go to WRKLYR]
(4-7) [go to WRKHRS]

Question ID:FSD.070_00.000

Instrument Variable Name: WRKHRS1
Question Text:

?[F1] How many hours [fill: did you work LAST WEEK at ALL jobs or businesses/did ALIAS work LAST WEEK at ALL jobs or businesses/do you USUALLY work at ALL jobs or businesses/does ALIAS USUALLY work at ALL jobs or businesses]?

001-168 1-168 hours
997 Refused
999 Don't know

Universe Text All persons 18 years of age or older who were working for pay at a job or business, or working, but not for pay, at a job or business last week, or on a planned vacation from work, or on family or maternity leave, or temporarily unable to work for health reasons, or have a job/contract and off-season
Skip Instructions:

(1-34,R,D) [go to WRKFTALL]
(35-94) [go to WRKLYR]
(95-1680 [go to ERR1_WRKHRS]

Soft Edit: * [Fill: WRKHRS] is an unusually high number.

* Please verify.

Question ID:FSD.080_00.000

Instrument Variable Name: WRKFTALL
Question Text:

?[F1] [fill: Do you/Does ALIAS] USUALLY work 35 hours or more per week in total at ALL jobs or businesses?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 18 years of age or older who worked less than 35 hours last week or did not know/refused to answer how many hours they worked last week
Skip Instructions:

[go to WRKLYR]

NOTE ON QUESTIONNAIRE FLOW: The instrument cycles through the appropriate questions from DOINGLW to WRKFTALL for each eligible person, then proceeds to WRKLYR.

Question ID:FSD.100_00.000

Instrument Variable Name: WRKLYR
Question Text:

?[F1] Did [fill1: you/ALIAS] work for pay at any time in [fill2: last calendar year in 4-digit format]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 18 years of age or older
Skip Instructions:

(1) [go to WRKMYR]
(2,R,D) [go to HIEMPOF]

Question ID:FSD.110_00.000

Instrument Variable Name: WRKMYR
Question Text:

How many months in [fill1: last calendar year in 4-digit format] did [fill2: you/ALIAS] have at least one job or business?
* If less than one month, enter '1'

01 1 month or less
02-12 2-12 months
97 Refused
99 Don't know

Universe Text All persons 18 years of age or older who worked last year
Skip Instructions:

go to ERNYR

Question ID:FSD.120_00.000

Instrument Variable Name: ERNYR
Question Text:

?[F1] What is your best estimate of [fill1: your/ALIAS's] earnings before taxes and deductions from ALL jobs and businesses in [fill2: last calendar year in 4-digit format]?
Include hourly wages, salaries, tips and commissions.
* Enter '999,995' if the reported income is greater than $999,995.

000001- 999994 $1-$999,994
999995 $999,995+
999997 Refused
999999 Don't know

Universe Text All persons 18 years of age or older who worked last year
Skip Instructions:

go to HIEMPOF

Question ID:FSD.130_00.000

Instrument Variable Name: HIEMPOF
Question Text:

Regarding [fill1: your/ALIAS's] job or work last week, was health insurance offered to [fill2: you/ALIAS] through [fill1: your/ALIAS's] workplace?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons 18 years of age or older who were working for pay at a job or business, or with a job or business, but not at work, or working, but not for pay, at a family-owned job or business
Skip Instructions:

go to INTROINC

NOTE ON QUESTIONNAIRE FLOW: The instrument cycles through the appropriate questions from WRKLYR to HIEMPOF for each eligible person, then proceeds to INTROINC.

Question ID:FIN.010_00.000

Instrument Variable Name: FINCINT
Question Text:

* Read the following. The next questions are about [fill1: your total/your total family] income in [fill2: last calendar year in 4-digit format] BEFORE TAXES.
Income is important in analyzing the health information we collect. For example, with this information, we can learn whether persons in one income group use certain types of medical services more or less often than those in another group. Please be assured that, like all other information you have provided, these answers will be kept strictly confidential.

1 Enter 1 to continue

Universe Text All families
Skip Instructions:

go to FSAL

Question ID:FIN.030_00.000

Instrument Variable Name: FSAL
Question Text:

? [F1] [fill1: Did you receive income in [fill2: last calendar year in 4-digit format] from wages and salaries?] [fill3: When answering these questions, please remember that by "combined family income," I mean your income PLUS the income of all family members living in this household (including cohabiting partners, and armed forces members living at home).
Did any family members 18 and older, that is * Read names (fill roster of people ge 18 years of age) receive income in [fill2: last calendar year in 4-digit format] from...wages and salaries?]

1 Yes
2 No
7 Refused
9 Don't know

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

(1) [if a single-person family, store the person number in PSAL and go to FSEINC; else, go to PSAL]
(2,R,D) [go to FSEINC]

Question ID:FIN.040_00.000

Instrument Variable Name: PSAL
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this? (Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with two or more persons 18 years of age or older and at least one received income from wages and salaries in the last calendar year
Skip Instructions:

go to FSEINC

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

Question ID:FIN.050_00.000

Instrument Variable Name: FSEINC
Question Text:

[fill1: Did you receive income in [fill2: last calendar year in 4-digit format] from self-employment including business and farm income?/ Did ALIAS receive income in [fill2: last calendar year in 4-digit format] from self-employment including business and farm income?/Did any family members 18 and older, that is *Read names (fill roster of people ge 18 years of age) receive income in [fill2: last calendar year in 4-digit format] from...self-employment including business and farm income?]

1 Yes
2 No
7 Refused
9 Don't know

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

(1) [if a single-person family, store the person number in PSEINC and go to FSSRR; else, go to PSEINC]
(2,R,D) [go to FSSRR]

Question ID:FIN.060_00.000

Instrument Variable Name: PSEINC
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this? (Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with two or more persons 18 years of age or older and at least one received income from self-employment in the last calendar year
Skip Instructions:

go to FSSRR

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

Question ID:FIN.070_00.000

Instrument Variable Name: FSSRR
Question Text:

? [F1] Did [fill1: you/any family members living here] receive income in [fill2: last calendar year in 4-digit format] from Social Security or Railroad Retirement?
* Read if necessary: Social Security checks are either automatically deposited in the bank or mailed to arrive on the third of every month.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

(1) [if a single-person family, store the person number in PSSRR and go to FSSRRD; else, go to PSSRR]
(2,R,D) [go to FPENS]

Question ID:FIN.080_00.000

Instrument Variable Name: PSSRR
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this? (Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with two or more persons and at least one received income from Social Security or Railroad
Retirement in the last calendar year
Skip Instructions:

go to FSSRRD

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

Question ID:FIN.082_00.000

Instrument Variable Name: FSSRRD
Question Text:

Was [fill: your/any family member's *Read names (fill roster of all persons selected at PSSRR and AGE LE 64)] Social Security or Railroad Retirement income received as a disability benefit?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with persons less than 65 years of age who received Social Security or Railroad Retirement income in the last calendar year
Skip Instructions:

(1) [if only one person less than 65 years of age received Social Security or Railroad Retirement income, fill the person number in PSSRRDB and goto PSSRRD; else, go to PSSRRDB]
(2,R,D) [go to FPENS]

Question ID:FIN.084_00.000

Instrument Variable Name: PSSRRDB
Question Text:

*Ask or verify. Enter applicable line number(s), separate with commas.
Was {person's} Social Security or Railroad Retirement income received as a disability benefit?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with two or more persons less than 65 years of age who received income from Social Security or Railroad Retirement in the last calendar year and at least one received the income as a disability benefit
Skip Instructions:

go to PSSRRD

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

Question ID:FIN.086_00.000

Instrument Variable Name: PSSRRD
Question Text:

Did [fill1: you/ALIAS] receive this benefit because [fill2: you are/he is/she is] disabled?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons less than 65 years of age who received Social Security or Railroad Retirement income as a disability benefit in the last calendar year
Skip Instructions:

repeat for all eligible persons, then go to FPENS

Question ID:FIN.090_00.000

Instrument Variable Name: FPENS
Question Text:

Did [fill1: you/any family members living here] receive income in [fill2: last calendar year in 4-digit format] from any disability pension [fill3: other than Social Security or Railroad Retirement]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

(1) [if a single-person family, store the person number in PPENS and goto FOPENS; else, go to PPENS]
(2,R,D) [go to FOPENS]

Question ID:FIN.100_00.000

Instrument Variable Name: PPENS
Question Text:

*Ask or verify. Enter applicable line number(s), separate with commas.
Who received this? (Anyone else?)
*Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with two or more persons and at least one received income from a disability pension (other than Social Security or Railroad Retirement) in the last calendar year
Skip Instructions:

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

Question ID:FIN.102_00.000

Instrument Variable Name: FOPENS
Question Text:

Did [fill1: you/any family members living here] receive income from any retirement or survivor pension other [fill2: than Social Security or Railroad Retirement/than a disability pension/than Social Security, Railroad Retirement, or a disability pension]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

(1) [if a single-person family, store the person number in POPENS and go to FSSI; else, go to POPENS]
(2,R,D) [go to FSSI]

Question ID:FIN.104_00.000

Instrument Variable Name: POPENS
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this? (Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with two or more persons and at least one received income from a retirement or survivor pension in the last calendar year
Skip Instructions:

go to FSSI

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

Question ID:FIN.110_00.000

Instrument Variable Name: FSSI
Question Text:

? [F1] Did [fill: you/any family members] receive Supplemental Security Income (SSI)?
* Read if necessary: Federal SSI checks are either automatically deposited in the bank or mailed to arrive on the first of every month.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

(1) [if a single-person family, fill the person number in PSSI and go to PSSID; else, go to PSSI]
(2,R,D) [go to FTANF]

Question ID:FIN.120_00.000

Instrument Variable Name: PSSI
Question Text:

*Ask or verify. Enter applicable line number(s), separate with commas.
Who in the family received this? (Anyone else?)
*Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with two or more persons and at least one received Supplemental Security Income (SSI) in the last calendar year
Skip Instructions:

go to PSSID

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

Question ID:FIN.122_00.000

Instrument Variable Name: PSSID
Question Text:

Did [fill1: you/ALIAS] receive SSI because [fill2: you have/he has/she has] a disability?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All persons who received SSI in the last calendar year
Skip Instructions:

repeat for all eligible persons, then go to FTANF

Question ID:FIN.150_00.000

Instrument Variable Name: FTANF
Question Text:

? [F1] At any time during [fill1: last calendar year in 4-digit format], even for one month, did [fill2: you/any family members living here] receive any CASH assistance from a state or county welfare program, such as (* fill specific program name)?
* Please do not include food stamps, SSI, energy assistance, or medical assistance payments.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

(1) [if a single-person family, store the person number in PTANF and go to FOWBEN; else, go to PTANF]
(2,R,D) [go to FOWBEN]

Question ID:FIN.160_00.000

Instrument Variable Name: PTANF
Question Text:

*Ask or verify. Enter applicable line number(s), separate with commas.
Who in the family received this? (Anyone else?)
*Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with two or more persons and at least one received cash assistance from a state or county welfare program in the last calendar year
Skip Instructions:

go to FOWBEN

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

Question ID:FIN.164_00.000

Instrument Variable Name: FOWBEN
Question Text:

At any time during [fill1: last calendar year in 4-digit format], did [fill2: you/any family members living here] receive any OTHER kind of welfare assistance such as help with getting a job, placement in education or job training programs, or help with transportation or child care?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

(1) [if a single-person family, store the person number in POWBEN and go to FINTRST; else, go to POWBEN]
(2,R,D) [go to FINTRST]

Question ID:FIN.166_00.000

Instrument Variable Name: POWBEN
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this? (Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with two or more persons and at least one received income from some "other" kind of welfare
assistance in the last calendar year
Skip Instructions:

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

Question ID:FIN.170_00.000

Instrument Variable Name: FINTRST
Question Text:

Did [fill: you/any family members living here] receive income from interest bearing checking accounts, savings accounts, IRAs or certificates of deposit, money market funds, treasury notes, bonds, or any other investments that earn interest?
* Do not include dividends

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

(1) [if a single-person family, store the person number in PINTRST and go to FDIVD; else, go to PINTRST]
(2,R,D) [go to FDIVD]

Question ID:FIN.180_00.000

Instrument Variable Name: PINTRST
Question Text:

*Ask or verify. Enter applicable line number(s), separate with commas.
Who received this? (Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with two or more persons and at least one received interest income in the last calendar year
Skip Instructions:

go to FDIVD

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

Question ID:FIN.190_00.000

Instrument Variable Name: FDIVD
Question Text:

Did [fill: you/any family members living here] receive income from dividends from stocks or mutual funds, or net rental income from property, royalties, estates or trusts?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

(1) [if a single-person family, store the person number in PDIVD and go to FCHLDSP; else, go to PDIVD]
(2,R,D) [go to FCHLDSP]

Question ID:FIN.200_00.000

Instrument Variable Name: PDIVD
Question Text:

* Ask or verify. Enter applicable line number(s). Separate with commas.
Who received this? (Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with two or more persons and at least one received dividend or net rental income in the last calendar year
Skip Instructions:

go to FCHLDSP

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

Question ID:FIN.210_00.000

Instrument Variable Name: FCHLDSP
Question Text:

? [F1] Did [fill: you/any family members living here] receive income from child support?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

(1) [if a single-person family, store the person number in PCHLDSP and go to FINCOT; else, go to PCHLDSP]
(2,R,D) [go to FINCOT]

Question ID:FIN.220_00.000

Instrument Variable Name: PCHLDSP
Question Text:

*Ask or verify. Enter applicable line number(s), separate with commas.
Who received this? (Anyone else?)
* Indicate which child in the family this is for. If that child is no longer residing with this family, enter line number of custodial parent.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with two or more persons and at least one received income from child support in the last calendar year
Skip Instructions:

go to FINCOT

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

Question ID:FIN.230_00.000

Instrument Variable Name: FINCOT
Question Text:

Did [fill: you/any family members living here] receive income from any other source such as alimony, contributions from family/others, VA payments, Worker's Compensation, or unemployment compensation?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

(1) [if a single-person family, store the person number in PINCOT and go to FINCTOT; else, go to PINCOT]
(2,R,D) [go to FINCTOT]

Question ID:FIN.240_00.000

Instrument Variable Name: PINCOT
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this? (Anyone else?)
* Indicate each family member with this income

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with two or more persons and at least one received some "other" source of income in the last calendar year
Skip Instructions:

go to FINCTOT

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

Question ID:FIN.250_00.000

Instrument Variable Name: FINCTOT
Question Text:

[fill1: When answering this next question, please remember to include your income PLUS the income of all family members living in this household.]
What is your best estimate of [fill2: your total income/the total income of all family members] from all sources, before taxes, in [fill3: last calendar year in 4 digit format]?
* Enter '999,995' if the reported income is greater than $999,995.

000000-999994 $0-$999,994
999995 $999,995+
999997 Refused
999999 Don't know

Universe Text All families
Skip Instructions:

(0-999) go to ERR1_FINCTOT
(250001-999995) go to ERR2_FINCTOT if edit suppressed and INC_FLG = 1 and INCDISC =1 then go to FINCEDIT else go to HOUSEOWN
(1000-250000) if INC_FLG = 1 and INCDISC =1 then go to FINCEDIT else go to HOUSEOWN
(D,R) go to FINC50

Soft Edit: ERR1_FINCTOT:

* Do not read to the respondent.
* $[fill: FINCTOT] is unusually low. Make corrections if necessary.

ERR2_FINCTOT:

* Do not read to the respondent.
* $[fill: FINCTOT] is unusually high. Make corrections if necessary.

Question ID:FIN.255_00.000

Instrument Variable Name: FINC50
Question Text:

Was your total [fill: family] income from all sources less than $50,000 or $50,000 or more?

1 Less than $50,000
2 $50,000 or more
7 Refused
9 Don't know

Universe Text Respondents who don't know or refuse their income
Skip Instructions:

(1) [go to FINC35]
(2) [go to FINC100]
(R,D) [HOUSEOWN]

Question ID:FIN.260_00.000

Instrument Variable Name: FINC35
Question Text:

Was your total [fill: family] income from all sources less than $35,000 or $35,000 or more?

1 Less than $35,000
2 $35,000 or more
7 Refused
9 Don't know

Universe Text The respondent answered Less than $50,000 in FINC50
Skip Instructions:

(1) if PCNT LTE '5', go to FINCPOV; else go to HOUSEOWN
(2,R,D) goto HOUSEOWN

Question ID:FIN.265_00.000

Instrument Variable Name: FINCPOV
Question Text:

Was your total [fill1: family] income from all sources less than [fill2: fill based on poverty threshold] or [fill2: fill based on poverty threshold] or more?

1 Less than [$10,500/$11,500/$13,500/$15,000/$18,000/$23,000/$27,000]
2 [$10,500/$11,500/$13,500/$15,000/$18,000/$23,000/$27,000] or more
7 Refused
9 Don't know

Universe Text The respondent answered Less than $35,000 and there were 5 or fewer persons in the family
Skip Instructions:

(1,R,D) go to HOUSEOWN
(2) if PCNT le '2' [go to F200POV] elseif PCNT gt '2' [go to HOUSEOWN]

Question ID:FIN.268_00.000

Instrument Variable Name: F200POV
Question Text:

Was your total [fill1: family/(blank)] income from all sources less than [fill2: fill based on 200% poverty threshold] or [fill2: fill based on 200% poverty threshold] or more?

1 Less than [$21,000/$23,000/$27,000/$30,000]
2 [$21,000/$23,000/$27,000/$30,000] or more
7 Refused
9 Don't know

Universe Text The respondent answered More than poverty threshold and there are 2 or fewer persons in the family
Skip Instructions:

(1,2,R,D) [go to HOUSEOWN]

Question ID:FIN.270_00.000

Instrument Variable Name: FINC100
Question Text:

Was your total [fill: family] income from all sources less than $100,000 or $100,000 or more?

1 Less than $100,000
2 $100,000 or more
7 Refused
9 Don't know

Universe Text The respondent answered More than $50,000 in FINC50
Skip Instructions:

(1) [go to FINC75]
(2) [go to FINC150]
(R,D) [go to HOUSEOWN]

Question ID:FIN.272_00.000

Instrument Variable Name: FINC150
Question Text:

Was your total [fill: family] income from all sources less than $150,000 or $150,000 or more?

1 Less than $150,000
2 $150,000 or more
7 Refused
9 Don't know

Universe Text The respondent answered $100,000 or more in FINC100
Skip Instructions:

(1,2,R,D) [go to HOUSEOWN]

Question ID:FIN.275_00.000

Instrument Variable Name: FINC75
Question Text:

Was your total [fill: family] income from all sources less than $75,000 or $75,000 or more?

1 Less than $75,000
2 $75,000 or more
7 Refused
9 Don't know

Universe Text The respondent answered Less than $100,000 in FINC100
Skip Instructions:

(1) if PCNT = '6'or '7', go to F200PV75; else go to HOUSEOWN
(2) if PCNT GTE '9', go to F200PV75; else go to HOUSEOWN
(R,D) go to HOUSEOWN

Question ID:FIN.276_00.000

Instrument Variable Name: F200PV75
Question Text:

Was your total family income from all sources less than [fill1: fill based on 200% poverty threshold] or [fill1: fill based on 200% poverty threshold] or more?

1 Less than [$61,000/$70,000/$93,000]
2 [$61,000/$70,000/$93,000] or more
7 Refused
9 Don't know

Universe Text The respondent answered less than $75,000 and there are 6 or 7 persons in the family OR the respondent answered $75,000 or more and there are 9 or more persons in the family
Skip Instructions:

(1,2,R,D) [go to HOUSEOWN]

Question ID:FIN.280_00.000

Instrument Variable Name: HOUSEOWN
Question Text:

Is this house/apartment owned or being bought, rented, or occupied by some other arrangement by you [fill: /or someone in your family]?

1 Owned or being bought
2 Rented
3 Other arrangement
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

(1,3,R,D) [go to FSSAPL]
(2) [go to FGAH]

Question ID:FIN.282_00.000

Instrument Variable Name: FGAH
Question Text:

? [F1] [fill: Are you/Is anyone in your family] paying lower rent because the Federal, State, or local government is paying part of the cost?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families that rent their house/apartment
Skip Instructions:

go to FSSAPL

Question ID:FIN.300_00.000

Instrument Variable Name: FSSAPL
Question Text:

[fill: Have you EVER applied for Supplemental Security Income or SSI, even if the claim was denied?/Have any family members living here EVER applied for Supplemental Security Income (SSI)? This includes people who applied for benefits, even if the claim was denied.]

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

(1) [if a single-person family, store the person number in PSSAPL and go to FSDAPL; else, go to PSSAPL]
(2,R,D) [go to FSDAPL]

Question ID:FIN.310_00.000

Instrument Variable Name: PSSAPL
Question Text:

*Ask or verify. Enter applicable line number(s), separate with a comma.
Who in the family applied for it? (Anyone else?)
* Indicate each family member who applied for SSI benefits.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with two or more persons and at least one applied for SSI
Skip Instructions:

go to FSDAPL

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

Question ID:FIN.330_00.000

Instrument Variable Name: FSDAPL
Question Text:

[fill: Have you EVER APPLIED for disability benefits from Social Security even if the claim was denied?/Have any family members living here EVER applied for disability benefits from Social Security? This includes people who applied for benefits, even if the claim was denied.]

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All Families
Skip Instructions:

(1) [if a single-person family, store the person number in PSDAPL and go to TANFMYR; else, go to PSDAPL]
(2,R,D) [go to TANFMYR]

Question ID:FIN.340_00.000

Instrument Variable Name: PSDAPL
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who in the family applied for it? (Anyone else?)
* Indicate each family member who applied for Social Security Disability benefits.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with two or more persons and at least one applied for Social Security Disability benefits
Skip Instructions:

go to TANFMYR

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

Question ID:FIN.350_00.000

Instrument Variable Name: TANFMYR
Question Text:

? [F1] Earlier I recorded that [fill1: you/ALIAS] received cash assistance from programs such as welfare or public assistance in [fill2: last calendar year in 4-digit format]. During [fill2: last calendar year in 4-digit format], about how many months did [fill1: you/ALIAS] receive this assistance?
*Enter '1' if less than one month.

01-12 1-12 months
97 Refused
99 Don't know

Universe Text All persons who received cash assistance from public assistance programs in the last calendar year
Skip Instructions:

repeat for all eligible persons, then go to FSNAP

Question ID:FIN.360_00.000

Instrument Variable Name: FSNAP
Question Text:

?[F1] At any time during [fill 1: last calendar year in 4-digit format], did [fill 2: you/any family members living here] receive [fill 3: food stamp benefits/SNAPNAME or food stamp benefits]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families
Skip Instructions:

(1) [go to FSNAPMYR]
(2, D, R> [Go to FINWIC to see if family falls into the universe for this question.]

Question ID:FIN.380_00.000

Instrument Variable Name: FSNAPMYR
Question Text:

?[F1] During [fill 1: last year in 4 digit format], about how many months were [fill 2: food stamp benefits/SNAPNAME or food stamp benefits] received?
* Enter "1" if less than 1 month

01-12 Months
97 Refused
99 Don't know

Universe Text Family received food stamp/SNAP benefits in previous calendar year
Skip Instructions:

Go to FINWIC to see if family fits into universe for this question.

Question ID:FIN.384_00.000

Instrument Variable Name: FINWIC
Question Text:

? [F1] At any time during [fill1: last calendar year in 4-digit format] did [fill2: you/anyone in your family] receive benefits from the WIC program, that is, the Women, Infants and Children program?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with females 12-55 years of age or children 0-5 years of age
Skip Instructions:

(1) [if a single-person family, store the person number in PWIC and go to FMSSN; else, go to PWIC]
(2,R,D) [go to FMSSN]

Question ID:FIN.385_00.000

Instrument Variable Name: PWIC
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who in the family received this? (Anyone else?)
* Indicate family members who were authorized to receive WIC benefits.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text All families with two or more persons who are female and between the ages of 12-55 or children between the ages of 0-5, and at least one received WIC benefits in the last calendar year
Skip Instructions:

go to FMSSN

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

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