fam
1

2016 NHIS Questionnaire - Family
Family Identification

Question ID:FID.100_00.000

Instrument Variable Name: HHCHANGE
Questionnaire File Name: Family
Question Text:

I have recorded that [your name is [fill full name], 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.245_00.000

Instrument Variable Name: HHCHANGE_1
Questionnaire File Name: Family
Question Text:

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

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

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

(1) if no additional PX remain
if SCREENIN = 0 and I_SCRN_STATUS = S, GOTO EXIT(HHC)
else GOTO FIDCC13
(2) GOTO ERR_HHCHANGE_1
ERR_HHCHANGE_1
Hard Edit:
* Press enter to go back to change some demographic information or arrow down and press enter to change your answer.
Default Goto should be CWHAT2

Question ID: FID.250_00.000

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

Question ID:FID.280_00.000

Instrument Variable Name:: COHAB1
Questionnaire File Name:: Family
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
Questionnaire File Name: Family
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
Questionnaire File Name: Family
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 GOTO is to change Relationship code of [ALIAS (COHAB3(PX))]
*Second GOTO is to choose different cohabiting partner at COHAB3
Questions involved Value
RPREL: Relationship to Ref Person RPREL(COHAB3 (PX))
COHAB3 ALIAS (COHAB3 (PX))
ERR3_COHAB3
*If [ALIAS (COHAB3(PX))] and [ALIAS (PX)] are cohabiting partners, it is not possible for both to have RPREL
codes equal to ?04? for ?Child?. One of their RPREL codes should equal ?12? for ?Other relative?.
*Correct relationship code at RPREL or change answer at COHAB3.
*First GOTO is to change Relationship code of [ALIAS (COHAB3(PX))]
*Second GOTO is to change Relationship code of [ALIAS (PX)]
*Third GOTO is to choose different cohabiting partner at COHAB3
Questions involved Value
RPREL: Relationship to Ref Person Child
RPREL: Relationship to Ref Person Child
COHAB3 ALIAS (COHAB3 (PX))
ERR4_ COHAB3
*Age difference between cohabiting partners is greater than or equal to 20 years.
I have recorded [ALIAS (PX)] is [AGE(PX)] years old and [fill: his/her] cohabiting partner
[ALIAS(COHAB3(PX))] is [AGE(COHAB3(PX))] years old. Are these ages and relationships correct?
*First GOTO is to choose different cohabiting partner at COHAB3
*Second GOTO is to change AGE of cohabiting partner [ALIAS (COHAB3(PX))]
*Third GOTO is to change AGE of [ALIAS(PX)]
Questions involved Value
COHAB3 ALIAS (COHAB3 (PX))
AGE AGE (COHAB3 (PX))
AGE AGE (PX)

Question ID: FID.322_00.000

Instrument Variable Name: DEGREE4
Questionnaire File Name: Family
Question Text:

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

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

Universe Text:
Skip Instructions:

Hard Edit:
Soft Edit:
When the reference person is the person in question's parent.
(1) if AGEDIFF (12 [goto ERR_DEGREE4]
if ERR_DEGREE4 = 1 [goto FIDCCI4B]
else reset DEGREE4 [goto DEGREE4] endif
else [goto FIDCCI4B]
(2-5,R,D) [goto FIDCCI4B]
ERR2_DEGREE4
*Age difference between father and child is [AGEDIFF] years.
I have recorded [ALIAS (X2)] is [AGE(X2)] years old and his child [ALIAS(PX)] is [AGE(PX)] years old.
Are these ages and relationships correct?
* Please correct relationship code or age.
*First GOTO is to change Relationship code of [ALIAS(X2)]
*Second GOTO is to change Relationship code of [ALIAS(PX)]
*Third GOTO is to change AGE of father [ALIAS(X2)]
*Fourth GOTO is to change AGE of child [ALIAS(PX)]
Questions involved Value
RPREL: Relationship to Ref Person Spouse (husband) or Unmarried Partner
RPREL: Relationship to Ref Person Child or Child of Partner
AGE AGE (X2)
AGE AGE(PX)
ERR1_DEGREE4
*Age difference between father and child is only [AGEDIFF] years.
I have recorded [ALIAS (X2)] is [AGE(X2)] years old and his child [ALIAS(PX)] is [AGE(PX)] years old. Are
these ages and relationships correct?
*First GOTO is to change Relationship code of [ALIAS(X2)]
*Second GOTO is to change Relationship code of [ALIAS(PX)]
*Third GOTO is to change AGE of father [ALIAS(X2)]
*Fourth GOTO is to change AGE of child [ALIAS(PX)]
Questions involved Value
RPREL: Relationship to Ref Person Spouse (husband) or Unmarried Partner
RPREL: Relationship to Ref Person Child or Child of Partner
AGE AGE (X2)
AGE AGE(PX)
If suppressed and additional persons remain, GOTO FIDCCI4
else GOTO FIDCCI4B, endif
ERR3_DEGREE4
*Age difference between father and child is greater than or equal to 50 years.
I have recorded [ALIAS (X2)] is [AGE(X2)] years old and his child [ALIAS(PX)] is [AGE(PX)] years old. Are
these ages and relationships correct?
*First GOTO is to change Relationship code of [ALIAS(X2)]
*Second GOTO is to change Relationship code of [ALIAS(PX)]
*Third GOTO is to change AGE of father [ALIAS(X2)]
*Fourth GOTO is to change AGE of child [ALIAS(PX)]
Questions involved Value
RPREL: Relationship to Ref Person Spouse (husband) or Unmarried Partner
RPREL: Relationship to Ref Person Child or Child of Partner
AGE AGE (X2)
AGE AGE(PX)
If suppressed and additional persons remain, GOTO FIDCCI4 else GOTO FIDCCI4B, endif

Question ID:FID.324_00.000

Instrument Variable Name: DEGREE5
Questionnaire File Name: Family
Question Text:

I noted that [mother's full name] is the mother of [child's full name]. Is [child's full name] 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:
Skip Instructions:

Hard Edit:
Soft Edit:
When the reference person is the person in question's parent.
(1) if AGEDIFF (12 [goto ERR_DEGREE5]
if yes, continue the interview [goto FIDCCI4B]
else, reset DEGREE5 [goto DEGREE5] endif
else [goto FIDCCI4B]
(2-5,R,D) [goto FIDCCI4B]
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 GOTO is to change Relationship code of [ALIAS(X2)]
*Second GOTO is to change Relationship code of [ALIAS(PX)]
*Third GOTO is to change AGE of mother [ALIAS(X2)]
*Fourth GOTO 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 GOTO is to change Relationship code of [ALIAS(X2)]
*Second GOTO is to change Relationship code of [ALIAS(PX)]
*Third GOTO is to change AGE of mother [ALIAS(X2)]
*Fourth GOTO 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
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 GOTO is to change Relationship code of [ALIAS(X2)]
*Second GOTO is to change Relationship code of [ALIAS(PX)]
*Third GOTO is to change AGE of mother [ALIAS(X2)]
*Fourth GOTO 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
Questionnaire File Name: Family
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".
* Choose mother over mother-in-law if both are present.

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

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

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

Question ID: FID.330_01.000

Instrument Variable Name: MOTHERCK_A
Questionnaire File Name: Family
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:
Skip Instructions:

Hard Edit:
Soft Edit:
Mother is in the immediate family.
(1) If AGEDIFF (12 [goto ERR_MOTHERCK_A]
if (1) [goto FIDCCI5]
elseif (2) [goto MOTHER]
elseif (3), reset MOTHERCK_A [goto MOTHERCK_A]
else [goto FIDCCI5]
(2-5,R,D) [goto FIDCCI5]
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 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)
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 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 goto 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 goto FIDCCI5

Question ID: FID.340_00.000

Instrument Variable Name: FATHER
Questionnaire File Name: Family
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'.
* Choose father over father-in-law if both are present.

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

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

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

Question ID: FID.350_01.000

Instrument Variable Name: FATHERCK_A
Questionnaire File Name: Family
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:
Skip Instructions:

Hard Edit:
Soft Edit:
(1) If AGEDIFF (12 [goto ERR_FATHERCK_A]
if ERRFATHERCK_A = (1) [goto FIDCCI4]
elseif (2) [goto FATHER]
elseif (3) reset FATHERCK_A
[goto FATHERCK_A] endif
else [goto FIDCCI4]
(2-5,R,D) [goto FIDCCI4]
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 GOTO is to change code at FATHER
*Second GOTO is to change AGE of father [ALIAS (LNDAD[PX])]
*Third GOTO is to change AGE of child [ALIAS(PX)]
Questions involved
Value
FATHER
ALIAS(FATHER [PX])
AGE
AGE(LNDAD[PX])
AGE
AGE(PX)
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 GOTO is to change code at FATHER
*Second GOTO is to change AGE of father [ALIAS (LNDAD[PX])]
*Third GOTO is to change AGE of child [ALIAS(PX)]
Questions involved Value
FATHER ALIAS(FATHER [PX])
AGE AGE(LNDAD[PX])
AGE AGE(PX)
if suppressed goto 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 GOTO is to change code at FATHER
*Second GOTO is to change AGE of father [ALIAS (LNDAD[PX])]
*Third GOTO is to change AGE of child [ALIAS(PX)]
Questions involved Value
FATHER ALIAS(FATHER [PX])
AGE AGE(LNDAD[PX])
AGE AGE(PX)
if suppressed goto FIDCCI4

Question ID:FID.361_00.000

Instrument Variable Name: LGGUARD1
Questionnaire File Name: Family
Question Text:

[fill: Do you/Does ALIAS] have a legal guardian?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text:(Person is ward of reference person OR both mother and father are not present in the household) AND person is less than 18 AND person is not deleted
Skip Instructions:

(1) [goto LGGUARD2]
(2,R,D) if additional persons remain, GOTO FIDCCI4
else GOTO ROSTERCK

Question ID: FID.362_00.000

Instrument Variable Name: LGGUARD2
Questionnaire File Name: Family
Question Text:

*Ask or verify.
Is [fill ALIAS?S] legal guardian a household member?
*Enter the line number of the legal guardian.
*If the legal 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 Person less than 18 has legal guardian
Skip Instructions:

(0-25, D, R) if additional persons remain, GOTO FIDCCI4
else GOTO ROSTERCK

Question ID:FID.380_00.000

Instrument Variable Name: KNOW2
Questionnaire File Name: Family
Question Text:

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

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

Universe Text: More than one adult
Skip Instructions:

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

Question ID:FID.390_03.000

Instrument Variable Name: FINTRO2
Questionnaire File Name: Family
Question Text:

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

1 Present
2 Not present

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

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

Question ID:FID.390_04.000

Instrument Variable Name: FAMRESP
Questionnaire File Name: Family
Question Text:

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

01-25
Person # of Family Respondent

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

goto HLTH_BEG

Question ID: FHS.005_00.000

Instrument Variable Name: FLAPLYLM
Questionnaire File Name: Family
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 goto PLAPLYUN; else, goto PLAPLYLM] (2,R,D) [goto FSPEDEIS]

Question ID: FHS.010_00.000

Instrument Variable Name: PLAPLYLM
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHS.020_00.000

Instrument Variable Name: PLAPLYUN
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHS.050_00.000

Instrument Variable Name: FSPEDEIS
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHS.060_00.000

Instrument Variable Name: PSPEDEIS
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHS.065_00.000

Instrument Variable Name: PSPEDEM
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHS.070_00.000

Instrument Variable Name: FLAADL
Questionnaire File Name:Family
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 goto LABATH; else, goto PLAADL] (2,R,D) [goto FLAIADL]

Question ID: FHS.080_00.000

Instrument Variable Name: PLAADL
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHS.090_01.000

Instrument Variable Name: LABATH
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

goto LADRESS

Question ID: FHS.090_02.000

Instrument Variable Name: LADRESS
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

goto LAEAT

Question ID: FHS.090_03.000

Instrument Variable Name: LAEAT
Questionnaire File Name:Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

goto LABED

Question ID: FHS.090_04.000

Instrument Variable Name: LABED
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

goto LATOILT

Question ID: FHS.090_05.000

Instrument Variable Name: LATOILT
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

goto LAHOME

Question ID: FHS.090_06.000

Instrument Variable Name: LAHOME
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHS.150_00.000

Instrument Variable Name: FLAIADL
Questionnaire File Name:Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHS.160_00.000

Instrument Variable Name: PLAIADL
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHS.170_00.000

Instrument Variable Name: FLAWKNOW
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID:FHS.180_00.000

Instrument Variable Name:PLAWKNOW
Questionnaire File Name:Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHS.190_00.000

Instrument Variable Name: FLAWKLIM
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHS.200_00.000

Instrument Variable Name:: PLAWKLIM
Questionnaire File Name:Family
Question Text:

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

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

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

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

Question ID:FHS.210_00.000

Instrument Variable Name: FLAWALK
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

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

Question ID: FHS.220_00.000

Instrument Variable Name: PLAWALK
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHS.230_00.000

Instrument Variable Name: FLAREMEM
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text:All families
Skip Instructions:

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

Question ID:FHS.240_00.000

Instrument Variable Name: PLAREMEM
Questionnaire File Name: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHS.250_00.000

Instrument Variable Name: FLIMANY
Questionnaire File Name:Family
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
Questionnaire File Name: Family
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:

goto LAHCC

Question ID: FHS.270_00.000

Instrument Variable Name: LAHCC
Questionnaire File Name: Family
Question Text:

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

01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Intellectual disability, also known as mental retardation
08 Other developmental problem (for example, cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure

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

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

Question ID: FHS.271_90.000

Instrument Variable Name: LAHCC_S1
Questionnaire File Name:: Family
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

goto LHCL90N

Question ID:FHS.271_91.000

Instrument Variable Name: LAHCC_S2
Questionnaire File Name: Family
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

goto LHCL91N

Question ID: FHS.280_01.000

Instrument Variable Name: LHCL01N
Questionnaire File Name: Family
Question Text:

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

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

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

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

Question ID:FHS.280_02.000

Instrument Variable Name: LHCL01T
Questionnaire File Name:: Family
Question Text

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

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

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

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

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

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

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

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

Question ID: FHS.282_02.000

Instrument Variable Name: LHCL02T
Questionnaire File Name: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID:FHS.284_02.000

Instrument Variable Name: LHCL03T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID:FHS.286_02.000

Instrument Variable Name: LHCL04T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.288_02.000

Instrument Variable Name: LHCL06T
Questionnaire File Name:: Family
Question Text:

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

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

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

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(6) [goto ERR2_LHCL06T]
if (LHCL06T = 4 and LHCL06N ) AGE) or (LHCL06T = 3 and LHCL06N ) AGE in months) or (LHCL06T = 2 and LHCL06N ) AGE in weeks), goto ERR1_LHCL06T
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
Questionnaire File Name:: Family
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) [goto LHCL07T]
(96) [fill "6" in LHCL07T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL07T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]

Question ID:FHS.290_02.000

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

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

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

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

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

Question ID: FHS.292_02.000

Instrument Variable Name: LHCL08T
Questionnaire File Name:: Family
Question Text:

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

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

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

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(6) [goto ERR2_LHCL08T]
if (LHCL08T = 4 and LHCL08N ) AGE) or (LHCL08T = 3 and LHCL08N ) AGE in months) or (LHCL08T = 2 and LHCL08N ) AGE in weeks), goto ERR1_LHCL08T
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
Questionnaire File Name:: Family
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) [goto LHCL09T]
(96) [fill "6" in LHCL09T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL09T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]

Question ID: FHS.294_02.000

Instrument Variable Name: LHCL09T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.296_02.000

Instrument Variable Name: LHCL10T
Questionnaire File Name:: Family
Question Text:

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

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

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

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(6) [goto ERR2_LHCL10T]
if (LHCL10T = 4 and LHCL10N ) AGE) or (LHCL10T = 3 and LHCL10N ) AGE in months) or (LHCL10T = 2 and LHCL10N ) AGE in weeks), goto ERR1_LHCL10T
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
Questionnaire File Name:: Family
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) [goto LHCL11T]
(96) [fill "6" in LHCL11T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL11T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]

Question ID: FHS.298_02.000

Instrument Variable Name: LHCL11T
Questionnaire File Name: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID:FHS.300_02.000

Instrument Variable Name: LHCL12T
Questionnaire File Name: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.302_02.000

Instrument Variable Name: LHCL13T
Questionnaire File Name: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.304_02.000

Instrument Variable Name: LHCL90T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.306_02.000

Instrument Variable Name: LHCL91T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

Instrument Variable Name: LAHCA
Question Text:

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

01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(for example, asthma and emphysema)
12 Cancer
13 Birth defect
14 Intellectual disability, also known as mental retardation
15 Other developmental problem (for example cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure

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

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

Question ID: FHS.351_90.000

Instrument Variable Name: LAHCA_S1
Questionnaire File Name:: Family
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

goto LHAL90N

Question ID: FHS.351_91.000

Instrument Variable Name: LAHCA_S2
Questionnaire File Name:: Family
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

goto LHAL91N

Question ID:FHS.360_01.000

Instrument Variable Name: LHAL01N
Questionnaire File Name:: Family
Question Text:

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

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

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

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

Question ID:FHS.360_02.000

Instrument Variable Name: LHAL01T
Questionnaire File Name: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.362_02.000

Instrument Variable Name: LHAL02T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.364_02.000

Instrument Variable Name: LHAL03T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.366_02.000

Instrument Variable Name: LHAL04T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID:FHS.368_02.000

Instrument Variable Name: LHAL05T
Questionnaire File Name: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.370_02.000

Instrument Variable Name: LHAL06T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID:FHS.372_02.000

Instrument Variable Name: LHAL07T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID:FHS.374_02.000

Instrument Variable Name: LHAL08T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID:FHS.376_02.000

Instrument Variable Name: LHAL09T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID:FHS.378_02.000

Instrument Variable Name: LHAL10T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.380_02.000

Instrument Variable Name: LHAL11T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.382_02.000

Instrument Variable Name: LHAL12T
Questionnaire File Name:: Family
Question Text:

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

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

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

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL12T]
if LHAL12T = 4 and LHAL12N ) AGE, goto ERR1_LHAL12T
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
Questionnaire File Name:: Family
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) [goto LHAL14T]
(96) [fill "6" in LHAL14T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL14T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.384_02.000

Instrument Variable Name: LHAL14T
Questionnaire File Name:: Family
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) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL14T]
if LHAL14T = 4 and LHAL14N ) AGE, goto ERR1_LHAL14T
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
Questionnaire File Name:: Family
Question Text:

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

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

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

Question ID: FHS.386_02.000

Instrument Variable Name: LHAL15T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.388_02.000

Instrument Variable Name: LHAL16T
Questionnaire File Name: Family
Question Text:

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

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

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

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL16T]
if LHAL16T = 4 and LHAL16N ) AGE, goto ERR1_LHAL16T
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
Questionnaire File Name:: Family
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) [goto LHAL17T]
(96) [fill "6" in LHAL17T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL17T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.390_02.000

Instrument Variable Name: LHAL17T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.392_02.000

Instrument Variable Name: LHAL18T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.394_02.000

Instrument Variable Name: LHAL19T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.396_02.000

Instrument Variable Name: LHAL20T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.398_02.000

Instrument Variable Name: LHAL21T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.400_02.000

Instrument Variable Name: LHAL22T
Questionnaire File Name:: Family
Question Text:

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

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

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

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL22T]
if LHAL22T = 4 and LHAL22N ) AGE, goto ERR1_LHAL22T
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
Questionnaire File Name:: Family
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) [goto LHAL23T]
(96) [fill "6" in LHAL23T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL23T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.402_02.000

Instrument Variable Name: LHAL23T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.404_02.000

Instrument Variable Name: LHAL24T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.406_02.000

Instrument Variable Name: LHAL25T
Questionnaire File Name:: Family
Question Text:

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

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

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

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL25T]
if LHAL25T = 4 and LHAL25N ) AGE, goto ERR1_LHAL25T
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
Questionnaire File Name:: Family
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) [goto LHAL26T]
(96) [fill "6" in LHAL26T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL26T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.408_02.000

Instrument Variable Name: LHAL26T
Questionnaire File Name:: Family
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) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL26T]
if LHAL26T = 4 and LHAL26N ) AGE, goto ERR1_LHAL26T
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
Questionnaire File Name:: Family
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) [goto LHAL27T]
(96) [fill "6" in LHAL27T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL27T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.410_02.000

Instrument Variable Name: LHAL27T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.412_02.000

Instrument Variable Name: LHAL28T
Questionnaire File Name:: Family
Question Text:

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

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

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

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL28T]
if LHAL28T = 4 and LHAL28N ) AGE, goto ERR1_LHAL28T
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
Questionnaire File Name:: Family
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) [goto LHAL29T]
(96) [fill "6" in LHAL29T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL29T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.414_02.000

Instrument Variable Name: LHAL29T
Questionnaire File Name:: Family
Question Text:

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

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

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

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL29T]
if LHAL29T = 4 and LHAL29N ) AGE, goto ERR1_LHAL29T
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
Questionnaire File Name:: Family
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) [goto LHAL30T]
(96) [fill "6" in LHAL30T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL30T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.416_02.000

Instrument Variable Name: LHAL30T
Questionnaire File Name:: Family
Question Text:

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

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

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

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL30T]
if LHAL30T = 4 and LHAL30N ) AGE, goto ERR1_LHAL30T
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
Questionnaire File Name:: Family
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) [goto LHAL31T]
(96) [fill "6" in LHAL31T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL31T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.418_02.000

Instrument Variable Name: LHAL31T
Questionnaire File Name:: Family
Question Text:

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

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

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

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL31T]
if LHAL31T = 4 and LHAL31N ) AGE, goto ERR1_LHAL31T
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
Questionnaire File Name:: Family
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) [goto LHAL32T]
(96) [fill "6" in LHAL32T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL32T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.420_02.000

Instrument Variable Name: LHAL32T
Questionnaire File Name:: Family
Question Text:

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

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

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

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL32T]
if LHAL32T = 4 and LHAL32N ) AGE, goto ERR1_LHAL32T
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
Questionnaire File Name:: Family
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) [goto LHAL33T]
(96) [fill "6" in LHAL33T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL33T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.422_02.000

Instrument Variable Name: LHAL33T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.424_02.000

Instrument Variable Name: LHAL34T
Questionnaire File Name:: Family
Question Text:

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

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

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

(1-4,R,D) [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL34T]
if LHAL34T = 4 and LHAL34N ) AGE, goto ERR1_LHAL34T
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
Questionnaire File Name:: Family
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) [goto LHAL35T]
(96) [fill "6" in LHAL35T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL35T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]

Question ID: FHS.426_02.000

Instrument Variable Name: LHAL35T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.450_02.000

Instrument Variable Name: LHAL90T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

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

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

Question ID: FHS.452_02.000

Instrument Variable Name: LHAL91T
Questionnaire File Name:: Family
Question Text:

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

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

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

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

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

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

Universe Text: All persons
Skip Instructions:

repeat for all persons in the family, goto FINJ3M

Question ID: FFS.010_00.000

Instrument Variable Name: FSRUNOUT
Questionnaire File Name:: Family
Question Text:

These next questions are about whether you were always able to afford the food you needed in the last 30 days. I'm going to read you several statements that people have made about their food situation. For these statements, please tell me whether the statement was often true, sometimes true, or never true for [fill 1: you/your family] in the last 30 days.
The first statement is "[fill 2: I/We] worried whether [fill 3: my/our] food would run out before [fill 4: I/we] got money to buy more." Was that often true, sometimes true, or never true for [fill 1: you/your family] in the last 30 days?

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

Universe Text: All families
Skip Instructions:

(1-3,R,D) goto FSLAST

Question ID: FFS.020_00.000

Instrument Variable Name: FSLAST
Questionnaire File Name:: Family
Question Text:

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

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

Universe Text: All families
Skip Instructions:

(1-3,R,D) goto FSBALANC

Question ID: FFS.030_00.000

Instrument Variable Name: FSBALANC
Questionnaire File Name:: Family
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) [goto FSSKIP] (3,D,R) [if FSRUNOUT in(1,2) or FSLAST in(1,2), goto FSSKIP; else goto FINJ3M]

Question ID: FFS.040_00.000

Instrument Variable Name: FSSKIP
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FFS.050_00.000

Instrument Variable Name: FSSKDAYS
Questionnaire File Name:: Family
Question Text:

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

01-30 Days
97 Refused
99 Don't know

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

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

Question ID: FFS.060_00.000

Instrument Variable Name: FSLESS
Questionnaire File Name:: Family
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) [goto FSHUNGRY]

Question ID: FFS.070_00.000

Instrument Variable Name: FSHUNGRY
Questionnaire File Name:: Family
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) [goto FSWEIGHT]

Question ID: FFS.080_00.000

Instrument Variable Name: FSWEIGHT
Questionnaire File Name:: Family
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) [goto FSNOTEAT]
(2,R,D) [if FSSKIP=1 or FSLESS=1 or FSHUNGRY=1, goto FSNOTEAT; else goto FINJ3M]

Question ID: FFS.090_00.000

Instrument Variable Name: FSNOTEAT
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FFS.100_00.000

Instrument Variable Name: FSNEDAYS
Questionnaire File Name:: Family
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) [goto FINJ3M]

Question ID: FIJ.010_00.000

Instrument Variable Name: FINJ3M
Questionnaire File Name:: Family
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, goto WFINJ3M]
(2,R,D) [goto FPOI3M]

Question ID: FIJ.012_00.000

Instrument Variable Name: WFINJ3M
Questionnaire File Name:: Family
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) [goto FPOI3M]
else, goto 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
Questionnaire File Name:: Family
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) [goto MFINJ3M]
(R) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury episode,
goto FPOI3M]
(11-91) [goto ERR_TFINJ3M]
ERR_TFINJ3M
Soft Edit:
* ^TFINJ3M is unusually high. Please verify.
(Suppress) [goto MFINJ3M]
(Close) [reset TFINJ3M for new entry]
(Goto) [reset TFINJ3M for new entry]

Question ID: FIJ.016_00.000

Instrument Variable Name: MFINJ3M
Questionnaire File Name:: Family
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 goto IPDATEM; else, goto MTFINJ3M] (2,R,D) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury episode, goto FPOI3M]

Question ID: FIJ.018_00.000

Instrument Variable Name: MTFINJ3M
Questionnaire File Name:: Family
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, goto ERR1_MTFINJ3M; else, if MTFINJ3M gt 3 and TFINJ3M eq D, goto ERR2_MTFINJ3M; else, goto IPDATEM] (R,D) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury episode, goto 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.
Goto
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
Goto
Close

Question ID: FIJ.020_00.000

Instrument Variable Name: FPOI3M
Questionnaire File Name:: Family
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 goto TFPOI3M; else,
goto WFPOI3M]
(2,DK,R) [goto next section]

Question ID: FIJ.022_00.000

Instrument Variable Name: WFPOI3M
Questionnaire File Name:: Family
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; goto TFPOI3M]
(DK,R) [goto next section]

Question ID: FIJ.024_00.000

Instrument Variable Name: TFPOI3M
Questionnaire File Name:: Family
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) [goto MFPOI3M]
(R) [goto TFPOI3M for next person with reported poisoning; if no more persons with a poisoning, goto next section] (11-91) [goto ERR_TFPOI3M]
ERR_TFPOI3M
Soft Edit:
[If TFPOI3M gt 10, display ERR_TFPOI3M]
* ^TFPOI3M is unusually high. Please verify.
(Suppress) [goto MFPOI3M]
(Close) [goto TFPOI3M for new entry]
(Goto) [goto TFPOI3M for new entry]

Question ID: FIJ.026_00.000

Instrument Variable Name: MFPOI3M
Questionnaire File Name:: Family
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 goto IPDATEM; else goto MTFPOI3M]
(2,DK,R) [goto TFPOI3M for next person with reported poisoning; if no more persons with a poisoning, goto next section]

Question ID: FIJ.028_00.000

Instrument Variable Name: MTFPOI3M
Questionnaire File Name:: Family
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, goto ERR1_MTFPOI3M; else, goto IPDATEM]
(DK, R) [goto TFPOI3M for next person with reported poisoning; if no more persons with a poisoning, goto 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) [goto MTFPOI3M for new entry]
(Goto) [goto 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
Goto
Close

Question ID: FIJ.050_01.000

Instrument Variable Name: IPDATEM
Questionnaire File Name:: Family
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) [goto IPDATED]
(R) [goto IPHOW]
(D) [goto IPDATENO]

Question ID: FIJ.050_02.000

Instrument Variable Name: IPDATED
Questionnaire File Name:: Family
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) [goto IPDATEY]
(R) [goto IPHOW]
(D) [goto IPDATEMT]
ERR_IPDATED
Hard Edit:
[fill1: IPDATED] is not a valid day for [fill2: IPDATEM ].
(Close) [reset IPDATED for new entry]
(Goto) [reset IPDATED for new entry]

Question ID: FIJ.050_03.000

Instrument Variable Name: IPDATEY
Questionnaire File Name:: Family
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, goto
ERR1_IPDATEY; else, goto IPHOW
ERR_IPDATEY
Hard Edit:
* Future date invalid.
* Please correct.
(Close) [reset IPDATED for new entry]
(Goto) [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
Questionnaire File Name:: Family
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) [goto IPDATETP]
(R,D) [goto IPHOW]

Question ID: FIJ.051_02.000

Instrument Variable Name: IPDATETP
Questionnaire File Name:: Family
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:

goto IPHOW
If IPDATENO GT 91 days (1) or
Hard Edit:
IPDATENO GT 13 weeks (2) or
IPDATENO GT 4 months (3) then goto 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
Questionnaire File Name:: Family
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:

goto IPHOW

Question ID: FIJ.060_00.000

Instrument Variable Name: IPHOW
Questionnaire File Name:: Family
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, goto ICAUS; else, if a poisoning episode, goto PPCC]
(R) [if an injury episode, fill "R" in ICAUS and goto IJBODY; else, if a poisoning episode, goto PPCC]
(D) [if an injury episode, fill "D" in ICAUS and goto IJBODY; else, if a poisoning episode, goto PPCC]

Question ID: FIJ.065_00.000

Instrument Variable Name: ICAUS
Questionnaire File Name:: Family
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:

goto IJBODY

Question ID: FIJ.070_00.000

Instrument Variable Name: IJBODY
Questionnaire File Name:: Family
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) [goto IJTYPE1]
(29) [goto IJBODYOS]
(R,D) [goto IPEV]

Question ID: FIJ.071_00.000

Instrument Variable Name: IJBODYOS
Questionnaire File Name:: Family
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:

goto IJTYPE1

Question ID: FIJ.072_00.000

Instrument Variable Name: IJTYPE1
Questionnaire File Name:: Family
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) [goto IJTYPE2 for next body part entered at IJBODY; if no more body parts, goto IPEV]
(9) [goto IJTYP1OS]
(R) [goto IPEV]

Question ID: FIJ.073_00.000

Instrument Variable Name: IJTYP1OS
Questionnaire File Name:: Family
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:

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

Question ID: FIJ.074_00.000

Instrument Variable Name: IJTYPE2
Questionnaire File Name:: Family
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) [goto IJTYPE3 for next body part entered at IJBODY; if no more body parts, goto IPEV]
(9) [goto IJTYP2OS]
(R) [goto IPEV]

Question ID: FIJ.075_00.000

Instrument Variable Name: IJTYP2OS
Questionnaire File Name:: Family
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:

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

Question ID: FIJ.076_00.000

Instrument Variable Name: IJTYPE3
Questionnaire File Name:: Family
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) [goto IJTYPE4 for next body part entered at IJBODY; if no more body parts, goto IPEV]
(9) [goto IJTYP3OS]
(R) [goto IPEV]

Question ID: FIJ.077_00.000

Instrument Variable Name: IJTYP3OS
Questionnaire File Name:: Family
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:

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

Question ID: FIJ.078_00.000

Instrument Variable Name: IJTYPE4
Questionnaire File Name:: Family
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) [goto IPEV]
(9) [goto IJTYP4OS]

Question ID: FIJ.079_00.000

Instrument Variable Name: IJTYP4OS
Questionnaire File Name:: Family
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, goto PPCC; else, goto IPEV

Question ID: FIJ.080_01.000

Instrument Variable Name: PPCC
Questionnaire File Name:: Family
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) [goto IPEV]
(R) [goto IPHOSP]

Question ID: FIJ.080_02.000

Instrument Variable Name: IPEV
Questionnaire File Name:: Family
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) [goto IPER]
(R) [goto IPHOSP]

Question ID: FIJ.080_03.000

Instrument Variable Name: IPER
Questionnaire File Name:: Family
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) [goto IPDO]
(R) [goto IPHOSP]

Question ID: FIJ.080_04.000

Instrument Variable Name: IPDO
Questionnaire File Name:: Family
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) [goto IPPCHCP]
(R) [goto IPHOSP]

Question ID: FIJ.080_05.000

Instrument Variable Name: IPPCHCP
Questionnaire File Name:: Family
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) [goto IPOTH]
(R) [goto IPHOSP]

Question ID: FIJ.080_06.000

Instrument Variable Name: IPOTH
Questionnaire File Name:: Family
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) [goto IPOTHOS]
if [MTFINJ3M= 01-91 and IPEV=2] goto 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,
goto 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 goto IPHOSP]
(R,D) [goto IPHOSP]

Question ID: FIJ.081_00.000

Instrument Variable Name: IPOTHOS
Questionnaire File Name:: Family
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:

goto IPHOSP

Question ID: FIJ.082_00.000

Instrument Variable Name: IPVER
Questionnaire File Name:: Family
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, goto PPCC for new entries; else if injury, goto IPEV for new entries]
ERR_IPVER
Hard Edit:

Question ID: FIJ.090_00.000

Instrument Variable Name: IPHOSP
Questionnaire File Name:: Family
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) [goto IPIHNO]
(2,R,D) [if an injury episode, goto IMTRAF; if a poisoning episode, goto PPOIS]

Question ID: FIJ.091_00.000

Instrument Variable Name: IPIHNO
Questionnaire File Name:: Family
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, goto IMTRAF; else, if ICAUS eq 4-7,R,D, goto IPWHAT; else, if ICAUS eq 5, goto IFALL; if a poisoning episode, goto PPOIS] (61-95) [goto ERR_IPIHNO]
[if IPIHNO gt 60, display ERR_IPIHNO]
Soft Edit:
* ^IPIHNO is unusually high. Please verify.
Suppress
Goto
Close
(Supress) [if ICAUS eq 01 or 02 or 03, goto IMTRAF]
if ICAUS eq 04 or 06 or 07 or 97, or 99, goto IPWHAT]
if ICAUS eq 05, goto IFALL]]
(Close, Goto) [reset IPIHNO for new entry]

Question ID: FIJ.109_00.000

Instrument Variable Name: IMTRAF
Questionnaire File Name:: Family
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:

goto IMVWHO

Question ID: FIJ.110_00.000

Instrument Variable Name: IMVWHO
Questionnaire File Name:: Family
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) [goto IMVTYP]
(4,5) [goto IHELMT]
(3,R,D) [goto IPWHAT]

Question ID: FIJ.111_00.000

Instrument Variable Name: IMVTYP
Questionnaire File Name:: Family
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) [goto ISBELT]
(5,6) [goto IHELMT]
(3,7,8,9,R,D) [goto IPWHAT]

Question ID: FIJ.112_00.000

Instrument Variable Name: ISBELT
Questionnaire File Name:: Family
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:

goto IPWHAT

Question ID: FIJ.113_00.000

Instrument Variable Name: IHELMT
Questionnaire File Name:: Family
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:

goto IPWHAT

Question ID: FIJ.130_00.000

Instrument Variable Name: IFALL
Questionnaire File Name:: Family
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:

goto IFALLWHY

Question ID: FIJ.131_00.000

Instrument Variable Name: IFALLWHY
Questionnaire File Name:: Family
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:

goto IPWHAT

Question ID: FIJ.140_00.000

Instrument Variable Name: PPOIS
Questionnaire File Name:: Family
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) [goto IPWHAT]
(6) [goto PPOISOS]

Question ID: FIJ.141_00.000

Instrument Variable Name: PPOISOS
Questionnaire File Name:: Family
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:

goto IPWHAT

Question ID: FIJ.150_00.000

Instrument Variable Name: IPWHAT
Questionnaire File Name:: Family
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) [goto IPWHER]
(11) [goto IPWHATOT]

Question ID: FIJ.151_00.000

Instrument Variable Name: IPWHATOT
Questionnaire File Name:: Family
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:

goto IPWHER

Question ID: FIJ.160_00.000

Instrument Variable Name: IPWHER
Questionnaire File Name:: Family
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, goto IPDATEM for that person; else if AGE lt 5 and person DOES NOT HAVE more injury/poisoning episodes, goto 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, goto IPEMP; else if AGE ge 5 and AGE le 12, goto IPSTU]

Question ID: FIJ.170_00.000

Instrument Variable Name: IPEMP
Questionnaire File Name:: Family
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) [goto IPWKLS]
(3,R,D) [goto IPSTU]

Question ID: FIJ.171_00.000

Instrument Variable Name: IPWKLS
Questionnaire File Name:: Family
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:

goto IPSTU

Question ID: FIJ.180_00.000

Instrument Variable Name: IPSTU
Questionnaire File Name:: Family
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) [goto IPSCLS] (3,R,DK) [If person HAS more injury/poisoning episodes, goto IPDATEM for that person; else if person DOES NOT HAVE more injury/poisoning episodes, goto TFINJ3M/TFPOI3M for next person with an injury/poisoning; else if no more family members with an injury/poisoning, goto next section]

Question ID: FIJ.181_00.000

Instrument Variable Name: IPSCLS
Questionnaire File Name:: Family
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, goto IPDATEM for that person; else if person DOES NOT HAVE more injury/poisoning episodes, goto TFINJ3M/TFPOI3M for next person with an injury/poisoning; else if no more family members with an injury/poisoning, goto next section]

Question ID: FAU.010_00.000

Instrument Variable Name: FDMED12M
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

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

Question ID: FAU.020_00.000

Instrument Variable Name: PDMED12M
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FAU.030_00.000

Instrument Variable Name: FNMED12M
Questionnaire File Name:: Family
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 Text: All families
Skip Instructions:

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

Question ID: FAU.040_00.000

Instrument Variable Name: PNMED12M
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FAU.050_00.000

Instrument Variable Name: FHOSPYR
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

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

Question ID: FAU.060_00.000

Instrument Variable Name: PHOSPYR
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FAU.070_00.000

Instrument Variable Name: HOSPNO
Questionnaire File Name:: Family
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) [goto HPNITE]
(11-365) [goto ERR_HOSPNO]
(R,D) [goto HPNITE]
ERR_HOSPNO
Soft Edit:
* [fill: HOSPNO] is unusually high.
* Verify entry.
* Make corrections if necessary.

Question ID: FAU.110_00.000

Instrument Variable Name: HPNITE
Questionnaire File Name:: Family
Question Text:

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

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

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

(1-50,R,D) [goto next person selected at PHOSPYR; if no more persons, goto FHCHM2W]
(51-365) [goto ERR1_HPNITE]
ERR1_HPNITE
Soft Edit:
* [fill: HPNITE] is unusually high.
* Verify entry.
* Make corrections if necessary.
ERR2_HPNITE
* Do not read.
* [fill: HPNITE] night(s) is less than the total number of times in the hospital overnight.
* Please verify.
Note: If edit suppressed, store S in HPNITE_FLG

Question ID: FAU.120_00.000

Instrument Variable Name: FHCHM2W
Questionnaire File Name:: Family
Question Text:

?[F1]
These next questions are about health care received DURING THE LAST 2 WEEKS. Include care from ALL types of medical doctors, such as dermatologists, psychiatrists, ophthalmologists (AHF-thal-MOL-oh-jists), and general practitioners. Also include care from OTHER health professionals such as nurses, physical therapists, and chiropractors.
Do not include dental care. Do not include care while an overnight patient in a hospital.
DURING THE LAST 2 WEEKS, did [fill: you/anyone in the family] receive care
AT HOME from a nurse or other health care professional?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

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

Question ID: FAU.130_00.000

Instrument Variable Name: PHCHM2W
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FAU.140_00.000

Instrument Variable Name: PHCHMN2W
Questionnaire File Name:: Family
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 goto FHCPH2W]
(15-50) [goto ERR_PHCHMN2W]
ERR_PHCHMN2W
Soft Edit:
* [fill: PHCHMN2W] is unusually high.
* Verify entry.
* DO NOT PROBE. Make corrections if necessary.

Question ID: FAU.150_00.000

Instrument Variable Name: FHCPH2W
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

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

Question ID: FAU.160_00.000

Instrument Variable Name: PHCPH2W
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FAU.170_00.000

Instrument Variable Name: PHCPHN2W
Questionnaire File Name:: Family
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 goto FHCDV2W]
(15-50) [goto ERR_PHCPHN2W]
ERR_PHCPHN2W
Soft Edit:
* [fill: PHCPHN2W] is unusually high.
* Verify that all calls were within the two week period.
* Make corrections if necessary.

Question ID: FAU.180_00.000

Instrument Variable Name: FHCDV2W
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

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

Question ID: FAU.190_00.000

Instrument Variable Name: PHCDV2W
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FAU.200_00.000

Instrument Variable Name: PHCDVN2W
Questionnaire File Name:: Family
Question Text:

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

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

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

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

(15-50) [goto ERR_PHCDVN2W]
ERR_PHCDVN2W
Soft Edit:
* [fill: PHCDVN2W] is unusually high.
* Verify that all visits were within the two week reference period.
* Make corrections if necessary.

Question ID: FAU.210_00.000

Instrument Variable Name: F10DVYR
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

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

Question ID: FAU.220_00.000

Instrument Variable Name: P10DVYR
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHI.050_00.000

Instrument Variable Name: FHICOV
Questionnaire File Name:: Family
Question Text:

(book) F12 and (book) F14
The next questions are about health insurance. Include health insurance obtained through employment or purchased directly as well as government programs like Medicare and Medicaid that provide Medical care or help pay medical bills.
[fill: Are you/Is anyone in the family] covered by any kind of health insurance or some other kind of health care plan?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

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

Question ID: FHI.070_00.000

Instrument Variable Name: HIKIND
Questionnaire File Name:: Family
Question Text:

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

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

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

(R,D) [goto HCSPFYR]
(1-10) [if AGE ge 65 and HIKIND ne 2, goto MCAREPRB; else, if HIKIND ne 10 goto SINCOV; else, goto
HICHANGE]
(11) [if HIKIND = 1-10, goto ERR_HIKIND; else, if AGE ge 65 goto MCAREPRB; else, goto MCAIDPRB]
ERR_HIKIND:
Hard Edit:
* Cannot mark "No coverage of any kind" and another type.
* Please correct.

Question ID: FHI.072_00.000

Instrument Variable Name: MCAREPRB
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHI.073_00.000

Instrument Variable Name: MCAIDPRB
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

goto SINCOV

Question ID: FHI.074_00.000

Instrument Variable Name: SINCOV
Questionnaire File Name:: Family
Question Text:

[fill 1: Do you/Does ALIAS] have a separate insurance plan that pays for only one type of service such as dental, vision, or prescriptions?

1 Yes
2 No
7 Refused
9 Don't know

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

goto HICHANGE

Question ID: FHI.075_00.000

Instrument Variable Name: HICHANGE
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons
Skip Instructions:

(1,R,D) [repeat for all eligible persons, then goto MCPART]
(2) [goto ERR_HICHANGE]
ERR_HICHANGE
Hard Edit:
*Press enter to go back to HIKIND and update coverage.

Question ID: FHI.090_00.000

Instrument Variable Name: MCPART
Questionnaire File Name:: Family
Question Text:

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

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

Universe Text: All persons with Medicare
Skip Instructions:

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

Question ID: FHI.092_00.000

Instrument Variable Name: MCCARD
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No

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

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

Question ID: FHI.095_00.000

Instrument Variable Name: MCCHOICE
Questionnaire File Name:: Family
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:

goto MCHMO

Question ID: FHI.100_00.000

Instrument Variable Name: MCHMO
Questionnaire File Name:: Family
Question Text:

? [F1]
[fill: Are you/Is ALIAS] under a Medicare managed care arrangement, such as an HMO, that is, a Health Maintenance Organization? (With an HMO, you must generally receive care from HMO doctors, otherwise the expense is not covered unless you were referred by the HMO or there was a medical emergency).

1 Yes
2 No
7 Refused
9 Don't know

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

(1) [goto MCANAME]
(2,R,D) [if MCCHOICE=1, goto MCANAME; else if MCCHOICE=2,R,D, goto MCREF]

Question ID: FHI.112_00.000

Instrument Variable Name: MCANAME
Questionnaire File Name:: Family
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) goto MCPREM

Question ID: FHI.113_00.000

Instrument Variable Name: MCPREM
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

(1,2,R,D) goto MCREF

Question ID: FHI.114_00.000

Instrument Variable Name: MCREF
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

(1,2,R,D) goto MCPARTD

Question ID: FHI.118_00.000

Instrument Variable Name: MCPARTD
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with Medicare
Skip Instructions:

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

Question ID: FHI.120_00.000

Instrument Variable Name: MACHMD
Questionnaire File Name:: Family
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). [fill 2:you are/ALIAS is] listed as having Medicaid coverage. Can [fill 3: you/ALIAS] go to ANY doctor who will accept Medicaid or MUST [fill 4:you/he/she] choose from a list of doctors or is a doctor assigned?

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

Universe Text: All persons with Medicaid
Skip Instructions:

1,R,D [goto MXCHNG]
2 [goto MACHMD1]
3 [goto MACHMD2]

Question ID: FHI.130_00.000

Instrument Variable Name: MACHMD1
Questionnaire File Name:: Family
Question Text:

* Ask or verify. What is the name of the health plan that provided the 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 list of doctors
Skip Instructions:

goto MANAM

Question ID: FHI.131_00.000

Instrument Variable Name: MACHMD2
Questionnaire File Name:: Family
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

goto MANAM

Question ID: FHI.132_00.000

Instrument Variable Name: MANAM
Questionnaire File Name:: Family
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

1 Yes
2 No

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

goto MXCHNG

Question ID: FHI.135_00.010

Instrument Variable Name: MXCHNG
Questionnaire File Name:: Family
Question Text:

Was [fill: your/ALIAS's] Medicaid obtained through Healthcare.gov or the [fill: Health Insurance Marketplace/Health Insurance Marketplace, such as (fill: state name)]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with Medicaid coverage
Skip Instructions:

(1, 2, R, D) goto MEDPREM

Question ID: FHI.135_00.020

Instrument Variable Name: MEDPREM
Questionnaire File Name:: Family
Question Text:

A health insurance premium is the amount you or a family member pays each month for health care coverage. Do you or a family member pay a premium for [Fill 1 : your/ALIAS's] Medicaid plan?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with Medicaid coverage
Skip Instructions:

(1) goto MDPRINC (2,R,D) goto loop through all persons in the family with Medicaid, when roster is finished, goto next appropriate group of questions

Question ID: FHI.137_00.030

Instrument Variable Name: MDPRINC
Questionnaire File Name:: Family
Question Text:

Is the premium paid for this Medicaid plan based on income?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with Medicaid coverage who pay a premium for their plan
Skip Instructions:

loop through all persons in the family with Medicaid, when roster is finished, goto next appropriate group of questions

Question ID: FHI.156_00.000

Instrument Variable Name: SSTYPE2
Questionnaire File Name:: Family
Question Text:

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

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

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

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

Question ID: FHI.157_00.000

Instrument Variable Name: SSOTHER
Questionnaire File Name:: Family
Question Text:

* Other type of single-service plan

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Question ID: FHI.158_00.000

Instrument Variable Name: FHICCI6
Questionnaire File Name:: Family
Question Text:

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

1 Continue

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

goto HIPNAM1

Question ID: FHI.160_00.000

Instrument Variable Name: HIPNAM1
Questionnaire File Name:: Family
Question Text:

It is important that we record the complete and accurate name of each health insurance plan. What is the COMPLETE name of the first plan?
Do NOT include plans that only provide extra cash while in the hospital or plans that pay for only one type of service, such as nursing home care, accidents, or dental care.
* Read if necessary: Do you have your health plan card or something with the plan name on it?

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Question ID: FHI.160_01.000

Instrument Variable Name: PCARD1
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No

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

goto HIPNAM1B

Question ID: FHI.170_00.000

Instrument Variable Name: HIPNAM1B
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHI.171_00.000

Instrument Variable Name: MORPLAN
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHI.172_00.000

Instrument Variable Name: HIPNAM2
Questionnaire File Name:: Family
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Question ID: FHI.172_01.000

Instrument Variable Name: PCARD2
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No

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

goto HIPNAM2B

Question ID: FHI.173_00.000

Instrument Variable Name: HIPNAM2B
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHI.174_00.000

Instrument Variable Name: MORPLAN2
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHI.175_00.000

Instrument Variable Name: HIPNAM3
Questionnaire File Name:: Family
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Question ID: FHI.175_01.000

Instrument Variable Name: PCARD3
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No

Universe Text: All private health insurance plans where the plan name was entered at HIPNAM3
Skip Instructions:

goto HIPNAM3B

Question ID: FHI.176_00.000

Instrument Variable Name: HIPNAM3B
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHI.177_00.000

Instrument Variable Name: MORPLAN3
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHI.178_00.000

Instrument Variable Name: HIPNAM4
Questionnaire File Name:: Family
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Question ID: FHI.178_01.000

Instrument Variable Name: PCARD4
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No

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

goto HIPNAM4B

Question ID: FHI.179_00.000

Instrument Variable Name: HIPNAM4B
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHI.180_00.000

Instrument Variable Name: HIVER1
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

(1) [ goto HIVER2]
(2,R,D) [goto ERR_HIVER1]
ERR_HIVER1
Hard Edit:
*Press ENTER to go back to HIKIND to update health insurance coverage.

Question ID: FHI.190_00.000

Instrument Variable Name: HIVER2
Questionnaire File Name:: Family
Question Text:

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

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

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

(1-4) [update responses for HIPNAM1B/HIPNAM2B/HIPNAM3B/HIPNAM4B and goto FHICCI8]
(5) [if 4 plans were reported, ignore this 5th plan and goto FHICCI8; else, goto HIPNAM2, or HIPNAM3, or
HIPNAM4 accordingly to enter information on this plan]
(R,D) [goto FHICCI8]

Question ID: FHI.195_01.000

Instrument Variable Name: FHICCI8
Questionnaire File Name:: Family
Question Text:

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

1 Continue

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

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

Question ID: FHI.200_01.000

Instrument Variable Name: FHI200
Questionnaire File Name:: Family
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) [ goto PRPOLH]
(01 to 25) [go to PRCOOH]
(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.202_01.010

Instrument Variable Name: PRPOLH
Questionnaire File Name:: Family
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) [goto PLNWRK]
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.

Question ID: FHI.204_01.010

Instrument Variable Name: PRCOOH
Questionnaire File Name:: Family
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:

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

Question ID: FHI.210_01.000

Instrument Variable Name: PLNWRK
Questionnaire File Name:: Family
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 Healthcare.gov or the Affordable Care Act, also known as Obamacare
07 Through a state/local government or community program
08 Other, specify
97 Refused
99 Don't know

Universe Text: All private health insurance plans
Skip Instructions:

(1-4,6) goto PLNPAY
(5,7,R,D) goto PLNEXCHG
(8) goto PLNWKSP
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.

Question ID: FHI.211_01.000

Instrument Variable Name: PLNWKSP
Questionnaire File Name:: Family
Question Text:

*Read if necessary.
How was this plan obtained?

Verbatim Verbatim response
7 Refused
9 Don't know

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

Goto PLNEXCHG
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.215_01.010

Instrument Variable Name: PLNEXCHG
Questionnaire File Name:: Family
Question Text:

Was the plan obtained through Healthcare.gov or the [fill: Health Insurance Marketplace/Health Insurance Marketplace, such as (fill: state name)]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All private health insurance plans that are not employer based, have not indicated through the exchange (or of unknown origins)
Skip Instructions:

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

Question ID: FHI.220_10.000

Instrument Variable Name: PLNPAY
Questionnaire File Name:: Family
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:

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

Question ID: FHI.225_01.000

Instrument Variable Name: PLNPRE
Questionnaire File Name:: Family
Question Text:

Is the premium paid for this plan based on income?

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Private plan paid for by self or family
Skip Instructions:

(1,2,R,D) [goto HICOSTN]
NOTE: This is a new question beginning in Q4 2013. 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
Questionnaire File Name:: Family
Question Text:

1of 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:

(1-99995) [goto HICOSTT]
(R) [store "R" in HICOSTT and goto PLNMGD]
(D) [store "D" in HICOSTT and goto PLNMGD]
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.
ERR_HICOSTN
Soft Edit:
* [fill # from HICOSTN] is unusually high. Please verify.
Make corrections if necessary.

Question ID: FHI.230_12.000

Instrument Variable Name: HICOSTT
Questionnaire File Name:: Family
Question Text:

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

Question ID: FHI.240_01.000

Instrument Variable Name: PLNMGD
Questionnaire File Name:: Family
Question Text:

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

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

Universe Text: All private health insurance plans
Skip Instructions:

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

Question ID: FHI.241_01.000

Instrument Variable Name: HDHP
Questionnaire File Name:: Family
Question Text:

?[F1]
[If only one person covered by this plan:]
Is the annual deductible for medical care for this plan less than $1,300 or $1,300 or more? If there is a separate deductible for prescription drugs, hospitalization, or out-of-network care, do not include those deductible amounts here.
[If two or more persons in the family are covered by this plan:]
Is the family annual deductible for medical care for this plan less than $2,600 or $2,600 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 [$1,300/$2,600]
2 [$1,300/$2,600] or more
7 Refused
9 Don't know

Universe Text: All private health insurance plans
Skip Instructions:

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

Question ID: FHI.242_01.000

Instrument Variable Name: HSAHRA
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FHI.243_01.000

Instrument Variable Name: MGCHMD
Questionnaire File Name:: Family
Question Text:

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

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

Universe Text: All private health insurance plans
Skip Instructions:

(1) [goto MGPRMD]
(2) [goto MGPYMD] (R,D) [goto PCPREQ]
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
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

goto PCPREQ

Question ID: FHI.246_01.000

Instrument Variable Name: MGPYMD
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

goto PCPREQ 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_05.000

Instrument Variable Name: PCPREQ
Questionnaire File Name:: Family
Question Text:

Does this plan REQUIRE [fill1: you/ALIAS/the family members with this plan] to have a primary care doctor who approves all your 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) [goto PRRXCOV] NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.

Question ID: FHI.249_01.010

Instrument Variable Name: PRRXCOV
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All private health insurance plans
Skip Instructions:

goto 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
Questionnaire File Name:: Family
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:

goto FHICCI8 for the next private health insurance plan; else, goto FCOVCONF 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_03.000

Instrument Variable Name: FCOVCONF
Questionnaire File Name:: Family
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) goto STNAME1 or STNAME2 or STNAME3 or MILSPC or HILAST or HINOTYR

Question ID: FHI.250_00.000

Instrument Variable Name: STNAME1
Questionnaire File Name:: Family
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text: All persons with SCHIP
Skip Instructions:

goto CHXCHNG

Question ID: FHI.250_00.010

Instrument Variable Name: CHXCHNG
Questionnaire File Name:: Family
Question Text:

Was [fill 1: your/ALIAS's] CHIP plan obtained through Healthcare.gov or the [Health Insurance Marketplace/Health Insurance Marketplace, such as (fill: state name)]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with SCHIP
Skip Instructions:

(1,2,R,D) goto STRFPRM1

Question ID: FHI.250_00.020

Instrument Variable Name: STRFPRM1
Questionnaire File Name:: Family
Question Text:

A health insurance premium is the amount you or a family member pays each month for health care coverage. Do you or a family member pay a premium for this CHIP plan?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with SCHIP
Skip Instructions:

(1) goto CHPRINC
(2,R,D) goto STDOC1

Question ID: FHI.250_00.030

Instrument Variable Name: CHPRINC
Questionnaire File Name:: Family
Question Text:

Is the premium paid for [fill 1: ^STNAME1/this CHIP plan] based on income?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Those with SCHIP coverage who pay a premium for their plan
Skip Instructions:

(1,2,R,D) goto STDOC1

Question ID: FHI.251_00.000

Instrument Variable Name: STDOC1
Questionnaire File Name:: Family
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 list of doctors or is a doctor assigned?

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

Universe Text: All persons with SCHIP
Skip Instructions:

(1,2,R,D) goto next person in roster, else goto STNAME2

Question ID: FHI.257_00.000

Instrument Variable Name: STNAME2
Questionnaire File Name:: Family
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

goto OPXCHNG

Question ID: FHI.257_00.010

Instrument Variable Name: OPXCHNG
Questionnaire File Name:: Family
Question Text:

Was [fill 1: your/ALIAS's] state sponsored health plan obtained through Healthcare.gov or the [fill: Health Insurance Marketplace/Health Insurance Marketplace, such as (fill: state name)]?

1 Yes
2 No
7 Refused
9 Don't know

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

(1,2,R,D) goto STRFPRM2

Question ID: FHI.257_00.020

Instrument Variable Name: STRFPRM2
Questionnaire File Name:: Family
Question Text:

A health insurance premium is the amount you or a family member pays each month for health care coverage. Do you or a family member pay a premium for [fill : your/ALIAS's] state-sponsored health plan?

1 Yes
2 No
7 Refused
9 Don't know

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

(1) goto SSPRINC (2,R,D) goto STDOC2

Question ID: FHI.257_00.030

Instrument Variable Name: SSPRINC
Questionnaire File Name:: Family
Question Text:

Is the premium paid for [fill 1: ^STNAME2/this state sponsored plan] based on income?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Those with state sponsored health plan who pay a premium for their plan
Skip Instructions:

(1,2,R,D) goto STDOC2

Question ID: FHI.258_00.000

Instrument Variable Name: STDOC2
Questionnaire File Name:: Family
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 list of doctors or is a doctor assigned?

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

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

(1,2,R,D) goto STNAME3

Question ID: FHI.264_00.000

Instrument Variable Name: STNAME3
Questionnaire File Name:: Family
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

goto OGXCHNG

Question ID: FHI.264_00.010

Instrument Variable Name: OGXCHNG
Questionnaire File Name:: Family
Question Text:

Was [fill1: your/ALIAS's] other government program obtained through Healthcare.gov or the [fill: Health Insurance Marketplace/Health Insurance Marketplace, such as (fill: state name)]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with an other government program
Skip Instructions:

(1,2,R,D) goto STRFPRM3

Question ID: FHI.264_00.020

Instrument Variable Name: STRFPRM3
Questionnaire File Name:: Family
Question Text:

A health insurance premium is the amount you or a family member pays each month for health care coverage. Do you or a family member pay a premium for [fill : your/ALIAS's] other government program?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with an other government program
Skip Instructions:

(1) goto OGPRINC (2,R,D) goto STDOC3

Question ID: FHI.264_00.030

Instrument Variable Name: OGPRINC
Questionnaire File Name:: Family
Question Text:

Is the premium paid for [fill 1: ^STNAME3/this other government plan] based on income?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Those with other government health plan who pay a premium for their plan
Skip Instructions:

(1,2,R,D) goto STDOC3

Question ID: FHI.265_00.000

Instrument Variable Name: STDOC3
Questionnaire File Name:: Family
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 list of doctors or is a doctor assigned?

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

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

(1,2,R,D) goto MILSPC

Question ID: FHI.270_00.000

Instrument Variable Name: MILSPC
Questionnaire File Name:: Family
Question Text:

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

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

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

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

Question ID: FHI.271_00.000

Instrument Variable Name: MILSPCOT
Questionnaire File Name:: Family
Question Text:

* Other military coverage

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Question ID: FHI.275_00.000

Instrument Variable Name: MILMAN
Questionnaire File Name:: Family
Question Text:

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

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

Universe Text: All persons with TRICARE coverage
Skip Instructions:

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

Question ID: FHI.276_00.000

Instrument Variable Name: MILMANOT
Questionnaire File Name:: Family
Question Text:

* Other type of TRICARE coverage

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Question ID: FHI.280_00.000

Instrument Variable Name: HILAST
Questionnaire File Name:: Family
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 less than 1 year
3 1 year
4 More than 1 year, but less than 3 years
5 3 years or more
6 Never
7 Refused
9 Don't know

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

goto HISTOP

Question ID: FHI.290_00.000

Instrument Variable Name: HISTOP
Questionnaire File Name:: Family
Question Text:

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

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

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

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

Question ID: FHI.291_00.000

Instrument Variable Name: HISTOPOT
Questionnaire File Name:: Family
Question Text:

? [F1]
* Other reason for not having coverage

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Question ID: FHI.300_00.000

Instrument Variable Name: HINOTYR
Questionnaire File Name:: Family
Question Text:

In the PAST 12 MONTHS, was there any time when [fill: you/ALIAS] did NOT have ANY health insurance or coverage?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with known health insurance coverage except single service plans
Skip Instructions:

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

Question ID: FHI.310_00.000

Instrument Variable Name: HINOTMYR
Questionnaire File Name:: Family
Question Text:

In the PAST 12 MONTHS, about how many months [fill: were you/was ALIAS] without coverage?
* If less than 1 month, enter '1'.

01-12 1-12 months
97 Refused
99 Don't know

Universe Text: All persons with known health insurance coverage, but did not have health insurance for some period of time in the past 12 months
Skip Instructions:

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

Question ID: FHI.312_00.010

Instrument Variable Name: FHICHNG
Questionnaire File Name:: Family
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) [goto HCSPFYR]
(2) [goto FHIKDB]

Question ID: FHI.315_00.010

Instrument Variable Name: FHIKDB
Questionnaire File Name:: Family
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) [goto PWRKB]
(2-11,R,D) [goto HCSPFYR]

Question ID: FHI.316_00.010

Instrument Variable Name: PWRKB
Questionnaire File Name:: Family
Question Text:

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

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

Universe Text: All persons who had private health insurance previously
Skip Instructions:

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

Question ID: FHI.317_00.010

Instrument Variable Name: PWRKBSP
Questionnaire File Name:: Family
Question Text:

*Enter how private health insurance was obtained.

Verbatim Verbatim response
7 Refused
9 Don't know

Universe Text: All persons who had private health insurance obtained from other source previously
Skip Instructions:

(Allow 75 characters) [goto HCSPFYR]

Question ID: FHI.320_00.000

Instrument Variable Name: HCSPFYR
Questionnaire File Name:: Family
Question Text:

(book) F19
The next question is about money that [fill1: you have/your family has] spent out of pocket on medical care. We do NOT want you to count health insurance premiums, over the counter drugs, or costs that you will be reimbursed for. In the PAST 12 MONTHS, about how much did [fill2: you/your family] spend for medical care and dental care?

0 Zero
1 Less than $500
2 $500 - $1,999
3 $2,000 - $2,999
4 $3,000 - $4,999
5 $5,000 or more
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

goto MEDBILL

Question ID: FHI.325_00.010

Instrument Variable Name: MEDBILL
Questionnaire File Name:: Family
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) [goto MEDBPAY]

Question ID: FHI.327_00.010

Instrument Variable Name: MEDBPAY
Questionnaire File Name:: Family
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 [goto FSA]; else [goto MEDBNOP]

Question ID: FHI.327_00.020

Instrument Variable Name: MEDBNOP
Questionnaire File Name:: Family
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) [goto FSA]

Question ID: FHI.330_00.000

Instrument Variable Name: FSA
Questionnaire File Name:: Family
Question Text:

[fill 1: Do you/Does anyone in your family] have a Flexible Spending Account for health expenses? These accounts are offered by some employers to allow employees to set aside pre-tax dollars of their own money for their use throughout the year to reimburse themselves for their out-of-pocket expenses for health care. With this type of account, any money remaining in the account at the end of the year, following a short grace period, is lost to the employee.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All Families
Skip Instructions:

goto PLBORN

Question ID: FSD.001_00.000

Instrument Variable Name: PLBORN
Questionnaire File Name:: Family
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons
Skip Instructions:

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

Question ID: FSD.002_00.000

Instrument Variable Name: PLBORN1
Questionnaire File Name:: Family
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) [goto HEADST]

Question ID: FSD.003_00.000

Instrument Variable Name: PLBORN2
Questionnaire File Name:: Family
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 SOUH 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 goto USYR] (100-696,996,R,D) [goto USYR]

Question ID: FSD.004_00.000

Instrument Variable Name: USYR
Questionnaire File Name:: Family
Question Text:

* Read if necessary. Earlier I recorded [fill1: your/ALIAS's] date of birth as [fill2: AGEDOB@3(text version) AGEDOB@4, AGEDOB@5]. In what year did [fill3: you/ALIAS] come to the United States to stay?

1880-Current 1880-Current
Year Year
9997 Refused
9999 Don't know

Universe Text: All persons not born in the United States
Skip Instructions:

(1880-Current Year) [if USYR lt AGEDOB@5, goto ERR2_USYR; else, goto CITIZEN]
(R,D) [goto USLONG]
NOTE: The "*Read if necessary?Earlier I recorded?" portion of this question is included for persons with
complete date of birth information.
ERR1_USYR
Hard Edit:
*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
Questionnaire File Name:: Family
Question Text:

About how long [fill1: have you/has ALIAS] been in the United States?
* Read if necessary: Earlier I recorded that [fill2: you are/ALIAS is] [fill3: AGE] years old.
*Enter '95' for 95 or more years.
*If less than 1 year given as a response, code the answer as '0'.

00-94 00-94 years
95 95+ years
97 Refused
99 Don't know

Universe Text: All persons not born in the United States and refused or don't know was reported for USYR
Skip Instructions:

(0-95) [if USLONG gt AGE, goto ERR_USLONG; else, goto CITIZEN]
(R,D) [goto CITIZEN]
ERR_LONG: * In US longer than alive!
Hard Edit:
* Please correct.

Question ID: FSD.006_00.000

Instrument Variable Name: CITIZEN
Questionnaire File Name:: Family
Question Text:

(book) F20 ?[F1]
[fill: Are you/Is ALIAS] a CITIZEN of the United States?

1 Yes, born in one of the 50 United States or the District of Columbia
2 Yes, born in Puerto Rico, Guam, American Virgin Islands, or other U.S. territory
3 Yes, born abroad to American parent(s)
4 Yes, U.S. citizen by naturalization
5 No, not a citizen of the United States
7 Refused
9 Don't know

Universe Text: All persons not born in the United States or a United States territory
Skip Instructions:

(1) [if PLBORN eq 2, goto ERR1_CITIZEN; else, if PLBORN eq R, goto ERR3_CITIZEN; else, goto HEADST]
(2) [if (PLBORN eq 2 or PLBORN eq R), goto ERR2_CITIZEN; else, goto HEADST] (R,D) [goto HEADST]
ERR1_CITIZEN
Hard Edit:
*Already indicated birth outside the United States.
*Please correct.
ERR2_CITIZEN
*Already indicated birth outside United States territory.
*Please correct.
ERR3_CITIZEN: Refused
Soft Edit:
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
Questionnaire File Name:: Family
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, goto EDUC; else, repeat this question for the next eligible person] (2,R,D) [ goto HEADSTEV]

Question ID: FSD.008_00.000

Instrument Variable Name: HEADSTEV
Questionnaire File Name:: Family
Question Text:

Has [fill: ALIAS] ever attended Head Start?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons less than 18 years of age and not currently enrolled in Head Start
Skip Instructions:

if no more persons less than 7 years of age, goto EDUC; else, goto HEADST for the next eligible person

Question ID: FSD.010_00.000

Instrument Variable Name: EDUC
Questionnaire File Name:: Family
Question Text:

(book) F21 ?[F1]
What is the HIGHEST level of school [fill: you have/ALIAS has] completed or the highest degree [fill: you have/ALIAS has] received? Please tell me the number from the card.
* Enter highest level of school completed.

00 Never attended/kindergarten only
01 1st grade
02 2nd grade
03 3rd grade
04 4th grade
05 5th grade
06 6th grade
07 7th grade
08 8th grade
09 9th grade
10 10th grade
11 11th grade
12 12th grade, no diploma
13 GED or equivalent
14 High School Graduate
15 Some college, no degree
16 Associate degree: occupational, technical, or vocational program
17 Associate degree: academic program
18 Bachelor's degree (Example: BA, AB, BS, BBA)
19 Master's degree (Example: MA, MS, MEng, MEd, MBA)
20 Professional School degree (Example: MD, DDS, DVM, JD)
21 Doctoral degree (Example: PhD, EdD)
96 Child under 5 years old
97 Refused
99 Don't know

Universe Text: All persons 5 years of age or older
Skip Instructions:

repeat for all eligible persons, then goto ARMFVER

Question ID: FSD.020_00.000

Instrument Variable Name: ARMFVER
Questionnaire File Name:: Family
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) [goto ARMFFC] (2,R,D) [goto ARMFEV]

Question ID: FSD.021_00.000

Instrument Variable Name: ARMFEV
Questionnaire File Name:: Family
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) [goto ARMFFC] (2,R,D) [goto DOINGLW]

Question ID: FSD.022_00.000

Instrument Variable Name: ARMFFC
Questionnaire File Name:: Family
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) [goto ARMFTMP]

Question ID: FSD.023_00.000

Instrument Variable Name: ARMFTMP
Questionnaire File Name:: Family
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 May 1975 to July 1990
04 Vietnam era (August 1964 to April 1975)
05 February 1955 to July 1964
06 Korean War (July 1950 to January 1955)
07 January 1947 to June 1950
08 December 1946 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:

(1,3-8,R,D) [goto DOINGLW] (2) [goto ARMFDS]
If gray answer code is selected please display:
Hard Edit:
That selection is not valid at this time.
Please correct.

Question ID: FSD.024_00.000

Instrument Variable Name: ARMFDS
Questionnaire File Name:: Family
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) [goto DOINGLW]

Question ID: FSD.050_00.000

Instrument Variable Name: DOINGLW
Questionnaire File Name:: Family
Question Text:

(book) F22 ? [F1]
The next few questions are about employment status.
Which of the following [fill: were you/was ALIAS] doing last week?
* Read answer categories.

1 Working for pay at a job or business
2 With a job or business but not at work
3 Looking for work
4 Working, but not for pay, at a family-owned job or business
5 Not working at a job or business and not looking for work
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older
Skip Instructions:

(1,4) [goto WRKHRS]
(2,5) [goto WHYNOWRK]
(3,R,D) [goto WRKLYR]
NOTE: A flashcard was added to this question in quarter 3 of 2005.

Question ID: FSD.060_00.000

Instrument Variable Name: WHYNOWRK
Questionnaire File Name:: Family
Question Text:

?[F1]
What is the main reason [fill1: you/ALIAS] did not [fill2: work last week/have a job or business last week]?

01 Taking care of house or family
02 Going to school
03 Retired
04 On a planned vacation from work
05 On family or maternity leave
06 Temporarily unable to work for health reasons
07 Have job/contract and off-season
08 On layoff
09 Disabled
10 Other
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who were either with a job or business but not at work, or not working at a job or business and not looking for work
Skip Instructions:

(1-3,8-10,R,D) [goto WRKLYR]
(4-7) [goto WRKHRS]

Question ID: FSD.070_00.000

Instrument Variable Name: WRKHRS1
Questionnaire File Name:: Family
Question Text:

?[F1]
How many hours [fill: did you work LAST WEEK at ALL jobs or businesses/did ALIAS work LAST WEEK at ALL jobs or businesses/do you USUALLY work at ALL jobs or businesses/does ALIAS USUALLY work at ALL jobs or businesses]?

001-168 1-168 hours
997 Refused
999 Don't know

Universe Text: All persons 18 years of age or older who were working for pay at a job or business, or working, but not for pay, at a job or business last week, or on a planned vacation from work, or on family or maternity leave, or temporarily unable to work for health reasons, or have a job/contract and off-season
Skip Instructions:

(1-34,R,D) [goto WRKFTALL]
(35-94) [goto WRKLYR]
(95-168) [goto ERR1_WRKHRS]
* [Fill: WRKHRS] is an unusually high number.
Soft Edit:
* Please verify.

Question ID: FSD.080_00.000

Instrument Variable Name: WRKFTALL
Questionnaire File Name:: Family
Question Text:

?[F1]
[fill: Do you/Does ALIAS] USUALLY work 35 hours or more per week in total at ALL jobs or businesses?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who worked less than 35 hours last week or did not know/refused to answer how many hours they worked last week
Skip Instructions:

[goto WRKLYR]
NOTE ON QUESTIONNAIRE FLOW: The instrument cycles through the appropriate questions from DOINGLW to WRKFTALL for each eligible person, then proceeds to WRKLYR.

Question ID: FSD.100_00.000

Instrument Variable Name: WRKLYR
Questionnaire File Name:: Family
Question Text:

?[F1]
Did [fill1: you/ALIAS] work for pay at any time in [fill2: last calendar year in 4-digit format]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older
Skip Instructions:

(1) [goto WRKMYR]
(2,R,D) [goto HIEMPOF]

Question ID: FSD.110_00.000

Instrument Variable Name: WRKMYR
Questionnaire File Name:: Family
Question Text:

How many months in [fill1: last calendar year in 4-digit format] did [fill2: you/ALIAS] have at least one job or business?
* If less than one month, enter '1'.

01 1 month or less
02-12 2-12 months
97 Refused
99 Don't know

Universe Text: All persons 18 years of age or older who worked last year
Skip Instructions:

goto ERNYR

Question ID: FSD.120_00.000

Instrument Variable Name: ERNYR
Questionnaire File Name:: Family
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:

goto HIEMPOF

Question ID: FSD.130_00.000

Instrument Variable Name: HIEMPOF
Questionnaire File Name:: Family
Question Text:

Regarding [fill1: your/ALIAS's] job or work last week, was health insurance offered to [fill2: you/ALIAS] through [fill1: your/ALIAS's] workplace?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons 18 years of age or older who were working for pay at a job or business, or with a job or business, but not at work, or working, but not for pay, at a family-owned job or business
Skip Instructions:

goto INTROINC
NOTE ON QUESTIONNAIRE FLOW: The instrument cycles through the appropriate questions from WRKLYR to HIEMPOF for each eligible person, then proceeds to INTROINC.

Question ID: FIN.010_00.000

Instrument Variable Name: FINCINT
Questionnaire File Name:: Family
Question Text:

* Read the following.
The next questions are about [fill1: your total/your total family] income in [fill2: last calendar year in 4-digit format] BEFORE TAXES.
Income is important in analyzing the health information we collect. For example, with this information, we can learn whether persons in one income group use certain types of medical services more or less often than those in another group. Please be assured that, like all other information you have provided, these answers will be kept strictly confidential.

1 Enter 1 to continue

Universe Text: All families
Skip Instructions:

goto FSAL

Question ID: FIN.030_00.000

Instrument Variable Name: FSAL
Questionnaire File Name:: Family
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 goto FSEINC; else, goto PSAL]
(2,R,D) [goto FSEINC]

Question ID: FIN.040_00.000

Instrument Variable Name: PSAL
Questionnaire File Name:: Family
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons 18 years of age or older and at least one received income from wages and salaries in the last calendar year
Skip Instructions:

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

Question ID: FIN.050_00.000

Instrument Variable Name: FSEINC
Questionnaire File Name:: Family
Question Text:

[fill1: Did you receive income in [fill2: last calendar year in 4-digit format] from self-employment including business and farm income?/ Did ALIAS receive income in [fill2: last calendar year in 4-digit format] from self-employment including business and farm income?/Did any family members 18 and older, that is
*Read names
(fill roster of people ge 18 years of age)
receive income in [fill2: last calendar year in 4-digit format] from...self-employment including business and farm income?]

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: FIN.060_00.000

Instrument Variable Name: PSEINC
Questionnaire File Name:: Family
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons 18 years of age or older and at least one received income from self-employment in the last calendar year
Skip Instructions:

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

Question ID: FIN.070_00.000

Instrument Variable Name: FSSRR
Questionnaire File Name:: Family
Question Text:

? [F1]
Did [fill1: you/any family members living here] receive income in [fill2: last calendar year in 4-digit format] from Social Security or Railroad Retirement?
* Read if necessary: Social Security checks are either automatically deposited in the bank or mailed to arrive on the third of every month.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

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

Question ID: FIN.080_00.000

Instrument Variable Name: PSSRR
Questionnaire File Name:: Family
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received income from Social Security or Railroad Retirement in the last calendar year
Skip Instructions:

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

Question ID: FIN.082_00.000

Instrument Variable Name: FSSRRD
Questionnaire File Name:: Family
Question Text:

Was [fill: your/any family member's *Read names
(fill roster of all persons selected at PSSRR and AGE LE 64)]
Social Security or Railroad Retirement income received as a disability benefit?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with persons less than 65 years of age who received Social Security or Railroad Retirement income in the last calendar year
Skip Instructions:

(1) [if only one person less than 65 years of age received Social Security or Railroad Retirement income, fill the person number in PSSRRDB and goto PSSRRD; else, goto PSSRRDB] (2,R,D) [goto FPENS]

Question ID: FIN.084_00.000

Instrument Variable Name: PSSRRDB
Questionnaire File Name:: Family
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:

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

Question ID: FIN.086_00.000

Instrument Variable Name: PSSRRD
Questionnaire File Name:: Family
Question Text:

Did [fill1: you/ALIAS] receive this benefit because [fill2: you are/he is/she is] disabled?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons less than 65 years of age who received Social Security or Railroad Retirement income as a disability benefit in the last calendar year
Skip Instructions:

repeat for all eligible persons, then goto FPENS

Question ID: FIN.090_00.000

Instrument Variable Name: FPENS
Questionnaire File Name:: Family
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, goto PPENS] (2,R,D) [goto FOPENS]

Question ID: FIN.100_00.000

Instrument Variable Name: PPENS
Questionnaire File Name:: Family
Question Text:

*Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
*Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received income from a disability pension (other than Social Security or Railroad Retirement) in the last calendar year
Skip Instructions:

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

Question ID: FIN.102_00.000

Instrument Variable Name: FOPENS
Questionnaire File Name:: Family
Question Text:

Did [fill1: you/any family members living here] receive income from any retirement or survivor pension other [fill2: than Social Security or Railroad Retirement/than a disability pension/than Social Security, Railroad Retirement, or a disability pension]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

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

Question ID: FIN.104_00.000

Instrument Variable Name: POPENS
Questionnaire File Name:: Family
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received income from a retirement or survivor pension in the last calendar year
Skip Instructions:

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

Question ID: FIN.110_00.000

Instrument Variable Name: FSSI
Questionnaire File Name:: Family
Question Text:

? [F1]
Did [fill: you/any family members] receive Supplemental Security Income (SSI)?
* Read if necessary: Federal SSI checks are either automatically deposited in the bank or mailed to arrive on the first of every month.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1) [if a single-person family, fill the person number in PSSI and goto PSSID; else, goto PSSI]
(2,R,D) [goto FTANF]

Question ID: FIN.120_00.000

Instrument Variable Name: PSSI
Questionnaire File Name:: Family
Question Text:

*Ask or verify. Enter applicable line number(s), separate with commas.
Who in the family received this?
(Anyone else?)
*Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received Supplemental Security Income (SSI) in the last calendar year
Skip Instructions:

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

Question ID: FIN.122_00.000

Instrument Variable Name: PSSID
Questionnaire File Name:: Family
Question Text:

Did [fill1: you/ALIAS] receive SSI because [fill2: you have/he has/she has] a disability?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons who received SSI in the last calendar year
Skip Instructions:

repeat for all eligible persons, then goto FTANF

Question ID: FIN.150_00.000

Instrument Variable Name: FTANF
Questionnaire File Name:: Family
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 goto FOWBEN; else, goto PTANF]
(2,R,D) [goto FOWBEN]

Question ID: FIN.160_00.000

Instrument Variable Name: PTANF
Questionnaire File Name:: Family
Question Text:

*Ask or verify. Enter applicable line number(s), separate with commas.
Who in the family received this?
(Anyone else?)
*Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received cash assistance from a state or county welfare program in the last calendar year
Skip Instructions:

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

Question ID: FIN.164_00.000

Instrument Variable Name: FOWBEN
Questionnaire File Name:: Family
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 goto FINTRST; else, goto POWBEN] (2,R,D) [goto FINTRST]

Question ID: FIN.166_00.000

Instrument Variable Name: POWBEN
Questionnaire File Name:: Family
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received income from some "other" kind of welfare assistance in the last calendar year
Skip Instructions:

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

Question ID: FIN.170_00.000

Instrument Variable Name: FINTRST
Questionnaire File Name:: Family
Question Text:

Did [fill: you/any family members living here] receive income from interest bearing checking accounts, savings accounts, IRAs or certificates of deposit, money market funds, treasury notes, bonds, or any other investments that earn interest?
* Do not include dividends

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

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

Question ID: FIN.180_00.000

Instrument Variable Name: PINTRST
Questionnaire File Name:: Family
Question Text:

*Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received interest income in the last calendar year
Skip Instructions:

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

Question ID: FIN.190_00.000

Instrument Variable Name: FDIVD
Questionnaire File Name:: Family
Question Text:

Did [fill: you/any family members living here] receive income from dividends from stocks or mutual funds, or net rental income from property, royalties, estates or trusts?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

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

Question ID: FIN.200_00.000

Instrument Variable Name: PDIVD
Questionnaire File Name:: Family
Question Text:

Ask or verify. Enter applicable line number(s). Separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received dividend or net rental income in the last calendar year
Skip Instructions:

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

Question ID: FIN.210_00.000

Instrument Variable Name: FCHLDSP
Questionnaire File Name:: Family
Question Text:

? [F1]
Did [fill: you/any family members living here] receive income from child support?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

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

Question ID: FIN.220_00.000

Instrument Variable Name: PCHLDSP
Questionnaire File Name:: Family
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:

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

Question ID: FIN.230_00.000

Instrument Variable Name: FINCOT
Questionnaire File Name:: Family
Question Text:

Did [fill: you/any family members living here] receive income from any other source such as alimony, contributions from family/others, VA payments, Worker?s Compensation, or unemployment compensation?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

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

Question ID: FIN.240_00.000

Instrument Variable Name: PINCOT
Questionnaire File Name:: Family
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one received some "other" source of income in the last calendar year
Skip Instructions:

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

Question ID: FIN.250_00.000

Instrument Variable Name: FINCTOT
Questionnaire File Name:: Family
Question Text:

[fill1: When answering this next question, please remember to include your income PLUS the income of all family members living in this household.]
What is your best estimate of [fill2: your total income/the total income of all family members] from all sources, before taxes, in [fill3: last calendar year in 4 digit format]?
* Enter ?999,995? if the reported income is greater than $999,995.

000000-999994 $0-$999,994
999995 $999,995+
999997 Refused
999999 Don't know

Universe Text: All families
Skip Instructions:

(0-999) goto ERR1_FINCTOT
(250001-999995) goto ERR2_FINCTOT
(1000-250000) goto HOUSEOWN
(D,R) goto FPOV250
ERR1_FINCTOT:
Soft Edit:
* 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: FPOV250
Questionnaire File Name:: Family
Question Text:

Was your total [fill1: family/ ] income from all sources less than [fill2: 250% of poverty threshold] or [fill2: 250% of poverty threshold] or more?

1 Less than [fill2: 250% of poverty threshold]
2 [fill2: 250% of poverty threshold] or more
7 Refused
9 Don't know

Universe Text: Respondents who don't know or refuse their total family income
Skip Instructions:

(1) goto FPOV138
(2) if PCNT in('01','02') then goto FINC75; else if PCNT in('04','07','08','09') then goto FPOV400; else if PCNT in('03','05','06') then goto FINC100 (R,D) goto HOUSEOWN

Question ID: FIN.258_00.000

Instrument Variable Name: FPOV138
Questionnaire File Name:: Family
Question Text:

Was your total [fill1: family/ ] income from all sources less than [fill2: 138% of poverty threshold] or [fill2: 138% of poverty threshold] or more?

1 Less than [fill2: 138% of poverty threshold]
2 [fill2: 138% of poverty threshold] or more
7 Refused
9 Don't know

Universe Text: The respondent answered less than 250% of poverty at FPOV250
Skip Instructions:

(1) goto FPOV100
(2) goto FPOV200 (R,D) goto HOUSEOWN

Question ID: FIN.261_00.000

Instrument Variable Name: FPOV100
Questionnaire File Name:: Family
Question Text:

Was your total [fill1: family/ ] income from all sources less than [fill2: 100% poverty threshold] or [fill2: 100% poverty threshold] or more?

1 Less than [fill2: 100% of poverty threshold]
2 [fill2: 100% poverty threshold] or more
7 Refused
9 Don't know

Universe Text: The respondent answered less than 138% of poverty at FPOV138
Skip Instructions:

(1,2,R,D) goto HOUSEOWN

Question ID: FIN.264_00.000

Instrument Variable Name: FPOV200
Questionnaire File Name:: Family
Question Text:

Was your total [fill1: family/ ] income from all sources less than [fill2: 200% of poverty threshold] or [fill2: 200% of poverty threshold] or more?

1 Less than [fill2: 200% of poverty threshold]
2 [fill2: 200% of poverty threshold] or more
7 Refused
9 Don't know

Universe Text: The respondent answered 138% of poverty or more at FPOV138
Skip Instructions:

(1,2,R,D) goto HOUSEOWN

Question ID: FIN.267_00.000

Instrument Variable Name: FINC75
Questionnaire File Name:: Family
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 250% of poverty threshold or more at FPOV250 and he/she is from a 1 or 2 person family
Skip Instructions:

(1) goto FPOV400
(2) goto FINC100
(R,D) goto HOUSEOWN

Question ID: FIN.270_00.000

Instrument Variable Name: FINC100
Questionnaire File Name:: Family
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 $75,000 or more at FINC75 and he/she is from a 1 or 2 person family; or the respondent answered 250% of poverty or more at FPOV250 and he/she is from a 3, 5, or 6 person family
Skip Instructions:

(1) if PCNT in(?01?,?02?,?05?,?06?) then goto HOUSEOWN;
else if PCNT=?03? then goto FPOV400
(2) ) if PCNT in(?01?,?02?,?03?) then goto FINC150;
else if PCNT in (?05?,?06?) then goto FPOV400
(R,D) [goto HOUSEOWN]

Question ID: FIN.273_00.000

Instrument Variable Name: FPOV400
Questionnaire File Name:: Family
Question Text:

Was your total [fill1: family/ ] income from all sources less than [fill2: 400% of poverty threshold] or [fill2: 400% of poverty threshold] or more?

1 Less than [fill2: 400% of poverty threshold]
2 [fill2: 400% of poverty threshold] or more
7 Refused
9 Don't know

Universe Text: The respondent answered less than $75,000 at FINC75 and he/she is from a 1 or 2 person family; or the respondent answered less than $100,000 at FINC100 and he/she is from a 3 person family; or the respondent answered $100,000 or more at FINC100 and he/she is from a 5 or 6 person family; or the respondent answered 250% of poverty or more at FPOV250 and he/she is from a 4, 7, 8, or 9+ person family
Skip Instructions:

(1) if PCNT )= '09' then goto FINC150; else goto HOUSEOWN
(2) if PCNT in(?01?,?02?,?03?,?07','08' ) goto HOUSEOWN;
else if PCNT in('04','05','06') goto FINC150 (R,D) goto HOUSEOWN

Question ID: FIN.276_00.000

Instrument Variable Name: FINC150
Questionnaire File Name:: Family
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 at FINC100 and he/she is from a 1, 2, or 3 person family; or the respondent answered 400% of poverty or more at FPOV400 and he/she is from a 4, 5, or 6 person family; or the respondent answered less than 400% of poverty at FPOV400 and he/she is from a family of 9 or more persons
Skip Instructions:

(1,2,R,D) goto HOUSEOWN

Question ID: FIN.280_00.000

Instrument Variable Name: HOUSEOWN
Questionnaire File Name:: Family
Question Text:

Is this house/apartment owned or being bought, rented, or occupied by some other arrangement by you [fill: /or someone in your family]?

1 Owned or being bought
2 Rented
3 Other arrangement
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

(1,3,R,D) [goto FSSAPL]
(2) [goto FGAH]

Question ID: FIN.282_00.000

Instrument Variable Name: FGAH
Questionnaire File Name:: Family
Question Text:

? [F1]
[fill: Are you/Is anyone in your family] paying lower rent because the Federal, State, or local government is paying part of the cost?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families that rent their house/apartment
Skip Instructions:

goto FSSAPL

Question ID: FIN.300_00.000

Instrument Variable Name: FSSAPL
Questionnaire File Name:: Family
Question Text:

[fill: Have you EVER applied for Supplemental Security Income or SSI, even if the claim was denied?/Have any family members living here EVER applied for Supplemental Security Income (SSI)? This includes people who applied for benefits, even if the claim was denied.]

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families
Skip Instructions:

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

Question ID: FIN.310_00.000

Instrument Variable Name: PSSAPL
Questionnaire File Name:: Family
Question Text:

*Ask or verify. Enter applicable line number(s), separate with a comma.
Who in the family applied for it?
(Anyone else?)
* Indicate each family member who applied for SSI benefits.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one applied for SSI
Skip Instructions:

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

Question ID: FIN.330_00.000

Instrument Variable Name: FSDAPL
Questionnaire File Name:: Family
Question Text:

[fill: Have you EVER APPLIED for disability benefits from Social Security even if the claim was denied?/Have any family members living here EVER applied for disability benefits from Social Security? This includes people who applied for benefits, even if the claim was denied.]

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All Families
Skip Instructions:

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

Question ID: FIN.340_00.000

Instrument Variable Name: PSDAPL
Questionnaire File Name:: Family
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who in the family applied for it?
(Anyone else?)
* Indicate each family member who applied for Social Security Disability benefits.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons and at least one applied for Social Security Disability benefits
Skip Instructions:

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

Question ID: FIN.350_00.000

Instrument Variable Name: TANFMYR
Questionnaire File Name:: Family
Question Text:

? [F1]
Earlier I recorded that [fill1: you/ALIAS] received cash assistance from programs such as welfare or public assistance in [fill2: last calendar year in 4-digit format]. During [fill2: last calendar year in 4-digit format], about how many months did [fill1: you/ALIAS] receive this assistance?
*Enter '1' if less than one month.

01-12 1-12 months
97 Refused
99 Don't know

Universe Text: All persons who received cash assistance from public assistance programs in the last calendar year
Skip Instructions:

repeat for all eligible persons, then goto FSNAP

Question ID: FIN.360_00.000

Instrument Variable Name: FSNAP
Questionnaire File Name:: Family
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) [goto FSNAPMYR]
(2, D, R) [Goto FINWIC to see if family falls into the universe for this question.]

Question ID: FIN.380_00.000

Instrument Variable Name: FSNAPMYR
Questionnaire File Name:: Family
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:

Goto FINWIC to see if family fits into universe for this question.

Question ID: FIN.384_00.000

Instrument Variable Name: FINWIC
Questionnaire File Name:: Family
Question Text:

? [F1]
At any time during [fill1: last calendar year in 4-digit format] did [fill2: you/anyone in your family] receive benefits from the WIC program, that is, the Women, Infants and Children program?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with females 12-55 years of age or children 0-5 years of age
Skip Instructions:

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

Question ID: FIN.385_00.000

Instrument Variable Name: PWIC
Questionnaire File Name:: Family
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who in the family received this?
(Anyone else?)
* Indicate family members who were authorized to receive WIC benefits.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All families with two or more persons who are female and between the ages of 12-55 or children between the ages of 0-5, and at least one received WIC benefits in the last calendar year
Skip Instructions:

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

Question ID: FLG.010_00.000

Instrument Variable Name: ENGLANG
Questionnaire File Name:: Person
Question Text:

How well [fill: do you/ does ALIAS] speak English? Would you say?
*Read categories below.

1 Very well
2 Well
3 Not well
4 Not at all
7 Refused
9 Don?t know

Universe Text: All persons age 5 and older
Skip Instructions:

(1-4) goto next section

Data Cart

Your data extract

0	variables
0	samples