Document Version Date: 12-Jun-17

Instrument Variable Name: P2DFHEAR
Questionnaire File Name: Family
Question Text:

With this next set of questions, we want to learn about people who have physical, mental, or emotional conditions that cause serious difficulties with their daily activities. Though different, these questions may sound similar to ones I asked earlier.
[fill 1: Are you/Is ALIAS] deaf or [fill 2: do you/does ALIAS] have serious difficulty hearing?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons age 1 or older and random number generator=2
Skip Instructions:

(1,2,D,R) goto P2DFSEE

Instrument Variable Name: P2DFSEE
Questionnaire File Name: Family
Question Text:

[fill 1: Are you/Is ALIAS] blind or [fill 2: do you/does ALIAS] have serious difficulty seeing even when wearing glasses?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons age 1 or older
Skip Instructions:

(1,2,D,R) if no more persons age 5 or older, goto next section;
else goto P2DFCON

Instrument Variable Name: P2DFCON
Questionnaire File Name: Family
Question Text:

Because of a physical, mental, or emotional condition, [fill 1: do you/does ALIAS] have serious difficulty concentrating, remembering, or making decisions?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons age 5 or older and random number generator=2
Skip Instructions:

(1,2,D,R) goto P2DFWALK

Instrument Variable Name: P2DFWALK
Questionnaire File Name: Family
Question Text:

[fill 1: Do you/Does ALIAS] have serious difficulty walking or climbing stairs?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons age 5 or older and random number generator=2
Skip Instructions:

(1,2,D,R) goto P2DFDRES

Instrument Variable Name: P2DFDRES
Questionnaire File Name: Family
Question Text:

[fill 1: Do you/Does ALIAS] have difficulty dressing or bathing?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons 5 or older
Skip Instructions:

(1,2,D,R) if no more persons age 15 or older, goto next section;
else goto P2DFERR

Instrument Variable Name: P2DFERR
Questionnaire File Name: Family
Question Text:

Because of a physical, mental, or emotional condition, [fill 1: do you/does ALIAS] have difficulty doing errands alone such as visiting a doctor's office or shopping?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons 15 or older
Skip Instructions:

(1,2,D,R) if no more persons age 1 or older, goto next section;
else return to P2DFHEAR for next person age 1 or older