Survey Text

2014 2005 1996 1987
2013 2004 1995 1986
2012 2003 1994 1985
2011 2002 1993 1984
2010 2001 1992 1983
2009 2000 1991 1982
2008 1999 1990 1981
2007 1998 1989
2006 1997 1988
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2014
Survey form view entire document:  text  image

Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
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
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]

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2013
Survey form view entire document:  text  image

Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
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
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]

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2012
Survey form view entire document:  text  image

Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
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
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]

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2011
Survey form view entire document:  text  image

Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
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
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]

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2010
Survey form view entire document:  text  image

Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
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
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]

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2009
Survey form view entire document:  text  image

Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
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
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]

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2008
Survey form view entire document:  text  image

Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
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
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]

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2007
Survey form view entire document:  text  image

Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
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
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]

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2006
Survey form view entire document:  text  image

Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
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
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]

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2005
Survey form view entire document:  text  image

Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
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
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]

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2004
Survey form view entire document:  text  image

Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
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
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]

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2003
Survey form view entire document:  text  image

HHC.120

What is {your/name} age and date of birth? Please give month, day, and year for the date of birth.

(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't know

Age:
AGEDOB_1 [ ] Number
AGEDOB_2 [ ] Time Period
(1) Day(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)

Date of Birth:
DOB_M MONTH: ______________________
DOB_BDAY DAY: ______________________
DOB_Y_P YEAR: ______________________

Check item AGECAL:AGE1 takes information entered in AGEDOB_1 and AGEDOB_2 and calculates an age.
AGE2 takes the date-of-birth information entered in AGEDOB and calculates an age.
AGE3 = current year - birth year -1, AGE4 = AGE3 + 1. If not enough DOB information was given to calculate an age,AD@ will be assigned to AGE2.

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2002
Survey form view entire document:  text  image

HHC.120

What is {your/name} age and date of birth? Please give month, day, and year for the date of birth.

(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't know

Age:
AGEDOB_1 [ ] Number
AGEDOB_2 [ ] Time Period
(1) Day(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)

Date of Birth:
DOB_M MONTH: ______________________
DOB_BDAY DAY: ______________________
DOB_Y_P YEAR: ______________________

Check item AGECAL:AGE1 takes information entered in AGEDOB_1 and AGEDOB_2 and calculates an age.
AGE2 takes the date-of-birth information entered in AGEDOB and calculates an age.
AGE3 = current year - birth year -1, AGE4 = AGE3 + 1. If not enough DOB information was given to calculate an age,AD@ will be assigned to AGE2.

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2001
Survey form view entire document:  text  image

HHC.120

What is {your/name} age and date of birth? Please give month, day, and year for the date of birth.

(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't know

Age:
AGEDOB_1 [ ] Number
AGEDOB_2 [ ] Time Period
(1) Day(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)

Date of Birth:
DOB_M MONTH: ______________________
DOB_BDAY DAY: ______________________
DOB_Y_P YEAR: ______________________

Check item AGECAL:AGE1 takes information entered in AGEDOB_1 and AGEDOB_2 and calculates an age.
AGE2 takes the date-of-birth information entered in AGEDOB and calculates an age.
AGE3 = current year - birth year -1, AGE4 = AGE3 + 1. If not enough DOB information was given to calculate an age,AD@ will be assigned to AGE2.

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2000
Survey form view entire document:  text  image

HHC.120

What is {your/name} age and date of birth? Please give month, day, and year for the date of birth.

(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't know

Age:
AGEDOB_1 [ ] Number
AGEDOB_2 [ ] Time Period
(1) Day(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)

Date of Birth:
DOB_M MONTH: ______________________
DOB_BDAY DAY: ______________________
DOB_Y_P YEAR: ______________________

Check item AGECAL:AGE1 takes information entered in AGEDOB_1 and AGEDOB_2 and calculates an age.
AGE2 takes the date-of-birth information entered in AGEDOB and calculates an age.
AGE3 = current year - birth year -1, AGE4 = AGE3 + 1. If not enough DOB information was given to calculate an age,AD@ will be assigned to AGE2.

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1999
Survey form view entire document:  text  image

HHC.120

What is {your/name} age and date of birth? Please give month, day, and year for the date of birth.

(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't know

Age:
AGEDOB_1 [ ] Number
AGEDOB_2 [ ] Time Period
(1) Day(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)

Date of Birth:
DOB_M MONTH: ______________________
DOB_BDAY DAY: ______________________
DOB_Y_P YEAR: ______________________

Check item AGECAL:AGE1 takes information entered in AGEDOB_1 and AGEDOB_2 and calculates an age.
AGE2 takes the date-of-birth information entered in AGEDOB and calculates an age.
AGE3 = current year - birth year -1, AGE4 = AGE3 + 1. If not enough DOB information was given to calculate an age,AD@ will be assigned to AGE2.

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1998
Survey form view entire document:  text  image

FID.125

What is {name/your} age and date of birth? Please give month, day, and year for the date of birth.

(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't know
CHG_AG01 ________Age/ Number
CHG_AG02 ________Time Period
(1) Day(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)
Date of Birth:

DOB_MMONTH: ______________________
DOB_BDAY DAY: ______________________
DOB_Y_PYEAR: ______________________

Check item CHG_AGECAL1: C_AGE1 takes information entered in CHG_AG01 and CHG_AG02 and calculates an age.
C_AGE2 takes the date-of birth information entered in FID.125 and calculates an
age.
C_AGE3 = current year - birth year -1, C_AGE4 = C_AGE3 + 1. If not enough
DOB information was given to calculate an age, "D" will be assigned to C_AGE2.
Check item CHG_AGECK: CHG_AGECK compares the two ages calculated in C_AGE1 and C_AGE2. C_AGE1 and C_AGE2 will either contain an age, or "D" if an age could not be
calculated.

If C_AGE1 eq (D) and C_AGE2 ne (D), set AGE = C_AGE2, go to FID.190
If C_AGE1 eq (D) and C_AGE2 eq (D), and C_AGE3 eq blank, go to FID.145
If C_AGE1 eq (D) and C_AGE2 eq (D), and C_AGE3 ne blank, go to FID.140
If C_AGE1 ne (D) and C_AGE2 ne (D), and C_AGE1 eq C_AGE2, go to FID.190
If C_AGE1 ne (D) and C_AGE2 ne (D), and C_AGE1 ne C_AGE2, and CHG_DOBV eq lt or gt, go to FID.130.
If C_AGE1 ne (D) and C_AGE2 ne (D), and C_AGE1 ne C_AGE2, and CHG_DOBV ne lt or gt, set AGE=C_AGE2, got to FID. 190
If C_AGE1 ne (D) and C_AGE2 = (D), and (C_AGE1 = C_AGE3 or C_AGE1 = C_AGE4); set AGE = C_AGE1; go to FID.190
If C_AGE1 ne C_AGE3 and C_AGE1 ne C_AGE4 and birth year eq blank, go to FID.140
If C_AGE1 ne C_AGE3 and C_AGE1 ne C_AGE4 and birth year ne lt or gt; set AGE = C_AGE1, go to FID.190

FID.130

There is a difference between the age the computer calculated from {your/name's} date-of-birth and the age that you gave me. I recorded {your/name's} date-of-birth as {BMONTH in words}/{BDAY}/{BYEAR}. Is that {your/name's} correct date-of-birth?
CHG_DOBV [equiv DOBVER]
(1) Yes (Go to CHG_LOOP)
(2) No (Go to FID.135)

FID.135

What is {your/name's} correct date-of-birth?

FR: OLD DATE of BIRTH = {BMONTH/BDAY/BYEAR} ASK IF NECESSARY:

(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't know
DOB_MMONTH: ____________
DOB_BDAY DAY: ____________
DOB_B_PYEAR: ____________
(Go to FID.150)

FID.140

{Are you/Would you} say {name} is
CHG_AG06 [equiv AGEPIC]
(1) [fill C_AGE3/message] year(s) old? (Go to CHG_LOOP)
(2) [fill C_AGE4] year(s) old? (Go to CHG_LOOP)
(N) Neither is correct (Go to FID.145)
(7) Refused (Go to FID.145)
(9) Don't Know (Go to FID.145)

[If answer is (1,2), update AGE accordingly; go to CHG_LOOP.]

FID.145

What is your best guess of {name's} age?

FR: IF THE RESPONDENT DOES NOT KNOW THE AGE, ENTER YOUR BEST ESTIMATE OF THE PERSON'S AGE. ENTER (C) FOR COMPUTE IF THE RESPONSE IS A RANGE OF AGES.
CHG_AG07 [equiv AGEGES11] ____ Number
CHG_AG08 [equiv AGEGES12] ____ Time Period
(3) Month(s) (Check item)
(4) Year(s) (Check item)
(6) Compute from range (FID.165)
(7) Refused (FID.150)
(9) DK (FID.150)
Check item: If CHG_AG08 is (3) then AGE eq (NUM/12); If CHG_AG08 is (4) then AGE eq (NUM). If DOB_Y_P eq (D,R); set BYY1 eq (current year-AGE1-1) and BYY2 eq (current year-AGE) go to FID.170; If DOB_Y_P ne (D,R); set AGE eq (C_AGE1), go to CHG_LOOP. If CHG_AG08 eq (D,R), go to FID.150.

FID.150

Certain sections of this interview depend on knowing if a person is 18 years old or older. Could you please tell me if {you/name} {are/is} at least 18 years old?
CHG_AG09 [equiv AGEGES2]
(1) Less than 18 (FID.155)
(2) 18 or older (FID.160)
(7) Refused ( FID.160)
(9) DK (FID.160)

FID.155

FR: ENTER YOUR BEST ESTIMATE OF {name's} AGE.
ENTER "0" IF LESS THAN 1 YEAR OLD.
CHG_LESS [equiv LESS18] Age:___________
(Go to CHG_LOOP)

FID.160

FR: ENTER YOUR BEST ESTIMATE OF {name's} AGE.
CHG_GREA [equiv GREAT18] Age: ___________
(Go to CHG_LOOP)

FID.165

FR: ENTER FIRST AND LAST AGES OF THE RANGE.

First/lower:
CHG_AG10 [equiv AGERNG_1] Number____________
CHG_AG12 [equiv AGERNG_3] Time Period ____________
(3) Month(s)
(4) Year(s)
Last/higher
CHG_AG11[equiv AGERNG_2] Number ____________
CHG_AG13[equiv AGERNG_4] Time Period ____________
(3) Month(s)
(4) Year(s)

(Go to CHG_LOOP)

[Set AGE = (CHG_AG10 + CHG_AG11) /2]

FID.170

Would you say that {name} was born in:
CHG_YEAR [equiv YEARPIC]
(1) [fill with 4-digit BYEAR1]
(2) [fill with 4-digit BYEAR2]
(N) either is correct
(7) Refused
(9) Don't Know

(Go to CHG_LOOP)

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1997
Survey form view entire document:  text  image

HHC.050

What is {FULLNAME}'s date of birth? Month, day and year, please.

(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
DOB_M MONTH: ____________________________
DOB_BDAY DAY: ____________________________
DOB_Y_P YEAR: ____________________________
[If the year is known at HHC.050, goto Check item HHC01; Else goto HHC.080.]
Check item HHC01: Check item HHC01: Calculate AGE by subtracting reported Birth Year (before top coded to DOB_Y_P) (HHC.050) from CURRENT YEAR. If the birth month, day, and year are valid and if current date is less than birth date - subtract 1 from AGE, and goto HHC.070. If the birth month and year are valid, day is missing, and if current month is less than birth month- subtract 1 from AGE and goto HHC.070. If the birth month is missing then AGE1 = (AGE-1) and AGE2 = (AGE) and goto HHC.060.

HHC.060

Would you say {FULLNAME}:
RPAGEPIC
(1) {AGE1} years of age? (Check item HHC02)
(2) {AGE2} years of age? (Check item HHC02)
(7) Refused (HHC.080)
(9) DK (HHC.080)
(N) Neither is correct (HHC.080)

HHC.070

That would make {FULLNAME} {AGE} years old. Is that correct?
RPAGEVER
(1) Yes (Check item HHC02)
(2) No (HHC.080)
(7) Refused (HHC.080)
(9) DK (HHC.080)

HHC.080

What is {FULLNAME}'s age?

FR: ASK IF APPROPRIATE; OTHERWISE, ENTER YOUR BEST ESTIMATE OF THE PERSON'S AGE. ENTER "0" IF UNDER 1. ENTER (C) FOR COMPUTE IF THE RESPONSE IS A RANGE OF AGES.
RPAGEGES
________________ (0-120) years old (Check Item HHC02)
(C) Compute from range (HHC.090)

HHC.090

FR: ENTER FIRST AND LAST NUMBERS OF THE RANGE.
RPRANGE1 First/lower _________________________________
RPRANGE2 Last/higher _________________________________
[Store (RPRANGE1 + RPRANGE2)/2 in RPAGEGES]
Check item HHC02:
If HHC.060 equals 1, store AGE1 in AGE; Else
If HHC.060 equals 2, store AGE2 in AGE; Else
If HHC.070 equals 1, set AGE equals AGE; Else store RPAGEGES in AGE.

Check item MORCK: If Person number (PX) less than 30: Append 1 more member into the roster, goto Check item SET; Else set HHC.240 equal to 2, and goto Check item MAXPER.

HHC.150

What is {FULLNAME}'s date of birth? Month, day and year, please.

(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
DOB_M MONTH: ____________________________
DOB_BDAY DAY: ____________________________
DOB_Y_P YEAR: ____________________________
[If the year is know at HHC.150, goto Check item HH15; Else goto HHC.180]
Check item HH15: Calculate AGE by subtracting reported Birth Year (HHC.150) from CURRENT YEAR. If the birth month, day, and year are valid and are known, and if current month is less than birth month - subtract 1 from AGE and goto HHC.170. If current month is the same as birth month and current day is less than birth day - subtract 1 from AGE and goto HHC.170. If the birth month is missing; then AGE1= (AGE - 1) and AGE2 = (AGE) and goto HHC.160.

HHC.160

Would you say {FULLNAME} is:
AGEPIC
(1) {AGE1} years of age? (Check item HHC09)
(2) {AGE2} years of age? (Check item HHC09)
(7) Refused (HHC.180)
(9) DK (HHC.180)
(N) Neither is correct (HHC.180)

HHC.170

That would make {FULLNAME} {AGE} years old. Is that correct?
AGEVER_A
(1) Yes (Check item HHC09)
(2) No (AGEVER_B)
(7) Refused (HHC.180)
(9) DK (HHC.180)

[If answer equals 2, ask:]
Would you like to correct {his/her} date of birth?
AGEVER_B
(1) Yes (HHC.150)
(2) No, not remember for sure. (HHC.180)

HHC.180

What is {FULLNAME}'s age?

FR: ASK IF APPROPRIATE; OTHERWISE, ENTER YOUR BEST ESTIMATE OF THE PERSON'S AGE. ENTER "0" IF UNDER 1. ENTER (C) FOR COMPUTE IF THE REPONSE IS A RANGE OF AGE.
AGEGES
__________ (0-120) years old (Check item HHC09)
(C) Compute from range

HHC.190

FR: ENTER FIRST AND LAST NUMBERS OF THE RANGE.
AGEGES_1 First/lower:____________________
AGEGES_2 Last/higher:____________________
[Store (AGEGES_1 + AGEGES_2)/2 in AGEGES]
Check item HHC09:
If HHC.160 equals 1 and AGE is not equal to zero, store AGE1 in AGE; Else
If HHC.160 equals 2 and AGE is not equal to zero, store AGE2 in AGE; Else
If HHC.170 equals 1, set AGE equal to AGE; Else set AGE equal AGEGES in HHC.180.

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1996

No questionnaire text is available for this sample.


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1995

No questionnaire text is available for this sample.


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1994

No questionnaire text is available for this sample.


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1993

No questionnaire text is available for this sample.


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1992

No questionnaire text is available for this sample.


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1991

No questionnaire text is available for this sample.


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1990

No questionnaire text is available for this sample.


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1989

No questionnaire text is available for this sample.


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1988

No questionnaire text is available for this sample.


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1987

No questionnaire text is available for this sample.


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1986

No questionnaire text is available for this sample.


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1985

No questionnaire text is available for this sample.


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1984

No questionnaire text is available for this sample.


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1983

No questionnaire text is available for this sample.


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1982

No questionnaire text is available for this sample.


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1981

No questionnaire text is available for this sample.