Attachment 2b Updated

Attachment 2b: Reinterview Questionnaire

Hello, This is ..... from the U.S.Census Bureau.

Our records show that one of our interviewers, (interviewer name), recently contacted your

household.

We're doing a short quality control check to make sure that our interviewers are

following correct procedures.

As for the original interview, all information collected will be kept strictly confidential.

Can you or another household member answer a few questions to help us evaluate the

interviewer's work?

1 Yes

2 No

3 Inconvenient time. Try again later

__________________________________________________

We expect this interview to take about five minutes. We have limited questions

in this survey to those essential to current policy initiatives. If you have

any comments about this survey, please send them to :

Associate Director for Administration

Paperwork Reduction Project

Room 3104, FOB3

Bureau of the Census

Washington, DC 20233-0001

OR

Office of Management and Budget

Paperwork Reduction Project

Washington, DC 20503

__________________________________________________

TOLL FREE (800) TELEPHONE NUMBER to confirm

To verify that I am calling from the Census Bureau, you may call my regional office

(PROVIDE RESPONDENT WITH THE TELEPHONE NUMBER OF THE REGIONAL OFFICE).

When you call, please provide your name and the following identification number:

0000015.

READ IF NECESSARY:

To verify that the toll free number is legitimate, you may call Directory Assistance on:

1-800-555-1212.

__________________________________________________

Reinterview Help Menu

Press F8 to proceed with reinterview.

1 Why are you calling me again?

2 Are you calling everyone or am I just lucky?

3 Don't you have anything better to do with my tax dollars? I'm too busy to answer your questions again.

4 Are you "checking up" on me? I told you the truth the first time you called.

5 Do I have to answer your questions?

6 Who sees my answers?

7 Return to Reinterview.

__________________________________________________

Why are you calling me again?

Like any business, we're interested in maintaining the quality of our product, so each

month we reinterview a few households who are in the survey to ensure we are

efficiently and accurately collecting data.

__________________________________________________

Are you calling everyone or am I just lucky?

We are able to get a reliable measure of data quality by reinterviewing only a small

percentage of the total households interviewed in the survey.

__________________________________________________

Don't you have anything better to do with my tax dollars?

I'm too busy to answer your questions again.

The National Center for Health Statistics, other federal agencies, and businesses will

use the data to assess the health services people receive. The Census Bureau

feels a strong need for an independent measure of its quality. As a result, we feel

that the results from our reinterview are a wise use of our tax dollars.

__________________________________________________

Are you "checking up" on me?

I told you the truth the first time you called

The purpose of reinterview is not to check up on respondents. In order to ensure that

we are efficiently and accurately collecting data, we reinterview a few households

who are in the survey.

__________________________________________________

Do I have to answer all your questions?

Your participation in this survey is voluntary. However, the information you provide

will help us to ensure the efficiency and accuracy of our data collection procedures.

Like any business, we're interested in maintaining the quality of our product.

__________________________________________________

Who sees my answers?

We want to reassure you that your confidentiality is completely protected. We conduct

this survey under the authority of Title 13, United States Code, Sections 8 and 9. As

required by Title 13, only sworn Census Bureau employees who have taken an oath to

protect your confidentiality will see the actual responses. The penalties for violating

this oath include jail and substantial fines.

__________________________________________________

Choose one of the following options to continue:

1 Telephone Reinterview

2 Personal Visit Reinterview

3 Quit - Attempt later

4 Reinterview Noninterview

5 RO/HQ Discretion - Type A (Contact Supervisor)

__________________________________________________

Contact your supervisor for authorization before conducting a personal visit.

1 Personal visit reinterview authorized

2 Quit - Attempt later

__________________________________________________

May I speak to (respondent’s name)?

1 This is correct person, or correct person called to the phone.

2 Person not available now. Call back later.

3 Person can not be reached. Speak with another household member.

4 Person unknown at this number.

5 Person no longer lives there.

6 Person deceased.

7 Person can be reached at another number.

8 Reinterview Noninterview.

__________________________________________________

Have I reached area code (number)?

1 Yes

2 No

3 Refused to verify

__________________________________________________

I'm sorry, I'll dial again to be sure I've dialed correctly.

1 After several attempts, wrap up case.

2 Redial

__________________________________________________

This case was a Type A in the original interview.

Please use any available resource to check that the original outcome was:

1 Original outcome was correct.

2 Original outcome was incorrect.

3 Reinterview Noninterview.

4 Quit - Attempt later.

__________________________________________________

Is your address:

(households’s address)

1 Yes

2 No

3 Refused to verify Address

__________________________________________________

Did the interviewer visit in person or call on the telephone?

1 Personal visit only

2 Telephone call only

3 Both - Interviewer visited and called

__________________________________________________

Was the interviewer polite and professional?

1 Yes

2 No

__________________________________________________

Enter comments from the reinterview respondent here.

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________

__________________________________________________

About how long did the interview last?

Answer must be in the range from 0 up to 9:

__________________________________________________

Did the interviewer use a laptop computer?

1 Yes

2 No

__________________________________________________

Our records indicate that (names from roster) was/were living or staying at:

(households’s_address)

on (interview date).

Is this correct?

1 Yes

2 No

__________________________________________________

Enter the line number of the household member(s) (line number on roster)

who wasn't/weren't living or staying at the household on (interview date).

__________________________________________________

Have I missed any household member who was living or staying at:

(households’s_address)

On (interview date).

1 Yes

2 No

__________________________________________________

Enter the name of each missing household member who was living or staying at:

(households’s_address)

on (interview date).

__________________________________________________

Were you present during the original interview?

1 Yes

2 No

__________________________________________________

A non-household member (proxy) was used in the original interview.

Probe to determine if there were any household members able to respond to

the survey at the time the interview was conducted (i.e., they were not

hospitalized, institutionalized, seriously ill, or deceased.)?

1 Yes

2 No

__________________________________________________

Did an interviewer ask you or someone in your household if anyone in

the household was INJURED or POISONED seriously enough that they got

medical advice or treatment between (Date1) and (Date2)?

A 'NO' in the reinterview could indicate that not all questions

were asked in the original interview. The reinterview disposition codes

should reflect this discrepancy.

1 Yes

2 No

__________________________________________________

DURING THE PAST 12 MONTHS, prior to (interview date), did an interviewer ask you or

someone in your household if anyone in the household was covered by health insurance or some

other kind of health care plan?

A 'NO' in the reinterview could indicate that not all questions

were asked in the original interview. The reinterview disposition codes

should reflect this discrepancy.

1 Yes

2 No

__________________________________________________

DURING THE PAST 12 MONTHS, prior to (interview date), was there any time when you or someone in family needed medical care, but did not get it because you or the family couldn't afford it?

1 Yes

2 No

__________________________________________________

As of (interview date), what is the HIGHEST level of school

you completed or the highest degree you had received?

0 Never attended, preschool, kindergarten

1 1st grade

2 2nd grade

3 3rd grade

4 4th grade

5 5th grade

6 6th grade

7 7th grade

8 8th grade

9 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 Associates degree: occupational, technical, or vocational program

17 Associate's 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 Doctorate degree (Example: PhD, EdD)

__________________________________________________

Do you consider yourself to be Hispanic or Latino?

* Read if necessary.

Puerto Rican

Cuban/Cuban American

Dominican (Republic)

Mexican

Mexican American

Central or South American

Other Latin American

Other Hispanic/Latino

1 Yes

2 No

7 Refused

9 Don't know

__________________________________________________

What race or races do you consider yourself to be? Please select 1 or more of

these categories.

* Enter all that apply, separate with commas. Read list if necessary but do not read response categories 16, 97, or 99.

01 White

02 Black/African American

03 Indian (American)

04 Alaska Native

05 Native Hawaiin

06 Guamanian

07 Samoan

08 Other Pacific Islander

09 Asian Indian

10 Chinese

11 Filipino

12 Japanese

13 Korean

14 Vietnamese

15 Other Asian

16 Some other race

97 Refused

99 Don't know

__________________________________________________

Could the interviewer have spoken to another person at

(households’s_address)?

1 Yes

2 No

__________________________________________________

May I speak to her/him?

1 Yes

2 No

__________________________________________________

Hello. I'm ... from the U.S. Census Bureau.

Our records show that one of our interviewers, (interviewer name), recently contacted this

location to verify the status of:

(households’s_address)

We're doing a short quality control check to make sure that our interviewers are following

correct procedures.

Was

(households’s_address)

vacant on (interview date)?

1 Yes

2 No

__________________________________________________

What was the status of

(households’s_address)

on or about (interview date)?

Enter reported status.

Explain any discrepancy between reported status and original outcome.

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________

__________________________________________________

This case is not completed.

Make several attempts to contact respondent/contact person before selecting reinterview

noninterview.

1 Quit - Complete later

2 Reinterview Noninterview

__________________________________________________

Was the original outcome correct?

1 Yes

2 No

3 Reinterview Noninterview

__________________________________________________

Which outcome describes this reinterview case?

1 Type A Noninterview.

2 Type B Noninterview.

3 Type C Noninterview.

4 Type D Noninterview - Household replaced by new household since the original interview.

__________________________________________________

Which Type A outcome describes this reinterview case?

1 Unable to complete, bad telephone number.

2 Unable to locate.

3 No one home.

4 Temporarily absent.

5 Refused.

6 Language problem.

7 Respondent can't remember.

8 Insufficient partial.

9 Other Type A - Specify in the Reinterview Notes.

__________________________________________________

Which Type B outcome describes this reinterview case?

1 Vacant, regular.

2 Vacant, seasonal.

3 Vacant, storage of household furniture.

4 Converted to temporary business or storage.

5 Unoccupied tent or trailer site.

6 Unfit, to be demolished.

7 HH institutionalized or temporarily ineligible.

8 Entire HH under age ^MIN_AGE.

9 Temporarily occupied by persons with Usual Residence Elsewhere (URE), regular.

10 Temporarily occupied by persons with Usual Residence Elsewhere (URE), seasonal.

11 Other Type B - Specify in the Reinterview Notes.

__________________________________________________

Which Type C outcome describes this reinterview case?

1 Demolished.

2 House or trailer moved.

3 Converted to permanent business or storage.

4 Condemned.

5 Deceased.

6 Moved out of country.

7 Other Type C - Specify in the Reinterview Notes.

__________________________________________________

Which of the following options describes the misclassification of the original Type B case?

1 Should have been an Interview or Type A.

2 Should have been a vacant interview.

3 Should have been another Type B.

4 Should have been a Type C.

5 Type D3

__________________________________________________

Which of the following options describes the misclassification of the original Type C case?

1 Should have been an Interview or Type A.

2 Should have been a vacant interview.

3 Should have been a Type B.

4 Should have been another Type C.

5 Type D4

__________________________________________________

Which of the following options describes the misclassification of the original vacant interview case?

1 Should have been an Interview or Type A.

2 Should have been a Type B or C.

__________________________________________________

Do you suspect falsification?

1 Yes

2 No

3 Unable to determine

__________________________________________________

Explain why you do not suspect falsification in the Reinterview Notes now.

Press Ctrl-F7 to access Reinterview Notes.

Enter 1 when done with your explanation in the Reinterview Notes.

__________________________________________________

Your reinterview detected multiple discrepancies:

Enter the code of the detected discrepancy below which best describes this case.

1 ^DISCREP_DESCRP[1]

2 ^DISCREP_DESCRP[2]

3 ^DISCREP_DESCRP[3]

4 ^DISCREP_DESCRP[4]

5 ^DISCREP_DESCRP[5]

6 ^DISCREP_DESCRP[6]

7 ^DISCREP_DESCRP[7]

8 ^DISCREP_DESCRP[8]

9 ^DISCREP_DESCRP[9]

10 ^DISCREP_DESCRP[10]

11 ^DISCREP_DESCRP[11]

12 ^DISCREP_DESCRP[12]

13 ^DISCREP_DESCRP[13]

14 ^DISCREP_DESCRP[14]

15 ^DISCREP_DESCRP[15]

16 ^DISCREP_DESCRP[16]

17 ^DISCREP_DESCRP[17]

18 ^DISCREP_DESCRP[18]

19 ^DISCREP_DESCRP[19]

20 ^DISCREP_DESCRP[20]

__________________________________________________

Caution: Obtain supervisor's permission before seleting an option below.

Which of the following options describes this reinterview case?

1 Hard to interview original case

2 More than 50 miles from nearest reinterviewer and no phone number

3 Observed during the original interview

4 Personal visit needed, but not authorized

5 Case management or ROSCO problems - Obtain HQ approval

6 Sample adjustment - Obtain HQ approval

7 Other RO discretion - Specify in the Reinterview Notes

__________________________________________________

Explain why you suspect falsification in the Reinterview Notes now.

Press Ctrl-F7 to access Reinterview Notes.

Enter 1 when done with your explanation in the Reinterview Notes.

__________________________________________________

Your reinterview detected multiple discrepancies:

Enter the code of the detected discrepancy below which best describes the primary reason you suspect

falsification.

1 ^DISCREP_DESCRP[1]

2 ^DISCREP_DESCRP[2]

3 ^DISCREP_DESCRP[3]

4 ^DISCREP_DESCRP[4]

5 ^DISCREP_DESCRP[5]

6 ^DISCREP_DESCRP[6]

7 ^DISCREP_DESCRP[7]

8 ^DISCREP_DESCRP[8]

9 ^DISCREP_DESCRP[9]

10 ^DISCREP_DESCRP[10]

11 ^DISCREP_DESCRP[11]

12 ^DISCREP_DESCRP[12]

13 ^DISCREP_DESCRP[13]

14 ^DISCREP_DESCRP[14]

15 ^DISCREP_DESCRP[15]

16 ^DISCREP_DESCRP[16]

17 ^DISCREP_DESCRP[17]

18 ^DISCREP_DESCRP[18]

19 ^DISCREP_DESCRP[19]

20 ^DISCREP_DESCRP[20]

__________________________________________________

I'm sorry, I have the wrong address/telephone number. Thank you for your help.

Attempt to contact the correct household now or at a later time.

__________________________________________________

Thank you for your cooperation. You've been very helpful.

__________________________________________________

Thank you for your help, but I need to speak to a household member. I'll try back later.

__________________________________________________

I'd like to schedule a date to complete/conduct the quality check. What date AND time would

be best to call/visit?

Enter date AND time

Enter (1) if you don't intend to follow up on this case.

_________________________

What date AND time would be best to contact

(respondent’s name) in order to conduct the quality check?

Enter date AND time.

Enter (1) if you don't intend to follow up on this case.

__________________________________________________

Thank you for your help.

We will call/visit again at the time suggested.

Enter 1 to continue

__________________________________________________

Enter reinterview notes about this case now, or view and edit existing notes.

Press Ctrl-F7 to access Reinterview Notes.

Press SHIFT-F11 to access Abbreviation List.

Press SHIFT-F12 to view Original CAPI Notes.

Enter 1 to continue after completing reinterview notes.

__________________________________________________

This case is ready to be wrapped up. After exiting, the case will be

deleted from your case list.

_________________________________________________

THIS CASE IS NOT COMPLETED

Enter 1 to continue

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