Form Assigned Screener Questionnaire

2007 Q1 NHIS Instrument Spec Report

Section name: Coverage

Module 02

Section Name Coverage

Part

Question ID COV.010

Variable Name VERADD

Universe START(Front Section) = Proceed (1) and (POS2 and POS3 = 0)

or

All from TYPEA2(Front Section) when LIVQRT = null

or

All from TYPEB2(Front Section) when LIVQRT = null

Universe-text

Question Text I have your address listed as:

Address: [Fill: HNO HNOSUF STRNAME]

[Fill: UNITDES]

[Fill: GQUNITINFO]

[Fill: NONCITYADD]

[Fill: PHYSDES]

[Fill: PO, ST ZIP5 - ZIP4]

[Fill: BLDGNAME]

Is that your exact address?

Answer Codes 1. Yes, address is EXACTLY CORRECT as listed

2. Address is MOSTLY CORRECT, but needs some minor changes

3. INCORRECT ADDRESS - terminate interview and find correct address

Question Type Pick One - answer list pane

Field Pane Description Verify address

Fill Instructions

Special Instructions if MARK < Household reached (7), store Household reached (7) in MARK

Don't allow a Don't know or Refused

Skip Instructions <1> if POS2 ne 0 and START (Front) = Proceed (1), GOTO TELENUM

elseif OUTCOME = 213-235

if I_SEGTYP = 4

if POS1 ne 0, GOTO LOCATE

else, GOTO OTHLIVQ, endif

elseif (I_SEGTYP = 1 and I_NPA_PA = N) or I_GQINAREA = 1 or I_MOBHM = 1

if OUTCOME = Type A Non-interview (213-220), GOTO LOCATE

elseif POS1 ne 0, GOTO LOCATE

elseif I_GQINAREA = 1

if MULTUNIT = 0, GOTO OTHLIVQ

else GOTO LOCATE, endif

elseif MULTUNIT = 0 GOTO OTHLIVQ

else GOTO LOCATE, endif

else, GOTO YRBLT, endif

else GOTO MAILADD, endif

<2> store 1 in ADDRCHG, GOTO HNO

<3> store Accessed instrument, no progress (202) in OUTCOME, Unreached household (3) in

MARK, GOTO VISITCNT (Back Section)

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Module 02

Section Name Coverage

Part

Question ID COV.030

Variable Name MAILADD

Universe VERADD ne Incorrect address (3) and OUTCOME ne Non-interview (213-214, 216-223, 225-235,

240-290)

or

START (Front) = Proceed (1) and POS2 ne 0

Universe-text All cases with a correct address or an address that required only a few revisions

Question Text [Fill 1:] Is this also your mailing address?

Address: [Fill: HNO HNOSUF STRNAME]

[Fill: UNITDES]

[Fill: GQUNITINFO]

[Fill: NONCITYADD]

[Fill: PO, ST ZIP5 - ZIP4]

Answer Codes 1. Yes

2. No

Don't Know

Refused

Question Type Yes/No

Field Pane Description Mailing address

Fill Instructions If POS2 ne '0'

[fill 1: What is your exact mailing address?]

else

[fill 1: Is this also your mailing address?]

endif

Special Instructions store HNO in MAILHNO, HNOSUF in MAILHNOSUF, STRNAME in MAILSTRNAME,

UNITDES in MAILUNITDES, GQUNITINFO in MAILGQUNITINFO, NONCITYADD in

MAILNONCITYADD, PO in MAILPO, ST in MAILST, ZIP5 in MAILZIP5, ZIP4 in MAILZIP4

if POS2 or POS3 ne 0, store Household Reached (7) in MARK

<1,Refused,Don't know> store 1 in MFLAG

<2> store 2 in MFLAG

Skip Instructions <1, D, R> store 1 in MFLAG

if POS2 ne 0 and START (Front) = Proceed (1), GOTO TELENUM

if I_SEGTYP = 4

if POS1 ne 0

GOTO LOCATE

else, GOTO OTHLIVQ, endif

else if (I_SEGTYP = 1 and I_NPA_PA = N) or I_GQINAREA = 1 or I_MOBHM = 1

if POS1 ne 0, GOTO LOCATE

elseif I_GQINAREA = 1

if MULTUNIT = 0, GOTO OTHLIVQ

else GOTO LOCATE, endif

elseif MULTUNIT = 0 GOTO OTHLIVQ

else GOTO LOCATE, endif

else GOTO YRBLT, endif

<2> GOTO MAILHNO

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Module 02

Section Name Coverage

Part

Question ID COV.060

Variable Name YRBLT

Universe I_SEGTYP = 1 and I_NPA_PA = P and GQINAREA ne 1 and MOBHM ne 1 and TYPEC1 = empty

or nonresponse

Universe-text Permit issuing area segments with non-mobile home addresses and addresses not in a GQ.

Question Text * If this address is a GQ, Mobile Home, Trailer, Tent, Boat or other Unit not in a structure, enter

"Not asked" (3) without asking about year built.

Was this structure built before April of 2000?

Answer Codes 1. Yes

2. No

3. Not asked

Don’t Know

Refused

Question Type Pick One - answer list pane

Field Pane Description Year built

Fill Instructions

Special Instructions

Skip Instructions <1, 3, D,R> if OUTCOME = Type A Non-interview (213-220), GOTO LOCATE

elseif POS1 ne 0, GOTO LOCATE

elseif GQINAREA ne 1

if MULTUNIT = 0, GOTO OTHLIVQ

else GOTO LOCATE, endif

else GOTO LOCATE, endif

<2> store Built after April 2000 (246) in OUTCOME

goto CLOSE4

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AssocHelp H_YRBLT

Module 02

Section Name Coverage

Part

Question ID COV.070

Variable Name OTHLIVQ

Universe POS1 = 0 and POS2 = 0 and POS3 = 0 and MULTUNIT ne 1 and (I_SEGTYP = 4 or (I_SEGTYP =

1 and GQINAREA ne 1)) and YRBLT ne '2' and TYPEC1 = empty or nonresponse

Universe-text Parent cases at single units in permit segments or at single units not in group quarters in area

segments

Question Text Are there any other living quarters---either occupied or vacant---at this address?

Answer Codes 1. Yes

2. No

Question Type Yes/No

Field Pane Description Other Living Quarters

Fill Instructions

Special Instructions Don't allow a Don't know or Refused

Skip Instructions <1> GOTO OTHADD_1

<2> GOTO LOCATE

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Module 02

Section Name Coverage

Part

Question ID COV.220

Variable Name LOCATE

Universe [I_SEGTYP = 4 and POS1 ne 0 and OUTCOME ne Type C Non-Interview (240-290)]

or

[((I_SEGTYP = 1 and I_NPA_PA = N) or GQINAREA = 1 or MOBHM = 1)

and (OUTCOME = 213-220 or POS1 ne 0) and OUTCOME ne Type C Non-Interview (240-290)

or

[((I_SEGTYP = 1 and I_NPA_PA = N) or GQINAREA = 1 or MOBHM = 1) and GQINAREA = 1 and

MULTUNIT ne 0 and OUTCOME ne 240-290]

or

[((I_SEGTYP = 1 and I_NPA_PA = N) or GQINAREA = 1 or MOBHM = 1) and POS1 ne 0 and

(OUTCOME ne 213-220 or GQINAREA ne 1) and MULTUNIT ne 0) and OUTCOME ne Type C

Non-Interview (240-290)]

or

[YRBLT = 1,3,RF,DK and OUTCOME = 213-220]

or

[YRBLT = 1,3,RF,DK and POS1 ne 0]

or

[YRBLT = 1,3,RF,DK and GQINAREA = 1 and MULTUNIT ne 0]

or

[YRBLT = 1,3,RF,DK and OUTCOME ne 213-220 and GQINAREA ne 1 and POS1 = 0 and

MULTUNIT ne 0]

or

[OTHLIVQ = 2]

or

[TOTEXTRA = 0]

or

[SEGLIST = 1]

Universe-text

Question Text * Indicate whether this sample unit is located in group quarters or not.

Answer Codes 1. Not in Group Quarters

2. In Group Quarters

Question Type Pick One - answer list pane

Field Pane Description Group quarters

Fill Instructions

Special Instructions Don't allow a Don't know or Refused

Skip Instructions <1> GOTO ACCESS

<2> GOTO LIVQRT

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Module 02

Section Name Coverage

Part

Question ID COV.230

Variable Name ACCESS

Universe LOCATE = 1

Universe-text The address isn't in a GQ

Question Text *Ask if not apparent. Is access to the unit direct or through another unit?

Answer Codes 1. Direct

2. Through another unit

Question Type Pick One - answer list pane

Field Pane Description Direct access

Fill Instructions

Special Instructions Don't allow a Don't know or Refused

Skip Instructions <1> GOTO LIVQTR

<2> GOTO MERGE

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AssocHelp H_ACCESS

Module 02

Section Name Coverage

Part

Question ID COV.260

Variable Name LIVQRT

Universe LOCATE = 2

or

ACCESS = 1

or

MERGE =1 and (OUTCOME ne 220 or START ne P or LIVQRT = null)

Universe-text

Question Text [fill 1]

[fill 2]

Answer Codes [fill 3]

[fill 4]

Question Type Pick One - answer list pane

Field Pane Description Housing type

Fill Instructions if LOCATE = Not in Group Quarters (1), use fill 1 and fill 3. Else use fill 2 and fill 4

fill 1:

*Enter appropriate type of housing unit.

fill 2:

*Enter appropriate type of group quarters.

fill 3:

1. House, apartment, flat, condo

2. Housing unit in nontransient hotel, motel, etc

3. Housing unit--permanent in transient hotel, motel, etc

4. Housing unit in rooming house

5. Mobile home or trailer with no permanent rooms andded

6. Mobile home or trailer with one or more permanent rooms added

7. Housing unit not specified above

fill 4:

8. Quarters not housing unit in rooming or boarding house

9. Unit not permanent in transient hotel, motel, etc

10. Unoccupied site for mobile home, trailer, or tent

11. Student quarters in college dormitory

12. Group quarter unit not specified above

Special Instructions Don't allow a Don't Know or Refused.

Skip Instructions <1-6, 8-11>

if OUTCOME = Refused (218), GOTO VISITCNT(Back Section)

else, if OUTCOME = Temporarily absent, follow-up possible (220) and START = Proceed (1),

GOTO TELENUM

else, if OUTCOME = Non-Interview (213-248), GOTO CLOSE4

else, GOTO TELNUM

<7, 12> GOTO LIVQRT_SPECIFY

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Module 02

Section Name Coverage

Part

Question ID COV.330

Variable Name TELENUM

Universe [POS2 ne 0 and START = Proceed (1)]

or

[MERGE = 1 and OUTCOME = 220 and START = P and LIVQRT ne null]

or

[LIVQRT = 1-6, 8-11 and ((OUTCOME = 220 and START = P) or (OUTCOME ne 213 - 290))]

or

[LIVQRT_SPECIFY ne null and ((OUTCOME = 220 and START = P) or (OUTCOME ne 213- 290))]

Universe-text

Question Text What is the telephone number here, beginning with the area code?

* Enter the area code and the number, or enter "N" if no phone.

* Include any phone number (landline or cell).

Answer Codes

Question Type Integer

Field Pane Description Telephone

Fill Instructions

Special Instructions Use standard telephone field format <( ) - >

If PHONENUM is ‘empty’ or has an incomplete or invalid phone number and TELENUM is RF, DK, N, or ‘empty’

Do not update PHONENUM with TELENUM

If PHONENUM is ‘empty’ or has an incomplete or invalid phone number and TELENUM has a valid phone number Update PHONENUM with TELENUM

If PHONENUM has a valid phone number and it is not equal to TELENUM and RCIFLAG ne '1' Update TELENUM with PHONENUM

If TELENUM is RF, DK, N, or ‘empty’ and PHONENUM is ‘empty’ or has an incomplete or invalid phone number Do not update TELENUM with PHONENUM

If TELENUM is RF, DK, N, or ‘empty’ and PHONENUM has a valid phone number and

RCIFLAG ne '1' Update TELENUM with PHONENUM

If TELENUM has a valid phone number and it is not equal to PHONENUM

Update PHONENUM with TELENUM

Do not update any variables from TELECHG

Skip Instructions <2000000000 - 9999999996, D, R> store in HPHONE1 [goto CURWRK]

<0-1999999999> [goto ERR_TELENUM]

<N> [goto RH1LNGDY_1]

Hard Edits ERR_TELENUM

* Enter the entire telephone number.

* Please correct.

AssocHelp H_TELENUM

Module 02

Section Name Coverage

Part

Question ID COV.331

Variable Name CURWRK

Universe TELENUM NE N

Universe-text All families with a phone

Question Text Is there at least one telephone INSIDE your home that is currently working and is not a cell phone?

Answer Codes 1. Yes

2. No

Don't Know

Refused

Question Type Yes/No

Field Pane Description Inside land line

Fill Instructions

Special Instructions

Skip Instructions <1, R, D> [goto RNOSERV]

<2> [goto RH1LNGDY_1]

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AssocHelp H_CURWRK

Module 02

Section Name Coverage

Part

Question ID COV.332

Variable Name RNOSERV

Universe CURWRK = 1,R,D

Universe-text No phone in home that is working and not a cellular phone (or R,D to provide this information)

Question Text Not including cell phones, have your or your family been without telephone service for one week or more during the past 12 months? Do not include interruptions of phone service due to weather or natural disasters.

Answer Codes 1. Yes

2. No

Don't know

Refused

Question Type Yes/No

Field Pane Description No service-past 12 months

Fill Instructions

Special Instructions

Skip Instructions <1> [goto RH1LNGDY_1]

<2,R,D> [goto TELCEL]

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Module 02

Section Name Coverage

Part

Question ID COV.333_1

Variable Name RH1LNGDY_1

Universe TELENUM=N or CURWRK=2 or RNOSERV=1

Universe-text Respondents with no phone or who have no working land-line phone or who have been without land-line phone service for one week or more during the past 12 months.

Question Text Not including cell phones, how long were you or your family without telephone service in the past 12 months?

*Enter number for time without telephone service.

*If less than one week, enter ‘0’

Answer Codes

Question Type Integer

Field Pane Description How long-number

Fill Instructions

Special Instructions

Skip Instructions <1-365> [goto RH1LNGDY_2]

<0,R,D> [goto TELCEL]

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AssocHelp H_RH1LNGDY

Module 02

Section Name Coverage

Part

Question ID COV.333_2

Variable Name RH1LNGDY_2

Universe RH1LNGDY_1 = 1-365

Universe-text Number given at RH1LNGDY_1

Question Text * Enter time period

Answer Codes 1. Days

2. Weeks

3. Months

Question Type Pick one answer list

Field Pane Description How long-time period

Fill Instructions

Special Instructions

Skip Instructions <1> if RH1LNGDY_1 ne 8-365, goto ERR1_RH1LNGDY_2

<2> if RH1LNGDY_1 ne 2-52, goto ERR2_RH1LNGDY_2

<3> if RH1LNGDY_1 ne 1 - 12, goto ERR3_RH1LNGDY_2

else, [goto TELCEL]

Hard Edits ERR1_RH1LNGDY_2

* Days should be in the range 8-365.

* Please correct

ERR2_RH1LNGDY_2

* Weeks should be in the range 2-52.

* Please correct.

ERR3_RH1LNGDY_2

* Months should be in the range 1-12.

* Please correct.

Soft Edits

AssocHelp H_RH1LNGDY

Module 02

Section Name COV

Part

Question ID COV.334

Variable Name TELCEL

Universe All families

Universe-text All families

Question Text Do you or anyone in your family have a working cell phone?

Answer Codes 1. Yes

2. No

Refused

Don't know

Question Type Yes/No

Field Pane Description Cell phone

Fill Instructions

Special Instructions

Skip Instructions <1> goto WRKCEL

<2, R, D> if CURWRK=1 and RNOSERV=1 [goto CELLOUT]; else if CURWRK=2 or (CURWRK=1 and RNOSERV=2,R,D) [goto NAME_FNAME (household composition section)]

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Module 21

Section Name REC

Part

Question ID REC.335

Variable Name WRKCEL

Universe TELCEL = 1

Universe-text Families with a working cell phone

Question Text How many working cell phones do you or people in your family have?

Answer Codes

Question Type Integer

Field Pane Description # of cell phones

Fill Instructions

Special Instructions

Skip Instructions <1-10,R, D> if CURWRK=1 and RNOSERV=1 [goto CELLOUT]; else if CURWRK=1 and RNOSERV=2,R,D [goto PHONEUSE]; else if CURWRK=2 [goto NAME_FNAME]

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Module 02

Section Name COV

Part

Question ID REC.336

Variable Name CELLOUT

Universe (TELCEL = 2,R,D and CURWRK=1 and RNOSERV=1) or (WRKCEL=1-10,R,D and CURWRK=1 and RNOSERV=1)

Universe-text Families with no cell phone, or Ref/DK whether they had working cell phone and have a current working land-line that was out of service in the past 12 months, or who have a least one working cell phone or REF DK number of working cell phones and have current working land-line that was out of service in the past 12 months

Question Text During the most recent time you or your family were without telephone service, did you have a working cell phone?

Answer Codes 1. Yes

2. No

Refused

Don’t know

Question Type Yes/No

Field Pane Description Working cell during outtage

Fill Instructions

Special Instructions

Skip Instructions <1,2,R,D> if TELCEL=1 [goto PHONEUSE]; else if TELCEL=2,R,D [goto NAME_FNAME]

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Module 02

Section Name COV

Part

Question ID REC.337

Variable Name PHONEUSE

Universe TELCEL=1 and CURWRK=1

Universe-text Working cell phone and working land line in family

Question Text Of all the telephone calls that you or your family receives, are...

*Read categories below.

Answer Codes 1. All or almost all calls received on cell phones?

2. Some received on cell phones and some on regular phones?

3. Very few or none received on cell phones?

Refused

Don't know

Question Type Pick one answer list

Field Pane Description Type of phone call

Fill Instructions

Special Instructions

Skip Instructions <1-3,R,D> [goto NAME_FNAME]

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