Cognitive Research on Experimental CPS Health Insurance Questions

Generic Clearence for Questionnaire Pretesting Research

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Cognitive Research on Experimental CPS Health Insurance Questions

OMB: 0607-0725

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Household Roster and Demographics

Case ID ________________ Interviewer Name __________________




Person line #

1a




FIRST NAME

1b




LAST NAME

2


[Flash A]

Relationship to Person 1

3




Sex

4




Age

5




Hispanic

6


[Flash B]

Race

Code(s)

7

(15+)

[Flash C]

Educ

Code

8

(15+)

Ever in Armed Forces?

9

(15+)

Marital Status Code

1



[Person 1]

M F


Y N



Y N


2




M F


Y N



Y N


3




M F


Y N



Y N


4




M F


Y N



Y N


5




M F


Y N



Y N


6




M F


Y N



Y N






10. Residency

□ DC

□ Maryland

□ Virginia



11. Total annual income [of household]

□ Above $30,000

□ Below $30,000

File Typeapplication/msword
File TitleControl card type information necessary for the household at the time of the interview
Authorbarte002
Last Modified ByBureau Of The Census
File Modified2008-05-08
File Created2008-05-08

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