Field Test of the National Household Food Acquisition and Purchase Survey

APPENDIX D
HOUSEHOLD SCREENER

National Household Food Acquisition and Purchase Survey, Mathematica Policy Research
Case ID #

OMB # place holder
IF HIGH INCENTIVE HH: $125 for completing all of the survey activities
for one week.

_______

HOUSEHOLD SCREENER
I need to ask you some questions to find out if your household is eligible
for the survey.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it displays a valid OMB
control number. The valid OMB control number for this information collection is xxxx-xxxx. The
time required to complete this information collection is estimated to average 8 minutes per
response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information.

IF HOUSEHOLD REFUSES, TRY AND PERSUADE TO DO THE SCREENER, IF
FINAL REFUSAL GO TO SHORT FORM FOR REFUSAL.

Hello, I’m [INTERVIEWER’S NAME]. I work for Mathematica Policy
Research and we’re conducting a survey for the U.S. Department of
Agriculture.

Taking part is voluntary and all the information you give us will be kept
in the strictest confidence. Your name will not be attached to any of
your answers. Your information will be used only in combination with
information from other households for statistical analyses. It will take
about 10 minutes to answer these questions.

SHOW ID CARD.
We recently sent a letter to this address explaining the survey, which is
called the National Food Study. This study looks at the foods people get
over the course of a week.

INTRO2. Do you have any questions before we begin?
(1) YES
(0) NO
(77) REFUSED
(99) DON’T KNOW

INTRO1. Did you get our letter?
(1) YES
(0) NO
(77) REFUSED
(99) DON’T KNOW

1. I have this address listed as [READ ADDRESS]. Is that your exact
address?
[SIPP04W1C, VERADD]

IF RESIDENT DOES NOT REMEMBER, HAND NEW COPY OF LETTER AND
BROCHURE.

(1) YES, ADDRESS IS EXACTLY CORRECT AS LISTED  GO TO Q2
(2) ADDRESS IS MOSTLY CORRECT, BUT NEEDS SOME MINOR
CHANGES  MAKE CHANGES ON CONTACT SHEET
(3) INCORRECT ADDRESS  TERMINATE INTERVIEW AND FIND
CORRECT ADDRESS

The addresses we visit have been scientifically selected to represent all
households in our country. If you are eligible, we can start the survey
today and you will receive at least
IF LOW INCENTIVE HH: $75for completing all of the survey activities for
one week.

1

National Household Food Acquisition and Purchase Survey, Mathematica Policy Research

  3a.  What is the exact address of the (first) unit or living quarters? 

2. Is your mailing address the same as your street address? Do you get 
your mail sent to this address? 

(1) YES → SKIP TO Q3 
(0) NO 
(77) REFUSED → SKIP TO Q3 
(99) DON’T KNOW→ SKIP TO Q3 

2a  Please give me your complete mailing address.  

STREET ADDRESS:  ____________________________ 

P.O. BOX OR RURAL ROUTE:_____________________ 

CITY:  _________________    STATE:  _______  ZIP:  _________ 

OMB # place holder

[SIPP04W1C, OTHADR] 

(1)  SAME  Æ Go to 3b 
(0)  NOT SAME Æ WRITE ADDRESS BELOW  
(77) REFUSED  Æ Go to 3b 
(99) DON’T KNOW  Æ Go to 3b 
First Unit: 
______________________________________  Street/P.O. 
Box 

______________________________________ Unit(s) 

___________________ City   
______________ Zip 

[IF  Q3=2,  RECORD  ADDITIONAL  ADDRESSES  ON  SEPARATE 
SHEET] 
SKIP TO 4 

3. Are  there  any  other  housing  units  or  living  quarters  ‐  either 
occupied or vacant ‐ at HH ADDRESS?  

A separate housing unit has either 1) direct access from the outside 
or  from  a  common  hallway,  or  2)  a  kitchen  or  cooking  equipment 
for the exclusive use of the occupants. 

[AFTER COMPLETING INTERVIEW, CALL SUPERVISOR TO CHECK IF 
THIS  ADDRESS  IS  IN  THE  FRAME.  IF  NOT  IN  FRAME,  INTERVIEW 
WILL NOT BE ATTEMPTED AT THIS ADDRESS.] 

[SIPP04W1C, ATADR] 

(1) Yes, one other unit 
(2) Yes, more than one other unit 
(0) No Æ Skip to Q4 
(77) REFUSED Æ Skip to Q4 
(99) DON’T KNOW Æ Skip to Q4 

IF  YES,  ASK  ABOUT  ADDITIONAL  LIVING  QUARTERS  AT  THIS 
ADDRESS  TO  DETERMINE  IF  THEY  QUALIFY AS  EXTRA  UNITS  TO  BE 
INTERVIEWED. 

3b. Do the occupants of the additional units or living quarters live 
separately from the people in your household?  
[modified SIPP04W1C, LVEAT1] 

(1) YES Æ  THIS ADDITIONAL LIVING QUARTER IS AN EXTRA 
UNIT AND MUST BE INTERVIEWED SEPARATELY 

(0) NO Æ THIS ADDITIONAL UNIT IS PART OF THE HOUSEHOLD. 
BE SURE TO COUNT THEM IN HOUSEHOLD SIZE. 

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National Household Food Acquisition and Purchase Survey, Mathematica Policy Research
IF YES, THIS ADDITIONAL LIVING QUARTERS IS AN EXTRA UNIT. DO 
NOT  INCLUDE  MEMBERS  OF  THIS  EXTRA  UNIT  AS  MEMBERS  OF 
THE CURRENT UNIT. THEY MUST BE INTERVIEWED SEPARATELY. 

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6. How often (do you/does someone) go food shopping for 
(yourself/your household)? Would you say… 
[NHANES CBQ.140]  

4. Including yourself, how many people live in your household? Don’t 
forget to include non‐relatives who live here and, of course, babies 
and  small  children.  Also  include  persons  who  usually  live  here  but 
are  temporarily  away  for  reasons  such  as:  vacation,  traveling  for 
work,  or  in  the  hospital.  Do  not  include  children  living  away  at 
school. 

________ NUMBER  
(77) REFUSED  
(99) DON’T KNOW  

5. Do all the people in your household live together and share food? 

  (1) Yes Æ SKIP TO HH SIZE BOX BELOW AND ENTER Q4 RESPONSE 
  (0) No 

  5a. IF NO: How many people live together and share food?  
ENTER THIS NUMBER IN HHSIZE BOX 

Household Size 

(1) more than once a week,  
(2) once a week,  
(3) once every two weeks,  
(4) once every three weeks, or  
(5) once a month or less?  
(6) RARELY MAKE ANY MAJOR SHOPPING TRIPS, ONLY SMALL TRIPS  
(7) RARELY SHOP FOR FOOD  
(77) REFUSED  
(99) DON'T KNOW  
IF HHSIZE = 1, SKIP TO Q8. ELSE ASK 

7. In a typical week, how many meals do all or most of the members of 
your  household  eat  together,  including  meals  eaten  away  from 
home?  
[modified, NHANES CBQ.180] 

|___|___| ENTER NUMBER  

(0) NONE 
(77) REFUSED 
(99) DON’T KNOW  

8. In  a  typical  week,  how  many  times  (do  you/does  someone  in  the 
household)  prepare  food  for  dinner  or  supper  at  home?  This 
includes putting the ingredients together for a meal. Do not include 
heating up leftovers or frozen meals.  

[modified, NHANES CBQ.190] 

3

|___|___| ENTER NUMBER  
(77) REFUSED  
(99) DON'T KNOW  

National Household Food Acquisition and Purchase Survey, Mathematica Policy Research

OMB # place holder
Table‐1: Income Hand Card 

9. Now  I  am  going  to  ask  about  the  total  income  for  (you/your 
household) last month. Please think about income from all sources 
such as wages, salaries, Social Security or retirement benefits, help 
from  relatives,  and  so  forth.  What  category  represents  the  total 
income  for  (you/your  household)  before  taxes  last  month?  SHOW 
HAND CARD. 

IF  NEEDED:  Income  is  important  in  determining  your  eligibility  for 
this  study  because  we  need  to  include  a  certain  number  of 
households  at  different  levels  of  income.  [modified,  NHANES0708 
INQ.200; changed last calendar year to last month] 

(1) CATEGORY A 

(2) CATEGORY B 

(3) CATEGORY C 

(77) REFUSED  

(99) DON'T KNOW   

10. Do you or any member of your household currently receive benefits 
from  [SNAP/STATE  NAME]?  This  program  used  to  be  called  food 
stamps. It puts money on an [EBT/STATE NAME] card that you can 
use to buy food. 

(1)   YES → GO TO INTERVIEWER CHECK #1 

(0)   NO → GO TO INTERVIEWER CHECK #2 

(77)  REFUSED → GO TO INTERVIEWER CHECK #2 

(99)  DON’T KNOW → GO TO INTERVIEWER CHECK #2  

For your household size, which category below matches your household's
monthly income (A, B or C)?

1
2
3
4
5
6
7

Below
(A)
$902
$1,213
$1,525
$1,837
$2,148
$2,460
$2,772

Between
(B)
$903 - $2,527
$1,214 - $3,400
$1,526 - $4,272
$1,838 - $5,145
$2,149 - $6,018
$2,461 - $6,890
$2,773 - $7,763

Above
(C)
$2,528
$3,401
$4,273
$5,146
$6,019
$6,891
$7,764

8 or more

$3,083

$3,084 - $8,636

$8,637

HH Size

Or if you think of your household income in annual amounts, which category
below matches your household's annual income (A, B or C)?

1
2
3
4
5
6
7

Below
(A)
$10,829
$14,569
$18,309
$22,049
$25,789
$29,529
$33,269

Between
(B)
$10,830 - $30,324
$14,570 - $40,796
$18,310 - $51,268
$22,050 - $61,740
$25,790 - $72,212
$29,530 - $82,684
$33,270 - $93,156

8 or more

$37,009

$37,010 - $103,628

HH Size

4

Above
(C)
$30,325
$40,797
$51,269
$61,741
$72,213
$82,685
$93,157
$103,629

National Household Food Acquisition and Purchase Survey, Mathematica Policy Research

INTERVIEWER CHECK #1:    

IS QUOTA GROUP‐D OPEN? 

(1) YES  Æ GO TO “ELIGIBLE”  

(0) NO Æ  GO TO “NOT ELIGIBLE” 

INTERVIEWER CHECK #2:    
IS THE HOUSEHOLD’S INCOME CATEGORY AN OPEN QUOTA GROUP? 

(1) YES Æ GO TO “ELIGIBLE”  

(0) NO Æ GO TO “NOT ELIGIBLE” 

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ELIGIBLE CONTINUE HERE 
Thank you. Your household is eligible for the survey! I’d like to continue 
now and get your complete contact information and tell you about the 
survey.  
INT: IF LOW INCENTIVE HH 
In  total,  it  will  take  about  six  to  seven  hours  of  your  time  during  the 
week. After you finish, we will give you $50.  
•

We will also mail $20 to each additional member of your household 
(over age 5) who reports the foods they get during the week.  

•

If  you  call  us  to  complete  three  short  telephone  interviews  about 
the foods you get during the week we will mail you a $25 telephone 
bonus.  

A  one‐person  household  may  get  $75  if  he/she  completes  all  survey 
activities;  a  four‐person  household  may  get  up  to  $135  for  completing 
all survey activities. 

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National Household Food Acquisition and Purchase Survey, Mathematica Policy Research
INT: IF HIGH INCENTIVE HH 

11. Are you the person who does most of the planning or preparing of 
meals in your family? [NHANES0708 DBQ.930] 

INT: IF R ANSWERS “SOMETIMES” OR “50/50”, ENTER YES 

(1) YES Æ SKIP TO Q12 
(0) NO 
(77) REFUSED Æ SKIP TO Q12 
(99) DON’T KNOW Æ SKIP TO Q12 

11a.  IF NO, ASK:. Who does most of the planning or preparing 
of meals? 

FIRST NAME: ______________________   

In  total,  it  will  take  about  six  to  seven  hours  of  your  time  during  the 
week. After you finish, we will give you $100.  
•

We will also mail $25 to each additional member of your household 
(over age 5) who reports the foods they get during the week.  

•

If  you  call  us  to  complete  three  short  telephone  interviews  about 
the foods you get during the week we will mail you a $25 telephone 
bonus.  

OMB # place holder

A  one‐person  household  may  get  $125  if  he/she  completes  all  survey 
activities;  a  four‐person  household  may  get  up  to  $200  for  completing 
all survey activities. 

I have a few more questions to see who in your household is the best 
person to complete the survey.  

LAST NAME:   ______________________ 

12. Are you the person who does most of the shopping for food in your 
family? 
[NHANES0708 DBQ.940] 

I have a few more questions to see who in your household is the best 
person to complete the survey.  

(1) YES  Æ SKIP TO Q13 
(0) NO 
(77) REFUSED Æ SKIP TO Q13 
(99) DON’T KNOW Æ SKIP TO Q13 

12a.  IF NO, ASK:  Who does most of the shopping for food? 

FIRST NAME: ___________________   
LAST NAME:   ___________________ 

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National Household Food Acquisition and Purchase Survey, Mathematica Policy Research
INTERVIEWER CHECK #3: IS R THE MEAL PLANNER OR FOOD SHOPPER?  

 (1) YES  Æ CONTINUE WITH SCREENER.  
 (0) NO Æ  ASK TO SPEAK WITH FOOD SHOPPER (Q12a) 
                    EXPLAIN THE SURVEY AND GET CONTACT INFORMATION 

OMB # place holder
14. Is  there  another  number  where  (you/FOOD  SHOPPER)  can  be 
reached  so  that  you  do  not  get  cell  phone  charges  when  you  talk 
with us? 

(1)  YES Æ LIST BELOW, THEN SKIP TO Q16 
(0)  NO Æ SKIP TO Q16 
(77)  REFUSED Æ SKIP TO Q16 
(99)  DON’T KNOW Æ  SKIP TO Q16 

______ ‐ __________ ‐ __________ OTHER TELEPHONE NUMBER  

  14a. Is that a home phone, work phone, or some other phone? 

(1)  CELL PHONE (DIFFERENT FROM ONE IN Q13) 
(2)  HOME PHONE 
(3)  WORK PHONE 
(4) RELATIVE’S HOME                                                       GO TO Q16 
(5) NEIGHBOR’S HOME  
(6) OTHER 

IF  FOOD  SHOPPER  AND  MEAL  PLANNER  ARE  NOT  THE  SAME 
PERSON,  ASK  FOR  MEAL  PLANNER  IF  FOOD  SHOPPER  IS  NOT 
AVAILABLE. 
IF  FOOD  SHOPPER/MEAL  PLANNER  NOT  AVAILABLE,  FINISH  THE 
SCREENER  TO  GET  FOOD  SHOPPER  CONTACT  INFO  FROM 
RESPONDENT. 

13. What is the best telephone number to reach (you/FOOD SHOPPER) 
at? 

(        ) ‐ ______ ‐ __________  

(0) NO  TELEPHONE Æ Skip to Q15 
(77) REFUSED Æ Skip to Q15 
(99) DON’T KNOW Æ Skip to Q15 

  13a. Is that a home phone, cell phone, work phone, or some other 
phone? 

(1)  CELL PHONE  
(2)  HOME PHONEÆ Skip to Q15 
(3)  WORK PHONE Æ Skip to Q15 
(4) RELATIVE’S HOME Æ Skip to Q15 
(5) NEIGHBOR’S HOME Æ Skip to Q15 
(6) OTHERÆ Skip to Q15 

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National Household Food Acquisition and Purchase Survey, Mathematica Policy Research
15. Is  there  another  number  where  (you/FOOD  SHOPPER)  can  be 
reached?  

 ______ ‐ __________ ‐ __________ OTHER TELEPHONE NUMBER  

(0) NO Æ Skip to Q16 
(77) REFUSED Æ Skip to Q16 
(99) DON’T KNOW   ÆSkip to Q16 

15a. Is that a home phone, cell phone, work phone, or some other 
phone? 

(1)  CELL PHONE 
(2)  HOME PHONE 
(3)  WORK PHONE 
(4) RELATIVE’S HOME  
(5) NEIGHBOR’S HOME  
(6) OTHER 

16. What  language  would  (you/FOOD  SHOPPER)  be  most  comfortable 
using for our interviews? 

(1)  English  

(2)  Spanish 

(3)  Other: ________________________________ 

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17. Do  you  have  time  now  to  discuss  the  study  and  learn  about  what 
you’ll be doing for the week? This will take a little over an hour. 

(1) YES – GO TO SURVEY INTRODUCTION IN CAPI. 
(0) NO – GO TO SCHEDULING 

ASK TO GO INSIDE TO CONDUCT STUDY INTRODUCTION, SIGN CONSENT 
FORM, AND CONDUCT TRAINING ON DATA COLLECTION ACTIVITIES OR 
TO SCHEDULE VISIT. 

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National Household Food Acquisition and Purchase Survey, Mathematica Policy Research

NOT ELIGIBLE 

Thank you for your time. I’m sorry your household is not eligible for the study.  

18. May I have your name and telephone number in case my supervisor wants 
to confirm that I spoke with you?  

FIRST NAME: ______________________   

LAST NAME:   ______________________ 

(        ) ‐ ______ ‐ __________  
(0) NO TELEPHONE 
(77) REFUSED 
(99) DON’T KNOW 

INTERVIEWER CHECK #4: WHAT LANGUAGE WAS THIS 

ADMINISTRATIVE 

19. ADMINISTRATIVE ONLY: After the training, assess the level of cooperation 
or level of support this household may need during the study week. 

(1)  RED – RELUCTANT/HIGH LEVEL OF SUPPORT ANTICIPATED 
(2) YELLOW – MODERATE INTEREST/MAY NEED ADDITIONAL SUPPORT 
(3) GREEN – COMPLIANT/INTERESTED/LIKELY MINIMAL SUPPORT 

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