Attachment 3o Reinterview Survey (5 minutes)
NHIS Reinterview Instrument Screens
Survey Response Analysis Branch
Demographic Statistical Methods Division
Screen OMB_NOTICE:
OMB No. 0920-0214: Approval Expires 12/31/xxxx
National Health Interview Survey (NHIS) Reinterview
Read the NOTICE statement to the respondent only if she/he has a serious grievance and would like to make a complaint regarding the survey. Allow the respondent in this situation to copy the agency titles and addresses listed in the NOTICE statement. Otherwise, continue with the reinterview.
NOTICE – Information contained on this form which would permit identification of any individual or establishment has been collected with a guarantee that it will be held in strict confidence, will be used only for purposes stated for this study, and will not be disclosed or released to others without the consent of the individual or establishment in accordance with Section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (44 USC 3501 note). Public reporting burden of this collection of information is estimated to average about five 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. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports, Clearance Officer; Paperwork Reduction Project (0920-0214), 1600 Clifton Rd., MS D-24, Atlanta, GA 30333.
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Front Section:
Screen RIREASON:
Reinterview Help Menu
Press F8 to proceed to the reinterview.
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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. How long will this reinterview take? 7. I thought you only counted people. 8. TOLL FREE (800) Telephone Number to Verify Reinterview 9. Return to Reinterview |
Screen RIREF1:
Why are you calling me again?
Like any business, we're interested in maintaining the quality of our product, so we reinterview a few households who are in the survey to ensure we are efficiently and accurately collecting data.
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1. Continue 2. Back to Reinterview Help Menu |
Screen RIREF2:
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.
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1. Continue 2. Back to Reinterview Help Menu |
Screen RIREF3:
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.
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1. Continue 2. Back to Reinterview Help Menu |
Screen RIREF4:
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.
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1. Continue 2. Back to Reinterview Help Menu |
Screen RIREF5:
Do I have to answer 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. |
1. Continue 2. Back to Reinterview Help Menu |
Screen RIREF6:
How long will this reinterview take?
We expect this reinterview to take about five to ten minutes. We have limited questions in this survey to those essential to current policy initiatives.
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1. Continue 2. Back to Reinterview Help Menu |
Screen RIREF7:
I thought you only counted people.
We also conduct surveys to collect information monthly, quarterly, and yearly, on labor force, retail and wholesale trade, household expenses, household items, and education, to name a few examples.
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1. Continue 2. Back to Reinterview Help Menu |
Screen RIREF8:
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.
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1. Continue 2. Back to Reinterview Help Menu |
Screen H_PURPOSE:
Frequently Asked Questions for the National Health Interview Survey
Press F8 to proceed with the reinterview.
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1. General Information 2. How was I chosen for the National Health Interview Survey? 3. Why not interview the house across the street? Why is my participation important? 4. I’m not sick – why should I be included in a health survey? 5. Will the data be held confidential? 6. Why should I provide my social security number? 7. How are the National Health Interview Survey data used? 8. Address for Survey Comments 9. Return to Reinterview |
Screen H_PURPOSE1:
General Information
The basic purpose of the National Health Interview Survey is to obtain national information about the amount and distribution of illness, its effects in terms of disability and chronic impairments, and the kind of health services people receive.
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1. Continue 2. Back to original FAQ list |
Screen H_PURPOSE2:
How was I chosen for the National Health Interview Survey?
Every week about 1,400 addresses are chosen by scientific sampling methods to serve as a cross section of the entire United States. The people at those addresses are interviewed to obtain information used to describe the health of all Americans.
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1. Continue 2. Back to original FAQ list |
Screen H_PURPOSE3:
Why not interview at the house across the street? Why is my participation important?
We cannot change another address for yours. Scientific sampling methods do not permit the substitution of another address for those originally selected. It is important that the people living in the address selected be a part of the survey in order to provide the most accurate picture of the country’s health.
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1. Continue 2. Back to original FAQ list |
Screen H_PURPOSE4:
I’m not sick – why should I be included in a health survey?
This is a survey of the nation’s health. Health is often described as people who are not sick. We want to know how many people are sick and why they are sick, but it is also important to know how many people are healthy and why they are healthy. These answers will help keep the nation healthy.
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1. Continue 2. Back to original FAQ list |
Screen H_PURPOSE5:
Will the data be held confidential?
All information collected in this survey that would permit identification of any individual or any other business will be held in strict confidence. This information is in accordance with Section 308(d) of the Public Health Service Act (42 United States Code 242m (d)). We will not release information that could identify you or your family without your consent. If any federal employee or contractor gives out confidential information not authorized by law, he or she can be fired and fined and/or imprisoned.
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1. Continue 2. Back to original FAQ list |
Screen H_PURPOSE6:
Why should I provide my Social Security Number?
We would like to know your Social Security Number so we can obtain information that you have given to other government agencies. The information will be used to conduct research on issues related to health. This will help us avoid asking questions for which information is already available. It will also help ensure the accuracy and completeness of survey results, and help us recontact you, if necessary. We will protect any information we obtain about you from these agencies from unauthorized use just as the survey responses are protected. Providing this information is voluntary, and is collected under the authority of the Public Health Service Act. There will be no effect on your benefits if you do not provide it.
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1. Continue 2. Back to original FAQ list |
Screen H_PURPOSE7:
How are the National Health Interview Survey data used?
NCHS was authorized by Congress in Section 306 of the Public Health Service Act to conduct this survey and to produce health information for the nation. Government agencies, universities, private health planners, and researchers use the data to identify and work on significant health problems. The data are also used to determine how best to use available dollars and personnel to solve these health problems.
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1. Continue 2. Back to original FAQ list |
Screen H_PURPOSE8:
Address for Survey Comments
If you have any comments about this survey, please send them to:
CDC/ATSDR Reports, Clearance Officer Paperwork Reduction Project (0920 – 0214) 1600 Clifton Road, MS D-24 Atlanta, GA 30333
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1. Continue 2. Back to original FAQ list |
Screen FIN:
THIS CASE IS NOT COMPLETED.
Enter 1 to continue.
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1. Continue |
1. Continue |
Screen START:
[Fill: SURVEY_NAME] CAPI Quality Control Reinterview
Date: [Fill: RIDATE] Time: [Fill: TIME_C]
Reinterview Case Status: [Fill: OUTCOME and OUTCOME’s description]
Original Interview Date: [Fill: INTDATE]
Original FR Code Name: [Fill: ORIFR] "-" [Fill: FR_NAME] Original Outcome: [Fill: ORIOUT and ORIOUT’s description] [Fill: TYPEA_SP / TYPEB_SP / TYPEC_SP /blank] Original Respondent Name: [Fill: RESPNAME] Sample Unit Phone: ([Fill: AREA]) [Fill: PREFIX]-[Fill: SUFFIX], ext.[Fill:EXTN] ([Fill:PHTYPE]) [Fill: "Second Phone:" SPHONE (SPHTYP) / blank] Sample Unit Address: [Fill: ADDRESS1 / ADDRESS2 / ADDRESS3 / ADDRESS4]
[Fill: "Best Time to Contact:" BESTTIME’s description / "Best Time to Contact:" BESTTIM2 / blank] [Fill: "Or" BESTTIM2 / blank] [Fill: “DO NOT call on Sunday” / blank] [Fill: “Spanish speaking” / blank]
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1. Continue 2. Quit - Attempt later |
Screen START_1A:
CONTACT PERSON INFORMATION
Name: [Fill: CPNAME] Title: [Fill: CPTITL] Phone: [Fill: CPPHON], ext. [Fill: CPEXT] ([Fill: CPPHT]) Address: [Fill: CPADD1] CPADD2 CPPO, CPST CPZP5-CPZP4]
[Fill: “NO CONTACT PERSON INFORMATION IS AVAILABLE” / blank]
Enter 1 to continue.
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1. Continue |
Screen START_1:
Original CAPI Notes
Reinterview Notes
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1. Continue |
Screen HHCOMP:
? [F1]
Press Shift-F1 to access this screen at any time during the reinterview.
Enter 1 to continue.
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1. Continue |
Screen BY_OBS:
The (S)FR determined the original outcome by observation. No contact person information was collected.
Enter 1 to continue.
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1. Continue |
Screen METHOD:
Choose one of the following options to continue:
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1. Telephone Reinterview 2. Personal Visit Reinterview 3. Quit - Attempt later 4. Reinterview Noninterview 5. RO/HQ Discretion - Type A (Contact Supervisor) |
Screen DIAL:
Respondent Name: [Fill: RESPNAME] Respondent Address: [Fill: ADDRESS1 / ADDRESS2 / ADDRESS3 / ADDRESS4] / Contact Name: [Fill: CPNAME] Contact Address: [Fill: CPADD1 CPADD2 CPPO, CPST CPZP5-CPZP4]
Dial this number:
([Fill: AREA]) [Fill: PREFIX]-[Fill: SUFFIX], ext. [Fill: EXTN] ([Fill: PHTYPE]) / [Fill: CPPHON], ext. [Fill: CPEXT] ([Fill: CPPHT])
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1. Someone answers 2. Enter new telephone number 3. Reinterview Noninterview 4. Quit - Attempt later |
Screen _INTRO_:
Enter 1 to update the telephone number.
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1. Update telephone number |
Screen NEWNUMBER_A:
In Area Code: [Fill: AREA] Edit area code or press Enter for same. New Number: [Fill: PREFIX]-[Fill: SUFFIX] EXT: [Fill: EXTN]
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Screen NEWNUMBER_P:
In Area Code: [Fill: NEWNUMBER_A] New Number: [Fill: PREFIX]-[Fill: SUFFIX] Edit prefix or press Enter for same. EXT: [Fill: EXTN]
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Screen NEWNUMBER_S:
In Area Code: [Fill: NEWNUMBER_A] New Number: [Fill: NEWNUMBER_P]-[Fill: SUFFIX] Edit suffix or press Enter for same. EXT: [Fill: EXTN]
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Screen NEWNUMBER_E:
In Area Code: [Fill: NEWNUMBER_A] New Number: [Fill: NEWNUMBER_P]-[Fill: NEWNUMBER_P] EXT: [Fill: EXTN] ♦ Edit extension or press Enter for same.
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Screen NEWNUMBER_CP:
Record new number.
New Number: [Fill: CPPHON] ♦ Edit phone number or press Enter for same. EXT: [Fill: CPEXT]
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Screen NEWNUMBER_CE:
New Number: [Fill: NEWNUMBER_CP] EXT: [Fill: CPEXT] ♦ Edit extension or press Enter for same.
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Screen _END_:
Enter 1 to go back to Dial screen.
You may have to press Enter twice to update the phone number entries.
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Screen CKSUP:
Contact your supervisor for authorization before conducting a personal visit.
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1. Personal visit reinterview authorized 2. Quit - Attempt later |
Screen HELLO_TC:
Hello, I'm ... from the U.S. Census Bureau.
May I speak to [Fill: RESPNAME]?
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1. This is correct person, or correct person called to the phone. 2. Person not available now. Call back later. 3. Person cannot 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. |
Screen HELLO_TCX:
Hello. This is ... from the U.S. Census Bureau.
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted your household.
We’re doing a short quality control check to make sure that our interviewers are following correct procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s work?
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1. Yes 2. No 3. Inconvenient time. Try again later. |
Screen VERTELE:
Have I reached area code [Fill: (AREA) PREFIX-SUFFIX, ext. EXTN] / [CPPHON, ext. CPEXT]?
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1. Yes 2. No 3. Refused to verify |
Screen INTRO_TC:
Thank you for helping us recently by answering questions about[Fill: CONTACT_C_INFO1] [Fill: CONTACT_C_INFO2].
We’re doing a short quality control check to make sure that our interviewers are following correct procedures.
Is your address: [Fill: ADDRESS1 / ADDRESS2 / ADDRESS3 / ADDRESS4]?
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1. Yes 2. No 3. Refused to verify address |
Screen WRNUM:
I'm sorry. I must have dialed incorrectly. I'll try again.
Enter 1 to go back to Dial screen.
You may have to press Enter twice to go back to Dial screen.
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1. Redial |
Screen REFNUM:
I'm sorry. I'll dial again to be sure I've dialed correctly.
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1. After several attempts, wrap up case. 2. Redial |
Screen HELLO_TN:
Hello, I’m... from the U.S. Census Bureau.
May I speak to [Fill: CPNAME]?
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1. This is correct person, or correct person called to the phone. 2. Person not available now. 3. Person unknown at this number 4. Person no longer lives there. 5. Person deceased. 6. Person can be reached at another number. 7. Reinterview Noninterview |
Screen VERTYPEA:
This case was a Type A in the original interview.
Please use any available resource to check that the original outcome was:
[Fill: ORIOUT’s description] [Fill: “-” TYPEA_SP / blank] on [Fill: INTDATE].
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1. Original outcome was correct. 2. Original outcome was incorrect. 3. Reinterview Noninterview. 4. Quit - Attempt later. |
Screen HELLO_TNX:
Hello. I'm ... from the U.S. Census Bureau.
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted your location to verify the status of:
[Fill: ADDRESS1 / ADDRESS2 /ADDRESS3 / ADDRESS4]
We’re doing a short quality control check to make sure that our interviewers are following correct procedures.
Can you or someone else answer a few questions to help us evaluate the interviewer’s work?
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1. Yes 2. No 3. Inconvenient time. Try again later. |
Screen INTRO_TN:
Thank you for recently helping us verify the status of:
[Fill: ADDRESS1 / ADDRESS2 / ADDRESS3 /ADDRESS4]
We’re doing a short quality control check to make sure that our interviewers are following correct procedures.
Enter 1 to continue.
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1. Continue |
Screen HELLO_PC:
Hello. I’m ... from the U.S. Census Bureau. Here is my identification card.
Show ID card.
May I speak to [FILL: RESPNAME]?
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1. Correct person available. 2. Person not available now. 3. Person unknown at this address. 4. Person no longer lives there. 5. Person deceased. 6. No one lives at this address. 7. Reinterview Noninterview. |
Screen HELLO_PCX:
Hello, I'm ... from the U.S. Census Bureau. Here is my identification card.
Show ID card.
Our records show that one of our interviewers, [Fill : FR_NAME], recently contacted your household.
We’re doing a short quality control check to make sure that our interviewers are following correct procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s work?
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1. Yes 2. No 3. Inconvenient time. Try again later. 4. No one lives at this address. |
Screen INTRO_PC:
Thank you for helping us recently by answering questions about your health, your family’s health, and health insurance coverage for you and your family.
We’re doing a short quality control check to make sure that our interviewers are following correct procedures.
Is your address: [Fill: ADDRESS1 / ADDRESS2 /ADDRESS3 / ADDRESS4]? |
1. Yes 2. No 3. Refused to verify address |
Screen HELLO_PN:
Hello. I’m... from the U.S. Census Bureau. Here is my identification card.
Show ID card.
May I speak to [Fill: CPNAME]?
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1. Correct person available. 2. Person not available now. 3. Person unknown at this address. 4. Person no longer lives there. 5. Person deceased. 6. Reinterview Noninterview. |
Screen HELLO_PNX:
Hello, I’m... from the U.S. Census Bureau. Here is my identification card. Show ID card.
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted this location to verify the status of: [Fill: ADDRESS1 / ADDRESS2 / ADDRESS3 / ADDRESS4]
We’re doing a short quality control check to make sure that our interviewers are following correct procedures.
Can you or someone else answer a few questions to help us evaluate the interviewer’s work?
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1. Yes 2. No 3. Inconvenient time. Try again later. |
Screen ADDVER:
I need to verify that the address [Fill: “here” / “there”] is:
[Fill: ADDRESS1 / ADDRESS2 / ADDRESS3 / ADDRESS4 / CPADD1 CPADD2 CPPO, CPST CPZP5-CPZP4]
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1. Same address. 2. Not same address. 3. Refused to verify. |
Screen INTRO_PN:
Thank you for recently helping us verify the status of:
[Fill: ADDRESS1 / ADDRESS2 /ADDRESS3 / ADDRESS4]
We’re doing a short quality control check to make sure that our interviewers are following correct procedures.
Enter 1 to continue.
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1. Continue |
Screen VERBYOBS:
The (S)FR determined the original outcome by observation.
Please use any available resource to check that:
[Fill: ADDRESS1 / ADDRESS2 / ADDRESS3 / ADDRESS4]
was [Fill: ORIOUT’s description] [Fill: “-” TYPEB_SP / “-” TYPEC_SP / blank] on [Fill: INTDATE].
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1. Original outcome was correct. 2. Original outcome was incorrect. 3. Reinterview Noninterview. 4. Quit - Attempt later. |
Screen HHMEM:
Perhaps you can help me.
Are you a household member [Fill: “who is” MIN_AGE “years or older” / blank]?
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1. Yes 2. No |
Screen HHMEM2:
Is there a household member present I may speak to [Fill: “who is” MIN_AGE “years or older” / blank]?
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1. Yes 2. No |
Screen PROX_C:
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted your household.
We’re doing a short quality control check to make sure that our interviewers are following correct procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s work?
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1. Yes 2. No |
Screen PROX_N:
Perhaps you can help me.
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted this location to verify the status of [Fill: ADDRESS1/ ADDRESS2/ADDRESS3/ ADDRESS4].
We’re doing a short quality control check to make sure that our interviewers are following correct procedures.
Can you or someone else answer a few questions to help us evaluate the interviewer’s work?
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1. Yes 2. No |
Screen PROX_UC:
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted your household.
We’re doing a short quality control check to make sure that our interviewers are following correct procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s work?
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1. Yes 2. No 3. Inconvenient time. Try again later. |
Screen PROX_UN:
Perhaps you can help me.
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted this location to verify the status of [Fill: ADDRESS1 / ADDRESS2 /ADDRESS3 / ADDRESS4].
We’re doing a short quality control check to make sure that our interviewers are following correct procedures.
Can you or someone else answer a few questions to help us evaluate the interviewer’s work?
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1. Yes 2. No 3. Inconvenient time. Try again later. |
Middle Section:
Screen RIRESP:
? [F1]
Ask if necessaryWith whom am I speaking?
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Screen CONTACT_C:
Did an interviewer contact you on or about [Fill: INTDATE] and ask questions about your health, your family’s health, and health insurance coverage for you and your family?
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1. Yes 2. No |
Screen ORMODE:
Did the interviewer visit in person or call on the telephone?
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1. Personal visit only 2. Telephone call only 3. Both - Interviewer visited and called |
Screen POLITE:
Was the interviewer polite and professional?
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1. Yes 2. No |
Screen PO_NOTES:
Enter comments from the reinterview respondent here.
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Screen LENGTH_H:
About how long did the interview last?
____ hours ____ minutes
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Screen LENGTH_M:
Screen LAPTOP:
Did the interviewer use a laptop computer?
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1. Yes 2. No |
Screen ROSTER_1:
? [F1]
Our records indicate that Read above name(s) in blue was/were living or staying at
[Fill: ADDRESS1 / ADDRESS2 / ADDRESS3 / ADDRESS4]
on [Fill: INTDATE].
Is this correct? |
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1. Yes 2. No |
Screen ROSTER_2:
? [F1]
Enter the line number of the household member(s) (above name(s) in blue) who wasn’t/weren’t living or staying at the household on [Fill: INTDATE].
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Screen ROSTER_3:
? [F1]
Have I missed any household member who
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1. Yes 2. No |
Screen ROSTER_4:
? [F1]
Enter the name of each missing household member who
Press Enter after each name and again after last name to continue.
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Screen PROX_PRESENT:
Were you present during the original interview?
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1. Yes 2. No |
Screen CKANCEST:
Is [Fill: “your”/ FNAME LNAME“’s”] national ancestry Puerto Rican, Cuban, Mexican/Mexicano, Mexican American, Chicano, other Latin American, or other Spanish?
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1. Hispanic 2. Non-Hispanic |
Screen CKRACE:
What [Fill: “is your race” / “race is [FNAME LNAME]”]?
Read if necessary: White, Black, American Indian, Eskimo, Aleut, or Asian/ Pacific Islander
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1. Black or Asian 2. Non-Black and Non-Asian |
Screen RI_MONTH:
What is your date of birth?
Click on or enter the number that corresponds to the month (1-12).
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1. January 2. February 3. March 4. April 5. May 6. June 7. July 8. August 9. September 10. October 11. November 12. December |
Screen RI_DAY:
What is your date of birth?
Enter the number that corresponds to the day of the month (1-31).
Month: [FILL: RI_MONTH] Day: ____ Year: ___
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Screen RI_YEAR:
What is your date of birth?
Enter the four digit year.
Month: [FILL: RI_MONTH] Day: [FILL: RI_DAY] Year: ____
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Screen HH_1:
Did the interviewer ask you questions about having a cell phone?
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1. Yes 2. No |
Screen FAM_1:
Did the 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?
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1. Yes 2. No |
Screen FAM_2:
Did the interviewer ask you about the highest level of school that you and other family members have completed?
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1. Yes 2. No |
Screen FAM_3:
Did the interviewer ask you about the amount of your total family income?
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1. Yes 2. No |
Screen SA1_HEALTH:
Did the interviewer ask you about health conditions such as high blood pressure, asthma, diabetes, or a cold?
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1. Yes 2. No |
Screen SA2_ALCOHOL:
Did the interviewer ask you…
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1. Yes 2. No |
Screen SA2_EXERCISE:
Did the interviewer ask you…
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1. Yes 2. No |
Screen SA2_DOCTOR:
Did the interviewer ask you…
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1. Yes 2. No |
Screen SA3_EMROOM:
Did the interviewer ask you…
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1. Yes 2. No |
Screen SA3_SHOT:
Did the interviewer ask you…
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1. Yes 2. No |
Screen SA3_SLEEP:
Did the interviewer ask you…
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1. Yes 2. No |
Screen SOMEONE_ELSE:
Could the interviewer have spoken to another person at
[Fill: ADDRESS1 / ADDRESS2 / ADDRESS3 / ADDRESS4 / CPADD1 CPADD2 CPPO, CPST CPZP5-CPZP4]?
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1. Yes 2. No |
Screen SPEAKTO:
May I speak to her/him?
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1. Yes 2. No |
Screen CONTACT_N:
Did an interviewer visit or call regarding:
[Fill: ADDRESS1 / ADDRESS2 / ADDRESS3 /ADDRESS4]?
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1. Yes 2. No |
Screen VACANT*:
Was
[Fill: ADDRESS1 / ADDRESS2 / ADDRESS3 / ADDRESS4]
vacant on [Fill: INTDATE]?
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1. Yes 2. No |
Screen STAT_VER*:
Is there someone present I could speak with who could tell me the status of
[Fill: ADDRESS1 / ADDRESS2 / ADDRESS3 / ADDRESS4]
on or about[Fill: INTDATE]?
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1. Yes 2. No |
Screen SPEAKTO2*:
May I speak to her/him?
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1. Yes 2. No |
Screen VACANT2*:
Hello, I’m ... from the U.S. Census Bureau.
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted this location to verify the status of: [Fill: ADDRESS1 / ADDRESS2 / ADDRESS3 / ADDRESS4]
We’re doing a short quality control check to make sure that our interviewers are following correct procedures.
Was
[Fill: ADDRESS1 / ADDRESS2 / ADDRESS3 / ADDRESS4]
vacant on [Fill: INTDATE]?
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1. Yes 2. No |
Screen STATUS:
Our records show that on [Fill: INTDATE],
[Fill: ADDRESS1 / ADDRESS2 / ADDRESS3 / ADDRESS4]
[Fill: ORIOUT’s description].
Is this information correct?
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1. Yes 2. No |
Screen STAT_PROBE:
Original Outcome: [Fill: ORIOUT] - [Fill: ORIOUT’s description] [Fill: TYPEB_SP / TYPEC_SP / blank]
Original Interview Date: [Fill: INTDATE]
What was the status of [Fill: ADDRESS1 / ADDRESS2 / ADDRESS3 / ADDRESS4]
on or about [Fill: INTDATE]?
Enter reported status.
Explain any discrepancy between reported status and original outcome.
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Screen STAT_PROB2:
Original Outcome: [Fill: ORIOUT] - [Fill: ORIOUT’s description] Original Interview Date: [Fill: INDATE]
What was the status of [Fill: ADDRESS1 / ADDRESS2 /ADDRESS3 / ADDRESS4]
on or about [Fill: INDATE]?
Enter reported status.
Explain any discrepancy between reported status and original outcome.
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Back Section:
Screen THANK_SORRY:
I'm sorry. I have the wrong address/telephone number. Thank you for your help.
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1. Continue |
Screen THANK_YOU:
Thank you for your cooperation. You've been very helpful.
Enter 1 to continue.
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1. Continue |
Screen THANK_REF:
I’m sorry to have bothered you.
Enter 1 to continue
|
1. Continue |
Screen THANK_NOHH:
Thank you for your help, but I need to speak to a household member. I'll try back later.
Enter 1 to continue.
|
1. Continue |
Screen APPT:
? [F1]
I'd like to schedule a date to complete/conduct the quality check. What DATE and TIME would be best to call/visit?
Today is: [Fill: RIDATE].
Enter DATE and TIME Enter (0) if this is a break-off case. Enter (1) if you don’t intend to follow up on this case.
|
Screen APPT2:
What DATE and TIME would be best to contact [Fill: RESPNAME /CPNAME, CPTITL] in order to conduct the quality check?
Today is: [Fill: RIDATE]
Enter DATE and TIME
Enter 1 if you don't intend to follow up on this case.
|
Screen CBTHANK:
Thank you for your help. We will call/visit again at the time suggested.
Enter 1 to continue.
|
1. Continue |
Screen STATUS_RI:
This case is not completed.
Make several attempts to contact respondent/contact person before selecting reinterview noninterview.
|
1. Quit - Complete later 2. Reinterview Noninterview |
Screen RI_BREAKOFF:
What was the MAIN reason for breaking off the reinterview?
|
1. Respondent was too busy 2. Respondent had to leave 3. Questions were too personal for respondent 4. Reinterview was too long for respondent 5. Respondent physically/mentally unable to participate 6. Dislike/mistrust of the government 7. Relative did not want respondent to participate 8. Language problem 9. Reinterviewer computer error 10. Other |
Screen RI_OUTCM:
Original Outcome: [FILL: ORIOUT] - [FILL: ORIOUT’s description] [Fill: TYPEA_SP/TYPEB_SP/TYPEC_SP/blank] Original Interview Date: [FILL: INTDATE].
Was the original outcome correct?
|
1. Yes 2. No 3. Reinterview Noninterview |
Screen NONINT:
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. |
Screen TYPEA:
|
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. |
Screen TYPEB*:
Which Type B outcome describes this reinterview case?
|
1. Vacant, regular or seasonal. 2. Vacant, storage of household furniture. 3. Converted to temporary business or storage. 4. Unoccupied tent or trailer site. 5. Unfit, to be demolished. 6. HH institutionalized or temporarily ineligible. 7. Entire HH under age [Fill: MIN_AGE]. 8. Temporarily occupied by persons with Usual Residence Elsewhere (URE). 9. Other Type B - Specify in the Reinterview Notes. |
Screen TYPEB_ALT:
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 [Fill: 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. |
Screen TYPEC:
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. |
Screen MISC_B:
Which of the following options describes the misclassification of this original Type B case?
|
1. Should have been an Interview or Type A. 2. Should have been another Type B. 3. Should have been a Type C. |
Screen MISC_C:
Which of the following options describes the misclassification of this original Type C case?
|
1. Should have been an Interview or Type A. 2. Should have been a Type B. 3. Should have been another Type C. |
Screen MISC_VINT*:
Which of the following options describes the misclassification of this original vacant interview case?
|
1. Should have been an Interview or Type A. 2. Should have been a Type B or C. |
Screen MISC_BVINT*:
Which of the following options describes the misclassification of this 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. Should have been a Type D. |
Screen MISC_CVINT*:
Which of the following options describes the misclassification of this 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. Should have been a Type D. |
Screen FALSIF:
[Fill: “Your reinterview indicates the following discrepancies:” code and description of each code listed in DISCREPANCY array / “Your reinterview did not indicate any discrepancies.”]
Do you suspect falsification?
|
1. Yes 2. No 3. Unable to determine |
Screen DISCREP_NOTES:
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.
|
Screen NSF_RIDISP:
Your reinterview detected multiple discrepancies.
|
** List of discrepancies ** |
Screen RO_DISC:
|
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 |
Screen NO_DISCREP:
|
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.
|
Screen SF_RIDISP:
Your reinterview detected multiple discrepancies.
Enter the code of the detected discrepancy which best describes the primary reason you suspect falsification.
|
** List of discrepancies ** |
Screen RINOTES_PRE:
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. |
1. Continue |
Screen READYWRAP:
This case is ready to be wrapped up. After exiting, the case will be deleted from your case list.
Enter 1 to continue.
|
1. Continue |
Reinterview Instrument Screen Index
_END_, 10
_INTRO_, 9
ADDVER, 15
APPT, 27
APPT2, 28
BY_OBS, 8
CBTHANK, 28
CKANCEST, 21
CKRACE, 21
CKSUP, 10
CONTACT_C, 18
CONTACT_N, 24
DIAL, 9
DISCREP_NOTES, 31
FALSIF, 31
FAM_1, 22
FAM_2, 22
FAM_3, 22
FIN, 6
H_PURPOSE, 3
H_PURPOSE1, 4
H_PURPOSE2, 4
H_PURPOSE3, 4
H_PURPOSE4, 4
H_PURPOSE5, 5
H_PURPOSE6, 5
H_PURPOSE7, 5
H_PURPOSE8, 6
HELLO_PC, 14
HELLO_PCX, 14
HELLO_PN, 15
HELLO_PNX, 15
HELLO_TC, 11
HELLO_TCX, 11
HELLO_TN, 12
HELLO_TNX, 13
HH_1, 22
HHCOMP, 8
HHMEM, 16
HHMEM2, 16
INTRO_PC, 14
INTRO_PN, 16
INTRO_TC, 12
INTRO_TN, 13
LAPTOP, 19
LENGTH_H, 19
LENGTH_M, 19
METHOD, 8
MISC_B, 30
MISC_BVINT, 31
MISC_C, 30
MISC_CVINT, 31
MISC_VINT, 31
NEWNUMBER_A, 9
NEWNUMBER_CE, 10
NEWNUMBER_CP, 10
NEWNUMBER_E, 10
NEWNUMBER_P, 9
NEWNUMBER_S, 10
NO_DISCREP, 32
NONINT, 29
NSF_RIDISP, 32
OMB_NOTICE, 6
ORMODE, 18
PO_NOTES, 19
POLITE, 19
PROX_C, 17
PROX_N, 17
PROX_PRESENT, 20
PROX_UC, 17
PROX_UN, 18
READYWRAP, 33
REFNUM, 12
RI_BREAKOFF, 28
RI_DAY, 21
RI_MONTH, 21
RI_OUTCM, 29
RI_YEAR, 21
RINOTES_PRE, 32
RIREASON, 1
RIREF1, 1
RIREF2, 1
RIREF3, 2
RIREF4, 2
RIREF5, 2
RIREF6, 2
RIREF7, 3
RIREF8, 3
RIRESP, 18
RO_DISC, 32
ROSTER_1, 19
ROSTER_2, 20
ROSTER_3, 20
ROSTER_4, 20
SA1_HEALTH, 22
SA2_ALCOHOL, 22
SA2_DOCTOR, 23
SA2_EXERCISE, 23
SA3_EMROOM, 23
SA3_SHOT, 23
SA3_SLEEP, 23
SF_RIDISP, 32
SOMEONE_ELSE, 24
SPEAKTO, 24
SPEAKTO2, 25
START, 7
START_1, 8
START_1A, 7
STAT_PROB2, 26
STAT_PROBE, 26
STAT_VER, 25
STATUS, 26
STATUS_RI, 28
THANK_NOHH, 27
THANK_REF, 27
THANK_SORRY, 27
THANK_YOU, 27
TYPEA, 29
TYPEB, 29
TYPEB_ALT, 30
TYPEC, 30
VACANT, 24
VACANT2, 25
VERBYOBS, 16
VERTELE, 11
VERTYPEA, 13
WRNUM, 12
2009 NHIS Reinterview Screens
| File Type | application/msword |
| File Title | Attachment 3o Reinterview Survey (5 minutes) |
| Author | lawre324 |
| Last Modified By | Howard Riddick |
| File Modified | 2009-09-10 |
| File Created | 2009-07-31 |