1 Moderator's Guide

OMB No.: 0925-0642

Expiration Date: 9/30/2014

Public reporting burden for this collection of information is estimated to range from 5 to 30 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 aspects of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0642). Do not return the completed form to this address.

Attachment 3: Cognitive Interview Moderator Guide

Introduction

You are being asked to provide feedback on the clarity and meaning of about 25 questions. There is no right and wrong answers. The answers you provide will assist us in finalizing the functional ability questionnaire that is being developed for Social Security Disability claims. Your answers will not be used to determine or access benefits from the Social Security Administration or health clinics. The objective is to refine this questionnaire to provide a more comprehensive functional abilities questionnaire for the SSA. This project is being conducted by Boston University's Health and Disability Research Institute who is working with the National Institutes of Health and the Social Security Administration.

Before we start, do you have any questions?

[For the Interviewer: Cognitive interviewing is a question and answer process so not all of the questions below will be asked.]

Demographic information for Cognitive Interviews

1.) Age

2.) Gender (male, female, Refuse)

3.) Ethnicity (Choose one: Are you of Hispanic or Latino Origin? Yes, No)

4.) Race (Choose one or more of the following): American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Pacific Islander, White)

5). Education Level (Less than high school diploma, High school diploma (or a GED), Associate's degree, Vocational Training, Some college – no degree, College or more)

Cognitive Interview Probes

The following types of probes will be used to evaluate sources of response error in survey:

• What is this question asking?

• What does “ “ mean to you?

• What did you think about when answering this question?

• Can you repeat this question using your own words?

• How did you arrive at your answer?

• What this question easy or hard to answer?

• How would you change this question?

• How sure are you of your answer?

• How do you remember this?

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