Quesitonaire

Appendix F

Form Approved

OMB No. 0923-XXXX

Exp. Date xx/xx/20xx

KATRINA AND RITA EXPOSURES REGISTRY MAIN INTERVIEW

Programming note: For proxy interviews, use the sample member’s first name for where it says (insert name) below.

[IF P1=3 (DECEASED), GO TO DEC0; ELSE GO TO EX0]

EX0. First, I have some questions about the FEMA homes that {fill: you} {if proxy fill: (insert name)} lived in, stayed at, or visited after Hurricanes Katrina and Rita.

1. CONTINUE

EX1. For the following questions, please think about the {fill: first, second, etc} FEMA home {fill: you} {if proxy fill: (insert name )} lived or stayed in for at least seven consecutive days. What type of home was it? Was it a …

[INTERVIEWER: A FEMA home does not include HOUSING rentals. A FEMA home refers to a temporary housing unit such as a travel trailer, park model, or mobile home. The HOME DID NOT HAVE TO BE REGISTERED TO THE RESPONDENT.]

[INTERVIEWER: PRESS F5 TO ACCESS HELP MENU]

1. Travel trailer, which is towed by another vehicle such as a pick-up truck, and used for recreation, camping, or travel. It has one bedroom plus a fold-out couch and is less than 25 feet long.

2 Park model, which is bigger than a travel trailer and typically has one or two bedrooms with a
fold-out hide-a-bed. It is less than 40 feet long in traveling mode and would be towed by a
heavy tow vehicle such as a tow truck.

3 Mobile home, also known as a “manufactured home,” which is bigger than a travel trailer or a
park model. It is about 60 feet long and 14 feet wide and has three bedrooms. The mobile
home would be towed by a heavy tow vehicle such as a tow truck.

8 DON’T KNOW

9 REFUSED

Public reporting burden of this collection of information is estimated to average 18 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0923-XXXX).

Programming note: For future fills that refer to “EX1 answer” use these shortened forms: travel trailer, park model, mobile home. If EX1=DK/REF, use “FEMA Home” as the fill.

EX1a. What county or parish was the {fill: EX1 answer or “FEMA Home”} located in when {fill: you} {if proxy fill: (insert name )}moved in?

[INTERVIEWER: REPEAT COUNTY/PARISH NAME AND VERIFY SPELLING]

{allow 60 characters}

8 DON’T KNOW

9 REFUSED

EX1b. What city was the {fill: EX1 answer or “FEMA Home”} located in when {fill: you} {if proxy fill: (insert name )}moved in?

[INTERVIEWER: REPEAT CITY NAME AND VERIFY SPELLING]

{allow 60 characters}

8 DON’T KNOW

9 REFUSED

EX2. Including {fill: yourself} {if proxy fill: (insert name)}, how many people ever lived or stayed in the {fill: EX1 answer or “FEMA Home”} while {fill: you were} {if proxy fill: he/she was} there? Please include only people who stayed at least seven consecutive days in the {fill: EX1 answer or “FEMA Home”}.

_____ Number of people [Range: 1-10]

98 DON’T KNOW

99 REFUSED

[IF EX2=1, 98, OR 99, GO TO EX4A; ELSE GO TO EX3]

EX3. I have a few questions about the {fill: (calculate EX2 MINUS ONE)} other {if previous fill=1 fill: person; else fill: people} who lived or stayed in the {fill: EX1 answer or “FEMA Home”} while {fill: you were} {if proxy fill: (insert name) was} there. {fill, except when on last person: Starting with the first oldest person, not including {fill: yourself} {if proxy fill: (insert name)},} could you please tell me …

1 CONTINUE

EX3A. …this person’s first name? {allow 60 characters}

[INTERVIEWER: DO NOT INCLUDE RESPONDENT/SAMPLE MEMBER.]

8 DON’T KNOW

9 REFUSED

EX3B. What is this person’s last name? {allow 60 characters}

8 DON’T KNOW

9 REFUSED

EX3C. For survey purposes, I need to confirm if {fill: EX3A answer or “this person”} is male or female?

1 MALE

2 FEMALE

8 DON’T KNOW

9 REFUSED

EX3D. What is {fill: EX3A answer or “this person”}’s current age?

[INTERVIEWER: IF PERSON IS DECEASED ASK: “What would their age have been now?”]

[INTERVIEWER: IF NECESSARY, SAY: “Your best guess is fine.”]

____ Age [Range: 0-110]

998 DON’T KNOW

999 REFUSED

EX3E. What month is {fill: EX3A answer or “this person”}’s birthday in?

1. January

2. February

3. March

4. April

5. May

6. June

7. July

8. August

9. September

10. October

11. November

12. December

98 Don’t Know

99 Refused

EX3F. Is {fill: EX3A answer or “this person”}of Hispanic, Latino/a, or Spanish origin?

1. No, not of Hispanic, Latino/a, or Spanish origin

2. Yes, Mexican, Mexican American, Chicano/a

3. Yes, Puerto Rican

4. Yes, Cuban

5. Yes, another Hispanic, Latino/a, or Spanish origin

8. DON’T KNOW

9. REFUSED

EX3G. What is {fill: EX3A answer or “this person”}’s race?

[INTERVIEWER: CODE ALL THAT APPLY]

1 White

2 Black or African American

3 American Indian or Alaskan Native

4 Asian Indian

5 Chinese

6 Filipino

7 Japanese

8 Korean

9 Vietnamese

10 Other Asian

11 Native Hawaiian

12 Guamanian or Chamorro

13. Samoan

14. Other Pacific Islander

98 DON’T KNOW

99 REFUSED

EX3H. What is the highest level of education {fill: EX3A answer or “this person”} completed?

1 Less than high school degree

2 High school degree (or equivalent)

3 Some college

4 Bachelor’s degree

5 Advanced degree (masters, professional, doctoral degree)

8 DON’T KNOW

9 REFUSED

[IF NOT ON LAST PERSON IN (calculateEX2 MINUS ONE), GO TO EX3; ELSE GO TO EX3SUMMARY]

Programming note: The text below for EX3 will replace the text used in the previous EX3 as we loop through these questions again for a new person.

EX3. Now tell me about the {fill: next oldest}{if on last person to roster fill: last} person, not including {fill: yourself} {if proxy fill: (insert name)}. What is…

1 CONTINUE

[LOOP THROUGH QUESTIONS EX3A-EX3H AGAIN FOR EACH PERSON, 9 LOOPS MAX.]

EX3SUMMARY. Please tell me if the information I have recorded is correct. I have the following people listed as having lived in the {fill: EX1 answer or “FEMA Home”}, not including {fill: yourself} {if proxy fill: (insert name)}:

[INTERVIEWER: PLEASE VERIFY THAT ALL KEY INFORMATION PRESENTED BELOW IS CORRECT.]

Programming note: Show summary screen in one big grid:

	First Name	Last Name	Gender	Age	Race
1	Person 1 info
2	Person 2 info
3	Person 3 info
4	Person 4 info
5	Person 5 info
6	Person 6 info
7	Person 7 info
8	Person 8 info
9	Person 9 info

1. ALL INFORMATION IS CORRECT

2. PERSON 1 INFORMATION NEEDS TO BE CORRECTED

3. PERSON 2 INFORMATION NEEDS TO BE CORRECTED

ETC.

11 ADD A PERSON TO THE ROSTER

Testers: (OPTIONS 2-10) If any information recorded is incorrect, select the answer option of the person to fix. You will receive a Hard Error box. With EX3A selected, click the “go to” button and you will be taken to the first question in the series of questions for that person. Advance to the question you need to fix by hitting “enter.” Once you have fixed the information for this person and advanced to the next screen to save it press the “END” key on your keyboard. You will receive the Hard Error box again. This time select EX3SUMMARY with your mouse and click the “go to” button. This will take you back to the summary screen so you can see that the change was made and continue where you left off.

(OPTION 11) If after reading the summary screen the respondent says they left someone off, select option 11. You will receive a Hard Error box. Click the “go to” button and you will be taken to EX2 where you specify the number of people who lived in the FEMA home. Change this number and advance to the next question by hitting “enter” so you can save what you entered. Next, press the “END” key on your keyboard. You will be taken to the screen where you can enter in a new person who lived in the FEMA home.

[IF EX3SUMMARY=1, GO TO EX4A; ELSE REFER TO TESTER NOTES ABOVE AS TO WHERE YOU SHOULD GO.]

EX4A. In what year did {fill: you} {if proxy fill: (insert name)} start living or staying in the {fill: EX1 answer or “FEMA Home”}?

[INTERVIEWER: DO NOT READ RESPONSE OPTIONS.]

1. 2005

2. 2006

3. 2007

4. 2008

5. 2009

6. 2010

8. DON’T KNOW

9. REFUSED

EX4B. In what month in {fill: EX4A answer or “that year”} did {fill: you} {if proxy fill: (insert name)} start living or staying in the {fill: EX1 answer or “FEMA Home”}? {if not proxy fill: You can look at the brochure we sent you earlier to help you answer this question.}

[INTERVIEWER: if RESPONDENT SAYs THEY started living or staying there BEFORE AUGUST 2005 (WHEN KATRINA OCCURRED), code as august. ]

1. January

2. February

3. March

4. April

5. May

6. June

7. July

8. August

9. September

10. October

11. November

12. December

98 Don’t Know

99 Refused

[IF EX4B = DK/REF, GO TO EX4B_2; ELSE GO TO EX4C]

EX4B_2. Was it in the spring, summer, fall, or winter of {fill: EX4A answer or “that year”}?

1. SPRING

2. SUMMER

3. FALL

4. WINTER

8 Don’t Know

9 Refused

[GO TO EX5A]

EX4C. On what day in {fill EX4B EX4A or “that year”} did {fill: you} {if proxy fill: (insert name)} start living or staying in the {fill: EX1 answer or “FEMA Home”}? {if not proxy fill: Again, you can look at the brochure we sent you earlier to help you answer this question. }

[INTERVIEWER: PROBE AS NECESSARY.]

_____ Day [Range: 1-31]

98 DON’T KNOW

99 REFUSED

[IF EX4C = DK/REF, GO TO EX4C_2; ELSE GO TO EX5A]

EX4C_2. Was it at the beginning of the month, the middle of the month, or the end of the month?

1. BEGINNING

2. MIDDLE

3. END

8 Don’t Know

9 Refused

EX5A. In what year did {fill: you} {if proxy fill: (insert name)} stop living or staying in the {fill: EX1 answer or “FEMA Home”}?

[INTERVIEWER: DO NOT READ RESPONSES.]

1. 2005

2. 2006

3. 2007

4. 2008

5. 2009

6. 2010

8 DON’T KNOW

9 REFUSED

EX5B. In what month in {fill: EX5A answer or “that year”} did {fill: you} {if proxy fill: (insert name)} stop living or staying in the {fill: EX1 answer or “FEMA Home”}? {if not proxy fill: You can look at the brochure we sent you earlier to help you answer this question.}

1. January

2. February

3. March

4. April

5. May

6. June

7. July

8. August

9. September

10. October

11. November

12. December

98 Don’t Know

99 Refused

[IF EX5B = DK/REF, GO TO EX5B_2; ELSE GO TO EX5C]

EX5B_2. Was it in the spring, summer, fall, or winter of {fill: EX5A answer or “that year”}?

1. SPRING

2. SUMMER

3. FALL

4. WINTER

8 Don’t Know

9 Refused

[GO TO EX_CHECK1]

EX5C. On what day in {fill: EX5B EX5A or “that year”} did {fill: you} {if proxy fill: (insert name)} stop living or staying in the {fill: EX1 answer or “FEMA Home”}? {if not proxy fill: Again, you can look at the brochure we sent you earlier to help you answer this question.}

[INTERVIEWER: PROBE AS NECESSARY.]

_____ Day [Range: 1-31]

98 DON’T KNOW

99 REFUSED

[IF EX5C=DK/REF, GO TO EX5C_2; ELSE GO TO EX_CHECK1]

EX5C_2. Was it at the beginning of the month, the middle of the month, or the end of the month?

1. BEGINNING

2. MIDDLE

3. END

8 Don’t Know

9 Refused

[IF EX4A, EX4B, EX5A, AND EX5B ALL =DK/REF, GO TO EX_AWAY1; ELSE GO TO EX_CHECK1]

EX_CHECK1. Could we take a minute to review your answers? You said {fill: you} {if proxy fill: (insert name)} started living or staying in the {fill: EX1 answer or “FEMA Home”} on {fill: the EX4C_2 of}{fill: EX4B/EX4B_2}{fill: EX4C}{fill: EX4A or “of the year you started living there”}, and stopped living or staying there on {fill: the EX5C_2 of}{fill: EX5B/EX5B_2}{fill: EX5C}{fill: EX5A or “of the year you stopped living there”}. Does this sound right, or do you want to change your answers?

Programming note: If all of EX4 series or all of EX5 series not given (DK/REF was chosen), fill as [DATE NOT PROVIDED] in the sentence above.

[INTERVIEWER: IF ANY ANSWERS ARE INCORRECT, PROBE FOR THE CORRECT ANSWER AND PRESS OPTION 2 TO GO BACK TO THE BEGINNING OF THIS SERIES SO YOU CAN CORRECT THE ANSWER]

1. ANSWERS ARE RIGHT

2 CHANGE ANSWERS

Testers: If option 2 selected you will receive a Hard Error box. Click the “go to” button and you will be taken back to EX4A. Advance to the question you need to fix by hitting “enter.” Once you have fixed the information and pressed “enter” to advance to the next screen to save it, press the “END” key on your keyboard. You will receive the Hard Error box again. This time select EX_CHECK1 with your mouse and click the “go to” button. This will take you back to the EX_CHECK1 screen so you can see that the change was made and continue where you left off.

[IF EX_CHECK1=1, GO TO EX_AWAY1; ELSE GOTO EX4A]

EX_AWAY1. Did {fill: you} {if proxy fill: (insert name)} ever spend a week or more away from the {fill: EX1 answer or “FEMA Home”} while {fill: you were} {if proxy fill: he/she was}living or staying there?

1 YES

2 NO

8 DON’T KNOW

9 Refused

[IF EX_AWAY1 = 1, GO TO EX_AWAY2_NUM; ELSE GO TO EX_EMPLOY]

EX_AWAY2_NUM. In total, how long {fill: were you} {if proxy fill: was (insert name)} away from the {fill: EX1 answer or “FEMA Home”}?

IF NECESSARY, SAY: How many days, weeks, or months in total?

[INTERVIEWER: FIRST CODE THE TOTAL NUMBER (OF DAYS, WEEKS OR MONTHS).]

___ Total Number [RANGE: 1-365]

998 DON’T KNOW

999 REFUSED

EX_AWAY2_DUR. (In total, how long {fill: were you} {if proxy fill: was (insert name)} away from the {fill: EX1 answer or “FEMA Home”}?)

IF NECESSARY, ASK: Was that days, weeks, or months?

[INTERVIEWER: NOW CODE WHETHER THE NUMBER IS OF DAYS, WEEKS OR MONTHS.]

1 Days

2 Weeks

3 Months

8 DON’T KNOW

9 REFUSED

[IF EX_AWAY2_NUM = 1, 2, 3, 4, 5, or 6 AND EX_AWAY2_DUR=1, GO TO EX_AWAY2_CHECK; ELSE GO TO EX_EMPLOY]

EX_AWAY2_CHECK. You previously stated that {fill: you} {if proxy fill: (insert name)} spent a week or more away from the {fill: EX1 answer or “FEMA Home”} but your last answer indicated it was only for {fill: EX_AWAY2_NUM} days. Is this correct?

1 YES, ANSWER GIVEN IS CORRECT (CONTINUE TO EX6A)

2 CHANGE AMOUNT OF TIME SPENT AWAY (WILL RECEIVE HARD ERROR BOX. GO TO EX_AWAY2_NUM)

3 DID NOT SPEND A WEEK OR MORE AWAY FROM THE {FILL: EX1 ANSWER or “FEMA Home”} (WILL RECEIVE HARD ERROR BOX. GO BACK TO EX_AWAY1 TO CHANGE ANSWER)

EX_EMPLOY. Were {fill: you} {if proxy fill: (insert name)} employed while living in the {fill: EX1 answer or “FEMA Home”}?

1 YES
2 NO

8 DON’T KNOW

9 REFUSED

[IF EX_EMPLOY = 1, GO TO EX_EMPLOY_DAY; ELSE GO TO EX6A]

EX_EMPLOY_DAY. What days of the week did {fill: you} {if proxy fill: (insert name)} work at {fill: your} {if proxy fill: his/her} job?

[INTERVIEWER: IF RESPONDENT HAD MORE THAN ONE JOB, ASK THEM TO REPORT ON THE JOB THEY WORKED AT FOR THE MOST AMOUNT OF TIME.]

(CHECK ALL THAT APPLY)

1  Monday
2  Tuesday
3  Wednesday
4  Thursday
5  Friday
6  Saturday
7  Sunday
8  DON’T KNOW
9  REFUSED

EX_EMPLOY_HOUR. On these days that {fill: you} {if proxy fill: (insert name)} worked, how many hours a day on average did {fill: you} {if proxy fill: he/she} work? [INTERVIEWER: IF RESPONDENT HAD MORE THAN ONE JOB, ASK THEM TO REPORT ON THE JOB THEY WORKED AT FOR THE MOST AMOUNT OF TIME.]

[INTERVIEWER: IF RESPONDENT IS STRUGGLING WITH PROVIDING AN AVERAGE, PLEASE USE OTHER SPECIFY TO CAPTURE THEIR RESPONSE VERBATIM]

_____Hours {0-24}  

97 OTHER, SPECIFY{allow 250 characters}
98  DON’T KNOW
99  REFUSED

EX_EMPLOY_SHIFT. On these days that {fill: you} {if proxy fill: (insert name)} worked, what shift did you normally work?

[INTERVIEWER: IF RESPONDENT HAD MORE THAN ONE JOB, ASK THEM TO REPORT ON THE JOB THEY WORKED AT FOR THE MOST AMOUNT OF TIME.]

[INTERVIEWER: WE ARE NOT COLLECTING EXACT START AND END TIMES FOR SHIFTS.]

Would you say you worked….

1 1^st Shift: Morning to Afternoon
2 2^nd Shift: Afternoon to Evening
3 3^rd Shift: Evening to Overnight
8  DON’T KNOW
9  REFUSED

[IF EX4A, EX4B, EX5A, AND EX5B ALL =DK/REF, START EX6A WITH: how many nights etc…]

EX6A. Between {fill: the EX4C_2 of} {fill: EX4B/EX4B_2)}{fill: EX4C}{fill: EX4A}and {fill: the EX5C_2 of} {fill: EX5B/EX5B_2}{fill: EX5C}{fill: EX5A}, how many nights a week did {fill: you} {if proxy fill: (insert name)} usually sleep in the {fill: EX1 answer or “FEMA Home”}?

Programming note: If all of EX4 series or all of EX5 series not given (DK/REF was chosen), fill as [DATE NOT PROVIDED] in the sentence above.

[INTERVIEWER: IF NECESSARY, SAY: “Your best guess is fine” or “Can you give me an average number of nights a week?”]

____ Nights [Range: 0-7]

8 Don’t Know

9 Refused

EX6B. On a typical night, how many hours did {fill: you} {if proxy fill: (insert name)} sleep in the {fill: EX1 answer or “FEMA Home”}?

[INTERVIEWER: IF NECESSARY, SAY: “Your best guess is fine” or “Can you give me an average number of hours?”]

____ Hours [Range: 0-24]

98 Don’t Know

99 Refused

EX6C. On a typical weekday—that is, any day Monday through Friday— about how many hours did {fill: you} {if proxy fill: (insert name)} usually spend awake inside the {fill: EX1 answer or “FEMA Home”}?

[INTERVIEWER: IF NECESSARY, SAY: “Your best guess is fine” or “Can you give me an average number of hours?”]

____ Hours [Range: 0-24]

98 Don’t Know

99 Refused

EX6D. On a typical Saturday, about how many hours did {fill: you} {if proxy fill: (insert name)} usually spend awake inside the {fill: EX1 answer or “FEMA Home”}?

[INTERVIEWER: IF NECESSARY, SAY: “Your best guess is fine” or “Can you give me an average number of hours?”]

____ Hours [Range: 0-24]

98 Don’t Know

99 Refused

EX6E. On a typical Sunday, about how many hours did {fill: you} {if proxy fill: (insert name)} usually spend awake inside the {fill: EX1 answer or “FEMA Home”}?

[INTERVIEWER: IF NECESSARY, SAY: “Your best guess is fine” or “Can you give me an average number of hours?”]

____ Hours [Range: 0-24]

98 Don’t Know

99 Refused

EX_TIME1. After {fill: you} {if proxy fill: (insert name)} stopped living or staying in the {fill: EX1 answer or “FEMA Home”}, did {fill: you} {if proxy fill: he/she} ever spend time in the {fill: EX1 answer or “FEMA Home”}, even just for a few hours?

1 YES
2 NO

8 DON’T KNOW

9 REFUSED

[IF EX_TIME1 = 1, GO TO EX_TIME2_NUM; ELSE GO TO EX7]

EX_TIME2_NUM. How much time did {fill: you} {if proxy fill: (insert name)} spend in the {fill: EX1 answer or “FEMA Home”} after {fill: you} {if proxy fill: he/she} stopped living or staying there?

[INTERVIEWER: FIRST CODE NUMBER OF HOURS (PER DAY, WEEK, OR MONTH).]

___ # of hours [RANGE: 0-24]

[IF EX_TIME2_NUM=DK/REF, GO TO EX7; ELSE GO TO EX_TIME2_UNIT]

EX_TIME2_UNIT. (How much time did {fill: you} {if proxy fill: (insert name)} spend in the {fill: EX1 answer or “FEMA Home”} after {fill: you} {if proxy fill: he/she} stopped living or staying there?)

IF NECESSARY, ASK: Was that per day, per week, or per month?

[INTERVIEWER: NOW CODE WHETHER THE NUMBER OF HOURS IS PER DAY, PER WEEK, OR PER MONTH.]

1 Per day
2 Per week
3 Per month

8 DON’T KNOW

9 REFUSED

[IF EX_TIME2_UNIT=DK/REF, GO TO EX7, ELSE GO TO EX_TIME2_TOTAL]

EX_TIME2_TOTAL. (How much time did {fill: you} {if proxy fill: (insert name)} spend in the {fill: EX1 answer or “FEMA Home”} after {fill: you} {if proxy fill: he/she} stopped living or staying there?)

Programming note: EX_TIME2_UNIT answer will dictate what goes in the fills below.

[INTERVIEWER: IF NECESSARY, ASK: For how many {fill: days/weeks/months} in total?]

[INTERVIEWER: CODE THE TOTAL NUMBER OF {FILL: DAYS/WEEKS/MONTHS} THIS OCCURRED]

___ Total Number [RANGE: 1-365]

998 DON’T KNOW

999 REFUSED

[If loop counting variable registers that we are on the 7^th round of going through EX1-EX7, have the program go to EX8 instead of asking EX7 again.]

[IF EX4A, EX4B, EX5A, AND EX5B ALL =DK/REF, HAVE EX7 READ: In addition to the {fill: EX1 answer or “FEMA Home”} you just told me about, did {fill: you} {if proxy fill: (insert name)} live in, stay at, or visit another FEMA home for at least seven consecutive days?]

EX7. In addition to the {fill: EX1 answer or “FEMA Home”} you just told me about, which {fill: you} {if proxy fill: (insert name)} stayed in from {fill: the EX4C_2 of} {fill: EX4B/EX4B_2}{fill: EX4C}{fill: EX4A} to {fill: the EX5C_2 of}{fill: EX5B/EX5B_2}{fill: EX5C}{fill: EX5A}, did {fill: you} {if proxy fill: he/she} live in, stay at, or visit another FEMA home for at least seven consecutive days?

Programming note: If all of EX4series or all of EX5 series not given (DK/REF was chosen), fill as [DATE NOT PROVIDED] in the sentence above.

1 YES

2 NO

8 DON’T KNOW

9 REFUSED

[If EX7=1, loop back through EX1-EX7; else go to EX8. This loop can happen 6 more times. Thus

a person could be asked EX1-EX7 a total of 7 times.]

Programming note: If the dates provided for one FEMA home (in EX_CHECK1) are the same/overlap with another FEMA home, please have EX7_CHECK appear. If complete dates (mm/dd/yy) are not provided in EX4 and/or EX5 series, this check will not be performed.

EX7_CHECK. You have indicated that {fill: you} {if proxy fill: (insert name)} had two FEMA homes in {fill: your} {if proxy fill: his/her} possession at one time. We just want to make sure this is correct. We have that you had the:

#1: {Fill: EX1 answer or “FEMA Home”}from {fill: the EX4C_2 of} {fill: EX4B/EX4B_2}{fill: EX4C}{fill: EX4A} to {fill: the EX5C_2 of}{fill: EX5B/EX5B_2}{fill: EX5C}{fill: EX5A}

#2: {Fill: EX1 answer or “FEMA Home”}from {fill: the EX4C_2 of} {fill: EX4B/EX4B_2}{fill: EX4C}{fill: EX4A} to {fill: the EX5C_2 of}{fill: EX5B/EX5B_2}{fill: EX5C}{fill: EX5A}

Is this correct?

1. YES (continue to EX8)

2. {fill: FIRST, SECOND, ETC} FEMA HOME DATES NEED TO BE CORRECTED (GO TO EX4A)

3. {fill: FIRST, SECOND, ETC} FEMA HOME DATES NEED TO BE CORRECTED (GO TO EX4A)

Testers: If option 2 or 3 is selected you will receive a Hard Error box. Click the “go to” button and you will be taken back to EX4A. Advance to the question you need to fix by hitting “enter.” Once you have fixed the information and pressed “enter” to advance to the next screen to save it, press the “END” key on your keyboard. You will receive the Hard Error box again. This time select EX7_CHECK with your mouse and click the “go to” button. Since the error has been corrected you will bypass the EX7_CHECK screen and be taken to EX8.

Programming note: If we run through questions EX1-EX7 again, we have the potential to have more than one FEMA home type for EX1. We want to list all home types selected for EX1 in EX8.

EX8. Since living or staying in the {fill: EX1 answer or “FEMA Home”}, did {fill: you} {if proxy fill: (insert name)} ever permanently move back to the home {fill: you} {if proxy fill: he/she} lived in before Hurricanes Katrina and Rita?

1. YES

2. NO

8 DON’T KNOW

9 REFUSED

[IF EX8=1, GO TO EX9A; ELSE GO TO DEC0]

EX9A. In what year did {fill: you} {if proxy fill: (insert name)} first permanently move back to the home {fill: you} {if proxy fill: he/she} lived in before Hurricanes Katrina and Rita?

[INTERVIEWER: DO NOT READ RESPONSES.]

1. 2005

2. 2006

3. 2007

4. 2008

5. 2009

6. 2010

7. 2011

8. 2012

98 DON’T KNOW

99 REFUSED

EX9B. In what month did {fill: you} {if proxy fill: (insert name)} first permanently move back to the home {fill: you} {fill: he/she} lived in before Hurricanes Katrina and Rita?

1. January

2. February

3. March

4. April

5. May

6. June

7. July

8. August

9. September

10. October

11. November

12. December

98 Don’t Know

99 Refused

[IF EX9B = DK/REF, GO TO EX9B_2; ELSE GO TODEC0]

EX9B_2. Was it in the spring, summer, fall, or winter of {fill: EX9A answer or “that year”}?

1. SPRING

2. SUMMER

3. FALL

4. WINTER

8 Don’t Know

9 Refused

[IF P1=3, GO TO DEC0, ELSE GO TO C2a]

DEC0. Finally, I have some questions about {if proxy fill: (insert name)}.

1 CONTINUE

DEC2_mo. What was {if proxy fill: his/her} date of birth?

[INTERVIEWER: SELECT THE MONTH]

1. January

2. February

3. March

4. April

5. May

6. June

7. July

8. August

9. September

10. October

11. November

12. December

98 Don’t Know

99 Refused

DEC2_dy. (What was {if proxy fill: his/her} date of birth?)

[INTERVIEWER: ENTER THE DAY]

____Day [Range: 1 – 31]

98 DON’T KNOW

99 REFUSED

DEC2_yr. (What was {if proxy fill: his/her} date of birth?)

[INTERVIEWER: ENTER THE YEAR]

____Year [Range: 1900-1987]

9998 DON’T KNOW

9999 REFUSED

[IF YEAR IS > 1987 GO TO DEC2_yr_CHECK (EXCLUDE DK/REF). ELSE GO TO DEC3]

DEC2_yr_CHECK. Just to confirm, you stated that the year {if proxy fill: (insert name)} was born was {fill: DEC2_yr answer}. Is that correct?

1. YES (CONTINUE TO DEC3)
   2 NO (GO BACK TO DEC2_yr)

DEC3. Was {if proxy fill: he/she} Hispanic, Latino/a, or Spanish origin?

1. No, not of Hispanic, Latino/a, or Spanish origin

2. Yes, Mexican, Mexican American, Chicano/a

3. Yes, Puerto Rican

4. Yes, Cuban

5. Yes, another Hispanic, Latino, or Spanish origin

8 DON’T KNOW

9 REFUSED

DEC4. Which one or more of the following would you say was {if proxy fill: (insert name)} race?

[INTERVIEWER: CODE ALL THAT APPLY]

1 White

2 Black or African American

3 American Indian or Alaskan Native

4 Asian Indian

5 Chinese

6 Filipino

7 Japanese

8 Korean

9 Vietnamese

10 Other Asian

11 Native Hawaiian

12 Guamanian or Chamorro

13. Samoan

14. Other Pacific Islander

98 DON’T KNOW

99 REFUSED

DEC5. What was {if proxy fill: his/her} cause of death? Please be as specific as possible.

[INTERVIEWR: ENTER THE RESPONDENT’S ANSWER VERBATIM.] {allow 1,000 characters}

8 DON’T KNOW
9 REFUSED

DEC6. In what state did {if proxy fill: he/she} pass away?
[SELECT FROM LIST] {allow 2 characters}

DEC7_mo. On what date did {if proxy fill: he/she} pass away?

[INTERVIEWER: SELECT THE MONTH]

1. January

2. February

3. March

4. April

5. May

6. June

7. July

8. August

9. September

10. October

11. November

12. December

98 Don’t Know

99 Refused

DEC7_dy. (On what date did {if proxy fill: he/she} pass away?)

[INTERVIEWER: ENTER THE DAY]

____Day [Range: 1 – 31]

98 DON’T KNOW

99 REFUSED

DEC7_yr. (On what date did {if proxy fill: he/she} pass away?)

[INTERVIEWER: ENTER THE YEAR]

____Year [Range: 2005 – 2013]

9998 DON’T KNOW

9999 REFUSED

[IF S_GENDER=2, ASK DEC8; ELSE GO TO D17a]

DEC8. What was {if proxy fill: (insert name)’s} maiden name?

[INTERVIEWER: ENTER MAIDEN NAME]

{allow 60 characters}

[IF P1=3 (deceased), GO TO D17a, ELSE GO TO C2a]

C2a. Can you please tell me the name of someone who does not live with {fill: you} {if proxy fill: (insert name)} who can always reach {fill: you} {if proxy fill: him/her}?

ENTER FIRST NAME {allow 60 characters}

[IF C2a=DK/REF, GO TO D0; ELSE GO TO C2b]

C2b. (Can you please tell me the name of someone who does not live with {fill: you} {if proxy fill: (insert name)} who can always reach {fill: you} {if proxy fill: him/her}?)

ENTER MIDDLE INITIAL {allow 2 characters—allow interviewer to advance if nothing entered}

C2c. (Can you please tell me the name of someone who does not live with {fill: you} {if proxy fill: (insert name)} who can always reach {fill: you} {if proxy fill: him/her}?)

ENTER LAST NAME {allow 60 characters}

C2d. (Can you please tell me the name of someone who does not live with {fill: you} {if proxy fill: (insert name)} who can always reach {fill: you} {if proxy fill: him/her}?)

ENTER SUFFIX [EX. SR OR JR]{allow 5 characters—allow interviewer to advance if nothing
entered}

C3. What is this person’s relationship to {fill: you} {if proxy fill: him/her}?

1. Spouse or significant other

2. Parent

3. Child

4. Brother or sister

5. Friend

6. Other (specify){max 60 characters)

8. Don’t Know

9. Refused

C4a. Where does this person live now?

ENTER CITY{allow 60 characters}

C4b. (Where does this person live now?)

ENTER STATE [SELECT FROM STATE LOOKUP TABLE]{allow 2 characters}

C4c. (Where does this person live now?)

[INTERVIEWER: IF NECESSARY, ASK: What country does this person live in now?”]

ENTER COUNTRY [SELECT FROM COUNTRY LOOKUP TABLE]

C5a. First, can you please tell me his/her home telephone number?

{allow 10 characters—allow to advance if nothing entered}

C5b. Next, can you please tell me his/her work telephone number?

{allow 10 characters—allow to advance if nothing entered}

C5c. Can you please tell me his/her cell phone number?

{allow 10 characters—allow to advance if nothing entered}

C6. What is his/her email address?

[INTERVIEWER: IF NO EMAIL ADDRESS, PRESS DON’T KNOW KEY]

ENTER EMAIL ADDRESS {allow 60 characters}

C7a. Could you please tell me the name of another person who does not live with {fill: you} {if proxy fill: (insert name)} who can always reach {fill: you} {if proxy fill: him/her}?

ENTER FIRST NAME {allow 60 characters}

[IF C7a=DK/REF, GO TO D0; ELSE GO TO C7b]

C7b. (Could you please tell me the name of another person who does not live with {fill: you} {if proxy fill: (insert name)} who can always reach {fill: you} {if proxy fill: him/her}?)

ENTER MIDDLE INITIAL {allow 2 characters—allow interviewer to advance if nothing entered}

C7c. (Could you please tell me the name of another person who does not live with {fill: you} {if proxy fill: (insert name)} who can always reach {fill: you} {if proxy fill: him/her}?)

ENTER LAST NAME {allow 60 characters}

C7d. (Could you please tell me the name of another person who does not live with {fill: you} {if proxy fill: (insert name)} who can always reach {fill: you} {if proxy fill: him/her}?)

ENTER SUFFIX [EX. SR OR JR]{allow 5 characters—allow interviewer to advance if nothing entered}

C8. What is this person’s relationship to {fill: you} {if proxy fill: him/her}?

1. Spouse or significant other

2. Parent

3. Child

4. Brother or sister

5. Friend

6. Other (specify){max 60 characters)

8. Don’t Know

9. Refused

C9a. Where does this person live now?

ENTER CITY{allow 60 characters}

C9b. (Where does this person live now?)

ENTER STATE [SELECT FROM STATE LOOKUP TABLE]{allow 2 characters}

C9c. (Where does this person live now?)

[INTERVIEWER: IF NECESSARY, ASK: What country does this person live in now?”]

ENTER COUNTRY [SELECT FROM COUNTRY LOOKUP TABLE]

C10a. First, can you please tell me his/her home telephone number?

{allow 10 characters—allow to advance if nothing entered}

C10b. Next, can you please tell me his/her work telephone number?

{allow 10 characters—allow to advance if nothing entered}

C10c. Can you please tell me his/her cell phone number?

{allow 10 characters—allow to advance if nothing entered}

C11. What is his/her email address?

[INTERVIEWER: IF NO EMAIL ADDRESS, PRESS DON’T KNOW KEY]

ENTER EMAIL ADDRESS {allow 60 characters}

C12a. And finally, could you please tell me the name of one more person who does not live with {fill: you} {if proxy fill: (insert name)} who can always reach {fill: you} {if proxy fill: him/her}?

ENTER FIRST NAME {allow 60 characters}

[IF C12a=DK/REF, GO TO D0; ELSE GO TO C12b]

C12b. (And finally, could you please tell me the name of one more person who does not live with {fill: you} {if proxy fill: (insert name)} who can always reach {fill: you} {if proxy fill: him/her}?)

ENTER MIDDLE INITIAL {allow 2 characters-- allow interviewer to advance if nothing entered}

C12c. (And finally, could you please tell me the name of one more person who does not live with {fill: you} {if proxy fill: (insert name)} who can always reach {fill: you} {if proxy fill: him/her}?)

ENTER LAST NAME {allow 60 characters}

C12d. (And finally, could you please tell me the name of one more person who does not live with {fill: you} {if proxy fill: (insert name)} who can always reach {fill: you} {if proxy fill: him/her}?)

ENTER SUFFIX [EX. SR OR JR]{allow 5 characters—allow interviewer to advance if nothing entered}

C13. What is this person’s relationship to {fill: you} {if proxy fill: him/her}?

1. Spouse or significant other

2. Parent

3. Child

4. Brother or sister

5. Friend

6. Other (specify){max 60 characters)

8. Don’t Know

9. Refused

C14a. Where does this person live now?

ENTER CITY {allow 60 characters}

C14b. (Where does this person live now?)

ENTER STATE [SELECT FROM STATE LOOKUP TABLE]{allow 2 characters}

C14c. (Where does this person live now?)

[INTERVIEWER: IF NECESSARY, ASK: What country does this person live in now?”]

ENTER COUNTRY [SELECT FROM COUNTRY LOOKUP TABLE]

C15a. First, can you please tell me his/her home telephone number?

{allow 10 characters—allow to advance if nothing entered}

C15b. Next, can you please tell me his/her work telephone number?

{allow 10 characters—allow to advance if nothing entered}

C15c. Can you please tell me his/her cell phone number?

{allow 10 characters—allow to advance if nothing entered}

C16. What is his/her email address?

[INTERVIEWER: IF NO EMAIL ADDRESS, PRESS DON’T KNOW KEY]

ENTER EMAIL ADDRESS {allow 60 characters}

D0. Finally, I have some questions about {fill: you} {if proxy fill: (insert name)}.

1 CONTINUE

D2_mo. What is {fill: your} {if proxy fill: (insert name)’s} date of birth?

[INTERVIEWER: SELECT THE MONTH]

1. January

2. February

3. March

4. April

5. May

6. June

7. July

8. August

9. September

10. October

11. November

12. December

98 Don’t Know

99 Refused

D2_dy. (What is {fill: your} {if proxy fill: (insert name)’s} date of birth?)

[INTERVIEWER: ENTER THE DAY]

_____ Day [Range: 1-31]

98 DON’T KNOW

99 REFUSED

D2_yr. (What is {fill: your} {if proxy fill: (insert name)’s} date of birth?)

[INTERVIEWER: ENTER THE YEAR]

_____ Year [Range: 1900- 1995]

9998 DON’T KNOW

9999 REFUSED

D3. {fill: Are you} {if proxy fill: Is (insert name)} of Hispanic, Latino/a, or Spanish origin?

1. No, not of Hispanic, Latino/a, or Spanish origin

2. Yes, Mexican, Mexican American, Chicano/a

3. Yes, Puerto Rican

4. Yes, Cuban

5. Yes, another Hispanic, Latino, or Spanish origin

8 DON’T KNOW

9 REFUSED

D4. What is {fill: your} {if proxy fill: (insert name)’s} race?

[INTERVIEWER: CODE ALL THAT APPLY]

1 White

2 Black or African American

3 American Indian or Alaskan Native

4 Asian Indian

5 Chinese

6 Filipino

7 Japanese

8 Korean

9 Vietnamese

10 Other Asian

11 Native Hawaiian

12 Guamanian or Chamorro

13. Samoan

14. Other Pacific Islander

98 DON’T KNOW

99 REFUSED

D4a. {fill: Are you} {if proxy fill: Is (insert name)} deaf or {fill: do you} {if proxy fill: does he/she} have serious difficulty hearing?

1 YES

2 NO

8 DON’T KNOW

9 REFUSED

D4b. {fill: Are you} {if proxy fill: Is (insert name)} blind or {fill: do you} {if proxy fill: does he/she} have serious difficulty seeing, even when wearing glasses?

1 YES

2 NO

8 DON’T KNOW

9 REFUSED

D4c. Because of a physical, mental, or emotional condition, {fill: do you} {if proxy fill: does (insert name)} have serious difficulty concentrating, remembering, or making decisions?

1 YES

2 NO

8 DON’T KNOW

9 REFUSED

D4d. {fill: Do you} {if proxy fill: Does (insert name)} have serious difficulty walking or climbing stairs?

1 YES

2 NO

8 DON’T KNOW

9 REFUSED

D4e. {fill: Do you} {if proxy fill: Does (insert name)} have difficulty dressing or bathing?

1 YES

2 NO

8 DON’T KNOW

9 REFUSED

D4f. Because of a physical, mental, or emotional condition, {fill: do you} {if proxy fill: does (insert name)} have difficulty doing errands alone such as visiting a doctor's office or shopping?

1 YES

2 NO

8 DON’T KNOW

9 REFUSED

D5. {fill: Are you} {if proxy fill: Is (insert name)} currently …

1 Married

2 Divorced

3 Widowed

4 Separated

5 Single, never married

6 Living with a partner (boyfriend or girlfriend)

8 DON’T KNOW

9 REFUSED

D6. What is the highest grade or year of school {fill: you} {if proxy fill: (insert name)} completed?

1 Less than high school degree

2 High school degree (or equivalent)

3 Some college

4 Bachelor’s degree

5 Advanced degree (masters, professional, doctoral degree)

8 DON’T KNOW

9 REFUSED

D7. {fill: Are you} {if proxy fill: Is (insert name)} currently employed?

1 YES

2 NO

8 DON’T KNOW

9 REFUSED

[IF D7=1, GO TO D8; ELSE GO TO D10]

D8. What is {fill: your} {if proxy fill: (insert name)’s} current occupation?

[INTERVIEWER: READ LIST AND SELECT ONE ONLY. IF RESPONDENT HAS TWO OCCUPATIONS, ASK HIM OR HER TO REPORT THE OCCUPATION IN WHICH HE/SHE WORKS THE MOST HOURS.]

[INTERVIEWER: PRESS F5 TO ACCESS HELP MENU]

1 Management, Business, and Financial Occupations
2 Computer, Engineering, and Science Occupations
3 Education, Legal, Community Service, Arts, and Media Occupations
4 Healthcare Practitioners and Technical Occupations
5 Service Occupations
6 Sales and Related Occupations
7 Office and Administrative Support Occupations
8 Farming, Fishing, and Forestry Occupations
9 Construction and Extraction Occupations
10 Installation, Maintenance, and Repair Occupations
11 Production Occupations
12 Transportation and Material Moving Occupations
13 Military Specific Occupations
98 DON’T KNOW
99 REFUSED

D9. What industry {fill: do you} {if proxy fill: does (insert name)} work in?

[INTERVIEWER: READ LIST. SELECT ONE ONLY. IF RESPONDENT WORKS IN TWO INDUSTRIES, ASK HIM OR HER TO REPORT THE INDUSTRY IN WHICH HE/SHE WORKS THE MOST HOURS.]

[INTERVIEWER: PRESS F5 TO ACCESS HELP MENU]

1  Agriculture, Forestry, Fishing and Hunting
2  Mining, Quarrying, and Oil and Gas Extraction
3  Utilities
4  Construction
5  Manufacturing
6  Wholesale Trade
7  Retail Trade
8  Transportation and Warehousing
9  Information
10   Finance and Insurance
11  Real Estate and Rental and Leasing
12  Professional, Scientific, and Technical Services
13  Management of Companies and Enterprises
14  Administrative and Support and Waste Management and Remediation Services
15  Educational Services
16  Health Care and Social Assistance
17  Arts, Entertainment, and Recreation
18  Accommodation and Food Services
19  Other Services (except Public Administration)
20  Public Administration
98 DON’T KNOW
99 REFUSED

D10. What is your best estimate of {fill: your} {if proxy fill: (insert name)’s} total income from all sources, before taxes, in the last year?

1 Less than $20,000

2 $20,000 - $49,999

3 $50,000 - $74,999

4 $75,000 - $99,999

5 $100,000 - $150,000

6 More than $150,000

8 DON’T KNOW

9 REFUSED

D11. What is your best estimate of {fill: your} {if proxy fill: (insert name)’s} household’s total income from all sources, before taxes, in the last year?

[INTERVIEWER: IF NECESSARY, SAY: “{Fill: Your} {If proxy fill: His /Her} household’s income includes everyone who lives with {fill: you} {if proxy fill: him/her}.”]

1 Less than $20,000

2 $20,000 - $49,999

3 $50,000 - $74,999

4 $75,000 - $99,999

5 $100,000 - $150,000

6 More than $150,000

8 DON’T KNOW

9 REFUSED

D13a. We have {fill: your} {if proxy fill: (insert name)’s} full name recorded as: {fill: (insert name)}.

[INTERVIERWER: SPELL BACK THE FIRST NAME TO VERIFY IT IS CORRECT AND
REENTER IT BELOW.]

First Name {allow 60 characters}

D13b. (We have {fill: your} {if proxy fill: (insert name)’s} full name recorded as: {fill: (insert name)}.)

[INTERVIERWER: CONFIRM/ASK FOR A MIDDLE INITIAL AND ENTER IT BELOW.]

Middle Initial {allow 2 characters—allow interviewer to advance if nothing entered}

D13c. (We have {fill: your} {if proxy fill: (insert name)’s} full name recorded as: {fill: (insert name)}.)

[INTERVIERWER: SPELL BACK THE LAST NAME TO VERIFY IT IS CORRECT AND
REENTER IT BELOW.]

Last Name {allow 60 characters}

D13d. (We have {fill: your} {if proxy fill: (insert name)’s} full name recorded as: {fill: (insert name)}.)

[INTERVIERWER: CONFIRM/ASK IF THEY HAVE A SUFFIX (EX. SR OR JR) AND
ENTER IT BELOW.]

Suffix {allow 5 characters—allow interviewer to advance if nothing entered}

D14. Earlier, you reported that {fill: your} {if proxy fill: (insert name)’s} primary home address before
Hurricanes Katrina or Rita was:

[FILL ADDRESS VERIFIED IN S2 OR PROVIDED IN S2a]

Is this still {fill: your} {if proxy fill: (insert name)’s} primary home address?

1 YES

2 NO
8 DON’T KNOW

9 REFUSED

[IF D14=1, GO TO D15, ELSE GO TO D14a]

D14a. What is {fill: your} {if proxy fill: (insert name)’s} current home address?

[INTERVIEWER: ENTER STREET ADDRESS. PLEASE ASK IF THERE IS AN APARTMENT NUMBER]

Address {allow 100 characters}

D14b. (What is {fill: your} {if proxy fill: (insert name)’s} current home address?)

[INTERVIEWER: ENTER CITY]

City {allow 60 characters}

D14c. (What is {fill: your} {if proxy fill: (insert name)’s} current home address?)

State [SELECT FROM LIST]{allow 2 characters}

D14d. (What is {fill: your} {if proxy fill: (insert name)’s} current home address?)
[INTERVIEWER: ENTER ZIP CODE]

Zip Code {allow 10 characters}

D15. What is {fill: your} {if proxy fill: (insert name)’s} email address?

[INTERVIEWER: IF NO EMAIL ADDRESS, PRESS DON’T KNOW KEY]

{max 60 characters}

D16a. What is {fill: your} {if proxy fill: (insert name)’s} home phone number?

{allow 10 characters—allow to advance if nothing entered}

D16b. What is {fill: your} {if proxy fill: (insert name)’s} work phone number?

{allow 10 characters—allow to advance if nothing entered}

D16c. What is {fill: your} {if proxy fill: (insert name)’s} cell phone number?

{allow 10 characters—allow to advance if nothing entered}

[IF INTRO1=2 (proxy needed) or S1=2 (under 18, proxy needed), GO TO D17a, ELSE GO TO D21]

D17a. Now I need some information about you, not {if proxy fill: (insert name)}.What is your full name?

First Name {allow 60 characters}

D17b. (What is your full name?)

Middle Initial {allow 2 characters—allow interviewer to advance if nothing entered}

D17c. (What is your full name?)

Last Name {allow 60 characters}

D17d. (What is your full name?)

Suffix [EX. SR or JR]{allow 5 characters—allow interviewer to advance if nothing entered}

D18a. What is your home address?

[INTERVIEWER: ENTER STREET ADDRESS. PLEASE ASK IF THERE IS AN APARTMENT NUMBER]

Address {allow 100 characters}

D18b. (What is your home address?)

City {allow 60 characters}

D18c. (What is your home address?)

State [SELECT FROM LIST]{allow 2 characters}

D18d. (What is your home address?)

Zip Code {allow 10 characters}

D19. What is your email address?

[INTERVIEWER: IF NO EMAIL ADDRESS, PRESS DON’T KNOW KEY]

{max 60 characters}

D20a. What is your home phone number?

{allow 10 characters—allow to advance if nothing entered}

D20b. What is your work phone number?

{allow 10 characters—allow to advance if nothing entered}

D20c. What is your cell phone number?

{allow 10 characters—allow to advance if nothing entered}

D21. Providing part of {fill: your} {if proxy fill: (insert name)’s} Social Security number is totally voluntary.  This information will be kept completely confidential and will only be used to confirm that we have only one interview record for {fill: you} {if proxy fill: him/her} in our system and in case we need to contact you again in the future. What are the last five digits of {fill: your} {if proxy fill: (insert name)’s} Social security number?

{allow 5 characters}

8 DON’T KNOW

9 REFUSED

END. That’s my last question in this survey. Thank you very much for participating in the Hurricanes Katrina and Rita Exposures Registry. If you know of anyone else who might be eligible to participate in the Registry, please give them our toll-free number, 1-XXX-XXXXXXX and encourage them to call us.

30