OMB #: 0925-0593
OMB Expiration Date: 8/31/2014
6M Questionnaire - Household, Phase 2g
OMB Specification
6M Questionnaire - Household
Event Category: |
Time-Based |
Event: |
6M |
Administration: |
N/A |
Instrument Target: |
Child's Primary Residence |
Instrument Respondent: |
Primary Caregiver |
Domain: |
Questionnaire |
Document Category: |
Questionnaire |
Method: |
Data Collector Administered |
Mode (for this instrument*): |
In-Person, CAI; |
OMB Approved Modes: |
In-Person, CAI; |
Estimated Administration Time: |
3 minutes |
Multiple Child/Sibling Consideration: |
Per Event |
Special Considerations: |
N/A |
Version: |
1.0 |
MDES Release: |
4.0 |
*This instrument is OMB-approved for multi-mode administration but this version of the instrument is designed for administration in this/these mode(s) only.
This page intentionally left blank.
6M Questionnaire - Household
TABLE OF CONTENTS
This page intentionally left blank.
6M Questionnaire - Household
WHEN PROGRAMMING INSTRUMENTS, VALIDATE FIELD LENGTHS AND TYPES AGAINST THE MDES TO ENSURE DATA COLLECTION RESPONSES DO NOT EXCEED THOSE OF THE MDES. SOME GENERAL ITEM LIMITS USED ARE AS FOLLOWS:
DATA ELEMENT FIELDS |
MAXIMUM CHARACTERS PERMITTED |
DATA TYPE |
PROGRAMMER INSTRUCTIONS |
ADDRESS AND EMAIL FIELDS |
100 |
CHARACTER |
|
UNIT AND PHONE FIELDS |
10 |
CHARACTER |
|
_OTH AND COMMENT FIELDS |
255 |
CHARACTER |
|
FIRST NAME AND LAST NAME |
30 |
CHARACTER |
|
ALL ID FIELDS |
36 |
CHARACTER |
|
ZIP CODE |
5 |
NUMERIC |
|
ZIP CODE LAST FOUR |
4 |
NUMERIC |
|
CITY |
50 |
CHARACTER |
|
DOB AND ALL OTHER DATE FIELDS (E.G., DT, DATE, ETC.) |
10 |
NUMERIC
CHARACTER
|
MM MUST EQUAL 01 TO 12 DD MUST EQUAL 01 TO 31 YYYY MUST BE BETWEEN 1900 AND CURRENT YEAR. |
TIME VARIABLES |
TWO-DIGIT HOUR AND TWO-DIGIT MINUTE, AM/PM DESIGNATION |
NUMERIC |
HOURS MUST BE BETWEEN 00 AND 12; MINUTES MUST BE BETWEEN 00 AND 59 |
Instrument Guidelines for Participant and Respondent IDs:
PRENATALLY, THE P_ID IN THE MDES HEADER IS THAT OF THE PARTICIPANT (E.G. THE NON-PREGNANT WOMAN, PREGNANT WOMAN, OR THE FATHER).
POSTNATALLY, A RESPONDENT ID WILL BE USED IN ADDITION TO THE PARTICIPANT ID BECAUSE SOMEBODY OTHER THAN THE PARTICIPANT MAY BE COMPLETING THE INTERVIEW. FOR EXAMPLE, THE PARTICIPANT MAY BE THE CHILD AND THE RESPONDENT MAY BE THE MOTHER, FATHER, OR ANOTHER CAREGIVER. THEREFORE, MDES VERSION 2.2 AND ALL FUTURE VERSIONS CONTAIN A R_P_ID (RESPONDENT PARTICIPANT ID) HEADER FIELD FOR EACH POST-BIRTH INSTRUMENT. THIS WILL ALLOW ROCs TO INDICATE WHETHER THE RESPONDENT IS SOMEBODY OTHER THAN THE PARTICIPANT ABOUT WHOM THE QUESTIONS ARE BEING ASKED.
A REMINDER:
ALL RESPONDENTS MUST BE CONSENTED AND HAVE RECORDS IN THE PERSON, PARTICIPANT, PARTICIPANT_CONSENT AND LINK_PERSON_PARTICIPANT TABLES, WHICH CAN BE PRELOADED INTO EACH INSTRUMENT. ADDITIONALLY, IN POST-BIRTH QUESTIONNAIRES WHERE THERE IS THE ABILITY TO LOOP THROUGH A SET OF QUESTIONS FOR MULTIPLE CHILDREN, IT IS IMPORTANT TO CAPTURE AND STORE THE CORRECT CHILD P_ID ALONG WITH THE LOOP INFORMATION. IN THE MDES VARIABLE LABEL/DEFINITION COLUMN, THIS IS INDICATED AS FOLLOWS: EXTERNAL IDENTIFIER: PARTICIPANT ID FOR CHILD DETAIL.
(TIME_STAMP_FS_ST).
PROGRAMMER INSTRUCTIONS |
|
FS01000/(AFFORD_HOME). At this time, do you feel you are able to afford a home suitable for yourself and your family?
Label |
Code |
Go To |
YES |
1 |
|
NO |
2 |
|
REFUSED |
-1 |
|
DON'T KNOW |
-2 |
|
SOURCE |
Pregnancy Infection and Nutrition Study (PINS) |
FS02000/(AFFORD_FURNITURE). Do you feel you are able to afford the furniture or household equipment that you need?
Label |
Code |
Go To |
YES |
1 |
|
NO |
2 |
|
REFUSED |
-1 |
|
DON'T KNOW |
-2 |
|
SOURCE |
Pregnancy Infection and Nutrition Study (PINS) |
FS03000/(AFFORD_CAR). Do you feel you are able to afford the kind of car you need?
Label |
Code |
Go To |
YES |
1 |
|
NO |
2 |
|
REFUSED |
-1 |
|
DON'T KNOW |
-2 |
|
SOURCE |
Pregnancy Infection and Nutrition Study (PINS) |
FS04000/(AFFORD_FOOD). At this time, do you have enough money for the kinds of food you think you and your family should have?
Label |
Code |
Go To |
YES |
1 |
|
NO |
2 |
|
REFUSED |
-1 |
|
DON'T KNOW |
-2 |
|
SOURCE |
Pregnancy Infection and Nutrition Study (PINS) |
FS05000/(AFFORD_MED_CARE). Do you have enough money for the kind of medical care you and your family should have?
Label |
Code |
Go To |
YES |
1 |
|
NO |
2 |
|
REFUSED |
-1 |
|
DON'T KNOW |
2 |
|
SOURCE |
Pregnancy Infection and Nutrition Study (PINS) |
FS06000/(AFFORD_CLOTHING). At this time, do you have enough money for the kind of clothing you and your family should have?
Label |
Code |
Go To |
YES |
1 |
|
NO |
2 |
|
REFUSED |
-1 |
|
DON'T KNOW |
-2 |
|
SOURCE |
Pregnancy Infection and Nutrition Study (PINS) |
FS07000/(AFFORD_LEISURE). Do you have enough money for the leisure activities you and your family want?
Label |
Code |
Go To |
YES |
1 |
|
NO |
2 |
|
REFUSED |
-1 |
|
DON'T KNOW |
-2 |
|
SOURCE |
Pregnancy Infection and Nutrition Study (PINS) |
FS08000/(DIFF_PAY_BILLS). How difficult is it for you and your family to pay your bills? Would you say it is…
Label |
Code |
Go To |
Very difficult |
1 |
|
Somewhat difficult |
2 |
|
Not very difficult |
3 |
|
Not difficult at all |
4 |
|
REFUSED |
-1 |
|
DON’T’ KNOW |
-2 |
|
SOURCE |
Pregnancy Infection and Nutrition Study (PINS) |
FS09000/(MONEY_END_MONTH). At the end of the month, how much money would you say you end up with?
Label |
Code |
Go To |
Not enough money |
1 |
|
Just enough money |
2 |
|
Some money left over |
3 |
|
A lot of money left over |
4 |
|
REFUSED |
-1 |
|
DON’T’ KNOW |
-2 |
|
SOURCE |
Pregnancy Infection and Nutrition Study (PINS) |
(TIME_STAMP_FS_ET).
PROGRAMMER INSTRUCTIONS |
|
(TIME_STAMP_LU_ST).
PROGRAMMER INSTRUCTIONS |
|
LU01000. These next questions are about the primary language spoken at home or to {the child/children}.
LU02000/(LANGUAGE_NON_ENG). Is any language other than English regularly spoken in your home?
Label |
Code |
Go To |
YES |
1 |
|
NO |
2 |
TIME_STAMP_LU_ET |
REFUSED |
-1 |
TIME_STAMP_LU_ET |
DON'T KNOW |
-2 |
TIME_STAMP_LU_ET |
SOURCE |
Early Childhood Longitudinal Study, Kindergarten Cohort Spring Parent Interview |
LU03000/(LANGUAGE_TYPE). What languages other than English are spoken in your home?
INTERVIEWER INSTRUCTIONS |
|
Label |
Code |
Go To |
SPANISH |
1 |
|
ARABIC |
2 |
|
BENGALI |
3 |
|
CHINESE (INCLUDING MANDARIN, CANTONESE) |
4 |
|
FARSI (PERSIAN) |
5 |
|
FRENCH |
6 |
|
FRENCH CREOLE |
7 |
|
GERMAN |
8 |
|
GREEK |
9 |
|
HINDI |
10 |
|
ITALIAN |
11 |
|
KOREAN |
12 |
|
POLISH |
13 |
|
PORTUGUESE |
14 |
|
PUNJABI |
15 |
|
RUSSIAN |
16 |
|
TAGALOG |
17 |
|
VIETNAMESE |
18 |
|
URDU |
19 |
|
SIGN LANGUAGE |
20 |
|
OTHER |
-5 |
|
REFUSED |
-1 |
|
DON’T KNOW |
-2 |
|
SOURCE |
Early Childhood Longitudinal Study, Kindergarten Cohort Fall Parent Interview (modified) |
PROGRAMMER INSTRUCTIONS |
|
LU04000/(LANGUAGE_TYPE_OTH). SPECIFY: ____________________________________________
SOURCE |
Early Childhood Longitudinal Study, Kindergarten Cohort Fall Parent Interview (modified) |
LU05000/(PRIMARY_LANGUAGE). What is the primary language spoken in your home?
INTERVIEWER INSTRUCTIONS |
|
Label |
Code |
Go To |
ENGLISH |
1 |
TIME_STAMP_LU_ET |
SPANISH |
2 |
ENGLISH_REGULAR |
ARABIC |
3 |
ENGLISH_REGULAR |
BENGALI |
4 |
ENGLISH_REGULAR |
CHINESE (INCLUDING MANDARIN, CANTONESE) |
5 |
ENGLISH_REGULAR |
FARSI (PERSIAN) |
6 |
ENGLISH_REGULAR |
FRENCH |
7 |
ENGLISH_REGULAR |
FRENCH CREOLE |
8 |
ENGLISH_REGULAR |
GERMAN |
9 |
ENGLISH_REGULAR |
GREEK |
10 |
ENGLISH_REGULAR |
HINDI |
11 |
ENGLISH_REGULAR |
ITALIAN |
12 |
ENGLISH_REGULAR |
KOREAN |
13 |
ENGLISH_REGULAR |
POLISH |
14 |
ENGLISH_REGULAR |
PORTUGUESE |
15 |
ENGLISH_REGULAR |
PUNJABI |
16 |
ENGLISH_REGULAR |
RUSSIAN |
17 |
ENGLISH_REGULAR |
TAGALOG |
18 |
ENGLISH_REGULAR |
VIETNAMESE |
19 |
ENGLISH_REGULAR |
URDU |
20 |
ENGLISH_REGULAR |
SIGN LANGUAGE |
21 |
ENGLISH_REGULAR |
OTHER |
-5 |
|
REFUSED |
-1 |
TIME_STAMP_LU_ET |
DON’T KNOW |
-2 |
TIME_STAMP_LU_ET |
SOURCE |
Early Childhood Longitudinal Study, Kindergarten Cohort Fall Parent Interview (modified) |
LU06000/(PRIMARY_LANGUAGE_OTH). SPECIFY: ____________________________________________
SOURCE |
Early Childhood Longitudinal Study, Kindergarten Cohort Fall Parent Interview (modified) |
LU07000/(ENGLISH_REGULAR). Is English also regularly spoken in your home?
Label |
Code |
Go To |
YES |
1 |
|
NO |
2 |
|
REFUSED |
-1 |
|
DON'T KNOW |
-2 |
|
SOURCE |
High School Longitudinal Study of 2009, First Follow-Up Questionnaire |
LU08000/(CHILD_LANGUAGE). What language do you usually speak to {the child/children} in your home?
Label |
Code |
Go To |
ENGLISH |
1 |
NONENGLISH_FREQ |
SPANISH |
2 |
NONENGLISH_FREQ |
ARABIC |
3 |
NONENGLISH_FREQ |
BENGALI |
4 |
NONENGLISH_FREQ |
CHINESE (INCLUDING MANDARIN, CANTONESE) |
5 |
NONENGLISH_FREQ |
FARSI (PERSIAN) |
6 |
NONENGLISH_FREQ |
FRENCH |
7 |
NONENGLISH_FREQ |
FRENCH CREOLE |
8 |
NONENGLISH_FREQ |
GERMAN |
9 |
NONENGLISH_FREQ |
GREEK |
10 |
NONENGLISH_FREQ |
HINDI |
11 |
NONENGLISH_FREQ |
ITALIAN |
12 |
NONENGLISH_FREQ |
KOREAN |
13 |
NONENGLISH_FREQ |
POLISH |
14 |
NONENGLISH_FREQ |
PORTUGUESE |
15 |
NONENGLISH_FREQ |
PUNJABI |
16 |
NONENGLISH_FREQ |
RUSSIAN |
17 |
NONENGLISH_FREQ |
TAGALOG |
18 |
NONENGLISH_FREQ |
VIETNAMESE |
19 |
NONENGLISH_FREQ |
URDU |
20 |
NONENGLISH_FREQ |
SIGN LANGUAGE |
21 |
NONENGLISH_FREQ |
OTHER |
-5 |
|
REFUSED |
-1 |
LANG_CHILD_SPEAK |
DON’T KNOW |
-2 |
LANG_CHILD_SPEAK |
SOURCE |
High School Longitudinal Study (HSLS) of 2009, First Follow-Up Questionnaire (modified) |
LU09000/(CHILD_LANGUAGE_OTH). SPECIFY: ___________________________________________
SOURCE |
High School Longitudinal Study (HSLS) of 2009, First Follow-Up Questionnaire (modified) |
LU10000/(NONENGLISH_FREQ). How often do you use a language other than English when speaking to {the child/the children}? Would you say…
INTERVIEWER INSTRUCTIONS |
|
Label |
Code |
Go To |
Never |
1 |
|
Sometimes |
2 |
|
Often |
3 |
|
Very often |
4 |
|
REFUSED |
-1 |
|
DON’T KNOW |
-2 |
|
SOURCE |
Early Childhood Longitudinal Program, Birth Cohort 9-Month Parent Interview (modified) |
LU11000/(LANG_CHILD_SPEAK). What language does {the child/children} usually speak to you in your home?
Label |
Code |
Go To |
ENGLISH |
1 |
TIME_STAMP_LU_ET |
SPANISH |
2 |
OTHER_LANG_FREQ |
ARABIC |
3 |
OTHER_LANG_FREQ |
BENGALI |
4 |
OTHER_LANG_FREQ |
CHINESE (INCLUDING MANDARIN, CANTONESE) |
5 |
OTHER_LANG_FREQ |
FARSI (PERSIAN) |
6 |
OTHER_LANG_FREQ |
FRENCH |
7 |
OTHER_LANG_FREQ |
FRENCH CREOLE |
8 |
OTHER_LANG_FREQ |
GERMAN |
9 |
OTHER_LANG_FREQ |
GREEK |
10 |
OTHER_LANG_FREQ |
HINDI |
11 |
OTHER_LANG_FREQ |
ITALIAN |
12 |
OTHER_LANG_FREQ |
KOREAN |
13 |
OTHER_LANG_FREQ |
POLISH |
14 |
OTHER_LANG_FREQ |
PORTUGUESE |
15 |
OTHER_LANG_FREQ |
PUNJABI |
16 |
OTHER_LANG_FREQ |
RUSSIAN |
17 |
OTHER_LANG_FREQ |
TAGALOG |
18 |
OTHER_LANG_FREQ |
VIETNAMESE |
19 |
OTHER_LANG_FREQ |
URDU |
20 |
OTHER_LANG_FREQ |
SIGN LANGUAGE |
21 |
OTHER_LANG_FREQ |
OTHER |
-5 |
|
REFUSED |
-1 |
TIME_STAMP_LU_ET |
DON’T KNOW |
2 |
TIME_STAMP_LU_ET |
SOURCE |
High School Longitudinal Study (HSLS) of 2009, First Follow-Up Questionnaire (modified) |
LU12000/(LANG_CHILD_SPEAK_OTH). SPECIFY: ____________________________________________
SOURCE |
High School Longitudinal Study (HSLS) of 2009, First Follow-Up Questionnaire (modified) |
LU13000/(OTHER_LANG_FREQ). How often does {the child/children} use this language when speaking to you? Would you say…
INTERVIEWER INSTRUCTIONS |
|
Label |
Code |
Go To |
Rarely |
1 |
|
Sometimes |
2 |
|
Often |
3 |
|
Very often |
4 |
|
All the time |
5 |
|
REFUSED |
-1 |
|
DON’T KNOW |
-2 |
|
SOURCE |
New |
(TIME_STAMP_LU_ET).
PROGRAMMER INSTRUCTIONS |
|
Public reporting burden for this collection of information is estimated to average 3 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593*). Do not return the completed form to this address.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Modified | 0000-00-00 |
File Created | 2021-01-27 |