40.2 Survey

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Noise Measurement Set-Up Instrument, Phase 2g

OMB Specification

Noise Measurement Set-Up Instrument

Event Category:	Time-Based
Event:	36M, 60M
Administration:	N/A
Instrument Target:	Child's Primary Residence
Instrument Respondent:	Primary Caregiver
Domain:	Environmental
Document Category:	Sample Collection
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.

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Noise Measurement Set-Up Instrument

TABLE OF CONTENTS

GENERAL PROGRAMMER INSTRUCTIONS: 1

NOISE MONITOR SET-UP 3

NOISE MONITOR MAILING INSTRUCTIONS 9

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Noise Measurement Set-Up Instrument

GENERAL PROGRAMMER INSTRUCTIONS:

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	Limit text to 255 characters
FIRST NAME AND LAST NAME	30	CHARACTER	Limit text to 30 characters
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	DISPLAY AS MM/DD/YYYY STORE AS YYYY-MM-DD HARD EDITS: 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	HARD EDITS: 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.

NOISE MONITOR SET-UP

(TIME_STAMP_NMS_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

• PRELOAD DWELLING_UNIT_ID FOR THE DWELLING UNIT

• PRELOAD PARTICIPANT ID (P_ID) FOR CHILD AND RESPONDENT ID (R_P_ID) FOR CAREGIVER

• PRELOAD MULT_CHILD AND CHILD_NUM (IF MULT_CHILD = 1), FROM PVST INSTRUMENT.

• IF MULT_CHILD  = 1, PRELOAD CHILD_QNUM

NMS01000/(STAFF_ID). ENTER STAFF ID

_______________________________________

STAFF ID

NMS02000. NOISE BROCHURE DISTRIBUTION

DATA COLLECTOR INSTRUCTIONS

• DISTRIBUTE THE NOISE BROCHURE IN ACCORDANCE WITH THE ENVIRONMENTAL NOISE MEASUREMENT SOP.

NMS03000/(NOISE_MEASURE_OKAY). We would like to measure noise in your home.  Is that okay?

Label	Code	Go To
YES	1	OUTDOOR_NOISE_SOURCE
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

New

NMS04000/(NOISE_REFUSE). RECORD THE REASON FOR REFUSAL IF GIVEN.

Label	Code	Go To
NONE GIVEN	1	MON_SETUP_COMMENTS
NO ONE WILL BE AT HOME	2	MON_SETUP_COMMENTS
NOT INTERESTED IN NOISE MONITORING	3	MON_SETUP_COMMENTS
DO NOT WANT EQUIPMENT LEFT IN THE HOME	4	MON_SETUP_COMMENTS
OTHER	-5

NMS05000/(NOISE_REFUSE_OTH). SPECIFY:  _______________________________________

SOURCE

New

PROGRAMMER INSTRUCTIONS

GO TO MON_SETUP_COMMENTS

NMS06000/(OUTDOOR_NOISE_SOURCE). Are there any of the following nearby?

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY.

Label	Code	Go To
Hospital	1
Fire station	2
Rescue squad station	3
Police station	4
Freeway/Interstate	5
Railroad tracks	6
Airport	7
Industries	8
Commercial/Retail/Shopping Centers	9
OTHER	-5
REFUSED	-1
DON'T KNOW	-2

SOURCE

New

PROGRAMMER INSTRUCTIONS

• IF OUTDOOR_NOISE_SOURCE  =  ANY COMBINATION OF 1 THROUGH 9, GO TO NMS08000.

• IF OUTDOOR_NOISE_SOURCE  =  -5, OR ANY COMBINATION OF 1 THROUGH 9 AND -5, GO TO OUTDOOR_NOISE_SOURCE_OTH.

• IF OUTDOOR_NOISE_SOURCE  =  -1 OR -2, DO NOT ALLOW SELECTION OF ANY OTHER RESPONSE AND GO TO NMS08000.

NMS07000/(OUTDOOR_NOISE_SOURCE_OTH). SPECIFY:  _________________________________________________

NMS08000. NOISE MONITOR SET UP INSTRUCTIONS:

DATA COLLECTOR INSTRUCTIONS

• SET UP THE NOISE MONITOR IN ACCORDANCE WITH THE ENVIRONMENTAL NOISE MEASUREMENT SOP.

NMS09000/(MON_SETUP). WERE YOU ABLE TO SET UP THE NOISE MONITOR?

Label	Code	Go To
YES	1	SAMPLE_ID
NO	2

NMS10000/(MON_NOT_SETUP). WHY WERE YOU NOT ABLE TO SET UP THE NOISE MONITOR?

Label	Code	Go To
SUPPLIES/EQUIPMENT NOT AVAILABLE	1	MON_SETUP_COMMENTS
EQUIPMENT FAILURE	2	NMS12000
RAN OUT OF TIME	3	MON_SETUP_COMMENTS
REFUSAL	4	MON_SETUP_COMMENTS
OTHER	-5

NMS11000/(MON_NOT_SETUP_OTH). SPECIFY:  _________________________________

PROGRAMMER INSTRUCTIONS

• GO TO MON_SETUP_COMMENTS

NMS12000. NOISE MONITOR FAILURE

DATA COLLECTOR INSTRUCTIONS

• IF MON_NOT_SETUP  = 2, COMPLETE THE ENVIRONMENTAL EQUIPMENT PROBLEM LOG.

PROGRAMMER INSTRUCTIONS

• GO TO MON_SETUP_COMMENTS

NMS13000/(SAMPLE_ID). ENVIRONMENTAL NOISE MEASUREMENT SAMPLE ID

 

| E |___|___|___|___|___|___|___| N E 0 1

NOISE-ENVIRONMENTAL ID

PROGRAMMER INSTRUCTIONS

• ID MUST BE FORMATTED WITH TWO ALPHA 7 NUMERIC DASH NE01.

NMS14000/(EQUIP_ID). NOISE MONITOR ID

_________________________________________

DATA COLLECTOR INSTRUCTIONS

• ENTER THE ID OF THE NOISE MONITOR

NMS15000. MONITOR SET-UP DATE

(MON_SET_DATE_MM) MONTH:  |____|____|

                  M      M

(MON_SET_DATE_DD) DAY:    |____|____|

               D       D

(MON_SET_DATE_YYYY) YEAR:    |____|____|____|____|

                 Y       Y       Y      Y

PROGRAMMER INSTRUCTIONS

• DISPLAY HARD EDIT IF MM, DD OR YYYY ARE OUTSIDE CRITERIA DEFINED IN GENERAL PROGRAMMER INSTRUCTIONS.

NMS16000. MONITOR SET-UP TIME

(MON_SET_TIME) |____|____|  :  |____|____|

    H      H              M     M

(MON_SET_TIME_UNIT)

Label	Code	Go To
AM	1
PM	2

NMS18000/(MON_SETUP_ROOM). IN WHICH ROOM WAS THE NOISE MONITOR SET UP?

Label	Code	Go To
COMMON LIVING AREA	1	MON_SETUP_DISTANCE
CHILD'S BEDROOM	2	CHILD_BEDROOM_SHARED
ADULT BEDROOM	3	MON_SETUP_DISTANCE
OTHER	-5

NMS19000/(MON_SETUP_ROOM_OTH). SPECIFY:  ______________________________________

NMS20000/(CHILD_BEDROOM_SHARED). DOES THE CHILD SHARE THE BEDROOM WITH OTHER FAMILY MEMBER(S)?

Label	Code	Go To
YES	1
NO	2
DON'T KNOW	-2

NMS21000/(MON_SETUP_DISTANCE). RECORD THE DISTANCE OF THE NOISE MONITOR FROM THE WALL.

Label	Code	Go To
LESS THAN 2 FT FROM WALL	1
MORE THAN OR EQUAL TO 2 FEET FROM WALL	2

NMS22000/(MON_SETUP_HEIGHT). RECORD THE HEIGHT OF THE NOISE MONITOR FROM THE FLOOR.

Label	Code	Go To
LESS THAN 3 FT FROM FLOOR	1
MORE THAN OR EQUAL TO 3 FT FROM FLOOR	2

NMS23000/(MON_SETUP_ROOM_WINDOW). RECORD WHERE THE WINDOWS IN THE SET-UP ROOM FACE.

DATA COLLECTOR INSTRUCTIONS

• SELECT ALL THAT APPLY

Label	Code	Go To
NO WINDOW	1
STREET WITH LIGHT TRAFFIC	2
STREET WITH HEAVY TRAFFIC	3
FREEWAY OR HIGHWAY	4
YARD, GARDEN, GREENSPACE, COURTYARD	5
OTHER	-5

PROGRAMMER INSTRUCTIONS

• IF MON_SETUP_ROOM_WINDOW  =  1, DO NOT ALLOW SELECTION OF ANY OTHER RESPONSE AND GO TO NEIGHBORHOOD_TYPE.

• IF MON_SETUP_ROOM_WINDOW  =  ANY COMBINATION OF 2 THROUGH 5, GO TO MON_SETUP_ROOM_WINDOW_OPEN.

• IF MON_SETUP_ROOM_WINDOW  =  -5 OR ANY COMBINATION OF 2 THROUGH 5 AND -5, GO TO MON_SETUP_ROOM_WINDOW_OTH

NMS24000/(MON_SETUP_ROOM_WINDOW_OTH). SPECIFY:  ______________________________________

NMS25000/(MON_SETUP_ROOM_WINDOW_OPEN). RECORD IF WINDOW(S) IN THE SET-UP ROOM ARE OPEN.

Label	Code	Go To
YES	1
NO	2

NMS26000/(NEIGHBORHOOD_TYPE). RECORD THE TYPE OF NEIGHBORHOOD.

DATA COLLECTOR INSTRUCTIONS

•   RECORD THE TYPE OF NEIGHBORHOOD BASED ON THE HOUSING CHARACTERISTICS WITHIN ONE BLOCK FROM THE PARTICIPANT'S HOME.

Label	Code	Go To
RURAL - FEW OR NO OTHER NEARBY HOMES WITHIN HALF MILE RADIUS	1	MON_SETUP_COMMENTS
SUBURB - MOSTLY DETACHED SINGLE FAMILY HOMES	2	MON_SETUP_COMMENTS
SUBURB - MOSTLY MULTI-RESIDENCE BUILDINGS	3	MON_SETUP_COMMENTS
SUBURB - MIXED RESIDENTIAL/COMMERCIAL	4	MON_SETUP_COMMENTS
URBAN - MOSTLY DETACHED SINGLE FAMILY HOMES	5	MON_SETUP_COMMENTS
URBAN - MOSTLY MULTI-RESIDENCE BUILDINGS	6	MON_SETUP_COMMENTS
URBAN - MIXED RESIDENTIAL/COMMERCIAL	7	MON_SETUP_COMMENTS
URBAN - MIXED RESIDENTIAL/INDUSTRIAL	8	MON_SETUP_COMMENTS
URBAN - COMMERCIAL - MORE STORES THAN RESIDENTIAL UNITS	9	MON_SETUP_COMMENTS
MOSTLY MANUFACTURED/MOBILE HOMES	10	MON_SETUP_COMMENTS
OTHER	-5
DON'T KNOW	-2	MON_SETUP_COMMENTS

NMS27000/(NEIGHBORHOOD_TYPE_OTH). SPECIFY:  ________________________________________

NMS28000/(MON_SETUP_COMMENTS). RECORD ANY COMMENTS ABOUT THE NOISE MONITOR SET UP.

COMMENTS:  _____________________________________________________________________

(TIME_STAMP_NMS_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

• IF NOISE_MEASURE_OKAY  =  2, -1 OR -2, OR IF MON_SETUP  = 2, GO TO TIME_STAMP_NMM_ET.

• OTHERWISE, GO TO TIME_STAMP_NMM_ST.

NOISE MONITOR MAILING INSTRUCTIONS

(TIME_STAMP_NMM_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

NMM01000/(MON_PARTICIPANT_MAILBACK). AT THIS VISIT, WILL THE RESPONDENT BE ASKED TO MAIL BACK THE NOISE MONITOR?

DATA COLLECTOR INSTRUCTIONS

• CHECK THE SITE OFFICE VISIT SPECIFICATIONS.

Label	Code	Go To
YES	1
NO	2	TIME_STAMP_NMM_ET

NMM01100. NOISE SAQ AND SHIPPING INSTRUCTION DISTRIBUTION

DATA COLLECTOR INSTRUCTIONS

• DISTRIBUTE THE NOISE MEASUREMENT SAQ AND NOISE MONITOR SHIPPING INSTRUCTIONS IN ACCORDANCE WITH THE NOISE MEASUREMENT SOP.

NMM02000/(PARTICIPANT_MAILBACK_OKAY). At the end of the noise monitoring period, we would like you to send the noise monitor back to us.  We have a kit with a pre-paid shipper to help you with that.  Is that okay?

Label	Code	Go To
YES	1	SHIPMENT_TRACKING_NUM
NO	2
REFUSED	-1
DON'T KNOW	-2

SOURCE

New

NMM03000/(PARTICIPANT_MAILBACK_REF). RECORD REASON FOR REFUSAL.

Label	Code	Go To
NONE GIVEN	1	KIT_DISTRIB_COMMENTS
WANT DATA COLLECTOR TO PICK UP	2	KIT_DISTRIB_COMMENTS
TOO MUCH TROUBLE TO MAIL STUFF BACK	3	KIT_DISTRIB_COMMENTS
OTHER	-5

NMM04000/(PARTICIPANT_MAILBACK_REF_OTH). SPECIFY:  _____________________________________

SOURCE

New

PROGRAMMER INSTRUCTIONS

• GO TO KIT_DISTRIB_COMMENTS.

NMM05000/(SHIPMENT_TRACKING_NUM). TRACKING NUMBER: _________________________________________

DATA COLLECTOR INSTRUCTIONS

• DISTRIBUTE THE NOISE MONITOR SHIPPING KIT IN ACCORDANCE WITH THE ENVIRONMENTAL NOISE MEASUREMENT SOP.

• ENTER THE SHIPMENT TRACKING NUMBER THAT IS PRINTED ON THE SHIPPING LABEL INCLUDED IN THE KIT.

NMM06000. RECORD THE EXPECTED SHIPMENT DATE FOR THE NOISE MONITOR:

(TARGET_SHIP_DATE_MM) MONTH:  |____|____|

                  M      M

(TARGET_SHIP_DATE_DD) DAY:    |____|____|

               D      D

(TARGET_SHIP_DATE_YYYY) YEAR:  |____|____|____|____|

               Y       Y      Y       Y

PROGRAMMER INSTRUCTIONS

• DISPLAY HARD EDIT IF MM, DD, OR YYYY ARE OUTSIDE CRITERIA DEFINED IN GENERAL PROGRAMMER INSTRUCTIONS.

NMM07000/(KIT_DISTRIB_COMMENTS). RECORD ANY COMMENTS ABOUT DISTRIBUTING THE NOISE MONITOR SHIPPING KIT.

COMMENTS:   _____________________________________________________

(TIME_STAMP_NMM_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

Public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for 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.