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pdfAttachment 4a - Main Questionnaire Household Composition and Family Section
Form Approved OMB Number 0920-0214 Exp. Date: xx/xx/20xx
Assurance of confidentiality – We take your privacy very seriously. All information that relates to or describes
identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes.
NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of
the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C.
242m(d)) and the Confidential Information Protection and Statistical Efficiency Act of 2002 (CIPSEA, Title 5 of Public
Law 107-347). In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is
subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY
identifiable information about you. In addition, NCHS complies with the Federal Cybersecurity Enhancement Act of
2015 (6 U.S.C. §§ 151 & 151 note). This law requires the federal government to protect federal computer networks
by using computer security programs to identify cybersecurity risks like hacking, internet attacks, and other security
weaknesses. If information sent through government networks triggers a cyber threat indicator, the information may
be intercepted and reviewed for cyber threats by computer network experts working for, or on behalf of, the
government.
Notice – Public reporting burden of this collection of information is estimated to average 23 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; 1600 Clifton Road, MS
D-74, Atlanta, GA 30333. ATTN: PRA (0920-0214).
2018 Q1 NHIS Instrument Spec Report
Section name: Coverage
Module
02
Section Name
Coverage
Part
Question ID
COV.010
Variable Name
VERADD
Universe
(frt.START=1 and POS2=0) or (frt.TYPEABC IN (1,2) when LIVQRT = empty)
Universe-text
All parent cases being interviewed or all Type A or Type B noninterview cases where
type of living quarters is not answered
Question Text
? [F1]
I have your address listed as:
Address: [Fill: HNO HNOSUF STRNAME]
[Fill: UNITDES]
[Fill: GQUNITINFO]
[Fill: NONCITYADD]
[Fill: PHYSDES]
[Fill: PO, ST ZIP5 - ZIP4]
[Fill: BLDGNAME]
Is that your exact address?
Answer Codes
Question Type
1. Yes, address is EXACTLY CORRECT as listed
2. Address is MOSTLY CORRECT, but needs some minor changes
3. INCORRECT ADDRESS - terminate interview and find correct address
Pick One - answer list pane
Field Pane Description
Verify address
Fill Instructions
Special Instructions <1,2> if MARK < Household reached (7), store Household reached (7) in MARK
<3> if MARK < Incorrect address (3), store Incorrect address (3) in MARK
Don't allow a Don't know or Refused
Skip Instructions
<1> if TYPEABC IN (1,2)
if I_SEGTYP =3
GOTO LOCATE
elseif I_SEGTYP IN (1,2)
if POS2 ne 0
GOTO LOCATE
elseif POS2 = 0
GOTO OTHLIVQ
endif
endif
else
GOTO MAILADD
endif
<2> store 1 in ADDRCHG, GOTO HNO
Wednesday, June 14, 2017
Page 1 of 79
<3> store Accessed instrument, no progress (202) in OUTCOME, Unreached
household (3) in MARK
if testing instrument (SURVTYPE = empty)
goto SHOFINAL
elseif training, systems test or production instrument (SURVTYPE = T,S,P)
goto exit the instrument
Hard Edits
Soft Edits
AssocHelp
H_VERADD
Module
02
Section Name
Coverage
Part
Question ID
COV.010_H
Variable Name
H_VERADD
Universe
Universe-text
Question Text
If the exact address is the same as the one displayed, enter 1.
If you are sure you are at the correct sample unit, but the address is not exactly the
same as displayed, or if a descriptive address is displayed, enter 2. Then, enter the
exact address on screen CHNGADD.
If you determine that you are not at the correct sample unit, enter 3, terminate the
interview, and find
the correct unit.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 2 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.020_01
Variable Name
HNO
Universe
VERADD = Address correct, but some additions/revisions (2)
Universe-text
Home address requires some corrections
Question Text
? [F1]
* Enter the correct house number or press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
House #
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with HNO.
Skip Instructions
GOTO HNOSUF
Hard Edits
Soft Edits
AssocHelp
H_CHNGADD
Wednesday, June 14, 2017
Page 3 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.020_02
Variable Name
HNOSUF
Universe
All from HNO
Universe-text
All from House Number
Question Text
? [F1]
* Enter the correct house number suffix or press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
House # suffix
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with HNOSUF.
Skip Instructions
GOTO STRNAME
Hard Edits
Soft Edits
AssocHelp
H_CHNGADD
Wednesday, June 14, 2017
Page 4 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.020_03
Variable Name
STRNAME
Universe
All from HNOSUF
Universe-text
All from House Number Suffix
Question Text
? [F1]
* Enter the correct street name or press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
Street name
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with STRNAME
Skip Instructions
GOTO UNITDES
Hard Edits
Soft Edits
AssocHelp
H_CHNGADD
Wednesday, June 14, 2017
Page 5 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.020_04
Variable Name
UNITDES
Universe
All from STRNAME
Universe-text
All from Street Name
Question Text
? [F1]
* Enter the correct unit designation or press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
Unit designation
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with UNITDES.
Skip Instructions
GOTO GQUNITINFO
Hard Edits
Soft Edits
AssocHelp
H_CHNGADD
Wednesday, June 14, 2017
Page 6 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.020_05
Variable Name
GQUNITINFO
Universe
All from UNITDES
Universe-text
All from Unit Designation
Question Text
? [F1]
* Enter the correct GQ unit description or press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
GQ unit description
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with GQUNITINFO.
Skip Instructions
GOTO NONCITYADD
Hard Edits
Soft Edits
AssocHelp
H_CHNGADD
Wednesday, June 14, 2017
Page 7 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.020_06
Variable Name
NONCITYADD
Universe
All from GQUNITINFO
Universe-text
All from GQ Unit Description
Question Text
? [F1]
* Enter the correct non city-style address, such as Rural Route and Box number, or
press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
Non-city style
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with NONCITYADD
Skip Instructions
GOTO PHYSDES
Hard Edits
Soft Edits
AssocHelp
H_CHNGADD
Wednesday, June 14, 2017
Page 8 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.020_07
Variable Name
PHYSDES
Universe
All from NONCITYADD
Universe-text
All from Non-city style address
Question Text
? [F1]
* Enter the correct physical description or press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
Description
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with PHYDES.
Skip Instructions
GOTO PO
Hard Edits
Soft Edits
AssocHelp
H_CHNGADD
Wednesday, June 14, 2017
Page 9 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.020_08
Variable Name
PO
Universe
All from PHYSDES
Universe-text
All from Physical Description
Question Text
? [F1]
* Enter the correct city or press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
City
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with PO.
Skip Instructions
GOTO ST
Hard Edits
Soft Edits
AssocHelp
H_CHNGADD
Wednesday, June 14, 2017
Page 10 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.020_09
Variable Name
ST
Universe
All from PO
Universe-text
All from City
Question Text
? [F1]
* Select the correct state or press "ENTER" for same or no change.
Answer Codes
Question Type
Pick One - popup window
Field Pane Description
State
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with ST.
Skip Instructions
GOTO ZIP5
Hard Edits
Soft Edits
AssocHelp
H_CHNGADD
Wednesday, June 14, 2017
Page 11 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.020_10
Variable Name
ZIP5
Universe
All from ST
Universe-text
All from State
Question Text
? [F1]
* Enter the correct zip code or press "ENTER" for same or no change.
Answer Codes
Question Type
Integer
Field Pane Description
Zip 5
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with ZIP5.
Skip Instructions
<01000-99996, empty> GOTO ZIP4
Hard Edits
Soft Edits
AssocHelp
H_CHNGADD
Wednesday, June 14, 2017
Page 12 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.020_11
Variable Name
ZIP4
Universe
All from ZIP5
Universe-text
All from Zip 5
Question Text
? [F1]
* Enter the correct zip 4 or press "ENTER" for same or no change.
Answer Codes
Question Type
Integer
Field Pane Description
Zip 4
Fill Instructions
Special Instructions Prefill the field pane with ZIP4.
Skip Instructions
<0000-9996, Refused, Don't know, empty> GOTO BLDGNAME
Hard Edits
Soft Edits
AssocHelp
H_CHNGADD
Wednesday, June 14, 2017
Page 13 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.020_12
Variable Name
BLDGNAME
Universe
All from ZIP4
Universe-text
All from Zip 4
Question Text
? [F1]
* Enter the building name or press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
Build name
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with BLDGNAME.
Skip Instructions
<100 characters, empty>
if TYPEABC IN (1,2)
if I_SEGTYP =3
GOTO LOCATE
elseif I_SEGTYP IN (1,2)
if POS2 ne 0
GOTO LOCATE
elseif POS2 = 0
GOTO OTHLIVQ
endif
endif
else
GOTO MAILADD
endif
Hard Edits
Soft Edits
AssocHelp
H_CHNGADD
Wednesday, June 14, 2017
Page 14 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.020_H
Variable Name
H_CHNGADD
Universe
Universe-text
Question Text
Enter additions or corrections to the address as necessary. Press "Enter" if the
displayed information is correct.
For example, suppose that the address contains the unit designation "Apartment 31B".
If this is not correct, enter the correct information in the space directly under the
displayed unit designation. If the unit designation is correct, press "Enter".
If the only information displayed is a description of the housing unit (and/or its location),
and an exact address is available, enter the exact address as appropriate. If no exact
address exists, leave the description, unless changes need to be made. Do not enter
the mailing address.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 15 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.030
Variable Name
MAILADD
Universe
frt.START = 1 and (VERADD IN (1,2) or POS2 ne 0)
Universe-text
All cases being interviewed with a correct address or an address that required only a
few revisions or all family spawn cases being interviewed
Question Text
[Fill 1:]
Address: [Fill: HNO HNOSUF STRNAME]
[Fill: UNITDES]
[Fill: GQUNITINFO]
[Fill: NONCITYADD]
[Fill: PO, ST ZIP5 - ZIP4]
Answer Codes
Question Type
1. Yes
2. No
Don't Know
Refused
Yes/No
Field Pane Description
Fill Instructions
Mailing address
If POS2 ne '0'
[fill 1: What is your exact mailing address?]
else if POS2 ='0'
[fill 1: Is this also your mailing address?]
endif
Special Instructions store HNO in MAILHNO, HNOSUF in MAILHNOSUF, STRNAME in MAILSTRNAME,
UNITDES in MAILUNITDES, GQUNITINFO in MAILGQUNITINFO, NONCITYADD in
MAILNONCITYADD, PO in MAILPO, ST in MAILST, ZIP5 in MAILZIP5, ZIP4 in
MAILZIP4
if POS2 or POS3 ne 0, store Household Reached (7) in MARK
<1,Refused,Don't know> store 1 in MFLAG
<2> store 2 in MFLAG
Skip Instructions
<1,R,D>
if POS2 ne 0 and FRT.START = 1
GOTO TELENUM
elseif I_SEGTYP =3
GOTO LOCATE
elseif I_SEGTYP IN (1,2)
if POS1 ne 0
GOTO LOCATE
elseif POS1 = 0 and POS 2 = 0
GOTO OTHLIVQ
endif
endif
<2> GOTO MAILHNO
Wednesday, June 14, 2017
Page 16 of 79
Hard Edits
Soft Edits
AssocHelp
Module
02
Section Name
Coverage
Part
Question ID
COV.040_01
Variable Name
MAILHNO
Universe
MAILADD = No (2)
Universe-text
Mailing address requires corrections
Question Text
? [F1]
* Enter the correct house number or press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
House #
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with HNO.
Skip Instructions
GOTO MAILHNOSUF
Hard Edits
Soft Edits
AssocHelp
H_CHNGMAIL
Wednesday, June 14, 2017
Page 17 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.040_02
Variable Name
MAILHNOSUF
Universe
all from MAILHNO
Universe-text
All from Mailing House Number
Question Text
? [F1]
* Enter the correct house number suffix or press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
House # suffix
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with HNOSUF.
Skip Instructions
GOTO MAILSTRNAME
Hard Edits
Soft Edits
AssocHelp
H_CHNGMAIL
Wednesday, June 14, 2017
Page 18 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.040_03
Variable Name
MAILSTRNAME
Universe
all from MAILHNOSUF
Universe-text
All from Mailing Housenumber Suffix
Question Text
? [F1]
* Enter the correct street name or press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
Street name
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with STRNAME.
Skip Instructions
GOTO MAILUNITDES
Hard Edits
Soft Edits
AssocHelp
H_CHNGMAIL
Wednesday, June 14, 2017
Page 19 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.040_04
Variable Name
MAILUNITDES
Universe
all from MAILSTRNAME
Universe-text
All from Mailing Street Name
Question Text
? [F1]
* Enter the correct unit designation or press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
Unit description
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with UNITDES
Skip Instructions
GOTO MAILGQUNITINFO
Hard Edits
Soft Edits
AssocHelp
H_CHNGMAIL
Wednesday, June 14, 2017
Page 20 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.040_05
Variable Name
MAILGQUNITINFO
Universe
all from MAILUNITDES
Universe-text
All from Mailing Unit Designation
Question Text
? [F1]
* Enter the correct GQ unit description or press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
GQ unit description
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with GQUNITINFO
Skip Instructions
GOTO MAILNONCITYADD
Hard Edits
Soft Edits
AssocHelp
H_CHNGMAIL
Wednesday, June 14, 2017
Page 21 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.040_06
Variable Name
MAILNONCITYADD
Universe
All from GQMAILUNITINFO
Universe-text
All from GQ Mailing Unit Description
Question Text
? [F1]
* Enter the correct non city-style address, such as Rural Route and Box number, or
press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
Non-city style address
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with NONCITYADD.
Skip Instructions
GOTO MAILPO
Hard Edits
Soft Edits
AssocHelp
H_CHNGMAIL
Wednesday, June 14, 2017
Page 22 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.040_07
Variable Name
MAILPO
Universe
All from MAILNONCITYADD
Universe-text
All from Mailing Non-city style address
Question Text
? [F1]
* Enter the correct city or press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
City
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with PO.
Skip Instructions
GOTO MAILST
Hard Edits
Soft Edits
AssocHelp
H_CHNGMAIL
Wednesday, June 14, 2017
Page 23 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.040_08
Variable Name
MAILST
Universe
all from MAILPO
Universe-text
All from Mailing City
Question Text
? [F1]
* Select the correct state or press "ENTER" for same or no change.
Answer Codes
Question Type
list of state abreviations
Pick One - popup window
Field Pane Description
State
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with ST.
Skip Instructions
GOTO MAILZIP5
Hard Edits
Soft Edits
AssocHelp
H_CHNGMAIL
Wednesday, June 14, 2017
Page 24 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.040_09
Variable Name
MAILZIP5
Universe
all from MAILST
Universe-text
All form Mailing State
Question Text
? [F1]
* Enter the correct zip code or press "ENTER" for same or no change.
Answer Codes
Question Type
Integer
Field Pane Description
Zip 5
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with ZIP5.
Skip Instructions
<01000-99996, empty> GOTO MAILZIP4
Hard Edits
Soft Edits
AssocHelp
H_CHNGMAIL
Wednesday, June 14, 2017
Page 25 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.040_10
Variable Name
MAILZIP4
Universe
all from MAILZIP5
Universe-text
All from Mailing Zip 5
Question Text
? [F1]
* Enter the correct zip 4 or press "ENTER" for same or no change.
Answer Codes
Question Type
Integer
Field Pane Description
Zip 4
Fill Instructions
Special Instructions Prefill the field pane with ZIP4.
Skip Instructions
<0000-9996, Refused, Don't know, empty>
if POS2 ne 0 and FRT.START = 1
GOTO TELENUM
elseif I_SEGTYP =3
GOTO LOCATE
elseif I_SEGTYP IN (1,2)
if POS1 ne 0
GOTO LOCATE
elseif POS1 = 0 and POS2 = 0
GOTO OTHLIVQ
endif
endif
Hard Edits
Soft Edits
AssocHelp
H_CHNGMAIL
Wednesday, June 14, 2017
Page 26 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.040_H
Variable Name
H_CHNGMAIL
Universe
Universe-text
Question Text
For parts of the mailing address that are exactly the same as displayed, press the
"ENTER" key. Otherwise, enter the mailing address as appropriate.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 27 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.070
Variable Name
OTHLIVQ
Universe
I_SEGTYP IN (1,2) and POS1 = 0 and POS2 = 0 and (frt.START = 1 or TYPEABC IN
(1,2))
Universe-text
Parent cases in area and unit segments and (being interviewed or a Type A or Type B
noninterview)
Question Text
Are there any other living quarters---either occupied or vacant---at this address?
Answer Codes
1. Yes
2. No
Question Type
Yes/No
Field Pane Description
Other Living Quarters
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Skip Instructions
<1> GOTO OTHADD_1
<2> GOTO LOCATE
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 28 of 79
Module
02
Section Name
Coverage
Part
1 of 9
Question ID
COV.110_1
Variable Name
OTHADD_1
Universe
OTHLIVQ = 1
Universe-text
From either the on property, in building, regular coverage or additional spawned
addresses screens, the FR answered yes to there being other units.
Question Text
? [F1]
1 of 9
* You are about to begin asking questions about one or more additional living
arrangements at this location to determine if they qualify as EXTRA UNITS!!!
* If you have accidentally reached this screen, PRESS "UP ARROW" to back up to the
previous screen and correct an earlier entry.
Parent address : [HNO] [HNOSUF]
[STRNAME]
[UNITDES]
[GQUNITINFO]
[NONCITYADD]
[BLDGNAME]
Answer Codes
Question Type
Enter 1 to Continue
Field Pane Description
Continue
Fill Instructions
Special Instructions START TABLE to collect the addresses for the additional units
Allow up to 26 extra units to be created
Don't allow a Don't know or Refused
All Blue Text
Skip Instructions
GOTO XHNO
Hard Edits
Soft Edits
AssocHelp
H_OTHADD
Wednesday, June 14, 2017
Page 29 of 79
Module
02
Section Name
Coverage
Part
2 of 9
Question ID
COV.110_2
Variable Name
XHNO
Universe
All from OTHADD_1
or
OTHADD_2 = 1
Universe-text
It's determined that there are extra units or when we loop for multiple extra units
Question Text
? [F1]
2 of 9
What is the exact address of this other living quarters?
* Enter House number:
* Press "ENTER" if no change is needed.
Parent address : [HNO] [HNOSUF]
[STRNAME]
[UNITDES]
[GQUNITINFO]
[NONCITYADD]
[BLDGNAME]
Answer Codes
Question Type
Text
Field Pane Description
House #
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Prefill the field pane with HNO.
Skip Instructions
GOTO XHNOSUF
Hard Edits
Soft Edits
AssocHelp
H_OTHADD
Wednesday, June 14, 2017
Page 30 of 79
Module
02
Section Name
Coverage
Part
3 of 9
Question ID
COV.110_3
Variable Name
XHNOSUF
Universe
All from XHNO
Universe-text
Question Text
? [F1]
3 of 9
* Enter House number suffix, if applicable:
* Press "ENTER" if no change is needed.
Parent address : [HNO] [HNOSUF]
[STRNAME]
[UNITDES]
[GQUNITINFO]
[NONCITYADD]
[BLDGNAME]
Answer Codes
Question Type
Text
Field Pane Description
House # suffix
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
All blue text
Prefill the field pane with HNOSUF.
Skip Instructions
GOTO XSTRNAME
Hard Edits
Soft Edits
AssocHelp
H_OTHADD
Wednesday, June 14, 2017
Page 31 of 79
Module
02
Section Name
Coverage
Part
4 of 9
Question ID
COV.110_4
Variable Name
XSTRNAME
Universe
All from XHNOSUF
Universe-text
Question Text
? [F1]
4 of 9
* Enter Street name:
* Press "ENTER" if no change is needed.
Parent address : [HNO] [HNOSUF]
[STRNAME]
[UNITDES]
[GQUNITINFO]
[NONCITYADD]
[BLDGNAME]
Answer Codes
Question Type
Text
Field Pane Description
Street name
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
All blue text
Prefill the field pane with STRNAME
Skip Instructions
GOTO XUNITDES
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H_OTHADD
Wednesday, June 14, 2017
Page 32 of 79
Module
02
Section Name
Coverage
Part
5 of 9
Question ID
COV.110_5
Variable Name
XUNITDES
Universe
All from XSTRNAME
Universe-text
Question Text
? [F1]
5 of 9
* Enter Unit designation:
* Press "ENTER" if no change is needed.
Parent address : [HNO] [HNOSUF]
[STRNAME]
[UNITDES]
[GQUNITINFO]
[NONCITYADD]
[BLDGNAME]
Answer Codes
Question Type
Text
Field Pane Description
Unit Description
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
All blue text
Prefill the field pane with UNITDES
Skip Instructions
GOTO XGQUNITINFO
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H_OTHADD
Wednesday, June 14, 2017
Page 33 of 79
Module
02
Section Name
Coverage
Part
6 of 9
Question ID
COV.110_6
Variable Name
XGQUNITINFO
Universe
All from XUNITDES
Universe-text
Question Text
? [F1]
6 of 9
* Enter GQ unit description:
* Press "ENTER" if no change is needed.
Parent address : [HNO] [HNOSUF]
[STRNAME]
[UNITDES]
[GQUNITINFO]
[NONCITYADD]
[BLDGNAME]
Answer Codes
Question Type
Text
Field Pane Description
GQ Unit Description
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
All blue text
Prefill the field pane with GQUNITINFO
Skip Instructions
GOTO XNONCITY
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H_OTHADD
Wednesday, June 14, 2017
Page 34 of 79
Module
02
Section Name
Coverage
Part
7 of 9
Question ID
COV.110_7
Variable Name
XNONCITY
Universe
All from XGQUNITINFO
Universe-text
Question Text
? [F1]
7 of 9
* Enter Non city-style address:
* Press "ENTER" if no change is needed.
Parent address : [HNO] [HNOSUF]
[STRNAME]
[UNITDES]
[GQUNITINFO]
[NONCITYADD]
[BLDGNAME]
Answer Codes
Question Type
Text
Field Pane Description
Non city
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
All blue text
Prefill the field pane with NONCITYADD
Skip Instructions
GOTO XBLDGNAME
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H_OTHADD
Wednesday, June 14, 2017
Page 35 of 79
Module
02
Section Name
Coverage
Part
8 of 9
Question ID
COV.110_8
Variable Name
XBLDGNAME
Universe
All from XNONCITY
Universe-text
Question Text
? [F1]
8 of 9
* Enter Building name:
* Press "ENTER" if no change is needed.
Parent address : [HNO] [HNOSUF]
[STRNAME]
[UNITDES]
[GQUNITINFO]
[NONCITYADD]
[BLDGNAME]
Answer Codes
Question Type
Text
Field Pane Description
Build name
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
All blue text
Prefill the field pane with BLDGNAME
Skip Instructions
GOTO OTHADD_2
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H_OTHADD
Wednesday, June 14, 2017
Page 36 of 79
Module
02
Section Name
Coverage
Part
9 of 9
Question ID
COV.110_9
Variable Name
OTHADD_2
Universe
All from XBLDGNAME
Universe-text
Question Text
? [F1]
9 of 9
Are there any OTHER living quarters, either occupied or vacant, at this original
address?
* Parent address : [HNO] [HNOSUF]
[STRNAME]
[UNITDES]
[GQUNITINFO]
[NONCITYADD]
[BLDGNAME]
Answer Codes
Question Type
1. Yes
2. No
Yes/No
Field Pane Description
Fill Instructions
Other Living Quarters
[fill: {fill the address of the parent case.}]
Special Instructions Don't allow a Don't know or Refused
Skip Instructions
<1> GOTO next available XHNO
<2> GOTO ADDLIV
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Wednesday, June 14, 2017
Page 37 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.110_H
Variable Name
H_OTHADD
Universe
Universe-text
Question Text
Enter the unit number and street address or the description of the first additional living
quarters on line 1. Enter the unit number and street address or the description of the
second additional unit on line 2 and so on.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 38 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.155
Variable Name
ADDLIV
Universe
OTHADD_2 = 2 and I_SEGTYP IN (1,2)
Universe-text
All newly spawned addresses from area type parents.
Question Text
*Additional living quarter is:
* [fill: XHNO XHNOSUF XSTRNAME]
* [fill: XUNITDES]
* [fill: XGQUNITINFO]
* [fill: PO, ST ZIP5-ZIP4]
* Non-city: [fill: XNONCITYADD]
* Building: [fill: XBLDGNAME]
*Are the additional living quarters in the same structure as the sample unit?
Answer Codes
Question Type
1. Yes
2. No
Yes/No
Field Pane Description
Fill Instructions
Within Same Structure
[fill: {fill the address of the extra unit from Table X being checked.}]
Special Instructions Don't allow a Don't Know or Refused.
All blue text.
Skip Instructions
<1> GOTO GRPQTR
<2> GOTO TABX_NO
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Wednesday, June 14, 2017
Page 39 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.160
Variable Name
GRPQTR
Universe
ADDLIV = 1
Universe-text
Spawned addresses, from a non-permit type parent, that are within the same structure.
Question Text
* Additional living quarter is:
* [fill: XHNO XHNOSUF XSTRNAME]
* [fill: XUNITDES]
* [fill: XGQUNITINFO]
* [fill: PO, ST ZIP5-ZIP4]
* Non-city: [fill: XNONCITYADD]
* Building: [fill: XBLDGNAME]
*Are the additional living quarters in a group quarters?
Answer Codes
Question Type
1. Yes
2. No
Yes/No
Field Pane Description
Fill Instructions
Group Quarter
[fill: {fill the address of the extra unit from Table X being checked.}]
Special Instructions Don't allow a Don't know or Refused
All blue text
Skip Instructions
<1> GOTO TABX_NO
<2> GOTO LIVESEP
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Wednesday, June 14, 2017
Page 40 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.170
Variable Name
LIVESEP
Universe
GRPQTR = 2
Universe-text
All newly spawned addresses
Question Text
* Additional living quarter is:
* [fill: XHNO XHNOSUF XSTRNAME]
* [fill: XUNITDES]
* [fill: XGQUNITINFO]
* [fill: PO, ST ZIP5-ZIP4]
* Non-city: [fill: XNONCITYADD]
* Building: [fill: XBLDGNAME]
Do the occupants or intended occupants of the additional living quarters live separately
from all other persons on the property?
Answer Codes
Question Type
1. Yes
2. No
Yes/No
Field Pane Description
Fill Instructions
GQ Verification
[fill: {fill the address of the extra unit from Table X being checked.}]
Special Instructions Don't allow a Don't know or Refused
Skip Instructions
<1> GOTO DIRACC
<2> GOTO TABX_NO
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Wednesday, June 14, 2017
Page 41 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.180
Variable Name
DIRACC
Universe
LIVESEP = 1
Universe-text
Occupants of the newly spawned address live seperately from the parent
Question Text
* Additional living quarter is:
* [fill: XHNO XHNOSUF XSTRNAME]
* [fill: XUNITDES]
* [fill: XGQUNITINFO]
* [fill: PO, ST ZIP5-ZIP4]
* Non-city: [fill: XNONCITYADD]
* Building: [fill: XBLDGNAME]
Do the occupants or intended occupants of the additional living quarters have direct
access from the outside or through a common hall?
Answer Codes
Question Type
1. Yes
2. No
Yes/No
Field Pane Description
Fill Instructions
Direct Access
[fill: {fill the address of the extra unit from Table X being checked.}]
Special Instructions Don't allow a Don't know or Refused
Skip Instructions
<1> GOTO TABXSPAWN
<2> GOTO TABX_NO
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Wednesday, June 14, 2017
Page 42 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.185
Variable Name
TABXSPAWN
Universe
DIRACC = 1
Universe-text
Question Text
* The other living quarters IS an EXTRA unit.
* Do not include members of this unit as members of the current unit.They MUST be
interviewed separately.
* Add the extra unit to your listing sheet according to the instructions in your Listing and
Coverage manual.
* [fill: XHNO XHNOSUF XSTRNAME]
* [fill: XUNITDES]
* [fill: XGQUNITINFO]
* [fill: PO, ST ZIP5-ZIP4]
* Non-city: [fill: XNONCITYADD]
* Building: [fill: XBLDGNAME]
* Enter 1 to continue.
Answer Codes
Question Type
1. Enter 1 to Continue
Enter 1 to Continue
Field Pane Description
Fill Instructions
Extra
[fill: {fill the address of the extra unit from Table X being checked.}]
Special Instructions Do not allow Refused or Don't know.
All blue text.
Store 1 (one) in GOOD_EXTRA
Skip Instructions
<1> if another extra unit address
goto ADDLIV
elseif no more extra unit addresses
if TOTEXTRA > 0
goto SEGLIST
endif
endif
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Wednesday, June 14, 2017
Page 43 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.190
Variable Name
TABX_NO
Universe
ADDLIV = 2 or GRPQTR = 1 or LIVSEP = 2 or DIRACC = 2
Universe-text
Question Text
* The other living quarters is NOT considered to be an EXTRA unit.
[fill 1:]
* [fill: XHNO XHNOSUF XSTRNAME]
* [fill: XUNITDES]
* [fill: XGQUNITINFO]
* [fill: PO, ST ZIP5-ZIP4]
* Non-city: [fill: XNONCITYADD]
* Building: [fill: XBLDGNAME]
* Enter 1 to continue.
Answer Codes
Question Type
1. Enter 1 to Continue
Enter 1 to Continue
Field Pane Description
Fill Instructions
Not extra
if ADDLIV = '2' (No) or GRPQTR = '1' (Yes)
[fill 1: * Do not interview.]
elseif LIVESEP = '2' (No) or DIRACC = '2' (No)
[fill 1: * Include the occupants of these living quarters with the original unit when
interviewing.]
endif
Special Instructions Do not allow Refused or Don't know.
All blue text.
Store 0 (zero) in GOOD_EXTRA
Skip Instructions
<1> if another extra unit address
goto ADDLIV
elseif no more extra unit addresses
if TOTEXTRA = 0
goto LOCATE
else
goto SEGLIST
endif
endif
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Wednesday, June 14, 2017
Page 44 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.195
Variable Name
SEGLIST
Universe
TOTEXTRA > 0 and (TABXSPAWN = 1 or TABX_NO = 1) and OTHADD_2 = 2
Universe-text
All
Question Text
* Interview the parent case.
* After interviewing the parent unit, you will receive instructions on what to do with the
EXTRA units in case management.
* You have identified [fill : TOTEXTRA] EXTRA [fill 1:].
* [fill 2:]
* Enter 1 to continue
Answer Codes
Question Type
1. Enter 1 to Continue
Enter 1 to Continue
Field Pane Description
Fill Instructions
Continue
if TOTEXTRA = 1
[fill 1: unit]
else
[fill 1: units]
endif
[fill 2: {fill the addresses of the extra units found in Table X where GOOD_EXTRA = 1.}
{Fill only with XHNO XHNOSUF XSTRNAME XUNITDES XGQUNITINFO}]
Special Instructions All blue text
Skip Instructions
<1> goto LOCATE
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Wednesday, June 14, 2017
Page 45 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.220
Variable Name
LOCATE
Universe
(frt.START = 1 and POS2 = 0) or TYPEABC IN (1,2)
Universe-text
All parent cases being interviewed or all Type A or Type B noninterview cases
Question Text
* Indicate whether this sample unit is located in group quarters or not.
Answer Codes
1. Not in Group Quarters
2. In Group Quarters
Question Type
Pick One - answer list pane
Field Pane Description
Group quarters
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Skip Instructions
<1> GOTO ACCESS
<2> GOTO LIVQRT
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Wednesday, June 14, 2017
Page 46 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.230
Variable Name
ACCESS
Universe
LOCATE = 1
Universe-text
The address isn't in a GQ
Question Text
? [F1]
*Ask if not apparent. Is access to the unit direct or through another unit?
Answer Codes
Question Type
1. Direct
2. Through another unit
Pick One - answer list pane
Field Pane Description
Direct access
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Skip Instructions
<1> GOTO LIVQRT
<2> GOTO MERGE
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H_ACCESS
Wednesday, June 14, 2017
Page 47 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.240_H
Variable Name
H_ACCESS
Universe
Universe-text
Question Text
Living quarters have direct access when the occupants can enter and leave the living
quarters directly from the outside of the structure or enter and leave from a common
hall or lobby that is used by occupants of more than one unit, and is not part of any
other persons living quarters.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 48 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.250
Variable Name
MERGE
Universe
ACCESS = 2
Universe-text
The address does not have direct access
Question Text
*This is not a separate housing unit and must be combined with the unit through which
access is gained. Apply the merged unit procedures in your listing and coverage
manual, then complete this item to indicate whether this sample unit should be retained
for interview or made a TYPE C noninterview.
Answer Codes
1. Retain/interview
2. Type C noninterview
Question Type
Pick One - answer list pane
Field Pane Description
Interview type
Fill Instructions
Special Instructions Don't allow a Don't Know or Refused.
If MERGE = 2
store '244' in OUTCOME
store '2' in frt.BYOBS
store 'P' in CLOSE4
goto RESPNME_1
Skip Instructions
<1> GOTO LIVQRT
<2> GOTO RESPNME_1
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Wednesday, June 14, 2017
Page 49 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.260
Variable Name
LIVQRT
Universe
LOCATE = 2 or ACCESS = 1 or MERGE =1
Universe-text
Question Text
? [F1]
[fill 1]
[fill 2]
Answer Codes
Question Type
[fill 3]
[fill 4]
Pick One - answer list pane
Field Pane Description
Fill Instructions
Housing type
if LOCATE = Not in Group Quarters (1), use fill 1 and fill 3. Else use fill 2 and fill 4
fill 1:
*Enter appropriate type of housing unit.
fill 2:
*Enter appropriate type of group quarters.
fill 3:
1. House, apartment, flat, condo
2. Housing unit in nontransient hotel, motel, etc
3. Housing unit--permanent in transient hotel, motel, etc
4. Housing unit in rooming house
5. Mobile home or trailer with no permanent rooms andded
6. Mobile home or trailer with one or more permanent rooms added
7. Housing unit not specified above
fill 4:
8. Quarters not housing unit in rooming or boarding house
9. Unit not permanent in transient hotel, motel, etc
10. Unoccupied site for mobile home, trailer, or tent
11. Student quarters in college dormitory
12. Group quarter unit not specified above
Special Instructions Don't allow a Don't Know or Refused.
Skip Instructions
<1-6, 8-11>
if frt.TYPEA1 = 1 (Refused)
if testing instrument (SURVTYPE = empty)
goto SHOFINAL
elseif training, systems test or production instrument (SURVTYPE = T,S,P)
goto OCDATE
elseif frt.TYPEA1 IN (2-5) or frt.TYPEB1 IN (1-9) or frt.TYPEC1 IN (1-8)
GOTO CLOSE4
else
Wednesday, June 14, 2017
Page 50 of 79
GOTO TELNUM
<7, 12> GOTO LIVQRT_SPECIFY
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H_LIVQRT
Wednesday, June 14, 2017
Page 51 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.260_H
Variable Name
H_LIVQRT
Universe
Universe-text
Question Text
Enter 1 for houses, apartments or flats, include such housing units as an apartment
over a garage or behind a house, janitor's quarters, and converted barns and sheds.
Enter 2 if the sample unit is a housing unit in a non-transient hotel, that is if 75% or
more of the rooms are occupied or intended for occupancy by permanent guests.
Enter 3 for separate living quarters in a transient hotel which are occupied or intended
for occupancy by permanent guests or resident employees. A hotel is transient if more
than 25% of the rooms are occupied by transient guests.
Enter 4 for sample units which meet the housing unit definition in a rooming house.
Rent paid in a rooming house usually covers linens and cleaning services, but not
meals.
Enter 5 for a mobile home or trailer which has no permanent rooms attached.
Enter 6 for a mobile home or trailer to which permanent rooms have been added.
Enter 7 for sample units which are housing units, but do not meet any specific housing
unit category. Include such things as tents, houseboats and railroad cars in the specify
space provided.
Enter 8 for a GQ unit in a rooming house, a combination rooming and boarding house
or a boarding house.
Enter 9 for units in a transient hotel or motel which are occupied or intended for
occupancy by transient guests, or which do not meet the housing unit definition.
Enter 10 for unoccupied sites for mobile homes, trailers, and tents.
Enter 11 for quarters for a student in a college dormitory.
Enter 12 for Group Quarters not otherwise specified and enter the type of group
quarters in the specify space provided.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Wednesday, June 14, 2017
Page 52 of 79
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Module
02
Section Name
Coverage
Part
Question ID
COV.270
Variable Name
LIVQRT_SPECIFY
Universe
LIVQRT = 7, 12
Universe-text
Unspecified Housing Unit types
Question Text
* Describe the HU or GQ unit.
Answer Codes
Question Type
Text
Field Pane Description
HU/GP description
Fill Instructions
Special Instructions Don't allow a Don't know or Refused
Skip Instructions
if frt.TYPEA1 = 1 (Refused)
if testing instrument (SURVTYPE = empty)
goto SHOFINAL
elseif training, systems test or production instrument (SURVTYPE = T,S,P)
goto OCDATE
elseif frt.TYPEA1 IN (2-5) or frt.TYPEB1 IN (1-9) or frt.TYPEC1 IN (1-8)
GOTO CLOSE4
else
GOTO TELNUM
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Wednesday, June 14, 2017
Page 53 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.280
Variable Name
CLOSE4
Universe
TYPEA1 IN (2-5) or TYPEB1 IN (1-9) or TYPEC1 IN (1-8) or MERGE = 2
Universe-text
Question Text
* If appropriate, read to respondent and press (P) to proceed. Otherwise, enter (N) for
not appropriate.
In case I or someone from my office needs to get in touch with you, we need your
name, address and telephone number.
Answer Codes
Question Type
P Proceed after reading
N Reading not appropriate
Refused
Pick One - answer list pane
Field Pane Description
Future contact
Fill Instructions
Special Instructions Do not allow an answer of 'don't know'
if TYPEABC IN (2,3)
if front.BYOBS = 1
store 'N' in CLOSE4
elseif front.BYOBS = 2
store 'P' in CLOSE4
endif
endif
if TYPEA1 IN (2-5)
ask CLOSE4
endif
N = not appropriate to collect contact person information
P = Proceed to collect contact person information
If MERGE = 2
store '244' in OUTCOME
store '2' in frt.BYOBS
store 'P' in CLOSE4
goto RESPNME_1
Skip Instructions
store '2' in front.BYOBS
goto RESPNME_1
store '1' in front.BYOBS
if testing instrument (SURVTYPE = empty)
goto SHOFINAL
elseif training, systems test or production instrument (SURVTYPE = T,S,P)
goto OCDATE
Wednesday, June 14, 2017
Page 54 of 79
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Module
02
Section Name
Coverage
Part
Question ID
COV.290_1
Variable Name
RESPNME_1
Universe
CLOSE4 = P
Universe-text
Respondent has agreed to provide future contact info
Question Text
? [F1]
[fill 1:]
What is your first name?
Answer Codes
Question Type
Text
Field Pane Description
Fill Instructions
First name
[fill 1:] = In case I or someone from my office needs to get in touch with you, we need
your name, address, and telephone number.
if OUTCOME = 221 - 248
display [fill 1:]
endif
Special Instructions Don't allow Don't Know
Skip Instructions
GOTO RESPNME_2
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H_RESPNME
Wednesday, June 14, 2017
Page 55 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.290_2
Variable Name
RESPNME_2
Universe
All from RESPNME_1
Universe-text
Question Text
? [F1]
What is your middle name?
Answer Codes
Question Type
Text
Field Pane Description
Middle name
Fill Instructions
Special Instructions Don't allow a Don't Know.
Skip Instructions
GOTO RESPNME_3
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H_RESPNME
Wednesday, June 14, 2017
Page 56 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.290_3
Variable Name
RESPNME_3
Universe
All from RESPNME_2
Universe-text
Question Text
? [F1]
What is your last name?
Answer Codes
Question Type
Text
Field Pane Description
Last name
Fill Instructions
Special Instructions Don't allow a Don't Know.
if RESPNME_1 = R
if RESPNME_3 ne R, make CP1NAME from RESPNME_3
else, store null in CP1NAME, endif
else, if RESPNME_3 ne R
make CP1NAME from RESPNME_1 < > RESPNME_3
else, make CP1NAME from RESPNME_1
Skip Instructions
GOTO CP1TITL
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H_RESPNME
Wednesday, June 14, 2017
Page 57 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.290_4
Variable Name
CP1TITL
Universe
all from RESPNME_3
Universe-text
Question Text
? [F1]
What is your full title?
* For the title, make entries like "Mailman", "Neighbor", etc.
Answer Codes
Question Type
Text
Field Pane Description
Title
Fill Instructions
Special Instructions Store 1 in CP1TYPE
Skip Instructions
GOTO RESPADD
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H_RESPNME
Wednesday, June 14, 2017
Page 58 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.290_H
Variable Name
H_RESPNME
Universe
Universe-text
Question Text
Verify that you have spelled the name correctly. If a middle name is given, enter the
initial. If no middle name or initial is given ask the respondent if there is a middle initial.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 59 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.300
Variable Name
RESPADD
Universe
All from CP1TITL
Universe-text
Question Text
* What is the respondent's exact address?
Address: [HNO] [HNOSUF] [STRNAME]
[UNITDES]
[PO] [ST] [ZIP5] - [ZIP4]
Answer Codes
Question Type
1. Address correct
2. Some additions/revisions needed
Text
Field Pane Description
Respondent address
Fill Instructions
Special Instructions Don't allow a Don't Know or Refused.
<1> store HNO HNOSUF STRNAME(join these three fields into one, using only
whitespace to seperate) in CP1ADD1, store UNITDES in CP1ADD2, store PO in
CP1PO, store ST in CP1ST, store ZIP5 in CP1ZIP5, store ZIP4 in CP1ZIP4,
Skip Instructions
<1> GOTO CP1PHON
<2> GOTO CP1ADD1
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Wednesday, June 14, 2017
Page 60 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.310_1
Variable Name
CP1ADD1
Universe
RESPADD = 2
Universe-text
Question Text
* Enter the House Number, House Number Suffix and Street Name or press "ENTER"
for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
House #, House # Suffix
Fill Instructions
Special Instructions Prefill the field pane with HNO, HNOSUF, STRNAME (join these three fields first, using
whitespace to seperate)
Don't allow a Don't know or Refused
Skip Instructions
GOTO CP1ADD2
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Wednesday, June 14, 2017
Page 61 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.310_2
Variable Name
CP1ADD2
Universe
All from CP1ADD1
Universe-text
Question Text
* Enter the Unit Description or press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
Unit description
Fill Instructions
Special Instructions Prefill the field pane with UNITDES
Don't allow a Don't know or Refused
Skip Instructions
GOTO CP1PO
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Wednesday, June 14, 2017
Page 62 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.310_3
Variable Name
CP1PO
Universe
All from CP1ADD2
Universe-text
Question Text
* Enter the City or press "ENTER" for same or no change.
Answer Codes
Question Type
Text
Field Pane Description
City
Fill Instructions
Special Instructions Prefill the field pane with PO
Don't allow a Don't know or Refused
Skip Instructions
GOTO CP1ST
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Wednesday, June 14, 2017
Page 63 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.310_4
Variable Name
CP1ST
Universe
All from CP1PO
Universe-text
Question Text
* Enter the State or press "ENTER" for the same or no change.
Answer Codes
Question Type
Pick One - popup window
Field Pane Description
State
Fill Instructions
Special Instructions Prefill the field pane with ST
Don't allow a Don't know or Refused
Skip Instructions
GOTO CP1ZIP5
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Wednesday, June 14, 2017
Page 64 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.310_5
Variable Name
CP1ZIP5
Universe
All from CP1ST
Universe-text
Question Text
* Enter the zip code or press "ENTER" for the same or no change.
Answer Codes
Question Type
Integer
Field Pane Description
Zip 5
Fill Instructions
Special Instructions Prefill the field pane with ZIP 5
Skip Instructions
<01000-99996, Refused, Don't know, empty> GOTO CP1ZIP4
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Wednesday, June 14, 2017
Page 65 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.310_6
Variable Name
CP1ZIP4
Universe
All from CP1ZIP5
Universe-text
Question Text
* Enter the Zip 4 or press "ENTER" for the same or no change.
Answer Codes
Question Type
Integer
Field Pane Description
Zip 4
Fill Instructions
Special Instructions Prefill the field pane with ZIP4
Skip Instructions
<0000-9996, Refused, Don't know, empty> GOTO CP1PHON
Hard Edits
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Wednesday, June 14, 2017
Page 66 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.320_1
Variable Name
CP1PHON
Universe
All from CP1ZIP4
or
RESPADD = 1
Universe-text
Question Text
* Enter the respondent's phone number or press "ENTER" for same or no change. If
no phone exists, enter "N".
[fill TELENUM]
Answer Codes
Question Type
Integer
Field Pane Description
Contact person phone
Fill Instructions
Special Instructions Use standard telephone field format <( ) - >
Skip Instructions
<2000000000-9999999996> GOTO CP1EXT
GOTO OCDATE (Back Section)
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Wednesday, June 14, 2017
Page 67 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.320_2
Variable Name
CP1EXT
Universe
CP1PHON ne R, D, N
Universe-text
Question Text
* Enter the extension or press "ENTER" to leave empty.
Answer Codes
Question Type
Integer
Field Pane Description
Extension
Fill Instructions
Special Instructions
Skip Instructions
<0-9996, Refused, Don't know, empty> GOTO OCDATE (Back Section)
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Wednesday, June 14, 2017
Page 68 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.330
Variable Name
TELENUM
Universe
[POS2 ne 0 and START = Proceed (1)]
or
[LIVQRT = 1-12 and START = Proceed (1)]
Universe-text
Question Text
?[F1]
What is the telephone number here, beginning with the area code?
* Enter the area code and the number, or enter "N" if no phone.
* Include any phone number (land-line or cell).
Answer Codes
Question Type
Integer
Field Pane Description
Telephone
Fill Instructions
Special Instructions Use standard telephone field format <( ) - >
If PHONENUM is ‘empty’ or has an incomplete or invalid phone number and
TELENUM is RF, DK, N, or ‘empty’
Do not update PHONENUM with TELENUM
If PHONENUM is ‘empty’ or has an incomplete or invalid phone number and
TELENUM has a valid phone number
Update PHONENUM with TELENUM
If PHONENUM has a valid phone number and it is not equal to TELENUM and
RCIFLAG ne '1'
Update TELENUM with PHONENUM
If TELENUM is RF, DK, N, or ‘empty’ and PHONENUM is ‘empty’ or has an incomplete
or invalid phone number
Do not update TELENUM with PHONENUM
If TELENUM is RF, DK, N, or ‘empty’ and PHONENUM has a valid phone number and
RCIFLAG ne '1'
Update TELENUM with PHONENUM
If TELENUM has a valid phone number and it is not equal to PHONENUM
Update PHONENUM with TELENUM
Do not update any variables from TELECHG
Skip Instructions
<2000000000 - 9999999996, D, R> store in HPHONE1, goto CURWRK
<0-1999999999> GOTO ERR_TELENUM
goto TELCEL
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Page 69 of 79
Hard Edits
ERR_TELENUM
* Enter the entire telephone number.
* Please correct.
Soft Edits
AssocHelp
H_TELENUM
Module
02
Section Name
Coverage
Part
Question ID
COV.330_H
Variable Name
H_TELENUM
Universe
Universe-text
Question Text
If you are given a number for a telephone not in the sample unit, such as a neighbor's
number, a work number, a public phone, and so forth, enter the location in an F7 note.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
TELENUM
Skip Instructions
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Page 70 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.331
Variable Name
CURWRK
Universe
TELENUM ne 'N'
Universe-text
All families with a phone
Question Text
?[F1]
Is there at least one telephone INSIDE your home that is currently working and is not a
cell phone?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Inside land line
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto TELCEL]
Hard Edits
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H_CURWRK
Wednesday, June 14, 2017
Page 71 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.331_H
Variable Name
H_CURWRK
Universe
Universe-text
Question Text
Accept only telephones which are inside the sample unit. For interviews conducted in
group quarters, reword the question to ask about telephones inside the room.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
CURWRK
Skip Instructions
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Soft Edits
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Wednesday, June 14, 2017
Page 72 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.334
Variable Name
TELCEL
Universe
All
Universe-text
All families
Question Text
Do you or anyone in your family have a working cell phone?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Cell phone
Fill Instructions
Special Instructions
Skip Instructions
<1> goto WRKCEL
<2,R,D> if POS2 = '0' [goto hhc.NAME_FNAME]
else [goto hhc.ADC]
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Wednesday, June 14, 2017
Page 73 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.335
Variable Name
WRKCEL
Universe
TELCEL = '1'
Universe-text
Families with a working cell phone
Question Text
How many working cell phones do you or people in your family have?
Answer Codes
1-10
Refused
Don't know
Question Type
Integer
Field Pane Description
# of cell phones
Fill Instructions
Special Instructions
Skip Instructions
<1-10,R,D> if CURWRK = '1' [goto PHONEUSE]
elseif POS2 = '0' [goto hhc.NAME_FNAME]
else [goto hhc.ADC]
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Wednesday, June 14, 2017
Page 74 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.337
Variable Name
PHONEUSE
Universe
TELCEL= '1' and CURWRK = '1'
Universe-text
Working cell phone and working land-line in family
Question Text
Of all the telephone calls that you or your family receives, are…
*Read categories below.
Answer Codes
Question Type
1. All or almost all calls received on cell phones?
2. Some received on cell phones and some on regular phones?
3. Very few or none received on cell phones?
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Type of phone call
Fill Instructions
Special Instructions
Skip Instructions
<1-3, Refused, Don't know> if POS2 = '0'
goto hhc.NAME_FNAME
else
goto hhc.ADC
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Wednesday, June 14, 2017
Page 75 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.410
Variable Name
ADDRCHG
Universe
Universe-text
Question Text
** Instrument Variable **
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Status flag for physical address changes. Set to 1 if physical address was altered.
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Wednesday, June 14, 2017
Page 76 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.420
Variable Name
MFLAG
Universe
Universe-text
Question Text
** Instrument Variable **
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Status flag for mailing address. Set to 1 if verified the mailing address is the same as
the physical address or refused to verify mailing address or said don't know to verifying
the mailing address, or set to 2 if the mailing address was altered.
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Page 77 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.430
Variable Name
TOTEXTRA
Universe
Universe-text
Question Text
** Instrument Variable **
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Counter used to reflect the total number of spawned addresses.
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Wednesday, June 14, 2017
Page 78 of 79
Module
02
Section Name
Coverage
Part
Question ID
COV.460
Variable Name
HPHONE1
Universe
Universe-text
Question Text
** Instrument Variable **
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Phone number used by laptop management system.
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Wednesday, June 14, 2017
Page 79 of 79
2018 Q1 NHIS Instrument Spec Report
Section name: Household Composition
Module
03
Section Name
Household Composition
Part
Question ID
HHC.001
Variable Name
ADC
Universe
POS2 or POS3 (Datamodel) ne 0
Universe-text
Family spawned cases
Question Text
I have listed . . .* Read names
[fill 1] . . .
as being in this family.
Is the family roster correct?
Answer Codes
1. Roster correct, continue with interview
2. Add person
3. Delete person
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Add, Delete, Continue
[fill 1]
Loop for all PX
[fill PX] [fill ALIAS]
end loop
Special Instructions Don't allow 'Don't know' or 'Refuse'
Skip Instructions
<1> if PCNT = 0, goto EXIT
esleif PCNT = 1, set HHSTAT9 = G, store PX in HHRESP
if AGE[PX] = 18-64 goto NOWAF_A
else goto HHCHANGE (FID)
elseif for all PX, HHSTAT[PX] = D or HHSTAT3[PX] = A, goto EXIT
elseif HHRESP = null, goto HHRESP
elseif an adult 18-64 years old, goto NOWAF_A
else goto HHREF_A
<2> goto NAME_FNAME
<3> goto SPAWNDEL
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Wednesday, June 14, 2017
Page 1 of 124
Module
03
Section Name
Household Composition
Part
Question ID
HHC.002
Variable Name
SPAWNDEL
Universe
ADC = Delete person (2)
Universe-text
Question Text
* Enter the line number of the person to delete.
[fill 1]
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Delete Person
[fill 1]
loop through all PX
[fill PX] [fill ALIAS]
end loop
Special Instructions Don't allow 'Don't know' or 'Refuse'
Set HHSTAT[PX] = D for entered PX
Subtract 1 from PCNT
Skip Instructions
<1-25> if HHSTAT[PX] = D or HHSTAT3[PX] = A, GOTO ERR_SPAWNDEL
else GOTO REASDEL
Hard Edits
ERR_SPAWNDEL
* Invalid entry.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 2 of 124
Module
03
Section Name
Household Composition
Part
Question ID
HHC.003
Variable Name
REASDEL
Universe
all from SPAWNDEL
Universe-text
Question Text
* Please enter the reason for deleting the person.
Answer Codes
<1> Lives elsewhere.
<2> Belongs to one of the other household families.
<3> Other
Question Type
Pick One - answer list pane
Field Pane Description
Delete reason
Fill Instructions
Special Instructions
Skip Instructions
<1, 2, R, D> GOTO ADC
<3> GOTO DEL_SPECIFY
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Wednesday, June 14, 2017
Page 3 of 124
Module
03
Section Name
Household Composition
Part
Question ID
HHC.004
Variable Name
DEL_SPECIFY
Universe
REASDEL = Other specify (3)
Universe-text
Question Text
* Please enter the reason.
Answer Codes
Question Type
Text
Field Pane Description
Delete other
Fill Instructions
Special Instructions
Skip Instructions
GOTO ADC
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Wednesday, June 14, 2017
Page 4 of 124
Module
03
Section Name
HOUSEHOLD COMPOSITION
Part
1
Question ID
HHC.010_1
Variable Name
NAME_FNAME
Universe
All cases where POS2 and POS3 (datamodel) = 0
or ADC = Add (2)
Universe-text
Question Text
? [F1]
[fill 1]
*Enter 999 if no more persons.
Answer Codes
Question Type
Text
Field Pane Description
Fill Instructions
First Name
[fill 1]
If TOTPCNT = 0
What are the names of all the persons living or staying here?
Start with the name of the person, or one of the persons, who owns or rents this home.
else
What is the name of the next person living or staying here?
Special Instructions If (valid name entered or ERR2_NAME_FNAME is suppressed) and MARK < 12, store
12 in MARK
Add 1 to PCNT and TOTPCNT, set PX = TOTPCNT
If ADC = 2, equiv this persons FX to the same as any other person's (they should all be
the same at this point).
Allow numbers in the first 3 characters of the string. If name entered contains numbers
in first 3 characters and entry does not equal ‘999’, goto ERR2_NAME_FNAME. If
number is entered in 4th character or beyond, goto ERR2_NAME_FNAME.
FAKE/FALSE NAME LIST
Use Search String at Beginning and End of Field:
MRS
FEMALE
CHILD
DAUGHTER
REFUSED
HUSBAND
YOUNG
Wednesday, June 14, 2017
MR
MALE
KID
DAU
PERSON
WIFE
#
MS
MISTER
GIRL
LADY
WOMAN
MOTHER
MISS
ADULT
Page 5 of 124
No Search String:
R
MAN
SON
ONE
BOY
MOM
DAD
If possible, these names should be used as search strings for matching so that not only
is "boy" flagged for the edit, but also "boy 1", "boy2", and so on would also be flagged.
Gray out the entries in this table for the original persons carried over to the spawn case
from the parent case or from a first level spawn case (for a second level spawn case).
These entries should not be allowed to be updated.
Skip Instructions
<999> if PCNT = 0, GOTO ERR1_NAME_FNAME
elseif POS2 or POS3 ne 0, GOTO HHRESP
else, GOTO MISPERS_MCHILD
if name on fake/false name list
goto ERR2_NAME_FNAME
elseif numbers entered and name not equal to ‘999’ OR
if number is entered in 4th character of name or beyond
goto ERR2_NAME_FNAME
else
goto NAME_MNAME
Hard Edits
ERR1_NAME_FNAME
* 999 not allowed for the first person in the household.
* Please correct.
Soft Edits
ERR2_NAME_FNAME
* You are entering a possible fake/false name.
* Please correct.
* If this is a legitimate name, suppress this error message and continue. Otherwise, go
back to the name field and enter a legitimate name. To enter an alias, enter 'Ctrl D' or
'Ctrl R' for 'Don't Know' or 'Refused' at the name field. Then, enter a matching
identifier/alias at the next screen (ALIAS).
AssocHelp
H_RPNAME
Wednesday, June 14, 2017
Page 6 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.010_2
Variable Name
NAME_MNAME
Universe
NAME_FNAME NE 999
Universe-text
First name is not blank
Question Text
? [F1]
* Enter Middle Name.
* Probe for middle name or middle initial if not reported.
* Press "ENTER" to skip to last name if no middle name.
Answer Codes
Question Type
Text
Field Pane Description
Middle Name
Fill Instructions
Special Instructions
Skip Instructions
GOTO NAME_LNAME
Hard Edits
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H_RPNAME
Wednesday, June 14, 2017
Page 7 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.010_3
Variable Name
NAME_LNAME
Universe
Entry other than 999 in NAME_FNAME
Universe-text
There is a name entered for 'first name'
Question Text
? [F1]
* If last name is the same as displayed, press "ENTER", otherwise, enter the new last
name.
*Enter Last Name.
Answer Codes
Question Type
Text
Field Pane Description
Last Name
Fill Instructions
Special Instructions If PX > 1, prefill NAME_LNAME with previous last name.
Allow numbers to be entered. If name entered contains numbers in first 3 characters
and entry equals ‘999’, goto ERR1_NAME_LNAME.
Elseif entry in first 3 characters is not equal to ‘999’, OR
if any number is entered in 4th character of name or beyond,
goto ERR2_NAME_LNAME.
FAKE/FALSE NAME LIST
Use Search String at Beginning and End of Field:
DOE
REFUSED
MALE
WOMAN
LADY
HH
FAMILY
DOUGH
ANONYMOUS
FEMALE
HEAD OF HOUSE
GIRL
HOUSEHOLD
#
No Search String:
REF
X
MAN
BOY
DAD
Skip Instructions
ONE
CHILD
HOUSE
MOM
<999> GOTO ERR1_NAME_FNAME
if name on fake/false name list
goto ERR2_NAME_LNAME
elseif numbers entered in first 3 characters is not equal to ‘999’, OR
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Page 8 of 124
number is entered in 4th character of name or beyond
goto ERR2_NAME_LNAME
else if NAME_FNAME and NAME_LNAME ne D, R
Set ALIAS = NAME_FNAME< >NAME _LNAME,
goto USUALRES
else goto ALIAS
Hard Edits
ERR1_NAME_FNAME
* 999 is not allowed in the last name when there is a first name.
Soft Edits
ERR2_NAME_LNAME
* You are entering a possible fake/false name.
* Please correct.
* If this is a legitimate name, suppress this error message and continue. Otherwise, go
back to the name field and enter a legitimate name. To enter an alias, enter 'Ctrl D' or
'Ctrl R' for 'Don't Know' or 'Refused' at the name field. Then, enter a matching
identifier/alias at the next screen (ALIAS).
AssocHelp
H_RPNAME
Wednesday, June 14, 2017
Page 9 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.010_H
Variable Name
H_RPNAME
Universe
Universe-text
Question Text
The first household member entered at the name screens should be 18 years of age or
older and the person who owns or rents the sample unit. This person will be selected
as the Household Reference Person. If two or more persons own or rent the sample
unit, enter the oldest of these persons first. If no occupant owns or rents the unit, the
Household Reference Person will be the first household member 18 years of age or
older entered at the name screens.
If no household members are 18 years of age or older, the first household member
entered should be:
1) The household member who owns or rents the sample unit
2) The oldest household member who owns or rents the sample unit if two or more
persons own or rent the sample unit
3) The oldest household member if no one owns or rents the sample unit
Ask for the full legal name, including middle name or initial. If a maiden name is
reported as the middle name, record that as the middle name. Always verify the correct
spelling of names with the respondent.
If there are two persons in the household with the same first, middle, and last names,
enter Sr., Jr., etc. with the last name.
If the person has a title that the respondent requests be used, enter it with the first
name, such as "DR JOHN", "GENERAL WILLIAM", and so forth.
For a person who uses an initial in place of his/her first name and goes by their middle
name, enter the initial of the first name in the first name field and enter their full middle
name in the middle initial field.
If the respondent is hesitant or refuses to give you names, explain that throughout the
interview it is necessary to refer to specific household members. Accept first names
only or last names only if this is all the respondent will provide.
If the respondent provides the names of the household members, but requests that
they not be entered, enter ‘Ctrl R’ for ‘Refused’ at the name screens. Then, enter an
alias at the ALIAS screen for each household member.
Answer Codes
Question Type
Help Screen
Field Pane Description
Reference Person Help Screen
Fill Instructions
Special Instructions Associated screens:
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Page 10 of 124
NAME_FNAME
NAME_MNAME
NAME_LNAME
CHG_NAME_FNAME
CHG_NAME_MNAME
CHG_NAME_LNAME
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 11 of 124
Module
03
Section Name
Household composition
Part
Question ID
HHC.012
Variable Name
HHCDATE
Universe
(POS2 = 0 and POS3 = 0 and NAME_FNAME = response) or
(POS2 ne 0 and ADC = response)
Universe-text
Household composition section has been started in either a parent or spawn case.
Question Text
Answer Codes
Question Type
DATETYPE
Field Pane Description
Fill Instructions
Special Instructions This is a storage/output variable. The format should be 'MMDDYYYY'. (no slashes (/)
in the date)
Set only if HHCDATE = empty
if POS2 = 0 and POS3 = 0
if NAME_FNAME ne empty
set HHCDATE = CDATE (current date) (now called ComputationDate)
endif
elseif POS2 ne 0
if ADC = response
set HHCDATE = CDATE (current date) (now called ComputationDate)
endif
endif
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 12 of 124
Module
03
Section Name
Household composition
Part
Question ID
HHC.013
Variable Name
HHCTIME
Universe
(POS2 = 0 and POS3 = 0 and NAME_FNAME = response) or
(POS2 ne 0 and ADC = response)
Universe-text
Household composition section has been started in either a parent or spawn case.
Question Text
Answer Codes
Question Type
TIMETYPE
Field Pane Description
Fill Instructions
Special Instructions This is a storage/output variable. The format should be 'HH:MM [fill a.m./p.m.]'.
Set only if HHCTIME = empty
if POS2 = 0 and POS3 = 0
if NAME_FNAME ne empty
set HHCTIME = current time
endif
elseif POS2 ne 0
if ADC = response
set HHCTIME = current time
endif
endif
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 13 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.015
Variable Name
ALIAS
Universe
[NAME_FNAME= D or R] or [NAME_LNAME= D or R]
Universe-text
Persons who don't know or refused to give first or last name.
Question Text
? [F1]
How shall I refer to (you/this person) for the rest of the interview?
Answer Codes
Question Type
Text
Field Pane Description
Alias
Fill Instructions
Special Instructions Do not allow 'D' or 'R' in this field.
Gray out the column heading of 'ALIAS' in the form pane.
Gray out the answer box and do not display the 'value' for 'ALIAS' in the answer box if
'legitimate' first and last names are entered in the previous name questions for this
person.
Activate the answer box and display the entry typed into the 'ALIAS' field if the first or
last name has an answer of 'don't know' (Ctrl D) or 'Refused' (Ctrl R).
Create a new variable called ALIAS_FLG in the instrument to capture true alias.
Skip Instructions
GOTO USUALRES
Hard Edits
Soft Edits
AssocHelp
H_RPALIAS
Wednesday, June 14, 2017
Page 14 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.015_H
Variable Name
H_RPALIAS
Universe
Universe-text
Question Text
If a respondent refuses all name information, ask them for an alias for each person to
distinguish between family members. If they refuse to give an alias, enter an alias of
your own choosing. For example, use Male 1 for the reference person, Female 1 for
his wife and Male 2 for his oldest son. These aliases will help you distinguish between
family members when the sample adult and sample child are chosen.
If the respondent provides the names of the household members, but requests that
they not be entered, enter ‘Ctrl R’ for ‘Refused’ at the name screens. Then, enter an
alias at the ALIAS screen for each household member.
Answer Codes
Question Type
Help Screen
Field Pane Description
Alias Help Screen
Fill Instructions
Special Instructions Associated screens:
ALIAS
CHG_ALIAS
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 15 of 124
Module
03
Section Name
Household composition
Part
Question ID
HHC.017
Variable Name
ALIAS_FLG
Universe
Universe-text
Question Text
Answer Codes
Question Type
Other
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 16 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.020
Variable Name
USUALRES
Universe
All non-deleted persons
Universe-text
All non-deleted persons
Question Text
? [F1]
[Fill]
Answer Codes
Question Type
1. Yes
2. No
Refused
Don’t Know
Yes/No
Field Pane Description
Fill Instructions
Usual Residence
[Fill 1] if I_SEGTYP=3 fill "Is this (your/[ALIAS[PX]'s] usual place of residence when
attending school?"
else fill "(Do/Does) (you/[ALIAS[PX]]) usually live here?"
Special Instructions
Skip Instructions
<1> GOTO NAME_FNAME
<2, D, R> GOTO ASKURE
Hard Edits
Soft Edits
AssocHelp
H_USUALRES
Wednesday, June 14, 2017
Page 17 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.020_H
Variable Name
H_USUALRES
Universe
Universe-text
Question Text
A person's usual place of residence is where they live more than 50 percent of the
time. If a person has two residences, consider his/her usual residence to be where
he/she spends the most time. If they spend an equal amount of time at both
residences, ask which they consider to be their usual residence, and use that to
determine household membership.
Answer Codes
Question Type
Help Screen
Field Pane Description
Usual Residence Help Screen
Fill Instructions
Special Instructions Associated screens:
USUALRES
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 18 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.030
Variable Name
ASKURE
Universe
If USUALRES= No or D or R.
Universe-text
If the usual residence is not here, or 'don't know', or 'refused'.
Question Text
? [F1]
(Do/Does) (you/[ALIAS[PX]]) have some other place where (he/she) usually lives?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don’t Know
Yes/No
Field Pane Description
Other Residence
Fill Instructions
Special Instructions
Skip Instructions
<1> GOTO NOLIST
<2, D, R> GOTO NAME_FNAME
Hard Edits
Soft Edits
AssocHelp
H_ASKURE
Wednesday, June 14, 2017
Page 19 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.030_H
Variable Name
H_ASKURE
Universe
Universe-text
Question Text
If the person does not usually live at this address and has another residence where
he/she does usually live, he/she will not be included in this interview. If this is the case,
identify some other owner/renter or if necessary, some other adult as the Reference
Person.
If the person does not have some other place where he/she usually lives, he/she will be
considered a household member and included in the interview.
Answer Codes
Question Type
Help Screen
Field Pane Description
Help Screen
Fill Instructions
Special Instructions Associated screens:
ASKURE
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 20 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.035
Variable Name
NOLIST
Universe
If ASKURE = yes
Universe-text
Person living elsewhere
Question Text
Since ( you/ [ALIAS[PX]]) (do/does] not usually live here and (have/has) another
residence elsewhere, (you/he/she) will not be included in this interview.
* Enter <1> to continue to the next person.
Answer Codes
Question Type
Enter 1 to Continue
Field Pane Description
Excluded
Fill Instructions
Special Instructions store D in HHSTAT[PX], subtract 1 from PCNT
Skip Instructions
GOTO NAME_FNAME
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 21 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.050_1
Variable Name
MISPERS_MCHILD
Universe
NAME_FNAME=999 and (POS2 and POS3 = 0)
Universe-text
After completing household roster
Question Text
? [F1]
I have listed living here ...
[fill 1)
Have I missed any babies or small children?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don’t know
Yes/No
Field Pane Description
Fill Instructions
Missed Child
[fill 1] entire roster for [ALIAS[PX]] if HHSTAT ne 'D'
Special Instructions Add Flag to capture entries: Create <0,1 FLAG>, if <1> set MISPERS_MCHILDFLG to
1.
Skip Instructions
<1> empty out '999' in NAME_FNAME
empty out MISPERS_MCHILD
empty out MISPERS_MLODGE
empty out MISPERS_MAWAY
empty out MISPERS_MELSE
goto NAME_FNAME
<2, D, R> goto MISPERS_MLODGE
Hard Edits
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H_MISPERS
Wednesday, June 14, 2017
Page 22 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.050_2
Variable Name
MISPERS_MLODGE
Universe
MISPERS_MCHILD=no or D or R
Universe-text
Not missing any children or D or R
Question Text
? [F1]
* Read if necessary.
I have listed living here ...
[fill 1)
Have I missed any lodgers, boarders, or persons you employ who live here?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don’t know
Yes/No
Field Pane Description
Fill Instructions
Missed Lodger
[fill 1] entire roster for [ALIAS[PX]] if HHSTAT ne 'D'
Special Instructions Add Flag to capture entries: Create <0,1 FLAG>, if <1> set MISPERS_MLODGEFLG to
1.
Skip Instructions
<1> empty out '999' in NAME_FNAME
empty out MISPERS_MCHILD
empty out MISPERS_MLODGE
empty out MISPERS_MAWAY
empty out MISPERS_MELSE
goto NAME_FNAME
<2,D,R> goto MISPERS_MAWAY
Hard Edits
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H_MISPERS
Wednesday, June 14, 2017
Page 23 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.050_3
Variable Name
MISPERS_MAWAY
Universe
MISPERS_MLODGE= no (2) or D or R
Universe-text
No 'lodgers' living here or D or R
Question Text
? [F1]
* Read if necessary.
I have listed living here...
[fill 1)
Have I missed anyone who USUALLY lives here, but is now away from home traveling
or in a hospital?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don’t know
Yes/No
Field Pane Description
Fill Instructions
Missed Away
[fill 1] entire roster for [ALIAS[PX]] if HHSTAT ne 'D'
Special Instructions Add Flag to capture entries: Create <0,1 FLAG>, if <1> set MISPERS_MMAWAYFLG
to 1.
Skip Instructions
<1> empty out '999' in NAME_FNAME
empty out MISPERS_MCHILD
empty out MISPERS_MLODGE
empty out MISPERS_MAWAY
empty out MISPERS_MELSE
goto NAME_FNAME
<2,D,R> goto MISPERS_MELSE
Hard Edits
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H_MISPERS
Wednesday, June 14, 2017
Page 24 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.050_4
Variable Name
MISPERS_MELSE
Universe
MISPERS_MAWAY = no or D or R
Universe-text
Nobody is away from home or D or R
Question Text
? [F1]
* Read if necessary.
I have listed living here...
[fill 1)
Have I missed anyone else staying here?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don’t know
Yes/No
Field Pane Description
Fill Instructions
Missed Else
[fill 1] entire roster for [ALIAS[PX]] if HHSTAT ne 'D'
Special Instructions Add Flag to capture entries: Create <0,1 FLAG>, if <1> set MISPERS_MMELSEFLG to
1.
Skip Instructions
<1> empty out '999' in NAME_FNAME
empty out MISPERS_MCHILD
empty out MISPERS_MLODGE
empty out MISPERS_MAWAY
empty out MISPERS_MELSE
goto NAME_FNAME
<2,D,R> if PCNT = 0, goto EXIT
elseif PCNT = 1
store Yes (1) in LIVEAT, goto OTHLIV
else goto LIVEAT
Hard Edits
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H_MISPERS
Wednesday, June 14, 2017
Page 25 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.050_H
Variable Name
H_MISPERS
Universe
Universe-text
Question Text
Read the list of names already entered in the household from the "window" at the side
of the screen.
If the answer to a question is "No", enter 2 and ask the next question.
If the answer to a question is "Yes" (you missed someone), enter 1 and the instrument
will take you through the appropriate questions for entering the missed person.
After entering all appropriate information for the missed person, you will be return to this
screen. Re-ask the question to which you received the "Yes" answer.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
MISPERS_MCHILD, MISPERS_MLODGE, MISPERS_MAWAY, MISPERS_MELSE
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 26 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.060
Variable Name
LIVEAT
Universe
PCNT > 1 and (POS2 and POS3 = 0)
Universe-text
Person count is greater than one
Question Text
? [F1]
Do all the persons I have listed live together?
*Read names if necessary.
[fill 1]
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Fill Instructions
Live Together
[fill 1] all non-deleted person's ALIAS
Special Instructions
Skip Instructions
<1, D, R> GOTO OTHLIV
<2> GOTO XACCESS
Hard Edits
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H_LIVEAT
Wednesday, June 14, 2017
Page 27 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.060_H
Variable Name
H_LIVEAT
Universe
Universe-text
Question Text
The purpose of this question is to identify any person(s) that have been listed as
household members, who may actually live in a separate housing unit, and thus do not
qualify as household members.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
LIVEAT
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 28 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.070
Variable Name
XACCESS
Universe
LIVEAT= no
Universe-text
All persons don't live together
Question Text
? [F1]
Do the people who do not live here have direct access from the outside or through a
common hallway to a separate living quarters?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don’t know
Yes/No
Field Pane Description
Direct Access
Fill Instructions
Special Instructions
Skip Instructions
<1> GOTO TABX
<2, D, R> GOTO OTHLIV
Hard Edits
Soft Edits
AssocHelp
H_XACCESS
Wednesday, June 14, 2017
Page 29 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.070_H
Variable Name
H_XACCESS
Universe
Universe-text
Question Text
Any persons entered in the household roster that do not live with the other household
members, AND have direct access from the outside or through a common hallway to
separate living quarters, will be deleted from the household roster.
Direct access means that they do not need to pass through any other persons living
quarters to reach their own living quarters.
Common hallways are typically found in apartment buildings. To be considered a
common hallway, a hallway must not be a part of any other persons living quarters.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
XACCESS
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 30 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.080
Variable Name
TABX
Universe
XACCESS=yes
Universe-text
All persons who live together and have direct access
Question Text
? [F1]
* Enter the line number of each person who does not live with this household.
* Enter applicable line number(s), separate with commas.
Answer Codes
Question Type
[fill 1]
Enter All That Apply
Field Pane Description
Fill Instructions
Not Live Here
[fill 1] Display roster for all household members and GRAY out deleted people with text:
'deleted'.
Special Instructions store D in HHSTAT[PX], subtract 1 from PCNT. Don't allow PCNT =0, if so GOTO
ERR3_TABX.
Allow this to occur as long as PCNT>1.
Do not allow a 'D' or 'R'.
Skip Instructions
for PX selected:
if PX is already deleted, GOTO ERR1_TABX
elseif PX > HIGH_LNO, GOTO ERR2_TABX
elseif PCNT=0, GOTO ERR3_TABX
else, GOTO OTHLIV
Hard Edits
ERR1_TABX
* You cannot choose a deleted person.
* Please correct.
ERR2_TABX
* You entered a line number that does not exist in this household.
* Please correct.
ERR3_TABX
* You are not allowed to choose the last nondeleted person from the household.
* Please correct.
Soft Edits
AssocHelp
H_TABLEX
Wednesday, June 14, 2017
Page 31 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.080_H
Variable Name
H_TABLEX
Universe
Universe-text
Question Text
Ask the respondent for the names of the person(s) that do not live with the other
household members, AND have direct access from the outside or through a common
hallway. Enter the line number that corresponds to every such person and enter "N"
after the last person entered. Each person entered will be deleted from the household
roster.
If the Reference Person is deleted, the next nondeleted person in the roster will
automatically be designated as the new Reference Person. If this person is not the
best choice, you will have a chance later to select another Reference Person yourself.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
TABX
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 32 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.090
Variable Name
OTHLIV
Universe
All when POS2 and POS3 = 0
Universe-text
All
Question Text
? [F1]
Do members of any other household on the property live with members of this
household?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don’t know
Yes/No
Field Pane Description
Others Live Together
Fill Instructions
Special Instructions 1. if PCNT = 1 and HHSTAT[PX] ne D
store PX in HHRESP
store 1 in QCRESP
store R in HHSTAT2[PX]
store G in HHSTAT9[PX]
store 1 in FX
2. If <1>, store null in LIVEAT and OTHLIV,
GOTO NAME_FNAME
Skip Instructions
<1> GOTO ERR_OTHLIV
<2, D, R> if PCNT = 1, GOTO SEX
else, GOTO HHRESP
Hard Edits
ERR_OTHLIV
* All such persons should be included in this interview.
* Please correct by adding the additional person(s) to the household.
Soft Edits
AssocHelp
H_OTHLIV
Wednesday, June 14, 2017
Page 33 of 124
Module
03
Section Name
Household Composition
Part
1
Question ID
HHC.090_H
Variable Name
H_OTHLIV
Universe
Universe-text
Question Text
If there is another household that lives on the same property as the household you have
already listed, those persons will be added to the household roster and included with
this interview.
Property includes:
The entire structure (or other type of living quarters such as a mobile home or trailer)
which contains the sample unit;
The land it stands on;
Any additional structures (or other types of living quarters) on the same plot of land as
the structure containing the sample unit that is owned by the same person;
Any adjacent land and structures (or other types of living quarters) which are owned by
the same person who owns the structure containing the sample unit.
For cooperative and condominium units, include the structure (or other type of living
quarters) containing the sample unit and the ground on which it stands as the property.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
OTHLIV
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 34 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.100
Variable Name
HHRESP
Universe
PCNT > 1 and [(POS2 = 0 and POS3 = 0) or (POS2 ne 0 and HHRESP = empty)]
Universe-text
All households with more than one nondeleted person in parent cases or more than
one nondeleted person in spawn cases and no household/family demographic
respondent identified yet.
Question Text
? [F1]
* Ask if necessary
With whom am I speaking?
* Enter the line number of the respondent. If more than one, enter the number of the
one you consider to be the main respondent.
Answer Codes
Question Type
Pick One - answer list pane
Field Pane Description
Household Respondent
Fill Instructions
Special Instructions 1. Display roster for all household members in the Answer Codes and GRAY out
deleted people with text: 'deleted'.
2. store 1 in QCRESP and G in HHSTAT9.
store ALIAS of HHRESP in RESPNAME and in RT1000.RESPNAME.
if POS2 and POS3 = 0, store R in HHSTAT2.
3. Don't allow a 'Don't know' or 'Refused'.
Skip Instructions
<1-25>
If deleted PX, goto ERR1_HHRESP
elseif out of bound, goto ERR2_HHRESP
elseif ADC = 1, GOTO HHREF_A
else GOTO SEX
Hard Edits
ERR1_HHRESP:
* Person was deleted from this household.
* Please correct.
ERR2_HHRESP:
*Invalid line number entered.
* Please correct.
Soft Edits
AssocHelp
H_HHRESP
Wednesday, June 14, 2017
Page 35 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.100_H
Variable Name
H_HHRESP
Universe
Universe-text
Question Text
Enter the Person Number of the person that has been responding to the questions so
far.
If more than one person has been responding to this point, enter the Person Number of
the one you consider the main respondent. This may be the one who gave the best
answers or who will be available for the rest of the interview.
For persons who are not able to answer questions for themselves and have no relative
living in the household who can answer for them, you may interview someone who is
responsible for their care. This respondent may or may not be a household member.
If the respondent is a household member, enter his/her Person Number.
If the respondent is not a household member, but is being assisted by a household
member, enter the household member's Person Number. Also, press F7 and note the
situation, including the name and relationship to the Reference Person of the nonhousehold member.
If the respondent is not a household member and is not being assisted by a household
member, press F7 and note the situation, including the name and relationship of the
respondent to the Reference Person.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
HHRESP
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 36 of 124
Module
03
Section Name
Household Composition
Part
Question ID
HHC.105
Variable Name
STARTINTERVIEW
Universe
Universe-text
Question Text
**Instrument Out Variable**
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions IF HHRESP=response, capture current date in STARTINTERVIEW.
Keep this date, even if case is exited and rentered.
Skip Instructions
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Wednesday, June 14, 2017
Page 37 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.110
Variable Name
SEX
Universe
HHSTAT ne D and [(POS2 = 0 and POS3 = 0) or (ADC = 2)]
Universe-text
All nondeleted persons in parent cases or all nondeleted persons being added in spawn
cases.
Question Text
[fill 1] male or female?
* If don’t know or refused enter your best guess.
Answer Codes
Question Type
1. Male
2. Female
Pick One - answer list pane
Field Pane Description
Fill Instructions
Sex
[fill 1]
if PX = LNO_RESP, then "Are you",
else "Is [ALIAS(PX)]"
Special Instructions Don't allow 'D' or 'R' for a response.
Gray out the entries in this table for the original persons carried over to the spawn case
from the parent case or from a first level spawn case (for a second level spawn case).
These entries should not be allowed to be updated.
Skip Instructions
<1,2> GOTO AGEDOB_1
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Wednesday, June 14, 2017
Page 38 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.120_1
Variable Name
AGEDOB_1
Universe
HHSTAT ne D and [(POS2 = 0 and POS3 = 0) or (ADC = 2)]
Universe-text
All nondeleted persons in parent cases or all nondeleted persons being added in spawn
cases.
Question Text
? [F1]
1 of 5
What is [fill 1] age?
* Enter number for age.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Age Num
[fill 1]
if PX = LNO_RESP, then "your
else "[ALIAS[PX]]'s"
Special Instructions If AGEDOB_1 = D or R, store 999 into AGE1
Skip Instructions
<000-120> GOTO AGEDOB_2
GOTO AGEDOB_3
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H_AGEDOB
Wednesday, June 14, 2017
Page 39 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.120_2
Variable Name
AGEDOB_2
Universe
AGEDOB_1 = <000-120>
Universe-text
Valid age - number entered
Question Text
? [F1]
2 of 5
* Enter number for age time period.
Answer Codes
Question Type
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Pick One - answer list pane
Field Pane Description
Age TP
Fill Instructions
Special Instructions 1. Do not allow don't know or refused.
2. Calculate age in years
If AGEDOB_2 = day, divide AGEDOB_1 by 365, truncate decimal and store integer
into AGE1.
If AGEDOB_2 = weeks, divide AGEDOB_1 by 52, truncate decimal and store integer
into AGE1.
If AGEDOB_2 = months, divide AGEDOB_1 by 12, truncate decimal and store integer
into AGE1.
If AGEDOB_2 = years, store integer into AGE1.
Skip Instructions
<1-4> GOTO AGEDOB_3
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H_AGEDOB
Wednesday, June 14, 2017
Page 40 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.120_3
Variable Name
AGEDOB_3
Universe
HHSTAT ne D and [(POS2 = 0 and POS3 = 0) or (ADC = 2)]
Universe-text
All nondeleted persons in parent cases or all nondeleted persons being added in spawn
cases.
Question Text
? [F1]
3 of 5
And what is [fill 1] date of birth?
Please give month, day, and year for the date of birth.
* Enter month of birth.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
Refused
Don’t know
Pick One - answer list pane
Field Pane Description
Fill Instructions
DOBM
[fill 1]
if PX = LNO_RESP, then "your
else "[ALIAS[PX]]'s"
Special Instructions
Skip Instructions
<1-12,R,D> GOTO AGEDOB_4
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H_AGEDOB
Wednesday, June 14, 2017
Page 41 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.120_4
Variable Name
AGEDOB_4
Universe
HHSTAT ne D and [(POS2 = 0 and POS3 = 0) or (ADC = 2)]
Universe-text
All nondeleted persons in parent cases or all nondeleted persons being added in spawn
cases.
Question Text
? [F1]
4 of 5
* Enter day of birth
Answer Codes
Question Type
Integer
Field Pane Description
DOBD
Fill Instructions
Special Instructions
Skip Instructions
<1-31, R, D>
Only allow valid days for month entered.
If days not valid, GOTO ERR_AGEDOB_4
ELSE GOTO AGEDOB_5
Hard Edits
ERR_AGEDOB_4
[fill1: AGEDOB_4] is not a valid day for [fill2: AGEDOB_3].
Soft Edits
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H_AGEDOB
Wednesday, June 14, 2017
Page 42 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.120_5
Variable Name
AGEDOB_5
Universe
HHSTAT ne D and [(POS2 = 0 and POS3 = 0) or (ADC = 2)]
Universe-text
All nondeleted persons in parent cases or all nondeleted persons being added in spawn
cases.
Question Text
? [F1]
5 of 5
* Enter year of birth.
Answer Codes
Question Type
Integer
Field Pane Description
DOBY
Fill Instructions
Special Instructions Store AGEDOB_3 in DOBM
Store AGEDOB_4 in DOBD
Store ABDDOB_5 in DOBY
1. If AGEDOB_5 > current year, GOTO ERR4_AGEDOB_5.
2. If AGEDOB_5 = current year and AGEDOB_3 > current month, GOTO
ERR1_AGEDOB_5.
3. If AGEDOB_5 = current year and AGEDOB_3 = current month and AGEDOB_4 >
current day, GOTO ERR2_AGEDOB_5.
4. If AGEDOB_3 = 2 and AGEDOB_4 = 29, divide AGEDOB_5 BY 4.00. If
AGEDOB_5 ne to (truncated decimal multiplied by 4.00), GOTO ERR3_AGEDOB_5.
5. Execute Procedure AGECAL.
6. Execute Procedure AGECK.
7. New Variable: >BIRTHDATE< Concatenate information gathered in AGEDOB_3,
AGEDOB_4, and AGEDOB_5 into a type DATETYPE variable called BIRTHDATE.
The format would be:
MM/DD/YYYY .
PLEASE NOTE: THAT THE AGE QUESTIONS COULD BE POPULATED WITH
'don't know' or 'refused' And therefore could have no information to populate this field.
Skip Instructions
<1880 - 2030, D,R> GOTO AGECAL
Hard Edits
ERR1_AGEDOB_5
Future month invalid:AGEDOB_3AGEDOB_4<,> AGEDOB_5
ERR2_AGEDOB_5
Future day invalid:AGEDOB_3AGEDOB_4<,> AGEDOB_5
ERR3_AGEDOB_5
Wednesday, June 14, 2017
Page 43 of 124
Invalid date:AGEDOB_3AGEDOB_4<,> AGEDOB_5
ERR4_AGEDOB_5
Future year invalid:AGEDOB_3AGEDOB_4<,> AGEDOB_5
Soft Edits
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H_AGEDOB
Wednesday, June 14, 2017
Page 44 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.120_6
Variable Name
AGECAL
Universe
HHSTAT ne D and [(POS2 = 0 and POS3 = 0) or (ADC = 2)]
Universe-text
All nondeleted persons in parent cases or all nondeleted persons being added in spawn
cases.
Question Text
Answer Codes
Question Type
Procedure
Field Pane Description
Calculates age(s) from Date of Birth
Fill Instructions
Special Instructions This item takes the date-of-birth information entered in AGEDOB_3, AGEDOB_4 and
AGEDOB_5 and calculates an age. The calculated age is stored in AGE2.
There are 4 main sections, number 1-4 below. Which section will be used depends on
whether complete DOB information was entered in AGEDOB, and which part of DOB
(month, day or year) is missing, if any. If not enough DOB information was given to
calculate an age, 999 is assigned to AGE2.
1. If complete DOB information was entered in AGEDOB_3, AGEDOB_4, and
AGEDOB_5
if AGEDOB_3, AGEDOB_4 and AGEDOB_5 are valid
if AGEDOB_3 < current month, store (current year - AGEDOB_5) in AGE2
if AGEDOB_3 > current month, store (current year - AGEDOB_5 - <1>) in AGE2]
if AGEDOB_3 = current month and AGEDOB_4 le current day,
store (current year - AGEDOB_5) in AGE2
if AGEDOB_3 = current month and AGEDOB_4 > current day.
store (current year - AGEDOB_5 - <1>) in AGE2]
Store AGEDOB_3 in DOBM
Store AGEDOB_4 in DOBD
Store ABDDOB_5 in DOBY
2. If only the day is missing an age may be calculated, depending on the month of
birth. If the birth month is the current month, two possible ages are calculated and
stored in AGE3 and AGE4.
If AGEDOB_3 valid and AGEDOB_5 valid
If AGEDOB_5 < current year and AGEDOB_3 < current month,
store (current year - AGEDOB_5) in AGE2
If AGEDOB_5 < current year and AGEDOB_3 > current month,
store (current year - AGEDOB_5 - <1>) in AGE2
If AGEDOB_5 < current year and AGEDOB_3 = current month,
store <999> in AGE2, store (current year - AGEDOB_5 - <1>) in AGE3, and
store (current year - AGEDOB_5) in AGE4
if AGEDOB_5 = current year, store <0> in AGE2
Store AGEDOB_3 in DOBM
Wednesday, June 14, 2017
Page 45 of 124
Store ABDDOB_5 in DOBY
3. If the birth month is missing (or month and day, because the day is useless without
the month) two possible ages are calculated, AGE3 and AGE4, if the birth year is less
than the current year. If the birth year = current year, an age of 0 is assigned to AGE2.
If AGEDOB_5 valid and AGEDOB_5 < current year, store <999> in AGE2,
store (current year - AGEDOB_5 - <1>) in AGE3, and
store (current year - AGEDOB_5) in AGE4
If AGEDOB_5 valid and AGEDOB_5 = current year, store <0> in AGE2
Store AGEDOB_5 in DOBY
4. If the birth year is missing (or any combination of month, month and day, or month,
day and year, because month and day are useless without the year) a 999 is stored in
AGE2.
If AGEDOB_5 = Refused or Don't know, store <999> in AGE2
Skip Instructions
GOTO AGECK
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Wednesday, June 14, 2017
Page 46 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.120_7
Variable Name
AGECK
Universe
HHSTAT ne D and [(POS2 = 0 and POS3 = 0) or (ADC = 2)]
Universe-text
All nondeleted persons in parent cases or all nondeleted persons being added in spawn
cases.
Question Text
Answer Codes
Question Type
Procedure
Field Pane Description
Checking age
Fill Instructions
Special Instructions AGECK compares the two ages calculated in AGE1 (actual age given) and AGE2 (calc.
From DOB information). AGE1 and AGE2 will contain an age or 999 if an age could
not be calculated.
Skip Instructions
if AGE1 = 999
if AGE2 ne 999, store AGE2 in AGE, GOTO AGEDOB_1, to collect information
about next person in roster,
else, GOTO NATOR
elseif AGE2 = 999
if AGE3 = null
if AGEDOB_5 ne refused, GOTO AGEGES1_NUM
else GOTO AGEGES2, endif
else GOTO AGEPIC, endif
endif
elseif AGE1 ne 999
if AGE2 ne 999
if AGE1 = AGE2, store AGE1 in AGE, GOTO AGEDOB_1, to collect information
about next person in roster,
else, GOTO NATOR
elseif AGE1 ne AGE2
if DOBVER = null, GOTO DOBVER
else, store AGE2 in AGE, GOTO AGEDOB_1, to collect information about
next person in roster,
else, GOTO NATOR, endif
endif
elseif AGE2 = 999
if AGE1 = AGE3 or AGE4, store AGE1 in AGE, GOTO AGEDOB_1, to collect
information about next person in roster,
else, GOTO NATOR
elseif AGE1 ne AGE3 or AGE4
if AGEDOB_5 = Don’t know
store AGE1 in AGE
store (current year - AGE1 - <1>) in BYY1
store (current year - AGE1) in BYY2, GOTO YEARPIC
else, store AGE1 in AGE, GOTO AGEDOB_1, to collect information about
next person in roster,
Wednesday, June 14, 2017
Page 47 of 124
else, GOTO NATOR
endifall
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Wednesday, June 14, 2017
Page 48 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.120_H
Variable Name
H_AGEDOB
Universe
Universe-text
Question Text
Attempt to obtain age and exact date of birth.
For age you must enter a number or "control D" (for Don't know) or "control R" (for
Refused). The age cannot be left blank. If you enter a number you will need to enter
the time period, and then the Month, Day and Year. If you enter "control D" or "control
R" the time period will be skipped, and it will go to the Month, Day and Year.
For MONTH and DAY enter one or two digits. For YEAR enter four digits.
If any part of the birth date is unknown, enter "control D" (for Don't Know). If the
respondent refuses to give the information, enter "control R" (for Refused).
Based on your entries , there are several different paths the instrument can take. If the
date-of-birth you entered matches the age you entered (assuming you entered all this
information) you will skip to the National Origin questions without verifying the
information.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
AGEDOB_1
AGEDOB_2
AGEDOB_3
AGEDOB_4
AGEDOB_5
CHG_AGEDOB_1
CHG_AGEDOB_2
CHG_AGEDOB_3
CHG_AGEDOB_4
CHG_AGEDOB_5
Skip Instructions
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Wednesday, June 14, 2017
Page 49 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.124
Variable Name
DOBVER
Universe
[AGE1 ne AGE2 ] and [AGE1 & AGE2 ne 999]
Universe-text
Age reported is not equal to age calculated from date of birth.
Question Text
"There is a difference between the age the computer calculated from [fill 1] date-ofbirth, [fill: computer calculated age (AGE2)], and the age that you gave me, [fill: age
respondent reported (AGE1)].
I recorded [fill 1] date-of-birth as [AGEDOB_3] [AGEDOB_4], [AGEDOB _5]. Is that [fill
1] correct date-of-birth?"
Answer Codes
Question Type
1. Yes
2. No
Refused
Don’t know
Yes/No
Field Pane Description
Fill Instructions
DOB Ver
[fill 1]
if PX = LNO_RESP, "your"
else, "[ALIAS[PX]]'s"
Special Instructions <1> store AGE2 in AGE
store AGE1 in AGE
FLAG for DOBVER_FLG, store 1 if suppressed
Skip Instructions
<1,D,R> GOTO AGEDOB_1, to collect information about next person in roster,
else, GOTO NATOR
<2> GOTO AGEDOB_3
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Wednesday, June 14, 2017
Page 50 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.130
Variable Name
AGEPIC
Universe
[(AGEDOB_1,_2,_3,_4 = D or R) and (AGEDOB_5 ne D,R)] or [(AGEDOB_3,_5 ne D
or R) and (AGEDOB_4 = D or R) and (AGEDOB_5 lt current year) and (AGEDOB_3 =
current month)]
Universe-text
Able to narrow age to two options
Question Text
[fill 1]
Answer Codes
1. [fill 2]
2. [AGE4] year(s) old?
3. Neither is correct
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Age Pick
[fill 1]
if PX = LNO_RESP, "Are you ..."
else "Would you say [ALIAS[PX]] is ..."
[fill 2]
if AGE3 = 0, "Less than 1 year old?"
else "[AGE3] year(s) old?"
Special Instructions <1> set AGE = AGE3
<2> set AGE = AGE4
Skip Instructions
<1, 2> GOTO AGEDOB_1, to collect information about next person in roster,
else, GOTO NATOR
<3, D, R> if AGEDOB_1 = R, GOTO AGEGES2
elseif AGEDOB_1 = D, GOTO AGEGES1_NUM
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Wednesday, June 14, 2017
Page 51 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.150_1
Variable Name
AGEGES1_NUM
Universe
[AGEPIC = (3or D or R) and AGEDOB_1 ne R] or [(AGEDOB_3 or AGEDOB_4 or
AGEDOB_5 = (D or R)) and (AGEPIC not asked and AGEDOB_1 ne R)]
Universe-text
Age unknown and unable to narrow age down to two age choices and respondent did
not refuse AGEDOB_1
Question Text
? [F1]
1 of 2
What is your best guess of [fill 1] age?
* If the respondent gives a range of ages, enter "C" to continue to the screen that will
compute an age.
* If the respondent does not know the age, enter your best estimate of the person's age.
Answer Codes
Question Type
C. Compute from range
Refused
Don't Know
Integer
Field Pane Description
Fill Instructions
Age Guess Num
[fill 1]
if PX = LNO_RESP, "your"
else, "[ALIAS[PX]]'s"
Special Instructions
Skip Instructions
<0-120> GOTO AGEGES1_TP
elseif outside range, GOTO ERR_AGEGES1_NUM
GOTO AGERNG_N1
GOTO AGEGES2
Hard Edits
ERR_AGEGES1_NUM
* Invalid entry.
* Please correct.
Soft Edits
AssocHelp
H_AGEGES
Wednesday, June 14, 2017
Page 52 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.150_2
Variable Name
AGEGES1_TP
Universe
AGEGES1_NUM = 0-120
Universe-text
Valid age number
Question Text
2 of 2
* Enter time period for age guess.
Answer Codes
Question Type
3. Month(s)
4. Year(s)
Pick One - answer list pane
Field Pane Description
Age Guess TP
Fill Instructions
Special Instructions Don't know or Refused not allowed.
<3> divide AGEGES1_NUM by 12, then store integer into AGE.
<4> store AGEGES1_NUM into AGE.
If AGEDOB_5 = D
store (current year - AGE - <1>) in BYY1
store (current year - AGE) in BYY2
Skip Instructions
<3, 4> If AGEDOB_5 = D, GOTO YEARPIC
else GOTO AGEDOB_1, to collect information about next person in roster,
else, GOTO NATOR
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Wednesday, June 14, 2017
Page 53 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.150_H
Variable Name
H_AGEGES
Universe
Universe-text
Question Text
You must make an age entry -- either your estimate or the respondent's estimate of the
person's age.
Always probe for an exact number. If the respondent can not give an exact age, try not
to compute from a range that contains "18". That is, ask the respondent for the more
appropriate age over 18 or under 18.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
AGEGES1_NUM
AGEGES2
CHG_AGEGES1_NUM
Skip Instructions
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Wednesday, June 14, 2017
Page 54 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.152
Variable Name
AGEGES2
Universe
[(AGEPIC = 3 or R or D) and AGEDOB_1 = R] or [AGEGES1_NUM= D or R] or
[((AGEDOB_3 or AGEDOB_4 or AGEDOB_5) = (D or R)) and (AGEPIC = empty) and
(AGEDOB_1 = R)]
Universe-text
(Age unknown and unable to narrow to two age choices and respondent refused or
didn't know age at AGEDOB_1) or (Refused to or did not guess age)
Question Text
? [F1]
Certain sections of this interview depend on knowing if a person is 18 years old or
older.
Could you please tell me if [fill 1] at least 18 years old?
Answer Codes
Question Type
1. Less than 18
2. 18 or older
Pick One - answer list pane
Field Pane Description
Fill Instructions
At least 18
[fill 1]
if PX = LNO_RESP, "you are"
else, "[ALIAS[PX] is"
Special Instructions Do not allow Don't Know and Refused as answers
Skip Instructions
<1> GOTO LESS18
<2> GOTO GREAT18
GOTO ERR_AGEGES2
Hard Edits
Don't Know and Refused responses are not allowed in this question. If the respondent
will not or cannot provide an age estimate, please choose one of the options based on
your best guess.
Soft Edits
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H_AGEGES
Wednesday, June 14, 2017
Page 55 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.154
Variable Name
LESS18
Universe
AGEGES2= less than 18
Universe-text
Person estimated less than eighteen years of age
Question Text
* Enter your best estimate of [ALIAS[PX]]'s age.
* Enter age "0" to 17
* Enter "0" if less than 1 year old.
Answer Codes
Question Type
Integer
Field Pane Description
Less than 18
Fill Instructions
Special Instructions Don't know and Refused not allowed.
Store LESS18 in AGE
Skip Instructions
<0-17> GOTO AGEDOB_1, to collect information about next person in roster,
else, GOTO NATOR
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Wednesday, June 14, 2017
Page 56 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.156
Variable Name
GREAT18
Universe
AGEGES2 = 2 (18 or older), Don't know, or Refused
Universe-text
Person estimated age (18 or older)
Question Text
* Enter your best estimate of [ALIAS[PX]]’s age.
* Enter age 18 or greater.
Answer Codes
Question Type
Integer
Field Pane Description
18 or Older
Fill Instructions
Special Instructions Store GREAT18 in AGE
Do not allow 'D' or 'R'.
Skip Instructions
<18-120> GOTO AGEDOB_1, to collect information about next person in roster,
else, GOTO NATOR
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Wednesday, June 14, 2017
Page 57 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.160_1
Variable Name
AGERNG_N1
Universe
AGEGES1= C
Universe-text
Computing age when not given the year the subject was born or the subject's age.
Question Text
1 of 4
* Enter lower age of the range in months or years.
Answer Codes
Question Type
Integer
Field Pane Description
Low-Age Num
Fill Instructions
Special Instructions 1. Do not allow "Don't know" or "Refused" as an answer.
2. Gray out everything in the Question text except for the FR instruction, First/lower,
and number underneath First/lower.
Skip Instructions
<0-120> GOTO AGERNG _T1
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Wednesday, June 14, 2017
Page 58 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.160_2
Variable Name
AGERNG_T1
Universe
AGERNG_N1=0-120
Universe-text
First age number has been entered for range.
Question Text
2 of 4
* Enter lower age time period.
Answer Codes
Question Type
3. Month(s)
4. Year(s)
Pick One - answer list pane
Field Pane Description
Low-Age TP
Fill Instructions
Special Instructions Do not allow "Don't know" or "Refused" as an answer.
<3> divide AGERNG_N1 by 12, truncate decimal and store integer into LOWER
<4> store AGERNG _N1 into LOWER
Gray out everything in the Question text except for the FR instruction, First/lower, and
Month(s) and Year(s) underneath First/lower.
Skip Instructions
GOTO AGERNG_N2
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Wednesday, June 14, 2017
Page 59 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.160_3
Variable Name
AGERNG_N2
Universe
AGERNG_2=3-4
Universe-text
First age number and time period has been entered for range.
Question Text
3 of 4
* Enter higher age of the range in months or years.
Answer Codes
Question Type
Integer
Field Pane Description
High-Age Num
Fill Instructions
Special Instructions 1. Do not allow "Don't know" or "Refused" as an answer.
2. Gray out everything in the Question text except for the FR instruction, Last/higher:,
and number underneath Last/higher.
Skip Instructions
<0-120> GOTO AGERNG _T2
Hard Edits
ERR_AGERNG_N2
* The higher age must be larger than the lower age.
* Please correct.
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Wednesday, June 14, 2017
Page 60 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.160_4
Variable Name
AGERNG_T2
Universe
AGEGES1_NUM= C
Universe-text
Second age number has been entered for range.
Question Text
4 of 4
* Enter higher age time period.
Answer Codes
Question Type
3. Month(s)
4. Year(s)
Pick One - answer list pane
Field Pane Description
High-Age TP
Fill Instructions
Special Instructions Do not allow "Don't know" or "Refused" as an answer.
Gray out everything in the Question text except for the FR instruction, Last/higher:, and
Month(s) and Year(s) underneath Last/higher:.
<3> divide AGERNG_N2 by 12, truncate decimal and store integer into HIGHER.
<4> store AGERNG _N2 into HIGHER.
If LOWER le HIGHER
add LOWER and HIGHER and divide by 2, truncate decimal and store integer in
AGE
store AGE in AGEGES1_NUM
store in AGEGES1_TP
If AGEDOB_5 = D
store (current year - AGE - <1>) in BYY1
store (current year - AGE) in BYY2
Skip Instructions
If LOWER > HIGHER, GOTO ERR_AGERNG_T2
<3,4> if AGEDOB_5 = Don't know, GOTO YEARPIC
else, GOTO GOTO AGEDOB_1, to collect information about next person in
roster,
else, GOTO NATOR
Hard Edits
ERR_AGERNG_T2
* The higher age must be larger than the lower age.
* Please correct.
goto AGERNG_N1
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Wednesday, June 14, 2017
Page 61 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.165_1
Variable Name
YEARPIC
Universe
[AGE is valid and [AGERNG_T2 or AGEGES1 or AGECK have AGEDOB_5 = Don't
know] and [BYY1 and BYY2 are not blank]
Universe-text
Person's age is known and birth year answered with 'don't know'
Question Text
Would you say that [fill 1] born in:
Answer Codes
1. [BYY1]
2. [BYY2]
3. Neither is correct
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Year Pick
[fill 1]
if PX = LNO_RESP, "you were"
else, "[ALIAS[PX]] was"
Special Instructions <1> store BYY1 in BYY.
<2> store BYY2 in BYY.
Skip Instructions
<1,2,3, D,R> GOTO AGEDOB_1, to collect information about next person in roster,
else, GOTO NATOR
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Wednesday, June 14, 2017
Page 62 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.170
Variable Name
NATOR
Universe
HHSTAT ne D and [(POS2 = 0 and POS3 = 0) or (ADC = 2)]
Universe-text
All nondeleted persons in parent cases or all nondeleted persons being added in spawn
cases.
Question Text
(book) H1 ? [F1]
[fill 1] to be Hispanic or Latino?
* Read if necessary.
Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American
Other Latin American
Other Hispanic/Latino/Spanish
(Where did [fill 2] ancestors come from?)
Answer Codes
Question Type
1. Yes
2. No
Refused
Don’t know
Yes/No
Field Pane Description
Fill Instructions
National Origin
[fill 1]
if PX = family respondent then "Do you consider yourself to be Hispanic or Latino?"
else if SEX(PX) = Male(1) then "Does [ALIAS(PX)] consider himself to be Hispanic or
Latino?"
else "Does [ALIAS(PX)] consider herself to be Hispanic or Latino?"
[fill 2]
If PX = family respondent then "your" else "[ALIAS(PX)]'s"
Special Instructions Gray out the entries in this table for the original persons carried over to the spawn case
from the parent case or from a first level spawn case (for a second level spawn case).
These entries should not be allowed to be updated.
Skip Instructions
<1> GOTO HISPAN
<2,D,R> GOTO NATOR for next person in roster
ELSE GOTO RACE
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H_NATOR
Wednesday, June 14, 2017
Page 63 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.170_H
Variable Name
H_NATOR
Universe
Universe-text
Question Text
Hand Flashcard H1 to the respondent.
The national or cultural group from which the person is descended as determined by
the nationality or lineage of the person's ancestors. There is no set rule as to how
many generations affect origin: a person may report his/her origin based on that of a
parent, grandparent or a far-removed ancestor.
If the respondent does not understand "National origin or ancestry", read the probe:
"Where did ___'s ancestors come from?"
If questioned as to why only Hispanic groups are included, say that we collect
information on different groups of people, and we are trying to increase the reliability of
the data on Hispanics.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
NATOR
CHG_NATOR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 64 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.180
Variable Name
HISPAN
Universe
NATOR = yes
Universe-text
National origin was answered yes to being Hispanic or Latino
Question Text
(book) H1 ? [F1]
Please give me the number of the group that represents [ fill: your/ ALIAS’s} Hispanic
origin or ancestry.
You may choose up to five (5), if applicable.
* If a nonhispanic group is named, backup to previous screen and change the answer
from "yes" to "no".
Enter all that apply, separate with commas.
Answer Codes
Question Type
1. Puerto Rican
2. Cuban/Cuban American
3. Dominican (Republic)
4. Mexican
5. Mexican American
6. Central or South American
7. Other Latin American
8. Other Hispanic/Latino/Spanish
Refused
Don’t know
Enter All That Apply
Field Pane Description
Hispanic Origin
Fill Instructions
Special Instructions Mark up to 5
Skip Instructions
<1-6,> GOTO NATOR (for the next person), else GOTO RACE
<7> GOTO HIS_SP2
<8> GOTO HIS_SP3
Hard Edits
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H_HISPAN
Wednesday, June 14, 2017
Page 65 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.180_H
Variable Name
H_HISPAN
Universe
Universe-text
Question Text
If the respondent reports a name instead of the number of a group:
- Enter the number corresponding to the name.
- If the name does not correspond to a listed group, probe by repeating the question:
"Please give me the number of the group."
- Back up to return to "NATOR" if the group is not Hispanic. Then, change "NATOR"
from precode 1 (Yes) to precode 2 (No).
Do not suggest an answer to the respondent and do not try to explain or define any
groups. Do not draw any conclusions based on personal observation.
Enter the numbers of up to 5 Hispanic origin groups per person, if appropriate.
If questioned as to why only Hispanic groups are included, say that we collect
information on different groups of people, and we are trying to increase the reliability of
the data on Hispanics.
If the response is precode 7 (Other Latin American) or precode 8 (Other
Hispanic/Latino/Spanish), probe for the country.
If the country falls into one of the categories corresponding to precodes 1, 2, 4, 5, or 6,
enter the appropriate precode.
If the country does not fall into one of the categories corresponding to precodes 1, 2, 4,
5, or 6, accept the respondent's response of "Other Latin American" or "Other
Hispanic/Latino/Spanish" regardless of the response. Then, enter either precode 7 or 8
(whichever applies).
Refer to the list of (6) Central or South American:
CENTRAL OR SOUTH AMERICAN
Argentinean
Bolivian
Chilean
Colombian
Costa Rican
Ecuadorian
Guatemalan
Honduran
Nicaraguan
Panamanian
Paraguayan
Peruvian
El Salvadoran
Uruguayan
Venezuelan
Answer Codes
Wednesday, June 14, 2017
Page 66 of 124
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
HISPAN
CHG_HISPAN
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 67 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.190
Variable Name
HIS_SP2
Universe
HISPAN=(7 or other Latin American)
Universe-text
HISPAN answered from selection 7 for Hispanic origin.
Question Text
? [F1]
* Probe for the country.
* If any of the following are mentioned, backup to previous screen and correct the entry.
Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American (REFER TO HELP SCREEN)
* (F1) For a list of Central or South American countries.
* Specify the other Latin American.
Answer Codes
Question Type
Text
Field Pane Description
Other Latin American
Fill Instructions
Special Instructions
Skip Instructions
GOTO NATOR (for the next person)
else GOTO RACE
Hard Edits
Soft Edits
AssocHelp
H_SPECH
Wednesday, June 14, 2017
Page 68 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.190_H
Variable Name
H_SPECH
Universe
Universe-text
Question Text
Refer to the following list for Central or South American:
CENTRAL OR SOUTH AMERICAN
Argentinean
Bolivian
Chilean
Colombian
Costa Rican
Ecuadorian
Guatemalan
Honduran
Nicaraguan
Panamanian
Paraguayan
Peruvian
El Salvadoran
Uruguayan
Venezuelan
Do not suggest an answer to the respondent and do not try to explain or define any
groups. Do not draw any conclusions based on personal observation.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
HIS_SP2
HIS_SP3
CHG_HIS_SP2
CHG_HIS_SP3
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 69 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.195
Variable Name
HIS_SP3
Universe
HISPAN= 8 (other Hispanic/Latino)
Universe-text
HISPAN answer from selection 8 (other Hispanic/Latino) origin
Question Text
? [F1]
* Probe for the country.
* If any of the following are mentioned, backup to previous screen and correct the entry.
Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American (REFER TO HELP SCREEN)
* (F1) For a list of Central or South American countries.
* Specify the other Hispanic/Latino/Spanish.
Answer Codes
Question Type
Text
Field Pane Description
Other Hisp/Lat
Fill Instructions
Special Instructions
Skip Instructions
GOTO NATOR (for the next person)
else GOTO RACE
Hard Edits
Soft Edits
AssocHelp
H_SPECH
Wednesday, June 14, 2017
Page 70 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.200
Variable Name
RACE
Universe
HHSTAT ne D and [(POS2 = 0 and POS3 = 0) or (ADC = 2)]
Universe-text
All nondeleted persons in parent cases or all nondeleted persons being added in spawn
cases.
Question Text
( book) H2 ? [F1]
What race or races [fill 1] to be? Please select 1 or more of these categories.
* Enter all that apply, separate with commas.
Answer Codes
Question Type
1. White
2. Black/African American
3. Indian (American)
4. Alaska Native
5. Native Hawaiian
6. Guamanian or Chamorro
7. Samoan
8. Other Pacific Islander
9. Asian Indian
Enter All That Apply
Field Pane Description
Fill Instructions
10. Chinese
11. Filipino
12. Japanese
13. Korean
14. Vietnamese
15. Other Asian
16. Some other race
Refused
Don’t know
Race
[fill 1]
if PX = LNO_RESP, then "do you consider yourself"
elseif SEX(PX) = Male(1), then "does [ALIAS(PX)] consider himself"
else "does [ALIAS(PX)] consider herself"
Special Instructions Allow up to 6 answers, and narrow down to 5.
Gray out the entries in this table for the original persons carried over to the spawn case
from the parent case or from a first level spawn case (for a second level spawn case).
These entries should not be allowed to be updated.
Skip Instructions
<1-7, 9-14> If more than one selected, goto MLTRAC
elseif at least one person with AGE[PX] = 18-64 goto NOWAF_A
elseif TOTPCNT = 1 goto fid.HHCHANGE
else goto HHREF_A
<8> goto RAC_SP1
<15> goto RAC_SP2
<16> goto RAC_SP3
goto RACE, for the next person in roster,
elseif at least one person with AGE[PX] = 18-64 goto NOWAF_A
elseif TOTPCNT = 1 goto fid.HHCHANGE
else goto HHREF_A
Hard Edits
Soft Edits
Wednesday, June 14, 2017
Page 71 of 124
AssocHelp
H_RACE
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.200_H
Variable Name
H_RACE
Universe
Universe-text
Question Text
Hand Flashcard H2 to the respondent.
Enter the numbers of up to 5 Racial groups per person, if appropriate.
Do not suggest an answer to the respondent and do not try to explain or define any
groups. Do not draw any conclusions based on personal observation.
If the response is Other Pacific Islander or Other Asian, enter 8 or 15 and select the
name of the group to which the person belongs from the lookup table. If that name is
not in the table, then select ZZ and go to the specify screen and type in the verbatim
response given to you.
For any other response that is not exactly the same as the groups on the Race card,
enter 16 and select the name of the group based on the verbatim response from the
lookup table. If that name is not in the table, then select ZZ and go to the specify
screen and type in the verbatim response given to you.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
RACE
CHG_RACE
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 72 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.210
Variable Name
RAC_SP1
Universe
RACE = 8 (Other Pacific Islander)
Universe-text
"Other Pacific Islander" race is selected
Question Text
FR: Specify the other pacific islander.
If the respondent’s answer could not be found, clear entry, type ‘ZZ’.
If any of the following are mentioned, go back to RACE screen to correct.
White
Black/African American
Indian (American)
Alaska Native
Native Hawaiian
Guamanian or Chamorro
Samoan
Answer Codes
Question Type
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Text (name of race)
Text
Field Pane Description
Other Pacific Islander
Fill Instructions
Special Instructions For each race chosen from the race lookup table, store the text and numeric code(s) in
the subsequent storage variable fields. The text will be stored in HHC.210 (RAC_SP1)
and in RAC_SP1_Text, while the numeric code(s) will be stored in HHC.210_02
(RAC_SP1_Code1) to HHC.210_05 (RAC_SP1_Code4).
Skip Instructions
If <15> is also selected in RACE GOTO RAC_SP2,
else if <16> is also selected in RACE GOTO RAC_SP3,
else if <1-7, 9-14> also selected in RACE GOTO MLTRAC,
else GOTO RACE for next person on the roster
elseif at least one person with AGE[PX] = 18-64] goto NOWAF_A
elseif TOTPCNT = 1 goto fid.HHCHANGE
else goto HHREF_A
goto RAC_SP1A
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 73 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.210_02
Variable Name
RAC_SP1_Code1
Universe
RAC_SP1 eq any race
Universe-text
Any race is selected from the pick screen of RAC_SP1
Question Text
Answer Codes
Question Type
<1-16> (First numeric code value from the race lookup table)
Instrument Out Variable
Field Pane Description
Other Pacific Islander
Fill Instructions
Special Instructions Set to first numeric code value from the lookup table.
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 74 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.210_03
Variable Name
RAC_SP1_Code2
Universe
RAC_SP1 eq any race
Universe-text
Any race is selected from the pick screen of RAC_SP1
Question Text
Answer Codes
Question Type
<1-16> (Second numeric code value from the race lookup table)
Instrument Out Variable
Field Pane Description
Other Pacific Islander
Fill Instructions
Special Instructions Set to second numeric code value, if there is one, from the lookup table.
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 75 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.210_04
Variable Name
RAC_SP1_Code3
Universe
RAC_SP1 eq any race
Universe-text
Any race is selected from the pick screen of RAC_SP1
Question Text
Answer Codes
Question Type
<1-16> (Third numeric code value from the race lookup table)
Instrument Out Variable
Field Pane Description
Other Pacific Islander
Fill Instructions
Special Instructions Set to third numeric code value, if there is one, from the lookup table.
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 76 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.210_05
Variable Name
RAC_SP1_Code4
Universe
RAC_SP1 eq any race
Universe-text
Any race is selected from the pick screen of RAC_SP1
Question Text
Answer Codes
Question Type
<1-16> (Fourth numeric code value from the race lookup table)
Instrument Out Variable
Field Pane Description
Other Pacific Islander
Fill Instructions
Special Instructions Set to fourth numeric code value, if there is one, from the lookup table.
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 77 of 124
Module
03
Section Name
Household composition
Part
2
Question ID
HHC.210_1
Variable Name
RAC_SP1A
Universe
RAC_SP1='ZZ NOT LISTED'
Universe-text
Selection in data base not found, go here to input actual response
Question Text
* Enter the Other Pacific Islander as reported by the respondent.
Answer Codes
Question Type
Text
Field Pane Description
Not Listed Other Pacific Islander
Fill Instructions
Special Instructions 1. Don't allow 'don't know' or 'refused'.
2. Add a new column to the right of the 'OTHER' column in the FORM PANE.
Skip Instructions
If <15> is also selected in RACE GOTO RAC_SP2,
else if <16> is also selected in RACE GOTO RAC_SP3,
else if <1-7, 9-14> also selected in RACE GOTO MLTRAC,
else GOTO RACE for next person on the roster
elseif at least one person with AGE[PX] = 18-64] goto NOWAF_A
elseif TOTPCNT = 1 goto fid.HHCHANGE
else goto HHREF_A
Hard Edits
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Wednesday, June 14, 2017
Page 78 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.212
Variable Name
RAC_SP2
Universe
[RACE = 15 (Other Asian)]
Universe-text
"Other Asian" race is selected.
Question Text
* Specify the other Asian.
* If the respondent's answer could not be found, type 'ZZ'.
* If any of the following are mentioned, backup to previous item and correct the entry.
White
Black/African American
Indian (American)
Alaska Native
Native Hawaiian
Guamanian or Chamorro
Samoan
Answer Codes
Question Type
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Text (name of race)
Text
Field Pane Description
Other Asian
Fill Instructions
Special Instructions For each race chosen from the race lookup table, store the text and numeric code(s) in
the subsequent storage variable fields. The text will be stored in HHC.212 (RAC_SP2)
and in RAC_SP2_Text, while the numeric code(s) will be stored in HHC.212_02
(RAC_SP2_Code1) to HHC.212_05 (RAC_SP2_Code4).
Skip Instructions
If <16> also selected in RACE GOTO RAC_SP3,
else if <1-7, 9-14> also selected in RACE GOTO MLTRAC,
else GOTO RACE for the next person on the roster,
elseif at least one person with AGE[PX] = 18-64] goto NOWAF_A
elseif TOTPCNT = 1 goto fid.HHCHANGE
else goto HHREF_A
goto RAC_SP2A
Hard Edits
Soft Edits
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Wednesday, June 14, 2017
Page 79 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.212_02
Variable Name
RAC_SP2_Code1
Universe
RAC_SP2 eq any country
Universe-text
Any country is selected from the pick screen of RAC_SP2
Question Text
Answer Codes
Question Type
<1-16> (First numeric code value from the race lookup table)
Instrument Out Variable
Field Pane Description
Other Asian
Fill Instructions
Special Instructions Set to first numeric code value from the lookup table.
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 80 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.212_03
Variable Name
RAC_SP2_Code2
Universe
RAC_SP2 eq any country
Universe-text
Any country is selected from the pick screen of RAC_SP2
Question Text
Answer Codes
Question Type
<1-16> (Second numeric code value from the race lookup table)
Instrument Out Variable
Field Pane Description
Other Asian
Fill Instructions
Special Instructions Set to second numeric code value, if there is one, from the lookup table.
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 81 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.212_04
Variable Name
RAC_SP2_Code3
Universe
RAC_SP2 eq any country
Universe-text
Any country is selected from the pick screen of RAC_SP2
Question Text
Answer Codes
Question Type
<1-16> (Third numeric code value from the race lookup table)
Instrument Out Variable
Field Pane Description
Other Asian
Fill Instructions
Special Instructions Set to third numeric code value, if there is one, from the lookup table.
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 82 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.212_05
Variable Name
RAC_SP2_Code4
Universe
RAC_SP2 eq any country
Universe-text
Any country is selected from the pick screen of RAC_SP2
Question Text
Answer Codes
Question Type
<1-16> (Fourth numeric code value from the race lookup table)
Instrument Out Variable
Field Pane Description
Other Asian
Fill Instructions
Special Instructions Set to fourth numeric code value, if there is one, from the lookup table.
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 83 of 124
Module
03
Section Name
Household composition
Part
2
Question ID
HHC.212_1
Variable Name
RAC_SP2A
Universe
RAC_SP2='ZZ NOT LISTED'
Universe-text
Selection in data base not found, go here to input actual response
Question Text
* Enter the Other Asian as reported by the respondent.
Answer Codes
Question Type
Text
Field Pane Description
Not Listed Other Asian
Fill Instructions
Special Instructions 1. Don't allow 'don't know' or 'refused'.
2. Add a new column to the right of the 'OTHER' column in the FORM PANE.
Skip Instructions
If <16> also selected in RACE GOTO RAC_SP3,
else if <1-7, 9-14> also selected in RACE GOTO MLTRAC,
else GOTO RACE for the next person on the roster,
elseif at least one person with AGE[PX] = 18-64] goto NOWAF_A
elseif TOTPCNT = 1 goto fid.HHCHANGE
else goto HHREF_A
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 84 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.214
Variable Name
RAC_SP3
Universe
RACE = 16 (Some other race)
Universe-text
"Some other race" race is selected.
Question Text
* Specify the other race.
* If any of the following are mentioned, backup to previous item and correct the entry.
White
Asian Indian
Black/African American
Chinese
Indian (American)
Filipino
Alaska Native
Japanese
Native Hawaiian
Korean
Guamanian or Chamorro Vietnamese
Samoan
* If the respondent's answer could not be found, type 'ZZ' to enable you to type an entry.
Answer Codes
Question Type
Text (name of race)
Text
Field Pane Description
Other Race
Fill Instructions
Special Instructions For each race chosen from the race lookup table, store the text and numeric code(s) in
the subsequent storage variable fields. The text will be stored in HHC.214 (RAC_SP3)
and in RAC_SP3_Text, while the numeric code(s) will be stored in HHC.214_02
(RAC_SP3_Code1) to HHC.214_05 (RAC_SP3_Code4).
Skip Instructions
If <1-7, 9-14> also selected in RACE GOTO MLTRAC,
else GOTO RACE for the next person on the roster,
elseif at least one person with AGE[PX] = 18-64] goto NOWAF_A
elseif TOTPCNT = 1 goto fid.HHCHANGE
else goto HHREF_A
goto RAC_SP3A
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 85 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.214_02
Variable Name
RAC_SP3_Code1
Universe
RAC_SP3 eq any country
Universe-text
Any country is selected from the pick screen of RAC_SP3
Question Text
Answer Codes
Question Type
<1-16> (First numeric code value from the race lookup table)
Instrument Out Variable
Field Pane Description
Other Race
Fill Instructions
Special Instructions Set to first numeric code value from the lookup table.
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 86 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.214_03
Variable Name
RAC_SP3_Code2
Universe
RAC_SP3 eq any country
Universe-text
Any country is selected from the pick screen of RAC_SP3
Question Text
Answer Codes
Question Type
<1-16> (Second numeric code value from the race lookup table)
Instrument Out Variable
Field Pane Description
Other Race
Fill Instructions
Special Instructions Set to second numeric code value, if there is one, from the lookup table.
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 87 of 124
Module
03
Section Name
Household Composition
Part
Question ID
HHC.214_04
Variable Name
RAC_SP3_Code3
Universe
RAC_SP3 eq any country
Universe-text
Any country is selected from the pick screen of RAC_SP3
Question Text
Answer Codes
Question Type
<1-16> (Third numeric code value from the race lookup table)
Instrument Out Variable
Field Pane Description
Other Race
Fill Instructions
Special Instructions Set to third numeric code value, if there is one, from the lookup table.
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 88 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.214_05
Variable Name
RAC_SP3_Code4
Universe
RAC_SP3 eq any country
Universe-text
Any country is selected from the pick screen of RAC_SP3
Question Text
Answer Codes
Question Type
<1-16> (Fourth numeric code value from the race lookup table)
Instrument Out Variable
Field Pane Description
Other Race
Fill Instructions
Special Instructions Set to fourth numeric code value, if there is one, from the lookup table.
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 89 of 124
Module
03
Section Name
Household composition
Part
2
Question ID
HHC.214_1
Variable Name
RAC_SP3A
Universe
RAC_SP3='ZZ NOT LISTED'
Universe-text
Selection in data base not found, go here to input actual response
Question Text
* Enter the Other Race as reported by the respondent.
Answer Codes
Question Type
Text
Field Pane Description
Not Listed Other Race
Fill Instructions
Special Instructions 1. Don't allow 'don't know' or 'refused'.
2. Add a new column to the right of the 'OTHER' column in the FORM PANE.
Skip Instructions
If more than one selected in RACE GOTO MLTRAC,
then GOTO RACE for next person on the roster.
elseif at least one person with AGE[PX] = 18-64] goto NOWAF_A
elseif TOTPCNT = 1 goto fid.HHCHANGE
else goto HHREF_A
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 90 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.220
Variable Name
MLTRAC
Universe
More than one race entered
Universe-text
More than one race entered
Question Text
? [F1]
Which one of these groups, that is
[fill 1]
would you say BEST represents [fill 2] race?
Answer Codes
Question Type
[fill 1]
Refused
Don’t know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Multiple Race
[fill 1]
display as 2 columns, answer codes entered in RACE in the order entered.
[fill 2]
if PX = LNO_RESP, "your"
else "[ALIAS[PX]]"
Special Instructions
Skip Instructions
<1-16,Refused,Don't know> If enter code that is not displayed goto ERR_MLTRAC
elseif at least one person with AGE[PX] = 18-64] goto NOWAF_A
elseif TOTPCNT = 1 goto fid.HHCHANGE
else goto HHREF_A
Hard Edits
ERR_MLTRAC
* Select valid race group number.
* Please correct.
Soft Edits
AssocHelp
H_MLTRAC
Wednesday, June 14, 2017
Page 91 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.220_H
Variable Name
H_MLTRAC
Universe
Universe-text
Question Text
If the respondent does not know which racial group best represents the person with a
multi-racial background, enter 'CTRL-D' for don't know, otherwise enter the number of
the group.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
MLTRAC
CHG_MLTRAC
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 92 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.230
Variable Name
NOWAF_A
Universe
If household contains 1 or more persons 18-64 years old and (ADC = empty or ADC =
1)
Universe-text
If household contains 1 or more persons 18-64 years old
Question Text
? [F1]
[fill 1]
* Persons eligible: **/display eligible persons in column format/**
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Fill Instructions
Now Armed Forces
[fill 1]
if ADULTCNT > 1
Is anyone in the household now on full-time active duty with the armed forces?
elseif family respondent is the only adult
Are you now on full-time active duty with the Armed Forces?
else
Is {[fill2: ALIAS] now on full-time active duty with the Armed Forces?
[fill2: ALIAS]= the name of person who pertains to this question
Special Instructions 1. BEFORE NOWAF_A screen: [Set ADULTCNT = # of persons with AGE in (18-64)
2. In Question Text, display all eligible persons in blue text underneath the Question.
3. If NOWAF_A=1 and ADULTCNT=1, for that person
set HHSTAT3=A
set NOWAF2_B = that person's line #
Skip Instructions
<1> if ADULTCNT = 1 and PCNT = 1 and I_SCRN_STATUS = S
goto SCREENIN
elseif I_SCRN_STATUS = I
goto EXIT
else
goto NOWAF2_B
endif
< 2,D,R> if ADC = 2 and POS2 ne 0
goto ADC
elseif I_SCRN_STATUS = S
if all PX with HHSTAT ne D have NATOR = 2 and RACE NOT IN
(2,9,10,11,12,13,14,15) and RACE ne empty
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goto SCREENIN
endif
elseif all PX have HHSTAT = D or HHSTAT3 = A
goto EXIT
else
goto HHREF_A
endif
Hard Edits
Soft Edits
AssocHelp
H_NOWAF
Wednesday, June 14, 2017
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Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.230_2
Variable Name
NOWAF2_B
Universe
NOWAF_A=yes and ADULTCNT gt one
Universe-text
At least 1 person in the AF & more than 1 person eligible to be in the AF
Question Text
? [F1]
Who is this? (Anyone else?)
* Enter applicable line number(s), separate with commas.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
More Than 1 in AF
Fill Instructions
Special Instructions 1. In the Question Text, DISPLAY all eligible persons.
2. Don't allow a 'D' or 'R' answer.
3. Whoever is marked: store HHSTAT3=A
Skip Instructions
<1-25> if ADC = 2 and POS2 ne 0
goto ADC
elseif I_SCRN_STATUS = S
if all PX with HHSTAT ne D have NATOR = 2 and RACE NOT IN
(2,9,10,11,12,13,14,15) and RACE ne empty
goto SCREENIN
endif
elseif all PX have HHSTAT = D or HHSTAT3 = A
goto EXIT
else
goto HHREF_A
endif
if invalid person # selected, GOTO ERR_NOWAF2_B
Hard Edits
ERR_NOWAF2_B
* Invalid person number selected.
* Please correct.
Soft Edits
AssocHelp
H_NOWAF
Wednesday, June 14, 2017
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Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.230_H
Variable Name
H_NOWAF
Universe
Universe-text
Question Text
Refer to the following table to determine if specific service is considered "active duty".
TYPE OF SERVICE
ACTIVE
DUTY?
Now serving full-time (including the 6-month period (of training) in:
1)U.S. Army/Navy/Air Force/Marine Corps/Coast Guard
2)Military service of a foreign country
YES
In a Reserve branch of any of the above currently activated
as part of the regular forces
YES
U.S. Public Health Service commissioned office currently
assigned to any branch of the armed forces
Members of the National Guard currently blanketed into the
regular forces by Presidential Order
TYPE OF SERVICE
YES
YES
ACTIVE
DUTY?
Cadets in U.S. military academy (West Point, Naval Academy,
Air Force Academy or Coast Guard Academy)
Persons whose only service is in the Coast Guard Temporarily
Reserve
Employees of the Merchant Marine, Maritime Commission, or
American Field Service
YES
NO
NO
Civilian employees of the Department of Defense
TYPE OF SERVICE
NO
ACTIVE
DUTY?
Persons in a National Guard or Reserve unit not currently
activated as part of the regular armed forces, even though:
1) currently attending meetings or summer camp
2) currently activated by Gubernatorial order because of a
disaster or civil disorder (flood, riot, etc.)
Wednesday, June 14, 2017
NO
Page 96 of 124
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
NOWAF_A
NOWAF2_B
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 97 of 124
Module
03
Section Name
Household Composition
Part
2
Question ID
HHC.240
Variable Name
EXIT
Universe
All HH members where HHSTAT = D or HHSTAT3 = A or
I_SCRN_STATUS = S and all PX with HHSTAT ne D have NATOR = 2 and RACE
NOT IN (2,9,10,11,12,13,14,15) and RACE ne empty
Universe-text
All persons are either deleted or in the Armed Forces or at least one persons is in the
armed forces and all others are deleted or all are non-Armed Forces persons and are
not Black or Asian or Hispanic and not marked for an interview or some, but not all, are
in the armed forces or deleted
Question Text
? [F1]
Not every household in our survey is asked all questions. I have all the information
about your household that I need at this time. Thank you for your assistance.
* Enter (1) to proceed.
Answer Codes
Question Type
Enter 1 to Continue
Field Pane Description
Screen Out Cases
Fill Instructions
Special Instructions if PCNT = 0,
set OUTCOME = Occupied entirely by URE (225)
set BYOBS = 2
elseif PCNT >= 1 and at least one PX has HHSTAT3 = A and all other PX have
HHSTAT = D or HHSTAT3 = A
set OUTCOME = Occupied entirely by armed forces members (223)
set BYOBS = 2
elseif I_SCRN_STATUS = S and Screenin = 0
set OUTCOME = Screened out by household (236)
set BYOBS = 2
Skip Instructions
<1> GOTO VISITCNT (Back Section)
Hard Edits
Soft Edits
AssocHelp
H_EXIT
Wednesday, June 14, 2017
Page 98 of 124
Module
03
Section Name
Household Composition
Part
3
Question ID
HHC.240_H
Variable Name
H_EXIT
Universe
Universe-text
Question Text
Interviews in households designated for screening will end at this point if no household
member is Black/African-American, Asian, or Hispanic.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
EXIT
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 99 of 124
Module
03
Section Name
Household Composition
Part
3
Question ID
HHC.250_1
Variable Name
HHREF_A
Universe
If more than one non-deleted person in the HH
Universe-text
If more than one non-deleted person in the HH
Question Text
* [fill 1] has been selected as the household reference person. Is this household
member an appropriate choice? Preferably a civilian adult?
[fill 2]
* Press shift F1 to see full roster information.
Answer Codes
Question Type
1. Yes, accept this person
2. No, select another person
Pick One - answer list pane
Field Pane Description
Fill Instructions
HH Reference Person Okay
[fill 1] = [ALIAS(PX)]
to select PX
1. Person with the lowest PX, whose age ge 18 and HHSTAT3 ne A and HHSTAT ne D
2. Else, person with the lowest PX, whose age ge 14 and HHSTAT ne D
[fill 2] all non-deleted household members ge 14 years of age
Special Instructions <1> If POS2 and POS3 = 0, store P in HHSTAT, endif
store PX in HHREF_B
store F in HHSTAT6
store <1> in RPREL
if FX = null, store 1 in FX, endif
set FAMINT = FX
Skip Instructions
<1> GOTO RPREL
<2> GOTO HHREF_B
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 100 of 124
Module
03
Section Name
Household Composition
Part
3
Question ID
HHC.250_2
Variable Name
HHREF_B
Universe
HHREF_A= no
Universe-text
Selecting another Reference person
Question Text
* Select another household member for the reference person.
* Enter the line number of the Household Reference person.
Answer Codes
Question Type
Pick One - answer list pane
Field Pane Description
HH Ref Person
Fill Instructions
Special Instructions 1. Display in Answer Codes all household members and gray out non-applicable
members.
2. [If AF person entered ) and (there is another person >18),
goto ERR1_HHREF_B to reject answer, and then another choice is entered.
3. [If person entered < 18 years old), and (another person >18 and not in the AF and
not deleted) then DISPLAY HHREF person,
goto ERR2_HHREF_B
4.
Skip Instructions
If POS2 and POS3 = 0, store P in HHSTAT, endif
store F in HHSTAT6
store <1> in RPREL
if FX = null, store 1 in FX, endif
set FAMINT = FX
<1-25> GOTO RPREL
Hard Edits
Soft Edits
ERR1_HHREF_B
* You have selected an Armed Forces person.
* Please select another person.
ERR2_HHREF_B
* You have selected a person less than 18 years old.
* Please select another person.
AssocHelp
Wednesday, June 14, 2017
Page 101 of 124
Module
03
Section Name
Household Composition
Part
4
Question ID
HHC.260
Variable Name
RPREL
Universe
All where RPREL NE Reference Person
Universe-text
All where RPREL NE Reference Person
Question Text
(book) H3 ? [F1]
[fill 4]
Answer Codes
Question Type
2. Spouse (husband/wife)
3. Unmarried Partner
4. Child (biological/ adoptive/
in-law/ step/ foster)
5. Child of partner
6. Grandchild
7. Parent (biological/ adoptive/
in-law/ step/ foster)
8. Brother/Sister (biological/
adoptive/ in-law/ step/ foster)
Pick One - answer list pane
Field Pane Description
Fill Instructions
9. Grandparent
(Grandmother/Grandfather)
10. Aunt/Uncle
11. Niece/Nephew
12. Other relative
13. Housemate/Roommate
14. Roomer/Boarder
15. Other non-relative
16. Legal Guardian
17. Ward
Refused
Don't know
Relationship to Reference Person
[fill 1] if HHRESP = HHREF_B fill "your"
else fill "[ALIAS(HHREF_B)]'s"
[fill 2] ALIAS(PX)
[fill 3] ALIAS(PX) of first person with RPREL = 2 or 3
if PX = HHRESP
[fill 4] What is [fill 1] relationship to you?
else
[fill 4] What is [fill 1] relationship to [fill 2]?
[fill 5] if SEX(HHREF_B) = Male (1), then "him", else "her"
[fill 6] ALIAS(HHREF_B)
[fill 7] if SEX(HHREF_B) = MALE, then fill "father", else fill "mother".
[fill 8] if SEX(PX) = MALE, then fill "father", else fill "mother".
Special Instructions <2> set AGEDIFF = |AGE[HHREF_B] - AGE[PX]|
<4,6> set AGEDIFF = AGE[HHREF_B] - AGE[PX]
<7,9> set AGEDIFF = AGE [PX] - AGE[HHREF_B]
<2-12, 16, 17, D, R> if FX[PX] = null, set FX[PX] = 1
<13-15> set UNRELTAL = UNRELTAL + 1
if POS3 ne O, set HHSTAT[PX] = D
After RPREL[PX] is collected for all persons: if UNRELTAL = 1, set FX[PX] of
Wednesday, June 14, 2017
Page 102 of 124
unrelated person (RPREL[PX] = 13-15) to next available FX.
<2> store 1 in MS[PX] and MS[HHREF_B] and SPOUS[PX] and SPOUS[HHREF_B]
store HHREF_B in SPOUS2[PX] and PX in SPOUS2[HHREF_B]
<3> store 6 in MS[PX] and MS[HHREF_B]
store PX in COHAB3[HHREF_B] and HHREF_B in COHAB3[PX]
Skip Instructions
Loop through all non-deleted PX
<2> if SEX(PX) = SEX(HHREF_B), GOTO ERR6_RPREL
elseif AGEDIFF GE 30, GOTO ERR7_RPREL
<2, 3> if selected for more than one PX, GOTO ERR4_RPREL
elseif AGE < 14, GOTO ERR1_RPREL
<4> if SEX[HHREF_B] = Male, store HHREF_B in LNDAD(PX)
else, store HHREF_B in LNMOM(PX), endif
if AGEDIFF = 5-14, GOTO ERR9_RPREL
elseif AGEDIFF GE 50, GOTO ERR10_RPREL
GOTO DEGREE1
<5> if loop is completed and no PX has RPREL = 3, GOTO ERR5_RPREL, endif
<6> if AGEDIFF < 25, GOTO ERR2_RPREL, endif
<7> if AGEDIFF= 5-14, GOTO ERR12_RPREL
elseif AGEDIFF GE 50, GOTO ERR13_RPREL
GOTO DEGREE2
<8> GOTO DEGREE3
<9> if AGEDIFF < 25, GOTO ERR3_RPREL, endif
<16> if AGE LT 18 GOTO ERR14_RPREL
<10-15,17, D, R>
end loop
if UNRELTAL > 1, GOTO FAMNUM
else GOTO HHCHANGE
Hard Edits
ERR1_RPREL:
*Spouse/partner must be 14 years old or older.
*Please correct.
ERR4_RPREL:
I have recorded that [fill 3] and [fill 2] are spouses or unmarried partners of [fill 6].
Which one is correct?
*First GOTO is for [fill 3]
*Second GOTO is for [fill 2]
Questions involved
Value
Rprel: Relationship to Ref Person
Spouse (husband/wife) or Unmarried Partner
Rprel: Relationship to Ref Person
Spouse (husband/wife) or Unmarried Partner
***THE 1ST LINE HERE SHOULD REFER TO THIS PERSON: [fill 3]
***THE 2ND LINE HERE SHOULD REFER TO THIS PERSON: [fill 2]
ERR5_RPREL
I have recorded that [fill 2] is a child of a partner. However, no one in the family was
picked as an unmarried partner in order to have this response.
* Please correct .
ERR14_RPREL
I have recorded that [fill2] is under the age of 18 and has been listed as a legal
guardian. Minors cannot be legal guardians. Minors can be wards of their legal
guardians.
*Please correct.
Wednesday, June 14, 2017
Page 103 of 124
*First GOTO is to change Relationship code of [fill 2]
Questions involved
Rprel: Relationship to Ref Person
Value
Legal guardian
***THE 1ST LINE HERE SHOULD REFER TO THIS PERSON: [fill 2]
Edit should trigger when age of ALIAS(PX)=0-17 and RPREL=16 (legal guardian)
Should cover instances where:
if PX = HHRES
[fill 4] What is [fill 1] relationship to you?
else
[fill 4] What is [fill 1] relationship to [fill 2]?
Soft Edits
ERR2_RPREL
I have recorded [fill 6] is [AGE(HHREF_B)] years old and [fill:his/her] grandchild [fill 2] is
[AGE(PX)] years old.
Are these ages and relationships correct?
ERR3_RPREL
I have recorded [fill 6] is [AGE(HHREF_B)] years old and [fill:his/her] grandparent [fill 2]
is [AGE(PX)] years old.
Are these ages and relationships correct?
ERR6_RPREL
*Do not read this message to the respondent.
*The married couple [ALIAS(PX)] and [ALIAS(HHREF_B)] are both [SEX (PX)].
*Suppress message if correct.
*Otherwise, correct SEX of either person or choose different spouse.
*First GOTO is to change Relationship code of [fill 2]
*Second GOTO is to change SEX of spouse [fill 2]
*Third GOTO is to change SEX of Ref Person [fill 6]
Questions involved
RPREL: Relationship to Ref Person
SEX
SEX
Value
Spouse (husband/wife)
SEX (PX)
SEX (HHREF_B)
ERR7_RPREL
*Age difference between spouses is greater than or equal to 30 years.
I have recorded [fill 6] is [AGE(HHREF_B)] years old and [fill: his/her] spouse
[ALIAS(PX)] is [AGE(PX)] years old. Are these ages and relationships correct?
*First GOTO is to change Relationship code of [fill 2]
*Second GOTO is to change AGE of spouse [fill 2]
*Third GOTO is to change AGE of Ref Person [fill 6]
Questions involved
RPREL: Relationship to Ref Person
AGE
AGE
Value
Spouse (husband/wife)
AGE (PX)
AGE (HHREF_B)
ERR9_RPREL
*Age difference between [fill 7] and child is only [AGEDIFF] years.
I have recorded [fill 6] is [AGE(HHREF_B)] years old and [fill:his/her] child [fill 2] is
[AGE(PX)] years old. Are these ages and relationships correct?
Wednesday, June 14, 2017
Page 104 of 124
*First GOTO is to change Relationship code of [fill 2]
*Second GOTO is to change AGE of child [fill 2]
*Third GOTO is to change AGE of parent [fill 6]
Questions involved
RPREL: Relationship to Ref Person
AGE
AGE
Value
Child
AGE (PX)
AGE (HHREF_B)
ERR10_RPREL
* Age difference between [fill 7] and child is greater than or equal to 50 years.
I have recorded [fill 6] is [AGE(HHREF_B)] years old and [fill:his/her] child [ALIAS(PX)]
is [AGE(PX)] years old. Are these ages and relationships correct?
*First GOTO is to change Relationship code of [fill 2]
*Second GOTO is to change AGE of child [fill 2]
*Third GOTO is to change AGE of parent [fill 6]
Questions involved
RPREL: Relationship to Ref Person
AGE
AGE
Value
Child
AGE (PX)
AGE (HHREF_B)
ERR12_RPREL
*Age difference between [fill 8] and child is only [AGEDIFF] years.
I have recorded [fill 6] is [AGE(HHREF_B)] years old and [fill:his/her] [fill 8] [fill 2] is
[AGE(PX)] years old. Are these ages and relationships correct?
*First GOTO is to change Relationship code of [fill 2]
*Second GOTO is to change AGE of parent [fill 2]
*Third GOTO is to change AGE of child [fill 6]
Questions involved
RPREL: Relationship to Ref Person
AGE
AGE
Value
Parent
AGE (PX)
AGE (HHREF_B)
ERR13_RPREL
* Age difference between [fill 8] and child is greater than or equal to 50 years.
I have recorded [fill 6] is [AGE(HHREF_B)] years old and [fill:his/her] [fill 8] [fill 2] is
[AGE(PX)] years old. Are these ages and relationships correct?
*First GOTO is to change Relationship code of [fill 2]
*Second GOTO is to change AGE of parent [fill 2]
*Third GOTO is to change AGE of child [fill 6]
Questions involved
RPREL: Relationship to Ref Person
AGE
AGE
AssocHelp
Value
Parent
AGE (PX)
AGE (HHREF_B)
H_NXTRRP
Wednesday, June 14, 2017
Page 105 of 124
Module
03
Section Name
Household Composition
Part
4
Question ID
HHC.260_H
Variable Name
H_NXTRRP
Universe
Universe-text
Question Text
Hand the respondent Card H3 and enter the relationship to the Reference Person.
All persons listed must be identified by their relationship to the reference person. If the
respondent has previously mentioned the relationship, you may verify the relationship,
rather than asking the question as worded.
(3) Unmarried partner applies to a person who shares living quarters with the
Reference Person because they have a close, personal relationship, but is not married
to the Reference Person. This applies to same-sex partners as well as opposite-sex
partners.
(4) Child applies to all sons and daughters of the Reference Person, including naturalborn, adopted, step, and foster, as well as son/daughter in-law, regardless of age. Do
not enter category (4) for children of an unmarried partner (see (5) Child of Partner
below)
(5) Child of Partner applies to all sons and daughters of the Reference Person's
unmarried partner, for which the Reference Person is not the biological parent.
(7) Parent...In addition to biological (natural) mother or father, parent includes adoptive,
step and foster mother or father, as well as a mother or father in-law.
(8) Brother/Sister - Include half, adopted, step and foster brothers and sisters, as well
as brother/sister in-law.
(12) Other Relative applies to persons related to the Reference Person that cannot be
included in categories (2), (4), or (6) - (11).
(13) Housemate/Roommate applies to all unrelated persons of either sex who share
living quarters with the Reference Person primarily to share expenses or reduce costs.
(14) Roomer/Boarder applies to a person not related to the Reference Person who
occupies a room(s) in the Reference Person's home, pays rent for the room(s), and
may or may not take meals with the Reference Person.
(15) Other Nonrelative applies to any persons not related to the Reference Person that
cannot be included in categories (3), (5), (13), (14), (16), or (17).
(16) Legal Guardian applies to a person appointed to take charge of the affairs of a
minor, or a person not capable of managing his/her own affairs.
(17) Ward applies to a child or person not capable of managing his/her own affairs
placed by law under the care of a guardian or court.
Answer Codes
Wednesday, June 14, 2017
Page 106 of 124
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
RPREL
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 107 of 124
Module
03
Section Name
Household Composition
Part
4
Question ID
HHC.270
Variable Name
DEGREE1
Universe
RPREL= Child
Universe-text
Question Text
? [F1]
[fill 4]
Answer Codes
Question Type
1. Biological (natural) [fill 3]
2. Adoptive [fill 3]
3. Step [fill 3]
4. Foster [fill 3]
5. [fill 5]-in-law
Refused
Don’t know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Child Type
[fill 1] if HHRESP = HHREF_B fill "your", else fill "[ALIAS(HHREF_B)]'s"
[fill 2] ALIAS[PX]
[fill 3] if SEX[PX] = MALE, then fill "son", else fill "daughter"
[fill 5] if SEX[PX] = MALE, then fill "Son", else fill "Daughter"
if PX ne HHRESP
[fill 4] = Is [fill 2], [fill 1] biological (natural), adoptive, step, foster [fill 3] or [fill 3]-in-law?
else
[fill 4] = Are you [fill 1] biological (natural), adoptive, step, foster [fill 3] or [fill 3]-in-law?
Endif
[fill 6] if SEX(HHREF_B) = MALE, then fill "father", else fill "mother".
[fill 7] ALIAS(HHREF_B)
Special Instructions set AGEDIFF = AGE[HHREF_B] - AGE[PX]
Skip Instructions
<1> If AGEDIFF < 5, GOTO ERR1_DEGREE1
<2-5,D,R> If AGEDIFF < 5, GOTO ERR2_DEGREE1
elseif additional persons remain, GOTO RPREL (for next person)
elseif UNRELTAL > 1, GOTO FAMNUM
else GOTO HHCHANGE
Hard Edits
ERR1_DEGREE1
*Age difference between [fill 6] and child is [AGEDIFF] years.
I have recorded [fill 7] is [AGE(HHREF_B)] years old and [fill:his/her] child [fill 2] is
[AGE(PX)] years old.
Are these ages and relationships correct?
Wednesday, June 14, 2017
Page 108 of 124
* Please correct relationship code or age.
*First GOTO is to change Relationship code of [fill 2]
*Second GOTO is to change AGE of child [fill 2]
*Third GOTO is to change AGE of parent [fill 7]
Questions involved
RPREL: Relationship to Ref Person
AGE
AGE
Soft Edits
Value
Child
AGE (PX)
AGE(HHREF_B)
ERR2_DEGREE1
*Age difference between [fill 6] and child is [AGEDIFF] years.
I have recorded [fill 7] is [AGE(HHREF_B)] years old and [fill:his/her] child [fill 2] is
[AGE(PX)] years old.
Are these ages and relationships correct?
*First GOTO is to change Relationship code of [fill 2]
*Second GOTO is to change AGE of child [fill 2]
*Third GOTO is to change AGE of parent [fill 7]
Questions involved
RPREL: Relationship to Ref Person
AGE
AGE
AssocHelp
Value
Child
AGE (PX)
AGE(HHREF_B)
H_DEGREE1
Wednesday, June 14, 2017
Page 109 of 124
Module
03
Section Name
Household Composition
Part
4
Question ID
HHC.270_H
Variable Name
H_DEGREE1
Universe
Universe-text
Question Text
(3) Step Child - This applies to children of the Reference Person's spouse for which the
Reference Person is not the biological mother/father.
(4) Foster Child - This applies to unrelated persons in the foster care of the reference
person.
(5) Son/Daughter in-law - This applies to the spouse of the Reference Person's children.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
DEGREE1
DEGREE4
DEGREE5
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 110 of 124
Module
03
Section Name
Household Composition
Part
4
Question ID
HHC.280
Variable Name
DEGREE2
Universe
RPREL=(7) parent
Universe-text
RPREL=(7) parent
Question Text
? [F1]
[fill1]
Answer Codes
Question Type
1. Biological (natural) [fill 2]
2. Adoptive [fill 2]
3. Step [fill 2]
4. Foster [fill 2]
5. [fill 3]-in-law
Refused
Don’t know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Parent relationship
[fill 1] If PX(from loop) = HHRESP
fill Are you [fill 6] biological (natural), adoptive, step, foster [fill 2] or [fill 2]-in-law?
else
fill Is [fill ALIAS(PX)] [fill 6] biological (natural), adoptive, step, foster [fill 2] or [fill 2]-inlaw?
endif
[fill 2] if SEX(PX) = male, then fill "father", else fill "mother"
[fill 3] if SEX(PX) = male, then fill "Father", else fill "Mother"
[fill 6] if HHRESP = HHREF_B fill your, else fill [ALIAS(HHREF_B)]’s
[fill 7] ALIAS(HHREF_B)
[fill 8] ALIAS(PX)
Special Instructions Set AGEDIFF = AGE [PX] - AGE[HHREF_B]
If DEGREE2(PX) = 1(biological)
If SEX(PX) = male
Store PX in LNDAD(HHREF_B)
Else
Store PX in LNMOM(HHREF_B)
Endif
Elseif DEGREE2(PX) = 2(adopted), 3(step), 4(foster)
If SEX(PX) = male and LNDAD(HHREF_B) = empty
Store PX in LNDAD(HHREF_B)
Elseif SEX(PX) = female and LNMOM(HHREF_B) = empty
Store PX in LNMOM(HHREF_B)
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Endif
Else if DEGREE2(PX) = 5(in-law)
If SEX(PX) = male and LNDAD(HHREF_B) = empty
Store PX in LNDAD(HHREF_B)
Elseif SEX(PX) = female and LNMOM(HHREF_B) = empty
Store PX in LNMOM(HHREF_B)
Endif
Elseif DEGREE2(PX) = refused, don’t know
If SEX(PX) = male and LNDAD(HHREF_B) = empty
Store PX in LNDAD(HHREF_B)
Elseif SEX(PX) = female and LNMOM(HHREF_B) = empty
Store PX in LNMOM(HHREF_B)
Endif
Endif
Skip Instructions
<1> If AGEDIFF < 5, GOTO ERR1_DEGREE2
<2-5,D,R> If AGEDIFF < 5, GOTO ERR2_DEGREE2
elseif additional persons remain, GOTO RPREL (for next person)
elseif UNRELTAL > 1, GOTO FAMNUM
else GOTO HHCHANGE
Hard Edits
ERR1_DEGREE2
*Age difference between [fill 2] and child is [AGEDIFF] years.
I have recorded [fill 7] is [AGE(HHREF_B)] years old and [fill:his/her] [fill 2] [fill 8] is
[AGE(PX)] years old.
Are these ages and relationships correct?
* Please correct relationship code or age.
*First GOTO is to change Relationship code of [fill 8]
*Second GOTO is to change AGE of parent [fill 8]
*Third GOTO is to change AGE of child [fill 7]
Questions involved
RPREL: Relationship to Ref Person
AGE
AGE
Soft Edits
Value
Parent
AGE (PX)
AGE(HHREF_B)
ERR2_DEGREE2
*Age difference between [fill 2] and child is only [AGEDIFF] years.
I have recorded [fill 7] is [AGE(HHREF_B)] years old and [fill:his/her] [fill 2] [fill 8] is
[AGE(PX)] years old.
Are these ages and relationships correct?
*First GOTO is to change Relationship code of [fill 8]
*Second GOTO is to change AGE of parent [fill 8]
*Third GOTO is to change AGE of child [fill 7]
Questions involved
RPREL: Relationship to Ref Person
AGE
AGE
AssocHelp
Value
Parent
AGE (PX)
AGE (HHREF_B)
H_DEGREE2
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Module
03
Section Name
Household Composition
Part
4
Question ID
HHC.280_H
Variable Name
H_DEGREE2
Universe
Universe-text
Question Text
(3) Step mother/father - This applies to a parent of the Reference Person that is not the
Reference Person's biological mother/father, and has become the Reference Person's
parent through marriage to the Reference Person's biological mother/father.
(5) Mother/father in-law - This applies to the parents of the Reference Person's spouse.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
DEGREE2
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
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Page 113 of 124
Module
03
Section Name
Household Composition
Part
4
Question ID
HHC.290_1
Variable Name
DEGREE3
Universe
RPREL = brother or sister
Universe-text
all siblings
Question Text
? [F1]
[fill 1]
Answer Codes
Question Type
1.Full [fill 2]
2. Half [fill 2]
3. Adopted [fill 2]
4. Step [fill 2]
5. Foster [fill 2]
6. [fill 3]-in-law
Refused
Don’t know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Sibling Type
[fill 1] if PX = HHRESP
fill "Are you [fill 4] full, half, adoptive, step, foster [fill 2], or [fill 2]-in-law?
else
fill "Is [ALIAS[PX]] [fill 4] full, half, adoptive, step, foster [fill 2], or [fill 2]-in-law?
[fill 2] if SEX[PX] = male, then "brother" else "sister"
[fill 3] if SEX[PX] = male, then "Brother" else "Sister"
[fill 4] if HHRESP = HHREF_B fill "your", else fill "[ALIAS(HHREF_B)]’s”"
Special Instructions
Skip Instructions
<1-6,D,R> GOTO RPREL
Hard Edits
Soft Edits
AssocHelp
H_DEGREE3
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Module
03
Section Name
Household Compositions
Part
4
Question ID
HHC.290_H
Variable Name
H_DEGREE3
Universe
Universe-text
Question Text
(2) Half brother/sister - This applies to brothers and/or sisters of the Reference Person
that have only one biological parent in common.
(4) Step brother/sister - This applies to brothers and/or sisters of the Reference Person
that have no biological parent in common, but whose parents are married to each other.
(6) Brother/sister in-law - This applies to the spouse of the Reference Person's brother /
sister.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
DEGREE3
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
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Page 115 of 124
Module
03
Section Name
Household Composition
Part
5
Question ID
HHC.300
Variable Name
FAMNUM
Universe
UNRELTAL > 1
Universe-text
Question Text
? [F1]
Earlier you said [TEMP] was not related to [ALIAS[reference person]].
Is [TEMP] related to anyone else in this household?
Answer Codes
Question Type
1. Yes
2. No
Don't Know
Refused
Pick One - answer list pane
Field Pane Description
Family Numbers
Fill Instructions
Special Instructions do while TEMP = null
loop through all PX
if HHSTAT[PX] ne D and FX[PX] = null and HHSTAT3[PX] ne A
set TEMP = ALIAS[PX]
endif
end loop
<2, D, R> set FX[TEMP] to next available FX
loop through all PX
if FX[PX] = null
COUNTER++
end loop
if COUNTER = 1
set FX[PX] = null to next available FX
Skip Instructions
<1> GOTO FAMNUM2
<2, D, R> if COUNTER = 0 or 1, GOTO FAMVER
else reset FAMNUM, GOTO FAMNUM
Hard Edits
Soft Edits
AssocHelp
H_FAMNUM
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Module
03
Section Name
Household Composition
Part
5
Question ID
HHC.300_H
Variable Name
H_FAMNUM
Universe
Universe-text
Question Text
When there is more than one family in the household you will need to make certain that
each family is identified by a distinct family number. Each family is interviewed
separately, and it is the family number that allows you to select which family you want to
interview.
Family numbers are assigned in the following way: the first person entered in the roster
is the Reference Person and is assigned family number 1. All persons related to the
reference person will also be assigned family number 1. All persons not related to the
Reference Person are initially assigned family number 2.
If all the persons assigned family number 2 are related to each other no new family
numbers need to be assigned.
If all the persons assigned family number 2 are not related to each other, new family
numbers need to be assigned.
Assign the appropriate family number to each, unrelated person or family as follows:
1 = Reference person's family (assigned automatically),
2 = First unrelated person/family,
3 = Second unrelated person/family, and so forth.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
FAMNUM
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
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Module
03
Section Name
Household Composition
Part
5
Question ID
HHC.310
Variable Name
FAMNUM2
Universe
FAMNUM= Yes (1)
Universe-text
Question Text
Who is [TEMP] related to?
* Probe: Anyone else?
* Enter line number(s), separate with commas.
Answer Codes
[fill 1]
Question Type
Enter All That Apply
Field Pane Description
Fill Instructions
Who related
[fill 1] ALIAS[PX] of all persons with FX[PX] = null (except TEMP)
**/exclude all DELETED PERSONS\**
Special Instructions <2-25> set FX to next available FX, for all PX's selected.
Loop through all PX
if FX[PX] = null
COUNTER++
endif
end loop
if COUNTER = 1, set FX[PX] = null to next available FX
Skip Instructions
<2-25> if COUNTER = 0 or 1, GOTO FAMVER
else GOTO FAMNUM
Hard Edits
Soft Edits
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Page 118 of 124
Module
03
Section Name
Household composition
Part
Question ID
HHC.320
Variable Name
FAMVER
Universe
FAMNUM = 2 and COUNTER = 0 or 1
or
all from FAMNUM2 when COUNTER = 0 or 1
or
all from FAMNUM4
Universe-text
All multi family cases
Question Text
* It is very important that, at this point, ALL family members are associated with their
correct family number. Please verify roster information below:
[fill 1]
Answer Codes
Question Type
1. Family member(s) correct, continue with family [FAMINT] interview.
2. Family member(s) incorrect.
3. Family number(s) correct, but family [FAMINT] not available at this time.
Pick One - answer list pane
Field Pane Description
Fill Instructions
Family Verification
[fill 1] FX[PX] PX ALIAS[PX] for entire roster
Special Instructions Do not allow answers of "Don't know" or "Refused".
<3> set OUTCOME = Insufficient Partial Interview, Follow-Up Needed (204)
<2,3> empty out the FAMVER value when reentering the case
<1,3> set SPAWNCOUNT value
Set TOTPCNT & PCNT = '0'
Loop for all PX
If FX[PX] = FAMINT,
add '1' to TOTPCNT
If HHSTAT[PX] is ne 'D'
add '1' to PCNT
ENDIF ALL
Skip Instructions
<1> if FAMINT = FX[LNO_RESP], GOTO HHCHANGE(FID)
else GOTO FAMNEW
<2> GOTO ERR_FAMVER
<3> GOTO FCALLBK1 (Callback section)
Hard Edits
ERR_FAMVER
* Family members incorrect.
* Please correct by backing up and changing persons(s) relationship to the Reference
Person.
Soft Edits
AssocHelp
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Wednesday, June 14, 2017
Page 120 of 124
Module
03
Section Name
Household composition
Part
2
Question ID
HHC.350
Variable Name
FAMNEW
Universe
FAMVER = Family members correct, continue with family # interview.(1) and FAMINT
ne FX of HHSTAT9 = G(family respondent)
Universe-text
Respondent is not part of interview family.
Question Text
Family Number: [FAMINT]
[fill1]
Answer Codes
Question Type
1. Yes, continue with Family section.
2. No, arrange a callback
Pick One - answer list pane
Field Pane Description
Fill Instructions
Adult Family Member Available
[fill 1]
if single person family
*Read if necessary:
I would like to speak with [fill 2].
Is [fill 3] available?
else
*Read if necessary:
I would like to speak with someone in this family, preferably an adult who is
knowledgeable about the family’s health, to complete the interview for their family.
Is [fill 4] available?
[fill 2] ALIAS of the only PX in FAMINT
[fill 3] if ALIAS of [fill 2] = Male, then "he", else "she"
[fill 4] list all ALIAS's in FAMINT that are non-deleted and AGE > 14. Separate with
commas.
Special Instructions <1,2> if MARK < Beginning of FID (13), store Beginning of FID (13) in MARK
Don't allow a Don't know or Refused
<1> if single person family
Set CSTAT eq <0>, (No Sample Child)
Store PX in RELRESP_A, LNO_RESP.
Set HHSTAT6(PX) = Family Reference Person
HHSTAT7(PX) = Family Respondent
HHSTAT9(PX) = Family Demographic Data Respondent
Skip Instructions
<1> if single person family, GOTO HHCHANGE
else, GOTO RELRESP_A
<2> GOTO FCALLBK1 (Callback section)
Hard Edits
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Soft Edits
AssocHelp
Module
03
Section Name
Household composition
Part
2
Question ID
HHC.360
Variable Name
RELRESP_A
Universe
FAMNEW = Yes, continue with Family section(1) and not a single person family
Universe-text
Multiple family with more than 1 person in the family
Question Text
* Enter the line number of the person you are speaking to.
[fill 1]
Answer Codes
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Family Respondent
[fill 1]
loop for all non-deleted persons with AGE > 14 in FAMINT
[FX]
[PX]
[ALIAS]
Special Instructions For PX selected:
store B in HHSTAT7
store G in HHSTAT9
make LNO_RESP = RELRESP_A
Do not allow Don't know and Refused.
The question ID in the instrument is FID.045. This is a leftover from the CASES
software before we switched to the Blaise software.
Skip Instructions
<1-25> If PX is not displayed in [fill 1], GOTO ERR1_RELRESP_A
elseif AGE(PX) < 18, GOTO ERR2_RELRESP_A
else GOTO HHCHANGE
Hard Edits
ERR1_RELRESP_A
* You have selected a person where either a line number is not on the roster template
or deleted or in a different family or less than 14 years of age.
* Please reselect.
Soft Edits
ERR2_RELRESP_A
You have selected a person less than 18 years old.
Is this correct?
AssocHelp
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Module
03
Section Name
Household composition
Part
Question ID
HHC.365
Variable Name
BIRTHDATE
Universe
Universe-text
Question Text
Answer Codes
Question Type
DATETYPE
Field Pane Description
Case Management Storage variable for date of birth
Fill Instructions
Special Instructions This was added to the AGEDOB_5 Special Instructions to create just one variable for
the entire date of birth.
7. New Variable: >BIRTHDATE< Concatenate information gathered in AGEDOB_3,
AGEDOB_4, and AGEDOB_5 into a type DATETYPE variable called BIRTHDATE.
The format would be:
MM/DD/YYYY .
PLEASE NOTE: THAT THE AGE QUESTIONS COULD BE POPULATED WITH
'don't know' or 'refused'. And therefore could have no information to populate this field.
Skip Instructions
Hard Edits
Soft Edits
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Page 123 of 124
Module
03
Section Name
Household composition
Part
Question ID
HHC.450
Variable Name
SCREENIN
Universe
NATOR NE empty and RACE NE empty and I_SCRN_STATUS = S
Universe-text
Question Text
Answer Codes
Question Type
Procedure
Field Pane Description
Fill Instructions
Special Instructions if I_SCRN_STATUS = S
if NATOR = 1
store 1 in SCREENIN
goto HHREF_A
elseif RACE IN (2, 9, 10, 11, 12, 13, 14, 15)
store 1 in SCREENIN
goto HHREF_A
else
store 0 in SCREENIN
goto EXIT
endif
endif
this is also an output variable
Skip Instructions
Hard Edits
Soft Edits
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Page 124 of 124
Main Questionnaire Family Section
2018 Q1 NHIS Instrument Spec Report
Section name: Family Identification Section
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.100
Variable Name
HHCHANGE
Universe
All persons who HHSTAT[PX] ne D and FX[PX] = FAMINT
Universe-text
All nondeleted family members
Question Text
I have recorded that [fill 5].
[fill 6] [fill 7] and [fill 9] [fill 10]
Is this information correct?
Answer Codes
Question Type
1. Yes, information is correct
2. No, correction(s) needed/more corrections needed
Pick One - answer list pane
Field Pane Description
Fill Instructions
Verify Info
[fill 1] if SEX[PX] = Male (1), then "he", else "she"
[fill 2] if SEX[PX] = Male (1), then "His", else "Her"
[fill 3] if AGEDOB_1 = R, then " age is refused "
elseif AGEDOB_1 = D, then " age is about [AGE[PX]] years old "
elseif AGE[PX] = 0, then " less than one year old "
else " [AGE[PX]] years old "
[fill 4] if AGEDOB_3 or AGEDOB_4 or AGEDOB_5 = R
" date-of-birth is refused."
elseif AGEDOB_3 or AGEDOB_4 or AGEDOB_5 = D
" date-of-birth is unknown."
else " [BMM[Month]] [BDD], [BYY]."
[fill 5]
if PX = LNO_RESP
if NAME_FNAME or NAME_LNAME = D
" your alias is (ALIAS[PX]), your name is unknown, you are [SEX(PX)], [fill 3], [fill
4]"
elseif NAME_FNAME or NAME_LNAME = R
" your alias is (ALIAS[PX]), your name is refused, you are [SEX[PX]], [fill 3], [fill 4]"
else " your name is (ALIAS[PX]), you are [SEX[PX]], [fill 3], [fill 4]" endif
else
if NAME_FNAME or NAME_LNAME = D
" [ALIAS(PX)]'s name is unknown, [fill 1] is [SEX[PX]], [fill 3], [fill 4]"
elseif NAME_FNAME or NAME_LNAME = R
" [ALIAS(PX)]'s name is refused, [fill 1] is [SEX[PX]], [fill 3], [fill 4]"
else " [ALIAS(PX)] is [SEX(PX)], [fill 3], [fill 4]"
[fill 6] if PX = LNO_RESP
if RACE = single response
"Your ethnic background is: "
else "Your ethnic backgrounds are: " endif
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else
if RACE = single response
"[fill 2] ethnic background is: "
else "[fill 2] ethnic backgrounds are: "
[fill 7] if NATOR = D, then "Unknown "
elseif NATOR = R, then "Refused "
elseif NATOR = No (2) "Non-Hispanic " endif
elseif HISPAN = R, then "Refused "
elseif HISPAN = D, then "Unknown "
elseif HISPAN = 1, then "Puerto Rican "
elseif HISPAN = 2, then "Cuban/Cuban American "
elseif HISPAN = 3, then "Dominican (Republic) "
elseif HISPAN = 4, then "Mexican "
elseif HISPAN = 5, then "Mexican American "
elseif HISPAN = 6, then "Central or South American "
elseif HISPAN = 7, then [HIS_SP2]
elseif HISPAN = 8, then [HIS_SP3]
[fill 8] if SEX[PX] = Male (1), then "his", else "her"
[fill 9] if PX = LNO_RESP
if RACE = single response
" your race is "
else " your races are " endif
else
if RACE = single response
"[fill 8] race is "
else "[fill 8] races are "
[fill 10] if RACE = D, then "Unknown"
elseif RACE = R, then "Refused"
elseif RACE = 1, then "White"
elseif RACE = 2, then "Black/African American"
elseif RACE = 3, then "Indian (American)"
elseif RACE = 4, then "Alaska Native"
elseif RACE = 5, then "Native Hawaiian"
elseif RACE = 6, then "Guamanian"
elseif RACE = 7, then "Samoan"
elseif RACE = 8, [fill RAC_SP1]
elseif RACE = 9, then "Asian Indian"
elseif RACE = 10, then "Chinese"
elseif RACE = 11, then "Filipino"
elseif RACE = 12, then "Japanese"
elseif RACE = 13, then "Korean"
elseif RACE = 14, then "Vietnamese"
elseif RACE = 15, [fill RAC_SP2]
else [fill RAC_SP3]
Special Instructions If MARK(datamodel) < 13, set MARK = 13
If no additional PX remain:
loop through all PX
if (NATOR = 1 or RACE = 2) and HHSTAT3 ne A & HHSTAT[PX] ne D
store 1 in SCREENIN, endif
end loop
Concatenate from these variables:
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Skip Instructions
<1> if no additional PX remain
if SCREENIN = 0 and I_SCRN_STATUS = S, GOTO EXIT(HHC)
else GOTO FIDCC13
<2> GOTO CWHAT2
Hard Edits
Soft Edits
AssocHelp
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.110
Variable Name
CWHAT2
Universe
HHCHANGE = 2 (No, not correct)
Universe-text
HHCHANGE = 2 (No, not correct)
Question Text
* Change(s) needed for [ALIAS(PX)].
* Enter each number that applies. If a wrong choice, type that choice again.
Answer Codes
Question Type
1. Name
2. Age or DOB
3. Sex
4. National origin
5. Race
Enter All That Apply
Field Pane Description
Character. To Change
Fill Instructions
Special Instructions Do not allow D or R
Skip Instructions
<1> GOTO CHG_NAME_FNAME
<2> GOTO CHG_AGEDOB_1
<3> GOTO CHG_SEX
<4> GOTO CHG_NATOR
<5> GOTO CHG_RACE
Hard Edits
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Wednesday, June 14, 2017
Page 3 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.112_1
Variable Name
CHG_NAME_FNAME
Universe
CWHAT2= 2 (Name)
Universe-text
Persons who have a first name change
Question Text
?[F1]
What is [ALIAS(PX)] correct name?
* Probe for middle name or middle initial if not reported. Initials "
* Press (enter) to skip to last name if no middle name.
* If last name is the same as displayed, press ,
Otherwise, enter the new last name.
Answer Codes
Question Type
Text
Field Pane Description
New First Name
Fill Instructions
Special Instructions 1. [store NAME_FNAME in CHG_NAME_FNAME and display in Answer Codes
2. [If CHG_NAME_FNAME valid ]
[store CHG_NAME_FNAME in NAME_FNAME]
[store NTEMP in ALIAS]
[store NTEMP in ALIAS(L_NO)]
Skip Instructions
<20 chars,R,D> GOTO CHG_NAME_MNAME
Hard Edits
Soft Edits
AssocHelp
H_RPNAME
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Page 4 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.112_2
Variable Name
CHG_NAME_MNAME
Universe
All from CHG_NAME_FNAME
Universe-text
Persons who have a middle name change
Question Text
?[F1]
* Enter Middle Name.
* Probe for middle name or middle initial if not reported.
* Press to skip to last name if no middle name.
Answer Codes
Question Type
Text
Field Pane Description
New Middle Name
Fill Instructions
Special Instructions 1. [store NAME_MNAME in CHG_NAME_MNAME] and display in Answer Codes
2. [If CHG_NAME_FNAME valid ]
[store CHG_NAME_MNAME in NAME_MNAME]
[store NTEMP in ALIAS]
[store NTEMP in R_ALIAS(L_NO)]
Skip Instructions
<20 chars,R,D, null> [goto CHG_NAME_LNAME]
Hard Edits
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H_RPNAME
Wednesday, June 14, 2017
Page 5 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.112_3
Variable Name
CHG_NAME_LNAME
Universe
All from CHG_NAME_FNAME
Universe-text
Persons who have a last name change
Question Text
?[F1]
* If last name is the same as displayed, press , otherwise, enter the new last
name.
*Enter Last Name.
Answer Codes
Question Type
Text
Field Pane Description
Fill Instructions
New Last Name
1. [If PX gt <1>] and CHG_NAME_LNAME is blank, then prefill CHG_NAME_LNAME
with previous last name.
Special Instructions 1. store NAME_LNAME in CHG_NAME_LNAME
2. If CHG_NAME_FNAME valid and CHG_NAME_LNAME valid
store CHG_NAME_LNAME in NAME_LNAME
make FULLNAME from CHG_NAME_FNAME < > CHG_NAME_LNAME
make NTEMP from CHG_NAME_FNAME < > CHG_NAME_LNAME
store NTEMP in ALIAS
store NTEMP in R_ALIAS(L_NO)
if L_NO ne RELRESP_A
make PTEMPNAME from ALIAS <'s>
store ALIAS in TEMPNAME
Skip Instructions
<20 chars, R,D>
IF
[(CHG_NAME_FNAME not valid) and/or (CHG_NAME_LNAME not valid)] OR
[(CHG_NAME_FNAME valid) and/or (CHG_NAME_LNAME not valid)] OR
[(CHG_NAME_FNAME not valid) and/or (CHG_NAME_LNAME valid)]
[goto CHG_ALIAS ]
Else
If CWHAT2 = 2 (Age or DOB) change is needed),
[ goto CHG_AGEDOB_M ]
If CWHAT2= 3 ( sex change), [goto CHG_SEX ]
If CWHAT2 = 4 (National origin change), [goto CHG_NATOR]
If CWHAT2 = 5 (Race change), [goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
Hard Edits
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AssocHelp
H_RPNAME
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.115
Variable Name
CHG_ALIAS
Universe
[(CHG_NAME_FNAME not valid) and/or (CHG_NAME_LNAME not valid)] OR
[(CHG_NAME_FNAME valid) and/or (CHG_NAME_LNAME not valid)] OR
[(CHG_NAME_FNAME not valid) and/or (CHG_NAME_LNAME valid)]
Universe-text
Persons who don't know or refused to give first and/or last name.
Question Text
?[F1]
How shall I refer to (you/this person) for the rest of the interview?
Answer Codes
Question Type
Text
Field Pane Description
New Alias
Fill Instructions
Special Instructions
Skip Instructions
<41 chars>
If CWHAT2 = 2 (Age or DOB) change is needed), [goto CHG_AGEDOB_M ]
If CWHAT2= 3 (sex change),
[goto CHG_SEX ]
If CWHAT2 = 4 (National origin change),
[goto CHG_NATOR]
If CWHAT2 = 5 (Race change),
[goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
Hard Edits
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H_RPALIAS
Wednesday, June 14, 2017
Page 7 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.125_1
Variable Name
CHG_AGEDOB_1
Universe
CWHAT2= 2 (age or DOB)
Universe-text
CWHAT2= 2 (age or DOB)
Question Text
?[F1]
1 of 5
What is [fill 1] age?
* Enter number for age.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
New Age-num
[fill 1]
if PX = LNO_RESP, then "your
else "[ALIAS[PX]]'s"
Special Instructions When entering this screen:
If DOBVER = empty
store AGE(PX) in CHG_AGEDOB_1
store <4> in CHG_AGEDOB_2
elseif DOBVER <> empty
store AGEDOB_1 in CHG_AGEDOB_1
store AGEDOB_2 in CHG_AGEDOB_2
endif
store DOBM in CHG_AGEDOB_3
store DOBD in CHG_AGEDOB_4
store DOBY in CHG_AGEDOB_5
Once a value is entered in these items or you have "entered through" an item, retain
that value unless it is overwritten.
If CHG_AGEDOB_1 eq store 999 into AGE1
if CHG_AGEDOB_1 = Refused, store '8' in CHG_AGEDOB_2
if CHG_AGEDOB_1 = Don't know, store '9' in CHG_AGEDOB_2
Skip Instructions
<001-120> [goto CHG_AGEDOB_2 ]
goto [CHG_AGEDOB_3]
Hard Edits
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H_AGEDOB
Wednesday, June 14, 2017
Page 8 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.125_2
Variable Name
CHG_AGEDOB_2
Universe
AGEDOB_1 = <001-120>
Universe-text
Valid age - number entered
Question Text
?[F1]
2 of 5
* Enter number for age time period.
Answer Codes
Question Type
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Pick One - answer list pane
Field Pane Description
New Age-tp
Fill Instructions
Special Instructions 1. Do not allow don't know or refused.
2. Calculate age in years
If AGEDOB_2 = day, divide AGEDOB_1 by 365, truncate decimal and store integer
into AGE1.
If AGEDOB_2 = weeks, divide AGEDOB_1 by 52, truncate decimal and store integer
into AGE1.
If AGEDOB_2 = months, divide AGEDOB_1 by 12, truncate decimal and store integer
into AGE1.
If AGEDOB_2 = years, store integer into AGE1.
Skip Instructions
<1-4> [goto CHG_AGEDOB_3]
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H_AGEDOB
Wednesday, June 14, 2017
Page 9 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.125_3
Variable Name
CHG_AGEDOB_3
Universe
All from CHG_AGEDOB_2
Universe-text
All from CHG_AGEDOB_2
Question Text
?[F1]
3 of 5
And what is [fill 1] date of birth?
Please give month, day, and year for the date of birth.
* Enter month of birth.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
Refused
Don’t know
Pick One - answer list pane
Field Pane Description
Fill Instructions
New DOBM
[fill 1]
if PX = LNO_RESP, then "your
else "[ALIAS[PX]]'s"
Special Instructions
Skip Instructions
<1-12,R,D>[goto CHG_AGEDOB_4]
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H_AGEDOB
Wednesday, June 14, 2017
Page 10 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.125_4
Variable Name
CHG_AGEDOB_4
Universe
All from CHG_AGEDOB_3
Universe-text
All from CHG_AGEDOB_3
Question Text
?[F1]
4 of 5
* Enter day of birth
Answer Codes
Question Type
Integer
Field Pane Description
New DOBD
Fill Instructions
Special Instructions
Skip Instructions
<1-31>
Only allow valid days for month entered. If days not valid, goto ERR_AGEDOB_4.
<1-31,R,D>[ goto CHG_AGEDOB_5]
Hard Edits
ERR_AGEDOB_4
* [fill1: AGEDOB_4] is not a valid day for [fill2: AGEDOB_3].
* Please correct.
Soft Edits
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H_AGEDOB
Wednesday, June 14, 2017
Page 11 of 91
Module
96
Section Name
Family Identification Section
Part
2
Question ID
FID.125_5
Variable Name
CHG_AGEDOB_5
Universe
All from CHG_AGEDOB_4
Universe-text
All from CHG_AGEDOB_4
Question Text
?[F1]
5 of 5
* Enter year of birth.
Answer Codes
Question Type
Integer
Field Pane Description
New DOBY
Fill Instructions
Special Instructions 1. If AGEDOB_5 gt current year, goto ERR4_AGEDOB_5.
2. If AGEDOB_5 = current year and AGEDOB_3 gt current month, goto
ERR1_AGEDOB_5.
3. If AGEDOB_5 = current year and AGEDOB_3 = current month and AGEDOB_4 gt
current day, goto ERR2_AGEDOB_5.
4. If AGEDOB_3 = 2 and AGEDOB_4 = 29, divide AGEDOB_5 BY 4.00. If
AGEDOB_5 ne to (truncated decimal multiplied by 4.00), goto ERR3_AGEDOB_5.
5. Execute Procedure AGECAL.
6. Execute Procedure AGECK.
7. Soft EDIT: Age reported is not equal to age calculated from date of birth, goto
ERR5_AGEDOB_5 and BOLD/BLACK text to be read.
8. Store Flag for suppress associated with soft edit.
9. If suppressed STORE AGE2 in AGE,
else STORE AGE1 in AGE.
Skip Instructions
<1880 - 2030, D,R> [goto AGECAL]
Hard Edits
ERR1_AGEDOB_5
Future month invalid:AGEDOB_3AGEDOB_4<,> AGEDOB_5
ERR2_AGEDOB_5
Future day invalid:AGEDOB_3AGEDOB_4<,> AGEDOB_5
ERR3_AGEDOB_5
Invalid date:AGEDOB_3AGEDOB_4<,> AGEDOB_5
ERR4_AGEDOB_5
Future year invalid:AGEDOB_3AGEDOB_4<,> AGEDOB_5
Wednesday, June 14, 2017
Page 12 of 91
Soft Edits
ERR5_AGEDOB_5
There is a difference between the age the computer calculated from [fill1: your/ALIAS’s]
date-of-birth and the age that you gave me.
I recorded [fill1: your/ALIAS’s] date-of-birth as
{AGEDOB_3AGEDOB_4<,>AGEDOB _5}. Is that [fll1: your/ALIAS’s]
} correct date-of-birth?
* Please verify.
AssocHelp
H_AGEDOB
Wednesday, June 14, 2017
Page 13 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.125_6
Variable Name
CHG_AGECAL
Universe
All from CHG_AGEDOB_5
Universe-text
All non-deleted persons
Question Text
Answer Codes
Question Type
Procedure
Field Pane Description
Calculates age(s) from Date of Birth
Fill Instructions
Special Instructions This item takes the date-of-birth information entered in AGEDOB_3, AGEDOB_4 and
AGEDOB_5 and calculates an age. The calculated age is stored in AGE2.
There are 4 main sections, number 1-4 below. Which section will be used depends on
whether complete DOB information was entered in AGEDOB, and which part of DOB
(month, day or year) is missing, if any. If not enough DOB information was given to
calculate an age, 999 is assigned to AGE2.
1. If complete DOB information was entered in AGEDOB_3, AGEDOB_4, and
AGEDOB_5
[if AGEDOB_3 valid and AGEDOB_4 valid and AGEDOB_5 valid]
[if AGEDOB_3 < current month, store (current year - AGEDOB_5) in AGE2]
[if AGEDOB_3 > current month, store (current year - AGEDOB_5 - <1>) in AGE2]
[if AGEDOB_3 = current month and AGEDOB_4 le current day,
store (current year - AGEDOB_5) in AGE2]
[if AGEDOB_3 = current month and AGEDOB_4 > current day.
store (current year - AGEDOB_5 - <1>) in AGE2]
Store AGEDOB_3 in DOBM
Store AGEDOB_4 in DOBD
Store ABDDOB_5 in DOBY
2. If only the day is missing an age may be calculated, depending on the month of
birth. If the
birth month is the current month, two possible ages are calculated and stored in AGE3
and AGE4.
[If AGEDOB_3 valid and AGEDOB_5 valid]
[If AGEDOB_5 < current year and AGEDOB_3 < current month,
store (current year - AGEDOB_5) in AGE2]
[If AGEDOB_5 < current year and AGEDOB_3 > current month,
store (current year - AGEDOB_5 - <1>) in AGE2]
[If AGEDOB_5 < current year and AGEDOB_3 = current month,
store <999> in AGE2, store (current year - AGEDOB_5 - <1>) in AGE3, and
store (current year - AGEDOB_5) in AGE4]
[if AGEDOB_5 = current year, store <0> in AGE2]
Wednesday, June 14, 2017
Page 14 of 91
Store AGEDOB_3 in DOBM
Store ABDDOB_5 in DOBY
3. If the birth month is missing (or month and day, because the day is useless without
the month) two possible ages are calculated, AGE3 and AGE4, if the birth year is less
than the current year. If the birth year = current year, an age of 0 is assigned to AGE2.
[If AGEDOB_5 valid and AGEDOB_5 < current year, store <999> in AGE2,
store (current year - AGEDOB_5 - <1>) in AGE3, and
store (current year - AGEDOB_5) in AGE4]
[If AGEDOB_5 valid and AGEDOB_5 = current year, store <0> in AGE2]
Store ABDDOB_5 in DOBY
4. If the birth year is missing (or any combination of month, month and day, or month,
day and year, because month and day are useless without the year) a 999 is stored in
AGE2.
[If AGEDOB_5 = Refused or Don't know, store <999> in AGE2]
Skip Instructions
[goto CHG_AGECK]
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Wednesday, June 14, 2017
Page 15 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.125_7
Variable Name
CHG_AGECK
Universe
HHSTAT ne D
Universe-text
All non-deleted persons
Question Text
Answer Codes
Question Type
Procedure
Field Pane Description
Checking age
Fill Instructions
Special Instructions AGECK compares the two ages calculated in AGE1 (actual age given) and AGE2 (calc.
From DOB information). AGE1 and AGE2 will contain an age or 999 if an age could
not be calculated.
There are 2 main sections to AGECK. If an age was not given at AGEDOB, section 1
and skips 1-3 will be used. If an age was given at AGEDOB, section 2 and skips 4-9
will be used.
Skip Instructions
[If AGE1 eq <999>]
[#an age was not given at AGEDOB
[If AGE2 ne <999>][store AGE2 in AGE]
If CWHAT2= 3 ( sex change),
[goto CHG_SEX ]
If CWHAT2 = 4 (National origin change),
[goto CHG_NATOR]
If CWHAT2 = 5 (Race change),
[goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
[If AGE2 eq <999>]
[If AGE3 eq <> goto CHG_GES1CK]
[If AGE3 ne <> goto CHG_AGEPIC]
[If AGE2 ne <999>]
[If AGE1 eq AGE2][store AGE1 in AGE]
If CWHAT2= 3 ( sex change),
[goto CHG_SEX ]
If CWHAT2 = 4 (National origin change),
[goto CHG_NATOR]
If CWHAT2 = 5 (Race change),
[goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
[If AGE1 ne AGE2]
[If CHG_DOBVER eq <>]
[goto CHG_DOBVER]
[Else]
[store AGE2 in AGE]
If CWHAT2= 3 ( sex change),
[goto CHG_SEX ]
If CWHAT2 = 4 (National origin change),
[goto CHG_NATOR]
If CWHAT2 = 5 (Race change),
[goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
[If AGE1 eq AGE3 or AGE1 eq AGE4]
[store AGE1 in AGE]
If CWHAT2= 3 ( sex change),
[goto CHG_SEX ]
Wednesday, June 14, 2017
Page 16 of 91
If CWHAT2 = 4 (National origin change),
[goto CHG_NATOR]
If CWHAT2 = 5 (Race change),
[goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
[else]
[If BYY eq <> and CHG_AGEDOB_5 eq ]
[store AGE1 in AGE]
[store ({int}CYEAR-AGE1-<1>) in BYY1]
[store ({int}CYEAR-AGE1) in BYY2]
[goto CHG_YEARPIC]
[else]
[store AGE1 in AGE]
If CWHAT2= 3 ( sex change),
[goto CHG_SEX ]
If CWHAT2 = 4 (National origin change),
[goto CHG_NATOR]
If CWHAT2 = 5 (Race change),
[goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
Hard Edits
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Wednesday, June 14, 2017
Page 17 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.130
Variable Name
CHG_DOBVER
Universe
CWHAT2= 2 (age or DOB not correct)
Universe-text
Age reported is not equal to age calculated from date of birth.
Question Text
"There is a difference between the age the computer calculated from [fill 1] date-ofbirth, [fill :computer calculated AGE (AGE2)], and the age that you gave me, [fill AGE
respondent reported (AGE1)].
I recorded [fill1: your/ALIAS’s] date-of-birth as
{AGEDOB_3AGEDOB_4<,>AGEDOB _5}. Is that [fll1: your/ALIAS’s]
} correct date-of-birth?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don’t know
Yes/No
Field Pane Description
Fill Instructions
Date of Birth Verification
[fill 1]
if PX = LNO_RESP, then "your
else "[ALIAS[PX]]'s"
Special Instructions 1. If CHG_DOBVER =
<1>, store AGE2 in AGE
2. If CHG_DOBVER = , store AGE1 in AGE
3. FLAG for CHG_DOBVERFG, store <1> if suppressed
Skip Instructions
<1, D, R > If CWHAT2= 3 ( sex change),
[goto CHG_SEX ]
If CWHAT2 = 4 (National origin change),
[goto CHG_NATOR]
If CWHAT2 = 5 (Race change),
[goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
<2> [goto CHG_AGEDOB_3]
Hard Edits
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Wednesday, June 14, 2017
Page 18 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.140
Variable Name
CHG_AGEPIC
Universe
CHG_AGECK= [AGE1 eq <999>] and [AGE2 eq <999>]and [AGE3 ne <>]
Universe-text
CHG_AGECK= [AGE1 eq <999>] and [AGE2 eq <999>]and [AGE3 ne <>]
Question Text
[fill1: Are you/Would you say [fill2: ALIAS] is]
Answer Codes
[fill3: 1. Less than 1 year old?]
[fill3: 1. [fill5: AGE3] year(s) old?]
2. [fill6: AGE4] year(s) old?
3. Neither is correct
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Change Agepic
if AGE3 = 0 then [fill3: 1. Less than 1 year old?] ;
else [fill3: 1. [fill5: AGE3] year(s) old?]
Special Instructions 1. Bold all answers
2. If CHG_AGEPIC = 1 then set AGE = AGE3.
3. If CHG_AGEPIC = 2 then set AGE = AGE4.
ANSW:<1> [store AGE3 in AGE]
[store CHG_AGEPIC in AGEPIC]
ANSW:<2> [store AGE4 in AGE]
[store CHG_AGEPIC in AGEPIC]
Skip Instructions
<1,2> If CWHAT2= 3 ( sex change),
[goto CHG_SEX ]
If CWHAT2 = 4 (National origin change), [goto CHG_NATOR]
If CWHAT2 = 5 (Race change),
[goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
<3,D,R> if CHG_AGEDOB@1 = 'Refused'
[goto CHG_AGEGES2]
else [goto CHG_AGEGES1
Hard Edits
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Wednesday, June 14, 2017
Page 19 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.145_1
Variable Name
CHG_AGEGES1_NUM
Universe
[CHG_AGEPIC = (3or D or R) and CHG_AGEDOB_1 ne R] or [(CHG_AGEDOB_3 or
CHG_AGEDOB_4 or CHG_AGEDOB_5 = (D or R)) and (CHG_AGEPIC not asked and
CHG_AGEDOB_1 ne R)]
Universe-text
Age unknown and unable to narrow age down to two age choices and respondent did
not refuse AGEDOB_1
Question Text
?[F1]
1 of 2
What is your best guess of [fill1: your/ALIAS’s] age?
* If the response is a range of ages, enter (C) for compute .
* If the respondent does not know the age, enter your best estimate of the person's age.
Answer Codes
Question Type
C. Compute from range
Refused
Don't Know
Integer
Field Pane Description
Age Guess - Number
Fill Instructions
Special Instructions
Skip Instructions
<0-120> [goto CHG_AGEGES1_TP]
[goto CHG_AGERNG_N1]
[goto CHG_AGEGES2]
Hard Edits
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H_AGEGES
Wednesday, June 14, 2017
Page 20 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.145_2
Variable Name
CHG_AGEGES1_TP
Universe
CHG_AGEGES1_NUM = 0-120
Universe-text
Valid age number
Question Text
2 of 2
* Enter time period
Answer Codes
Question Type
3. Month(s)
4. Year(s)
Pick One - answer list pane
Field Pane Description
Change Age Guess - TP
Fill Instructions
Special Instructions 1. Don't know or Refused not allowed.
2. If CHG_AGEGES1_TP = months, divide CHG_AGEGES1_NUM by 12, then store
integer
into AGE.
3. If CHG_AGEGES1_TP = year(s), then store CHG_AGEGES1_NUM into AGE.
4. If CHG_AGEDOB_5 = D
store (current year - AGE - <1>) in BYY1.
store (current year - AGE) in BYY2.
5. <3-4> [If CHG_AGEGES1_TP eq <3>]
[store (CHG_AGEGES1_NUM/<12>) in AGE][endif]
[If CHG_AGEGES1_TP eq <4>][store CHG_AGEGES1_NUM in AGE]
[If CHG_AGEDOB_5 eq ]
[store ({int}CYEAR-AGE-<1>) in BYY1]
[store ({int}CYEAR-AGE) in BYY2]
[store CHG_AGEGES1_NUM in AGEGES1_NUM]
[store CHG_AGEGES1CHG_AGEGES1_TP in
GEGES1CHG_AGEGES1_TP]
[Else]
[store CHG_AGEGES1_NUM in AGEGES1_NUM]
[store CHG_AGEGES1CHG_AGEGES1_TP in
AGEGES1CHG_AGEGES1_TP]
Skip Instructions
<3-4> [If CHG_AGEGES1_TP eq <3>]
[store (CHG_AGEGES1_NUM/<12>) in AGE][endif]
[If CHG_AGEGES1_TP eq <4>][store CHG_AGEGES1_NUM in AGE]
[If CHG_AGEDOB_5 eq ]
[store ({int}CYEAR-AGE-<1>) in BYY1]
[store ({int}CYEAR-AGE) in BYY2]
[store CHG_AGEGES1_NUM in AGEGES1_NUM]
[store CHG_AGEGES1CHG_AGEGES1_TP in
AGEGES1CHG_AGEGES1_TP]
[goto CHG_YEARPIC]
[Else]
[store CHG_AGEGES1_NUM in AGEGES1_NUM]
Wednesday, June 14, 2017
Page 21 of 91
[store CHG_AGEGES1CHG_AGEGES1_TP in
AGEGES1CHG_AGEGES1_TP]
If CWHAT2= 3 ( sex change),
[goto CHG_SEX ]
If CWHAT2 = 4 (National origin change), [goto CHG_NATOR]
If CWHAT2 = 5 (Race change),
[goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
[goto CHG_AGERNG]
[goto CHG_AGEGES2]
[etc ]
Hard Edits
Soft Edits
AssocHelp
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.150
Variable Name
CHG_AGEGES2
Universe
[(CHG_AGEPIC = 3 or R or D) and CHG_AGEDOB_1 = R] or
[CHG_AGEGES1_NUM= D or R] or [((CHG_AGEDOB_3 or CHG_AGEDOB_4 or
CHG_AGEDOB_5) = (D or R)) and (CHG_AGEPIC = empty) and (CHG_AGEDOB_1 =
R)]
Universe-text
(Age unknown and unable to narrow to two age choices and respondent refused or
didn't know age at AGEDOB_1) or (Refused to or did not guess age)
Question Text
Certain sections of this interview depend on knowing if a person is 18 years old or
older.
Could you please tell me if [fill1: you/ALIAS] [fill2: are/is] at least 18 years old?
Answer Codes
Question Type
1. Less than 18
2. 18 or older
Refused
Don't Know
Pick One - answer list pane
Field Pane Description
Change At least 18
Fill Instructions
Special Instructions
Skip Instructions
<1>
[goto CHG_LESS18]
<2,D,R> [goto CHG_GREAT18]
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Wednesday, June 14, 2017
Page 22 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.155
Variable Name
CHG_LESS18
Universe
CHG_AGEGES2 = 1 (Less than 18)
Universe-text
CHG_AGEGES2 = 1 (Less than 18)
Question Text
* Enter your best estimate of [fill alias]'s age.
Enter "0" if less than 1 year old.
Answer Codes
(Enter age 0 to 17)
Question Type
Integer
Field Pane Description
Chg Less18
Fill Instructions
Special Instructions [store CHG_LESS18 in LESS18]
[store LESS18 in AGE]
Skip Instructions
<0-17> If CWHAT2= 3 ( sex change),
[goto CHG_SEX ]
If CWHAT2 = 4 (National origin change), [goto CHG_NATOR]
If CWHAT2 = 5 (Race change),
[goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
Hard Edits
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Wednesday, June 14, 2017
Page 23 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.160
Variable Name
CHG_GREAT18
Universe
CHG_AGEGES2 = 2 (18 or older) or D or R
Universe-text
CHG_AGEGES2 = 2 (18 or older) or D or R
Question Text
* Enter your best estimate of [fill alias]'s age.
Answer Codes
(Enter age 18 or greater)
Question Type
Integer
Field Pane Description
Chg Great18
Fill Instructions
[store CHG_GREAT18 in GREAT18]
[store GREAT18 in AGE]
Special Instructions
Skip Instructions
<18-120> If CWHAT2= 3 ( sex change),
[goto CHG_SEX ]
If CWHAT2 = 4 (National origin change), [goto CHG_NATOR]
If CWHAT2 = 5 (Race change),
[goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
Hard Edits
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AssocHelp
Wednesday, June 14, 2017
Page 24 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.165_1
Variable Name
CHG_AGERNG_N1
Universe
CHG_AGEGES1 = C (compute from range)
Universe-text
Respondent doesn't know the age, so picking a range to compute the age.
Question Text
1 of 4
* Enter first and last ages of the range.
First/lower:
Last/higher:
Number
Number
Time Period
Time Period
Month (s)
Year(s)
Month(s)
Year(s)
* Enter First/lower age of the range.
Answer Codes
Question Type
<0-120>
Integer
Field Pane Description
First/lower
Fill Instructions
Special Instructions 1. Going into this screen, perform these:
[store AGERNG_N1 in CHG_AGERNG_N1]
[store AGERNG_T1 in CHG_AGERNG_T1]
[store AGERNG_N2 in CHG_AGERNG_N2]
[store AGERNG_T2 in CHG_AGERNG_T2]
2. Do not allow "Don't know" or "Refused" as an answer.
3. Gray out everything in the Question text except for the FR instruction, First/lower,
and
number underneath First/lower.
Skip Instructions
<0-120> [goto CHG_AGERNG_T1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 25 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.165_2
Variable Name
CHG_AGERNG_T1
Universe
CHG_AGEGES1 = C (compute from range)
Universe-text
Respondent doesn't know the age, so picking a range to compute the age.
Question Text
2 of 4
* Enter the first/lower time period of the range..
First/lower:
Last/higher:
Number
Number
Time Period
Time Period
Month(s)
Year(s)
Month(s)
Year(s)
.
Answer Codes
Question Type
3. Month(s)
4. Year(s)
Integer
Field Pane Description
Time Period
Fill Instructions
Special Instructions 1. Display in Question Text: Below the statement to enter first and last ages,
HIGHLIGHT only the column heading 'First/lower, then the words 'Time Period' below.
DON'T PUT IN THE MARKERS, CONSISTING OF N1, T1, N2, T2. They are there for
you to follow the sequence of questions to be answered for the 4 screens.
2. [If CHG_AGERNG_T1 eq <3>]
[store (CHG_AGERNG_N1 /<12>) in LOWER]
[else]
[store CHG_AGERNG_N1 in LOWER]
Skip Instructions
<3-4> [goto CHG_AGERNG_N2]
Hard Edits
Soft Edits
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Wednesday, June 14, 2017
Page 26 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.165_3
Variable Name
CHG_AGERNG_N2
Universe
AGERNG_2=3-4
Universe-text
First age number and time period has been entered for range.
Question Text
3 of 4
* Enter the Last/higher age of the range.
First/lower:
Answer Codes
Question Type
Last/higher:
Number
Number
Time Period
Time Period
Month(s)
Year(s)
Month(s)
Year(s)
0-120
Integer
Field Pane Description
Last/higher
Fill Instructions
Special Instructions 1. Do not allow "Don't know" or "Refused" as an answer.
2. Gray out everything in the Question text except for the FR instruction, Last/higher:,
and number underneath Last/higher.
Skip Instructions
<0-120> [goto AGERNG _T2]
Hard Edits
Soft Edits
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Wednesday, June 14, 2017
Page 27 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.165_4
Variable Name
CHG_AGERNG_T2
Universe
AGEGES1_NUM= C
Universe-text
Second age number has been entered for range.
Question Text
4 of 4
* Enter the Last/higher time period of the range..
First/lower:
Last/higher:
Number
Number
Time Period
Time Period
Month(s)
Year(s)
Month(s)
Year(s)
.
Answer Codes
Question Type
Month(s)
Year(s)
Pick One - answer list pane
Field Pane Description
Time Period
Fill Instructions
Special Instructions 1. Do not allow "Don't know" or "Refused" as an answer.
2. Gray out everything in the Question text except for the FR instruction, Last/higher:,
and Month(s) and Year(s) underneath Last/higher:.
3. If CHG_AGERNG_T2 = months, divide CHG_AGERNG_N2 by 12, truncate decimal
and store integer into HIGHER.
4. If CHG_AGERNG_T2 = years, store CHG_AGERNG _N2 into HIGHER.
5. If LOWER le HIGHER
add LOWER and HIGHER and divide by 2, truncate decimal and store integer in
AGE
store AGE in CHG_AGEGES1_NUM
store in CHG_AGEGES1_TP
6. If LOWER > HIGHER, goto ERR_CHG_AGERNG_T2
7. If CHG_AGEDOB_5 = D
store (current year - AGE - <1>) in BYY1
store (current year - AGE) in BYY2
Skip Instructions
[if CHG_AGEDOB_5 eq ]
[goto CHG_YEARPIC]
[Else]
Wednesday, June 14, 2017
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If CWHAT2= 3 ( sex change),
[goto CHG_SEX ]
If CWHAT2 = 4 (National origin change), [goto CHG_NATOR]
If CWHAT2 = 5 (Race change),
[goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
Hard Edits
ERR_AGERNG_T2
* The higher age must be larger than the lower age.
goto AGERNG_N1
Soft Edits
AssocHelp
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.170
Variable Name
CHG_YEARPIC
Universe
[AGE is valid and [AGERNG_T2 or AGEGES1 or AGECK have AGEDOB_5 = Don't
know] and [BYY1 and BYY2 are not blank]
Universe-text
Person's age is known and birth year answered with 'don't know'
Question Text
Would you say that [fill1: you/ALIAS] [fill2: were/was] born in:
Answer Codes
1. [ fill3: with 4-digit BYY1]
2. [ fill4: with 4-digit BYY2]
3. Neither is correct
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
New DOBY
[fill3: with 4-digit BYY1] = low guess for year born
[fill4: with 4-digit BYY2] = high guess for year born
Special Instructions 1. If CHG_YEARPIC = 1, store BYY1 in BYY.
2. If CHG_YEARPIC = 2, store BYY2 in BYY.
Skip Instructions
<1-3,R,D> goto HHCHANGE_1 to reverify the changed information
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 29 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.180
Variable Name
CHG_SEX
Universe
CWHAT2 = 3 (Sex)
Universe-text
Changing the sex of the person
Question Text
[fill 1] male or female?
*If don't know or refused enter your best guess.
Answer Codes
Question Type
1. Male
2. Female
Pick One - answer list pane
Field Pane Description
Fill Instructions
New Sex
[fill 1]
if PX = LNO_RESP, then "Are you",
else "Is [ALIAS(PX)]"
Special Instructions Don't allow 'D' or 'R' for a response.
1. store SEX in CHG_SEX
2. <1-2>
if CHG_SEX eq <1>
store in MF
else
store in MF
store CHG_SEX in SEX
3. CHANGE SEX FILLS:
store SEX in SEX(PX)
if SEX eq <2> and PX ne LNO_RESP
store in HESHE
store in C_HESHE]
store in HIMHER]
store in HISHER]
store in C_HISHER
store in SELF
store in SPOUSE
else
if PX ne LNO_RESP
store in HESHE
store in C_HESHE
store in HIMHER
store in HISHER
store in C_HISHER
store in SELF
store in SPOUSE
Wednesday, June 14, 2017
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Skip Instructions
<1-2> If CWHAT2 = 4 (National origin change), [goto CHG_NATOR]
If CWHAT2 = 5 (Race change),
[goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 31 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.190
Variable Name
CHG_NATOR
Universe
CWHAT2 = 4 (National origin change)
Universe-text
Changing the National origin of an individual
Question Text
(book) H1 ? [F1]
[ fill1: Do/Does] [fill2: you/ ALIAS] consider [ fill3: yourself/himself/herself ] to be
Hispanic or Latino?
* Read if necessary.
Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American
Other Latin American
Other Hispanic/Latino/Spanish
(Where did [fill4: your/ ALIAS’s] ancestors come from?)
Answer Codes
Question Type
1. Yes
2. No
Refused
Don’t know
Yes/No
Field Pane Description
New Nat. Orig
Fill Instructions
1. [ fill1: Do/Does] : use Do if the referring to the respondent, else Does
2. [ fill2: you/ ALIAS]: use you if referring to the respondent, else ALIAS for the person
you are referring to.
3. fill3: yourself/himself/herself ] : use yourself for the respondent, himself for ALIAS
being a male, or herself for ALIAS being a female.
4. [fill4: your/ ALIAS’s]: use your if referring to the respondent, else ALIAS's.
Special Instructions
<1,2,D,R>
[store CHG_NATOR in NATOR]
[store <> in TEMP]
[if CHG_NATOR eq <1> and HHSTAT3 ne ]
[store <1> in SCREENIN]
[else]
[store <> in HISPAN_1] [store <> in CHG_HISPAN_1]
[store <> in HISPAN_2] [store <> in CHG_HISPAN_2]
[store <> in HISPAN_3] [store <> in CHG_HISPAN_3]
[store <> in HISPAN_4] [store <> in CHG_HISPAN_4]
[store <> in HISPAN_5] [store <> in CHG_HISPAN_5]
[store <> in HIS_SP2] [store <> in CHG_HIS_SP2]
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Page 32 of 91
[store <> in HIS_SP3] [store <> in CHG_HIS_SP3]
[loop for X from <1> to <9>]
[if ({int}CHG_HISPAN_1 eq X and CHG_HISPAN_1 onpath) or
({int}CHG_HISPAN_2 eq X and CHG_HISPAN_2 onpath) or
({int}CHG_HISPAN_3 eq X and CHG_HISPAN_3 onpath) or
({int}CHG_HISPAN_4 eq X and CHG_HISPAN_4 onpath) or
({int}CHG_HISPAN_5 eq X and CHG_HISPAN_5 onpath)]
[if HISP_1 eq <>]
[store X in HISP_1]
[endif]
[store in HISPAN_ARR(X)]
[else]
[store <> in HISPAN_ARR(X)]
Skip Instructions
<1> [goto CHG_HISPAN]
<2,R,D> If CWHAT2 = 5 (Race change), [goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
Hard Edits
Soft Edits
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H_NATOR
Wednesday, June 14, 2017
Page 33 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.200
Variable Name
CHG_HISPAN
Universe
All from CHG_NATOR
Universe-text
CWHAT2 = National origin was answered yes to being Hispanic or Latino
Question Text
(book) H1 ? [F1]
Please give me the number of the group that represents [ fill: your/ ALIAS’s} Hispanic
origin or ancestry.
You may choose up to five (5), if applicable.
* If a nonhispanic group is named, backup to previous screen and change the answer
from "yes" to "no".
Enter all that apply, separate with commas.
Answer Codes
Question Type
1. Puerto Rican
2. Cuban/Cuban American
3. Dominican (Republic)
4. Mexican
5. Mexican American
6. Central or South American
7. Other Latin American
8. Other Hispanic/Latino/Spanish
Refused
Don’t know
Enter All That Apply
Field Pane Description
New Hisp Orig
Fill Instructions
Special Instructions Mark up to 5
Skip Instructions
<1-6,>If CWHAT2 = 5 (Race change), [goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
<7> [goto CHG_HIS_SP2]
<8> [goto CHG_HIS_SP3]
Hard Edits
Soft Edits
AssocHelp
H_HISPAN
Wednesday, June 14, 2017
Page 34 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.210
Variable Name
CHG_HIS_SP2
Universe
CHG_HISPAN=(7 or other Latin American)
Universe-text
CHG_HISPAN answered from selection 7 for Hispanic origin.
Question Text
? [F1]
* Probe for the country.
* If any of the following are mentioned, backup to previous screen and correct the entry.
Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American (REFER TO HELP SCREEN)
* (F1) For a list of Central or South American countries.
* Specify the other Latin American.
Answer Codes
Question Type
Text
Field Pane Description
New Oth Lat Amer
Fill Instructions
Special Instructions
Skip Instructions
<30 anychar> If <8> is also selected in CHG_HISPAN goto CHG_HIS_SP3
elseif CWHAT2 = 5 (Race change), [goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
Hard Edits
Soft Edits
AssocHelp
H_SPECH
Wednesday, June 14, 2017
Page 35 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.215
Variable Name
CHG_HIS_SP3
Universe
CHG_HISPAN= 8 (other Hispanic/Latino)
Universe-text
CHG_HISPAN answer from selection 8 (other Hispanic/Latino) origin
Question Text
? [F1]
* Probe for the country.
* If any of the following are mentioned, backup to previous screen and correct the entry.
Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American (REFER TO HELP SCREEN)
* (F1) For a list of Central or South American countries.
* Specify the other Hispanic/Latino/Spanish.
Answer Codes
Question Type
Text
Field Pane Description
New Oth Hisp/Lat
Fill Instructions
Special Instructions
Skip Instructions
<30 anychar> If CWHAT2 = 5 (Race change), [goto CHG_RACE ]
Else [ goto HHCHANGE_1 to reverify the changed information]
Hard Edits
Soft Edits
AssocHelp
H_SPECH
Wednesday, June 14, 2017
Page 36 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.220
Variable Name
CHG_RACE
Universe
All from CHG_HIS_SP3 or CWHAT2 = 5 (Race change)
Universe-text
All from CHG_HIS_SP3 or CWHAT2 = 5 (Race change)
Question Text
? [F1]
* Show flashcard H2
What race or races [ fil1l: do/does] [ fill2: you/ ALIAS] consider
[ fill3: yourself/himself/herself] to be? Please select 1 or more of these categories.
* Enter all that applies, separate with commas.
Answer Codes
Question Type
1. White
2. Black/African American
3. Indian (American)
4. Alaska Native
5. Native Hawaiian
6. Guamanian or Chamorro
7. Samoan
8. Other Pacific Islander
9. Asian Indian
Enter All That Apply
Field Pane Description
Fill Instructions
10. Chinese
11. Filipino
12. Japanese
13. Korean
14. Vietnamese
15. Other Asian
16. Some other race
Refused
Don’t know
New Race
1. [ fil1l: do/does]: use 'do' if referring to the respondent, else does.
2. [ fill2: you/ ALIAS]: use 'you' if referring to the respondent, else ALIAS.
3. [ fill3: yourself/himself/herself]: use 'yourself' if referring to the respondent, else
himself if person you are referring to is a male or 'herself' for female.
Special Instructions Allow up to 6 answers, and narrow down to 5.
Skip Instructions
<1-7,9-14> If more than one selected [ goto CHG_MLTRAC],
Else [goto HHCHANGE_1 to reverify the changed information]
<8> [ goto CHG_RAC_SP1]
<15> [ goto CHG_RAC_SP2]
<16> [ goto CHG_RAC_SP3]
[goto CHG_MLTRAC]
Hard Edits
Soft Edits
AssocHelp
H_RACE
Wednesday, June 14, 2017
Page 37 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.230
Variable Name
CHG_RAC_SP1
Universe
CHG_RACE= 8 (other Pacific Islander)
Universe-text
CHG_RACE= 8 (other Pacific Islander)
Question Text
* Specify the other pacific islander.
* If any of the following are mentioned, go back to RACE screen to correct.
White
Asian Indian
Black/African American
Chinese
Indian (American)
Filipino
Alaska Native
Japanese
Native Hawaiian
Korean
Guamanian or Chamorro
Vietnamese
Samoan
Answer Codes
Question Type
Text
Field Pane Description
New Oth Pac Isl
Fill Instructions
Special Instructions
Skip Instructions
<30 chars long> If more than one selected [ goto CHG_MLTRAC],
Else [goto HHCHANGE_1 to reverify the changed information]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 38 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.232
Variable Name
CHG_RAC_SP2
Universe
CHG_RACE=15 (other Asian)]
Universe-text
CHG_RACE = other Asian listed
Question Text
* If any of the following are mentioned, backup to previous item and correct the entry.
* Specify the other Asian.
White
Black/African American
Indian (American)
Alaska Native
Native Hawaiian
Guamanian or Chamorro
Samoan
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Answer Codes
Question Type
Text
Field Pane Description
New Oth Asian
Fill Instructions
Special Instructions
Skip Instructions
<30 chars long> If more than one selected [ goto CHG_MLTRAC],
Else [goto HHCHANGE_1 to reverify the changed information]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 39 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.234
Variable Name
CHG_RAC_SP3
Universe
[RACE=16 (Some other race)]
Universe-text
RACE answered some other race.
Question Text
* If any of the following are mentioned, backup to previous item and correct the entry.
* Specify the other race.
White
Black/African American
Indian (American)
Alaska Native
Native Hawaiian
Guamanian or Chamorro
Samoan
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Answer Codes
Question Type
Text
Field Pane Description
New Oth Race
Fill Instructions
Special Instructions
Skip Instructions
<30 chars long> If more than one selected [ goto CHG_MLTRAC],
Else [goto HHCHANGE_1 to reverify the changed information]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 40 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.240
Variable Name
CHG_MLTRAC
Universe
More than on race entered
Universe-text
More than on race entered
Question Text
? [F1]
Which one of these groups, that is (* Read groups) would you say BEST represents
[ fill1: your/ALIAS's] race?
Answer Codes
Question Type
1.
White
2.
Black/African American
3.
Indian (American)
4.
Alaska Native
5.
Native Hawaiian
6.
Guamanian or Chamorro
7.
Samoan
8.
[fill: RAC_SP1]
9.
Asian Indian
10. Chinese
11. Filipino
12. Japanese
13. Korean
14. Vietnamese
15. [fill RAC_SP2]
16. [fill RAC_SP3]
Refused
Don’t know
Pick One - answer list pane
Field Pane Description
Fill Instructions
New Multi Race
1. [ fill1: your/ALIAS's] = use 'you' if referring to the respondent, else ALIAS's.
2. [fill: RAC_SP1] = other Pacific Islander specified
3. [fill RAC_SP2] = other Asian specified
4. [fill RAC_SP3] = other race specified
Special Instructions 1. In the Question Text and Answer Codes, display as 2 columns only answer codes
entered in RACE in the order entered.
2. if answer NE < 1-16,D,R>(out-of-bound codes), [goto ERR_CHG_MLTRAC ]
Skip Instructions
If answer NE < 1-16,D,R>(out-of-bound codes), GOTO ERR_CHG_MLTRAC
else <1-16,D,R> GOTO HHCHANGE_1 to reverify the changed information
Hard Edits
ERR_CHG_MLTRAC
* Select valid race group number.
* Please correct.
Soft Edits
Wednesday, June 14, 2017
Page 41 of 91
AssocHelp
H_MLTRAC
Wednesday, June 14, 2017
Page 42 of 91
Module
96
Section Name
Family Identification Section
Part
4
Question ID
FID.245
Variable Name
HHCHANGE_1
Universe
All persons with HHSTAT[PX] <> D and FX[PX] = FAMINT and CWHAT2 <> empty
and CWHAT2 is on route
Universe-text
All nondeleted family members with a change made to their demographic information
Question Text
I have recorded that [fill 5]. [fill 6] [fill 7] and [fill 9] race is:
[fill 10]
Is this information correct?
Answer Codes
Question Type
1. Yes, information is correct
2. No, correction(s) needed/more corrections needed
Pick One - answer list pane
Field Pane Description
Fill Instructions
Reverify Info
[fill 1] if SEX[PX] = Male (1), then "he", else "she"
[fill 2] if SEX[PX] = Male (1), then "His", else "Her"
[fill 3] if AGEDOB_1 = R, then " age is refused "
elseif AGEDOB_1 = D, then " age is about [AGE[PX]] years old "
elseif AGE[PX] = 0, then " less than one year old "
else " [AGE[PX]] years old "
[fill 4] if AGEDOB_3 or AGEDOB_4 or AGEDOB_5 = R
" date-of-birth is refused."
elseif AGEDOB_3 or AGEDOB_4 or AGEDOB_5 = D
" date-of-birth is unknown."
else " [BMM[Month]] [BDD], [BYY]."
[fill 5]
if PX = LNO_RESP
if NAME_FNAME or NAME_LNAME = D
" your alias is (ALIAS[PX]), your name is unknown, you are [SEX(PX)], [fill 3], [fill
4]"
elseif NAME_FNAME or NAME_LNAME = R
" your alias is (ALIAS[PX]), your name is refused, you are [SEX[PX]], [fill 3], [fill 4]"
else " your name is (ALIAS[PX]), you are [SEX[PX]], [fill 3], [fill 4]" endif
else
if NAME_FNAME or NAME_LNAME = D
" [ALIAS(PX)]'s name is unknown, [fill 1] is [SEX[PX]], [fill 3], [fill 4]"
elseif NAME_FNAME or NAME_LNAME = R
" [ALIAS(PX)]'s name is refused, [fill 1] is [SEX[PX]], [fill 3], [fill 4]"
else " [ALIAS(PX)] is [SEX(PX)], [fill 3], [fill 4]"
[fill 6] if PX = LNO_RESP
if RACE = single response
"Your ethnic background is: "
else "Your ethnic backgrounds are: " endif
else
if RACE = single response
"[fill 2] ethnic background is: "
Wednesday, June 14, 2017
Page 43 of 91
else "[fill 2] ethnic backgrounds are: "
[fill 7] if NATOR = D, then "Unknown "
elseif NATOR = R, then "Refused "
elseif NATOR = No (2) "Non-Hispanic " endif
elseif HISPAN = R, then "Refused "
elseif HISPAN = D, then "Unknown "
elseif HISPAN = 1, then "Puerto Rican "
elseif HISPAN = 2, then "Cuban/Cuban American "
elseif HISPAN = 3, then "Dominican (Republic) "
elseif HISPAN = 4, then "Mexican "
elseif HISPAN = 5, then "Mexican American "
elseif HISPAN = 6, then "Central or South American "
elseif HISPAN = 7, then [HIS_SP2]
elseif HISPAN = 8, then [HIS_SP3]
[fill 8] if SEX[PX] = Male (1), then "his", else "her"
[fill 9] if PX = LNO_RESP
if RACE = single response
" your race is "
else " your races are " endif
else
if RACE = single response
"[fill 8] race is "
else "[fill 8] races are "
[fill 10] if RACE = D, then "Unknown"
elseif RACE = R, then "Refused"
elseif RACE = 1, then "White"
elseif RACE = 2, then "Black/African American"
elseif RACE = 3, then "Indian (American)"
elseif RACE = 4, then "Alaska Native"
elseif RACE = 5, then "Native Hawaiian"
elseif RACE = 6, then "Guamanian"
elseif RACE = 7, then "Samoan"
elseif RACE = 8, [fill RAC_SP1]
elseif RACE = 9, then "Asian Indian"
elseif RACE = 10, then "Chinese"
elseif RACE = 11, then "Filipino"
elseif RACE = 12, then "Japanese"
elseif RACE = 13, then "Korean"
elseif RACE = 14, then "Vietnamese"
elseif RACE = 15, [fill RAC_SP2]
else [fill RAC_SP3]
Special Instructions Do not allow an answer of 'Don't know' or 'Refused'
If no additional PX remain:
loop through all PX
if (NATOR = 1 or RACE = 2) and HHSTAT3 ne A & HHSTAT[PX] ne D
store 1 in SCREENIN, endif
end loop
Concatenate from these variables:
Skip Instructions
<1> if no additional PX remain
if SCREENIN = 0 and I_SCRN_STATUS = S, GOTO EXIT(HHC)
else GOTO FIDCC13
Wednesday, June 14, 2017
Page 44 of 91
<2> GOTO ERR_HHCHANGE_1
Hard Edits
ERR_HHCHANGE_1
* Press enter to go back to change some demographic information or arrow down and
press enter to change your answer.
Default Goto should be CWHAT2
Soft Edits
AssocHelp
Module
96
Section Name
Family Identification Section
Part
5
Question ID
FID.248
Variable Name
FIDCCI3
Universe
All persons
Universe-text
All persons
Question Text
Answer Codes
Question Type
Procedure
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Loop through all PX
if HHSTAT[PX] ne D and FX[PX] = FAMINT
if MARITAL[PX] = Living with a partner (6), GOTO COHAB1
elseif AGE[PX] > 13 and MARITAL[PX] = null, GOTO MARITAL, endif
endif
End loop
GOTO FIDCCI4
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Wednesday, June 14, 2017
Page 45 of 91
Module
96
Section Name
Family Identification Section
Part
5
Question ID
FID.250_1
Variable Name
MARITAL
Universe
FIDCCI3: HHSTAT[PX] ne D and FX[PX] = FAMINTand AGE[PX] > 13 and
MARITAL[PX] = null
or
MARVER = No (2)
Universe-text
all persons, 14 and older, who don't have a marital status yet
Question Text
* ASK OR VERIFY
[fill 1] now married, widowed, divorced, separated, never married, or living with a
partner?
Answer Codes
Question Type
1. Married
2. Widowed
3. Divorced
4. Separated
5. Never married
6. Living with a partner
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Marital Status
[fill 1]
if PX = LNO_RESP
"Are you "
else
"Is [ALIAS[PX]] "
Special Instructions
Skip Instructions
<1> GOTO SPFLG
<2-5, D, R> GOTO FIDCCI3
<6> if LINTAL[FAMINT] = 1, GOTO FIDCCI4
else GOTO COHAB1
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Wednesday, June 14, 2017
Page 46 of 91
Module
96
Section Name
Family Identification Section
Part
5
Question ID
FID.250_2
Variable Name
SPFLG
Universe
MARITAL = Married (1)
Universe-text
Person is married
Question Text
Answer Codes
Question Type
Procedure
Field Pane Description
Fill Instructions
Special Instructions loop for Y from 1 to HIGH_LNO
if FX[Y] = FAMINTand HHSTAT[Y] ne D and AGE[Y] > 13
and (SEX[PX] ne SEX[Y])
if RPREL[PX] = Child (4) and DEGREE1[PX] = Biological, Adoptive,
Step, Foster (1-4)
if (RPREL[Y] = Child (4) and DEGREE1[Y] = in-law (5)) or
RPREL[Y] = Other relative (12),
store 1 in SPFLAG[Y] and TEMP, endif
elseif RPREL[PX] = Child (4) and DEGREE1[PX] = in-law (5)
if (RPREL[Y] = Child (4) and DEGREE1[Y] = Biological, Adoptive,
Step, Foster (1-4) or RPREL[Y] = Other relative (12)
store 1 in SPFLAG[Y] and TEMP, endif
elseif RPREL[PX] = Child of partner (5)
if RPREL[Y] = Other relative (12),
store 1 in SPFLG[Y] and TEMP, endif
elseif RPREL[PX] = Grandchild (6)
if RPREL[Y] = Grandchild (6) or Other relative (12),
store 1 in SPFLG[Y] and TEMP, endif
elseif RPREL[PX] = Parent (7) and
DEGREE2(PX) = Biological, Adoptive, Step, Foster (1-4)
if RPREL(Y) = Parent (7) and DEGREE2(Y) = Biological,
Adoptive, Step, Foster (1-4)
store 1 in SPFLG[Y] and TEMP, endif
elseif RPREL[PX] = Parent (7) and DEGREE2[PX] = in-law (5)
if RPREL(Y) = Parent (7) and DEGREE2(Y) = in-law (5),
store 1 in SPFLG[Y] and TEMP, endif
elseif RPREL[PX] = Brother/Sister (8)
if RPREL(Y) = Brother/Sister (8),
store 1 in SPFLG[Y] and TEMP, endif
elseif RPREL[PX] = Grandparent (9)
if RPREL(Y) = Grandparent (9) or Other relative (12),
store 1 in SPFLG[Y] and TEMP, endif
elseif RPREL[PX] = Aunt/Uncle (10)
if RPREL(Y) = Aunt/Uncle (10) or Other relative (12),
store 1 in SPFLG[Y] and TEMP, endif
elseif RPREL[PX] = Niece/Nephew (11)
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if RPREL(Y) = Niece/Nephew (11) or Other relative (12),
store 1 in SPFLG[Y] and TEMP, endif
elseif RPREL[PX] = Other relative (12)
if RPREL(Y) = Child of partner (5), Grandchild (6), Grandparent (9),
Aunt/Uncle (10), Niece/Nephew (11), Other relative (12),
store 1 in SPFLG[Y] and TEMP, endif
loop end Y
Skip Instructions
if TEMP > 0, GOTO SPOUS
else, GOTO MARVER
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Module
96
Section Name
Family Identification Section
Part
5
Question ID
FID.250_3
Variable Name
MARVER
Universe
[SPFLG: TEMP = null ] OR[ AGE= 14, 15, 16, or 17]
Universe-text
Person is married and his/her potential spouse does not live in the household.
Question Text
* FR: ASK OR VERIFY
I have recorded that [fill 1] married.
Is this correct?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Marital Status Verification
if PX = LNO_RESP
[fill 1] = " you are "
else " [ALIAS[PX]] is"
Special Instructions <1, R, D> store 2 in SPOUS[PX]
Skip Instructions
<1, R, D> GOTO FIDCCI3
<2> Reset MARITAL, GOTO MARITAL
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Wednesday, June 14, 2017
Page 48 of 91
Module
96
Section Name
Family Identification Section
Part
5
Question ID
FID.260
Variable Name
SPOUS
Universe
SPFLG: TEMP > 0
Universe-text
A potential spouse lives in the unit.
Question Text
? [F1]
* ASK OR VERIFY
Is [fill 1] spouse living in the household?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Spouse in HH
if PX = LNO_RESP
[fill 1] = "your"
else
"[ALIAS[PX]]'s"
Special Instructions <2,D,R> store null in SPOUS2,
Skip Instructions
<1> If SPOUS2[PX] = null, GOTO SPOUS2
else, GOTO FIDCCI3
<2,D,R> GOTO FIDCCI3
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H_SPOUS1
Wednesday, June 14, 2017
Page 49 of 91
Module
96
Section Name
Family Identification Section
Part
5
Question ID
FID.265_H
Variable Name
H_SPOUS1
Universe
Universe-text
If the spouse is not a household member or has been deleted from
the household for any reason, enter 2 - "No".
Question Text
Answer Codes
Question Type
Help Screen
Field Pane Description
Help screen for determining spouse
Fill Instructions
Special Instructions Associated screens:
SPOUS
Skip Instructions
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Page 50 of 91
Module
96
Section Name
Family Identification Section
Part
5
Question ID
FID.270
Variable Name
SPOUS2
Universe
SPOUS = Yes (1) and SPOUS2 = null
Universe-text
Person has an unidentified spouse in the household.
Question Text
* Probe as necessary and enter the line number of the spouse.
[fill 1]
Answer Codes
Question Type
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Spouse Line #
[fill 1] Display all possible spouse candidates (SPFLG[Y] = 1).
Special Instructions store 1 in MARITAL[SPOUS2]
<1-25> store PX (from loop) in SPOUS2[SPOUS2]
set AGEDIFF = |AGE[PX] - AGE[SPOUS2]|
store 2 in SPOUS[PX]
Skip Instructions
Do not allow line number of the subject to be entered. If so, GOTO ERR1_SPOUS2
<1-25, R,D> If RPREL (PX) = 01 and RPREL (SPOUS2(PX)) NE 2, GOTO
ERR2_SPOUS2,
elseif SEX (PX) = SEX (SPOUS2(PX)), GOTO ERR3_SPOUS2,
elseif AGEDIFF GE 30, GOTO ERR4_SPOUS2
Else GOTO FIDCCI3
Hard Edits
ERR1_SPOUS2
*Person can't be his or her own spouse.
*Please correct.
Soft Edits
ERR2_SPOUS2
*If [ALIAS (SPOUS2(PX)] is [ALIAS (PX)]’s spouse, [ALIAS (SPOUS2(PX))]’s RPREL
value should be ‘02’.
*Correct relationship code at RPREL or change answer at SPOUS2.
*First GOTO is to change Relationship code of [ALIAS (SPOUS2(PX))]
*Second GOTO is to choose different spouse at SPOUS2
Questions involved
RPREL: Relationship to Ref Person
SPOUS2
Value
RPREL(SPOUS2(PX))
ALIAS (SPOUS2(PX))
ERR3_SPOUS2
*Do not read this message to the respondent.
*The married couple [ALIAS (SPOUS2(PX))] and [ALIAS (PX)] are both [SEX(PX)].
*Suppress message if correct.
*Otherwise, correct SEX of either person or choose different spouse.
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Page 51 of 91
*First GOTO is to choose different spouse at SPOUS2
*Second GOTO is to change SEX of spouse [ALIAS (SPOUS2(PX))]
*Third GOTO is to change SEX of [ALIAS(PX)]
Questions involved
SPOUS2
SEX
SEX
Value
ALIAS (SPOUS2(PX))
SEX (SPOUS2(PX))
SEX (PX)
ERR4_SPOUS2
*Age difference between spouses is greater than or equal to 30 years.
I have recorded [ALIAS (PX)] is [AGE(PX)] years old and [fill: his/her] spouse
[ALIAS(SPOUS2(PX))] is [AGE(SPOUS2(PX))] years old. Are these ages and
relationships correct?
*First GOTO is to choose different spouse at SPOUS2
*Second GOTO is to change AGE of spouse [ALIAS (SPOUS2(PX))]
*Third GOTO is to change AGE of [ALIAS(PX)]
Questions involved
SPOUS2
AGE
AGE
Value
ALIAS (SPOUS2(PX))
AGE (SPOUS2(PX))
AGE (PX)
AssocHelp
Wednesday, June 14, 2017
Page 52 of 91
Module
96
Section Name
Family Identification Section
Part
5
Question ID
FID.280
Variable Name
COHAB1
Universe
MARITAL[PX] = Living with a Partner (6) and LINTAL(FAMINT) > 1
Universe-text
Marital status is "living with a partner."
Question Text
? [F1]
[fill 1] ever been married?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Partner Ever Married
if PX = LNO_RESP
[fill 1] = "Have you"
else
"Has [ALIAS[PX]]"
Special Instructions
Skip Instructions
<1> GOTO COHAB2
<2, D, R> if COHAB3[PX] = null, GOTO COHAB3
else, GOTO FIDCCI3
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H_COHAB1
Wednesday, June 14, 2017
Page 53 of 91
Module
96
Section Name
Family Identification Section
Part
5
Question ID
FID.285_H
Variable Name
H_COHAB1
Universe
Universe-text
Question Text
Consider as "Never Married" a person whose marriage was legally annulled. In order to
consider an annulled marriage as "never having taken place," the annulment must have
been granted by the courts, not through religious decree.
Mark "Yes" for any "legal" marriage regardless of the outcome or current status. This
marriage does not have to have been to the current partner or anyone else in the
household.
Answer Codes
Question Type
Help Screen
Field Pane Description
Help on defining cohabitation
Fill Instructions
Special Instructions Associated screen:
COHAB1
Skip Instructions
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Wednesday, June 14, 2017
Page 54 of 91
Module
96
Section Name
Family Identification Section
Part
5
Question ID
FID.290
Variable Name
COHAB2
Universe
COHAB1 = Yes (1)
Universe-text
Person has been married.
Question Text
? [F1]
What is [fill 1] current legal marital status?
Answer Codes
Question Type
1. Married
2. Widowed
3. Divorced
4. Separated
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Partner Legal Marital Status
if PX = LNO_RESP
[fill 1] = "your"
else
"[ALIAS[PX]]'s"
Special Instructions
Skip Instructions
<1-4, D, R> If COHAB3[PX] = null, GOTO COHAB3
else, GOTO FIDCCI3
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H_COHAB2
Wednesday, June 14, 2017
Page 55 of 91
Module
96
Section Name
Family Identification Section
Part
5
Question ID
FID.295_H
Variable Name
H_COHAB2
Universe
Universe-text
Question Text
Determine the current legal marital status for any household member "living with a
partner" and who has been previously married.
Enter '1' - Married - for persons who are legally married as well as for the spouse of an
Armed Forces member not living at home, as well as for the spouse of a person who is
temporarily absent.
Enter '4' - Separated - only for persons who state that they have a legal separation
agreement or have otherwise parted due to marital discord.
Enter '5' - Never Married - for persons whose marriage has been legally annulled,
unless there was a previous marriage which ended in divorce or death. In order to
consider an annulled marriage as "never having taken place," the annulment must have
been granted by the courts, not through religious decree.
Answer Codes
Question Type
Help Screen
Field Pane Description
Legal marital status for persons living with a partner
Fill Instructions
Special Instructions Associated Screen:
COHAB2
Skip Instructions
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Wednesday, June 14, 2017
Page 56 of 91
Module
96
Section Name
Family Identification Section
Part
5
Question ID
FID.300_1
Variable Name
COHAB3
Universe
COHAB1 = No (2), D, R and COHAB3[PX] = null
or
All from COHAB2 when COHAB3[PX] = null
Universe-text
Co-habitating partner has yet to be identified.
Question Text
* Probe as necessary and enter the line number of the cohabiting partner.
[fill 1]
Answer Codes
Question Type
<1-25>
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Partner Line #
[fill 1] In the question text, display all possible co-habitation candidates (SPFLG[Y] = 1)
with their PX.
Special Instructions <1-25> store 6 in MARITAL[COHAB3], PX(from loop) in COHAB3[COHAB3 entry]
set AGEDIFF = |AGE[PX] - AGE[COHAB3(PX)]|
Skip Instructions
If line number of the subject is entered, GOTO ERR1_COHAB3
<1-25, D, R> If RPREL (PX) = 01 and RPREL (COHAB3(PX)) NE 3, GOTO
ERR2_COHAB3,
elseif RPREL (PX) = 04 and RPREL (COHAB3(PX)) = 04, GOTO
ERR3_COHAB3
elseif AGEDIFF GE 20, GOTO ERR4_ COHAB3
Else GOTO FIDCCI3
Hard Edits
ERR1_COHAB3
* Person can't be his or her own partner.
* Please correct.
Soft Edits
ERR2_COHAB3
*If [ALIAS (COHAB3(PX))] is [ALIAS (PX)]’s cohabiting partner, [ALIAS
(COHAB3(PX))]’s RPREL value should be ‘03’.
*Correct relationship code at RPREL or change answer at COHAB3.
*First GOTO is to change Relationship code of [ALIAS (COHAB3(PX))]
*Second GOTO is to choose different cohabiting partner at COHAB3
Questions involved
RPREL: Relationship to Ref Person
COHAB3
Wednesday, June 14, 2017
Value
RPREL(COHAB3 (PX))
ALIAS (COHAB3 (PX))
Page 57 of 91
ERR3_COHAB3
*If [ALIAS (COHAB3(PX))] and [ALIAS (PX)] are cohabiting partners, it is not possible
for both to have RPREL codes equal to ‘04’ for ‘Child’. One of their RPREL codes
should equal ‘12’ for ‘Other relative’.
*Correct relationship code at RPREL or change answer at COHAB3.
*First GOTO is to change Relationship code of [ALIAS (COHAB3(PX))]
*Second GOTO is to change Relationship code of [ALIAS (PX)]
*Third GOTO is to choose different cohabiting partner at COHAB3
Questions involved
RPREL: Relationship to Ref Person
RPREL: Relationship to Ref Person
COHAB3
Value
Child
Child
ALIAS (COHAB3 (PX))
ERR4_ COHAB3
*Age difference between cohabiting partners is greater than or equal to 20 years.
I have recorded [ALIAS (PX)] is [AGE(PX)] years old and [fill: his/her] cohabiting partner
[ALIAS(COHAB3(PX))] is [AGE(COHAB3(PX))] years old. Are these ages and
relationships correct?
*First GOTO is to choose different cohabiting partner at COHAB3
*Second GOTO is to change AGE of cohabiting partner [ALIAS (COHAB3(PX))]
*Third GOTO is to change AGE of [ALIAS(PX)]
Questions involved
COHAB3
AGE
AGE
Value
ALIAS (COHAB3 (PX))
AGE (COHAB3 (PX))
AGE (PX)
AssocHelp
Wednesday, June 14, 2017
Page 58 of 91
Module
96
Section Name
Family Identification Section
Part
6
Question ID
FID.321_3
Variable Name
FIDCCI4
Universe
All persons
Universe-text
All persons
Question Text
Answer Codes
Question Type
Procedure
Field Pane Description
Fill Instructions
Special Instructions if RPREL[PX] = Child (4) and MS(HHREF_B) = Married (1) and DEGREE1(PX) =
Biological(1), Adoptive(2), Step(3), Foster(4), Refused(8), Don't know(9) and
SPOUS2(HHREF_B) ne null and HHSTAT[SPOUS2[HHREF_B]] ne D, store
SPOUS2[HHREF_B] in X2
if RPREL[PX] = Child of Partner (5) and MS(HHREF_B) = Living with partner (6) and
COHAB3(HHREF_B) ne null and HHSTAT[COHAB3[HHREF_B]] ne D, store
COHAB3[HHREF_B] in X2
Skip Instructions
loop for all PX
if FX[PX] = FAMINT and HHSTAT[PX] ne D
if AGE[PX] < 90
if X2 ne null
if SEX[X2] = Male (1), GOTO DEGREE4
else GOTO DEGREE5, endif
else GOTO FIDCCI4B
endif
endif
endif
endloop
GOTO ROSTERCK
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Wednesday, June 14, 2017
Page 59 of 91
Module
96
Section Name
Family Identification Section
Part
6
Question ID
FID.322
Variable Name
DEGREE4
Universe
(FIDCCI4: FX[PX] = FAMINT and HHSTAT[PX] ne D and AGE[PX] < 90 and X2 ne null
and SEX[X2] = Male (1)) or (ERR1_DEGREE4 = closed or goto) or (ERR2_DEGREE4
= closed or goto)
Universe-text
When the reference person is the person in question's parent.
Question Text
? [F1]
I noted that [fill 3].
[fill 4] biological, adoptive, step, foster [fill 1], or [fill 1]-in-law?
Answer Codes
Question Type
1. Biological [fill 1]
2. Adoptive [fill 1]
3. Step [fill 1]
4. Foster [fill 1]
5. [fill 2]-in-law
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Male Spouse Parent Type
if SEX[PX] = Male (1)
[fill 1] = "son" and [fill 2] = "Son"
else
[fill 1] = "daughter" and [fill 2] = "Daughter"
if X2 = HHRESP or RELRESP_A
[fill 3] = "you are the father of [ALIAS[PX]]."
[fill 4] = "Is [ALIAS[PX]] your "
elseif PX = HHRESP or RELRESP_A
[fill 3] = "[fill ALIAS[X2] is your father."
[fill 4] = "Are you his "
else
[fill 3] = "[fill ALIAS[X2]] is the father of [fill ALIAS[PX]]."
[fill 4] = "Is [fill ALIAS[PX]] his "
Special Instructions
set AGEDIFF = AGE[X2] - AGE[PX]
<1-4,R,D> store X2 in LNDAD[PX]
Skip Instructions
<1> If AGEDIFF < 5, GOTO ERR2_DEGREE4,
elseif AGEDIFF = 5-14, GOTO ERR1_DEGREE4
elseif AGEDIFF GE 50, GOTO ERR3_DEGREE4
elseif additional persons remain, GOTO FIDCCI4
else, GOTO FIDCCI4B
<2-5, D,R> if AGEDIFF LE 14, GOTO ERR1_DEGREE4
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Page 60 of 91
elseif AGEDIFF GE 50, GOTO ERR3_DEGREE4
elseif additional persons remain, GOTO FIDCCI4
else, GOTO FIDCCI4B
Hard Edits
ERR2_DEGREE4
*Age difference between father and child is [AGEDIFF] years.
I have recorded [ALIAS (X2)] is [AGE(X2)] years old and his child [ALIAS(PX)] is
[AGE(PX)] years old.
Are these ages and relationships correct?
* Please correct relationship code or age.
*First GOTO is to change Relationship code of [ALIAS(X2)]
*Second GOTO is to change Relationship code of [ALIAS(PX)]
*Third GOTO is to change AGE of father [ALIAS(X2)]
*Fourth GOTO is to change AGE of child [ALIAS(PX)]
Questions involved
RPREL: Relationship to Ref Person
RPREL: Relationship to Ref Person
AGE
AGE
Soft Edits
Value
Spouse (husband) or Unmarried Partner
Child or Child of Partner
AGE (X2)
AGE(PX)
ERR1_DEGREE4
*Age difference between father and child is only [AGEDIFF] years.
I have recorded [ALIAS (X2)] is [AGE(X2)] years old and his child [ALIAS(PX)] is
[AGE(PX)] years old. Are these ages and relationships correct?
*First GOTO is to change Relationship code of [ALIAS(X2)]
*Second GOTO is to change Relationship code of [ALIAS(PX)]
*Third GOTO is to change AGE of father [ALIAS(X2)]
*Fourth GOTO is to change AGE of child [ALIAS(PX)]
Questions involved
RPREL: Relationship to Ref Person
RPREL: Relationship to Ref Person
AGE
AGE
Value
Spouse (husband) or Unmarried Partner
Child or Child of Partner
AGE (X2)
AGE(PX)
If suppressed and additional persons remain, GOTO FIDCCI4
else GOTO FIDCCI4B, endif
ERR3_DEGREE4
*Age difference between father and child is greater than or equal to 50 years.
I have recorded [ALIAS (X2)] is [AGE(X2)] years old and his child [ALIAS(PX)] is
[AGE(PX)] years old. Are these ages and relationships correct?
*First GOTO is to change Relationship code of [ALIAS(X2)]
*Second GOTO is to change Relationship code of [ALIAS(PX)]
*Third GOTO is to change AGE of father [ALIAS(X2)]
*Fourth GOTO is to change AGE of child [ALIAS(PX)]
Questions involved
RPREL: Relationship to Ref Person
RPREL: Relationship to Ref Person
AGE
AGE
Value
Spouse (husband) or Unmarried Partner
Child or Child of Partner
AGE (X2)
AGE(PX)
If suppressed and additional persons remain, GOTO FIDCCI4
else GOTO FIDCCI4B, endif
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Page 61 of 91
AssocHelp
H_DEGREE1
Wednesday, June 14, 2017
Page 62 of 91
Module
96
Section Name
Family Identification Section
Part
6
Question ID
FID.324
Variable Name
DEGREE5
Universe
(FIDCCI4: FX[PX] = FAMINT and HHSTAT[PX] ne D and AGE[PX] < 90 and X2 ne null
and SEX[X2] = Female (2)) or (ERR1_DEGREE5 = closed or goto) or
(ERR2_DEGREE5 = closed or goto)
Universe-text
When the reference person is the person in question's parent.
Question Text
? [F1]
I noted that [fill 3].
[fill 4] biological, adoptive, step, foster [fill 1], or [fill 1]-in-law?
Answer Codes
Question Type
1. Biological [fill 1]
2. Adoptive [fill 1]
3. Step [fill 1]
4. Foster [fill 1]
5. [fill 2]-in-law
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Female Spouse Parent Type
if SEX[PX] = Male (1)
[fill 1] = "son" and [fill 2] = "Son"
else
[fill 1] = "daughter" and [fill 2] = "Daughter"
if X2 = HHRESP or RELRESP_A
[fill 3] = "you are the mother of [ALIAS[PX]]."
[fill 4] = "Is [ALIAS[PX]] your "
elseif PX = HHRESP or RELRESP_A
[fill 3] = "[fill ALIAS[X2] is your mother."
[fill 4] = "Are you her "
else
[fill 3] = "[fill ALIAS[X2]] is the mother of [fill ALIAS[PX]]."
[fill 4] = "Is [fill ALIAS[PX]] her "
Special Instructions set AGEDIFF = AGE[X2] - AGE[PX]
<1-4,R,D> store X2 in LNMOM[PX]
Skip Instructions
<1> If AGEDIFF < 5, GOTO ERR2_DEGREE5
elseif AGEDIFF = 5-14, GOTO ERR1_DEGREE5
elseif AGEDIFF GE 50, GOTO ERR3_DEGREE5
elseif additional persons remain, GOTO FIDCCI4
else, GOTO FIDCCI4B
<2-5, D,R> if AGEDIFF LE 14, GOTO ERR1_DEGREE5
Wednesday, June 14, 2017
Page 63 of 91
elseif AGEDIFF GE 50, GOTO ERR3_DEGREE5
elseif additional persons remain, GOTO FIDCCI4
else, GOTO FIDCCI4B
Hard Edits
ERR2_DEGREE5
*Age difference between mother and child is [AGEDIFF] years.
I have recorded [ALIAS (X2)] is [AGE(X2)] years old and her child [ALIAS(PX)] is
[AGE(PX)] years old.
Are these ages and relationships correct?
* Please correct relationship code or age.
*First GOTO is to change Relationship code of [ALIAS(X2)]
*Second GOTO is to change Relationship code of [ALIAS(PX)]
*Third GOTO is to change AGE of mother [ALIAS(X2)]
*Fourth GOTO is to change AGE of child [ALIAS(PX)]
Questions involved
RPREL: Relationship to Ref Person
RPREL: Relationship to Ref Person
AGE
AGE
Soft Edits
Value
Spouse (wife) or Unmarried Partner
Child or Child of Partner
AGE (X2)
AGE(PX)
ERR1_DEGREE5
*Age difference between mother and child is only [AGEDIFF] years.
I have recorded [ALIAS (X2)] is [AGE(X2)] years old and her child [ALIAS(PX)] is
[AGE(PX)] years old. Are these ages and relationships correct?
*First GOTO is to change Relationship code of [ALIAS(X2)]
*Second GOTO is to change Relationship code of [ALIAS(PX)]
*Third GOTO is to change AGE of mother [ALIAS(X2)]
*Fourth GOTO is to change AGE of child [ALIAS(PX)]
Questions involved
RPREL: Relationship to Ref Person
RPREL: Relationship to Ref Person
AGE
AGE
Value
Spouse (wife) or Unmarried Partner
Child or Child of Partner
AGE (X2)
AGE(PX)
If suppressed and additional persons remain, GOTO FIDCCI4
else GOTO FIDCCI4B, endif
ERR3_DEGREE5
*Age difference between mother and child is greater than or equal to 50 years.
I have recorded [ALIAS (X2)] is [AGE(X2)] years old and her child [ALIAS(PX)] is
[AGE(PX)] years old. Are these ages and relationships correct?
*First GOTO is to change Relationship code of [ALIAS(X2)]
*Second GOTO is to change Relationship code of [ALIAS(PX)]
*Third GOTO is to change AGE of mother [ALIAS(X2)]
*Fourth GOTO is to change AGE of child [ALIAS(PX)]
Questions involved
RPREL: Relationship to Ref Person
RPREL: Relationship to Ref Person
AGE
AGE
Value
Spouse (wife) or Unmarried Partner
Child or Child of Partner
AGE (X2)
AGE(PX)
If suppressed and additional persons remain, GOTO FIDCCI4
else GOTO FIDCCI4B, endif
Wednesday, June 14, 2017
Page 64 of 91
AssocHelp
H_DEGREE1
Wednesday, June 14, 2017
Page 65 of 91
Module
96
Section Name
Family Identification Section
Part
6
Question ID
FID.325_2
Variable Name
FIDCCI4B
Universe
All persons who have HHSTAT[PX] ne D, AGE[PX] < 90 and FX[PX] = FAMINT
Universe-text
Question Text
Answer Codes
Question Type
Procedure
Field Pane Description
Possible mother
Fill Instructions
Special Instructions loop for Y from 1 to HIGH_LNO
if FX[Y] = FAMINT and HHSTAT[Y] ne D and Y ne PX and
AGE[Y] > 11 and SEX[Y] = 2
if RPREL[PX] = Spouse (2) or Unmarried Partner (3)
if RPREL[Y] = Parent (7) or Other Relative (12)
Add 1 to TEMP, store 1 in MOMFLG(Y), endif
elseif RPREL[PX] = Child (4) and DEGREE1[PX] = Biologica l(1), Adoptive (2),
Step (3), Foster (4), Refused (8), Don't know (9) and LNMOM[PX] = null
if RPREL[Y] = Unmarried Partner (3) or Other Relative (12)
Add 1 to TEMP, store 1 in MOMFLG(Y), endif
elseif (RPREL[PX] = Child (4) and DEGREE1[PX] = in-law (5))
or RPREL[PX] = Child of partner (5)
if RPREL[Y] = Spouse (2) Unmarried Partner (3)
or Other Relative (12)
Add 1 to TEMP, store 1 in MOMFLG(Y), endif
elseif RPREL[PX] = Grandchild (6)
if RPREL[Y] = Child (4), Child of partner (5) or Other relative (12)
Add 1 to TEMP, store 1 in MOMFLG(Y), endif
elseif RPREL[PX] = Parent (7)
if RPREL[Y] = Grandparent (9) or Other Relative (12)
Add 1 to TEMP, store 1 in MOMFLG(Y), endif
elseif RPREL[PX] = Brother/Sister (8)
if RPREL[Y] = Parent (7) or Other Relative (12)
Add 1 to TEMP, store 1 in MOMFLG(Y), endif
elseif RPREL(PX) = Grandparent (9)
if RPREL[Y] = Grandparent (9) or Other Relative (12)
Add 1 to TEMP, store 1 in MOMFLG(Y), endif
elseif RPREL[PX] = Aunt/Uncle (10)
if RPREL[Y] = Grandparent (9) or Other Relative (12)
Add 1 to TEMP, store 1 in MOMFLG(Y), endif
elseif RPREL(PX) = Niece/Nephew (11)
if RPREL[Y] = Brother/Sister (8) or Other Relative (12)
Add 1 to TEMP, store 1 in MOMFLG(Y), endif
elseif RPREL[PX] = Other Relative (12)
if RPREL[Y] = Niece/Nephew (11) or Other Relative (12)
Add 1 to TEMP, store 1 in MOMFLG(Y), endif
Wednesday, June 14, 2017
Page 66 of 91
loop end Y
Skip Instructions
If LNMOM[PX] = null and TEMP > 0, GOTO MOTHER
else, GOTO FIDCCI5
Hard Edits
Soft Edits
AssocHelp
Module
96
Section Name
Family Identification Section
Part
6
Question ID
FID.326
Variable Name
MOTHER
Universe
FIDCCI4B: TEMP > 0 and LNMOM[PX] = null
Universe-text
Potential mother in the Family, mother not already identified
Question Text
? [F1]
* Ask or verify
Is [fill 1] mother a household member? Include biological (natural), adoptive, step, or
foster mother or mother-in-law.
* Enter the line number of the mother or mother-in-law.
* If the mother or mother-in-law is not a household member, enter "0".
* Choose mother over mother-in-law if both are present.
Answer Codes
Question Type
0. Not Listed
[fill potential list of persons who could be the mother]
Pick One - answer list pane
Field Pane Description
Fill Instructions
Mother Line #
if PX = HHRESP or RELRESP_A
[fill 1] = "your"
else [fill 1] = "[ALIAS[PX]]'s"
Special Instructions Display potential list of persons who could be the mother (MOMFLG[PX] = 1) except for
self in the Answer Codes.
Skip Instructions
<01-25> GOTO MOTHERCK_A
<0, D, R> GOTO FIDCCI5
Hard Edits
Soft Edits
AssocHelp
H_MOTHER
Wednesday, June 14, 2017
Page 67 of 91
Module
96
Section Name
Family Identification Section
Part
6
Question ID
FID.327_H
Variable Name
H_MOTHER
Universe
Universe-text
Question Text
Include biological, step, adoptive, and foster mother/child relationships. Enter '0' if the
person's mother is not a household member or is deceased.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
MOTHER
MOTHERCK_A
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 68 of 91
Module
96
Section Name
Family Identification Section
Part
6
Question ID
FID.330_1
Variable Name
MOTHERCK_A
Universe
MOTHER = 1-25 or (ERR1_MOTHERCK_A = closed or goto) or
(ERR2_MOTHERCK_A = closed or goto)
Universe-text
Mother or mother-in-law has been identified.
Question Text
? [F1]
[fill 1] biological (natural), adoptive, step, or foster mother or mother-in-law?
Answer Codes
Question Type
1. Biological mother
2. Adoptive mother
3. Step mother
4. Foster mother
5. mother-in-law
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Mother Type
if LNMOM[PX] = HHRESP or RELRESP_A
[fill 1] = "Are you [fill ALIAS[PX]]'s "
elseif PX = HHRESP or RELRESP_A
[fill 1] = "Is [fill ALIAS[LNMOM[PX]]] your "
else
[fill 1] = "Is she [fill ALIAS[PX]]'s "
Special Instructions set AGEDIFF = AGE[LNMOM[PX]] - AGE[PX]
if MOTHER(PX) = 1(biological)
store MOTHER(PX) in LNMOM(PX)
elseif MOTHER(PX) = 2(adopted), 3(step), 4(foster)
if LNMOM(PX) = empty
store MOTHER(PX) in LNMOM(PX)
endif
elseif MOTHER(PX) = 5(in-law)
if LNMOM(PX) = empty
store MOTHER(PX) in LNMOM(PX)
endif
elseif MOTHER(PX) = refused, don’t know
if LNMOM(PX) = empty
store MOTHER(PX) in LNMOM(PX)
endif
endif
Skip Instructions
<1> If AGEDIFF < 5, GOTO ERR2_MOTHERCK_A
elseif AGEDIFF = 5-14, GOTO ERR1_MOTHERCK_A
elseif AGEDIFF GE 50, GOTO ERR3_ MOTHERCK_A
else, GOTO FIDCCI5
Wednesday, June 14, 2017
Page 69 of 91
<2-5, D, R> if AGEDIFF LE 14, GOTO ERR1_MOTHERCK_A
elseif AGEDIFF GE 50, GOTO ERR3_ MOTHERCK_A
else, GOTO FIDCCI5
Hard Edits
ERR2_MOTHERCK_A
*Age difference between mother and child is [AGEDIFF] years.
I have recorded [ALIAS (LNMOM[PX])] is [AGE(LNMOM[PX])] years old and her child
[ALIAS(PX)] is [AGE(PX)] years old. Are these ages and relationships correct?
* Please correct relationship code or age.
*First GOTO is to change code at MOTHER
*Second GOTO is to change AGE of mother [ALIAS (LNMOM[PX])]
*Third GOTO is to change AGE of child [ALIAS(PX)]
Questions involved
MOTHER
AGE
AGE
Soft Edits
Value
ALIAS (MOTHER [PX])
AGE(LNMOM[PX])
AGE(PX)
ERR1_MOTHERCK_A
*Age difference between mother and child is only [AGEDIFF] years.
I have recorded [ALIAS (LNMOM[PX])] is [AGE(LNMOM[PX])] years old and her child
[ALIAS(PX)] is [AGE(PX)] years old. Are these ages and relationships correct?
*First GOTO is to change code at MOTHER
*Second GOTO is to change AGE of mother [ALIAS (LNMOM[PX])]
*Third GOTO is to change AGE of child [ALIAS(PX)]
Questions involved
MOTHER
AGE
AGE
Value
ALIAS (MOTHER [PX])
AGE(LNMOM[PX])
AGE(PX)
if suppressed goto FIDCCI5
ERR3_MOTHERCK_A
*Age difference between mother and child is greater than or equal to 50 years.
I have recorded [ALIAS (LNMOM[PX])] is [AGE(LNMOM[PX])] years old and her child
[ALIAS(PX)] is [AGE(PX)] years old. Are these ages and relationships correct?
*First GOTO is to change code at MOTHER
*Second GOTO is to change AGE of mother [ALIAS (LNMOM[PX])]
*Third GOTO is to change AGE of child [ALIAS(PX)]
Questions involved
MOTHER
AGE
AGE
Value
ALIAS (MOTHER [PX])
AGE(LNMOM[PX])
AGE(PX)
if suppressed goto FIDCCI5
AssocHelp
H_MOTHER
Wednesday, June 14, 2017
Page 70 of 91
Module
96
Section Name
Family Identification Section
Part
6
Question ID
FID.330_3
Variable Name
FIDCCI5
Universe
All persons who have HHSTAT[PX] ne D, FX[PX] = FAMINT, AGE[PX] < 90
Universe-text
Question Text
Answer Codes
Question Type
Procedure
Field Pane Description
Possible Father
Fill Instructions
Special Instructions loop for Y from 1 to HIGH_LNO
if FX(Y) = FAMINT and SEX(Y) = 1 and AGE(Y) > 11
and Y ne PX and HHSTAT(Y) ne D
if RPREL[PX] = Spouse (2) or Unmarried partner (3)
if RPREL[Y] = Parent (7) or Other relative (12)
Add 1 to TEMP, store 1 in DADFLG(Y), endif
elseif RPREL[PX] = Child (4) and DEGREE1[PX] = Biological (1), Adoptive (2),
Step (3), Foster (4), Refused (8), Don't know (9) and LNDAD[PX] = null
if RPREL[Y] = Unmarried partner (3) or Other relative (12)
Add 1 to TEMP, store 1 in DADFLG(Y), endif
elseif (RPREL[PX] = Child (4) and DEGREE1[PX] = in-law (5)) or
RPREL[PX] = Child of partner (5)
if RPREL(Y) = Spouse (2), Unmarried partner (3) or Other Relative (12)
Add 1 to TEMP, store 1 in DADFLG(Y), endif
elseif RPREL[PX] = Grandchild (6)
if RPREL(Y) = Child (4), Child of partner (5) or Other relative (12)
Add 1 to TEMP, store 1 in DADFLG(Y), endif
elseif RPREL[PX] = Parent (7)
if RPREL(Y) = Grandparent (9) or Other relative (12)
Add 1 to TEMP, store 1 in DADFLG(Y)
elseif RPREL[PX] = Brother/Sister (8)
if RPREL(Y) = Parent (7) or Other relative (12)
Add 1 to TEMP, store 1 in DADFLG(Y)
elseif RPREL[PX] = Grandparent (9)
if RPREL(Y) = Grandparent (9) or Other relative (12)
Add 1 to TEMP, store 1 in DADFLG(Y), endif
elseif RPREL[PX] = Aunt/Uncle (10)
if RPREL(Y) = Grandparent (9) or Other relative (12)
Add 1 to TEMP, store 1 in DADFLG(Y), endif
elseif RPREL[PX] = Niece/Nephew (11)
if RPREL(Y) = Brother/Sister (8) or Other relative (12)
Add 1 to TEMP, store 1 in DADFLG(Y), endif
elseif RPREL[PX] = Other relative (12)
RPREL(Y) = Niece/Nephew (11) or Other relative (12)
Add 1 to TEMP, store 1 in DADFLG(Y), endif
loop end Y
Wednesday, June 14, 2017
Page 71 of 91
Skip Instructions
If LNDAD[PX] = null and TEMP > 0, GOTO FATHER
elseif LNDAD[PX], LNMOM[PX], LGGUARD1[PX] = null and AGE < 18, GOTO
LGGUARD1
elseif additional persons remain, GOTO FIDCCI4
else GOTO ROSTERCK
Hard Edits
Soft Edits
AssocHelp
Module
96
Section Name
Family Identification Section
Part
6
Question ID
FID.340
Variable Name
FATHER
Universe
FIDCCI5: TEMP > 0 and LNDAD[PX] = null
Universe-text
Potential Father in Family, not already identified
Question Text
? [F1]
* Ask or verify
Is [fill 1] father a household member? Include biological (natural), adoptive, step, or
foster father or father-in-law.
* Enter the line number of the father or father-in-law.
* If the father or father-in-law is not a household member, enter '0'.
* Choose father over father-in-law if both are present.
Answer Codes
Question Type
0. Not Listed
[fill potential list of persons who could be the father]
Pick One - answer list pane
Field Pane Description
Fill Instructions
Father Line #
If PX = HHRESP or RELRESP_A
[fill 1] = "your"
else
[fill 1] = "[ALIAS[PX]]'s"
Special Instructions Display potential Fathers (DADFLG[Y] = 1), except self in the Question Text
Skip Instructions
<1-25> GOTO FATHERCK_A
<0, D, R> if additional persons remain, GOTO FIDCCI4
else GOTO ROSTERCK
Hard Edits
Soft Edits
AssocHelp
H_FATHER
Wednesday, June 14, 2017
Page 72 of 91
Module
96
Section Name
Family Identification Section
Part
6
Question ID
FID.345_H
Variable Name
H_FATHER
Universe
Universe-text
Question Text
Include biological, step, adoptive, and foster father/child relationships. Enter '0' if the
person's father is not a household member or is deceased.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
FATHER
FATHERCK_A
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 73 of 91
Module
96
Section Name
Family Identification Section
Part
6
Question ID
FID.350_1
Variable Name
FATHERCK_A
Universe
FATHER = 1-25 or (ERR1_FATHERCK_A = closed or goto) or (ERR2_FATHERCK_A
= closed or goto)
Universe-text
Father or father-in-law has been identified
Question Text
? [F1]
[fill 1] biological (natural), adoptive, step, or foster father or father-in-law?
Answer Codes
Question Type
1. Biological father
2. Adoptive father
3. Step father
4. Foster father
5. father-in-law
Refused
Don't know
Procedure
Field Pane Description
Fill Instructions
Father Type
if LNDAD[PX] = HHRESP or RELRESP_A
[fill 1] = "Are you [fill ALIAS[PX]]'s "
elseif PX = HHRESP or RELRESP_A
[fill 1] = "Is [fill ALIAS[LNDAD[PX]]] your "
else
[fill 1] = "Is he [fill ALIAS[PX]]'s "
Special Instructions set AGEDIFF = AGE[LNDAD[PX]] - AGE[PX]
if FATHER(PX) = 1(biological)
store FATHER (PX) in LNDAD(PX)
elseif FATHER(PX) = 2(adopted), 3(step), 4(foster)
if LNDAD(PX) = empty
store FATHER(PX) in LNDAD(PX)
endif
elseif FATHER(PX) = 5(in-law)
if LNDAD(PX) = empty
store FATHER(PX) in LNDAD(PX)
endif
elseif FATHER(PX) = refused, don’t know
if LNDAD(PX) = empty
store FATHER(PX) in LNDAD(PX)
endif
endif
Skip Instructions
<1> If AGEDIFF < 5, GOTO ERR2_FATHERCK_A
elseif AGEDIFF = 5-14, GOTO ERR1_FATHERCK_A
elseif AGEDIFF GE 50, GOTO ERR3_ FATHERCK_A
elseif additional persons remain, GOTO FIDCCI4
Wednesday, June 14, 2017
Page 74 of 91
else, GOTO EMAN_SA_SC
<2-5, D, R> if AGEDIFF LE 14, GOTO ERR1_FATHERCK_A
elseif AGEDIFF GE 50, GOTO ERR3_ FATHERCK_A
elseif additional persons remain, GOTO FIDCCI4
else, GOTO EMAN_SA_SC
Hard Edits
ERR2_FATHERCK_A
*Age difference between father and child is [AGEDIFF] years.
I have recorded [ALIAS(LNDAD[PX])] is [AGE(LNDAD[PX])] years old and his child
[ALIAS(PX)] is [AGE(PX)] years old.
Are these ages and relationships correct?
* Please correct relationship code or age.
*First GOTO is to change code at FATHER
*Second GOTO is to change AGE of father [ALIAS (LNDAD[PX])]
*Third GOTO is to change AGE of child [ALIAS(PX)]
Questions involved
FATHER
AGE
AGE
Soft Edits
Value
ALIAS(FATHER [PX])
AGE(LNDAD[PX])
AGE(PX)
ERR1_FATHERCK_A
*Age difference between father and child is only [AGEDIFF] years.
I have recorded [ALIAS(LNDAD[PX])] is [AGE (LNDAD[PX])] years old and his child
[ALIAS(PX)] is [AGE(PX)] years old. Are these ages and relationships correct?
*First GOTO is to change code at FATHER
*Second GOTO is to change AGE of father [ALIAS (LNDAD[PX])]
*Third GOTO is to change AGE of child [ALIAS(PX)]
Questions involved
FATHER
AGE
AGE
Value
ALIAS(FATHER [PX])
AGE(LNDAD[PX])
AGE(PX)
if suppressed goto FIDCCI4
ERR3_FATHERCK_A
*Age difference between father and child is greater than or equal to 50 years.
I have recorded [ALIAS(LNDAD[PX])] is [AGE (LNDAD[PX])] years old and his child
[ALIAS(PX)] is [AGE(PX)] years old. Are these ages and relationships correct?
*First GOTO is to change code at FATHER
*Second GOTO is to change AGE of father [ALIAS (LNDAD[PX])]
*Third GOTO is to change AGE of child [ALIAS(PX)]
Questions involved
FATHER
AGE
AGE
Value
ALIAS(FATHER [PX])
AGE(LNDAD[PX])
AGE(PX)
if suppressed goto FIDCCI4
AssocHelp
H_FATHER
Wednesday, June 14, 2017
Page 75 of 91
Module
96
Section Name
Family Identification Section
Part
6
Question ID
FID.358
Variable Name
EXIT2
Universe
For all PX in FX with HHSTAT ne 'D' and ST NOT IN ('empty','Refused','Don't know')
and ((ST = 'MS' and AGE <'21') or (ST IN ('AL','NE') and AGE <'19') or (ST NOT IN
('MS','AL','NE') and AGE <'18'))
Universe-text
For all states all nondeleted persons who are less than 21 years old in MS or less than
19 years old in AL and NE or less than 18 years old in all other states
Question Text
Not every family in our survey is asked all questions. I have all the information about
your family that I need at this time. Thank you for your assistance.
* Enter (1) to proceed.
Answer Codes
Question Type
Enter 1 to Continue
Field Pane Description
Emancipation
Fill Instructions
Special Instructions
Skip Instructions
<1> set OUTCOME = Occupied entirely by minors (224)
set BYOBS = 2
GOTO VISITCNT (Back Section)
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 76 of 91
Module
96
Section Name
Family Identification Section
Part
6
Question ID
FID.361_00.000
Variable Name
LGGUARD1
Universe
[(RPREL=17) or (FIDCCI5: LNMOM[PX], LNDAD[PX], LGGUARD1, and TEMP = null
(0))] and (AGE[PX] < 18) and (All persons who have HHSTAT[PX] ne D) and (All
persons who have HHSTAT4[PX] ne E)
Universe-text
(Person is ward of reference person OR both mother and father are not present in the
household) AND person is less than 18 AND person is not deleted and is not an
emancipated minor
Question Text
[fill: Do you/Does ALIAS] have a legal guardian?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Fill Instructions
if PX = HHRESP or RELRESP_A
[fill 1] = "Do you"
else
[fill 1] = "[Does ALIAS[PX]]'s"
Special Instructions Display list of persons GE 18 in the Question text
Skip Instructions
<1> [goto LGGUARD2]
<2,R,D> if additional persons remain, GOTO FIDCCI4
else GOTO ROSTERCK
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 77 of 91
Module
96
Section Name
Family Identification Section
Part
6
Question ID
FID.362_00.000
Variable Name
LGGUARD2
Universe
LGGUARD1=1
Universe-text
Person less than 18 has legal guardian
Question Text
*Ask or verify.
Is [fill ALIAS’S] legal guardian a household member?
*Enter the line number of the legal guardian.
*If the legal guardian is not a household member, enter '0'.
Answer Codes
Question Type
(Allow 0, 1-25 for line number of legal guardian)
Integer
Field Pane Description
Fill Instructions
if PX = HHRESP or RELRESP_A
[fill 1] = "your"
else
[fill 1] = "[ALIAS[PX]]'s"
Special Instructions Display list of persons GE 18 in the Question text
Skip Instructions
<0-25, D, R> if additional persons remain, GOTO FIDCCI4
else GOTO ROSTERCK
Hard Edits
Soft Edits
AssocHelp
H_LGGUARD2
Wednesday, June 14, 2017
Page 78 of 91
Module
96
Section Name
Family Identification Section
Part
6
Question ID
FID.362_00_H
Variable Name
H_LGGUARD2
Universe
Universe-text
Question Text
If the person has a legal guardian living in the household enter the person number that
corresponds to the guardian. If the legal guardian is not a household member enter '0'.
Answer Codes
Question Type
Help Screen
Field Pane Description
Help about legal guardians
Fill Instructions
Special Instructions Associated Screen:
LGGUARD2
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 79 of 91
Module
96
Section Name
Family Identification Section
Part
Question ID
FID.365
Variable Name
ROSTERCK
Universe
All cases
Universe-text
Question Text
Fill:
Answer Codes
Question Type
Enter 1 to Continue
Field Pane Description
Fill Instructions
Verify roster
If Sample Child and/or Sample Adult not yet selected
Fill = * You WILL NOT be able to change demographic information after answering
this question.
* Please review the roster information listed below.
* If you are confident that it has been recorded accurately, you may enter 1 to
continue. Otherwise, go back and correct now.
LN
NAME
AGE
SEX
Relationship
(line number, name, age, sex, and relationship of all persons in the HH (not just
the family), including deleted persons)
else
Fill = * The demographic information is now locked and cannot be changed.
* Enter 1 to continue.
Endif
Special Instructions
Skip Instructions
goto EMAN_SA_SC
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Page 80 of 91
Module
96
Section Name
Family Identification Section
Part
7
Question ID
FID.368
Variable Name
EMAN_SA_SC
Universe
All cases
Universe-text
Question Text
Answer Codes
Question Type
Procedure
Field Pane Description
Fill Instructions
Special Instructions # Emancipated Minor Definition:
1. Age 14-20, married, widowed, divorced, separated, or living with a partner in MS
2. Age 14-18, married, widowed, divorced, separated, or living with a partner in AL or
NE
3. Age 14-17, married, widowed, divorced, separated, or living with a partner in all
other states
# Emancipated minor cannot be sample adult nor sample child.
** If there are any non-deleted persons in the family, who are > 17
** store N in AGE17
** Loop to determine emancipated minors.
Loop for all HH members:
if FX[PX] = FAMINT and ((ST = MS and AGE[PX] = 14-20) or (ST IN (AL,NE) and
AGE[PX] = 14-18) or (ST NOT IN (AL,NE,MS) and AGE[PX] = 14-17)) and
HHSTAT[PX] ne D and (MARITAL[PX] = married (1), widowed (2), divorced (3),
separated (4), or living with a partner (6)), store E in HHSTAT4[PX]
endloop
** loop to determine sample adult eligibility
loop through all PX
if FX[PX] = FAMINT and HHSTAT[PX] ne D and HHSTAT3[PX] ne A and
((ST = MS and AGE[PX] > 20) or (ST IN (AL,NE) and AGE[PX] > 18) or (ST NOT IN
(AL,NE,MS) and AGE[PX] > 17))
add 1 to TEMP, store 1 in ELIG[PX] and PX in HOLD, endif
loop end Y
if TEMP = 0
store 0 in SASEL, ASTAT
elseif TEMP = 1
store HOLD in SASEL, S in HHSTAT4[HOLD]
else
randomly select a PX, using only ELIG[PX] = 1 persons.
Store PX in SASEL, S in HHSTAT4[PX] AND SET SAFLG
endif
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Page 81 of 91
** Loop to determine if an eligible sample child exists.
** child must not be emancipated, deleted
** or in the armed forces
** and less than 18.
Set TEMP and HOLD = null
loop through all PX
if FX[PX] = FAMINT and HHSTAT[PX] ne D and HHSTAT3[PX] ne A
and AGE[PX] < 18 and HHSTAT4[PX] ne E
add 1 to TEMP, store 1 ELIG[PX] and PX in HOLD
endif
loop end
if TEMP = 0
store 0 in SCSEL, 0 in CSTAT
elseif TEMP = 1
store HOLD in SCSEL, C in HHSTAT4[HOLD]
else
randomly select a sample child using only ELIG[PX] = 1
store PX in SCSEL, C in HHSTAT4[PX] AND SET SCFLG
endif
Skip Instructions
GOTO SASCFLG
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Wednesday, June 14, 2017
Page 82 of 91
Module
96
Section Name
Family Identification Section
Part
7
Question ID
FID.370
Variable Name
SAID
Universe
All cases
Universe-text
Question Text
* [fill 1]
* [fill 2]
Answer Codes
Question Type
Enter 1 to Continue
Field Pane Description
Fill Instructions
[fill 1]
if SASEL ne 0
"[ALIAS[SASEL]] is selected as the sample adult."
else
"No sample adult was selected."
[fill2]
If SCSEL ne 0
"[ALIAS[SCSEL]] is selected as the sample child."
else
"No sample child was selected."
Special Instructions Cycle through all HH members to identify the total number of sample adults in the
family.
I. if FX[PX] = FAMINT and HHSTAT[PX] ne D and ((ST = MS and AGE[PX] > 20) or
(ST IN (AL,NE) and AGE[PX] > 18) or (ST NOT IN (AL,NE,MS) and AGE[PX] > 17))
add 1 to TOTADULT
store PX in HOLD (a temporary array variable)
endif
II. WEIGHTED CONDITIONS after meeting the above conditions:
A. Weight=1 for those greater than 17 years old.
B. Weight=2 for those AGE= (65 and up) AND a minority where either:
1. NATOR = 1 or
2. RACE = 2, 9, 10, 11, 12, 13, 14, or 15
III. if TOTADULT = 1 and HHRESP = HOLD (the PX of the only adult counted in
TOTADULT in the array)
store HOLD in KNOW2, FINTRO2, FAMRESP, LNO_RESP
set HHSTAT7[HOLD] = B and HSTAT = 1
if SCSEL ne 0
store HOLD in KNOWSC2
endif
endif
Skip Instructions
if TOTADULT > 1 or (TOTADULT = 1 and HHRESP ne HOLD)
goto KNOW2
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Page 83 of 91
elseif TOTADULT = 1 and HHRESP = HOLD
goto FHS.HLTH_BEG
endif
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Module
96
Section Name
Family Identification Section
Part
Question ID
FID.375
Variable Name
CNAM_FLG
Universe
Universe-text
Household respondent has backed up to change data in the sample adult or sample
child name fields after the sample persons selections have been made
Question Text
Answer Codes
Question Type
Blank - no change in name field
1 - change in name field
**Instrument variable**
Field Pane Description
Fill Instructions
Special Instructions if SAID screen has been passed, and if FR backs up and changes data in fields
HHC.010_1 (NAME_FNAME), HHC.010_2 (NAME_MNAME), or HHC.010_3
(NAME_LNAME ) or data in fields FID.112_1 (CHG_NAME_FNAME), FID.112_2
(CHG_NAME_MNAME) or FID.112_3 (CHG_NAME_LNAME) for the sample adult or
the sample child then output value of ‘1’; else value is blank
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Wednesday, June 14, 2017
Page 84 of 91
Module
96
Section Name
Family Identification Section
Part
8
Question ID
FID.380
Variable Name
KNOW2
Universe
TOTADULT > 1 or (TOTADULT = 1 and HHRESP ne HOLD)
Universe-text
More than one adult or (one adult and that adult is not the household respondent.)
Question Text
? [F1]
* Verify or ask
Who in the family would you say knows about the health of all the family members?
[fill 1]
* Mark all that apply, separate with commas.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Fill Instructions
[fill 1] Display all family members who are not deleted and ((ST = MS and AGE[PX] >
20) or
(ST IN (AL, NE) and AGE[PX] > 18) or (ST NOT IN (AL,NE,MS) and AGE[PX] >
17))
Special Instructions
Skip Instructions
<1-25, D, R>
if SCSEL = 0, GOTO FINTRO2
else, GOTO KNOWSC2
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H_KNOW2
Wednesday, June 14, 2017
Page 85 of 91
Module
96
Section Name
Family Identification Section
Part
8
Question ID
FID.385_H
Variable Name
H_KNOW2
Universe
Universe-text
Question Text
Enter the person numbers of up to 3 family members who are knowledgeable about the
health of the rest of the family.
The persons entered in this item must be "eligible" respondents, that is, they must be a
responsible adult household member 18 years of age or older. Adult Armed Forces
members living at home may respond for the family.
Do not include family members under 18 unless they have ever been married or there
are no persons 18+ in the family.
Answer Codes
Question Type
Help Screen
Field Pane Description
Help to determine who is knowledgeable about the health of family members
Fill Instructions
Special Instructions Associated Screen:
KNOW2
Skip Instructions
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Wednesday, June 14, 2017
Page 86 of 91
Module
96
Section Name
Family Identification Section
Part
8
Question ID
FID.390_1
Variable Name
KNOWSC2
Universe
(TOTADULT > 1 or (TOTADULT = 1 and HHRESP ne HOLD)) and SCSEL ne 0
Universe-text
(More than one adult or (one adult and that adult is not the household respondent)) and
a sample child is selected.
Question Text
? [F1]
We select one child in each family for additional health questions. In this family that is
[fill 2]. Who in the family would you say knows about and is responsible for the health
of [fill 2]?
[fill 1]
* Select up to three persons. Mark all that apply (up to three persons), separate by
commas.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Fill Instructions
[fill 1] Display all family members who are not deleted and ((ST = MS and AGE[PX] >
20) or
(ST IN (AL, NE) and AGE[PX] > 18) or (ST NOT IN (AL,NE,MS) and AGE[PX] >
17))
[fill 2] = [ALIAS[SCSEL]]
Special Instructions
Skip Instructions
<1-25, D, R> If more than 3 are selected, GOTO ERR_KNOWSC2
ELSE, GOTO FINTRO2
Hard Edits
ERR_KNOWSC2
* Can't have more than three. Unselect someone.
* Please correct.
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H_KNOWSC
Wednesday, June 14, 2017
Page 87 of 91
Module
96
Section Name
Family Identification Section
Part
8
Question ID
FID.390_2_H
Variable Name
H_KNOWSC
Universe
Universe-text
Question Text
Enter the person numbers of up to 3 family members who are the most knowledgeable
about the sample child.
The persons entered in this item must be "eligible" respondents, that is, they must be a
responsible adult household member 18 years of age or older. Adult Armed Forces
members living at home may respond for the sample child. Do not include family
members under 18 unless they have ever been married or there are no persons 18+ in
the family.
Answer Codes
Question Type
Help Screen
Field Pane Description
Help to determine who is knowledgeable about the health of family members
Fill Instructions
Special Instructions Associated Screen:
KNOWSC2
Skip Instructions
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Wednesday, June 14, 2017
Page 88 of 91
Module
96
Section Name
Family Identification Section
Part
8
Question ID
FID.390_3
Variable Name
FINTRO2
Universe
TOTADULT > 1 or (TOTADULT = 1 and HHRESP ne HOLD)
Universe-text
More than one adult or (one adult and that adult is not the household respondent.)
Question Text
* Enter line number(s) of family members listed that are currently present. Enter up to
10 numbers, separate with commas.
[fill 1]
* If any persons listed are not present, say:
We would like to have all adult family members who are at home take part in the
interview. Are (READ NAMES) at home now?
* If yes, ask: Could they join us?
* If nobody is presently available, enter "96" to procede to a callback screen.
Answer Codes
*/ ALLOW UP TO 10 ENTRIES FROM 1-25/*
96. No one available
Question Type
Enter All That Apply
Field Pane Description
Fill Instructions
Family members present
[fill 1] Display all family members who are not deleted and ((ST = MS and AGE[PX] >
20) or
(ST IN (AL, NE) and AGE[PX] > 18) or (ST NOT IN (AL,NE,MS) and AGE[PX] >
17))
Special Instructions Do not allow Don't Know or Refused
If only 1 PX entered,
store FINTRO2 in FAMRESP, LNO_RESP
set HHSTAT7=B, HSTAT=1
endif
Skip Instructions
<96> GOTO FCALLBK1 (Callback section)
if only one PX selected, GOTO HLTH_BEG (FHS)
else GOTO FAMRESP
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Wednesday, June 14, 2017
Page 89 of 91
Module
96
Section Name
Family Identification Section
Part
8
Question ID
FID.390_4
Variable Name
FAMRESP
Universe
FINTRO2 ne 96 and more than one adult person number is entered.
Universe-text
More than one adult is present and available for interviewing.
Question Text
* Ask if necessary: With whom am I speaking?
[fill 1]
* Enter the line number of the person you consider to be the main respondent for this
family's health questions.
Answer Codes
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Family respondent
[fill 1] Display all selected from FINTRO2
Special Instructions Do not allow Don't Know or Refused
Set HHSTAT7=B, HSTAT=1
Store PX in LNO_RESP
Skip Instructions
GOTO HLTH_BEG
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Wednesday, June 14, 2017
Page 90 of 91
Module
96
Section Name
Family Identification Section
Part
Question ID
FID.400
Variable Name
HHCFIDC_FLG
Universe
Universe-text
Question Text
***FLAG***
Answer Codes
0,1
Question Type
Flag
Field Pane Description
Fill Instructions
Special Instructions if HLTH_BEG in(1,8) then
HHCFIDC_FLG := 1
else
HHCFIDC_FLG := 0
endif
Skip Instructions
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Wednesday, June 14, 2017
Page 91 of 91
2018 Q1 NHIS Instrument Spec Report
Section name: HEALTH STATUS AND LIMITATION OF
ACTIVITIES
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.001
Variable Name
HLTH_BEG
Universe
FSTAT= empty or FSTAT=2
Universe-text
All families
Question Text
* Read the following introduction:
I am now going to ask about [fill1: your/the] general health [fill2: /of family members]
and the effects of any physical, mental, or emotional health problems.
* If refused enter CTRL-R.
Answer Codes
Enter 1 to Continue
Question Type
Text
Field Pane Description
Fill Instructions
Continue
fill1: if the subject=respondent fill "your" else fill "the".
fill2: if the subject=respondent fill an empty blank " " else, fill "of family members"
Special Instructions family level item; don’t store
do not allow
Skip Instructions
<1> [store <> in FSTAT; if AGE LE 4 goto FLAPLYLM; else goto FSPEDEIS]
goto [BCK.215_VISITCNT]
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Tuesday, June 13, 2017
Page 1 of 153
Module
04
Section Name
Family Health Ststus and Limitations of Activity
Part
Question ID
FHS.002
Variable Name
FAMDATE
Universe
HLTH_BEG = continue
Universe-text
Family Questionnaire has been started
Question Text
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions Set only if FAMDATE = empty
if HLTH_BEG = 1 (continue), set FAMDATE = CDATE (current date) (now called
ComputationDate)
This is an output variable that should be in the format 'MMDDYYYY'
Skip Instructions
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Page 2 of 153
Module
04
Section Name
Family Health Ststus and Limitations of Activity
Part
Question ID
FHS.003
Variable Name
FAMTIME
Universe
HLTH_BEG = continue
Universe-text
Family Questionnaire has been started
Question Text
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions Set only if FAMTIME = empty
if HLTH_BEG = 1 (continue), set FAMTIME = current time
This is an output variable that should be in the format "HH:MM [fill: a.m./p.m.]
Skip Instructions
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Page 3 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.005
Variable Name
FLAPLYLM
Universe
AGE<5
Universe-text
Families with one or more children age 0 to 4 years
Question Text
?[F1]
[fill1: Are/Is]
* Read names
(fill roster of persons age 0-4)
limited in the kind or amount of play activities [fill2: they/he/she] can do because of a
physical, mental, or emotional problem?
Answer Codes
1. Yes
2. No
Refused
Don’t Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Limited in Play
fill1: For multi-person children age 0 to 4 years fill "Are", else fill "Is"
fill2: For multi-person children age 0 to 4 years fill "they", else fill "he/she"
Special Instructions family level item;
roster grid (display roster of children age 0 to 4)
Store this family level value to the person level.
Skip Instructions
<1> and only one child <5 store line number in PLAPLYLM and goto PLAPLYUN.
Else, goto [PLAPLYLM]
<2,D,R> [goto FSPEDEIS]
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Tuesday, June 13, 2017
Page 4 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.005_H
Variable Name
H_FLAPLYLM
Universe
Universe-text
Question Text
This question is only for children four years old or younger.
Physical, mental, and emotional problems are respondent defined.
The term "limited" is respondent defined.
Enter "1" if the respondent believes that any of the children four years old or younger
are limited in the kind or amount of
play activities they can do because of a physical, mental, or emotional problem.
Enter "2" if the respondent does not believe that any of the children four years old or
younger are limited in the kind or
amount of play activities they can do because of a physical, mental, or emotional
problem.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
FLAPLYLM
Skip Instructions
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Tuesday, June 13, 2017
Page 5 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.010
Variable Name
PLAPLYLM
Universe
FLAPLYML=1
Universe-text
Persons <5 years and more than 1 child under 5
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions family level item; store at both family and at person level;
Eligible children with age 0-4 years
Store this family level value to the person level.
Skip Instructions
[Goto PLAPLYUN]
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Page 6 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.020
Variable Name
PLAPLYUN
Universe
FLAPLYLM =1 and persons selected in PLAPLYLM
Universe-text
Persons <5 yrs limited in play activities
Question Text
Is [fill: Alias listed in PLAPLYLM] able to take part AT ALL in
the usual kinds of play activities done by most children [Alias]’s age?
Answer Codes
1. Yes
2. No
Refused
Don’t Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Can Play at All
fill: Alias listed in PLAPLYLM
Special Instructions person level item
Skip Instructions
<1,2,D,R> [Repeat this question to those children listed in PLAPLYLM, then [Goto
FSPEDEIS]
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Tuesday, June 13, 2017
Page 7 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.050
Variable Name
FSPEDEIS
Universe
AGE<18
Universe-text
Persons<18 years
Question Text
?[F1]
[fill: Do you/Does/Do any of the following family members,
* Read names
(fill roster of persons less than age 18)]
receive Special Educational or Early Intervention Services?
Answer Codes
1. Yes
2. No
Refused
Don’t Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Ed/EIS
fill: for single-person household AGE<18 fill "Do you" (Emancipated minor), for multiperson houshold in which there is a single-person<18 years fill "Does" else fill "Do
any of the.."
Special Instructions family level item;
roster grid (display roster of persons<18 years)
Store this family level value to the person level.
Skip Instructions
<1> If only 1 child in the family, or if subject (child<18)=respondent
[store child’s person number in [PSPEDEIS]_1, goto PSPEDEM], else [goto
PSPEDEIS]
<2,D,R> [goto FLAADL]
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Tuesday, June 13, 2017
Page 8 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.050_H
Variable Name
H_FSPEDEIS
Universe
Universe-text
Question Text
This question is only for children 17 years old or younger.
Special Education is teaching designed to meet the needs of a child with special
needs and/or disabilities. They are designed for
children and youths aged 3 to 21. It is paid for by the public school system and may
take place at a regular school, a special
school, a private school, at home, or at a hospital.
Early Intervention Services are services designed to meet the needs of very young
children with special needs and/or disabilities. They
may include but are not limited to: medical and social services, parental counseling,
and therapy. They may be provided at the
child's home, a medical center, a day care center, or other place. They are provided
by the state or school system at no cost to the
parent.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
FSPEDEIS
Skip Instructions
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Tuesday, June 13, 2017
Page 9 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.060
Variable Name
PSPEDEIS
Universe
FSPEDEIS=1 and more than 1 child less than 18
Universe-text
Persons < 18 receive Special Ed/EIS
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions family level item; store at both family and at person level
eligible children ages 0-17 years
Store this family level value to the person level.
Skip Instructions
[Goto PSPEDEM]
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Tuesday, June 13, 2017
Page 10 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.065
Variable Name
PSPEDEM
Universe
FSPEDEIS= 1 and persons selected in PSPEDEIS
Universe-text
Question Text
[fill: Do you/Does ALIAS] receive these services because of an emotional or
behavioral problem?
Answer Codes
1. Yes
2. No
Refused
Don’t Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Due to Emotional/Behavioral Problem
fill: if the subject=respondent fill "Do you" else, fill "Does ALIAS"
Special Instructions person level item
Skip Instructions
<1,2,D,R> [goto FLAADL]
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Tuesday, June 13, 2017
Page 11 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.070
Variable Name
FLAADL
Universe
All families
Universe-text
Families with one or more persons ages 3 years and older
Question Text
Because of a physical, mental, or emotional problem, [fill1: do you/does anyone in the
family] need the help of other persons with PERSONAL CARE NEEDS, such as
eating, bathing, dressing, or getting around inside this home?
[fill2: Do not include family members age 2 and under.]
Answer Codes
1. Yes
2. No
Refused
Don’t Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Personal Care Needs
fill1: if one person family fill "do you" else, fill "does anyone in the family"
fill2: If there is a child < 3 years old in the family add "Do not include family members
age 2 and under."
Special Instructions family level item;
roster grid
Store this family level value to the person level.
Skip Instructions
<1>If one person family,
[store the respondent person number into PLAADL, [goto LABATH] , else [goto
PLAADL]
<2,D,R> [goto FLAIADL]
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Tuesday, June 13, 2017
Page 12 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.070_H
Variable Name
H_FLAADL
Universe
Universe-text
Question Text
This question is for all family members age 3 and over.
Physical, mental, and emotional problems are respondent defined.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
FLAADL
Skip Instructions
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Tuesday, June 13, 2017
Page 13 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.080
Variable Name
PLAADL
Universe
FLAADL= 1 and more than 1 person age 3+ years
Universe-text
All families
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions family level item; store at both family and at person level
Eligible persons ages 3+ years
Store this family level value to the person level.
Skip Instructions
[Goto LABATH]
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Tuesday, June 13, 2017
Page 14 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.090_1
Variable Name
LABATH
Universe
FLAADL= 1 and person selected in PLAADL
Universe-text
Persons with a limitation
Question Text
[fill: Do you/Does Alias] need the help of other persons with...
Bathing or showering?
Answer Codes
1. Yes
2. No
Refused
Don’t Know
Question Type
Repeating Series - Yes/No
Field Pane Description
Fill Instructions
Bathing
fill: if the subject= respondent fill "Do you" else, fill "Does Alias"
Special Instructions person level item;
Roster grid for all selected in PLAADL
Skip Instructions
<1, 2, D, R> [Repeat this question for family members listed in PLAADL, goto
LADRESS-LAHOME]
Else, [goto FLAIADL]
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Tuesday, June 13, 2017
Page 15 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.090_2
Variable Name
LADRESS
Universe
FLAADL= 1 and person selected in PLAADL
Universe-text
Persons with a limitation
Question Text
* Read if necessary.
[fill: Do you/Does Alias] need the help of other persons with...
Dressing?
Answer Codes
1. Yes
2. No
Refused
Don’t Know
Question Type
Repeating Series - Yes/No
Field Pane Description
Fill Instructions
Dressing
fill: if the subject=respondent fill "Do you" else, fill "Does Alias"
Special Instructions person level item
Roster grid
Skip Instructions
<1, 2, D, R> [Repeat this question for family members listed in PLAADL, goto LAEATLAHOME
Else, [goto FLAIADL]
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Tuesday, June 13, 2017
Page 16 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.090_3
Variable Name
LAEAT
Universe
FLAADL= 1 and person selected in PLAADL
Universe-text
Persons with a limitation
Question Text
* Read if necessary.
[fill: Do you/Does Alias] need the help of other persons with...
Eating?
Answer Codes
1. Yes
2. No
Refused
Don’t Know
Question Type
Repeating Series - Yes/No
Field Pane Description
Fill Instructions
Eating
fill: if the subject=respondent fill "Do you" else, fill "Does Alias"
Special Instructions person level item;
Roster grid
Skip Instructions
<1, 2, D, R> [Repeat this question for family members listed in PLAADL, goto LABEDLAHOME
Else [goto FLAIADL]
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Tuesday, June 13, 2017
Page 17 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.090_4
Variable Name
LABED
Universe
FLAADL= 1 and person selected in PLAADL
Universe-text
Persons with a limitation
Question Text
* Read if necessary.
[fill: Do you/Does Alias] need the help of other persons with...
Getting in or out of bed or chairs?
Answer Codes
1. Yes
2. No
Refused
Don’t Know
Question Type
Repeating Series - Yes/No
Field Pane Description
Fill Instructions
In/out Bed/ Chairs
fill: if the subject=respondent fill "Do you" else, fill "Does Alias"
Special Instructions person level item;
Roster grid
Skip Instructions
<1, 2, D, R> [Repeat this question for family members listed in PLAADL, goto
LATOILT- LAHOME
Else [goto FLAIADL]
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Tuesday, June 13, 2017
Page 18 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.090_5
Variable Name
LATOILT
Universe
FLAADL= 1 and person selected in PLAADL
Universe-text
Persons with a limitation
Question Text
* Read if necessary.
[fill: Do you/Does Alias] need the help of other persons with...
Using the toilet, including getting to the toilet?
Answer Codes
1. Yes
2. No
Refused
Don’t Know
Question Type
Repeating Series - Yes/No
Field Pane Description
Fill Instructions
Toileting
fill: if the subject=respondent fill "Do you" else, fill "Does Alias"
Special Instructions person level item;
Roster grid
Skip Instructions
<1, 2, D, R> [Repeat this question for family members listed in PLAADL, goto
LAHOME
Else [goto FLAIADL]
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Tuesday, June 13, 2017
Page 19 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.090_6
Variable Name
LAHOME
Universe
FLAADL= 1 and person selected in PLAADL
Universe-text
Persons with a limitation
Question Text
* Read if necessary.
[fill: Do you/Does Alias] need the help of other persons with...
Getting around inside the home?
Answer Codes
1. Yes
2. No
Refused
Don’t Know
Question Type
Repeating Series - Yes/No
Field Pane Description
Fill Instructions
Get Around in Home
fill: if the subject=respondent fill "Do you" else, fill "Does Alias"
Special Instructions person level item;
Roster grid
Skip Instructions
<1, 2, D, R> [Repeat this question for family members listed in PLAADL,
Else [goto FLAIADL]
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Tuesday, June 13, 2017
Page 20 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.150
Variable Name
FLAIADL
Universe
AGE>=18
Universe-text
Families with one or more persons ages 18 years and older
Question Text
?[F1]
Because of a physical, mental, or emotional problem, do [fill: you/any of these family
members
* Read names
(fill roster of persons greater than or equal to age 18)]
need the help of other persons in handling ROUTINE NEEDS, such as everyday
household chores, doing necessary business, shopping, or getting around for other
purposes?
Answer Codes
1. Yes
2. No
Refused
Don’t Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Routine needs
fill: if one person family fill "you" else, fill "any of these family members * (Read
names)"
Special Instructions family level item
new form pane
(display roster of persons AGE>=18)
Skip Instructions
<1> If one person family, store the respondent’s person number in PLAIADL, Goto
FLAWKNOW],
else [goto PLAIADL]
<2,D,R> [goto FLAWKNOW]
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H_FLAIADL
Tuesday, June 13, 2017
Page 21 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.150_H
Variable Name
H_FLAIADL
Universe
Universe-text
Question Text
This question is for all family members age 18 and older.
Physical, mental, and emotional problems are respondent defined.
Enter "1" if the respondent believes that someone in the family needs the help of other
persons in handling routine needs, such
as everyday household chores, doing necessary business, shopping, or getting
around for other purposes.
Enter "2" if the respondent does not believe that anyone in the family needs the help
of other persons in handling routine needs,
such as everyday household chores, doing necessary business, shopping, or getting
around for other purposes.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
FLAIADL
Skip Instructions
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Tuesday, June 13, 2017
Page 22 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.160
Variable Name
PLAIADL
Universe
FLAIADL= 1 and more than 1 person 18+
Universe-text
Families with limitations persons 18+yrs. and more than 1 persons 18+ yrs.
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions family level item; store at both family and at person level
Eligible persons age 18+
Skip Instructions
Family members not in delete status only.
Otherwise, [goto FLAWKNOW].
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Tuesday, June 13, 2017
Page 23 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.170
Variable Name
FLAWKNOW
Universe
AGE>= 18
Universe-text
Families with one or more persons ages 18 years and older
Question Text
?[F1]
Does a physical, mental, or emotional problem NOW keep [fill: you/any of these family
members
* Read names
(fill roster of persons greater than than or equal to age 18)]
from working at a job or business?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Unable to work
fill: if one person family fill "you" else, fill "any of these family members * (Read
names) (fill in names of family members aged 18 and older)"
Special Instructions family level item
display roster of persons 18 and older
Skip Instructions
<1>If one person family store in [PLAWKNOW] goto FLAWALK,
Else goto PLAWKNOW
<2,R,DK> [goto FLAWKLIM]
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H_FLAWKNOW
Tuesday, June 13, 2017
Page 24 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.170_H
Variable Name
H_FLAWKNOW
Universe
Universe-text
Question Text
This question is for family members 18 years old and older.
Physical, mental, and emotional problems are respondent defined.
Enter "1" if a physical, mental, or emotional problem NOW keeps any of the family
members 18 years old or older from working at a job
or business.
Enter "2" if a physical, mental, or emotional problem does not NOW keep any of the
family members 18 years old or older from working
at a job or business.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
FLAWKNOW
Skip Instructions
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Tuesday, June 13, 2017
Page 25 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.180
Variable Name
PLAWKNOW
Universe
FLAWKNOW=1 and more than 1 person 18+
Universe-text
Families with more than 1 limited person 18+ years
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions family level item; store at both family and at person level
Eligible persons age 18+
Skip Instructions
All selected goto [FLAWALK],
Else goto [FLAWKLIM]
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Tuesday, June 13, 2017
Page 26 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.190
Variable Name
FLAWKLIM
Universe
AGE >= 18 and at least 1 person NOT selected in PLAWKNOW
Universe-text
Families with (one or more persons ages 18 years and older and not selected in
PLAWKNOW)
Question Text
?[F1]
[fill: Are you limited in the kind OR amount of work you/ Is Alias limited in the kind OR
amount of work he/she/ Are any of these family members,
* Read names
(fill roster of persons greater than or equal to age 18)]
limited in the kind OR amount of work they] can do because of a physical, mental or
emotional problem?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Limited in work
fill: if the subject=respondent fill "Are you.." If only 1 person not selected in
PLAWKNOW then fill " Is Alias.." else, fill "Are any of these family members, * (Read
names below) limited in the kind OR amount of work they"
Special Instructions family level item
(Read names below) display roster of persons AGE>=18 and not selected in
PLAWKNOW
Skip Instructions
<1> [ if one-person family, or only 1 person 18+ not selected in PLAWKNOW, store
person number in PLAWKLIM and goto [FLAWALK]; else goto [PLAWKLIM]
<2,R,DK> [goto FLAWALK]
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H_FLAWKLIM
Tuesday, June 13, 2017
Page 27 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.190_H
Variable Name
H_FLAWKLIM
Universe
Universe-text
Question Text
This question is for family members 18 years old or older that were not previously
identified as having a physical, mental, or emotional
problem that NOW keeps them from working at a job or business.
Physical, mental, and emotional problems are respondent defined.
Enter "1" if any of the family members 18 years old or older that were not previously
identified as having a physical, mental, or
emotional problem that NOW keeps them from working at a job or business are limited
in the kind OR amount of work they can do
because of a physical, mental, or emotional problem.
Enter "2" if none of the family members 18 years old or older that were not previously
identified as having a physical, mental, or
emotional problem that NOW keeps them from working at a job or business are limited
in the kind OR amount of work they can do
because of a physical, mental, or emotional problem.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screen:
FLAWKLIM
Skip Instructions
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Tuesday, June 13, 2017
Page 28 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.200
Variable Name
PLAWKLIM
Universe
FLAWKLIM = 1 and more than 1 person 18+ NOT selected in PLAWKNOW
Universe-text
More than 1 persons 18+ years and able to work
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions family level item; store at both family and at person level
Eligible persons age 18+ and NOT selected in PLAWKNOW
Skip Instructions
Family members not in delete status only.
[goto FLAWALK];
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Tuesday, June 13, 2017
Page 29 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.210
Variable Name
FLAWALK
Universe
All
Universe-text
All families
Question Text
?[F1]
Because of a health problem, [fill: do you/does anyone in the family] have difficulty
walking without using any special equipment?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Difficulty walking
fill: if one person family fill "do you" else, fill "does anyone.."
Special Instructions family level item
Skip Instructions
<1> if one person family store in PLAWALK and goto [FLAREMEM], else goto
[PLAWALK]
<2,R,DK> [goto FLAREMEM]
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H_FLAWALK
Tuesday, June 13, 2017
Page 30 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.210_H
Variable Name
H_FLAWALK
Universe
Universe-text
Question Text
This question is for all family members.
The term "health problem" is respondent defined.
Enter "1" if any family member, because of a health problem, has difficulty walking
without using any special equipment.
Enter "2" if no family member, because of a health problem, has difficulty walking
without using any special equipment.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
FLAWALK
Skip Instructions
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Tuesday, June 13, 2017
Page 31 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.220
Variable Name
PLAWALK
Universe
FLAWALK = 1 and more than 1 person in family
Universe-text
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions family level item; store at both family and at person level
All non-deleted persons eligible
Skip Instructions
Family members not in delete status only.
Goto [FLAREMEM].
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Tuesday, June 13, 2017
Page 32 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.230
Variable Name
FLAREMEM
Universe
Universe-text
All families
Question Text
?[F1]
[fill1: Are you/Is anyone in the family] LIMITED IN ANY WAY because of difficulty
remembering or because [fill2: you/they] experience periods of confusion?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Difficulty remembering
fill1: if one person family fill "Are you" else, fill "Is anyone in the family"
fill2: if one person family fill "you" else, fill "they"
Special Instructions family level item
Skip Instructions
<1> if single-person family and age is less than 18, store person number in
PLAREMEM and goto [LAHCC]
Else, if single person family and age is 18+ store person # in [PLAREMEM] and goto
LAHCA.
Else goto [PLAREMEM]
<2,R,DK> [goto FLIMANY]
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H_FLAREMEM
Tuesday, June 13, 2017
Page 33 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.230_H
Variable Name
H_FLAREMEM
Universe
Universe-text
Question Text
This question is for all family members.
Consider a person to be "limited" if he/she can only partially perform an activity, or
can do it fully only part of the time,
or cannot do it at all.
Include only limitations related to difficulty remembering or experiencing periods of
confusion.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
FLAREMEM
Skip Instructions
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Tuesday, June 13, 2017
Page 34 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.240
Variable Name
PLAREMEM
Universe
FLAREMEM = 1 and more than 1 person in family
Universe-text
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions family level item; store at both family and at person level
All non-deleted persons eligible
Skip Instructions
Goto [FLIMANY]
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Tuesday, June 13, 2017
Page 35 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.250
Variable Name
FLIMANY
Universe
At least 1 person NOT selected in PLAPLYLM or in PSPEDEIS or in PLAADL or in
PLAIADL or in PLAWKNOW or in PLAWKLIM or in PLAWALK or in PLAREMEM
Universe-text
All families with any family members with no previously mentioned
limitations (NOT selected in PLAPLYLM or in PSPEDEIS or in PLAADL or in
PLAIADL or in PLAWKNOW or in PLAWKLIM or in PLAWALK or in PLAREMEM)
Question Text
?[F1]
[fill: Are you/ Is Alias/ Are any family members
* Read names
(fill roster of applicable persons.)]
LIMITED IN ANY WAY in any activities because of physical, mental or emotional
problems?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Any limitation
fill: if one person family fill "Are you" if more than 1 member not selected in
PLAPLYLM or in PSPEDEIS or in PLAADL or in PLAIADL or in PLAWKNOW or in
PLAWKLIM or in PLAWALK or in PLAREMEM, fill "Are any family members * (Read
names) (list names of persons without limitation)"
Else, fill "Is Alias"
Special Instructions family level item; Background validation using PLAPLYLM, PSPEDEIS, PLAADL,
PLAIADL, PLAWKNOW, PLAWKLIM, PLAWALK, and PLAREMEM. * Read names
below; Only display family members NOT selected in these items.
Skip Instructions
<1> [if 1 person family or respondent= only person NOT selected in [PLAPLYLM or in
PSPEDEIS or in PLAADL or in PLAIADL or in PLAWKNOW or in PLAWKLIM or in
PLAWALK or in PLAREMEM] fill "Are you". Else if only 1 person not selected in
[PLAPLYLM or in PSPEDEIS or in PLAADL or in PLAIADL or in PLAWKNOW or in
PLAWKLIM or in PLAWALK or in PLAREMEM] fill "Is Alias";
Else fill "Are any family members * Read names below (list names of person without
limitation)"
<2,R,DK> [goto LAHCC]
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H_FLIMANY
Tuesday, June 13, 2017
Page 36 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.250_H
Variable Name
H_FLIMANY
Universe
Universe-text
Question Text
This question is for those family members that have not been previously reported as
having a limitation due to a physical, mental, or emotional problem, or a limitation due
to difficulty remembering or experiencing periods of confusion.
Physical, mental, and emotional problems are respondent defined.
Consider a person to be "limited" if he/she can only partially perform an activity, or
can do it fully only part of the time, or cannot do it at all.
Include only limitations related to physical, mental, or emotional problems.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
FLIMANY
Skip Instructions
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Tuesday, June 13, 2017
Page 37 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.260
Variable Name
PLIMANY
Universe
FLIMANY = 1 and more than 1 person NOT selected in PLAPLYLM or in PSPEDEIS
or in PLAADL or in PLAIADL or in PLAWKNOW or in PLAWKLIM or in PLAWALK or
in PLAREMEM
Universe-text
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions family level item; store at both family and at person level
Eligible persons NOT selected in PLAPLYLM or in PSPEDEIS or in PLAADL or
in PLAIADL or in PLAWKNOW or in PLAWKLIM or in PLAWALK or in PLAREMEM.
Only display family members NOT selected in these items.
Skip Instructions
Goto LAHCC
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Tuesday, June 13, 2017
Page 38 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.270
Variable Name
LAHCC
Universe
Universe-text
age 0 to 17 years and (person selected in (PLAPLYLM or PSPEDEIS or PLAADL or
PLAWALK or PLAREMEM or PLIMANY))
Question Text
(book) F1
What conditions or health problems cause [fill: Alias]’s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
Answer Codes
1. Vision/ problem seeing
2. Hearing problem
3. Speech problem
4. Asthma/breathing problem
5. Birth defect
6. Injury
7. Intellectual disability, also known as mental retardation
8. Other developmental problem (for example, cerebral palsy)
9. Other mental, emotional, or behavioral problem
10. Bone, joint, or muscle problem
11. Epilepsy or seizures
12. Learning disability
13. Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90. Other impairment/problem (LAHCC_S1)
91. Other impairment/problem (LAHCC_S2)
Refused
Don’t know
Question Type
Enter All That Apply
Field Pane Description
Fill Instructions
Conditions/health problems
fill: [Alias]
Special Instructions person level item; store at person level
Condition Grid
Skip Instructions
<1-4, 6-13> selected entries goto appropriate follow up question LHCL##N [##= 0113, 90, 91]
<5> fill "96" in LHCL05N and fill "6" in LHCL05T
<90> goto LAHCC_S1
<91> goto LAHCC_S2
Roster through all selected in [PLAPLYLM or in PSPEDEIS or in PLAADL or
in PLAIADL or in PLAWKNOW or in PLAWKLIM or in PLAWALK or in PLAREMEM]
Once exhausted goto LAHCA.
For all selected LAHCC entries goto appropriate follow up question LHCL##N [##= 0113, 90,91]
Roster through all LAHCC entries. Roster through all selected in [PLAPLYLM or in
Tuesday, June 13, 2017
Page 39 of 153
PSPEDEIS or in PLAADL or in PLAIADL or in PLAWKNOW or in PLAWKLIM or in
PLAWALK or in PLAREMEM] Once exhausted goto LAHCA.
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H_LAHCC
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.270_H
Variable Name
H_LAHCC
Universe
Universe-text
Question Text
This question is for those family members less than 18 years old who were previously
reported as having a limitation.
The terms "conditions" and "health problems" are respondent defined.
Do not read the precoded categories to the respondent.
Enter "90 or 91" if the respondent mentions a condition or health problem not listed
and then specify the condition exactly as the respondent states it.
Consider a person to be "limited" if he/she can only partially perform an activity, or
can do it fully only part of the time, or
cannot do it at all.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
LAHCC
Skip Instructions
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Tuesday, June 13, 2017
Page 40 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.271_90
Variable Name
LAHCC_S1
Universe
If 90 selected in LAHCC
Universe-text
Other impairment selected in LAHCC
Question Text
* Read if necessary.
What is the other impairment or problem?
Answer Codes
Question Type
Text
Field Pane Description
Specify One
Fill Instructions
Special Instructions
Skip Instructions
<50 chars>
goto [LHCL90N]
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Tuesday, June 13, 2017
Page 41 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.271_91
Variable Name
LAHCC_S2
Universe
If 91 selected in LAHCC
Universe-text
Other impairment selected in LAHCC
Question Text
* Read if necessary.
What is the other impairment or problem?
Answer Codes
Question Type
Text
Field Pane Description
Specify One
Fill Instructions
Special Instructions
Skip Instructions
<50 chars>
goto [LHCL91N]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 42 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.280_1
Variable Name
LHCL01N
Universe
LAHCC=1
Universe-text
Condition number 1 selected in LAHCC
Question Text
1 of 2
How long [fill: have you/has Alias] had a vision problem or problem seeing?
* Enter number for time with vision problem or problem seeing.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-95, D> goto LHCL01T
<96> then fill "6" in LHCL01T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHCL##N and LHCL##T]; Roster through persons eligible in
LAHCC, else go to[LAHCA]
store "R" in [LHCL01T] goto next condition in [LAHCC]
Once exhausted goto [LAHCA]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 43 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.280_2
Variable Name
LHCL01T
Universe
LHCL01N=1-95, DK
Universe-text
Condition number 1 selected in LAHCC
Question Text
2 of 2
* Enter time period for time with vision problem or problem seeing.
(LHCL01N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCC], continue to ask number and time
period for each subsequent condition; else go to LAHCA
Roster through all LAHCC entries, roster through next child. Once exhausted goto
LAHCA.
<6> goto ERR2_LHCL01T
if (LHCL01T = 4 and LHCL01N > AGE) or (LHCL01T = 3 and LHCL01N > AGE
in months) or (LHCL01T = 2 and LHCL01N > AGE in weeks), goto [ERR1_LHCL01T]
Hard Edits
ERR1_LHCL01T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL01T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 44 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.282_1
Variable Name
LHCL02N
Universe
LAHCC=2
Universe-text
Condition number 2 selected in LAHCC
Question Text
1 of 2
How long [fill: have you/has Alias] had a hearing problem?
* Enter number for time with hearing problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-95, D> goto LHCL02T
<96> then fill "6" in LHCL02T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHCL##N and LHCL##T]; Roster through persons eligible in
LAHCC, else go to[LAHCA]
store "R" in [LHCL02T] goto next condition in [LAHCC]
Once exhausted goto [LAHCA]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 45 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.282_2
Variable Name
LHCL02T
Universe
LHCL02N=1-95, DK
Universe-text
Condition number 2 selected in LAHCC
Question Text
2 of 2
* Enter time period for time with hearing problem.
(LHCL02N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCC], continue to ask number and time
period for each subsequent condition; else go to LAHCA
Roster through all LAHCC entries, roster through next child. Once exhausted goto
LAHCA.
<6> goto ERR2_LHCL02T
if (LHCL02T = 4 and LHCL02N > AGE) or (LHCL02T = 3 and LHCL02N > AGE
in months) or (LHCL02T = 2 and LHCL02N > AGE in weeks), goto [ERR1_LHCL02T]
Hard Edits
ERR1_LHCL02T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL02T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 46 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.284_1
Variable Name
LHCL03N
Universe
LAHCC=3
Universe-text
Condition number 3 selected in LAHCC
Question Text
1 of 2
How long [fill: have you/has Alias] had a speech problem?
* Enter number for time with speech problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-95, D> goto LHCL03T
<96> then fill "6" in LHCL03T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHCL##N and LHCL##T]; Roster through persons eligible in
LAHCC, else go to[LAHCA]
store "R" in [LHCL03T] goto next condition in [LAHCC]
Once exhausted goto [LAHCA]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 47 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.284_2
Variable Name
LHCL03T
Universe
LHCL03N=1-95, DK
Universe-text
Condition number 3 selected in LAHCC
Question Text
2 of 2
* Enter time period for time with speech problem.
(LHCL03N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCC], continue to ask number and time
period for each subsequent condition; else go to LAHCA
Roster through all LAHCC entries, roster through next child. Once exhausted goto
LAHCA.
<6> goto ERR2_LHCL03T
if (LHCL03T = 4 and LHCL03N > AGE) or (LHCL03T = 3 and LHCL03N > AGE
in months) or (LHCL03T = 2 and LHCL03N > AGE in weeks), goto [ERR1_LHCL03T]
Hard Edits
ERR1_LHCL03T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL03T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 48 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.286_1
Variable Name
LHCL04N
Universe
LAHCC=4
Universe-text
Condition number 4 selected in LAHCC
Question Text
1 of 2
How long [fill: have you/has Alias] had asthma or a breathing problem?
* Enter number for time with asthma or breathing problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-95, D> goto LHCL04T
<96> then fill "6" in LHCL04T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHCL##N and LHCL##T]; Roster through persons eligible in
LAHCC, else go to[LAHCA]
store "R" in [LHCL04T] goto next condition in [LAHCC]
Once exhausted goto [LAHCA]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 49 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.286_2
Variable Name
LHCL04T
Universe
LHCL04N=1-95, DK
Universe-text
Condition number 4 selected in LAHCC
Question Text
2 of 2
* Enter time period for time with asthma or a breathing problem.
(LHCL04N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCC], continue to ask number and time
period for each subsequent condition; else go to LAHCA
Roster through all LAHCC entries, roster through next child. Once exhausted goto
LAHCA.
<6> goto ERR2_LHCL04T
if (LHCL04T = 4 and LHCL04N > AGE) or (LHCL04T = 3 and LHCL04N > AGE
in months) or (LHCL04T = 2 and LHCL04N > AGE in weeks), goto [ERR1_LHCL04T]
Hard Edits
ERR1_LHCL04T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL04T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 50 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.287_1
Variable Name
LHCL05N
Universe
LAHCC=5
Universe-text
Condition number 5 selected in LAHCC
Question Text
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Storage variable for the line number of the Health Status and Limitation section birth
defect condition.
Question text not displayed
person level item; store at person level
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 51 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.287_2
Variable Name
LHCL05T
Universe
LHCL05N=1-95, DK
Universe-text
Condition number 5 selected in LAHCC
Question Text
Answer Codes
Question Type
Pick One - answer list pane
Field Pane Description
Units
Fill Instructions
Special Instructions Storage variable for the line number of the Health Status and Limitation section birth
defect condition.
Question text not displayed
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 52 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.288_1
Variable Name
LHCL06N
Universe
LAHCC=6
Universe-text
Condition number 6 selected in LAHCC
Question Text
1 of 2
How long [fill1: have you/has Alias] had the injury that caused [fill2:your/his/her]
limitation?
* Enter number for time with the injury.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill1: if the subject=respondent fill "have you" else, fill "has Alias"
fill2: if the subject=respondent fill "your" else, fill "his/her"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-95, D> goto LHCL06T
<96> then fill "6" in LHCL06T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHCL##N and LHCL##T]; Roster through persons eligible in
LAHCC, else go to[LAHCA]
store "R" in [LHCL06T] goto next condition in [LAHCC]
Once exhausted goto [LAHCA]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 53 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.288_2
Variable Name
LHCL06T
Universe
LHCL06N=1-95, DK
Universe-text
Condition number 6 selected in LAHCC
Question Text
2 of 2
* Enter time period for time with the injury that caused [fill: your/his/her] limitation.
(LHCL06N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Time period
fill: if the subject=respondent fill "your" else, fill "his/her"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCC], continue to ask number and time
period for each subsequent condition; else go to LAHCA
Roster through all LAHCC entries, roster through next child. Once exhausted goto
LAHCA.
<6> goto ERR2_LHCL06T
if (LHCL06T = 4 and LHCL06N > AGE) or (LHCL06T = 3 and LHCL06N > AGE
in months) or (LHCL06T = 2 and LHCL06N > AGE in weeks), goto [ERR1_LHCL06T]
Hard Edits
ERR1_LHCL06T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL06T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 54 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.290_1
Variable Name
LHCL07N
Universe
LAHCC=7
Universe-text
Condition number 7 selected in LAHCC
Question Text
1 of 2
How long [fill: have you/has Alias] had intellectual disability, also known as mental
retardation?
* Enter number for time with intellectual disability/mental retardation.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-95, D> goto LHCL07T
<96> then fill "6" in LHCL07T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHCL##N and LHCL##T]; Roster through persons eligible in
LAHCC, else go to[LAHCA]
store "R" in [LHCL07T] goto next condition in [LAHCC]
Once exhausted goto [LAHCA]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 55 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.290_2
Variable Name
LHCL07T
Universe
LHCL07N=1-95, DK
Universe-text
Condition number 7 selected in LAHCC
Question Text
2 of 2
* Enter time period for time with intellectual disability/mental retardation.
(LHCL07N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCC], continue to ask number and time
period for each subsequent condition; else go to LAHCA
Roster through all LAHCC entries, roster through next child. Once exhausted goto
LAHCA.
<6> goto ERR2_LHCL07T
if (LHCL07T = 4 and LHCL07N > AGE) or (LHCL07T = 3 and LHCL07N > AGE
in months) or (LHCL07T = 2 and LHCL07N > AGE in weeks), goto [ERR1_LHCL07T]
Hard Edits
ERR1_LHCL07T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL07T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 56 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.292_1
Variable Name
LHCL08N
Universe
LAHCC=8
Universe-text
Condition number 8 selected in LAHCC
Question Text
1 of 2
How long [fill: have you/has Alias] had a developmental problem (e.g. cerebral palsy)?
* Enter number for time with developmental problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-95, D> goto LHCL08T
<96> then fill "6" in LHCL08T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHCL##N and LHCL##T]; Roster through persons eligible in
LAHCC, else go to[LAHCA]
store "R" in [LHCL08T] goto next condition in [LAHCC]
Once exhausted goto [LAHCA]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 57 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.292_2
Variable Name
LHCL08T
Universe
LHCL08N=1-95, DK
Universe-text
Condition number 8 selected in LAHCC
Question Text
2 of 2
* Enter time period for time with developmental problem (e.g. cerebral palsy).
(LHCL08N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCC], continue to ask number and time
period for each subsequent condition; else go to LAHCA
Roster through all LAHCC entries, roster through next child. Once exhausted goto
LAHCA.
<6> goto ERR2_LHCL08T
if (LHCL08T = 4 and LHCL08N > AGE) or (LHCL08T = 3 and LHCL08N > AGE
in months) or (LHCL08T = 2 and LHCL08N > AGE in weeks), goto [ERR1_LHCL08T]
Hard Edits
ERR1_LHCL08T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL08T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 58 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.294_1
Variable Name
LHCL09N
Universe
LAHCC=9
Universe-text
Condition number 9 selected in LAHCC
Question Text
1 of 2
How long [fill: have you/has Alias] had a mental, emotional, or behavioral problem?
* Enter number for time with mental, emotional, or behavioral problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-95, D> goto LHCL09T
<96> then fill "6" in LHCL09T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHCL##N and LHCL##T]; Roster through persons eligible in
LAHCC, else go to[LAHCA]
store "R" in [LHCL09T] goto next condition in [LAHCC]
Once exhausted goto [LAHCA]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 59 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.294_2
Variable Name
LHCL09T
Universe
LHCL09N=1-95, DK
Universe-text
Condition number 9 selected in LAHCC
Question Text
2 of 2
* Enter time period for time with mental, emotional, or behavioral problem.
(LHCL09N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCC], continue to ask number and time
period for each subsequent condition; else go to LAHCA
Roster through all LAHCC entries, roster through next child. Once exhausted goto
LAHCA.
<6> goto ERR2_LHCL09T
if (LHCL09T = 4 and LHCL09N > AGE) or (LHCL09T = 3 and LHCL09N > AGE
in months) or (LHCL09T = 2 and LHCL09N > AGE in weeks), goto [ERR1_LHCL09T]
Hard Edits
ERR1_LHCL09T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL09T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 60 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.296_1
Variable Name
LHCL10N
Universe
LAHCC=10
Universe-text
Condition number 10 selected in LAHCC
Question Text
1 of 2
How long [fill: have you/has Alias] had a bone, joint, or muscle problem?
* Enter number for time with bone, joint, or muscle problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-95, D> goto LHCL10T
<96> then fill "6" in LHCL10T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHCL##N and LHCL##T]; Roster through persons eligible in
LAHCC, else go to[LAHCA]
store "R" in [LHCL10T] goto next condition in [LAHCC]
Once exhausted goto [LAHCA]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 61 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.296_2
Variable Name
LHCL10T
Universe
LHCL10N=1-95, DK
Universe-text
Condition number 10 selected in LAHCC
Question Text
2 of 2
* Enter time period for time with bone, joint, or muscle problem.
(LHCL10N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCC], continue to ask number and time
period for each subsequent condition; else go to LAHCA
Roster through all LAHCC entries, roster through next child. Once exhausted goto
LAHCA.
<6> goto ERR2_LHCL10T
if (LHCL10T = 4 and LHCL10N > AGE) or (LHCL10T = 3 and LHCL10N > AGE
in months) or (LHCL10T = 2 and LHCL10N > AGE in weeks), goto [ERR1_LHCL10T]
Hard Edits
ERR1_LHCL10T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL10T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 62 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.298_1
Variable Name
LHCL11N
Universe
LAHCC=11
Universe-text
Condition number 11 selected in LAHCC
Question Text
1 of 2
How long [fill: have you/has Alias] had epilepsy or seizures?
* Enter number for time with epileplsy or seizures.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-95, D> goto LHCL11T
<96> then fill "6" in LHCL11T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHCL##N and LHCL##T]; Roster through persons eligible in
LAHCC, else go to[LAHCA]
store "R" in [LHCL11T] goto next condition in [LAHCC]
Once exhausted goto [LAHCA]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 63 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.298_2
Variable Name
LHCL11T
Universe
LHCL11N=1-95, DK
Universe-text
Condition number 11 selected in LAHCC
Question Text
2 of 2
* Enter time period for time with epilepsy or seizures.
(LHCL11N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCC], continue to ask number and time
period for each subsequent condition; else go to LAHCA
Roster through all LAHCC entries, roster through next child. Once exhausted goto
LAHCA.
<6> goto ERR2_LHCL11T
if (LHCL11T = 4 and LHCL11N > AGE) or (LHCL11T = 3 and LHCL11N > AGE
in months) or (LHCL11T = 2 and LHCL11N > AGE in weeks), goto [ERR1_LHCL11T]
Hard Edits
ERR1_LHCL11T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL11T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 64 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.300_1
Variable Name
LHCL12N
Universe
LAHCC=12
Universe-text
Condition number 12 selected in LAHCC
Question Text
1 of 2
How long [fill: have you/has Alias] had a learning disability?
* Enter number for time with learning disability.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-95, D> goto LHCL12T
<96> then fill "6" in LHCL12T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHCL##N and LHCL##T]; Roster through persons eligible in
LAHCC, else go to[LAHCA]
store "R" in [LHCL12T] goto next condition in [LAHCC]
Once exhausted goto [LAHCA]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 65 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.300_2
Variable Name
LHCL12T
Universe
LHCL12N=1-95, DK
Universe-text
Condition number 12 selected in LAHCC
Question Text
2 of 2
* Enter time period for time with learning disability.
(LHCL12N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCC], continue to ask number and time
period for each subsequent condition; else go to LAHCA
Roster through all LAHCC entries, roster through next child. Once exhausted goto
LAHCA.
<6> goto ERR2_LHCL12T
if (LHCL12T = 4 and LHCL12N > AGE) or (LHCL12T = 3 and LHCL12N > AGE
in months) or (LHCL12T = 2 and LHCL12N > AGE in weeks), goto [ERR1_LHCL12T]
Hard Edits
ERR1_LHCL12T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL12T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 66 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.302_1
Variable Name
LHCL13N
Universe
LAHCC=13
Universe-text
Condition number 13 selected in LAHCC
Question Text
1 of 2
How long [fill: have you/has Alias] had attention deficit/hyperactivity disorder?
* Enter number for time with attention deficit/hyperactivity disorder.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-95, D> goto LHCL13T
<96> then fill "6" in LHCL13T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHCL##N and LHCL##T]; Roster through persons eligible in
LAHCC, else go to[LAHCA]
store "R" in [LHCL13T] goto next condition in [LAHCC]
Once exhausted goto [LAHCA]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 67 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.302_2
Variable Name
LHCL13T
Universe
LHCL13N=1-95, DK
Universe-text
Condition number 13 selected in LAHCC
Question Text
2 of 2
* Enter time period for time with attention deficit/hyperactivity disorder.
(LHCL13N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCC], continue to ask number and time
period for each subsequent condition; else go to LAHCA
Roster through all LAHCC entries, roster through next child. Once exhausted goto
LAHCA.
<6> goto ERR2_LHCL13T
if (LHCL13T = 4 and LHCL13N > AGE) or (LHCL13T = 3 and LHCL13N > AGE
in months) or (LHCL13T = 2 and LHCL13N > AGE in weeks), goto [ERR1_LHCL13T]
Hard Edits
ERR1_LHCL13T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL13T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 68 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.304_1
Variable Name
LHCL90N
Universe
LAHCC=90
Universe-text
Condition number 90 selected in LAHCC
Question Text
1 of 2
How long [fill1: have you/has Alias] had [fill2: problem in LAHCC_S1]?
* Enter number for time with [fill1: problem in LAHCC_S1]?
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill1: if the subject=respondent fill "have you" else, fill "has Alias"
fill2: problem LAHCC2_S1
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-95, D> goto LHCL90T
<96> then fill "6" in LHCL90T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHCL##N and LHCL##T]; Roster through persons eligible in
LAHCC, else go to[LAHCA]
store "R" in [LHCL90T] goto next condition in [LAHCC]
Once exhausted goto [LAHCA]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 69 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.304_2
Variable Name
LHCL90T
Universe
LHCL90N=1-95, DK
Universe-text
Condition number 90 selected in LAHCC
Question Text
2 of 2
* Enter time period for time with [fill: problem in LAHCC_S1].
(LHCL90N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Time period
fill: problem in LAHCC2_S1
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-4, R, D>
if 91 selected in LAHCC, then goto LAHCC_S2,
Else, roster through all LAHCC entries and goto appropriate LHCL##N [##= 01-13,
90, 91]
Roster through all LAHCC entries, roster through next child. Once exhausted goto
LAHCA.
<6> goto ERR2_LHCL90T
if (LHCL90T = 4 and LHCL90N > AGE) or (LHCL90T = 3 and LHCL90N > AGE
in months) or (LHCL90T = 2 and LHCL90N > AGE in weeks), goto [ERR1_LHCL90T]
Hard Edits
ERR1_LHCL90T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL90T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 70 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.306_1
Variable Name
LHCL91N
Universe
LAHCC=91
Universe-text
Condition number 91 selected in LAHCC
Question Text
1 of 2
How long [fill1: have you/has Alias] had [fill2: problem in LAHCC_S2]?
* Enter number for time with [fill1: problem in LAHCC_S2].
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill1: if the subject=respondent fill "have you" else, fill "has Alias"
fill2: problem in LAHCC2_S2
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-95, D> goto LHCL91T
<96> then fill "6" in LHCL91T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHCL##N and LHCL##T]; Roster through persons eligible in
LAHCC, else go to[LAHCA]
store "R" in [LHCL91T] goto next condition in [LAHCC]
Once exhausted goto [LAHCA]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 71 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.306_2
Variable Name
LHCL91T
Universe
LHCL91N=1-95, DK
Universe-text
Condition number 91 selected in LAHCC
Question Text
2 of 2
* Enter time period for time with [fill: problem in LAHCC_S2].
(LHCL91N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Time period
fill: problem in LAHCC_S2
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCC will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCC.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCC], continue to ask number and time
period for each subsequent condition; else go to LAHCA
Roster through all LAHCC entries, roster through next child. Once exhausted goto
LAHCA.
<6> goto ERR2_LHCL91T
if (LHCL91T = 4 and LHCL91N > AGE) or (LHCL91T = 3 and LHCL91N > AGE
in months) or (LHCL91T = 2 and LHCL91N > AGE in weeks), goto [ERR1_LHCL91T]
Hard Edits
ERR1_LHCL91T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHCL91T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 72 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.350
Variable Name
LAHCA
Universe
Universe-text
age 18+ and (person selected in (PLAADL or PLAIADL or PLAWKNOW or PLAWKLIM
or PLAWALK or PLAREMEM or PLIMANY))
Question Text
(book) F2 ?[F1]
What conditions or health problems cause [fill: your/Alias’s] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
Answer Codes
1. Vision/problem seeing
2. Hearing problem
3. Arthritis/rheumatism
4. Back or neck problem
5. Fracture or bone/joint injury
6. Other injury
7. Heart problem
8. Stroke problem
9. Hypertension/high blood pressure
10. Diabetes
11. Lung/breathing problem (for example, asthma and emphysema)
12. Cancer
13. Birth defect
14. Intellectual disability, also known as mental retardation
15. Other developmental problem (for example, cerebral palsy)
16. Senility
17. Depression/anxiety/emotional problem
18. Weight problem
19. Missing limbs (fingers, toes or digits), amputee
20. Kidney, bladder or renal problems
21. Circulation problems (including blood clots)
22. Benign tumors, cysts
23. Fibromyalgia, lupus
24. Osteoporosis, tendinitis
25. Epilepsy, seizures
26. Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27. Polio(myelitis), paralysis, para/quadriplegia
28. Parkinson’s disease, other tremors
29. Other nerve damage, including carpal tunnel syndrome
30. Hernia
31. Ulcer
32. Varicose veins, hemorrhoids
33. Thyroid problems, Grave’s disease, gout
34. Knee problems (not arthritis (03), not joint injury(05))
35. Migraine headaches (not just headaches)
90. Other impairment/problem ( LAHCA_S1)
Tuesday, June 13, 2017
Page 73 of 153
91. Other impairment/problem ( LAHCA_S2)
Refused
Don’t know/not sure
Question Type
Enter All That Apply
Field Pane Description
Fill Instructions
Conditions/health problems
fill: if the subject=respondent fill "your" else, fill " Alias"
Special Instructions person level item; store at person level
Condition Grid
Skip Instructions
<1-12, 14-35, 90,91> selected entries goto appropriate follow up question LHAL##N
[##= 01-35, 90, 91]
<13> fill "96" in LHAL13N and fill "6" in LHAL13T
<90> goto LAHCA_S1
<91> goto LAHCA_S2
Roster through all selected in (PLAADL or PLAIADL or PLAWKNOW or
PLAWKLIM
or PLAWALK or PLAREMEM or PLIMANY)) Once exhausted goto PHSTAT
For all selected LAHCA entries goto appropriate followup question LHAL##N [##= 0135, 90, 91]
Roster through all LAHCA entries. Roster through all selected in (PLAADL or
PLAIADL or PLAWKNOW or PLAWKLIM or PLAWALK or PLAREMEM or PLIMANY))
Once exhausted goto PHSTAT.
Hard Edits
Soft Edits
AssocHelp
H_LAHCA
Tuesday, June 13, 2017
Page 74 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.350_H
Variable Name
H_LAHCA
Universe
Universe-text
Question Text
This question is for those family members 18 years old or older who were previously
reported as having a limitation.
The terms [b]conditions[b] and [b]health problems[b] are respondent defined.
Do not read the precoded categories to the respondent.
Enter "90" or "91" if the respondent mentions a condition or health problem not listed
and then specify the condition exactly as the respondent states it.
Consider a person to be [b]limited[b] if he/she can only partially perform an activity, or
can do it fully only part of the time, or cannot do it at all.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
LAHCA
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 75 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.351_90
Variable Name
LAHCA_S1
Universe
If 90 selected in LAHCA
Universe-text
Other impairment selected in LAHCA
Question Text
* Read if necessary.
What is the other impairment or problem?
Answer Codes
Question Type
Text
Field Pane Description
Specify One
Fill Instructions
Special Instructions
Skip Instructions
<50 chars>
goto [LHAL90N]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 76 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.351_91
Variable Name
LAHCA_S2
Universe
If 91 selected in LAHCA
Universe-text
Other impairment selected in LAHCA
Question Text
* Read if necessary.
What is the other impairment or problem?
Answer Codes
Question Type
Text
Field Pane Description
Specify One
Fill Instructions
Special Instructions
Skip Instructions
<50 chars> Roster through all LAHCA entries and goto appropriate LHAL##N [##= 0135, 90, 91]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 77 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.360_1
Variable Name
LHAL01N
Universe
LAHCA= 1
Universe-text
Condition number 1 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had a vision problem or problem seeing?
* Enter number for time with vision problem or problem seeing.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject= respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL01T
<96> then fill "6" in LHAL01T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL01T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 78 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.360_2
Variable Name
LHAL01T
Universe
LHAL01N= 1-95, DK
Universe-text
Condition number 1 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with vision problem or problem seeing.
(LHAL01N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL01T
if (LHAL01T = 4 and LHAL01N > AGE), goto [ERR1_LHAL01T]
Hard Edits
ERR1_LHAL01T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL01T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 79 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.362_1
Variable Name
LHAL02N
Universe
LAHCA= 2
Universe-text
Condition number 2 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had a hearing problem?
* Enter number for time with hearing problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL02T
<96> then fill "6" in LHAL02T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL02T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
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Tuesday, June 13, 2017
Page 80 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.362_2
Variable Name
LHAL02T
Universe
LHAL02N= 1-95, DK
Universe-text
Condition number 2 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with hearing problem.
(LHAL02N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL02T
if (LHAL02T = 4 and LHAL02N > AGE), goto [ERR1_LHAL02T]
Hard Edits
ERR1_LHAL02T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL02T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 81 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.364_1
Variable Name
LHAL03N
Universe
LAHCA= 3
Universe-text
Condition number 3 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had arthritis or rheumatism?
* Enter number for time with arthritis or rheumatism.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL03T
<96> then fill "6" in LHAL03T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL03T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 82 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.364_2
Variable Name
LHAL03T
Universe
LHAL03N= 1-95, DK
Universe-text
Condition number 3 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with arthritis or rheumatism.
(LHAL03N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL03T
if (LHAL03T = 4 and LHAL03N > AGE), goto [ERR1_LHAL03T]
Hard Edits
ERR1_LHAL03T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL03T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 83 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.366_1
Variable Name
LHAL04N
Universe
LAHCA= 4
Universe-text
Condition number 4 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had a back or neck problem?
* Enter number for time with back or neck problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL04T
<96> then fill "6" in LHAL04T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL04T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 84 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.366_2
Variable Name
LHAL04T
Universe
LHAL04N= 1-95, DK
Universe-text
Condition number 4 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with back or neck problem.
(LHAL04N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL04T
if (LHAL014T = 4 and LHAL04N > AGE) , goto [ERR1_LHAL04T]
Hard Edits
ERR1_LHAL04T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL04T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 85 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.368_1
Variable Name
LHAL05N
Universe
LAHCA= 5
Universe-text
Condition number 5 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had a fracture, bone, or joint injury?
* Enter number for time with fracture, bone or joint injury.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL05T
<96> then fill "6" in LHAL05T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL05T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 86 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.368_2
Variable Name
LHAL05T
Universe
LHAL05N= 1-95, DK
Universe-text
Condition number 5 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with fracture, bone, or joint injury.
(LHAL05N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL05T
if (LHAL05T = 4 and LHAL05N > AGE), goto [ERR1_LHAL05T]
Hard Edits
ERR1_LHAL05T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL05T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 87 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.370_1
Variable Name
LHAL06N
Universe
LAHCA= 6
Universe-text
Condition number 6 selected in LAHCA
Question Text
1 of 2
How long [fill1: have you/has Alias] had the [fill2: other] injury that caused [fill3:
your/his/her] limitation?
* Enter number for time with the injury.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill1: if the subject=respondent fill "have you" else, fill "has Alias"
fill2: if (LAHCA=5) fill "other"
fill3: if the subject=respondent fill "your" else, fill "his/her"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL06T
<96> then fill "6" in LHAL06T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL06T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 88 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.370_2
Variable Name
LHAL06T
Universe
LHAL06N= 1-95, DK
Universe-text
Condition number 6 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with [fill1: other] injury that caused [fill2: your/his/her]
limitation.
(LHAL06N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Time period
fill1: if (LAHCA=5) fill "other"
fill2: if the subject=respondent fill "your" else, fill "his/her"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL06T
if (LHAL06T = 4 and LHAL06N > AGE), goto [ERR1_LHAL06T]
Hard Edits
ERR1_LHAL06T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL06T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 89 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.372_1
Variable Name
LHAL07N
Universe
LAHCA= 7
Universe-text
Condition number 7 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had a heart problem?
* Enter number for time with heart problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL07T
<96> then fill "6" in LHAL07T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL07T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 90 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.372_2
Variable Name
LHAL07T
Universe
LHAL07N= 1-95, DK
Universe-text
Condition number 7 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with heart problem.
(LHAL07N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL07T
if (LHAL07T = 4 and LHAL07N > AGE), goto [ERR1_LHAL07T]
Hard Edits
ERR1_LHAL07T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL07T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 91 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.374_1
Variable Name
LHAL08N
Universe
LAHCA= 8
Universe-text
Condition number 8 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had a stroke problem?
* Enter number for time with stroke problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL08T
<96> then fill "6" in LHAL08T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL08T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 92 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.374_2
Variable Name
LHAL08T
Universe
LHAL08N= 1-95, DK
Universe-text
Condition number 8 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with stroke problem.
(LHAL08N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL08T
if (LHAL08T = 4 and LHAL08N > AGE) , goto [ERR1_LHAL08T]
Hard Edits
ERR1_LHAL08T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL08T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 93 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.376_1
Variable Name
LHAL09N
Universe
LAHCA= 9
Universe-text
Condition number 9 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had hypertension or high blood pressure?
* Enter number for time with hypertension or high blood pressure.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL09T
<96> then fill "6" in LHAL09T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL09T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 94 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.376_2
Variable Name
LHAL09T
Universe
LHAL09N= 1-95, DK
Universe-text
Condition number 9 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with hypertension or high blood pressure.
(LHAL09N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL09T
if (LHAL09T = 4 and LHAL09N > AGE) , goto [ERR1_LHAL09T]
Hard Edits
ERR1_LHAL09T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL09T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 95 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.378_1
Variable Name
LHAL10N
Universe
LAHCA= 10
Universe-text
Condition number 10 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had diabetes?
* Enter number for time with diabetes.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL10T
<96> then fill "6" in LHAL10T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL10T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 96 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.378_2
Variable Name
LHAL10T
Universe
LHAL10N= 1-95, DK
Universe-text
Condition number 10 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with diabetes.
(LHAL10N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL10T
if (LHAL10T = 4 and LHAL10N > AGE), goto [ERR1_LHAL10T]
Hard Edits
ERR1_LHAL10T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL10T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 97 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.380_1
Variable Name
LHAL11N
Universe
LAHCA= 11
Universe-text
Condition number 11 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had a lung problem or breathing problem (e.g.,
asthma and emphysema)?
* Enter number for time with lung problem or breathing problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL11T
<96> then fill "6" in LHAL11T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL11T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 98 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.380_2
Variable Name
LHAL11T
Universe
LHAL11N= 1-95, DK
Universe-text
Condition number 11 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with lung problem or breathing problem (e.g., asthma and
emphysema).
(LHAL11N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL11T
if (LHAL11T = 4 and LHAL11N > AGE), goto [ERR1_LHAL11T]
Hard Edits
ERR1_LHAL11T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL11T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 99 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.382_1
Variable Name
LHAL12N
Universe
LAHCA= 12
Universe-text
Condition number 12 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had cancer?
* Enter number for time with cancer.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL12T
<96> then fill "6" in LHAL12T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL12T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 100 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.382_2
Variable Name
LHAL12T
Universe
LHAL12N= 1-95, DK
Universe-text
Condition number 12 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with cancer.
(LHAL12N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL12T
if (LHAL12T = 4 and LHAL12N > AGE), goto [ERR1_LHAL12T]
Hard Edits
ERR1_LHAL12T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL12T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 101 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.383_1
Variable Name
LHAL13N
Universe
LAHCA=13
Universe-text
Condition number 13 selected in LAHCA
Question Text
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions Storage variable for the line number of the Health Status and Limitation section birth
defect condition.
Question text not displayed
person level item; store at person level
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 102 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.383_2
Variable Name
LHAL13T
Universe
LHCL13N=1-95, DK
Universe-text
Condition number 13 selected in LAHCA
Question Text
Answer Codes
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Storage variable for the line number of the Health Status and Limitation section birth
defect condition.
Question text not displayed
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 103 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.384_1
Variable Name
LHAL14N
Universe
LAHCA= 14
Universe-text
Condition number 14 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had intellectual disability, also known as mental
retardation?
* Enter number for time with intellectual disability/mental retardation.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL14T
<96> then fill "6" in LHAL14T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL14T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 104 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.384_2
Variable Name
LHAL14T
Universe
LHAL14N= 1-95, DK
Universe-text
Condition number 14 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with intellectual disability/mental retardation.
(LHAL14N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL14T
if (LHAL14T = 4 and LHAL14N > AGE), goto [ERR1_LHAL14T]
Hard Edits
ERR1_LHAL14T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL14T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 105 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.386_1
Variable Name
LHAL15N
Universe
LAHCA= 15
Universe-text
Condition number 15 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had a developmental problem (e.g. cerebral palsy)?
* Enter number for time with developmental problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL15T
<96> then fill "6" in LHAL15T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL15T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 106 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.386_2
Variable Name
LHAL15T
Universe
LHAL15N= 1-95, DK
Universe-text
Condition number 15 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with developmental problem (e.g. cerebral palsy).
(LHAL15N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL15T
if (LHAL15T = 4 and LHAL15N > AGE), goto [ERR1_LHAL15T]
Hard Edits
ERR1_LHAL15T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL15T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 107 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.388_1
Variable Name
LHAL16N
Universe
LAHCA= 16
Universe-text
Condition number 16 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had senility?
* Enter number for time with senility.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL16T
<96> then fill "6" in LHAL16T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL16T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 108 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.388_2
Variable Name
LHAL16T
Universe
LHAL16N= 1-95, DK
Universe-text
Condition number 16 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with senility.
(LHAL16N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL16T
if (LHAL16T = 4 and LHAL16N > AGE), goto [ERR1_LHAL16T]
Hard Edits
ERR1_LHAL16T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL16T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 109 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.390_1
Variable Name
LHAL17N
Universe
LAHCA= 17
Universe-text
Condition number 17 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had depression, anxiety, or an emotional problem?
* Enter number for time with depression, anxiety or an emotional problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL17T
<96> then fill "6" in LHAL17T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL17T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 110 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.390_2
Variable Name
LHAL17T
Universe
LHAL17N= 1-95, DK
Universe-text
Condition number 17 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with depression, anxiety, or an emotional problem.
(LHAL17N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL17T
if (LHAL17T = 4 and LHAL17N > AGE), goto [ERR1_LHAL17T]
Hard Edits
ERR1_LHAL17T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL17T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 111 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.392_1
Variable Name
LHAL18N
Universe
LAHCA= 18
Universe-text
Condition number 18 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had a weight problem?
* Enter number for time with weight problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL18T
<96> then fill "6" in LHAL18T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL18T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 112 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.392_2
Variable Name
LHAL18T
Universe
LHAL18N= 1-95, DK
Universe-text
Condition number 18 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with weight problem.
(LHAL18N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL18T
if (LHAL18T = 4 and LHAL18N > AGE) , goto [ERR1_LHAL18T]
Hard Edits
ERR1_LHAL18T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL18T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 113 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.394_1
Variable Name
LHAL19N
Universe
LAHCA= 19
Universe-text
Condition number 19 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had a missing limb (finger, toe, or digit)?
* Enter number for time with missing limb.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL19T
<96> then fill "6" in LHAL19T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL19T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 114 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.394_2
Variable Name
LHAL19T
Universe
LHAL19N= 1-95, DK
Universe-text
Condition number 19 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with missing limb (finger, toe, or digit).
(LHAL19N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL19T
if (LHAL19T = 4 and LHAL19N > AGE) , goto [ERR1_LHAL19T]
Hard Edits
ERR1_LHAL19T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL19T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 115 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.396_1
Variable Name
LHAL20N
Universe
LAHCA= 20
Universe-text
Condition number 20 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had a kidney, bladder or renal problem?
* Enter number for time with kidney, bladder or renal problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL20T
<96> then fill "6" in LHAL20T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL20T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 116 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.396_2
Variable Name
LHAL20T
Universe
LHAL20N= 1-95, DK
Universe-text
Condition number 20 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with kidney, bladder or renal problem.
(LHAL20N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL20T
if (LHAL20T = 4 and LHAL20N > AGE), goto [ERR1_LHAL20T]
Hard Edits
ERR1_LHAL20T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL20T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 117 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.398_1
Variable Name
LHAL21N
Universe
LAHCA= 21
Universe-text
Condition number 21 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had a circulation problem (including blood clots)?
* Enter number for time with circulation problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL21T
<96> then fill "6" in LHAL21T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL21T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 118 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.398_2
Variable Name
LHAL21T
Universe
LHAL21N= 1-95, DK
Universe-text
Condition number 21 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with circulation problem (including blood clots).
(LHAL21N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL21T
if (LHAL21T = 4 and LHAL21N > AGE), goto [ERR1_LHAL21T]
Hard Edits
ERR1_LHAL21T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL21T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 119 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.400_1
Variable Name
LHAL22N
Universe
LAHCA= 22
Universe-text
Condition number 22 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had benign tumors or cysts?
* Enter number for time with benign tumors or cysts.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL22T
<96> then fill "6" in LHAL22T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL22T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 120 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.400_2
Variable Name
LHAL22T
Universe
LHAL22N= 1-95, DK
Universe-text
Condition number 22 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with benign tumors or cysts.
(LHAL22N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL22T
if (LHAL22T = 4 and LHAL22N > AGE), goto [ERR1_LHAL22T]
Hard Edits
ERR1_LHAL22T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL22T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 121 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.402_1
Variable Name
LHAL23N
Universe
LAHCA= 23
Universe-text
Condition number 23 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had fibromyalgia or lupus?
* Enter number for time with fibromyalgia or lupus.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL23T
<96> then fill "6" in LHAL23T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL23T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 122 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.402_2
Variable Name
LHAL23T
Universe
LHAL23N= 1-95, DK
Universe-text
Condition number 23 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with fibromyalgia or lupus.
(LHAL23N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL23T
if (LHAL23T = 4 and LHAL23N > AGE) , goto [ERR1_LHAL23T]
Hard Edits
ERR1_LHAL23T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL23T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 123 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.404_1
Variable Name
LHAL24N
Universe
LAHCA= 24
Universe-text
Condition number 24 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had osteoporosis or tendinitis?
* Enter number for time with osteoporosis or tendinitis.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL24T
<96> then fill "6" in LHAL24T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL24T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 124 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.404_2
Variable Name
LHAL24T
Universe
LHAL24N= 1-95, DK
Universe-text
Condition number 24 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with osteoporosis or tendinitis.
(LHAL24N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL24T
if (LHAL24T = 4 and LHAL24N > AGE), goto [ERR1_LHAL24T]
Hard Edits
ERR1_LHAL24T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL24T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 125 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.406_1
Variable Name
LHAL25N
Universe
LAHCA= 25
Universe-text
Condition number 25 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had epilepsy or seizures?
* Enter number for time with epilepsy or seizures.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL25T
<96> then fill "6" in LHAL25T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL25T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 126 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.406_2
Variable Name
LHAL25T
Universe
LHAL25N= 1-95, DK
Universe-text
Condition number 25 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with epilepsy or seizures.
(LHAL25N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL25T
if (LHAL25T = 4 and LHAL25N > AGE), goto [ERR1_LHAL25T]
Hard Edits
ERR1_LHAL25T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL25T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 127 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.408_1
Variable Name
LHAL26N
Universe
LAHCA= 26
Universe-text
Condition number 26 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had multiple sclerosis (MS) or muscular dystrophy
(MD)?
* Enter number for time with multiple sclerosis (MS) or muscular dtstrophy (MD)?
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL26T
<96> then fill "6" in LHAL26T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL26T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 128 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.408_2
Variable Name
LHAL26T
Universe
LHAL26N= 1-95, DK
Universe-text
Condition number 26 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with multiple sclerosis (MS) or muscular dystrophy (MD).
(LHAL26N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL26T
if (LHAL26T = 4 and LHAL26N > AGE), goto [ERR1_LHAL26T]
Hard Edits
ERR1_LHAL26T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL26T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 129 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.410_1
Variable Name
LHAL27N
Universe
LAHCA= 27
Universe-text
Condition number 27 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had polio(myelitis), paralysis or para/quadriplegia?
* Enter number for time with polio (myelitis) paralysis or para/quadriplegia.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL27T
<96> then fill "6" in LHAL27T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL27T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 130 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.410_2
Variable Name
LHAL27T
Universe
LHAL27N= 1-95, DK
Universe-text
Condition number 27 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with polio(myelitis), paralysis or para/quadriplegia.
(LHAL27N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL27T
if (LHAL27T = 4 and LHAL27N > AGE), goto [ERR1_LHAL27T]
Hard Edits
ERR1_LHAL27T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL27T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 131 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.412_1
Variable Name
LHAL28N
Universe
LAHCA= 28
Universe-text
Condition number 28 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had Parkinson’s disease or tremors?
* Enter number for time with Parkinson's disease or tremors.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL28T
<96> then fill "6" in LHAL28T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL28T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 132 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.412_2
Variable Name
LHAL28T
Universe
LHAL28N= 1-95, DK
Universe-text
Condition number 28 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with Parkinson’s disease or tremors.
(LHAL28N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL28T
if (LHAL28T = 4 and LHAL28N > AGE) , goto [ERR1_LHAL28T]
Hard Edits
ERR1_LHAL28T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL28T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 133 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.414_1
Variable Name
LHAL29N
Universe
LAHCA= 29
Universe-text
Condition number 29 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had nerve damage (including carpal tunnel
syndrome)?
* Enter number for time with nerve damage.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL29T
<96> then fill "6" in LHAL29T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL29T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 134 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.414_2
Variable Name
LHAL29T
Universe
LHAL29N= 1-95, DK
Universe-text
Condition number 29 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with nerve damage (including carpal tunnel syndrome).
(LHAL29N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL29T
if (LHAL29T = 4 and LHAL29N > AGE) , goto [ERR1_LHAL29T]
Hard Edits
ERR1_LHAL29T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL29T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 135 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.416_1
Variable Name
LHAL30N
Universe
LAHCA= 30
Universe-text
Condition number 30 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had a hernia?
* Enter number for time with hernia.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL30T
<96> then fill "6" in LHAL30T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL30T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 136 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.416_2
Variable Name
LHAL30T
Universe
LHAL30N= 1-95, DK
Universe-text
Condition number 30 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with hernia.
(LHAL30N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL30T
if (LHAL30T = 4 and LHAL30N > AGE), goto [ERR1_LHAL30T]
Hard Edits
ERR1_LHAL30T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL30T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 137 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.418_1
Variable Name
LHAL31N
Universe
LAHCA= 31
Universe-text
Condition number 31 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had an ulcer?
* Enter number for time with an ulcer.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL31T
<96> then fill "6" in LHAL31T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL31T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 138 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.418_2
Variable Name
LHAL31T
Universe
LHAL31N= 1-95, DK
Universe-text
Condition number 31 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with ulcer.
(LHAL31N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL31T
if (LHAL31T = 4 and LHAL31N > AGE), goto [ERR1_LHAL31T]
Hard Edits
ERR1_LHAL31T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL31T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 139 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.420_1
Variable Name
LHAL32N
Universe
LAHCA= 32
Universe-text
Condition number 32 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had varicose veins or hemorrhoids?
* Enter number for time with varicose veins or hemorrhoids.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL32T
<96> then fill "6" in LHAL32T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL32T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 140 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.420_2
Variable Name
LHAL32T
Universe
LHAL32N= 1-95, DK
Universe-text
Condition number 32 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with varicose veins or hemorrhoids.
(LHAL32N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL32T
if (LHAL32T = 4 and LHAL32N > AGE), goto [ERR1_LHAL32T]
Hard Edits
ERR1_LHAL32T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL32T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 141 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.422_1
Variable Name
LHAL33N
Universe
LAHCA= 33
Universe-text
Condition number 33 selected in LAHCA
Question Text
1 of 2
How long [fill: have you/has Alias] had a thyroid problem, Grave’s disease or gout?
* Enter number for time with thyroid problem, Grave's disease or gout.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent, fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL33T
<96> then fill "6" in LHAL33T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL33T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 142 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.422_2
Variable Name
LHAL33T
Universe
LHAL33N= 1-95, DK
Universe-text
Condition number 33 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with thyroid problem, Grave’s disease or gout.
(LHAL33N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL33T
if (LHAL33T = 4 and LHAL33N > AGE), goto [ERR1_LHAL33T]
Hard Edits
ERR1_LHAL33T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL33T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 143 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.424_1
Variable Name
LHAL34N
Universe
LAHCA= 34
Universe-text
Condition number 34 selected in LAHCA
Question Text
1 of 2
How long fill: have you/has Alias] had a knee problem?
* Enter number for time with knee problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL34T
<96> then fill "6" in LHAL34T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL34T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 144 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.424_2
Variable Name
LHAL34T
Universe
LHAL34N= 1-95, DK
Universe-text
Condition number 34 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with knee problem.
(LHAL34N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL34T
if (LHAL34T = 4 and LHAL34N > AGE), goto [ERR1_LHAL34T]
Hard Edits
ERR1_LHAL34T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL34T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 145 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.426_1
Variable Name
LHAL35N
Universe
LAHCA= 35
Universe-text
Condition number 35 selected in LAHCA
Question Text
1 of 2
How long {have you/has Alias} had migraine headaches?
* Enter number for time with migrane headaches.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill: if the subject=respondent fill "have you" else, fill "has Alias"
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL35T
<96> then fill "6" in LHAL35T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL35T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 146 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.426_2
Variable Name
LHAL35T
Universe
LHAL35N= 1-95, DK
Universe-text
Condition number 35 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with migraine headaches.
(LHAL35N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL35T
if (LHAL35T = 4 and LHAL35N > AGE) , goto [ERR1_LHAL35T]
Hard Edits
ERR1_LHAL35T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL35T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 147 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.450_1
Variable Name
LHAL90N
Universe
LAHCA= 90
Universe-text
Condition number 90 selected in LAHCA
Question Text
1 of 2
How long [fill1: have you/has Alias] had [fill2: LAHCA_S1]?
* Enter number for time with [fill1: LAHCA_S1].
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill1: if the subject=respondent fill "have you" else, fill "has Alias"
fill2: LAHCA_S1
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL90T
<96> then fill "6" in LHAL90T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL90T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 148 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.450_2
Variable Name
LHAL90T
Universe
LHAL90N= 1-95, DK
Universe-text
Condition number 90 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with [fill: LAHCA_S1].
(LHAL90N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Time period
fill: LAHCA_S1
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D>
If 91 selected in LAHCA, then goto LAHCA_S2,
Else, roster through all LAHCA entries and goto appropriate LHAL##N [##= 01-35, 90,
91]
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL90T
if (LHAL90T = 4 and LHAL90N > AGE), goto [ERR1_LHAL90T]
Hard Edits
ERR1_LHAL90T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL90T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 149 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.452_1
Variable Name
LHAL91N
Universe
LAHCA= 91
Universe-text
Condition number 91 selected in LAHCA
Question Text
1 of 2
How long [fill1: have you/has Alias] had [fill2: LAHCA_S2]?
* Enter number for time with [fill1: LAHCA_S2].
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
fill1: if the subject=respondent fill "have you" else, fill "has Alias"
fill2: LAHCA_S2
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-95, D> goto LHAL91T
<96> then fill "6" in LHAL91T
If another condition selected, continue to ask number and time period for each
subsequent condition (LHAL##N and LHAL##T]; Roster through persons eligible in
LAHCA, else go to [PHSTAT]
store "R" in [LHAL91T] goto next condition in [LAHCA]
Once exhausted goto [PHSTAT]
Hard Edits
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Tuesday, June 13, 2017
Page 150 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.452_2
Variable Name
LHAL91T
Universe
LHAL91N= 1-95, DK
Universe-text
Condition number 91 selected in LAHCA
Question Text
2 of 2
* Enter time period for time with [fill: LAHCA_S2].
(LHAL91N..)
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Since Birth
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Time period
fill: LAHCA_S2
Special Instructions person level item; store at person level.
The form pane for this item was redesigned for Q2, such that only conditions that were
selected at LAHCA will display. Also, the conditions will display in the order in which
the FR entered the data in LAHCA.
Skip Instructions
<1-4, R, D> [goto next condition selected in LAHCA], continue to ask number and time
period for each subsequent condition; else go to PHSTAT
Roster through all LAHCA entries, roster through next person 18+ Once exhausted
goto PHSTAT.
<6> goto ERR2_LHAL91T
if (LHAL91T = 4 and LHAL91N > AGE), goto [ERR1_LHAL91T]
Hard Edits
ERR1_LHAL91T
* Time with condition cannot be greater than age. Please correct.
ERR2_LHAL91T
* "6" not selectable.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 151 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.500
Variable Name
PHSTAT
Universe
All persons
Universe-text
Question Text
Would you say [fill: your/Alias’s] health in general is excellent, very good, good, fair,
or poor?
Answer Codes
1. Excellent
2. Very good
3. Good
4. Fair
5. Poor
Refused
Don’t Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
General Health
fill: if subject= respondent fill "your" else fill "Alias"
Special Instructions Associated Screens:
H_PHSTAT
Skip Instructions
Repeat for all people in the household
Every family member goto next section
Hard Edits
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H_PHSTAT
Tuesday, June 13, 2017
Page 152 of 153
Module
04
Section Name
HEALTH STATUS AND LIMITATION OF ACTIVITIES
Part
Question ID
FHS.500_H
Variable Name
H_PHSTAT
Universe
Universe-text
Question Text
If the response is not one of the given categories (for example, "pretty good" or "up
and down"), repeat the question, emphasizing
"IN GENERAL" and clearly state the answer choices. In no instance should you
choose an answer for the respondent.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
PHSTAT
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 153 of 153
2018 Q1 NHIS Instrument Spec Report
Section name: HEALTH CARE ACCESS AND UTILIZATION
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
A
Question ID
FAU.010
Variable Name
FDMED12M
Universe
AGE=All
Universe-text
All families
Question Text
?[F1]
The following questions are about the use of health care. Do not include dental care.
DURING THE PAST 12 MONTHS, [fill1: have you delayed seeking medical care/has
medical care been delayed for anyone in the family] because of worry about the cost?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Medical care delayed cost
fill1: For a 1 person family fill "have you delayed .. " For multi-person families, fill "
has medical care been delayed .. "
Special Instructions
Skip Instructions
<1> [If one person family, store the person number in
PDMED12M, goto FNMED12M; else, goto PDMED12M]
<2,D,R> goto FNMED12M
Hard Edits
Soft Edits
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H_FDMED12M
Tuesday, June 13, 2017
Page 1 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
Question ID
FAU.010_H
Variable Name
H_FDMED12M
Universe
Universe-text
Question Text
Includes all types of financial limitations that delayed a person in getting medical care.
[b]Delayed[b] assumes that medical care has been or will eventually be received.
[b]Medical Care[b] means medical care from a trained medical professional.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
FDMED12M
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 2 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
A
Question ID
FAU.020
Variable Name
PDMED12M
Universe
AGE=All and FDMED12M= yes and family members > 1
Universe-text
1+ Persons had medical care delayed due to worry about cost during past 12 months
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
For which family member was medical care delayed?
(Anyone else?)
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all non-deleted family members.
Skip Instructions
goto FNMED12M
Hard Edits
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Tuesday, June 13, 2017
Page 3 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
A
Question ID
FAU.030
Variable Name
FNMED12M
Universe
AGE=All
Universe-text
All families
Question Text
?[F1]
DURING THE PAST 12 MONTHS, was there any time when [fill 1: you/someone in the
family] needed medical care, but did not get it because [fill 2: you/the family] couldn't
afford it?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Could not afford medical care
fill 1: for a 1 person family fill "you" For a multi-person family fill "someone in the
family"
fill 2: for a 1 person family fill "you" For a multi-person family fill "the family"
Special Instructions
Skip Instructions
<1> [If one person family, store the person number in
PNMED12M, goto FHOSPYR; else, goto PNMED12M]
<2,D,R> goto FHOSPYR
Hard Edits
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H_FNMED12M
Tuesday, June 13, 2017
Page 4 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
Question ID
FAU.030_H
Variable Name
H_FNMED12M
Universe
Universe-text
Question Text
Include all types of financial limitations that prevented a person(s) from getting
medical care.
[b]Medical Care[b] means medical care from a trained medical professional.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
FNMED12M
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 5 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
A
Question ID
FAU.040
Variable Name
PNMED12M
Universe
AGE=All and FNMED12M = yes and family members > 1
Universe-text
1+ Persons didn’t get med care due to cost during the past 12 months
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who didn't get needed care?
(Anyone else?)
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all non-deleted family members.
Skip Instructions
go to FHOSPYR
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 6 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
B
Question ID
FAU.050
Variable Name
FHOSPYR
Universe
AGE=All
Universe-text
All families
Question Text
?[F1]
[fill1: Have you/Including all infants born in a hospital, has anyone in the family] been
hospitalized OVERNIGHT in the past 12 months? Do not include an overnight stay in
the emergency room.
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Fill Instructions
In Hospital Overnight
fill1: for a 1 person family fill "Have you" For a multi-person family fill "Including all
infants born in a hospital, has anyone in the family"
Special Instructions Store this family level value to the person level.
Skip Instructions
<1> [If one person family, store the person number in PHOSPYR
goto HOSPNO; Else,goto PHOSPYR]
<2,D,R> goto FHCHM2W
Hard Edits
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H_FHOSPYR
Tuesday, June 13, 2017
Page 7 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
Question ID
FAU.050_H
Variable Name
H_FHOSPYR
Universe
Universe-text
Question Text
INCLUDE as a patient in a hospital only persons who were admitted and stayed
overnight or longer.
EXCLUDE persons who visit emergency rooms or outpatient clinics, unless that
person was admitted and stayed overnight.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
FHOSPYR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 8 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
B
Question ID
FAU.060
Variable Name
PHOSPYR
Universe
AGE=All and FHOSPYR= yes and family members > 1
Universe-text
1+ Persons who were patients in a hospital OVERNIGHT during past 12 months
(Excl. ER)
Question Text
*Ask or verify. Enter applicable line number(s), separate with commas.
Who was in a hospital overnight?
(Anyone else?)
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all non-deleted family members.
Store this family level value to the person level.
Skip Instructions
Go to HOSPNO.
Hard Edits
Soft Edits
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Tuesday, June 13, 2017
Page 9 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
B
Question ID
FAU.070
Variable Name
HOSPNO
Universe
Persons selected in PHOSPYR
Universe-text
Persons who stayed overnight in a hospital during past 12 months (Excl. ER)
Question Text
?[F1]
How many different times did [fill: you/Alias] stay in any hospital overnight or longer
DURING THE PAST 12 MONTHS?
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
How many different times
fill: for a 1 person family fill "you"
For a multi-person family fill "Alias"
Special Instructions Ask HOSPNO and HPNITE together for each person selected in PHOSPYR
<1-10> goto HPNITE <11-365> goto ERR_HOSPNO
goto HPNITE
Skip Instructions
Hard Edits
Soft Edits
ERR_HOSPNO
* [fill: HOSPNO] is unusually high.
* Verify entry.
* Make corrections if necessary.
AssocHelp
H_HOSPNO
Tuesday, June 13, 2017
Page 10 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
Question ID
FAU.070_H
Variable Name
H_HOSPNO
Universe
Universe-text
Question Text
This question refers to hospital stays, not the total number of nights spent in the
hospital. For example, if a person is admitted as a patient in the hospital and stays for
5 nights, this would count as 1 hospital stay.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
HOSPNO
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 11 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
B
Question ID
FAU.110
Variable Name
HPNITE
Universe
Persons selected in PHOSPYR and HOSPNO not empty
Universe-text
Persons who stayed overnight in a hospital during past 12 months (Excl. ER)
Question Text
?[F1]
Altogether how many nights [fill1: were you/was Alias] in the hospital DURING THE
PAST 12 MONTHS?
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Altogether how many nights
fill 1: for a 1 person family fill "were you" for a multi-person family fill "was Alias"
Special Instructions Ask HOSPNO and HPNITE together for each person selected in PHOSPYR
Set flag if instrument goes to ERR2_HPNITE.
Skip Instructions
<1-50,D,R> goto next person selected in [PHOSPYR], once exhausted goto
[FHCM2W]
<51-365> goto ERR1_HPNITE
[if HOSPNO le HPNITE goto the next person selected in PHOSPYR] else go to
ERR2_HPNITE once exhausted move to FHCM2W
Hard Edits
Soft Edits
ERR1_HPNITE
* [fill: HPNITE] is unusually high.
* Verify entry.
* Make corrections if necessary.
ERR2_HPNITE
* Do not read.
* [fill: HPNITE] night(s) is less than the total number of times in the hospital overnight.
* Please verify.
Note: If edit suppressed, store S in HPNITE_FLG
AssocHelp
H_HPNITE
Tuesday, June 13, 2017
Page 12 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
A
Question ID
FAU.110_FLG
Variable Name
HPNITE_FLG
Universe
Universe-text
Question Text
***OUT VARIABLE***
Answer Codes
S
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions If ERR2_HPNITE edit is suppressed, store S in HPNITE_FLG
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 13 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
Question ID
FAU.110_H
Variable Name
H_HPNITE
Universe
Universe-text
Question Text
If the respondent answers in terms of days, repeat the question so that it is
understood we are interested only in the number of nights. For example, a first
answer of, "I was in for 7 days", could mean 6, 7, or 8 nights. Always follow up such
answers by repeating the question, emphasizing the word "nights".
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
HPNITE
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 14 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
C
Question ID
FAU.120
Variable Name
FHCHM2W
Universe
AGE=All
Universe-text
All families
Question Text
?[F1]
These next questions are about health care received DURING THE LAST 2 WEEKS.
Include care from ALL types of medical doctors, such as dermatologists, psychiatrists,
ophthalmologists (AHF-thal-MOL-oh-jists), and general practitioners. Also include
care from OTHER health professionals such as nurses, physical therapists, and
chiropractors.
Do not include dental care. Do not include care while an overnight patient in a
hospital.
DURING THE LAST 2 WEEKS, did [fill: you/anyone in the family] receive care
AT HOME from a nurse or other health care professional?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Received Home Care
fill: for a 1 person family fill "you"
For a multi-person family fill "anyone in the family"
Special Instructions Store this family level value to the person level.
Skip Instructions
<1> [If one person family, store the person number in PHCHM2W
goto PHCHMN2W; Else, goto PHCHM2W]
<2,D,R> [goto FHCPH2W]
Hard Edits
Soft Edits
AssocHelp
H_FHCHM2W
Tuesday, June 13, 2017
Page 15 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
Question ID
FAU.120_H
Variable Name
H_FHCHM2W
Universe
Universe-text
Question Text
This question refers to health care received in the person's home by a trained medical
professional.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
FHCHM2W
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 16 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
C
Question ID
FAU.130
Variable Name
PHCHM2W
Universe
AGE=All and FHCHM2W=yes and family members > 1
Universe-text
1+ Persons received care AT HOME from hlth care professional during the past 2
weeks
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who received care at home?
(Anyone else?)
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all non-deleted family members.
Store this family level value to the person level.
Skip Instructions
go to PHCHMN2W
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 17 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
C
Question ID
FAU.140
Variable Name
PHCHMN2W
Universe
Persons selected in PHCHM2W
Universe-text
Persons who received care AT HOME from health care professional during the past 2
weeks (excl. dental care)
Question Text
How many home visits did [fill: you/ Alias] receive DURING THE LAST 2 WEEKS?
* Enter '50' for 50 or more visits.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
How Many Home Visits
fill: for a 1 person family fill "you"
For a multi-person family fill "Alias"
Special Instructions Roster through for every person marked in PHCHM2W
Skip Instructions
<1-14> [goto FHCPH2W] <15-50> [goto ERR_PHCPHMN2W]
[goto FHCPH2W]
Hard Edits
Soft Edits
ERR_PHCHMN2W
* [fill: PHCHMN2W] is unusually high.
* Verify entry.
* DO NOT PROBE. Make corrections if necessary.
AssocHelp
Tuesday, June 13, 2017
Page 18 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
C
Question ID
FAU.150
Variable Name
FHCPH2W
Universe
AGE=All
Universe-text
All families
Question Text
DURING THE LAST 2 WEEKS, did [fill: you/anyone in the family] get any medical
advice or test results over the PHONE from a doctor, nurse, or other health care
professional?
Do not include phone calls to make appointments, for billing questions or for
prescription refills.
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Received Medical Advice/Test Results by Phone
fill: for a 1 person family fill "you"
For a multi-person family fill "anyone in the family"
Special Instructions Store this family level value to the person level.
Skip Instructions
<1> [If one person family, store the person number in PHCPH2W
goto PHCPHN2W; Else, goto PHCPH2W]
<2,D,R> [goto FHCDV2W]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 19 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
C
Question ID
FAU.160
Variable Name
PHCPH2W
Universe
AGE=All and FHCPH2W= yes and family members >1
Universe-text
1+ Persons for whom medical advise or test results were received over the phone
from a health care professional during the past 2 weeks (exclude calls for
appointments, billing questions, or prescription medicines)
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who was the phone call about?
(Anyone else?)
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all non-deleted family members.
Store this family level value to the person level.
Skip Instructions
go to PHCPHN2W
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 20 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
C
Question ID
FAU.170
Variable Name
PHCPHN2W
Universe
Persons selected in PHCPH2W
Universe-text
Persons for whom medical advice or test results were received over the phone from a
health care professional during the past 2 weeks (exclude calls for appointments,
billing questions, or prescription refills)
Question Text
DURING THE LAST 2 WEEKS, how many telephone calls
[fill1: did you make?]
[fill2: were made about [fill: Alias]?
* Enter '50' for 50 or more phone calls.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
How Many Phone Calls Were Made
fill1: For a 1 person family fill "did you make?"
fill2: For a multi-person family fill "were made about '[fill: Alias]'"
Special Instructions Roster through for all persons marked in PHCPH2W
Skip Instructions
<1-14> [goto FHCDV2W] <15-50> [goto ERR_PHCPHN2W]
[goto FHCDV2W]
Hard Edits
Soft Edits
ERR_PHCPHN2W
* [fill: PHCPHN2W] is unusually high.
* Verify that all calls were within the two week period.
* Make corrections if necessary.
AssocHelp
Tuesday, June 13, 2017
Page 21 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
C
Question ID
FAU.180
Variable Name
FHCDV2W
Universe
AGE=All
Universe-text
All families
Question Text
DURING THE LAST 2 WEEKS, did [fill1: you/anyone in the family] see a doctor or
other health care professional at a doctor's OFFICE, a clinic, an emergency room, or
some other place?
[fill2: Do not include times during an overnight hospital stay.]
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Visit Doctor's Office, Etc.
fill1: For a 1 person family fill "you" For a multi-family fill "anyone in the family"
fill2: if FHOSPYR=1 then fill "Do not include times during an overnight hospital stay."
Special Instructions Store this family level value to the person level.
Skip Instructions
<1> [If one person family, store the person number in PHCDV2W
goto PHCDVN2W; Else, goto PHCDV2W]
<2,D,R> [goto F10DVYR]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 22 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
C
Question ID
FAU.190
Variable Name
PHCDV2W
Universe
AGE=All and FHCDV2W = yes and family members>1
Universe-text
1+ Persons who saw a health care professional in office, etc. during past 2 weeks
(exclude visits during overnight hospital stays)
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who received care?
(Anyone else?)
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster including all non-deleted family members
Skip Instructions
goto PHCDVN2W
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 23 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
C
Question ID
FAU.200
Variable Name
PHCDVN2W
Universe
AGE=All and persons selected in PHCDV2W
Universe-text
Persons who had a visit to a health care professional during past 2 weeks (excl. Visits
during overnight hospital stays)
Question Text
How many times did [fill: you/ Alias] visit a doctor or other health care professional
DURING THE LAST 2 WEEKS?
* Enter '50' for 50 or more visits.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
How Many Visits to Health Professional
fill: for a 1 person family fill "you" For a multi-person family fill "Alias"
Special Instructions Roster through for all persons marked in PHCDV2W
Skip Instructions
<1-14> [goto F10DVYR] <15-50> [goto ERR_PHCDVN2W]
[goto F10DVYR]
Hard Edits
Soft Edits
ERR_PHCDVN2W
* [fill: PHCDVN2W] is unusually high.
* Verify that all visits were within the two week reference period.
* Make corrections if necessary.
AssocHelp
H_PHCDVN2W
Tuesday, June 13, 2017
Page 24 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
C
Question ID
FAU.210
Variable Name
F10DVYR
Universe
AGE=All
Universe-text
All families
Question Text
DURING THE PAST 12 MONTHS did [fill: you/any member of the family] receive care
from doctors or other health care professionals 10 or more times? Do not include
telephone calls.
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Received care 10 or more times
fill: For a 1 person family fill "you" For a multi-person family fill "any member of the
family"
Special Instructions
Skip Instructions
<1> [If one person family, store the person number in P10DVYR
goto FHICOV; Else, goto P10DVYR]
<2,D,R> [goto FHICOV] next section
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 25 of 26
Module
06
Section Name
HEALTH CARE ACCESS AND UTILIZATION
Part
C
Question ID
FAU.220
Variable Name
P10DVYR
Universe
AGE=All and F10DVYR= yes and family members >1
Universe-text
1+ Persons received care 10 or more times from health care professional during past
12 months (exclude telephone calls)
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who received care 10 or more times?
(Anyone else?)
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster including all non-deleted family members
Skip Instructions
goto FHICOV
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 26 of 26
2018 Q1 NHIS Instrument Spec Report
Section name: Family Health Insurance
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.050
Variable Name
FHICOV
Universe
AGE=All
Universe-text
All families
Question Text
(book) F3 and (book) F5
The next questions are about health insurance. Include health insurance obtained
through employment or purchased directly as well as government programs like
Medicare and Medicaid that provide Medical care or help pay medical bills.
[fill 1:Are you/Is anyone in the family] covered by any kind of health insurance or some
other kind of health care plan?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Family Health Insurance
Fill 1: If single person family fill "Are you"; else fill "Is anyone in the family".
Special Instructions If FR enters 2, mark HIKIND = 11 for all persons in family
Skip Instructions
<1, D, R> [goto HIKIND]
<2> [if AGE ge 65, goto MCAREPRB; else goto MCAIDPRB]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 1 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.070
Variable Name
HIKIND
Universe
AGE=All and FHICOV=1,D,R
Universe-text
All persons in the family where FHICOV= yes, Don't Know or Refused for that family
Question Text
(book) F3 and (book) F5
What kind of health insurance or health care coverage [fill 1: do you/does ALIAS]
have? INCLUDE those that pay for only one type of service (nursing home care,
accidents, or dental care). EXCLUDE private plans that only provide extra cash while
hospitalized.
* Enter all that apply, separate with commas.
Answer Codes
1. Private health insurance
2. Medicare
3. Medi-Gap
4. Medicaid
5. CHIP (SCHIP/ Children’s Health Insurance Program)
6. Military health care (TRICARE/VA/CHAMP-VA)
7. Indian Health Service
8. State-sponsored health plan
9. Other government program
10. Single service plan (e.g., dental, vision, prescriptions)
11. No coverage of any type
Don't Know
Refused
Question Type
Enter All That Apply
Field Pane Description
Fill Instructions
Coverage Type
Fill 1: If subject=respondent, fill [do you]; else fill [does ALIAS].
Special Instructions
Skip Instructions
[goto HCSPFYR]
<1-10> [if AGE ge 65 and HIKIND ne 2, goto MCAREPRB; else if HIKIND ne 10 goto
SINCOV; else goto HICHANGE]
<11> [if HIKIND = 1-10, goto ERR_HIKIND; else if AGE ge 65 goto MCAREPRB, else
goto MCAIDPRB]
Hard Edits
ERR_HIKIND:
* Cannot mark "No coverage of any kind" and another type.
* Please correct.
Soft Edits
AssocHelp
H_HIKIND
Tuesday, June 13, 2017
Page 2 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.070_H
Variable Name
H_HIKIND
Universe
Universe-text
Question Text
1. A [b]private health insurance plan[b] is any type of health insurance, including
Health Maintenance Organizations (HMOs), other than the programs in categories (2)
and (4-10). These plans may be provided in part or full by the person's employer or
union, or may be purchased directly by the individual.
2. [b] Medicare[b] refers to the Federal health insurance coverage for persons 65+
years of age and certain disabled persons under 65 years of age. [b]Medicare
Managed Care or Medicare + Choice[b] is a way of receiving your Medicare benefits.
These types of plans involve specific groups of doctors, hospitals, and other health
care providers who have agreed to provide care to Medicare beneficiaries in
exchange for a fixed payment from Medicare every month. In these plans, a person
must receive all of their care from the Medicare managed care plan, except for
emergencies.
3. [b]Medigap[b] insurance (also called Medicare Supplement Insurance, Medsup and
Medicare Select) is a private health insurance policy which provides reimbursement
for the out-of-pocket costs that are not covered by Medicare (for example:
prescription drugs, hearing aids, and foot care). There are ten standard Medigap
policies (A through J).
4. [b] Medicaid[b] refers to a medical assistance program that provides health care
coverage to low income and disabled persons. The Medicaid program is a joint
federal-state program which is administered by the states. In some states the
Medicaid programs have distinct names.
5. [b]Children's Health Insurance Program[b] (also called [b]SCHIP[b] or [b]CHIP[b])
refers to a joint federal and state program, administered by each state that offers
health care coverage to low-income, uninsured children. The program has recently
expanded in some states to include low income adults as well. This law was passed
in 1997. In some states, CHIP programs have distinct names.
6. [b]Military health care[b] includes health care available to active duty personnel
and their dependents ([b]TRICARE[b]) as well as [b]VA[b] (Veterans Administration)
which provides medical assistance to veterans of the Armed Forces, particularly those
with service-connected ailments and [b]CHAMP-VA[b] (Comprehensive Health and
Medical Plan of the Veterans Administration) provides health care for the spouse,
dependents, or survivors of a veteran who has a total, permanent service-connected
disability. TRICARE is a regionally managed health care program for active duty and
retired members of the uniformed services, their families, and survivors.
[b]TRICARE[b] offers eligible beneficiaries four choices for their health care:
TRICARE Prime, TRICARE Extra, TRICARE Standard and TRICARE for life.
TRICARE Standard is the new name for traditional [b]CHAMPUS[b] (Comprehensive
Health and Medical Plan for the Uniformed Services).
6. [b]Military health care[b] includes:
Tuesday, June 13, 2017
Page 3 of 117
[b]TRICARE[b] - a regionally managed health care program for active duty and
retired members of the uniformed services, their families, and survivors. TRICARE
offers eligible beneficiaries four choices for their health care: TRICARE Prime,
TRICARE Extra, TRICARE Standard and TRICARE for life. TRICARE Standard is the
new name for traditional CHAMPUS (Comprehensive Health and Medical Plan for the
Uniformed Services).
[b]VA[b] (Veterans Administration) - provides medical assistance to veterans of the
Armed Forces, particularly those with service-connected ailments.
[b]CHAMP-VA[b] (Comprehensive Health and Medical Plan of the Veterans
Administration) - provides health care for the spouse, dependents, or survivors of a
veteran who has a total, permanent service-connected disability.
7. [b]Indian Health Service[b] is the Federal health care program for Native Americans.
8. [b]State-sponsored health plan[b] refers to any other health care coverage run by a
specific state, including public assistance programs other than "Medicaid" that pay for
health care.
9. [b]Other Government Program[b] is a catch-all category for any public program
providing health care coverage other than those programs in categories 2, and 4-8.
10. [b]Single Service Plans[b] A Single Service Plan (SSP) is designed to provide
coverage for a specific type of service/care. This plan is usually limited to one type of
service or treatment for a specific condition and is frequently obtained to supplement
a comprehensive plan that may not provide that type of service. Examples of SSPs
are dental care, vision care, prescriptions, nursing home care, hospice care,
accidents, catastrophic care, cancer treatment, AIDS care, and/or hospitalization.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
HIKIND
Tuesday, June 13, 2017
Page 4 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.072
Variable Name
MCAREPRB
Universe
AGE ge 65 and (FHICOV ='2' or (HIKIND ne '2' and ne '3'))
Universe-text
All persons age 65 or older in the family where FHICOV is no, or where HIKIND is not
equal to Medicare for that person
Question Text
(book) F4
People covered by Medicare have a card that looks like this. [fill 1: Are you/Is ALIAS]
covered by Medicare?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Medicare Probe
Fill 1: If subject = respondent fill: [Are you]; else fill: [Is ALIAS].
Special Instructions If FR enters "1" add precode 2 to HIKIND;
If FR enters "1" and HIKIND=11, replace HIKIND with a 2.
Skip Instructions
<1,2,D,R> [if HIKIND ne 10 goto SINCOV; else goto HICHANGE]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 5 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.073
Variable Name
MCAIDPRB
Universe
AGE lt 65 and (FHICOV='2' or HIKIND='11')
Universe-text
All persons in the family whose age is less than 65 where FHICOV is no, or where
HIKIND is not equal to Medicaid for that person
Question Text
(book F5)
* Refer to flashcard F14 for state Medicaid names.
There is a program called Medicaid that pays for health care for persons in need. In
this State it is also called [fill 2: State name]. [fill 1: Are you/Is ALIAS] covered by
Medicaid?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Medicaid Probe
Fill 1: If subject = respondent fill: [Are you]; else fill: [Is ALIAS].
Fill 2: State Name
Special Instructions If FR enters "1" add precode 4 to HIKIND;
If FR enters "1" and HIKIND=11, replace HIKIND with a 4.
Skip Instructions
<1,2,D,R> [if HIKIND ne 10 goto SINCOV; else goto HICHANGE]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 6 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.074
Variable Name
SINCOV
Universe
AGE= All and (FHICOV='2', or HIKIND ne '10')
Universe-text
All persons in the family where FHICOV is no, or where HIKIND is not equal to single
service plan for that person
Question Text
[fill 1: Do you/Does ALIAS] have a separate insurance plan that pays for only one type
of service such as dental, vision, or prescriptions?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Single Service Probe
Fill 1: If subject = respondent fill: [Do you]; else fill: [Does ALIAS].
Special Instructions If FR enters "1" add precode "10" to HIKIND;
If FR enters "1", and HIKIND ='11', replace with a "10".
Skip Instructions
<1,2,D,R> [goto HICHANGE]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 7 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.075
Variable Name
HICHANGE
Universe
AGE=All
Universe-text
All persons
Question Text
I have recorded [fill 1:you are/ALIAS is] [fill 2: covered by/not covered by health
insurance.]
[fill 3:^HIKIND]
Is this correct?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Other
Field Pane Description
Fill Instructions
Verification
Fill1: If subject=respondent, fill:"you are"; else, fill:" ALIAS is".
Fill 2: If (FHICOV=2 or HIKIND=11) and (MCAREPRB=2,R,D or MCAIDPRB=2,R,D)
and SINCOV=2,R,D fill "covered by"; else fill "not covered by health insurance".
Fill 3: fill coverage types from HIKIND, except HIKIND=11,
else if MCAREPRB=1, fill "Medicare";
else if SINCOV=1, fill "single service plan";
else if MCAIDPRB=1, fill "Medicaid".
Special Instructions If HIKIND=3, and HIKIND ne 2, add precode "2" to HIKIND (This is being done in the
post processing.)
Hard error should include variables HIKIND and HICHANGE. HIKIND should be listed
first.
Skip Instructions
[1, D, R] goto next person;
[2] goto ERR_HICHANGE
Hard Edits
ERR_HICHANGE
*Press enter to go back to HIKIND and update coverage.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 8 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.090
Variable Name
MCPART
Universe
Age=All and (HIKIND IN ('2','3') or MCAREPRB = '1')
Universe-text
All persons with Medicare
Question Text
Earlier I recorded that [fill 1: you are/ALIAS is] covered by Medicare. May I please
see [fill 2: your/ALIAS’s] Medicare card to determine the type of coverage?
* Reports from memory are acceptable if the Medicare card (or some other form of
documentation) is not available.
* Enter the coverage type.
Answer Codes
1. Part A - Hospital Only
2. Part B - Medical Only
3. Both Part A & Part B
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Coverage Type
Fill 1: If subject=respondent, fill:[you are]; else fill, [ALIAS is]
Fill 2: If subject=respondent, fill:[your]; else fill:[ALIAS’s]
Special Instructions
Skip Instructions
<1-3> [goto MCCARD]
[prefill MCCARD with a "2", goto MCCHOICE]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 9 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.092
Variable Name
MCCARD
Universe
MCPART = ('1', '2', '3')
Universe-text
All persons with Part A Medicare coverage, Part B Medicare coverage, or both
Question Text
* Do not read. Was the type of coverage obtained from a Medicare card or some
other form of documentation?
Answer Codes
1. Yes
2. No
Question Type
Yes/No
Field Pane Description
Plan Card
Fill Instructions
Special Instructions Do not allow D or R
Skip Instructions
<1,2> [If MCPART = 1, goto MCPARTD;
else if MCPART = 2,3, goto MCCHOICE]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 10 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.095
Variable Name
MCCHOICE
Universe
MCPART IN ('2','3','R','D')
Universe-text
All persons with Medicare who have signed up for part B coverage or for whom it is
unknown if they have signed up for Part B coverage
Question Text
? [F1]
Medicare Advantage is the new name for Medicare Plus Choice plans. [fill 1: Are
you/Is ALIAS] enrolled in a Medicare Advantage plan?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Advantage
Fill 1: If subject= respondent, fill: [Are you]; else fill:[Is ALIAS]
Special Instructions
Skip Instructions
<1,2,R,D> goto MCHMO
Hard Edits
Soft Edits
AssocHelp
H_MCCHOICE
Tuesday, June 13, 2017
Page 11 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.095_H
Variable Name
H_MCCHOICE
Universe
Universe-text
Question Text
[b]Medicare Plus Choice[b] is also known as Medicare+Choice, M Plus C, and
Medicare Part C. [b]Medicare Plus Choice[b] expands the Medicare Health Plan
options to include a broader range of plans in addition to the original fee-for-service
Medicare and Health Maintenance Organizations (HMO's). New Medicare Health
plans include: Preferred provider Organizations (PPO's), Health Maintenance
Organizations with a Point of Service Option, Point of Service plans, Private Fee-ForService (PFFS) plans (not the same as Medigap),
and Medical Savings Accounts (MSA).
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
MCCHOICE
Tuesday, June 13, 2017
Page 12 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.100
Variable Name
MCHMO
Universe
MCPART IN ('2','3','R','D')
Universe-text
All persons with Medicare who have signed up for part B coverage or for whom it is
unknown if they have signed up for Part B coverage
Question Text
? [F1]
[fill 1:Are you/Is ALIAS] under a Medicare managed care arrangement, such as an
HMO, that is, a Health Maintenance Organization?
(With an HMO, you must generally receive care from HMO doctors, otherwise the
expense is not covered unless you were referred by the HMO or there was a medical
emergency.)
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
HMO
Fill 1: If subject=respondent, fill:[ Are you]; else fill, [Is ALIAS]
Special Instructions
Skip Instructions
<1> [goto MCANAME]
<2,D,R> if MCCHOICE=1 [goto MCANAME];
else if MCCHOICE in(2,D,R) [goto MCREF]
Hard Edits
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AssocHelp
H_MCHMO
Tuesday, June 13, 2017
Page 13 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.100_H
Variable Name
H_MCHMO
Universe
Universe-text
Question Text
[b]Medicare Managed Care[b] is a way of receiving your Medicare benefits. These
types of plans involve specific groups of doctors, hospitals, and other health care
providers who have agreed to provide care to Medicare beneficiaries in exchange for
a fixed payment from Medicare every month. In these plans, a person must receive all
of their care from the Medicare managed care plan, except for emergencies.
[b]Health Maintenance Organization (HMO)[b] is a health care plan that delivers
comprehensive, coordinated medical services to enrolled members on a prepaid basis.
There are three basic types of HMOs:
1) Group/Staff HMO delivers services at one or more locations through a group of
physicians that contracts with the HMO to provide care or through its own physicians
who are employees of the HMO.
2) An Individual Practice Association (IPA) makes contractual arrangements with
doctors in the community, who treat HMO members out of their own offices.
3) Network HMO contracts with two or more group practices to provide health services.
Other managed care arrangements that may be available through Medicare include:
HMO's with Point of Service Options (POS), Provider sponsored Organizations
(PSO's), and Preferred Provider Organizations (PPO's).
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
MCHMO
Tuesday, June 13, 2017
Page 14 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.112
Variable Name
MCANAME
Universe
MCCHOICE='1' or MCHMO='1'
Universe-text
All persons who answered that they had either a Medicare Advantage plan or a
Medicare HMO plan
Question Text
? [F1]
What is the name of [fill 1: your/ALIAS’s] Medicare Advantage or Medicare HMO plan?
* Read if necessary: Do you have a health plan card or something with the plan name
on it?
Answer Codes
Question Type
Text
Field Pane Description
Fill Instructions
HMO Name
Fill 1: If subject = respondent, fill: [your]; else fill:[ ALIAS's]
Special Instructions Allow 80 characters, Allow D, R
Display the text "Do you have a health plan card or something with the plan name on
it?" in BOLD GRAY text.
Skip Instructions
goto MCPREM
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AssocHelp
H_MCANAME
Tuesday, June 13, 2017
Page 15 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.112_H
Variable Name
H_MCANAME
Universe
Universe-text
Question Text
Verify that the name given is the EXACT name of the Health Plan. Verify that you
have spelled it correctly.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
MCANAME
Tuesday, June 13, 2017
Page 16 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.113
Variable Name
MCPREM
Universe
MCCHOICE='1' or MCHMO='1'
Universe-text
All persons who answered that they had either a Medicare Advantage plan or a
Medicare HMO plan
Question Text
Besides [fill 1: your/ALIAS’s] Medicare Part B payment, [fill 2: are you/is ALIAS] paying
a premium for [fill 3: your/his/her] Medicare Advantage or Medicare HMO plan?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Additional Premium
Fill 1: If subject = respondent, fill: [your]; else fill:[ ALIAS's]
Fill 2: If subject = respondent, fill: [are you]; else fill: [is ALIAS]
Fill 3: if subject = respondent, fill: [your]; else if subject is not the respondent and is
male, fill: [his]; else fill: [her]
Special Instructions
Skip Instructions
<1,2,R,D> goto MCREF
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 17 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.114
Variable Name
MCREF
Universe
MCPART IN ('2','3','R','D')
Universe-text
All persons with Medicare who have signed up for part B coverage or
for whom it is unknown if they have signed up for Part B coverage
Question Text
? [F1]
Under [fill 1: your/ALIAS's] Medicare plan, if [fill 2: you need/he needs/she needs] to
go to a different doctor or place for special care, [fill 3: do you/does he/does she] need
approval or a referral? Do not include emergency care.
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Referral
Fill 1: If subject= respondent, fill: [your]; else, fill:[ALIAS's]
Fill 2: If subject= respondent, fill: [you need]; else if subject's SEX= male, fill: [he
needs]; else if subject's SEX= female, fill: [she needs]
Fill 3: If subject= respondent, fill: [do you]; else if subject's SEX= male, fill: [does he];
else if subject's SEX= female, fill: [does she]
Special Instructions
Skip Instructions
<1,2,R,D> goto MCPARTD
Hard Edits
Soft Edits
AssocHelp
H_MCREF
Tuesday, June 13, 2017
Page 18 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.114_H
Variable Name
H_MCREF
Universe
Universe-text
Question Text
Most managed care plans require approval or a referral from one of the doctors
participating in the plan before the person can see a specialist who participates in the
plan or a doctor not participating in the plan.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
MCREF
Tuesday, June 13, 2017
Page 19 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.118
Variable Name
MCPARTD
Universe
AGE= ALL and (HIKIND IN ('2','3') or MCAREPRB = '1')
Universe-text
All persons with Medicare
Question Text
[Fill 1: Are you/Is ALIAS] enrolled in Medicare Part D, also known as the Medicare
Prescription Drug Plan?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Medicare part D
Fill 1: If subject = respondent, fill: [Are you]; else fill:[Is ALIAS]
Special Instructions If more persons with Medicare, goto MCPART. If no more persons with Medicare, goto
next appropriate question.
Skip Instructions
If more persons with Medicare, goto MCPART. If no more persons with Medicare, goto
next appropriate question.
Hard Edits
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Tuesday, June 13, 2017
Page 20 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.120
Variable Name
MACHMD
Universe
AGE= All and (HIKIND= '4' or MCAIDPRB = '1')
Universe-text
All persons with Medicaid coverage
Question Text
?[F1]
(book) F5
* Refer to flashcard F14 for state Medicaid name
The next questions are about Medicaid coverage. In this State it is also called [fill1:
State Name]. [fill 2: You are/ALIAS is] listed as having Medicaid coverage.
Can [fill 3: you/ALIAS] go to ANY doctor who will accept Medicaid or MUST [fill
4:you/he/she] choose from a list of doctors or is a doctor assigned?
Answer Codes
1. Any doctor
2. Select from list
3. Doctor is assigned
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Any Doctor
Fill 1: fill State Name
Fill 2: If subject= respondent, fill: [You are]; else fill: [ALIAS is]
Fill 3: If subject= respondent, fill: [you]; else fill: [ALIAS]
Fill 4: If subject= respondent, fill: [you]; else if subject's SEX= male, fill: [he]; else, if
subject's SEX = female, fill: [she]
Special Instructions
Skip Instructions
<1,R,D> [goto MXCHNG]
<2> [goto MACHMD1]
<3> [goto MACHMD2]
Hard Edits
Soft Edits
AssocHelp
H_MACHMD
Tuesday, June 13, 2017
Page 21 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.120_H
Variable Name
H_MACHMD
Universe
Universe-text
Question Text
[b]Medicaid[b] refers to a medical assistance program that provides health care
coverage to low income and disabled persons. The Medicaid program is a joint
federal-state program which is administered by the States. The Medicaid program is
also often referred to as "Medical Assistance Program", "Medical Assistance", "Title
19" or "(State) Medicaid", such as "Alabama Medicaid". In the listing below are some
additional program names for Medicaid by state.
STATE NAMES FOR MEDICAID:
Alabama - Patients 1st; SOBRA
Arizona - AHCCS (Pronounced "Access") (Arizona Health Care Cost Containment
System); Healthy Arizona
Arkansas - ConnectCare
California - Medi-Cal
Colorado - Primary Care Physician Program (PCPP); BabyCare/KidsCare
Connecticut - Medical Assistance Program; HUSKY Part A
Delaware - Diamond State Health Plan
District of Columbia - Medical Assistance
Florida - MediPass
Georgia - Better Health Care; Right from the Start
Hawaii - Hawaii-QUEST
Idaho - Healthy Connections; Medical Assistance
Illinois - Medical Assistance; Healthy Start; Parent Assist; Kidcare Assist
Indiana - Hoosier Healthwise; Primestep; Risk Based Managed Care
Iowa - Medical Assistance; MediPASS; Iowa Plan
Kansas - HealthConnect; Healthwave 19
Kentucky - KenPAC (Kentucky Patient Access and Care System)
Louisiana - CommunityCARE; LaMoms
Maine - PrimeCare; Maine Care
Maryland - Medical Assistance Program; Healthchoice; REM Program
Massachusetts - MassHealth
Michigan - MICHOICE; Medical Assistance Program; Healthy Kids
Minnesota - Medical Assistance (MA)
Missouri - Missouri Managed Care Plus (MC+); MCPlus ; Sarah Lopez Waiver
Montana - Passport to Health
Nebraska - Nebraska Health Connection (NHC); Medical Assistance Program
New Hampshire - Medical Assistance Program; Healthy Kids Gold
New Jersey - New Jersey Care 2000+
New Mexico - SALUD!
New York - The Partnership Plan
North Carolina - Carolina Access; Health Care Connection; Access II; Access III
North Dakota - Medical Services; North Dakota Access and Care Program (NoDAC)
Ohio - Premier Care; Healthy Families, Healthy Start
Oklahoma - SoonerCare;
Oregon - Oregon Health Plan (OHP)
Tuesday, June 13, 2017
Page 22 of 117
Pennsylvania - Medical Assistance; Access Card; HealthChoices
Rhode Island - Rite Care; RI Medical Assistance; Katie Beckett
South Carolina - Healthy Options; Physicians Enhanced Program; South Carolina
Partners for Health Medicaid Insurance
South Dakota - Prime; Medical Assistance; M-CHIP
Tennessee - TennCare Medicaid
Texas - State of Texas Access Reform (STAR); Star+Plus
Virginia - Virginia Medallion; Medallion II
Washington - Basic Health Plus
West Virginia - Medical Assistance; Mountain Health Trust; Physicians Assured
Access System (PAAS)
Wisconsin Medical Assistance; Healthy Start
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
MACHMD
Tuesday, June 13, 2017
Page 23 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.130
Variable Name
MACHMD1
Universe
MACHMD= '2'
Universe-text
Persons with Medicaid who must select a doctor from a list of doctors
Question Text
* Ask or verify.
What is the name of the health plan that provided the list?
*Read if necessary: Do you have a health plan card or something with the plan name
on it?
Answer Codes
Question Type
Text
Field Pane Description
Plan with list
Fill Instructions
Special Instructions Allow 80 characters
Prefill the response of the 1st person for subsequent family members who get this
question, but still display question so FR can ask or verify.
Skip Instructions
goto MANAM
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 24 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.131
Variable Name
MACHMD2
Universe
MACHMD= '3'
Universe-text
Persons with Medicaid for whom a doctor is assigned
Question Text
* Ask or verify.
What is the name of the health plan that assigned the doctor?
*Read if necessary: Do you have a health plan card or something with the plan name
on it?
Answer Codes
Question Type
Text
Field Pane Description
Plan Assigned
Fill Instructions
Special Instructions allow 80 characters
prefill the response of the 1st person for subsequent family members who get this
question, but still display question so FR can ask or verify.
Skip Instructions
goto MANAM
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 25 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.132
Variable Name
MANAM
Universe
MACHMD= '2','3'
Universe-text
Persons with Medicaid who must select a doctor from a list or for whom a doctor is
assigned
Question Text
? [F1]
* Do not read. Was the Health Plan name obtained from a Health Plan Card or
something with the Health Plan name on it?
Answer Codes
1. Yes
2. No
Question Type
Yes/No
Field Pane Description
Name from Card
Fill Instructions
Special Instructions Do not allow D or R
Skip Instructions
<1, 2> goto MXCHNG
Hard Edits
Soft Edits
AssocHelp
H_MANAME
Tuesday, June 13, 2017
Page 26 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.132_H
Variable Name
H_MANAME
Universe
Universe-text
Question Text
Verify that the name given is the EXACT name of the Health Plan. Verify that you
have spelled it correctly.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
MANAM
Tuesday, June 13, 2017
Page 27 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.135_00.010
Variable Name
MXCHNG
Universe
AGE=All and (HIKIND='04' or MCAIDPRB='1')
Universe-text
All persons with Medicaid coverage
Question Text
Was [fill: your/ALIAS's] Medicaid obtained through Healthcare.gov or the [fill2: Health
Insurance Marketplace/state specific name fill]?
Answer Codes
1. Yes
2. No
Don't know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Medicaid from marketplace
Fill 1: If subject = respondent, fill [your]; else, fill [ALIAS's]
Fill 2: If no state specified below, fill Health Insurance Marketplace
If state specified below fill:
If CA then fill Health Insurance Marketplace, such as Covered California
If CO then fill Health Insurance Marketplace, such as Connect for Health Colorado
If CT then fill Health Insurance Marketplace, such as Access Health CT
If DC then fill Health Insurance Marketplace, such as DC Health Link
If DE then fill Health Insurance Marketplace, such as Choose Health Delaware
If HI then fill Health Insurance Marketplace, such as Hawaii Health Connector
If ID then fill Health Insurance Marketplace, such as Your Health Idaho
If KY then fill Health Insurance Marketplace, such as KYnect
If MA then fill Health Insurance Marketplace, such as Health Connector
If MD then fill Health Insurance Marketplace, such as Maryland Health Connection
If MN then fill Health Insurance Marketplace, such as MNsure
If NM then fill Health Insurance Marketplace, such as New Mexico Health
Connections
If MS then fill Health Insurance Marketplace, such as One, Mississippi
If NV then fill Health Insurance Marketplace, such as Nevada Health Link
If NY then fill Health Insurance Marketplace, such as New York State of Health
If OR then fill Health Insurance Marketplace, such as Cover Oregon
If RI then fill Health Insurance Marketplace, such as HealthSource RI
If VT then fill Health Insurance Marketplace, such as Vermont Health Connect
If WA then fill Health Insurance Marketplace, such as Washington Healthplanfinder
If UT then fill Health Insurance Marketplace, or through Avenue H
Special Instructions
Skip Instructions
<1, 2, R, D> goto MEDPREM
Hard Edits
Soft Edits
Tuesday, June 13, 2017
Page 28 of 117
AssocHelp
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.137_00.020
Variable Name
MEDPREM
Universe
AGE=All and (HIKIND(e)='04' or MCAIDPRB(e)='1'
Universe-text
All persons with Medicaid coverage
Question Text
A health insurance premium is the amount you or a family member pays each month
for health care coverage. Do you or a family member pay a premium for [Fill 1 :
your/ALIAS's] Medicaid plan?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Medicaid premium
Fill 1: If subject = respondent, fill [your]; else, fill [ALIAS's]
Special Instructions
Skip Instructions
<1> goto MDPRINC
<2,R,D> goto MAPCMD
Hard Edits
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AssocHelp
Tuesday, June 13, 2017
Page 29 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.137_00.030
Variable Name
MDPRINC
Universe
AGE=All and MEDPREM(e)='1'
Universe-text
All persons with Medicaid coverage who pay a premium for their plan
Question Text
Is the premium paid for this Medicaid plan based on income?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Premium based on income
Fill Instructions
Special Instructions
Skip Instructions
loop through all persons in the family with Medicaid, when roster is finished, goto next
appropriate group of questions.
If HIKIND=10 goto SSTYPE2; else goto If HIKIND=1 or 3, goto FHICCI6
If any person with HIKIND=1 or 3, but not in NEXTPNM*_B, goto HIVER1; else gotot
FHICC18
If any family member with HIKIND=5; goto STNAME, else if any member with
HIKIND=10,11, goto HILAST; else if HIKIND=1-9 goto HINOTYR, else goto HILAST
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Tuesday, June 13, 2017
Page 30 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.156
Variable Name
SSTYPE2
Universe
AGE=All and (HIKIND = '10' or SINCOV = '1').
Universe-text
All persons with single service plans
Question Text
(book) F6
* Enter all that apply, separate with commas.
You mentioned that [fill 1: you have/ALIAS has] a single-service plan - that is, an
insurance plan that provides one specific type of coverage. What type of service or
care does [fill 2: your/ALIAS's] single service plan or plans pay for?
Answer Codes
1. Accidents
2. AIDS care
3. Cancer treatment
4. Catastrophic care
5. Dental care
6. Disability insurance (cash payments when unable to work for health reasons)
7. Hospice care
8. Hospitalization only
9. Long-term care (nursing home care)
10. Prescriptions
11. Vision care
12. Other (specify)
Refused
Don’t know
Question Type
Enter All That Apply
Field Pane Description
Fill Instructions
Single Service Plan Type
Fill 1: If subject= respondent, fill: [you have]; Else fill: [ALIAS has]
Fill 2: If subject= respondent, fill: [your]; Else fill: [ALIAS's]
Special Instructions
Skip Instructions
1-11, D, R roster through for all people with single service plans, then goto next
appropriate question
12 goto SSOTHER
Hard Edits
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AssocHelp
Tuesday, June 13, 2017
Page 31 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.157
Variable Name
SSOTHER
Universe
SSTYPE= 12
Universe-text
Persons with "Other" Single service plan
Question Text
* Other type of single-service plan
Answer Codes
Question Type
Text
Field Pane Description
Other Single Service Plan
Fill Instructions
Special Instructions Allow 80 characters
Skip Instructions
if other persons with single service plan, goto SSTYPE2 until roster is exhausted.
Else goto next appropriate group of questions.
Hard Edits
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AssocHelp
Tuesday, June 13, 2017
Page 32 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.158
Variable Name
FHICCI6
Universe
AGE=All and HIKIND= '1','3' for any person in the family
Universe-text
All families with at least one person with private health insurance
Question Text
The next questions are about private health insurance plans [fill 2: including MediGap]. These plans can be obtained through work, purchased directly, or through a
state or local government program or community program.
[Fill 1: We have the following persons listed as being covered by such plans:
* Read names.
(Display roster of persons covered by private health insurance plans.)]
Answer Codes
1. Enter 1 to Continue
Question Type
Enter 1 to Continue
Field Pane Description
Fill Instructions
Continue
Fill 1: If more than 1 person has private health insurance, fill:
We have the following persons listed as being covered by such plans:
* Read names.
(Display roster of persons covered by private health insurance plans.)
Fill 2: When HIKIND = Medigap (3), fill: [including Medi-Gap].
Special Instructions If more than 1 person has private health insurance, display roster of family members
with private health insurance (HIKIND = 1 or 3)
Skip Instructions
goto HIPNAM1
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Tuesday, June 13, 2017
Page 33 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.160
Variable Name
HIPNAM1
Universe
AGE=All and HIKIND= '1','3' for any person in the family
Universe-text
All families with at least one person with private health insurance
Question Text
It is important that we record the complete and accurate name of each health
insurance plan. What is the COMPLETE name of the first plan?
Do NOT include plans that only provide extra cash while in the hospital or plans that
pay for only one type of service, such as nursing home care, accidents, or dental care.
* Read if necessary: Do you have your health plan card or something with the plan
name on it?
Answer Codes
Question Type
Text
Field Pane Description
First plan
Fill Instructions
Special Instructions Allow 80 characters
if HIPNAM1 = 'refused' or 'don't know' set plan name='Plan 1'
else set plan name =HIPNAM1 value
Skip Instructions
[prefill PCARD1 with a "2", goto HIPNAM1B]
else goto PCARD1
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Tuesday, June 13, 2017
Page 34 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.160_1
Variable Name
PCARD1
Universe
HIPNAM1 ne ' ', 'D', 'R'
Universe-text
Health plan name was collected in HIPNAM1
Question Text
* Do not read. Was the health plan name obtained from a health plan card or
something with the health plan name on it?
Answer Codes
1. Yes
2. No
Question Type
Yes/No
Field Pane Description
Plan card
Fill Instructions
Special Instructions Do not allow answer codes D, R
Skip Instructions
goto HIPNAM1B
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Tuesday, June 13, 2017
Page 35 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.170
Variable Name
HIPNAM1B
Universe
HIPNAM1 ne ' '
Universe-text
Health plan name was collected in HIPNAM1 or HIPNAM1 refused or don't know
Question Text
* Ask or verify. Enter all that apply, separate with commas.
Which family members are covered by this plan?
* Indicate each family member covered by this plan.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all persons with HIKIND=1 or 3 in answer pane. (Private health
insurance or MediGap.)
Please have the instrument automatically fill the person number if only one person is
covered by private health insurance or MediGap.
Skip Instructions
<1-25> if line number has FX='1' and le TOTPCNT and HHSTAT ne 'D' goto
MORPLAN
[if HIPNAM1= D, R, goto STNAME1 or STNAME2 or STNAME3 or MILSPC or
HILAST or HINOTYR
else, goto MORPLAN
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Tuesday, June 13, 2017
Page 36 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.171
Variable Name
MORPLAN
Universe
(HIPNAM1 ne 'R','D', ' ') or (HIPNAM1B ne 'R','D', ' ') or HIVER2='5' and
MORPLAN='2','R','D')
Universe-text
Health plan name was collected in HIPNAM1 or a person number was collected in
HIPNAM1B or another plan was mentioned at HIVER2 and MORPLAN='2','R','D'
Question Text
* Ask if necessary
Are there any more private health insurance plans?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
More plans
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto HIPNAM2]
<2,D,R> [(If all persons listed in HIPNAM1B goto FHICCI8); else
(If some or no persons listed in HIPNAM1B, but not all persons with
HIKIND=1,3 listed in HIPNAM1B, goto HIVER1)]
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Tuesday, June 13, 2017
Page 37 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.172
Variable Name
HIPNAM2
Universe
MORPLAN = '1'
Universe-text
All families with a second private health insurance plan
Question Text
What is the name of the next plan?
*Read if necessary: Do you have a health plan card or something with the plan name
on it?
Answer Codes
Question Type
Text
Field Pane Description
Second plan
Fill Instructions
Special Instructions Allow 80 characters
if HIPNAM2='refused' or 'don't know' set plan name='Plan 2'
else set plan name=HIPNAM2 value
Skip Instructions
[prefill PCARD2 with a "2", goto HIPNAM2B]
else goto PCARD2
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Tuesday, June 13, 2017
Page 38 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.172_1
Variable Name
PCARD2
Universe
HIPNAM2 ne ' ', D or R
Universe-text
Health plan name was recorded in HIPNAM2
Question Text
* Do not read. Was the health plan name obtained from a health plan card or
something with the health plan name on it?
Answer Codes
1. Yes
2. No
Question Type
Yes/No
Field Pane Description
Plan card
Fill Instructions
Special Instructions do not allow answer codes of D or R
Skip Instructions
goto HIPNAM2B
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Tuesday, June 13, 2017
Page 39 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.173
Variable Name
HIPNAM2B
Universe
HIPNAM2 ne ' '
Universe-text
Health plan name was collected in HIPNAM2 or HIPNAM2 = D, R
Question Text
* Ask or verify. Enter all that apply, separate with commas.
Which family members are covered by that plan?
* Indicate each family member covered by this plan.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all persons with HIKIND=1 or 3 in answer pane. (Private health
insurance or MediGap.)
Please have the instrument automatically fill the person number if only one person is
covered by private health insurance or MediGap.
Skip Instructions
<1-25> if line number has FX='1' and le TOTPCNT and HHSTAT ne 'D' goto
MORPLAN2
[if HIPNAM2 eq D or R and persons listed in HIPNAM1B, but not all persons
with HIKIND eq 1 or 3 listed in HIPNAM1B, goto HIVER1;
else if HIPNAM2 eq D or R and persons listed in HIPNAM1B, and all persons with
HIKIND eq 1 or 3 listed in HIPNAM1B, goto FHICCI8;
else if HIPNAM2 eq D or R and persons not listed in HIPNAM1B, goto HIVER1;
else if health plan name recorded in HIPNAM2, goto MORPLAN2]
else goto MORPLAN2
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Tuesday, June 13, 2017
Page 40 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.174
Variable Name
MORPLAN2
Universe
(HIPNAM2 ne 'R', 'D', ' ') or (HIPNAM2B ne 'R', 'D', ' ') or (HIVER2='5' and MORPLAN2
= '2','R','D')
Universe-text
Health plan name was collected in HIPNAM2 or a person number was collected in
HIPNAM2B or another plan was mentioned at HIVER2 and MORPLAN2='2','R','D'
Question Text
* Ask if necessary
Are there any more private health insurance plans?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
More plans
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto HIPNAM3]
<2,D,R> [if some or no persons listed in HIPNAM2B or HIPNAM1B, but not all persons
with HIKIND eq 1 or 3 listed in
HIPNAM2B or HIPNAM1B, goto HIVER1;
else goto FHICCI8]
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Tuesday, June 13, 2017
Page 41 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.175
Variable Name
HIPNAM3
Universe
MORPLAN2 = '1'
Universe-text
All families with a third private health insurance plan
Question Text
What is the name of the next plan?
*Read if necessary: Do you have a health plan card or something with the plan name
on it?
Answer Codes
Question Type
Text
Field Pane Description
Third plan
Fill Instructions
Special Instructions Allow 80 characters
if HIPNAM3 = 'refused' or 'don't know' set plan name = 'Plan 3' else set plan name =
HIPNAM3 value
Skip Instructions
[prefill PCARD3 with a "2", goto HIPNAM3B]
else goto PCARD3
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Tuesday, June 13, 2017
Page 42 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.175_1
Variable Name
PCARD3
Universe
HIPNAM3 ne ' ', 'D' or 'R'
Universe-text
Health plan name was recorded in HIPNAM3
Question Text
* Do not read. Was the health plan name obtained from a health plan card or
something with the health plan name on it?
Answer Codes
1. Yes
2.No
Question Type
Yes/No
Field Pane Description
Plan card
Fill Instructions
Special Instructions Do not allow answer codes of D or R
Skip Instructions
goto HIPNAM3B
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Tuesday, June 13, 2017
Page 43 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.176
Variable Name
HIPNAM3B
Universe
HIPNAM3 ne ' '
Universe-text
Health plan name was collected in HIPNAM3 or HIPNAM3 don't know or refused
Question Text
* Ask or verify. Enter all that apply, separate with commas.
Which family members are covered by that plan?
* Indicate each family member covered by this plan.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all persons with HIKIND=1 or 3 in answer pane. (Private health
insurance or MediGap.)
Please have the instrument automatically fill the person number if only one person is
covered by private health insurance or MediGap.
Skip Instructions
<1-25> if line number has FX='1' and le TOTPCNT and HHSTAT ne 'D' goto
MORPLAN3
[if HIPNAM3 eq D or R and persons listed in HIPNAM1B or HIPNAM2B, but not
all persons with HIKIND eq 1 or 3 listed in HIPNAM1B or HIPNAM2B, goto HIVER1;
else if HIPNAM3 eq D or R and persons listed in HIPNAM1B or HIPNAM2B, and
all persons with HIKIND eq 1 or 3 listed in HIPNAM1B or HIPNAM2B, goto FHICCI8;
else if HIPNAM3 eq D or R and persons not listed in HIPNAM1B and HIPNAM2B,
goto HIVER1;
else if health plan name recorded in HIPNAM3, goto MORPLAN3]
else goto MORPLAN3
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Tuesday, June 13, 2017
Page 44 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.177
Variable Name
MORPLAN3
Universe
(HIPNAM3 ne 'R', 'D', ' ') or (HIPNAM3B ne 'R', 'D', ' ') or (HIVER2='5' and
MORPLAN3='2','R','D')
Universe-text
Health plan name was collected in HIPNAM3 or a person number was collected in
HIPNAM3B or another plan was mentioned at HIVER2 and MORPLAN3='2','R','D'
Question Text
* Ask if necessary
Are there any more private health insurance plans?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
More plans
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto HIPNAM4]
<2,D,R> [if some or no persons listed in HIPNAM1B or HIPNAM2B or HIPNAM3B, but
not all persons with HIKIND eq 1 or 3 listed in HIPNAM1B or HIPNAM2B or
HIPNAM3B, goto HIVER1;
else goto FHICCI8]
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Tuesday, June 13, 2017
Page 45 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.178
Variable Name
HIPNAM4
Universe
MORPLAN3 = '1'
Universe-text
All families with a fourth private health insurance plan
Question Text
What is the name of the next plan?
*Read if necessary: Do you have a health plan card or something with the plan name
on it?
Answer Codes
Question Type
Text
Field Pane Description
Fourth plan
Fill Instructions
Special Instructions Allow 80 characters
if HIPNAM4 = 'refused' or 'don't know' set plan name = 'Plan 4' else set plan name =
HIPNAM4 value
Skip Instructions
[prefill PCARD4 with a "2", goto HIPNAM4B]
else goto PCARD4
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Tuesday, June 13, 2017
Page 46 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.178_1
Variable Name
PCARD4
Universe
HIPNAM4 ne ' ', D or R
Universe-text
Health plan name was recorded in HIPNAM4
Question Text
* Do not read. Was the health plan name obtained from a health plan card or
something with the health plan name on it?
Answer Codes
1. Yes
2.No
Question Type
Yes/No
Field Pane Description
Plan card
Fill Instructions
Special Instructions Do not allow answer codes of D or R
Skip Instructions
goto HIPNAM4B
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Tuesday, June 13, 2017
Page 47 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.179
Variable Name
HIPNAM4B
Universe
HIPNAM4 ne ' '
Universe-text
Health plan name was collected in HIPNAM4 or HIPNAM4 don't know or refused
Question Text
* Ask or verify. Enter all that apply, separate with commas.
Which family members are covered by that plan?
* Indicate each family member covered by this plan.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all persons with HIKIND=1 or 3 in answer pane. (Private health
insurance or MediGap.)
Please have the instrument automatically fill the person number if only one person is
covered by private health insurance or MediGap
Skip Instructions
<1-25> if line number has FX='1' and le TOTPCNT and HHSTAT ne 'D' but not all
persons with HIKIND eq 1 or 3 listed in HIPNAM1B or HIPNAM2B or HIPNAM3B or
HIPNAM4B goto HIVER1
else goto FHICCI8
[if persons listed in HIPNAM1B or HIPNAM2B or HIPNAM3B, but not all
persons with HIKIND eq 1 or 3 listed in HIPNAM1B or HIPNAM2B or HIPNAM3B, goto
HIVER1;
else if persons not listed in HIPNAM1B and HIPNAM2B and HIPNAM3B, goto
HIVER1;
else goto FHICCI8]
else goto FHICCI8
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Tuesday, June 13, 2017
Page 48 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.180
Variable Name
HIVER1
Universe
(HIKIND= '1','3') and (person not selected in HIPNAM1B and HIPNAM2B and
HIPNAM3B and HIPNAM4B)
Universe-text
Persons with private health insurance, but not listed under any of the mentioned plans
Question Text
? [F1]
[fill 1: You are/ALIAS is] listed as having private insurance but [fill 2: were/was] not
mentioned as being covered by any of the plans we just discussed. [fill 3: Are you/Is
ALIAS] covered by private insurance?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Covered
Fill 1: If subject= respondent, fill: [You are]; Else fill: [ALIAS is]
Fill 2: If subject= respondent, fill: [were]; Else fill: [was]
Fill 3: If subject= respondent, fill: [Are you]; Else fill: [Is ALIAS]
Special Instructions Loop through all persons with HIKIND=1 or 3, but not mentioned in HIPNAM1B or
HIPNAM2B or HIPNAM3B or HIPNAM4B
Hard error message should involve HIKIND and HIVER1, with HIKIND listed first.
Skip Instructions
<1> [goto HIVER2]
<2> [goto ERR_HIVER1]
goto FHICCI8 or STNAME1 or STNAME2 or STNAME3 or MILSPC or HILAST or
HINOTYR
if another person meets criteria goto HIVER1
else goto FHICCI8 or STNAME1 or STNAME2 or STNAME3 or MILSPC or
HILAST or HINOTYR
Hard Edits
ERR_HIVER1
*Press ENTER to go back to HIKIND to update health insurance coverage.
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H_HIVER1
Tuesday, June 13, 2017
Page 49 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.180_H
Variable Name
H_HIVER1
Universe
Universe-text
Question Text
A private health insurance plan may be provided in part or full by the persons'
employer or union, may be purchased directly by the individual, or may be provided
through a state government or local community program.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
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HIVER
Tuesday, June 13, 2017
Page 50 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.190
Variable Name
HIVER2
Universe
HIVER1= '1'
Universe-text
All persons who answered yes at HIVER1
Question Text
? [F1]
* Enter all that apply, separate with commas.
Is [fill 1: your/ALIAS's] health insurance plan the same as one of those already
mentioned?
Answer Codes
Authors: fill names of plans, if not empty, for precodes 1-4 as follows:
1. [HIPNAM1 or 'Plan 1']
2. [HIPNAM2 or 'Plan 2'] (if available)
3. [HIPNAM3 or 'Plan 3'] (if available)
4. [HIPNAM4 or 'Plan 4'] (if available)
5. Some other plan not already mentioned
Refused
Don’t know
Question Type
Enter All That Apply
Field Pane Description
Fill Instructions
Which Plan
Fill 1: If subject= respondent, fill: [your]; Else fill: [ALIAS's]
Special Instructions if HIVER2 = '1' add person's line number to HIPNAM1B or replace 'Don’t know' or
'Refused' answer
if HIVER2 = '2' add person's line number to HIPNAM2B or replace 'Don’t know' or
'Refused' answer
if HIVER2 = '3' add person's line number to HIPNAM3B or replace 'Don’t know' or
'Refused' answer
if HIVER2 = '4' add person's line number to HIPNAM4B or replace 'Don’t know' or
'Refused' answer
If HIVER2 = '5' and less than 4 plan names entered, change MORPLAN or
MORPLAN2 or MORPLAN3, as appropriate, to '1' (Yes)
Skip Instructions
<1-4> [Update any inputs into the appropriate list (HIPNAM1B, HIPNAM2B,
HIPNAM3B, HIPNAM4B),
if another person meets criteria, goto HIVER1,
else goto FHICCI8 or STNAME1 or STNAME2 or STNAME3 or MILSPC or
HILAST or HINOTYR]
<5> [If 4 plan names were given, ignore this 5th plan and if another person meets
criteria, goto HIVER1,
else goto FHICCI8 or FHI200 or STNAME1 or STNAME2 or STNAME3 or
MILSPC or HILAST or HINOTYR]
If less than 4 plan names, goto MORPLAN or MORPLAN2 or MORPLAN3, as
appropriate, to add more private health insurance plans]
goto FHICCI8 or STNAME1 or STNAME2 or STNAME3 or MILSPC or HILAST or
Tuesday, June 13, 2017
Page 51 of 117
HINOTYR
if another person meets criteria goto HIVER1
else goto FHICCI8 or STNAME1 or STNAME2 or STNAME3 or MILSPC or
HILAST or HINOTYR
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H_FHIVER2
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.190_H
Variable Name
H_FHIVER2
Universe
Universe-text
Question Text
A private health insurance plan may be provided in part or full by the persons'
employer or union, may be purchased directly by the individual, or may be provided
through a state government or local community program.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
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Tuesday, June 13, 2017
Page 52 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.195
Variable Name
FHICCI8
Universe
(HIPNAM1 ne ' ') and (HIPNAM1 ne 'D', 'R' or HIPNAM1B ne 'D', 'R')
Universe-text
If there is a private health insurance plan mentioned
Question Text
[Fill 1]
Answer Codes
1. Enter 1 to Continue
Question Type
Enter 1 to Continue
Field Pane Description
Fill Instructions
Continue
Fill 1: If this is the first plan in the roster (i.e. from HIPNAM1), then fill: [Now I am
going to ask some questions about the [fill 2] you just told me about [fill 3].]; Else fill:
[Next I would like to ask you about [fill 5].]
Fill 2: If only one plan mentioned, fill: [plan], else fill: [plans]
Fill 3: If more than one plan mentioned, fill: [, starting with [fill 4]]; else no fill
Fill 4: Fill name of plan mentioned in HIPNAM1 or if HIPNAM1= D, R, fill: [Plan 1]
Fill 5: Fill name of next plan from roster. (HIPNAM2, HIPNAM3, HIPNAM4)
if HIPNAM2=D,R, fill [Plan 2] or if HIPNAM3=D,R, fill [Plan 3] or If HIPNAM4=D,R fill
[Plan 4]
Special Instructions This begins the roster of private health insurance detail questions.
Do not allow answer codes D, R
Skip Instructions
<1> [goto FHI200]
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Tuesday, June 13, 2017
Page 53 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.200
Variable Name
FHI200
Universe
All private health insurance plans - FHICCI8='1'
Universe-text
asked of all private health insurance plans
Question Text
? [F1]
Health insurance plans are usually obtained in one person's name even if other family
members are covered. That person is called the policyholder. In whose name is this
plan?
* Enter line number of family member (from list below) in whose name this plan is held.
* Enter 0 if the policyholder is not on the family roster."
Answer Codes
Question Type
Pick One - answer list pane
Field Pane Description
Policyholder
Fill Instructions
Special Instructions Allow "0" response for "Policyholder outside of the family"
Skip Instructions
If <00> goto PRPOLH
if <1-25> goto PRCOOH
if goto PLNWRK
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H_PLNNAM
Tuesday, June 13, 2017
Page 54 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.200_H
Variable Name
H_PLNNAM
Universe
Universe-text
Question Text
This refers to (1) the person who purchased the policy, or (2) the person whose
employment or membership in a particular group makes
the person or the family eligible for coverage under the health insurance plan.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
FHI200
Tuesday, June 13, 2017
Page 55 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.202_01.010
Variable Name
PRPOLH
Universe
FHI200(e)='0'
Universe-text
All persons on each plan where the policyholder is outside of the family roster
Question Text
How [fill1:are you/is ALIAS] related to the policyholder for [fill2:
plan1/plan2/plan3/plan4]?
*Read if Necessary…
[fill3:You are/ALIAS is} the policyholder’s…
Answer Codes
1. Child (including stepchildren)
2. Spouse
3. Former spouse
4. Some other relationship
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Fill 1: If subject = respondent, fill: [are you]; else fill:[is ALIAS]
Fill 2: If subject = respondent, fill: name of plan being asked about
[plan1/plan2/plan3/plan4]
Fill 3: If subject = respondent, fill: [You are]; else fill:[ALIAS is]
Special Instructions Looped for each person per plan mentioned in fill 2.
Skip Instructions
<1-4,R,D> [goto PLNWRK]
NOTE: Detailed questions about private health insurance plans are looped through for
each plan mentioned in a family. Information on up to 4 plans per family is collected.
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Tuesday, June 13, 2017
Page 56 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.204_01.010
Variable Name
PRCOOH
Universe
('01'<=FHI200(e)<='25')
Universe-text
All private health insurance plans with policyholder on family roster
Question Text
Does this plan cover anyone who does not live here?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto PLNWRK]
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Tuesday, June 13, 2017
Page 57 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.210
Variable Name
PLNWRK
Universe
All private health insurance plans - FHICCI8='1'
Universe-text
asked of all private health insurance plans
Question Text
? [F1]
(book) F7
Which one of these categories best describes how this plan was obtained?
Answer Codes
1. Through employer
2. Through union
3. Through workplace, but don't know if employer or union
4. Through workplace, self-employed or professional association
5. Purchased directly
6. Through Healthcare.gov or the Affordable Care Act, also known as Obamacare
7. Through a state/local government or community program
8. Other (specify)
Don't Know
Refused
Question Type
Pick One - answer list pane
Field Pane Description
How plan obtained
Fill Instructions
Special Instructions
Skip Instructions
<1-4, 6> goto PLNPAY
<5,7,R,D> goto PLNEXCHG
<8> goto PLNWKSP
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H_PLNWRK
Tuesday, June 13, 2017
Page 58 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.210_1
Variable Name
PLNWKSP
Universe
PLNWRK= '08'
Universe-text
All private health insurance plans where the plan was obtained through an other
source
Question Text
*Read if necessary.
How was this plan obtained?
Answer Codes
Question Type
Text
Field Pane Description
Other
Fill Instructions
Special Instructions Allow 80 characters.
Skip Instructions
Goto PLNEXCHG
Hard Edits
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AssocHelp
Tuesday, June 13, 2017
Page 59 of 117
Module
07
Section Name
Family Health insurance
Part
Question ID
FHI.210_H
Variable Name
H_PLNWRK
Universe
Universe-text
Question Text
A private health insurance plan may be provided in part or full by the persons'
employer or union, may be purchased directly by the individual, or may be provided
through a state or local government or community program.
A private health insurance plan through a state or local government program or
community program is a type of private insurance for which state or local government
or community effort pays part or all of the cost of a private insurance plan, such as
Blue Cross/Blue Shield. The individual may also contribute to the cost of the health
insurance and may receive a card such as a Blue Cross/Blue Shield card.
A community program or effort may include a variety of mechanisms to achieve health
insurance for persons who would otherwise be uninsured. An example would be a
private company giving a grant to an HMO to pay for health insurance coverage.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
PLNWRK
Tuesday, June 13, 2017
Page 60 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.215_00.010
Variable Name
PLNEXCHG
Universe
PLNWRK(e) IN ('05', '07', ‘08’, 97, 99)
Universe-text
All private health insurance plans that are not employer based (or of unknown origins)
Question Text
Was the plan obtained through the Healthcare.gov or the [fill 1: Health Insurance
Marketplace/state specific name fill]?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Purchased through marketplace
Fill 1: If no state specified below, fill Health Insurance Marketplace
If state specified below fill:
If CA then fill Health Insurance Marketplace, such as Covered California
If CO then fill Health Insurance Marketplace, such as Connect for Health Colorado
If CT then fill Health Insurance Marketplace, such as Access Health CT
If DC then fill Health Insurance Marketplace, such as DC Health Link
If DE then fill Health Insurance Marketplace, such as Choose Health Delaware
If HI then fill Health Insurance Marketplace, such as Hawaii Health Connector
If ID then fill Health Insurance Marketplace, such as Your Health Idaho
If KY then fill Health Insurance Marketplace, such as KYnect
If MA then fill Health Insurance Marketplace, such as Health Connector
If MD then fill Health Insurance Marketplace, such as Maryland Health Connection
If MN then fill Health Insurance Marketplace, such as MNsure
If NM then fill Health Insurance Marketplace, such as New Mexico Health
Connections
If MS then fill Health Insurance Marketplace, such as One, Mississippi
If NV then fill Health Insurance Marketplace, such as Nevada Health Link
If NY then fill Health Insurance Marketplace, such as New York State of Health
If OR then fill Health Insurance Marketplace, such as Cover Oregon
If RI then fill Health Insurance Marketplace, such as HealthSource RI
If VT then fill Health Insurance Marketplace, such as Vermont Health Connect
If WA then fill Health Insurance Marketplace, such as Washington Healthplanfinder
If UT then fill Health Insurance Marketplace, or through Avenue H
Special Instructions
Skip Instructions
<1,2,R,D> goto PLNPAY
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Tuesday, June 13, 2017
Page 61 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.220
Variable Name
PLNPAY
Universe
All private health insurance plans - FHICCI8='1'
Universe-text
asked of all private health insurance plans
Question Text
? [F1]
* Enter all that apply, separate with commas.
Who pays for this health insurance plan?
* If government program is reported, probe for Medicare or Medicaid or CHIP before
entering code 7. If government is the employer, enter code 2.
Answer Codes
1. Self or Family (living in the household)
2. Employer or Union
3. Someone outside the household
4. Medicare
5. Medicaid
6. CHIP (SCHIP/Children’s Health Insurance Program)
7. State or local government or community program
Refused
Don’t know
Question Type
Enter All That Apply
Field Pane Description
Who pays
Fill Instructions
Special Instructions
Skip Instructions
<1-7,R,D> if includes '1' [goto PLNPRE]
else [goto PLNMGD]
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H_PLNPAY
Tuesday, June 13, 2017
Page 62 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.220_H
Variable Name
H_PLNPAY
Universe
Universe-text
Question Text
This refers to the payment of premiums, not health care services or out-of-pocket
expenditures. Premiums are regular payments for health insurance coverage.
Frequently, these payments are made by payroll deduction.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 63 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.225_00.000
Variable Name
PLNPRE
Universe
PLNPAY includes '1'
Universe-text
Private plan paid for by self or family
Question Text
Is the premium paid for this plan based on income?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Premium paid
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto HICOSTN]
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Tuesday, June 13, 2017
Page 64 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.230_1
Variable Name
HICOSTN
Universe
PLNPAY includes '1'
Universe-text
Plans payed for by self or family
Question Text
?[F1]
1 of 2
How much [fill 1: do you/does your family] currently spend for health insurance
premiums for [fill 2: fill plan name/fill name of Plan 1]? Please include payroll
deductions for premiums.
*Enter dollar amount for premium payments.
Answer Codes
Question Type
Multi Part
Field Pane Description
Fill Instructions
Amount
fill 1: If single person family, fill: [do you]; else fill: [does your family]
fill 2: fill plan name from HIPNAM1 or HIPNAM2 or HIPNAM3 or HIPNAM4 depending
upon which sequence in the roster you are in. If HIPNAM1, HIPNAM2, HIPNAM3, or
HIPNAM4=D,R, fill [Plan 1], etc. as appropriate.
Special Instructions allow 1-99995, D, R
part 1 of 2 part question
if HICOSTN = 'D' store 'D' in HICOSTT
if HICOSTN = 'R' store 'R' in HICOSTT
Skip Instructions
<1-99995> [goto HICOSTT]
[store "R" in HICOSTT and goto PLNMGD]
[store "D" in HICOSTT and goto PLNMGD]
Hard Edits
Soft Edits
ERR_HICOSTN
* [fill # from HICOSTN] is unusually high. Please verify.
Make corrections if necessary.
AssocHelp
H_HICOST
Tuesday, June 13, 2017
Page 65 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.230_1_H
Variable Name
H_HICOST
Universe
Universe-text
Question Text
This refers to the payment of premiums, not health care services or out-of-pocket
expenditures. Premiums are regular payments for health insurance coverage.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
HICOSTN
HICOSTT
Tuesday, June 13, 2017
Page 66 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.230_2
Variable Name
HICOSTT
Universe
HICOSTN = 1-99995
Universe-text
All private health insurance plans with a valid response to HICOSTN
Question Text
?[F1]
2 of 2
* Enter time period for premium payments.
Answer Codes
1. Once a week
2. Once every 2 weeks
3. Once a month
4. Twice a month
5. Every two months
6. Quarterly (every 3 months)
7. Once a year
8. Twice a year
Refused
Don’t know
Question Type
Multi Part
Field Pane Description
Time period
Fill Instructions
Special Instructions part 2 of 2 part question
Skip Instructions
<1-8,R,D> [goto PLNMGD]
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H_HICOST
Tuesday, June 13, 2017
Page 67 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.240
Variable Name
PLNMGD
Universe
all private health insurance plans - FHICCI8='1'
Universe-text
asked of all private health insurance plans
Question Text
? [F1]
Is [fill 1: fill plan name/fill name of Plan 1] an HMO (Health Maintenance
Organization), an IPA (Individual Practice Association), a PPO (Preferred Provider
Organization), a POS (Point-Of-Service), fee-for-service or is it some other kind of
plan?
Answer Codes
1. HMO/IPA
2. PPO
3. POS
4. Fee-for-service
5. Other
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Type of plan
fill 1: [fill plan name from HIPNAM1 or HIPNAM2 or HIPNAM3 or HIPNAM4] or [if
HIPNAM1, HIPNAM2, HIPNAM3, or HIPNAM4=D,R, fill [Plan 1], etc. as appropriate.
Special Instructions Add an answer tag for this question.
Skip Instructions
<1-5,D,R> [goto HDHP]
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H_PLNMGD
Tuesday, June 13, 2017
Page 68 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.240_H
Variable Name
H_PLNMGD
Universe
Universe-text
Question Text
[b]HMO[b] - Health Maintenance Organizations are health delivery systems that offer
comprehensive health coverage for hospital and physician services for a prepaid,
fixed fee.
[b]IPA[b] - type of HMO which contracts directly with physicians in independent
practices, and/or contracts with one or more associations of physicians in independent
practices, or multi-specialties. The plan is predominantly organized around
solo/single practices.
[b]PPO[b] - Preferred Provider Organizations are a form of managed care although
not a "traditional" HMO. Enrollees in PPOs are encouraged to use designated or
"preferred" health providers. Financial incentives for individuals include lower
payments or coinsurance and maximum limits on out-of-pocket costs for in-network
use. PPOs are less restrictive than HMO's in that visits to specialists are not
dependent on the authorization by a member’s primary care physician. Unlike HMOs,
out-of-network usage is allowed by PPOs though at a higher cost to enrollee.
[b]POS[b] - Point-of-Service plans are a form of managed care although not a
"traditional" HMO. POS plans allow for "opt-out" or out-of-network coverage, but
accompanied by strong economic incentives to the enrollees to use network providers.
POS plans generally use gatekeepers for referrals to specialists in the network. It is
this attribute that most readily distinguishes a POS plan from a PPO.
[b]Fee-for-Service[b] - This is the traditional kind of health care policy. Insurance
companies pay fees for the services provided to the insured people covered by the
policy. This type of health insurance offers the most choices of doctors and hospitals.
You can choose any doctor you wish and change doctors any time. You can go to any
hospital in any part of the country. With fee-for-service, the insurer only pays for part
of your doctor and hospital bills. A fee-for-service plan pays for covered services after
services have been received.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
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Tuesday, June 13, 2017
Page 69 of 117
AssocHelp
PLNMGD
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.241
Variable Name
HDHP
Universe
All Private Health Insurance Plans - FHICCI8='1'
Universe-text
Asked of All Private Health Insurance Plans
Question Text
?[F1]
[If only one person covered by this plan:]
Is the annual deductible for medical care for this plan less than $1,300 or $1,300 or
more? If there is a separate deductible for prescription drugs, hospitalization, or outof-network care, do not include those deductible amounts here.
[If two or more persons in the family are covered by this plan:]
Is the family annual deductible for medical care for this plan less than $2,600 or
$2,600 or more? If there is a separate deductible for prescription drugs,
hospitalization, or out-of-network care, do not include those deductible amounts here.
Answer Codes
1. Less than [fill 1: $1,300/$2,600]
2. [fill 1: $1,300/$2,600] or more
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
HDHP Plan
fill 1: if one person covered by the plan, fill $1,300;
else, if two or more persons covered by the plan, fill $2,600
Special Instructions
Skip Instructions
<1,R,D> [goto MGCHMD]
<2> [goto HSAHRA]
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H_HSAHRA
Tuesday, June 13, 2017
Page 70 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.242
Variable Name
HSAHRA
Universe
HDHP=2
Universe-text
Asked of All High Deductible Private Health Plans
Question Text
?[F1]
With this plan, is there a special account or fund that can be used to pay for medical
expenses? The accounts are sometimes referred to as Health Savings Accounts
(HSAs), Health Reimbursement Accounts (HRAs), Personal Care accounts, Personal
Medical funds, or Choice funds, and are different from Flexible Spending Accounts.
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
HSAHRA
Fill Instructions
Special Instructions
Skip Instructions
1,2,R,D [goto MGCHMD]
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H_HSAHRA
Tuesday, June 13, 2017
Page 71 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.242_H
Variable Name
H_HSAHRA
Universe
Universe-text
Question Text
[b]Health Savings Account[b] - A Health Savings Account or HSA is an account that is
used to pay for medical expenses not covered by one’s insurance plan. HSAs require
a companion high deductible insurance policy. The employer may fund them or the
employee and balances may rollover from year to year. Features of a HSA include:
tax-deductible deposits, tax deferred interest earned on the account, tax-free
withdrawals for qualified medical expenses, carryover of unused funds and interest
from year to year, and portability. A HSA qualified insurance policy must have a
deductible of at least $1300 for individuals and $2600 for families.
[b]Health Reimbursable Agreement[b] - A Health Reimbursable Agreement or HRA is
an account that is used to pay for medical expenses. HRAs are an employer-funded
account with the following features: tax free withdrawals for qualified medical
expenses, carryover of unused credits from year to year, credits in a HRA do not earn
interest, credits in a HRA are forfeited if health insurance plan is switched.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 72 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.243
Variable Name
MGCHMD
Universe
all private health insurance plans - FHICCI8='1'
Universe-text
asked of all private health insurance plans
Question Text
Under this plan, can [fill 1:you/ALIAS/the family members with this plan] choose ANY
doctor or MUST [fill2:you/he/she/they] choose one from a specific group or list of
doctors?
Answer Codes
1. Any doctor
2. Select from group/list
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Any doctor
Fill 1: If single person family, or if respondent is the only person covered, fill: [you];
else, if only one person is covered, and that person is not the respondent, fill :[
ALIAS]; else, fill: [the family members with this plan]
Fill 2: If single person family, or if respondent is the only person covered, fill: [you];
else, if only one person is covered, and that person is not the respondent and SEX =
1, fill :[ he]; else, if only one person is covered, and that person is not the respondent
and SEX = 2, fill :[ she]; else, fill: [they]
Special Instructions
Skip Instructions
<1> [goto MGPRMD]
<2> [goto MGPYMD]
[goto PCPREQ]
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Tuesday, June 13, 2017
Page 73 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.244
Variable Name
MGPRMD
Universe
MGCHMD = '1'
Universe-text
All private health insurance plans where covered persons can choose any doctor
Question Text
[fill 1:Do you/Does ALIAS/Do the family members with this plan] have the option of
choosing a doctor from a preferred or select list at a lower cost?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Choose from list
Fill 1: If single person family, or if respondent is the only person covered, fill: [Do
you]; else if only one person is covered, and that person is not the respondent, fill :[
Does ALIAS]; else fill: [Do the family members with this plan]
Special Instructions
Skip Instructions
[goto PCPREQ]
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Tuesday, June 13, 2017
Page 74 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.246
Variable Name
MGPYMD
Universe
MGCHMD = '2'
Universe-text
All private health insurance plans where covered persons must select from a group or
list of doctors
Question Text
If [fill 1: you select/ALIAS selects/the family members with this plan select] a doctor
who is not in the plan, will [fill 2:^HIPNAM1/ ^HIPNAM2/^HIPNAM3/^ HIPNAM4/Plan
1/Plan 2/Plan 3/Plan 4] pay for any part of the cost?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Pay for cost
Fill 1: If single person family, or if respondent is the only person covered, fill: [you
select]; else if only one person is covered, and that person is not the respondent, fill :[
ALIAS selects]; else fill: [the family members with this plan select]
fill 2: Fill the plan name from HIPNAM1 or HIPNAM2 or HIPNAM3 or HIPNAM4
depending upon the sequence in the roster. If HIPNAM, HIPNAM2 or HIPNAM3 or
HIPNAM4= D, R, fill [Plan 1], etc. as appropriate.
Special Instructions
Skip Instructions
[goto PCPREQ]
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Tuesday, June 13, 2017
Page 75 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.248_05.000
Variable Name
PCPREQ
Universe
All private health insurance plans - FHICCI8 = '1'
Universe-text
Asked of all private health insurance plans
Question Text
Does this plan REQUIRE [fill1: you/ALIAS/the family members with this plan] to have a
primary care doctor who approves all [fill2: your/their] care?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Fill 1: If single person family, or if respondent is the only person covered, fill: [you];
else if only one person is covered, and that person is not the respondent, fill :[ ALIAS];
else fill: [the family members with this plan]
Fill 2: if single person family or if respondent is the only person covered, fill: [your];
else fill: [their]
Special Instructions
Skip Instructions
<1,2,R,D> [goto PRRXCOV]
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Tuesday, June 13, 2017
Page 76 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.249_01
Variable Name
PRRXCOV
Universe
All private health insurance plans - FHICCI8='1'
Universe-text
All private health insurance plans
Question Text
Does [fill 1: ^HIPNAM1 or ^HIPNAM2, or ^HIPNAM3, or ^HIPNAM4 or Plan 1 or Plan 2
or Plan 3 or Plan 4] pay for any of the costs for medicines prescribed by a doctor?
* Read if necessary: Does this plan have a drug benefit?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Pays for Drugs Private
Fill 1: ^HIPNAM1 or ^HIPNAM2, or ^HIPNAM3, or ^HIPNAM4 or Plan 1 or Plan 2 or
Plan 3 or Plan 4
Special Instructions Loop through from FHICCI8 for any other private plans. When roster is exhausted,
goto next appropriate question.
Skip Instructions
goto PRDNCOV
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Tuesday, June 13, 2017
Page 77 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.249_02
Variable Name
PRDNCOV
Universe
All private health insurance plans - FHICCI8='1'
Universe-text
All private health insurance plans
Question Text
Does [fill 1: ^HIPNAM1 or ^HIPNAM2, or ^HIPNAM3, or ^HIPNAM4 or Plan 1 or Plan 2
or Plan 3 or Plan 4] pay for any of the costs for dental care?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Dental insurance
Fill 1: ^HIPNAM1 or ^HIPNAM2, or ^HIPNAM3, or ^HIPNAM4 or Plan 1 or Plan 2 or
Plan 3 or Plan 4
Special Instructions
Skip Instructions
Loop through from FHICCI8 for any other private plans. When roster is exhausted,
if any PLNWRK in ('1','2','3','4') goto FCOVCONF
else goto STNAME1 or STNAME2 or STNAME3 or MILSPC or HILAST or HINOTYR
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Tuesday, June 13, 2017
Page 78 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.249_03
Variable Name
FCOVCONF
Universe
PLNWRK(e) IN('1','2','3','4')
Universe-text
All families with an employer-based health plan
Question Text
If [fill1: you/your family] had to buy a health plan on [fill 2: your/its] own with no help
from [fill 3: your/an] employer, how confident are you that [fill 1: you/your family] would
be able to obtain affordable coverage Would you say…
*Read categories below.
Answer Codes
1. Very confident
2. Somewhat confident
3. Not too confident
4. Not confident at all
Don’t know
Refused
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Fill 1: if single person family fill "you"; else fill "your family"
Fill 2: if single person family fill "your"; else fill "its"
Fill 3: if single person family fill "your"; else fill "an"
Special Instructions
Skip Instructions
<1-4,R,D> goto STNAME1 or STNAME2 or STNAME3 or MILSPC or HILAST or
HINOTYR
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Tuesday, June 13, 2017
Page 79 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.250
Variable Name
STNAME1
Universe
AGE = All and HIKIND = '05'
Universe-text
All persons with CHIP
Question Text
Earlier I recorded that [fill 1: you are/ALIAS is] covered by the Children’s Health
Insurance Program (CHIP/SCHIP). What is the name of the plan?
* Read if necessary: Do you have a health plan card or something with the plan name
on it?
Answer Codes
Question Type
Text
Field Pane Description
Fill Instructions
Name of CHIP Plan
Fill 1:If subject = respondent, fill: [you are]; else, fill: [ALIAS is]
Special Instructions Loop through STNAME1 - STREF1 on a person basis.
Allow 80 characters, D, R
Skip Instructions
[goto CHXCHNG]
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Tuesday, June 13, 2017
Page 80 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.250_00.010
Variable Name
CHXCHNG
Universe
AGE = All and HIKIND(e)='05'
Universe-text
All persons with CHIP
Question Text
Was [fill 1: your/ALIAS's] CHIP plan obtained through the [fill 2: Health Insurance
Marketplace/ fill state specific fill]?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
CHIP through marketplace
Fill 1: If subject = respondent, fill [your]; else, fill [ALIAS's]
Fill 2: If no state specified below, fill Health Insurance Marketplace
If state specified below fill:
If CA then fill Health Insurance Marketplace, such as Covered California
If CO then fill Health Insurance Marketplace, such as Connect for Health Colorado
If CT then fill Health Insurance Marketplace, such as Access Health CT
If DC then fill Health Insurance Marketplace, such as DC Health Link
If DE then fill Health Insurance Marketplace, such as Choose Health Delaware
If HI then fill Health Insurance Marketplace, such as Hawaii Health Connector
If ID then fill Health Insurance Marketplace, such as Your Health Idaho
If KY then fill Health Insurance Marketplace, such as KYnect
If MA then fill Health Insurance Marketplace, such as Health Connector
If MD then fill Health Insurance Marketplace, such as Maryland Health Connection
If MN then fill Health Insurance Marketplace, such as MNsure
If NM then fill Health Insurance Marketplace, such as New Mexico Health
Connections
If MS then fill Health Insurance Marketplace, such as One, Mississippi
If NV then fill Health Insurance Marketplace, such as Nevada Health Link
If NY then fill Health Insurance Marketplace, such as New York State of Health
If OR then fill Health Insurance Marketplace, such as Cover Oregon
If RI then fill Health Insurance Marketplace, such as HealthSource RI
If VT then fill Health Insurance Marketplace, such as Vermont Health Connect
If WA then fill Health Insurance Marketplace, such as Washington Healthplanfinder
If UT then fill Health Insurance Marketplace, or through Avenue H
Special Instructions
Skip Instructions
<1,2,R,D> [goto STRFPRM1]
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Tuesday, June 13, 2017
Page 81 of 117
AssocHelp
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.250_00.020
Variable Name
STRFPRM1
Universe
AGE = All and HIKIND(e)='05'
Universe-text
All persons with CHIP
Question Text
A health insurance premium is the amount you or a family member pays each month
for health care coverage. Do you or a family member pay a premium for this CHIP
plan?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
CHIP premium
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CHPRINC]
<2,R,D> [goto STDOC1]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 82 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.250_00.030
Variable Name
CHPRINC
Universe
AGE = All and STRFPRM1(e)='01'
Universe-text
Those with CHIP coverage who pay a premium for their plan
Question Text
Is the premium paid for [fill 1: ^STNAME1/this CHIP plan] based on income?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Premium based on income
Fill 1: [fill: ^STNAME1], else if STNAME1 = to D or R, fill: [this CHIP plan]
Special Instructions
Skip Instructions
<1,2,R,D> goto STDOC1
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Tuesday, June 13, 2017
Page 83 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.251
Variable Name
STDOC1
Universe
AGE = All and HIKIND = '05'
Universe-text
All persons with SCHIP
Question Text
Under the [fill 1:^STNAME1/CHIP PLAN] can [fill 2: you/ALIAS] go to ANY doctor who
will accept this plan or MUST [fill 3: you/he/she] choose from a list of doctors or is the
doctor assigned?
Answer Codes
1. Any doctor
2. Select from list
3. Doctor is assigned
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Any Doctor
Fill 1: fill: [^STNAME1]; else, if STNAME1 = D or R, fill: [CHIP Plan]
Fill 2: If subject = respondent, fill [you]; else fill: [ALIAS]
Fill 3: If subject = respondent, fill [you]; else if sex = 1, fill: [he]; else, if sex = 2, fill:
[she]
Special Instructions
Skip Instructions
<1, 2, D, R> goto next person in roster, else [goto STNAME2]
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Soft Edits
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Tuesday, June 13, 2017
Page 84 of 117
Module
07
Section Name
Part
Question ID
FHI.257
Variable Name
STNAME2
Universe
AGE = All and HIKIND = '08'
Universe-text
All persons with a state sponsored health plan
Question Text
Earlier I recorded that [fill 1: you are/ALIAS is] covered by a state sponsored health
plan. What is the name of the plan?
* Read if necessary: Do you have a health plan card or something with the plan name
on it?
Answer Codes
Question Type
Text
Field Pane Description
Fill Instructions
Name of State Sponsored Plan
Fill 1:If subject = respondent, fill: [you are]; else, fill: [ALIAS is]
Special Instructions Loop through STNAME2 - STREF2 on a person basis.
Skip Instructions
goto OPXCHNG
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Tuesday, June 13, 2017
Page 85 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.257_00.010
Variable Name
OPXCHNG
Universe
AGE = All and HIKIND(e) = '08'
Universe-text
All persons with a state sponsored health plan
Question Text
Was [fill 1: your/ALIAS's] state sponsored health plan obtained through
Healthcare.gov or the [fill 2: Health Insurance Marketplace/ fill state specific name]?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
State plan through marketplace
Fill 1: If subject = respondent, fill [your]; else, fill [ALIAS's]
Fill 2: If no state specified below, fill Health Insurance Marketplace
If state specified below fill:
If CA then fill Health Insurance Marketplace, such as Covered California
If CO then fill Health Insurance Marketplace, such as Connect for Health Colorado
If CT then fill Health Insurance Marketplace, such as Access Health CT
If DC then fill Health Insurance Marketplace, such as DC Health Link
If DE then fill Health Insurance Marketplace, such as Choose Health Delaware
If HI then fill Health Insurance Marketplace, such as Hawaii Health Connector
If ID then fill Health Insurance Marketplace, such as Your Health Idaho
If KY then fill Health Insurance Marketplace, such as KYnect
If MA then fill Health Insurance Marketplace, such as Health Connector
If MD then fill Health Insurance Marketplace, such as Maryland Health Connection
If MN then fill Health Insurance Marketplace, such as MNsure
If NM then fill Health Insurance Marketplace, such as New Mexico Health
Connections
If MS then fill Health Insurance Marketplace, such as One, Mississippi
If NV then fill Health Insurance Marketplace, such as Nevada Health Link
If NY then fill Health Insurance Marketplace, such as New York State of Health
If OR then fill Health Insurance Marketplace, such as Cover Oregon
If RI then fill Health Insurance Marketplace, such as HealthSource RI
If VT then fill Health Insurance Marketplace, such as Vermont Health Connect
If WA then fill Health Insurance Marketplace, such as Washington Healthplanfinder
If UT then fill Health Insurance Marketplace, or through Avenue H
Special Instructions
Skip Instructions
<1,2,R,D> goto STRFPRM2
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Tuesday, June 13, 2017
Page 86 of 117
AssocHelp
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.257_00.020
Variable Name
STRFPRM2
Universe
AGE = All and HIKIND(e) = '08'
Universe-text
All persons with a state sponsored health plan
Question Text
A health insurance premium is the amount you or a family member pays each month
for health
care coverage. Do you or a family member pay a premium for [fill : your/ALIAS's]
state-sponsored health plan?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
State plan premium
Fill 1: If subject = respondent, fill [your]; else, fill [ALIAS's]
Special Instructions
Skip Instructions
<1> goto SSPRINC
<2,R,D> goto STDOC2
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Tuesday, June 13, 2017
Page 87 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.257_00.030
Variable Name
SSPRINC
Universe
AGE = All and STRFPRM2(e)='1'
Universe-text
Those with state sponsored health plan who pay a premium for their plan
Question Text
Is the premium paid for [fill 1: ^STNAME2/this state sponsored plan] based on income?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Premium based on income
Fill 1: [fill: ^STNAME2], else if STNAME2 = to D or R, fill: [this state sponsored plan]
Special Instructions
Skip Instructions
<1,2,R,D> goto STDOC2
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Tuesday, June 13, 2017
Page 88 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.258
Variable Name
STDOC2
Universe
AGE = All and HIKIND = '08'
Universe-text
All persons with state sponsored health care
Question Text
Under the [fill 1:^STNAME2/state sponsored plan] can [fill 2: you/ALIAS] go to ANY
doctor who will accept this plan or MUST [fill 3: you/he/she] choose from a list of
doctors or is the doctor assigned?
Answer Codes
1. Any doctor
2. Select from list
3. Doctor is assigned
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Any Doctor
Fill 1: [fill: ^STNAME2], else; if STNAME2 = to D or R, fill: [state sponsored plan]
Fill 2: If subject = respondent, fill [you]; else fill: [ALIAS]
Fill 3: If subject = respondent, fill [you]; else if sex = 1, fill: [he]; else, if sex = 2, fill:
[she]
Special Instructions
Skip Instructions
<1, 2, D, R> [goto STNAME3]
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Tuesday, June 13, 2017
Page 89 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.264
Variable Name
STNAME3
Universe
AGE = All and HIKIND = '09'
Universe-text
All persons with an other government plan
Question Text
Earlier I recorded that [fill 1: you are/ALIAS is] covered by an other government
program. What is the name of the plan?
* Read if necessary: Do you have a health plan card or something with the plan name
on it?
Answer Codes
Question Type
Text
Field Pane Description
Fill Instructions
Name of Other Government Plan
Fill 1:If subject = respondent, fill: [you are]; else, fill: [ALIAS is]
Special Instructions Loop through STNAME3 - STREF3 on a person basis.
Allow 80 characters, D, R
Skip Instructions
[goto OGXCHNG]
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Tuesday, June 13, 2017
Page 90 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.264_00.010
Variable Name
OGXCHNG
Universe
AGE = All and HIKIND(e)='09'
Universe-text
All persons with an other government program
Question Text
Was [fill1: your/ALIAS's] other government program obtained through Healthcare.gov
or the [fill2]?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Other plan through marketplace
Fill 1: If subject = respondent, fill [your]; else, fill [ALIAS's]
Fill 2: If no state specified below, fill Health Insurance Marketplace
If state specified below fill:
If CA then fill Health Insurance Marketplace, such as Covered California
If CO then fill Health Insurance Marketplace, such as Connect for Health Colorado
If CT then fill Health Insurance Marketplace, such as Access Health CT
If DC then fill Health Insurance Marketplace, such as DC Health Link
If HI then fill Health Insurance Marketplace, such as Hawaii Health Connector
If ID then fill Health Insurance Marketplace, such as Your Health Idaho
If KY then fill Health Insurance Marketplace, such as KYnect
If MA then fill Health Insurance Marketplace, such as Health Connector
If MD then fill Health Insurance Marketplace, such as Maryland Health Connection
If MN then fill Health Insurance Marketplace, such as MNsure
If NM then fill Health Insurance Marketplace, such as New Mexico Health
Connections
If MS then fill Health Insurance Marketplace, such as One, Mississippi
If NV then fill Health Insurance Marketplace, such as Nevada Health Link
If NY then fill Health Insurance Marketplace, such as New York State of Health
If OR then fill Health Insurance Marketplace, such as Cover Oregon
If RI then fill Health Insurance Marketplace, such as HealthSource RI
If VT then fill Health Insurance Marketplace, such as Vermont Health Connect
If WA then fill Health Insurance Marketplace, such as Washington Healthplanfinder
If UT then fill Health Insurance Marketplace, or through Avenue H
Special Instructions
Skip Instructions
<1,2,R,D> goto STRFPRM3
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Tuesday, June 13, 2017
Page 91 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.264_00.020
Variable Name
STRFPRM3
Universe
AGE = All and HIKIND(e)='09'
Universe-text
All persons with an other government program
Question Text
A health insurance premium is the amount you or a family member pays each month
for health care coverage. Do you or a family member pay a premium for [fill :
your/ALIAS's] other government program?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Other plan premium
Fill 1: If subject = respondent, fill [your]; else, fill [ALIAS's]
Special Instructions
Skip Instructions
<1> goto OGPRINC
<2,R,D> goto STDOC3
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AssocHelp
Tuesday, June 13, 2017
Page 92 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.264_00.030
Variable Name
OGPRINC
Universe
AGE = All and STRFPRM3(e)='01'
Universe-text
Those with other government health plan who pay a premium for their plan
Question Text
Is the premium paid for [fill 1: ^STNAME3/this other government plan] based on
income?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Premium based on income
Fill 1: [fill: ^STNAME3], else if STNAME3 = to D or R, fill: [this other government plan]
Special Instructions
Skip Instructions
<1,2,R,D> goto STDOC3
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Tuesday, June 13, 2017
Page 93 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.265
Variable Name
STDOC3
Universe
AGE = All and HIKIND = '09'
Universe-text
All persons with an other government plan
Question Text
Under the [fill 1:^STNAME3/other government plan] can [fill 2: you/ALIAS] go to ANY
doctor who will accept this plan or MUST [fill 3:you/he/she] choose from a list of
doctors or is the doctor assigned?
Answer Codes
1. Any doctor
2. Select from list
3. Doctor is assigned
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Any Doctor
Fill 1: [^STNAME3]; else, if STNAME3= to D or R, fill: [other government plan]
Fill 2: If subject = respondent, fill [you]; else fill: [ALIAS]
Fill 3: If subject = respondent, fill [you]; else if sex = 1, fill: [he]; else, if sex = 2, fill:
[she]
Special Instructions
Skip Instructions
<1,2,D,R> [goto STNAME3] *see flowchart
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Tuesday, June 13, 2017
Page 94 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.270
Variable Name
MILSPC
Universe
AGE = All and HIKIND = '06'
Universe-text
All persons with military health care
Question Text
? [F1]
* Enter all that apply, separate with commas.
Earlier I recorded that [fill 1] covered by military health care. What types of military
health care [fill 2:] covered by?
Answer Codes
1. TRICARE
2. VA
3. CHAMP-VA
4. Other military coverage (specify)
Don’t know
Refused
Question Type
Enter All That Apply
Field Pane Description
Fill Instructions
Type of Military Coverage
Fill 1: If subject = respondent, fill: [you are]; Else fill: [ALIAS is]
Fill 2: If subject = respondent, fill: [are you]; Else fill: [is ALIAS]
Special Instructions
Skip Instructions
<1> [goto MILMAN]
<4> [goto MILSPCOT]
<2,3,D,R> [loop through for all persons in roster, when exhausted, goto next
appropriate question.]
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Tuesday, June 13, 2017
Page 95 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.270_H
Variable Name
H_MILSPC
Universe
Universe-text
Question Text
[b]TRICARE[b] is a regionally managed health care program for active duty and
retired members of the uniformed services, their families, and survivors. TRICARE for
military dependents was previously known as CHAMPUS.
[b]VA[b] (Veterans Administration) provides medical assistance to veterans of the
Armed Forces, particularly those with service-connected ailments.
[b]CHAMP-VA[b] (Comprehensive Health and Medical Plan of the Veterans
Administration) provides health care for the spouse, dependents, or survivors of a
veteran who has a total, permanent service-connected disability.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
MILSPC
Tuesday, June 13, 2017
Page 96 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.271
Variable Name
MILSPCOT
Universe
MILSPC = '04'
Universe-text
All persons with other military coverage
Question Text
* Other military coverage
Answer Codes
Question Type
Text
Field Pane Description
Other
Fill Instructions
Special Instructions Allow 80 characters
Skip Instructions
if MILSPC eq 1, goto MILMAN;
else, goto next appropriate question
Hard Edits
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Tuesday, June 13, 2017
Page 97 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.275
Variable Name
MILMAN
Universe
MILSPC = '01'
Universe-text
All persons with TRICARE coverage
Question Text
? [F1]
Is [fill 1: your/ALIAS's] TRICARE plan, TRICARE prime, TRICARE Extra, TRICARE
Standard or TRICARE for Life?
Answer Codes
1. TRICARE Prime
2. TRICARE Extra
3. TRICARE Standard
4. TRICARE for Life
5. TRICARE other (specify)
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Type of TRICARE
Fill 1:If subject = respondent, fill: [your]; Else, fill: [ALIAS’s]
Special Instructions
Skip Instructions
<1-4,D,R> [goto next appropriate question]
<5> [goto MILMANOT]
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H_MILMAN
Tuesday, June 13, 2017
Page 98 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.275_H
Variable Name
H_MILMAN
Universe
Universe-text
Question Text
[b]TRICARE[b] is a regionally managed health care program for active duty and
retired members of the uniformed services, their families, and survivors. TRICARE
offers eligible beneficiaries four choices for their health care:
[b]TRICARE Prime[b] - Under this TRICARE option, Military Treatment Facilities are
the principal source of health
care. Active duty military personnel are automatically enrolled in TRICARE Prime.
Family members and
survivors of active duty personnel and retirees and their family members and survivors
under age 65 are also
eligible for TRCARE prime.
[b]TRICARE Extra[b] - Under this TRICARE option you choose a doctor, hospital, or
other medical provider listed in
the TRICARE Provider Directory. Anyone who is CHAMPUS (Comprehensive Health
and Medical Plan for the
Uniformed Services) eligible may use TRICARE Extra.
[b]TRICARE Standard[b] - This is the new name for traditional CHAMPUS. Under
this plan, you can see the
authorized provider of your choice. Treatment may also be available at a Military
Treatment Facility. Anyone
who is CHAMPUS (Comprehensive Health and Medical Plan for the Uniformed
Services) eligible may use
TRICARE Standard.
[b]TRICARE for Life (TFL)[b] - This option is available to all Medicare-eligible
uniformed services retirees,
Medicare-eligible family members, and Medicare-eligible widows/widowers and certain
former spouses who
were eligible for TRICARE before age 65. Beneficiaries are required to purchase
Medicare Part B and MUST
pay the appropriate Medicare Part B monthly premiums. TRICARE for Life pays
secondary to Medicare.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Tuesday, June 13, 2017
Page 99 of 117
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MILMAN
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.276
Variable Name
MILMANOT
Universe
MILMAN = '5'
Universe-text
All persons with other type of TRICARE coverage
Question Text
* Other type of TRICARE coverage
Answer Codes
Question Type
Text
Field Pane Description
Other TRICARE
Fill Instructions
Special Instructions Allow 80 characters
Skip Instructions
Loop through from MILSPC for all persons with this coverage. When exhausted, goto
next appropriate question.
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Tuesday, June 13, 2017
Page 100 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.280
Variable Name
HILAST
Universe
AGE = All and HIKIND = '10','11'
Universe-text
All persons without known health insurance or with only single service plans
Question Text
(book) F8
? [F1]
Not including Single Service Plans, about how long has it been since [fill 1:
you/ALIAS] last had health care coverage?
Answer Codes
1. 6 months or less
2. More than 6 months, but less than 1 year
3. 1 year
4. More than 1 year, but less than 3 years
5. 3 years or more
6. Never
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Time Since Last Covered
Fill 1: If subject = respondent, fill: [you]; Else fill: [ALIAS]
Special Instructions
Skip Instructions
[goto HISTOP]
Hard Edits
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H_HILAST
Tuesday, June 13, 2017
Page 101 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.280_H
Variable Name
H_HILAST
Universe
Universe-text
Question Text
Single Service Plans do not count for this item. A Single Service Plan is designed to
provide coverage for a specific type of service/care. This plan is usually limited to one
type of service or treatment for a specific condition and is frequently obtained to
supplement a comprehensive plan that may not provide that type of service.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
HILAST
Tuesday, June 13, 2017
Page 102 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.290
Variable Name
HISTOP
Universe
AGE = All and HIKIND = '10','11'
Universe-text
All persons without known health insurance or with only single service plans
Question Text
(book) F9
[Fill 1: [Which of these are reasons [fill 2:you/ALIAS] stopped being covered?/Which
of these are reasons [fill 3: you do/ALIAS does] not have health insurance?]
* Enter up to 5 reasons, separate with commas.
Answer Codes
1. Person in family with health insurance lost job or changed employers
2. Got divorced or separated/death of spouse or parent
3. Became ineligible because of age/left school
4. Employer does not offer coverage/or not eligible for coverage
5. Cost is too high
6. Insurance company refused coverage
7. Medicaid/Medical plan stopped after pregnancy
8. Lost Medicaid/Medical plan because of new job or increase in income
9. Other reason for losing Medicaid
10. Other (specify)
Refused
Don’t know
Question Type
Enter All That Apply
Field Pane Description
Fill Instructions
Why No Coverage
Fill 1: If HILAST eq <1-5>, fill: [Which of these are reasons [fill 2] stopped being
covered?]; else if HILAST eq <6,R,D>, fill: [Which of these are reasons [fill 3] not have
health insurance?]
Fill 2: If subject = respondent, fill: [you]; else fill: [ALIAS]
Fill 3: If subject = respondent, fill: [you do]; else fill: [ALIAS does]
Special Instructions
Skip Instructions
<1-9,D,R> [goto FHIKDB]
<10> [goto HISTOPOT]
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Tuesday, June 13, 2017
Page 103 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.291
Variable Name
HISTOPOT
Universe
HISTOP = '10'
Universe-text
All persons without known health insurance and other reason for stopping or not
having coverage
Question Text
? [F1]
* Other reason for not having coverage
Answer Codes
Question Type
Text
Field Pane Description
Other
Fill Instructions
Special Instructions Allow 80 characters
Skip Instructions
Goto FHIKDB
Hard Edits
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AssocHelp
H_HISTOPO
Tuesday, June 13, 2017
Page 104 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.291_H
Variable Name
H_HISTOPO
Universe
Universe-text
Question Text
Enter exactly what the respondent tells you, in their own words.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
HISTOPOT
Tuesday, June 13, 2017
Page 105 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.300
Variable Name
HINOTYR
Universe
HIKIND= '1','2','3','4','5','6','7','8','9'
Universe-text
All persons with known health insurance, except single service plans
Question Text
In the PAST 12 MONTHS, was there any time when [fill 1: you/ALIAS] did NOT have
ANY health insurance or coverage?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Fill 1: If subject = respondent, fill: [you]; Else fill: [ALIAS]
Loop through HINOTYR and PWRKBSP for each person in universe.
Special Instructions
Skip Instructions
Without Coverage
<1> [goto HINOTMYR]
<2,D,R> [goto FHICHNG]
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Tuesday, June 13, 2017
Page 106 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.310
Variable Name
HINOTMYR
Universe
HINOTYR = '1'
Universe-text
All persons who currently have health insurance who did not have
health insurance/coverage for some period of time in the past 12 months
Question Text
In the PAST 12 MONTHS, about how many months [fill 1: were you/was ALIAS]
without coverage?
* If less than 1 month, enter '1'.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Months Without Coverage
Fill 1: If subject = respondent, fill: [were you]; Else fill: [was ALIAS]
Special Instructions Allow 1-12, D, R
Insert answer tag "months to the right of answer field.
When roster is exhausted, goto FHIKDB
Skip Instructions
<1-12,D,R>
When roster is exhausted, goto FHIKDB
Hard Edits
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Tuesday, June 13, 2017
Page 107 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.312_00.010
Variable Name
FHICHNG
Universe
HINOTYR(e)='2','D','R'
Universe-text
All persons who are currently insured who were continuously covered in the past year
Question Text
Did [fill1: you/ALIAS] have [fill2: type of health insurance coverage] for the past 12
months?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Fill1: If single person family fill "you"; else fill "ALIAS"
Fill 2: fill with [HIKIND] and separate with a comma for multiple plans, when
applicable. If MCAREPRB=1 or MCAIDPRB=1, add a fill of 'Medicare' or 'Medicaid' to
any other plans mentioned in HIKIND. If HIKIND=11 (No coverage of any type), do
not fill this text in the fill variable (tempHIKIND).
Special Instructions
Skip Instructions
<1,R,D> [goto HCSPFYR]
<2> [goto FHIKDB]
Hard Edits
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Tuesday, June 13, 2017
Page 108 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.315_00.010
Variable Name
FHIKDB
Universe
HISTOP = '1','2','3','4','5','6','7','8','9','10','D', 'R' or HINOTYR = '1' or FHICHNG = '2'
Universe-text
All persons except those with continuous coverage who are currently uninsured for
more than 1 year with no changes
Question Text
(book) F3 and (book) F5
If person is currently uninsured:
{Think about the last time [fill1: you/ALIAS] had health insurance or health care
coverage. What type did [fill1: you/ALIAS] have?}
If person had a period without coverage in the past year:
{I recorded that [fill1: you/ALIAS] had a period without health insurance in the past
year. What type of health insurance or coverage did [fill1: you/ALIAS] have before
this period?}
If person had a change in coverage type in the past year:
{What other types of health insurance or health care coverage did [fill1: you/ALIAS]
have?}
*Enter all that apply, separate with commas.
Answer Codes
1. Private health insurance
2. Medicare
3. Medi-Gap
4. Medicaid
5. CHIP (SCHIP/Children's Health Insurance Program)
6. Military health care (TRICARE/VA/CHAMP-VA)
7. Indian Health Service
8. State-sponsored health plan
9. Other government program
10. Single service plan (e.g., dental, vision, prescriptions)
11. No coverage of any type
Refused
Don't know
Question Type
Enter all that apply
Field Pane Description
Fill Instructions
If HISTOP <1-10, D, R> for currently uninsured fill: [Think about the last time [fill1:
you/ALIAS] had health insurance or health care coverage. What type(s) did [fill 1:
you/ALIAS] have?]
If HINOTMYR not = to empty, for period without coverage in the past year fill: {I
recorded that [fill1: you/ALIAS] had a period without health insurance in the past year.
What type of health insurance or coverage did [fill1:you/ALIAS] have before this
Tuesday, June 13, 2017
Page 109 of 117
period?}
If FHICHNG=2, for a change in coverage type in the last year fill: {What other types
of health insurance or health care coverage did [fill1: you/ALIAS] have?}
Special Instructions
Skip Instructions
<1> [goto PWRKB]
<2-11,R,D> [goto HCSPFYR]
Hard Edits
Soft Edits
AssocHelp
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.316_00.010
Variable Name
PWRKB
Universe
FHIKDB(e)='01'
Universe-text
All persons who had private health insurance previously
Question Text
Which one of these categories best describes how [fill1: your/ALIAS’s] private health
insurance was obtained?
Answer Codes
1. Through employer
2. Through union
3. Through workplace, but don't know if employer or union
4. Through workplace, self-employed or professional association
5. Purchased directly
6. Through a state/local government or community program
7. Other, specify
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Fill 1: If subject = respondent, fill: [your]; else fill:[ALIAS's]
Special Instructions
Skip Instructions
<1-6,R,D> [goto HCSPFYR] <7> [goto PWRKBSP]
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Tuesday, June 13, 2017
Page 110 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.317_00.010
Variable Name
PWRKBSP
Universe
PWRKBSP(e)='07'
Universe-text
All persons who had private health insurance obtained from other source previously
Question Text
*Enter how private health insurance was obtained.
Answer Codes
Question Type
Verbatim
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
[goto HCSPFYR]
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 111 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.320
Variable Name
HCSPFYR
Universe
All families
Universe-text
All families
Question Text
(book) F10
The next question is about money that [fill 1:you have/your family has] spent out of
pocket on medical care. We do NOT want you to count health insurance premiums,
over the counter drugs, or costs that you will be reimbursed for. In the PAST 12
MONTHS, about how much did [fill 2: you/your family] spend for medical care and
dental care?
Answer Codes
0. Zero
1. Less than $500
2. $500-$1,999
3. $2,000-$2,999
4. $3,000-$4,999
5. $5,000 or more
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Out of pocket costs
Fill 1: If single person family, fill: [you have]; Else, fill; [your family has]
Fill 2: If single person family, fill: [you]; Else, fill; [your family]
Special Instructions
Skip Instructions
goto MEDBILL
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Tuesday, June 13, 2017
Page 112 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.325_00.010
Variable Name
MEDBILL
Universe
All families
Universe-text
All families
Question Text
In the past 12 months did [fill1: you/anyone in the family] have problems paying or
were unable to pay any medical bills? Include bills for doctors, dentists, hospitals,
therapists, medication, equipment, nursing home or home care.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Fill1: if single person family fill "you"; else fill "anyone in the family"
Special Instructions
Skip Instructions
<1,2,7,9> [goto MEDBPAY]
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Tuesday, June 13, 2017
Page 113 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.327_00.010
Variable Name
MEDBPAY
Universe
All families
Universe-text
All families
Question Text
[fill 1: Do you/Does anyone in your family] currently have any medical bills that are
being paid off over time? This could include medical bills being paid off with a credit
card, through personal loans, or bill paying arrangements with hospitals or other
providers. The bills can be from earlier years as well as this year.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Fill1: if single person family, fill "Do you"; else fill "Does anyone in your family"
Special Instructions
Skip Instructions
<1,2,7,9> if MEDBILL=2 [goto FSA]; else [goto MEDBNOP]
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Tuesday, June 13, 2017
Page 114 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.327_00.020
Variable Name
MEDBNOP
Universe
MEDBILL='1','R','D'
Universe-text
All families but those who said they don’t have problems paying their medical bills
Question Text
[fill 1: Do you/Does anyone in your family] currently have any medical bills that you
are unable to pay at all?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Fill1: if single person family fill "Do you"; else fill "Does anyone in your family"
Special Instructions
Skip Instructions
<1,2,7,9> [goto FSA]
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Tuesday, June 13, 2017
Page 115 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.330
Variable Name
FSA
Universe
All Families
Universe-text
All Families
Question Text
? [F1]
[fill 1: Do you/Does anyone in your family] have a Flexible Spending Account for
health expenses? These accounts are offered by some employers to allow employees
to set aside pre-tax dollars of their own money for their use throughout the year to
reimburse themselves for their out-of-pocket expenses for health care. With this type
of account, any money remaining in the account at the end of the year, following a
short grace period, is lost to the employee.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
FSAs
fill 1: If single person family, fill: [Do you]; else, fill; [Does anyone in your family]
Special Instructions
Skip Instructions
goto PLBORN
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H_FSA
Tuesday, June 13, 2017
Page 116 of 117
Module
07
Section Name
Family Health Insurance
Part
Question ID
FHI.330_H
Variable Name
H_FSA
Universe
Universe-text
Question Text
[b]Flexible Spending Accounts (FSAs)[b] - Health care flexible spending accounts are
employer-established benefit plans that reimburse employees for specified medical
expenses as they are incurred. These accounts are allowed under section 125 of the
Internal Revenue Code. The employee contributes funds to the account through a
salary reduction agreement and is able to withdraw the funds set aside to pay for
medical bills. The salary reduction agreement means that any funds set aside in a
FSA escape both income tax and Social Security tax. Employers may contribute to
these accounts as well.
Once the amount of contribution has been designated during an open enrollment
period that occurs once each year, the employee is not allowed to change the amount
or drop out of the FSA during the year unless he or she experiences a change in
family status. By law, the employee forfeits any unspent funds in the account at the
end of the year other than the 2.5-month grace period. There is no requirement to
have a private health insurance plan with a FSA.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
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Tuesday, June 13, 2017
Page 117 of 117
2018 Q1 NHIS Instrument Spec Report
Section name: Socio-Demographic
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.001
Variable Name
PLBORN
Universe
All
Universe-text
All persons
Question Text
[fill 1: Were you/Was ALIAS] born in the United States?
Answer Codes
1. Yes
2. No
Don't know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Born US
1. If subject = respondent, fill: [ Were you], else fill: [Was ALIAS]
Special Instructions
Skip Instructions
<1> [store 1 in CITIZEN and goto PLBORN1]
<2> [goto PLBORN2]
[goto CITIZEN]
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Tuesday, June 13, 2017
Page 1 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.002
Variable Name
PLBORN1
Universe
PLBORN='1'
Universe-text
All persons born in the U.S.
Question Text
In what state [fill 1:were you/was ALIAS] born?
Answer Codes
1. Alabama
19. Louisiana
37. Oklahoma
2. Alaska
20. Maine
38. Oregon
3. Arizona
21. Maryland
39. Pennsylvania
4. Arkansas
22. Massachusetts 40. Rhode Island
5. California
23. Michigan
41. South Carolina
6. Colorado
24. Minnesota
42. South Dakota
7. Connecticut
25. Mississippi
43. South Dakota
8. Delaware
26. Missouri
44. Texas
9. Dist. Of Columbia 27. Montana
45. Utah
10. Florida
28. Nebraska
46. Vermont
11. Georgia
29. Nevada
47. Virginia
12. Hawaii
30. New Hampshire 48. Washington
13. Idaho
31. New Jersey
49. West Virginia
14. Illinois
32. New Mexico
50. Wisconsin
15. Indiana
33. New York
51. Wyoming
16. Iowa
34. North Carolina
17. Kansas
35. North Dakota
Refused
18. Kentucky
36. Ohio
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
State of Birth
1. If subject = respondent, fill: [were you], else, fill [was alias]
Special Instructions <1-51,52> [store 1 in CITIZEN]
Make this a look-up table.
No D/R allowed.
Insert answer name.
****(NCHS wants this to be output as 2 variables. Does this go in output specs?)
Skip Instructions
<1-51, D, R> [goto HEADST]
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Tuesday, June 13, 2017
Page 2 of 37
Module
08
Section Name
Family Socio Demographic
Part
Question ID
FSD.002_01
Variable Name
STATECODE
Universe
Universe-text
Question Text
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions Created in the instrument. State name from PLBORN1 stored in this variable.
Skip Instructions
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Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 3 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.003
Variable Name
PLBORN2
Universe
PLBORN = '2'
Universe-text
All persons not born in the US
Question Text
In what country [fill: 1] born?
* Please record country of birth. If country not found, type "ZZ"
Answer Codes
Question Type
Pick One - popup window
Field Pane Description
Fill Instructions
Country of Birth
1. If subject = respondent, fill: [were you], else, fill [was alias]
Special Instructions Display list of all countries in a lookup table.
Should allow 40 characters.
Skip Instructions
<60-85> [store 2 in CITIZEN; goto USYR]
<100-696> [goto USYR]
[goto USYR]
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Tuesday, June 13, 2017
Page 4 of 37
Module
08
Section Name
Family Socio Demographic
Part
Question ID
FSD.003_01
Variable Name
COUNTRYCODE
Universe
Universe-text
Question Text
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions Created in the instrument. Country name from PLBORN2 stored in this variable.
Should allow 40 characters.
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 5 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.004
Variable Name
USYR
Universe
PLBORN='2'
Universe-text
All persons not born in the US
Question Text
[Fill: 1]
In what year did [fill: 3] come to the United States to stay?
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Year Came to US
1. If AGEDOB@3 and AGEDOB 4 and AGEDOB 5 are valid, fill [* Read if necessary.
Earlier I recorded [fill: 2] date of birth as [month in words, 2-digit day, 4-digit year]. ]
2. If subject = respondent, fill [your], else fill [alias's]
3. If subject = respondent, fill [you], else fill [alias]
Special Instructions Allow answers of [1880-current year]
Skip Instructions
goto USLONG
<1880-2220> If USYR > CURYEAR THEN
Goto ERR1_USYR
Elseif AGEDOB_5 not IN('REFUSAL','DONTKNOW') THEN
If AGEDOB_5 > USYR THEN
Goto ERR2_USYR
Endif
Elseif AGE < (CURYEAR - USYR - 1) THEN
Goto ERR2_USYR
Else
Goto CITIZEN
Endif
Hard Edits
ERR1_USYR
*Future year invalid: [fill: USYR]. Please correct.
ERR2_USYR: * [fill year from USYR] is prior to the person's birth year.
*Please correct.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 6 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.005
Variable Name
USLONG
Universe
USYR = D or R
Universe-text
All persons not born in the US and refused or did not know USYR
Question Text
About how long [fill: 1] been in the United States?
* Read if necessary: Earlier I recorded that [fill: 2] [fill: AGE] years old.
*Enter 95 for 95 or more years.
*If less than 1 year given as a response, code the answer as "0".
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
How Long in US
1. If subject = respondent, fill: [have you]; else fill: [has alias].
2. If subject = respondent, fill: [you are]; else fill: [alias is].
Special Instructions Allow answers of [0-95]
Skip Instructions
[goto CITIZEN]; else [if gt AGE goto ERR_USLONG]; else goto CITIZEN
Hard Edits
ERR_LONG: * In US longer than alive!
* Please correct.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 7 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.006
Variable Name
CITIZEN
Universe
PLBORN2 ge 100 or (PLBORN in (R,D)) or (
Universe-text
All persons not born in the US or US territory
Question Text
(book) F11
?[F1]
[Fill: 1] a CITIZEN of the United States?
Answer Codes
1. Yes, born in one of the 50 United States or the District of Columbia
2. Yes, born in Puerto Rico, Guam, American Virgin Islands, or other U.S. territory
3. Yes, born abroad to American parent(s)
4. Yes, U.S. citizen by naturalization
5. No, not a citizen of the United States
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Citizen Status
1. If subject = respondent fill [Are you]; else fill [Is alias]
Special Instructions All persons born in the US (PLBORN1 eq 1-52) should automatically get 1 on
CITIZEN, and should NOT be asked this question;
All persons born in a US territory (PLBORN2 eq 60-99) should automatically get 2 on
CITIZEN, and should NOT be asked this question
Error meesages involving CITIZEN and PLBORN1
Skip Instructions
<1> (If PLBORN eq 2 and CITIZEN eq 1): goto ERR1_CITIZEN; [If PLBORN eq R and
CITIZEN eq 1]; goto ERR3_CITIZEN [If PLBORN eq D and CITIZEN eq 1]; goto
ERR4_CITIZEN
<2> goto ERR2_CITIZEN
else goto HEADST
Hard Edits
ERR1_CITIZEN
*Already indicated birth outside the United States.
*Please correct.
ERR2_CITIZEN
*Already indicated birth outside United States territory.
*Please correct.
Soft Edits
ERR3_CITIZEN: Refused
Previously, you refused to say if [usted/ALIAS] was born in the United States.
Would you like to change your answer to the question?
ERR4_CITIZEN: Don't Know
Previosuly, you didn't know if [you/ALIAS] were born in the United States.
Would you like to change your answer to the question?
Tuesday, June 13, 2017
Page 8 of 37
AssocHelp
H_CITIZEN
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.006_H
Variable Name
H_CITIZEN
Universe
Universe-text
Question Text
Information about citizenship is being collected by the Department of Health and
Human Services to perform health-related research pertaining to place of birth and
length of time in the United States. Providing this information is voluntary and is
collected under the authority of the Public Health Service Act. There will be no effect
on pending immigration or citizenship petitions.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
CITIZEN
Tuesday, June 13, 2017
Page 9 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.007
Variable Name
HEADST
Universe
AGE le 6
Universe-text
All persons age 6 and under
Question Text
?[F1]
Is [alias] now attending Head Start?
Answer Codes
1. Yes
2. No
Don't know
Refused
Question Type
Yes/No
Field Pane Description
Now Attend Head Start
Fill Instructions
Special Instructions
Skip Instructions
<2, D, R> [ goto HEADSTEV]
<1> [goto EDUC]
Hard Edits
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H_HEADST
Tuesday, June 13, 2017
Page 10 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.007_H
Variable Name
H_HEADST
Universe
Universe-text
Question Text
Headstart programs are designed to provide services for children living in families with
incomes below poverty. These services may include but are not limited to: medical,
dental, social, and education services. If a child who is eligible for these services has
special needs or disabilities, the child may receive both Headstart and Early
Intervention Services or Special Education Services. Although many children begin
Headstart at age three or four, in some areas Headstart services begin with prenatal
care and infant care.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
HEADST
HEADSTEV
Tuesday, June 13, 2017
Page 11 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.008
Variable Name
HEADSTEV
Universe
AGE lt 18 and HEADST ne 1
Universe-text
All persons under age 18 and not currently enrolled in Head Start
Question Text
?[F1]
Has [alias] ever attended Head Start?
Answer Codes
1. Yes
2. No
Don't know
Refused
Question Type
Yes/No
Field Pane Description
Ever Attended Head Start
Fill Instructions
Special Instructions
Skip Instructions
<1, 2, D, R> [if no more AGE le 18, goto EDUC]
Hard Edits
Soft Edits
AssocHelp
H_HEADST
Tuesday, June 13, 2017
Page 12 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.010
Variable Name
EDUC
Universe
AGE= 5+
Universe-text
All persons 5 years of age and older
Question Text
(book) F21
?[F1]
What is the HIGHEST level of school [fill:1] completed or the highest degree [fill:1]
received? Please tell me the number from the card.
* Enter highest level of school completed.
Answer Codes
0. Never attended/kindergarten only
1. 1st grade
2. 2nd grade
3. 3rd grade
4. 4th grade
technical or vocational program
5. 5th grade
program
6. 6th grade
AB, BS, BBA)
7. 7th grade
MS, MEng, MEd, MBA)
8. 8th grade
(Example: MD, DDS, DVM, JD)
9. 9th grade
EdD)
10. 10th grade
11. 11th grade
Question Type
17. Associate's degree: academic
18. Bachelor's degree (Example: BA,
19. Master's degree (Example: MA,
20. Professional School degree
21. Doctoral degree ( Example: PhD,
Refused
Don't know
Long List
Field Pane Description
Fill Instructions
12. 12th grade, no diploma
13. GED or equivalent
14. HIGH SCHOOL GRADUATE
15. Some college, no degree
16. Associate's degree: occupational,
Highest Level School Completed
1. If subject = respondent, fill "you have"; else fill "alias has"
Special Instructions If AGE lt <5> [Do not ask this question, store <96> in EDUC]
if MARK [goto ARMFFC] <2,R,D> [goto ARMFEV]
Hard Edits
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AssocHelp
Tuesday, June 13, 2017
Page 16 of 37
Module
08
Section Name
Family Socio-Demographic
Part
Question ID
FSD.021_00.000
Variable Name
ARMFEV
Universe
AGE GE '018' and AGE not IN('997','999') and (ARMFVER(e) IN(‘2’,’7’,’9’) or
HHSTAT3 ne 'A')
Universe-text
All families with a person age 18 or older who is not currently on active duty or said
R,D to active duty question
Question Text
[fill1: Have you/Has alias] ever served on active duty in the U.S. Armed Forces,
military Reserves, or National Guard?
*Read if necessary. Active duty does not include training for the Reserves or National
Guard, but DOES include activation, for example, for service in the US or in a foreign
country, in support of military or humanitarian operations.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
fill1: if subject=respondent fill “Have you” else fill “Has alias”
Special Instructions Roster through all applicable persons 18+. If ARMFVER=1 fill ARMFEV=1
Skip Instructions
<1> [goto ARMFFC] <2,R,D> [goto DOINGLW]
Hard Edits
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Tuesday, June 13, 2017
Page 17 of 37
Module
08
Section Name
Family Socio-Demographic
Part
Question ID
FSD.022_00.000
Variable Name
ARMFFC
Universe
AGE GE '018' and AGE not IN('997','999') and ARMFEV(e)=’1’
Universe-text
All families with a person age 18 or older who has ever served in the armed forces
Question Text
Did [fill1: you/alias] ever serve in a foreign country during a time of armed conflict or
on a humanitarian or peace-keeping mission?
*Read if necessary. This would include National Guard or reserve or active duty
monitoring or conducting peace keeping operations in Bosnia Kosovo, in the Sinai
between Egypt and Israel, or in response to the 2004 tsunami, or Haiti in 2010.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
fill1: if subject=respondent fill “you” else fill “alias”
Special Instructions Roster through all applicable persons 18+.
Skip Instructions
<1,2,R,D> [goto ARMFTMP]
Hard Edits
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AssocHelp
Tuesday, June 13, 2017
Page 18 of 37
Module
08
Section Name
Family Socio-Demographic
Part
Question ID
FSD.023_00.000
Variable Name
ARMFTMP
Universe
AGE GE '018' and AGE not IN('997','999','') and ARMFEV(e)=’1’
Universe-text
All families with a person age 18 or older who has ever served in the armed forces
Question Text
When did [fill1: you/alias] serve on ACTIVE DUTY in the U.S. Armed Forces?
*Enter all that apply, separate with commas.
*Enter all periods in which this person served. Enter the item even if the person
served for just part of that period.
Answer Codes
1. Sept 2001 or later
2. August 1990 to August 2001 (including Persian Gulf War)
3. May 1975 to July 1990
4. Vietnam era (August 1964 to April 1975)
5. February 1955 to July 1964
6. Korean War (July 1950 to January 1955)
7. January 1947 to June 1950
8. December 1946 or earlier
Refused
Don’t know
Question Type
Enter all that apply
Field Pane Description
Fill Instructions
fill1: if subject=respondent fill “you” else fill “alias”
Special Instructions Roster through all applicable persons 18+. (NOTE: YEARLY UPDATES NEEDED TO
ADJUST YEAR NUMBER, BECAUSE EACH YEAR ADDS '1' YEAR AWAY FROM
THE WARS/CONFLICTS SHOWN IN THE ANSWER CODES)
If AGE > = 82, gray out answer code 1
if AGE < = 32 or AGE > = 93, gray out answer code 2
if AGE < = 43 or AGE > = 108, gray out answer code 3
if AGE < = 58 or AGE > = 118, gray out answer code 4
if AGE < = 69, gray out answer code 5
if AGE < = 78, gray out answer code 6
if AGE < = 83, gray out answer code 7
if AGE < = 87, gray out answer code 8
Skip Instructions
<1-11,R,D> [goto VACOV]
Hard Edits
If gray answer code is selected please display:
That selection is not valid at this time.
Pleae correct.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 19 of 37
Module
08
Section Name
Family Socio-Demographic
Part
Question ID
FSD.023_01.000
Variable Name
VACOV
Universe
AGE GE '018' and AGE not IN('997','999','') and (ARMFEV(e)=’1’ and MILSPC2(e)
IN('2','7','9'))
Universe-text
All families with a person age 18 or older who has ever served in the armed forces
and are not covered by VA military health care
Question Text
[fill1: Have you/ Has alias] ever used or enrolled in VA health care?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
fill1: if subject=respondent fill “Have you” else fill “Has alias”
Special Instructions Roster through all applicable persons 18+.
Skip Instructions
If ARMFTMP eq 1,3-11,R,D [goto DOINGLW] <2> [goto ARMFDS]
Hard Edits
If gray answer code is selected please display:
That selection is not valid at this time.
Pleae correct.
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 20 of 37
Module
08
Section Name
Family Socio-Demographic
Part
Question ID
FSD.024_00.000
Variable Name
ARMFDS
Universe
AGE GE '018' and AGE not IN('997','999','') and ARMFTMP(e)=’2’
Universe-text
All families with a person age 18 or older who served from August 1990 to August
2001
Question Text
Did [fill1: you/alias] serve in the Persian Gulf during Operation Desert Shield or
Operation Desert Storm between August 1990 and April 1991?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
fill1: if subject=respondent fill “Have you” else fill “Has alias”
Special Instructions Roster through all applicable persons 18+.
**9.13.10 - Spanish Translation: Desert Shield and Desert Storm were left as is. No
translation is needed for these two concepts.**
Skip Instructions
<1,2,R,D> [goto DOINGLW]
Hard Edits
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AssocHelp
Tuesday, June 13, 2017
Page 21 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.050
Variable Name
DOINGLW
Universe
AGE=18+
Universe-text
All persons age 18+
Question Text
(book) F22 ? [F1]
The next few questions are about employment status.
Which of the following [fill: 1] doing last week?
* Read answer categories.
Answer Codes
1. Working for pay at a job or business
2. With a job or business but not at work
3. Looking for work
4. Working, but not for pay, at a family-owned job or business
5. Not working at a job or business and not looking for work.
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Doing last week
1. If subject = respondent fill: [were you]; else fill: [was alias]
Special Instructions
Skip Instructions
<1,4> [go to WRKHRS1]
<2,5> [go to WHYNOWRK]
<3,D,R> [go to WRKLYR]
Hard Edits
Soft Edits
AssocHelp
H_DOINGLW
Tuesday, June 13, 2017
Page 22 of 37
Module
08
Section Name
Family Socio Demographic
Part
Question ID
FSD.050_H
Variable Name
H_DOINGLW
Universe
Universe-text
Question Text
A [b]job[b] exists when there is a definite arrangement for regular work on a continuing
basis, and the person holding the job receives pay or other compensation for his/her
work. The schedule of hours or days can be irregular as long as there is a definite
arrangement to work on a continuing basis.
A [b]business[b] exists when machinery or equipment of substantial value is used in
conducting the business; an office, store, or other place of business is maintained; or
the business is advertised to the public.
An individual is [b]working for pay[b] if he or worked for wages, salary, commission,
tips, piece-rates, or pay-in-kind (e.g., room-and-board); worked for profit in his/her
own business, practice or farm; worked as a civilian for the National Guard or Dept. of
Defense; or performed exchange or share work on a farm.
[b]Have a job or business but not at work[b] includes individuals on annual leave or
vacation (paid or unpaid); on maternity or family leave (paid or unpaid); at jury duty;
involved in a labor dispute that is taking place at his/her place of employment; on sick
leave (paid or unpaid); on a temporary lay-off (lasting less than 30 days), and the
person expects to be called back within that time period.
An individual is [b]looking for work[b] if he or she is conducting an active job search,
which includes filling out applications or sending out resumes; placing or answering
classified ads; checking union/professional registers; bidding on a contract or
auditioning for a part in a play; contacting friends or relatives about possible jobs;
contacting school/college university employment offices; contacting prospective
employers directly; contacting public or private employment offices.
Include as [b]working, but not for pay[b] at least 15 hours of work per week without
pay in a business or farm operated by a related household member. Volunteer efforts
should NOT be considered as working. Likewise, unpaid internships are not
considered as working.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
Tuesday, June 13, 2017
Page 23 of 37
AssocHelp
DOINGLW
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.060
Variable Name
WHYNOWRK
Universe
(AGE= 18+) and (DOINGLW = with a job or business but not at work, or not working at
a job or business and not looking for work)
Universe-text
All persons age 18 + who were either with a job or business but not at work, or not
working at a job or business and not looking for work.
Question Text
?[F1]
What is the main reason [fill: 1] did not [fill: 2]
Answer Codes
1. Taking care of house or family
2. Going to school
3. Retired
4. On a planned vacation from work
5. On family or maternity leave
6. Temporarily unable to work for health reasons
7. Have job/contract and off-season
8. On layoff
9. Disabled
10. Other
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Reason for not Working
1. If subject = respondent, fill: [you]; else fill: [alias]
2. If DOINGLW = with a job or business but not at work, fill: [work last week?]; else
fill: [have a job or business last week?]
Special Instructions
Skip Instructions
<01-03, 08-10,D,R> [goto WRKLYR] else <04-07> [goto WRKHRS1]
Hard Edits
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H_WHYNOWRK
Tuesday, June 13, 2017
Page 24 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.060_H
Variable Name
H_WHYNOWRK
Universe
Universe-text
Question Text
[b]Taking care of house or family[b] is any type of work around the house such as
cleaning, cooking, maintaining the yard, caring for children or family, etc.
[b]Going to school[b] means attending any type of public or private educational
establishment both in and out of the regular school system.
[b]Retired, Unable to work for health reasons[b], and [b]Disabled[b] are respondent
defined.
[b]Layoff[b] means that the person is waiting to be called back to a job from which they
have been temporarily laid-off or furloughed. Layoffs can be due to slack work, plant
retooling or remodeling, inventory taking, and the like. Do not consider a person who
was not working because of a labor dispute at his/her own place of employment as
being on layoff.
[b]Have job/contract and off-season[b] includes school personnel (teachers,
administrators, custodians, etc.) on summer vacation who have a definite
arrangement, either written or oral, to return to work in the fall, are not considered to
be on layoff during the summer. They may, however, be laid off from a summer job or
looking for work for the summer months (but this would NOT be considered their main
job or employment activity).
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
WHYNOWRK
Tuesday, June 13, 2017
Page 25 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.070
Variable Name
WRKHRS1
Universe
(AGE=18+ ) and [(DOINGLW = Working for pay at a job or business or working, but
not for pay, at a family owned job or business) or (WHYNOWRK = on a planned
vacation from work, or on family or maternity leave, or temporarily unable to work for
health reasons, or have job/contract and off-season)]
Universe-text
All persons aged 18+ who were working for pay at a job or business or working, but
not for pay, at a job or business last week or on a planned vacation from work, or on
family or maternity leave, or temporarily unable to work for health reasons, or have
job/contract and off-season
Question Text
?[F1]
How many hours [fill: 1]
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Hours Worked
1. If DOINGLW = (working for pay at a job or business) or (working, but not for pay, at
a family-owned job or business) fill: [did [fill:2] work LAST WEEK at ALL jobs or
businesses?]; else, fill: [do [fill: 2] USUALLY work at ALL jobs or businesses?]
2. If subject = respondent, fill: [you]; else, fill: [alias]
Special Instructions Allow 1-168, D, R
Display "Hours" answer tag in form pane.
Skip Instructions
<1-34, D, R> [goto WRKFTALL]
<95-168> goto soft error message
<35-168> [goto WRKLYR]
Hard Edits
Soft Edits
* [Fill: WRKHRS] is an unusually high number.
* Please verify.
AssocHelp
H_WRKHRS
Tuesday, June 13, 2017
Page 26 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.070_H
Variable Name
H_WRKHRS
Universe
Universe-text
Question Text
Include only the actual hours spent on the job last week. Exclude time off for any
reason, even if they were paid for the time off. For example, exclude the half hour paid
lunch break, any "sick leave" used due to illness or to see a doctor, and any
"vacation" time or "personal days".
Enter Hours in whole numbers, rounding 30 minutes or more UP to the next whole
number and dropping 29 or fewer minutes.
For persons with businesses, include hours spent setting up a new business or
profession, even if it is not opened yet. Also, include hours worked at a person's
business, even if he/she actually transacted no business.
Include extra hours worked last week, even if they were without compensation. For
example: include the time a teacher spent at home grading papers.
Include hours spent doing unpaid work on a family farm or business owned by a
related household member.
Do NOT include hours spent on jury duty or on the National Guard duty.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
WRKHRS
Tuesday, June 13, 2017
Page 27 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.080
Variable Name
WRKFTALL
Universe
AGE=18+ and WRKHRS1 = 1-34, D, R
Universe-text
All persons aged 18+ who worked less than 35 hours last week or did not know/refuse
to answer how many hours they worked last week
Question Text
?[F1]
[Fill: 1] USUALLY work 35 hours or more per week in total at ALL jobs or businesses?
Answer Codes
1. Yes
2. No
Don't know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Usually Work Full Time
1. If subject = respondent, fill: [Do you]; else fill: [Does ALIAS]
Special Instructions
Skip Instructions
[goto WRKLYR]
Hard Edits
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H_WRKFTALL
Tuesday, June 13, 2017
Page 28 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.080_H
Variable Name
H_WRKFTALL
Universe
Universe-text
Question Text
Include only the actual hours spent on the job last week. Exclude time off for any
reason, even if they were paid for the time off. For example, exclude the half hour paid
lunch break, any sick leave used due to illness or to see a doctor, and any "vacation"
time or "personal days".
Enter Hours in whole numbers, rounding 30 minutes or more UP to the next whole
number and dropping 29 or fewer minutes.
For persons with businesses, include hours spent setting up a new business or
profession, even if it is not opened yet. Also, include hours worked at a person's
business, even if he/she actually transacted no business.
Include extra hours worked last week, even if they were without compensation. For
example: include the time a teacher spent at home grading papers.
Include hours spent doing unpaid work on a family farm or business owned by a
related household member.
Do NOT include hours spent on jury duty or on the National Guard duty.
Consider the [b]usual number of hours worked[b] (more or less than 35 hours) to be
those worked in 50 percent or more of the weeks in which the person works. If exactly
half are 35+ and half are less than 35, enter "yes". If a new job began last week,
"usual" means what the person expects to work.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
WRKFTALL
Tuesday, June 13, 2017
Page 29 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.100
Variable Name
WRKLYR
Universe
AGE = 18+
Universe-text
All persons age 18+
Question Text
?[F1]
Did [fill: 1] work for pay at any time in [last year in 4 digit format]?
Answer Codes
1. Yes
2. No
Don't know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Work for Pay Last Year
1. If subject = respondent, fill: [you]; else if SEX = male, fill: [he]: else if SEX = female,
fill: [she]
Special Instructions
Skip Instructions
<1> [goto WRKMYR]
<2, D, R> [goto HIEMPOF]
Hard Edits
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AssocHelp
H_WRKLYR
Tuesday, June 13, 2017
Page 30 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.100_H
Variable Name
H_WRKLYR
Universe
Universe-text
Question Text
Include as working:
[blt]Work for pay.
Work for profit in one's own business, practice or farm.
Work without pay in a business or farm operated by a related household
member.
Work as a civilian for the National Guard or Dept. of Defense.
Exchange or share work on a farm.[blt]
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
WRKLYR
WRKMYR
Tuesday, June 13, 2017
Page 31 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.110
Variable Name
WRKMYR
Universe
AGE = 18+ and WRKLYR = yes
Universe-text
All persons age 18+ who worked last year
Question Text
?[F1]
How many months in [last year in 4 digit format] did [fill: 1] have at least one job or
business?
*If less than one month, enter '1'.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Months Worked Last Year
1. If subject = respondent, fill: [you]; else fill [ALIAS]
Special Instructions Allow 1-12, D, R
Display "months" answer tag in form pane.
Skip Instructions
[goto ERNYR]
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H_WRKLYR
Tuesday, June 13, 2017
Page 32 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.120
Variable Name
ERNYR
Universe
AGE = 18+ and WRKLYR = yes
Universe-text
All persons age 18+ who worked last year
Question Text
?[F1]
What is your best estimate of [fill: 1] earnings before taxes and deductions from ALL
jobs and businesses in [fill: last year in 4 digit format]?
Include hourly wages, salaries, tips and commissions.
* Enter '999,995' if the reported income is greater than $999,995.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Earnings Last Year
1. If subject = respondent, fill: [you]; else fill: [ALIAS]
Special Instructions Allow 1-999995, D, R
Display "$" tag in form pane and digit grouping.
Skip Instructions
[goto HIEMPOF]
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H_ERNYR
Tuesday, June 13, 2017
Page 33 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.120_H
Variable Name
H_ERNYR
Universe
Universe-text
Question Text
Earnings includes:
[blt]Wages and salaries including tips, commissions, Armed Forces pay and cash
bonuses, as well as subsistence
allowances.
Net income from unincorporated businesses, professional practices, farms, or from
rental property. ("Net" means after deducting business expenses, but before
deducting personal taxes.)
Unemployment or workman's compensation.[blt]
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
ERNYR
Tuesday, June 13, 2017
Page 34 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.130
Variable Name
HIEMPOF
Universe
(AGE = 18+) and (DOINGLW = working for pay at a job or business, or with a job or
business, but not at work, or working, but not for pay, at a family-owned job or
business.)
Universe-text
persons who are age 18+ and working for pay at a job or business or with a job or
business, but not at work, or working, but not for pay, at a family-owned job or
business.
Question Text
?[F1]
Regarding [fill:1] job or work last week, was health insurance offered to [fill: 2] through
[fill:3] workplace?
Answer Codes
1. Yes
2. No
Don't know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Health Insurance Offered
1. If subject = respondent, fill: [your]; else fill: [alias's]
2.. If subject = respondent, fill: [you]; else fill: [alias]
3. If subject = respondent, fill: [your]; else if SEX = male, fill: [his]; else if SEX =
female, fill: [her]
Special Instructions
Skip Instructions
If roster is exhausted, [goto next section]
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H_HIEMPOF
Tuesday, June 13, 2017
Page 35 of 37
Module
08
Section Name
Socio-Demographic
Part
Question ID
FSD.130_H
Variable Name
H_HIEMPOF
Universe
Universe-text
Question Text
Health Insurance may be provided in part or full by the persons' employer. Enter
"yes" even if the person must pay part of the cost of the insurance.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
HIEMPOF
Tuesday, June 13, 2017
Page 36 of 37
Module
08
Section Name
Family Socio-Demographic
Part
Question ID
FSD.135
Variable Name
FERNTOT
Universe
(for all family members 18+ WRKLYR not in ('7' '9')) and (for all family members 18+
ERNYR not in ('999997' '999999')) and (WRKLYR = '1' for at least one family member
18+)
Universe-text
Families with WRKLYR not equal to Don't Know or Refused for any adult in the family
and ERNYR not equal to "Don't Know" or "Refused" for any adult in the family and at
least one family member reports working in the past year.
Question Text
***This item sums the reported personal earnings (ERNYR) for each person in the
family where all earnings information is known and at least one family member reports
working in the past year. Where the sum of personal earnings is greater than
$999,994, use $999,995 . ***
Answer Codes
Question Type
Procedure
Field Pane Description
Fill Instructions
Special Instructions ***This variable requires summing values across persons within a family.***
Skip Instructions
<000001-999995> goto next section
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Tuesday, June 13, 2017
Page 37 of 37
2018 Q1 NHIS Instrument Spec Report
Section name: Family Sources of Income
Module
09
Section Name
Family Sources of Income
Part
Question ID
FIN.010
Variable Name
FINCINT
Universe
All
Universe-text
All
Question Text
* Read the following.
The next questions are about [fill1: your total/your total family] income in [fill2: last
calendar year in 4-digit format] BEFORE TAXES.
Income is important in analyzing the health information we collect. For example, with
this information, we can learn whether persons in one income group use certain types
of medical services more or less often than those in another group. Please be
assured that, like all other information you have provided, these answers are
protected by strict federal laws.
Answer Codes
1. Enter 1 to Continue
Question Type
Enter 1 to Continue
Field Pane Description
Fill Instructions
Continue
Fill1: If one person family, fill [your total]; else, fill:[your total family]
Fill2: variable for last calander year
Special Instructions Do Not Allow D/R.
Skip Instructions
goto FSAL
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Tuesday, June 13, 2017
Page 1 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.030
Variable Name
FSAL
Universe
AGE GE18
Universe-text
Any person in the family is 18+
Question Text
?[F1]
[fill Did you receive income in [fill: last calendar year in 4 digit format] from wages and
salaries?]
[fill: When answering these questions, please remember that by "combined family
income," I mean your income PLUS the income of all family members living in this
household (including cohabiting partners, and armed forces members living at home).
Did any family members 18 and older, that is * Read names
[fill roster of people GE 18 in column format, in bold black]
receive income in [fill: last calendar year in 4 digit format] from wages and salaries?]
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Wages and Salaries
1. If 1 person in the family, fill: [Did you receive...]; Else fill: [When answering...]
Special Instructions If all family members are emancipated minors, this question should be skipped.
Skip Instructions
<1> [If 1 person family, store person number in PSAL and skip to FSEINC; Else goto
PSAL]
<2, D, R,> [Goto FSEINC]
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H_FSAL
Tuesday, June 13, 2017
Page 2 of 64
Module
09
Section Name
Family Sources of Income
Part
Question ID
FIN.030_H
Variable Name
H_FSAL
Universe
Universe-text
Question Text
Include:
Wages and salaries including tips, commissions, Armed Forces pay and cash
bonuses, as well as subsistence allowances.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 3 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.040
Variable Name
PSAL
Universe
AGE GE18 and FSAL=yes and family members > 1
Universe-text
If the respondent answered yes to FSAL and there is more than one person 18+ in the
family.
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions display roster of all non-deleted family members GE 18
Skip Instructions
Goto FSEINC
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 4 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.050
Variable Name
FSEINC
Universe
AGE GE18
Universe-text
Any person in the family 18+
Question Text
[fill: Did you receive income in [fill: last calendar year in 4-digit format] from selfemployment including business and farm income?/ Did ALIAS receive income in [fill:
last calendar year in 4-digit format] from self-employment including business and farm
income?/Did any family members 18 and older, that is
*Read names
[fill roster of people GE 18 in column format and bold black]
receive income in [fill: last calendar year in 4-digit format] from...self-employment
including business and farm income?]
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Self Employment
If only one person in the roster and that person = respondent, then
[fill 1: Did you receive income in [fill: last calendar year in 4-digit format] from...selfemployment including business and farm income?]
If only one person in the roster, and that person ne respondent, then
[fill 2: Did ALIAS receive income in [fill: last calendar year in 4-digit format]
from...self-employment including business and farm income?]
If multiple names in the roster, then
[fill 3: Did any family members 18 and older, that is *Read names
[fill roster of people GE 18 in column format and bold black]
receive income in [fill: last calendar year in 4-digit format] from...self-employment
including business and farm income?]
Special Instructions If all family members are emancipated minors, this question should be skipped.
Skip Instructions
<1> [If 1 person family, store person number in PSEINC and skip to FSSRR; Else goto
PSEINC]
<2, D, R> [Goto FSSRR]
Hard Edits
Soft Edits
Tuesday, June 13, 2017
Page 5 of 64
AssocHelp
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.060
Variable Name
PSEINC
Universe
AGE GE 18 and FSEINC=yes and family members > 1
Universe-text
If the respondent answered yes to FSEINC and there is more than one person 18+ in
the family.
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all non-deleted family members GE age 18
Skip Instructions
Goto FSSRR
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Tuesday, June 13, 2017
Page 6 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.070
Variable Name
FSSRR
Universe
AGE=ALL
Universe-text
All families
Question Text
?[F1]
Did [fill: you/any family members living here] receive income in [fill: last year in 4 digit
format] from Social Security or Railroad Retirement?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
SS/ RR
1. If one person family fill: [you]; Else fill: [ any family members...]
Special Instructions
Skip Instructions
<1> If 1 person family, store person number in PSSRR and skip to FSSRRD; Else,
goto PSSRR.
<2, D, R> [Goto FPENS]
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H_FSSRR
Tuesday, June 13, 2017
Page 7 of 64
Module
09
Section Name
Family Sources of Income
Part
Question ID
FIN.070_H
Variable Name
H_FSSRR
Universe
Universe-text
Question Text
[b]U. S. Government Railroad Retirement Benefits[b] are based on a person's longterm employment in the railroad industry.
[b]Social Security (SS)[b] payments are received by persons who have worked long
enough in employment which had SS deductions taken from their salary in order to be
entitled to payments. Payments may be made to the spouse or dependent children of
the covered workers. SS also pays benefits to student dependents (under 19 years of
age) of eligible social security recipients.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 8 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.080
Variable Name
PSSRR
Universe
AGE= ALL and FSSRR = yes and family members > 1
Universe-text
If respondent answered yes to FSSRR and there is more than one person in the family
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all persons in the family.
Skip Instructions
Goto FSSRRD
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 9 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.082
Variable Name
FSSRRD
Universe
Families with person selected in PSSRR and AGE LE 64
Universe-text
If person selected in PSSRR and age is less than or equal to 64 years old
Question Text
?[F1]
Was [fill: your/any family member's *Read names
[fill roster of all non-deleted family members selected in PSSRR and AGE LE 64 in
column format in bold black]]
Social Security or Railroad Retirement income received as a disability benefit?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Disability Benefit
1. If only one person in the family, fill: [your]; Else fill: [any family member's....] Also fill
a list of the names of the persons in the family (in bold black) into the info pane before
"Social Security..."
Special Instructions
Skip Instructions
<1> [If only one person in the roster, fill the person number in PSSRRDB, and skip to
PSSRRD; Else goto PSSRRDB]
<2, D, R> [Go to FPENS]
Hard Edits
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H_FSSRR
Tuesday, June 13, 2017
Page 10 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.084
Variable Name
PSSRRDB
Universe
FSSRRD=yes and family members > 1
Universe-text
If respondent answered yes to FSSRRD and there is more than one person in the
family less than or equal to 64
Question Text
*Ask or verify. Enter applicable line number(s), separate with commas.
Who received Social Security or Railroad Retirement as a disability benefit?
(Anyone else?)
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all persons marked in PSSRR and age is than or equal to 64
Skip Instructions
Goto PSSRRD.
Hard Edits
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AssocHelp
Tuesday, June 13, 2017
Page 11 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.086
Variable Name
PSSRRD
Universe
Person selected in PSSRRDB
Universe-text
Ask for everyone listed in PSSRRDB.
Question Text
Did [fill: you/alias] receive this benefit because [fill: you are/he is/she is] disabled?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Disabled
1. If subject=respondent, fill: [you]; else fill [alias].
2. If subject=respondent, fill: [you are]; else if subject sex =male, fill: [he is] else if
subject sex=female, fill: [she is]
Special Instructions
Skip Instructions
<1, 2, D, R> [after rostering through everyone listed in PSSRRDB, goto FPENS]
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Tuesday, June 13, 2017
Page 12 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.090
Variable Name
FPENS
Universe
AGE=All
Universe-text
All families
Question Text
Did [fill: you/any family members living here] receive income in [fill:variable for last
calander year] from any disability pension [fill: other than Social Security or Railroad
Retirement]?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Disability Pension
1. If one person in the family, fill: [you] else, fill: [any family...]
2. If FSSRRD=yes, fill: [other than...] else, no fill.
Special Instructions
Skip Instructions
<1> If only one person in the family, fill the person number in PPENS, and skip to
FOPENS; Else goto PPENS
<2, D, R> [Goto FOPENS]
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Tuesday, June 13, 2017
Page 13 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.100
Variable Name
PPENS
Universe
AGE=All and FPENS=yes and family members > 1
Universe-text
If respondent answered yes to FPENS and there is more than one person in the family
Question Text
*Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
*Indicate each family member with this income.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all non-deleted family members.
Skip Instructions
Goto FOPENS
Hard Edits
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AssocHelp
Tuesday, June 13, 2017
Page 14 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.102
Variable Name
FOPENS
Universe
AGE=All
Universe-text
All families
Question Text
Did [fill 1] receive income from any retirement or survivor pension [fill 2] [fill 3] [fill 4]?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Survivor pension
1. If one person in the family, fill: [you] else, fill: [any family...]
2. If FSSRR=yes and FPENS ne yes, fill [other than Social Security or Railroad
Retirement]
3. If FPENS=yes and FSSRR ne yes, fill [other than disability pension]
4. If FSSRR=yes and FPENS=yes, fill [other than Social Security, Railroad Retirement
or other disabilty pension]
5. If FSSRR ne yes and FPENS ne yes, then no fill.
Special Instructions
Skip Instructions
<1> [If only one person in the family, fill line number into POPENS, and skip to FSSI;
Else goto POPENS]
<2, D, R> Goto FSSI
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Tuesday, June 13, 2017
Page 15 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.104
Variable Name
POPENS
Universe
AGE=All and FOPENS=yes and family members > 1
Universe-text
If anyone in the family received income from retirement or survivor pension.
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all non-deleted family members.
Skip Instructions
Goto FSSI
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 16 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.110
Variable Name
FSSI
Universe
AGE=All
Universe-text
All families
Question Text
?[F1]
Did [fill: 1] receive Supplemental Security Income (SSI) ?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Supplemental Security Income
1. If one person in the family, fill: [you] else, fill: [any family...]
Special Instructions
Skip Instructions
<1> If only one person in the family, fill person number in PSSI and skip to PSSID;
else goto PSSI
<2, D, R> [goto FTANF]
Hard Edits
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H_FSSI
Tuesday, June 13, 2017
Page 17 of 64
Module
09
Section Name
Part
Question ID
FIN.110_H
Variable Name
H_FSSI
Universe
Universe-text
Question Text
SSI pays monthly benefits to aged, disabled, and blind people who have limited
income and assets, regardless of age. A person may be eligible for SSI payments
even if they have never worked.
SSI is NOT the same as Social Security. A person can get SSI in addition to Social
Security.
The SSI program is issued by the Social Security Administration. Each state may add
to the Federal payment from its own funds. This additional money may be included in
the federal payment or it may be received as a separate check. If it is combined with
the Federal payment, the words "STATE PAYMENT INCLUDED" will appear on the
Federal check. A few states make SSI payments to individuals who do not receive a
Federal payment.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
FSSI, PSSID, FSSAPL, FSDAPL
Skip Instructions
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Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 18 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.120
Variable Name
PSSI
Universe
AGE=all and FSSI=yes and family members > 1
Universe-text
If respondent answered yes to FSSI and there is more than one person in the family
Question Text
*Ask or verify. Enter applicable line number(s), separate with commas.
Who in the family received this?
(Anyone else?)
*Indicate each family member with this income.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all non-deleted family members.
Skip Instructions
Goto PSSID.
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 19 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.122
Variable Name
PSSID
Universe
Persons selected in PSSI
Universe-text
roster through this for all persons listed in PSSI
Question Text
?[F1]
Did [fill: 1] receive SSI because [fill: 2] a disability?
Answer Codes
1. Yes
2. No
Don't know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Because of a disability
1. If subject=respondent, fill: [you]; else, fill: [alias]
2. If subject=respondent, fill: [you have]; else, if SEX=male fill: [he has]; if
SEX=female, fill: [she has]
Special Instructions
Skip Instructions
<1, 2, D, R> [After rostering through for each family member listed in PSSI, goto
FTANF]
Hard Edits
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AssocHelp
H_FSSI
Tuesday, June 13, 2017
Page 20 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.150
Variable Name
FTANF
Universe
AGE=All
Universe-text
All families
Question Text
?[F1]
At any time during [fill 1: last year in 4 digit format], even for one month, did [fill 2:
you/any family members living here] receive any CASH assistance from a state or
county welfare program, such as [fill 3: state-specific program name]?
* Please do not include food stamps, SSI, energy assistance, or medical assistance
payments.
Answer Codes
1. Yes
2. No
Don't know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Cash Assistance
1. Fill the last calendar year in 4-digit format.
2. If one person in the family, fill: [you] else, fill: [any family...]
3. Fill the state program name(s) for the family's state of residence (VERADD
(COV.010) for variable ST). For those states, fill both names separated by "or" as
listed below.
If AL then fill "Alabama Family Assistance Program or JOBS"
If AK then fill "Alaska Temporary Assistance Program (ATAP)"
If AZ then fill "Arizona Cash Assistance or EMPOWER (Employing and Moving People
Off Welfare and Encouraging Responsibility)"
If AR then fill "Arkansas Temporary Assistance for Needy Families (TANF) or
Arkansas Work Pays"
If CA then fill "California Work Opportunity and Responsibility to Kids (CALWORKS)"
If CO then fill "Colorado Works"
If CT then fill "Temporary Family Assistance (TFA) or Jobs First"
If DE then fill "Temporary Assistance for Needy Families (TANF)"
If DC then fill "District of Columbia Temporary Assistance for Needy Families (TANF)"
If FL then fill "Florida Temporary Cash Assistance or Welfare Transition Program or
ACCESS Florida"
If GA then fill "Georgia Temporary Assistance for Needy Families (TANF)"
If HI then fill "Hawaii Temporary Assistance for Needy Families (TANF) or Temporary
Assistance for Other Needy Families (TAONF)"
If ID then fill "Temporary Assistance for Families in Idaho (TAFI)"
If IL then fill "Illinois Temporary Assistance for Needy Families (TANF)"
If IN then fill "Indiana Temporary Assistance for Needy Families (TANF) or Indiana
Manpower Placement and Comprehensive Training (IMPACT)"
If IA then fill "Iowa Family Investment Program (FIP) or PROMISE JOBS"
If KS then fill "Successful Families Program - Temporary Assistance for Needy
Families (TANF) or KansasWorks"
Tuesday, June 13, 2017
Page 21 of 64
If KY then fill "Kentucky Transitional Assistance Program (K-TAP)"
If LA then fill "Louisiana Family Independence Temporary Assistance Program
(FITAP) or Strategies to Empower People (STEP)"
If ME then fill "Maine Temporary Assistance for Needy Families (TANF) or Additional
Support for People in Retraining and Employment (ASPIRE)"
If MD then fill "Temporary Cash Assistance"
If MA then fill "Transitional Aid to Families with Dependent Children (TAFDC) or
Employment Services Program (ESP)"
If MI then fill "Family Independence Program (FIP)"
If MN then fill "Minnesota Family Investment Program (MFIP)"
If MS then fill "Mississippi Temporary Assistance for Needy Families (TANF)"
If MO then fill "Temporary Assistance or Beyond Welfare"
If MT then fill "Montana Temporary Assistance for Needy Families (TANF) or FAIM
(Families Achieving Independence in Montana)"
If NE then fill "Aid to Dependent Children (ADC) or Employment First"
If NV then fill "Nevada Temporary Assistance for Needy Families (TANF) or New
Employees of Nevada (NEON)"
If NH then fill "New Hampshire Financial Assistance to Needy Families (FANF) or New
Hampshire Employment Program (NHEP)"
If NJ then fill "Work First New Jersey (WFNJ)"
If NM then fill "NMWorks"
If NY then fill "Family Assistance (FA) Program or Safety Net Assistance (SNA)"
If NC then fill "Work First"
If ND then fill "Temporary Assistance for Needy Families (TANF) or Job Opportunities
and Basic Skills (JOBS)"
If OH then fill "Ohio Works First (OWF) or Prevention, Retention and Contingency
(PRC)"
If OK then fill "Oklahoma Temporary Assistance for Needy Families (TANF)"
If OR then fill "Oregon Temporary Assistance for Needy Families (TANF) or JOBS
Plus"
If PA then fill "Pennsylvania Temporary Assistance for Needy Families (TANF)"
If RI then fill "Rhode Island Works"
If SC then fill "South Carolina Family Independence Program"
If SD then fill "South Dakota Temporary Assistance for Needy Families (TANF)"
If TN then fill "Tennessee Families First"
If TX then fill "Texas Temporary Assistance for Needy Families (TANF)"
If UT then fill "Family Employment Program (FEP and FEPTP)"
If VT then fill "Reach UP (TANF) or Reach Ahead (transition program)"
If VA then fill "Virginia Temporary Assistance for Needy Families (TANF) or Virginia
Initiative for Employment not Welfare (VIEW)"
If WA then fill "Washington Temporary Assistance for Needy Families (TANF) or
WorkFirst"
If WV then fill "West Virginia Works Program (WV WORKS)"
If WI then fill "Wisconsin Works (W-2) Program"
If WY then fill "Wyoming TANF or Personal Opportunities with Employment
Responsibility (POWER)"
Special Instructions <1> [If one person in the family, fill person number into PTANF and skip to FOWBEN;
Else goto PTANF.
<2, D, R> [goto FOWBEN]
Skip Instructions
<1> [If one person in the family, fill person number into PTANF and skip to FOWBEN;
Else goto PTANF.
<2, D, R> [goto FOWBEN]
Hard Edits
Tuesday, June 13, 2017
Page 22 of 64
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H_FTANF
Tuesday, June 13, 2017
Page 23 of 64
Module
09
Section Name
Part
Question ID
FIN.150_H
Variable Name
H_FTANF
Universe
Universe-text
Question Text
Include in this question any CASH assistance from a state or county welfare program,
and not other types of non-cash welfare assistance. Non-cash assistance (such as
job training, job placement, child care, various kinds of vouchers, or transportation
help) should be included in the question FOWBEN.
Cash assistance state or county welfare programs may come through program types
such as [b] Welfare or Welfare-to-Work, General Assistance/Emergency Assistance,
Refugee Cash Assistance, General Assistance from the Bureau of Indian Affairs, or
Tribal Administered General Assistance [b].
Generally, cash assistance comes in the form of a check, but some states give
recipients a debit card which is linked to an account containing their monies. Debit
cards and welfare-subsidized wages are considered cash assistance.
The following is a list of state-specific program names:
Alabama - Alabama Family Assistance Program, JOBS
Alaska - Alaska Temporary Assistance Program (ATAP)
Arizona – Arizona Cash Assistance Program, EMPOWER (Employing and Moving
People Off Welfare and Encouraging Responsibility)
Arkansas – Arkansas Temporary Assistance for Needy Families (TANF), Arkansas
Work Pays
California - California Work Opportunity and Responsibility to Kids (CALWORKS)
Colorado - Colorado Works
Connecticut - Temporary Family Assistance (TFA), Jobs First
Delaware - Temporary Assistance for Needy Families (TANF)
District of Columbia -District of Columbia Temporary Assistance for Needy Families
(TANF)
Florida - Florida Temporary Cash Assistance or Welfare Transition Program or
ACCESS Florida
Georgia - Georgia Temporary Assistance for Needy Families (TANF)
Hawaii - Temporary Assistance for Needy Families (TANF), Temporary Assistance for
Other Needy Families (TAONF)
Idaho - Temporary Assistance for Families in Idaho (TAFI)
Illinois - Illinois Temporary Assistance for Needy Families (TANF)
Indiana - Indiana Temporary Assistance for Needy Families (TANF), Indiana
Manpower Placement and Comprehensive Training (IMPACT)
Iowa - Iowa Family Investment Program (FIP), PROMISE JOBS
Kansas - Successful Families Program - Temporary Assistance for Needy Families
(TANF), KansasWorks
Kentucky - Kentucky Transitional Assistance Program (K-TAP)
Louisiana - Louisiana Family Independence Temporary Assistance Program (FITAP),
Strategies to Empower People (STEP)
Maine - Maine Temporary Assistance for Needy Families (TANF), Additional Support
for People in Retraining and Employment (ASPIRE)
Tuesday, June 13, 2017
Page 24 of 64
Maryland - Temporary Cash Assistance (TCA)
Massachusetts - Transitional Aid to Families with Dependent Children (TAFDC),
Employment Services Program (ESP)
Michigan - Family Independence Program (FIP),
Parnership.Accountability.Training.Hope. (PATH)
Minnesota - Minnesota Family Investment Program (MFIP)
Mississippi - Mississippi Temporary Assistance for Needy Families (TANF)
Missouri - Temporary Assistance (TA), Beyond Welfare
Montana - Temporary Assistance for Needy Families (TANF), FAIM (Families
Achieving Independence in Montana)
Nebraska - Aid to Dependent Children (ADC), Employment First
Nevada - Nevada Temporary Assistance for Needy Families (TANF), New Employees
of Nevada (NEON)
New Hampshire - Financial Assistance to Needy Families (FANF), New Hampshire
Employment Program (NHEP)
New Jersey - Work First New Jersey (WFNJ)
New Mexico - NMWorks
New York - Family Assistance (FA) Program, Safety Net Assistance (SNA)
North Carolina - Work First
North Dakota - Temporary Assistance for Needy Families (TANF), Job Opportunities
and Basic Skills (JOBS)
Ohio - Ohio Works First (OWF), Prevention, Retention and Contingency (PRC)
Oklahoma - Oklahoma Temporary Assistance for Needy Families (TANF)
Oregon - Oregon Temporary Assistance for Needy Families (TANF), JOBS Plus
Pennsylvania - Pennsylvania Temporary Assistance for Needy Families (TANF)
Rhode Island - Rhode Island Works
South Carolina - South Carolina Family Independence Program
South Dakota - South Dakota Temporary Assistance for Needy Families (TANF)
Tennessee - Tennessee Families First
Texas - Texas Temporary Assistance for Needy Families (TANF)
Utah - Family Employment Program (FEP and FEPTP)
Vermont - Reach UP (TANF), Reach Ahead (transition program)
Virginia - Virginia Temporary Assistance for Needy Families (TANF), Virginia Initiative
for Employment not Welfare (VIEW)
Washington -Washington Temporary Assistance for Needy Families (TANF),
WorkFirst
West Virginia - West Virginia Works Program (WV WORKS)
Wisconsin - Wisconsin Works (W-2) Program
Wyoming - Wyoming TANF, Personal Opportunities with Employment Responsibility
(POWER)
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
FTANF
Tuesday, June 13, 2017
Page 25 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.160
Variable Name
PTANF
Universe
AGE=All and FTANF=yes and family members > 1
Universe-text
If respondent answered yes to FTANF and there is more than one person in the family
Question Text
*Ask or verify. Enter applicable line number(s), separate with commas.
Who in the family received this?
(Anyone else?)
*Indicate each family member with this income.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all non-deleted family members.
Skip Instructions
Goto FOWBEN
Hard Edits
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Tuesday, June 13, 2017
Page 26 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.164
Variable Name
FOWBEN
Universe
AGE=All
Universe-text
All families
Question Text
At any time during [fill: variable for calculating last calander year], did [fill: 1] receive
any OTHER kind of welfare assistance such as help with getting a job, placement in
education or job training programs, or help with transportation or child care?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Other Welfare
1. If one person in the family, fill: [you] else, fill: [anyone in...]
Special Instructions
Skip Instructions
<1> [if 1 person family, store line number in POWBEN, goto FINTRST]; else goto
POWBEN
<2, D, R> [goto FINTRST]
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Tuesday, June 13, 2017
Page 27 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.166
Variable Name
POWBEN
Universe
AGE=All and FOWBEN=yes and familiy members > 1
Universe-text
If the respondent answered yes to FOWBEN and there is more than one person in the
family
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all non-deleted family members.
Skip Instructions
Goto FINTRST
Hard Edits
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Tuesday, June 13, 2017
Page 28 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.170
Variable Name
FINTRST
Universe
AGE=All
Universe-text
All families
Question Text
Did [fill: 1] receive income from interest bearing checking accounts, savings accounts,
IRAs or certificates of deposit, money market funds, treasury notes, bonds, or any
other investments that earn interest?
* Do not include dividends
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Interest Accounts
1. If one person in the family, fill: [you] else, fill: [any family...]
Special Instructions
Skip Instructions
<1> [if 1 person family, store line number in PINTRST, goto FDIVD]; Else goto
PINTRST.
<2, D, R> [goto FDIVD]
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Tuesday, June 13, 2017
Page 29 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.180
Variable Name
PINTRST
Universe
AGE=All and FINTRST=1 and family members > 1
Universe-text
If respondent answered yes to FINTRST and there is more than one person in the
family
Question Text
*Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display a roster of all non-deleted family members.
Skip Instructions
Goto FDIVD
Hard Edits
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Tuesday, June 13, 2017
Page 30 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.190
Variable Name
FDIVD
Universe
AGE=All
Universe-text
All families
Question Text
Did [fill: 1] receive income from dividends from stocks or mutual funds, or net rental
income from property, royalties, estates or trusts?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Dividends
1. If one person in the family, fill: [you] else, fill: [any family members living here]
Special Instructions
Skip Instructions
<1> [If one person in family, store person number in PDIVD skip to FCHLDSP; else
goto PDIVD]
<2, D, R> [goto FCHLDSP]
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Tuesday, June 13, 2017
Page 31 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.200
Variable Name
PDIVD
Universe
AGE=All and FDIVD=yes and family members > 1
Universe-text
If respondent answered yes to FDIVD and there is more than one person in the family
Question Text
* Ask or verify. Enter applicable line number(s). Separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income.
Answer Codes
Display roster of all non-deleted family members
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all non-deleted family members.
Skip Instructions
Goto FCHLDSP
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Tuesday, June 13, 2017
Page 32 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.210
Variable Name
FCHLDSP
Universe
AGE=All
Universe-text
All families
Question Text
?[F1]
Did [fill: 1] receive income from child support?
Answer Codes
1. Yes
2. No
Dont Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Child Support
1. If one person in the family, fill: [you] else, fill: [any family members living here]
Special Instructions
Skip Instructions
<1> [If 1 person family, store person number in PCHLDSP goto FINCOT; else goto
PCHLDSP]
<2, D, R> [goto FINCOT]
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H_CHLDPSP
Tuesday, June 13, 2017
Page 33 of 64
Module
09
Section Name
Part
Question ID
FIN.210_H
Variable Name
H_CHLDSP
Universe
Universe-text
Question Text
An adult in the family may have received child support income on behalf of a minor
child (or children) present in the household. If this was the case, you should then
indicate in PCHLDSP the line number OF THE CHILD for whom the money was
intended. Although the mother may have received the money, it was only received
because of a child or children.
There may be instances where a child receiving support in the last calendar year is
not living in the household at the time of the interview. As a result, the child will not be
included in either the household or family rosters. In such a case, you should use the
person number of the custodial parent.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Associated screens:
FCHLDSP, PCHLDSP
Tuesday, June 13, 2017
Page 34 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.220
Variable Name
PCHLDSP
Universe
AGE=All and FCHLDSP=yes and family members > 1
Universe-text
If respondent answered yes to FCHLDSP and there is more than one person in the
family
Question Text
?[F1]
*Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate which child in the family this is for. If that child is no longer residing with this
family, enter line number of custodial parent.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display a roster of all non-deleted family members.
Skip Instructions
Goto FINCOT
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H_CHLDSP
Tuesday, June 13, 2017
Page 35 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.230
Variable Name
FINCOT
Universe
AGE=All
Universe-text
All families
Question Text
Did [you/any family member living here] receive income from any other source such as
alimony, contributions from family/others, VA payments, Workers' Compensation, or
unemployment compensation?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Other Income
1. If one person in the family, fill: [you] else, fill: [any family...]
Special Instructions
Skip Instructions
<1> [If one person in the family, store person number in PINCOT, goto FINCTOT];
else goto PINCOT.
<2, D, R> goto FINCTOT
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Tuesday, June 13, 2017
Page 36 of 64
Module
09
Section Name
Family Sources of Income
Part
A
Question ID
FIN.240
Variable Name
PINCOT
Universe
AGE=All and FINCOT=yes and family members > 1
Universe-text
Respondent answered yes to FINCOT, and there is more than one person in the family
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who received this?
(Anyone else?)
* Indicate each family member with this income
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of non-deleted family members.
Skip Instructions
Goto FINCTOT
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Tuesday, June 13, 2017
Page 37 of 64
Module
09
Section Name
Family Income Amounts and Home Ownership
Part
B
Question ID
FIN.250
Variable Name
FINCTOT
Universe
AGE= ALL
Universe-text
All families
Question Text
[fill1: When answering this next question, please remember to include your income
PLUS the income of all family members living in this household.]
What is your best estimate of [fill2: your total income/the total income of all family
members] from all sources, before taxes, in [fill3: last calendar year in 4 digit format]?
* Enter ‘999,995’ if the reported income is greater than $999,995.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Family Income
fill1: If more than one person in the family
fill2: If one person in the family, fill: [your total income]; else, fill: [the total income of all
family members]
Special Instructions
Skip Instructions
<0-999> goto ERR1_FINCTOT
<250001-999995> goto ERR2_FINCTOT
<1000-250000> goto HOUSEOWN
goto FPOV250
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ERR1_FINCTOT:
* Do not read to the respondent.
* $[fill: FINCTOT] is unusually low. Make corrections if necessary.
ERR2_FINCTOT:
* Do not read to the respondent.
* $[fill: FINCTOT] is unusually high. Make corrections if necessary.
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Tuesday, June 13, 2017
Page 38 of 64
Module
09
Section Name
Family Income Amounts and Home Ownership
Part
B
Question ID
FIN.255
Variable Name
FPOV250
Universe
FINCTOT=R,D
Universe-text
Respondents who don't know or refuse their total family income
Question Text
Was your total [fill1: family/ ] income from all sources less than [fill2: 250% of poverty
threshold] or [fill2: 250% of poverty threshold] or more?
Answer Codes
1. Less than [fill2: 250% of poverty threshold]
2. [fill2: 250% of poverty threshold] or more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
250% of poverty
fill1: If more than one person in the family, fill "family"; else leave blank
fill2: fill 250% of poverty threshold value based on family size
Special Instructions Use the following thresholds (2017 survey year) based on family size:
1 person, age < 66: $31,000
1 person, age >= 66: $29,000
2 persons, age of all < 66: $40,000
2 persons, age of one >= 66: $36,000
3 persons: $48,000
4 persons: $61,000
5 persons: $73,000
6 persons: $82,000
7 persons: $93,000
8 persons: $104,000
9+ persons: $124,000
Please store the filled amount in POV250.
Skip Instructions
<1> goto FPOV138
<2> if PCNT in('01','02') then goto FINC75;
else if (PCNT ='04' or PCNT>='07') then goto FPOV400;
else if PCNT in('03','05','06') then goto FINC100
goto HOUSEOWN
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Tuesday, June 13, 2017
Page 39 of 64
Module
09
Section Name
Family Income Amounts and Home Ownership
Part
B
Question ID
FIN.258
Variable Name
FPOV138
Universe
FPOV250='1'
Universe-text
The respondent answered less than 250% of poverty at FPOV250
Question Text
Was your total [fill1: family/ ] income from all sources less than [fill2: 138% of poverty
threshold] or [fill2: 138% of poverty threshold] or more?
Answer Codes
1. Less than [fill2: 138% of poverty threshold]
2. [fill2: 138% of poverty threshold] or more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
138% of poverty
fill1: If more than one person in the family, fill "family"; else leave blank
fill2: fill 138% of poverty threshold value based on family size
Special Instructions Use the following thresholds (2017 survey year) based on family size:
1 person, age < 66: $17,000
1 person, age >= 66: $16,000
2 persons, age of all < 66: $22,000
2 persons, age of one >= 66: $20,000
3 persons: $26,000
4 persons: $34,000
5 persons: $40,000
6 persons: $45,000
7 persons: $52,000
8 persons: $57,000
9+ persons: $69,000
Please store the filled amount in POV138.
Skip Instructions
<1> goto FPOV100
<2> goto FPOV200
goto HOUSEOWN
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Tuesday, June 13, 2017
Page 40 of 64
Module
09
Section Name
Family Income Amounts and Home Ownership
Part
B
Question ID
FIN.261
Variable Name
FPOV100
Universe
FPOV138='1'
Universe-text
The respondent answered less than 138% of poverty at FPOV138
Question Text
Was your total [fill1: family/ ] income from all sources less than [fill2: 100% poverty
threshold] or [fill2: 100% poverty threshold] or more?
Answer Codes
1. Less than [fill2: 100% of poverty threshold]
2. [fill2: 100% poverty threshold] or more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
100% of poverty
fill1: If more than one person in the family, fill "family"; else leave blank
fill2: fill 100% of poverty threshold value based on family size
Special Instructions Use the following thresholds (2017 survey year) based on family size:
1 person, age < 66: $12,000
1 person, age >= 66: $11,000
2 persons, age of all < 66: $16,000
2 persons, age of one >= 66: $15,000
3 persons: $19,000
4 persons: $25,000
5 persons: $29,000
6 persons: $33,000
7 persons: $37,000
8 persons: $41,000
9+ persons: $50,000
Please store the filled amount in POV100.
Skip Instructions
<1,2,R,D> goto HOUSEOWN
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Tuesday, June 13, 2017
Page 41 of 64
Module
09
Section Name
Family Income Amounts and Home Ownership
Part
B
Question ID
FIN.264
Variable Name
FPOV200
Universe
FPOV138='2'
Universe-text
The respondent answered 138% of poverty or more at FPOV138
Question Text
Was your total [fill1: family/ ] income from all sources less than [fill2: 200% of poverty
threshold] or [fill2: 200% of poverty threshold] or more?
Answer Codes
1. Less than [fill2: 200% of poverty threshold]
2. [fill2: 200% of poverty threshold] or more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
200% of poverty
fill1: If more than one person in the family, fill "family"; else leave blank
fill2: fill 200% of poverty threshold value based on family size
Special Instructions Use the following thresholds (2017 survey year) based on family size:
1 person, age < 66: $25,000
1 person, age >= 66: $23,000
2 persons, age of all < 66: $32,000
2 persons, age of one >= 66: $29,000
3 persons: $38,000
4 persons: $49,000
5 persons: $58,000
6 persons: $66,000
7 persons: $75,000
8 persons: $83,000
9+ persons: $99,000
Please store the filled amount in POV200.
Skip Instructions
<1,2,R,D> goto HOUSEOWN
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Tuesday, June 13, 2017
Page 42 of 64
Module
09
Section Name
Family Income Amounts and Home Ownership
Part
B
Question ID
FIN.267
Variable Name
FINC75
Universe
FPOV250='2' and PCNT in('01','02')
Universe-text
The respondent answered 250% of poverty threshold or more at FPOV250 and he/she
is from a 1 or 2 person family
Question Text
Was your total [fill: family/ ] income from all sources less than $75,000 or $75,000 or
more?
Answer Codes
1. Less than $75,000
2. $75,000 or more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
$75,000
fill: If more than one person in the family, fill "family"; else leave blank
Special Instructions
Skip Instructions
<1> goto FPOV400
<2> goto FINC100
goto HOUSEOWN
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Tuesday, June 13, 2017
Page 43 of 64
Module
09
Section Name
Family Income Amounts and Home Ownership
Part
B
Question ID
FIN.270
Variable Name
FINC100
Universe
(FINC75='2' and PCNT in('01','02')) or (FPOV250='2' and PCNT in('03','05','06'))
Universe-text
The respondent answered $75,000 or more at FINC75 and he/she is from a 1 or 2
person family; or the respondent answered 250% of poverty or more at FPOV250 and
he/she is from a 3, 5, or 6 person family
Question Text
Was your total [fill: family/ ] income from all sources less than $100,000 or $100,000
or more?
Answer Codes
1. Less than $100,000
2. $100,000 or more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
$100,000
fill: If more than one person in the family, fill "family"; else leave blank
Special Instructions
Skip Instructions
<1> if PCNT in(‘01’,’02’,’05’,’06’) then goto HOUSEOWN;
else if PCNT=’03’ then goto FPOV400
<2> > if PCNT in(‘01’,’02’,’03’) then goto FINC150;
else if PCNT in (‘05’,’06’) then goto FPOV400
[goto HOUSEOWN]
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Tuesday, June 13, 2017
Page 44 of 64
Module
09
Section Name
Family Income Amounts and Home Ownership
Part
B
Question ID
FIN.273
Variable Name
FPOV400
Universe
(FINC75=’1’ and PCNT in(‘01’,’02’)) or (FINC100=’1’ and PCNT=’03’) or (FINC100=’2’
and PCNT in(’05’,’06’)) or (F250POV=’2’ and (PCNT=’04’ or PCNT >=’07’))
Universe-text
The respondent answered less than $75,000 at FINC75 and he/she is from a 1 or 2
person family; or the respondent answered less than $100,000 at FINC100 and
he/she is from a 3 person family; or the respondent answered $100,000 or more at
FINC100 and he/she is from a 5 or 6 person family; or the respondent answered 250%
of poverty or more at FPOV250 and he/she is from a 4, 7, 8, or 9+ person family
Question Text
Was your total [fill1: family/ ] income from all sources less than [fill2: 400% of poverty
threshold] or [fill2: 400% of poverty threshold] or more?
Answer Codes
1. Less than [fill2: 400% of poverty threshold]
2. [fill2: 400% of poverty threshold] or more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
400% of poverty
fill1: If more than one person in the family, fill "family"; else leave blank
fill2: fill 400% of poverty threshold value based on family size
Special Instructions Use the following thresholds (2017 survey year) based on family size:
1 person, age < 66: $50,000
1 person, age >= 66: $46,000
2 persons, age of all < 66: $65,000
2 persons, age of one >= 66: $58,000
3 persons: $76,000
4 persons: $98,000
5 persons: $116,000
6 persons: $132,000
7 persons: $150,000
8 persons: $166,000
9+ persons: $199,000
Please store the filled amount in POV400.
Skip Instructions
<1> if PCNT >= '08' then goto FINC150;
else goto HOUSEOWN
<2> if PCNT in(‘01’,’02’,’03’,’07','08' ) goto HOUSEOWN;
else if PCNT in('04','05','06') goto FINC150
goto HOUSEOWN
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Tuesday, June 13, 2017
Page 45 of 64
Module
09
Section Name
Family Income Amounts and Home Ownership
Part
B
Question ID
FIN.276
Variable Name
FINC150
Universe
(FINC100=’2’ and PCNT in(‘01’,’02’,’03’)) or (FPOV400=’2’ and PCNT in(‘04’,’05’,’06’))
or (FPOV400=’1’ and PCNT >= '08’)
Universe-text
The respondent answered $100,00 or more at FINC100 and he/she is from a 1, 2, or 3
person family; or the respondent answered 400% of poverty or more at FPOV400 and
he/she is from a 4, 5, or 6 person family; or the respondent answered less than 400%
of poverty at FPOV400 and he/she is from a family of 8 or more persons
Question Text
Was your total [fill: family/ ] income from all sources less than $150,000 or $150,000
or more?
Answer Codes
1. Less than $150,000
2. $150,000 or more
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
$150,000
fill: If more than one person in the family, fill "family"; else leave blank
Special Instructions
Skip Instructions
<1,2,R,D> goto HOUSEOWN
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Tuesday, June 13, 2017
Page 46 of 64
Module
09
Section Name
Family Income Amounts and Home Ownership
Part
B
Question ID
FIN.280
Variable Name
HOUSEOWN
Universe
AGE = ALL
Universe-text
All Families
Question Text
Is this house/apartment owned or being bought, rented, or occupied by some other
arrangement by you [fill: /or someone in your family]?
Answer Codes
1. Owned or being bought
2. Rented
3. Other arrangement
Don't Know
Refused
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Owned or Rent
1. If family members> 1, fill: [... or someone in your family?]
Special Instructions place answer name to the right
Skip Instructions
<1,3,R,D> [goto FSSAPL]
<2> [goto FGAH]
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Tuesday, June 13, 2017
Page 47 of 64
Module
09
Section Name
Family Income Amounts and Home Ownership
Part
B
Question ID
FIN.282
Variable Name
FGAH
Universe
HOUSEOWN= rented
Universe-text
Families who rent
Question Text
?[F1]
[fill: 1] paying lower rent because the Federal, State, or local government is paying
part of the cost?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Lower Rent
1. If one person in the family, fill:[Are you], Else fill: [Is anyone in your family]
Special Instructions
Skip Instructions
<1, 2, D, R> [goto FSSAPL to see if family fits into the universe for this question]
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H_FGAH
Tuesday, June 13, 2017
Page 48 of 64
Module
09
Section Name
Family Income Amounts and Home Ownership
Part
Question ID
FIN.282_H
Variable Name
H_FGAH
Universe
Universe-text
Question Text
Federal, State, or Local government housing programs for persons with low income
may take many forms. Government housing assistance could come from:
[blt]monetary assistance to help pay rent,
a program called "Section 8,"
direct payments to landlords,
vouchers,
or other types of assistance from a local housing authority.[blt]
Living in public housing is considered housing assistance from the government.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screen:
FGAH
Skip Instructions
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Tuesday, June 13, 2017
Page 49 of 64
Module
09
Section Name
Family Income Program Participation
Part
C
Question ID
FIN.300
Variable Name
FSSAPL
Universe
AGE=All
Universe-text
All
Question Text
?[F1]
[fill: Have you EVER applied for Supplemental Security Income or SSI, even if the
claim was denied?/Have any family members living here EVER applied for
Supplemental Security Income (SSI)? This includes people who applied for benefits,
even if the claim was denied.]
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Applied SSI
1. If one person in the family, fill: [Have you EVER applied for Supplemental Security
Income or SSI, even if the claim was denied?] else, fill: [Have any family members
living here EVER applied for Supplemental Security Income (SSI)? This includes
people who applied for benefits, even if the claim was denied.]
Special Instructions
Skip Instructions
<1> [If one person family, store line number in PSSAPL. Goto FSDAPL to see if family
fits into universe for this question; Else goto PSSAPL]
<2, D, R> [goto FSDAPL to see if family fits into universe for this question]
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H_FSSI
Tuesday, June 13, 2017
Page 50 of 64
Module
09
Section Name
Family Income Program Participation
Part
C
Question ID
FIN.310
Variable Name
PSSAPL
Universe
AGE=All and familiy members > 1
Universe-text
If respondent said yes to FSSAPL and there is more than one person in the family
Question Text
*Ask or verify. Enter applicable line number(s), separate with a comma.
Who in the family applied for it?
(Anyone else?)
* Indicate each family member who applied for SSI benefits.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of all non-deleted family members.
Skip Instructions
Goto FSDAPL
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Tuesday, June 13, 2017
Page 51 of 64
Module
09
Section Name
Family Income Program Participation
Part
C
Question ID
FIN.330
Variable Name
FSDAPL
Universe
AGE= ALL
Universe-text
All Families
Question Text
?[F1]
[fill: Have you EVER APPLIED for disability benefits from Social Security even if the
claim was denied?/Have any family members living here EVER applied for disability
benefits from Social Security? This includes people who applied for benefits, even if
the claim was denied.]
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Applied Disability Benefits
1. If one person in the family, fill: [Have you EVER APPLIED for disability benefits
from Social Security even if the claim was denied?] else, fill: [Have any family
members living here EVER applied for disability benefits from Social Security? This
includes people who applied for benefits, even if the claim was denied.]
Special Instructions
Skip Instructions
<1> [If one person family, store line number in PSDAPL. Goto TANFMYR to see if the
family fits in the universe for TANFMYR; Else goto PSDAPL]
<2, D, R> [goto TANFMYR to see if family fits into the universe for this question]
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H_FSSRR
Tuesday, June 13, 2017
Page 52 of 64
Module
09
Section Name
Family Income Program Participation
Part
C
Question ID
FIN.340
Variable Name
PSDAPL
Universe
AGE=All and FSDAPL=yes and family members > 1
Universe-text
Respondent answered yes to FSDAPL and there is more than one person in the
family.
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who in the family applied for it?
(Anyone else?)
* Indicate each family member who applied for Social Security Disability benefits.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display a roster of all non-deleted family members.
Skip Instructions
Goto TANFMYR to see if family fits into the universe for this question.
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Tuesday, June 13, 2017
Page 53 of 64
Module
09
Section Name
Family Income Program Participation
Part
C
Question ID
FIN.350
Variable Name
TANFMYR
Universe
AGE=All and person selected in PTANF
Universe-text
Persons who received AFDC or General Assistance
Question Text
?[F1]
Earlier I recorded that [fill: you/alias] received cash assistance from programs such as
welfare or public assistance in [fill: last year in 4 digit format]. During [fill: last year in
4 digit format], about how many months did [fill: you/alias] receive this assistance?
*Enter "1" if less than one month.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
# of Months of Cash Assistance
1. If one person family, fill: [you] else fill: [alias]
Special Instructions This is asked for all persons listed in PTANF. Roster through for each person.
Skip Instructions
<1-12, D, R> Repeat this question for all persons listed in PTANF, then goto FSNAP
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H_TANFMYR
Tuesday, June 13, 2017
Page 54 of 64
Module
09
Section Name
Part
Question ID
FIN.350_H
Variable Name
H_TANFMYR
Universe
Universe-text
To answer this question:
Question Text
1 = 1 month or less
2 = more than 1, but not more than 2 months
3 = more than 2, but not more than 3 months
4 = more than 3, but not more than 4 months
5 = more than 4, but not more than 5 months
6 = more than 5, but not more than 6 months
7 = more than 6, but not more than 7 months
8 = more than 7, but not more than 8 months
9 = more than 8, but not more than 9 months
10 = more than 9, but not more than 10 months
11 = more than 10, but not more than 11 months
12 = more than 11, but not more than 12 months
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
TANFMYR, FSNAPMYR
Skip Instructions
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Tuesday, June 13, 2017
Page 55 of 64
Module
09
Section Name
Family Income Program Participation
Part
C
Question ID
FIN.360
Variable Name
FSNAP
Universe
AGE=All
Universe-text
All families
Question Text
?[F1]
At any time during [fill 1: last calendar year in 4-digit format], did [fill 2: you/any family
members living here] receive [fill 3: food stamp benefits/SNAPNAME or food stamp
benefits]?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Food Stamps/SNAP
1. Fill the last calendar year in 4-digit format.
2. If one person in the family, fill: [you]; else fill: [any family members living here]
3. If the state program name is "Food Stamp Program", then just fill "food stamp
benefits";
else, fill state name for the family's state of residence (VERADD (COV.010) for
variable ST) along with "or food stamp benefits" as listed below.
If AL then fill "Food Assistance Program or food stamp benefits"
If AK then fill "food stamp benefits"
If AZ then fill "Nutrition Assistance or food stamp benefits"
If AR then fill "SNAP or food stamp benefits"
If CA then fill "CalFresh"
If CO then fill "Food Assistance Program or food stamp benefits"
If CT then fill "SNAP or food stamp benefits"
If DE then fill "Food Supplement Program or food stamp benefits"
If DC then fill "SNAP or food stamp benefits"
If FL then fill "Food Assistance Program or food stamp benefits"
If GA then fill "food stamp benefits"
If HI then fill "SNAP or food stamp benefits"
If ID then fill "food stamp benefits"
If IL then fill "SNAP or food stamp benefits"
If IN then fill "SNAP or food stamp benefits"
If IA then fill "Food Assistance Program and food stamp benefits"
If KS then fill "Food Assistance Program and food stamp benefits"
If KY then fill "SNAP or food stamp benefits"
If LA then fill "SNAP or food stamp benefits"
If ME then fill "Food Supplement Program or food stamp benefits"
If MD then fill "Food Supplement Program or food stamp benefits"
If MA then fill "SNAP or food stamp benefits"
If MI then fill "Food Assistance Program or food stamp benefits"
If MN then fill "SNAP or food stamp benefits"
Tuesday, June 13, 2017
Page 56 of 64
If MS then fill "SNAP or food stamp benefits"
If MO then fill "food stamp benefits"
If MT then fill "SNAP or food stamp benefits"
If NE then fill "SNAP or food stamp benefits"
If NV then fill "SNAP or food stamp benefits"
If NH then fill "food stamp benefits"
If NJ then fill "SNAP"
If NM then fill "SNAP or food stamp benefits"
If NY then fill "SNAP or food stamp benefits"
If NC then fill "Food and Nutrition Services or food stamp benefits"
If ND then fill "SNAP or food stamp benefits"
If OH then fill "Food Assistance Program or food stamp benefits"
If OK then fill "SNAP or food stamp benefits"
If OR then fill "SNAP or food stamp benefits"
If PA then fill "SNAP or food stamp benefits"
If RI then fill "SNAP or food stamp benefits"
If SC then fill "SNAP or food stamp benefits"
If SD then fill "SNAP or food stamp benefits"
If TN then fill "SNAP"
If TX then fill "SNAP or food stamp benefits"
If UT then fill "SNAP"
If VT then fill "3SquaresVT or food stamp benefits"
If VA then fill "SNAP or food stamp benefits"
If WA then fill "Basic Food or food stamp benefits"
If WV then fill "SNAP or food stamp benefits"
If WI then fill "FoodShare Wisconsin or food stamp benefits"
If WY then fill "SNAP or food stamp benefits"
Special Instructions
Skip Instructions
<1> [goto FSNAPMYR]
<2, D, R> [Goto FINWIC to see if family falls into the universe for this question.]
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H_FSNAP
Tuesday, June 13, 2017
Page 57 of 64
Module
09
Section Name
Part
Question ID
FIN.360_H
Variable Name
H_FSNAP
Universe
Universe-text
Question Text
SNAP or Food Stamp benefits are coupons that can be used to purchase food. The
SNAP or Food Stamp program is a joint federal-state program which is administered
by the state and local governments.
The following is a list of state-specific program names:
Alabama - Food Assistance Program
Alaska - Food Stamp Program (FSP)
Arizona - Nutrition Assistance
Arkansas - SNAP
California - CalFresh
Colorado - Food Assistance Program
Connecticut - SNAP
Delaware - Food Supplement Program
District of Columbia - SNAP
Florida - Food Assistance Program
Georgia - Food Stamp Program (FSP)
Hawaii - SNAP
Idaho - Food Stamp Program (FSP)
Illinois - SNAP
Indiana - SNAP
Iowa - Food Assistance Program
Kansas - Food Assistance Program
Kentucky - SNAP
Louisiana - SNAP
Maine - Food Supplement Program
Maryland - Food Supplement Program
Massachusetts - SNAP
Michigan - Food Assistance Program
Minnesota - SNAP
Mississippi - SNAP
Missouri - Food Stamp Program (FSP)
Montana - SNAP
Nebraska - SNAP
Nevada - SNAP
New Hampshire - Food Stamp Program (FSP)
New Jersey - SNAP
New Mexico - SNAP
New York - SNAP
North Carolina - Food and Nutrition Services
North Dakota - SNAP
Ohio - Food Assistance Program
Oklahoma - SNAP
Oregon - SNAP
Pennsylvania - SNAP
Tuesday, June 13, 2017
Page 58 of 64
Rhode Island - SNAP
South Carolina - SNAP
South Dakota - SNAP
Tennessee - SNAP
Texas - SNAP
Utah - SNAP
Vermont - 3SquaresVT
Virginia - SNAP
Washington - Basic Food
West Virginia - SNAP
Wisconsin - FoodShare Wisconsin
Wyoming - SNAP
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
FSNAP
Tuesday, June 13, 2017
Page 59 of 64
Module
09
Section Name
Family Income Program Participation
Part
C
Question ID
FIN.380
Variable Name
FSNAPMYR
Universe
FSNAP=1
Universe-text
Family received food stamp/SNAP benefits in previous calendar year
Question Text
?[F1]
During [fill 1: last year in 4 digit format], about how many months were [fill 2: food
stamp benefits/SNAPNAME or food stamp benefits] received?
* Enter "1" if less than 1 month
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
months of Food Stamps/SNAP
1. Fill last calendar year in 4-digit format.
2. If the state program name is "Food Stamp Program", then just fill "food stamp
benefits";
else fill state program name for the family's state of residence along with "or food
stamp benefits" as shown below.
If AL then fill "Food Assistance Program or food stamp benefits"
If AK then fill "food stamp benefits"
If AZ then fill "Nutrition Assistance or food stamp benefits"
If AR then fill "SNAP or food stamp benefits"
If CA then fill "CalFresh"
If CO then fill "Food Assistance Program or food stamp benefits"
If CT then fill "SNAP or food stamp benefits"
If DE then fill "Food Supplement Program or food stamp benefits"
If DC then fill "SNAP or food stamp benefits"
If FL then fill "Food Assistance Program or food stamp benefits"
If GA then fill "food stamp benefits"
If HI then fill "SNAP or food stamp benefits"
If ID then fill "food stamp benefits"
If IL then fill "SNAP or food stamp benefits"
If IN then fill "SNAP or food stamp benefits"
If IA then fill "Food Assistance Program and food stamp benefits"
If KS then fill "Food Assistance Program and food stamp benefits"
If KY then fill "SNAP or food stamp benefits"
If LA then fill "SNAP or food stamp benefits"
If ME then fill "Food Supplement Program or food stamp benefits"
If MD then fill "Food Supplement Program or food stamp benefits"
If MA then fill "SNAP or food stamp benefits"
If MI then fill "Food Assistance Program or food stamp benefits"
If MN then fill "SNAP or food stamp benefits"
If MS then fill "SNAP or food stamp benefits"
If MO then fill "food stamp benefits"
If MT then fill "SNAP or food stamp benefits"
Tuesday, June 13, 2017
Page 60 of 64
If NE then fill "SNAP or food stamp benefits"
If NV then fill "SNAP or food stamp benefits"
If NH then fill "food stamp benefits"
If NJ then fill "SNAP"
If NM then fill "SNAP or food stamp benefits"
If NY then fill "SNAP or food stamp benefits"
If NC then fill "Food and Nutrition Services or food stamp benefits"
If ND then fill "SNAP or food stamp benefits"
If OH then fill "Food Assistance Program or food stamp benefits"
If OK then fill "SNAP or food stamp benefits"
If OR then fill "SNAP or food stamp benefits"
If PA then fill "SNAP or food stamp benefits"
If RI then fill "SNAP or food stamp benefits"
If SC then fill "SNAP or food stamp benefits"
If SD then fill "SNAP or food stamp benefits"
If TN then fill "SNAP"
If TX then fill "SNAP or food stamp benefits"
If UT then fill "SNAP"
If VT then fill "3SquaresVT or food stamp benefits"
If VA then fill "SNAP or food stamp benefits"
If WA then fill "Basic Food or food stamp benefits"
If WV then fill "SNAP or food stamp benefits"
If WI then fill "FoodShare Wisconsin or food stamp benefits"
If WY then fill "SNAP or food stamp benefits"
Special Instructions
Skip Instructions
Goto FINWIC to see if family fits into universe for this question.
Hard Edits
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H_FSNAP
Tuesday, June 13, 2017
Page 61 of 64
Module
09
Section Name
Family Income Program Participation
Part
C
Question ID
FIN.384
Variable Name
FINWIC
Universe
(SEX= female and AGE=12-55) or (AGE=0-5)
Universe-text
Families with females aged 12-55 or children age 0-5
Question Text
?[F1]
At any time during [fill: last year in 4 digit format] did [you/anyone in your family]
receive benefits from the WIC program, that is, the Women, Infants and Children
program?
Answer Codes
1. Yes
2. No
Don't Know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
WIC
1. If one person in the family, fill: [you] else, fill: [anyone in your family...]
Special Instructions
Skip Instructions
<1> [If 1 person family, store person number in PWIC. [Goto end of section];
Else [goto PWIC]
<2, D, R> [Goto end of section.]
Hard Edits
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H_FINWIC
Tuesday, June 13, 2017
Page 62 of 64
Module
09
Section Name
Part
Question ID
FIN.384_H
Variable Name
H_FINWIC
Universe
Universe-text
Question Text
WIC or the Supplemental Food Program for Women, Infants and Children (WIC)
provides food and/or vouchers which can be exchanged for food. Pregnant women
without children may also qualify for this program. Children are eligible for WIC
benefits until their 5th birthday (although the parent/guardian receives the
food/vouchers).
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, June 13, 2017
Page 63 of 64
Module
09
Section Name
Family Income Program Participation
Part
C
Question ID
FIN.385
Variable Name
PWIC
Universe
FINWIC=yes and family members > 1
Universe-text
Respondent answered yes to FINWIC
Question Text
* Ask or verify. Enter applicable line number(s), separate with commas.
Who in the family received this?
(Anyone else?)
* Indicate family members who were authorized to receive WIC benefits.
Answer Codes
Question Type
Enter All That Apply
Field Pane Description
Who
Fill Instructions
Special Instructions Display roster of non-deleted family members.
Skip Instructions
Goto end of section
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Tuesday, June 13, 2017
Page 64 of 64
2018 Q1 NHIS Instrument Spec Report
Section name: Language of Interview
Module
55
Section Name
Language of Interview
Part
Question ID
FLG.010_00.000
Variable Name
ENGLANG
Universe
AGE >= 5
Universe-text
All persons age 5 or older
Question Text
How well [fill: do you/does ALIAS] speak English? Would you say…
Answer Codes
1. Very well
2. Well
3. Not well
4. Not at all
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
English language
if respondent fill "do you" else fill "does ALIAS"
Special Instructions Repeat question for all persons on roster age 5+
Question should come after FIN section but before FSD section.
Skip Instructions
<1-4> goto next section, goto S.C. section if sample child in the family;
Else If not, then goto S.A. secton;
Else no S.C. nor S.A., then goto RECONTACT section
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Tuesday, June 13, 2017
Page 1 of 1
| File Type | application/pdf |
| File Modified | 2017-11-01 |
| File Created | 2017-06-15 |