Form 0920-0214 Re-Designed Re-Interview Questionnaire

Attachment 6b - Redesigned Reinterview Questionnaire
Form Approved OMB Number 0920-0214 Expires: xx/xx/20xx
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identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes.
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the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C.
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Notice – Public reporting burden of this collection of information is estimated to average 5 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).

The content verification questions are specific to the sample adult respondent. These questions are only asked
when there was a response from the related question in the original interview. Respondents will not be
reinterviewed on topics they weren’t asked about originally.
All responses are dichotomous “Yes” or “No”
Read to respondent - These next questions are to make sure that the interviewer asked you the correct questions:
Adult Annual Content
Q1. Did the interviewer ask you questions about whether you or someone you live with has a cell phone?
(SACELL)
Universe: Sample adults 18+
Q2. Did the interviewer ask whether you had difficulty with self-care such as washing all over or dressing?
(SASLFCARE)
Universe: Sample adults 18+
Q3. Did the interviewer ask whether you were covered by health insurance or some other kind of health care
plan? (SAHINS)
Universe: Sample adults 18+
Q4. Did the interviewer ask you about the amount of your total family income? (SAINC, note: previously called
FAM3)
Universe: Sample adults 18+ (EXCEPT: Skip if child respondent completed income section AND child respondent
is not the sample adult)
Q5. Did the interviewer ask whether your house has a functioning smoke detector? (SMKDET)
Universe: Sample adults 18+ (NOTE: This is trick/dummy item, we do not ask about smoke detectors)
Q6. Did the interviewer ask you whether there is a place that you usually go to when you are sick or need advice
about your health? (SAAUSUAL)
Universe: Sample adults 18+
Q7. Did the interviewer ask whether you consider yourself to be gay, straight, bisexual, or something else?
(SAORIENT)
Universe: Sample adults 18+
Q8. Did the interviewer ask for the last four digits of your social security number? (SASOC)
Universe: Sample adults 18+
2018 Rotating Adult Core Content:
Q9. Did the interviewer ask if you recently had pain? (RCPAIN)
Universe: Sample adults 18+ in 2018
Q10. Did the interviewer ask whether you recently felt nervous, anxious, or on edge? (RCGAD71)
Universe: Sample adults 18+ in 2018

2018 Supplemental Content:
Q11. Did the interviewer ask whether you recently worried that food would run out before you got money to
buy more?
Universe: All sample adults 18+
Read to respondent –Thank you. These next two questions are to make sure that the interviewer recorded the
correct responses:
Adult Annual Content
Q12. [Other than during pregnancy] Have you ever been told by a doctor or health professional that you have
diabetes or sugar diabetes? (SADIBEV1)
Universe: We are now going to open it up to all sample adults to assess response variance. Previously we only
asked of people who had responded “No”.
Q13. Have you smoked at least 100 cigarettes in your ENTIRE LIFE? (SASMKEV)
Universe: All sample adults 18+
Read to respondent –Thank you. Now I am going to ask a two questions about the interview you completed on
behalf of the following child in your family: ^SCNAME.
Child Annual Content
Q14. Did the interviewer ask you if ^SCNAME was ever diagnosed with asthma?
Universe: All sample adults 18+ who were the proxy respondents for a sample child.
2018 Rotating Child Core Content:
Q15. Did the interviewer ask you how long it had been since ^SCNAME last had a dental examination or
cleaning?
Universe: All sample adults 18+ who were the proxy respondents for a sample child.
Read to respondent –Thank you again for your time.