1-CID Update

Page 1 of 7

2007 NHIS Questionnaire - Sample Child

Child Identification

Document Version Date: 12-Jul-06

Question ID: CID.001_00.000 Instrument Variable Name: CURRES QuestionnaireFileName: Sample Child

QuestionText: * Enter the line number of the person to whom you are speaking.

01-25 Person number of the respondent for Sample Child

UniverseText: Sample child section not started or not completed

SkipInstructions: if CSTAT <> empty and CSTAT <> 2 THEN

if ASTAT = empty or ASTAT = 2 THEN

goto adult.aid.SADULT

elseif recontact.RCIFLAG <> 1 THEN

goto recontact.RCI_BEGIN procedure

else

goto back.OUTCOMEB1 procedure

endif

goto back.OUTCOMEB1 procedure

endif

<01-25> if this is NOT an allowable line number

goto ERR_CURRES

elseif CURRES = a line number entered in KNOWSC2

store CURRES in CSPAVAIL and CSRESP

goto CSRELTIV

elseif KNOWSC2 = 'Don't know' or 'Refused' or empty (no line numbers in KNOWSC2)

goto KNOAVAIL

else

goto CSPAVAIL

endif

Page 2 of 7

2007 NHIS Questionnaire - Sample Child

Child Identification

Document Version Date: 12-Jul-06

Question ID: CID.010_00.000 Instrument Variable Name: CSPAVAIL QuestionnaireFileName: Sample Child

QuestionText: The next questions are about [fill1: S.C. name].

Is [fill2:KNOWSC2 names] available to answer some questions about [fill3: HISHER] health?

* Enter line number of available respondent from list or enter '96' if no one is available.

* If refused enter CTRL_R.

01-25 Person # of person available to answer questions about Sample Child

96 No person available

UniverseText: Someone identified as knowledgeable about child's health and knowledgeable person(s) not entered in CURRES

SkipInstructions: <01-25> if line number not equal one of the line numbers in KNOWSC2

goto child.cid.ERR_CSPAVAIL

else

store child.cid.CSPAVAIL in child.cid.CSRESP

goto child.cid.CSRELTIV

endif

<96> store child.cid.CSPAVAIL in child.cid.CSRESP

goto cbk.CCALLBK1

<R> store <4> in CSTAT(FAMINT)

if ASTAT = empty or ASTAT = 2 THEN

goto adult.aid.SADULT

elseif recontact.RCIFLAG <> 1 THEN

goto recontact.RCI_BEGIN procedure

else

goto back.OUTCOMEB1 procedure

endif

Question ID: CID.030_00.000 Instrument Variable Name: CSRELTIV QuestionnaireFileName: Sample Child

QuestionText: (book) C1

[fill1: The next questions are about [fill2: S.C. name]

What is your relationship to [fill2: S.C. name]?

01 Parent (Biological, adoptive, or step)

02 Grandparent

03 Aunt/Uncle

UniverseText: Someone identified as knowledgeable about child's health

SkipInstructions: <1-8,R,D> If CSRESP = demographics.hhc.RELRESP_A

goto child.chs.BWGT_LB

elseif CSRESP = demographics.hhc.HHRESP

goto child.chs.BWGT_LB

else]

goto CSPVERF_S

endif]

Page 3 of 7

2007 NHIS Questionnaire - Sample Child

Child Identification

Document Version Date: 12-Jul-06

Question ID: CID.040_00.000 Instrument Variable Name: CSPVERF_S QuestionnaireFileName: Sample Child

QuestionText: * Please verify the following information about the sample child before proceeding:

I have recorded [fill1: S.C. name]'s sex as [fill2: Sex of Sample Child]. Is this correct?

* If respondent "refuses" or says "don't know", enter "1" for "yes".

1 Yes

2 No

UniverseText: Respondent is not the person entered in HHRESP or RELRESP_A.

SkipInstructions: <1> goto CSPVERF_A

<2> goto NEWSEX

Question ID: CID.041_00.000 Instrument Variable Name: NEWSEX QuestionnaireFileName: Sample Child

QuestionText: * Ask if appropriate; otherwise, enter your best guess of the person's sex.

Is [fill: S.C. name] Male or Female?

1 Male

2 Female

UniverseText: Respondent said child's sex is not correct.

SkipInstructions: <1,2> store NEWSEX in SEX

goto ERR_NEWSEX

reset CSPVERF_S

goto CSPVERF_S

Question ID: CID.042_00.000 Instrument Variable Name: CSPVERF_A QuestionnaireFileName: Sample Child

QuestionText: * Please verify the following information about the sample child before proceeding:

I have recorded [fill1: S.C name]'s age as [fill2: Age of Sample Child] old. Is this correct?

* If respondent "refuses" or says "don't know", enter "1" for "yes".

1 Yes

2 No

UniverseText: Respondent verified child's sex

SkipInstructions: <1> goto CSPVERF_D

<2> goto NEWAGE

Page 4 of 7

2007 NHIS Questionnaire - Sample Child

Child Identification

Document Version Date: 12-Jul-06

Question ID: CID.043_00.000 Instrument Variable Name: NEWAGE QuestionnaireFileName: Sample Child

QuestionText: How old is [fill1: S.C. name]?

* If age given in months, weeks, or days, convert age to appropriate year. If less than one year old, enter "0".

000-120 Age in years

UniverseText: Respondent said child's age is not correct

SkipInstructions: <0-120, Refused, Don't know>

if NEWAGE = Refused or NEWAGE = Don't know or NEWAGE = AGE

reset CSPVERF_A

goto ERR_NEWAGE

else

store NEWAGE in AGE

goto NEWDOB_M

Question ID: CID.044_00.000 Instrument Variable Name: CSPVERF_D QuestionnaireFileName: Sample Child

QuestionText: * Please verify the following information about the sample child before proceeding:

I have recorded [fill1: S.C. name]'s birthday as [fill2: Birthday of Sample Child]. Is this correct?

* If respondent "refuses" or says "don't know", enter "1" for "yes".

1 Yes

2 No

UniverseText: Respondent verified child's sex

SkipInstructions: <1> if AGE of Sample Child ge <18>

goto CNO_MORE

else

goto child.chs.BWGT_LB

endif

<2> goto NEWDOB_M

Page 5 of 7

2007 NHIS Questionnaire - Sample Child

Child Identification

Document Version Date: 12-Jul-06

Question ID: CID.046_01.000 Instrument Variable Name: NEWDOB_M QuestionnaireFileName: Sample Child

QuestionText: 1 of 3

What is [fill: S.C. name]'s birthday?

*Enter month of birth.

1 January

10 October

11 November

12 December

2 February

3 March

4 April

5 May

6 June

7 July

8 August

9 September

UniverseText: Respondent said child's date of birth is not correct or child's age is not correct

SkipInstructions: <01-12, Refused, Don't know> goto NEWDOB_D

Question ID: CID.046_02.000 Instrument Variable Name: NEWDOB_D QuestionnaireFileName: Sample Child

QuestionText: 2 of 3

* Enter day of birth.

01-31 Day of the month

UniverseText: Respondent said child's date of birth is not correct or child's age is not correct

SkipInstructions: <01-31,Refused,Don't know> goto NEWDOB_Y

If days not valid, goto ERR_NEWDOB_D

Page 6 of 7

2007 NHIS Questionnaire - Sample Child

Child Identification

Document Version Date: 12-Jul-06

Question ID: CID.046_03.000 Instrument Variable Name: NEWDOB_Y QuestionnaireFileName: Sample Child

QuestionText: 3 of 3

* Enter year of birth.

1880-2020 Year of birth

UniverseText: Respondent said child's date of birth is not correct or child's age is not correct

SkipInstructions: <1880-2020, Refused, Don't know> if CSPVERF_A = No then reset CSPVERF_A to empty

goto CSPVERF_A

elseif CSPVERF_D = No then reset CSPVERF_D to empty

goto CSPVERF_D

endif

(if year GT current year) or (if year = current year and month GT current month) or (if year = current year and month

= current month and day GT current day)

goto ERR1_NEWDOB_Y

endif

(if birth month = <02> and birth day = <29> and this is not a leap year)

goto ERR2_NEWDOB_Y

endif

(if NEWDOB_M = Ref or DK) or (if NEWDOB_D = Ref or DK) or (if NEWDOB_Y = Ref or DK)

goto ERR3_NEWDOB_Y

else

store NEWDOB_M in DOBM

store NEWDOB_D in DOBD

store NEWDOB_Y in DOBY

if CSPVERF_A = No then reset CSPVERF_A to empty

goto CSPVERF_A

elseif CSPVERF_D = No then reset CSPVERF_D to empty

goto CSPVERF_D

endif

endif

Calculate age from NEWDOB_M, NEWDOB_D, and NEWDOB_Y.

if age from NEWDOB items is ne AGE and age from NEWDOB items is valid

reset CSPVERF_A or CSPVERF_D

goto ERR4_NEWDOB_Y

endif

Page 7 of 7

2007 NHIS Questionnaire - Sample Child

Child Identification

Document Version Date: 12-Jul-06

Split sample 1. Linkage permission question prior to question for SSN: sample

child

Question ID cID.051

Question Text Finally, we would like to link (child’s name)’s survey data with health-related records of other

government agencies. This will allow us to conduct additional research without taking up

your time with more questions. Any data obtained will be kept strictly private as

required by law. May we try to link (child’s name)’s survey data with other health-related records?

* Read if necessary: The specific federal laws are the Public Health Service Act (Title 42, United States Code, Section 242K)

Answer Codes 1. Yes

2. No

Refused

Don’t know

Skip Instructions <1> [goto AID.052]

<2,R,D> [goto beginning of Recontact or Back section]

Question ID cID.052

Question Text

To help us link (child’s name)’s survey data with vital statistics and health-related records of other government agencies, we would like the last four digits of (child’s)’s Social Security Number. The National Center for Health Statistics uses this information for research purposes only. Providing this information is voluntary. Federal laws authorize us to ask for this information and require us to keep it strictly private. There will be no effect on (child’s name)’s benefits if you do not provide this information.

* Read if necessary: The specific federal laws are the Public

Health Service Act (Title 42, United States Code, Section 242K) and the Confidential Information Protection and Statistical Efficiency Act (Title V of Public Law 107-347).

What are the last four digits of (child’s name)’s Social Security Number?

• Enter 'N' if no Social Security Number.

Question ID cID.053

Question Text * Enter how the last four digits of the Social Security Number were reported.

Answer Codes 1. From memory

2. From records

Question ID cID.054

Question Text * Select one category below to indicate reporting of the last four digits of the Social

Security Number.

Answer Codes 1. In person

2. Telephone

SkipInstructions: <1,2> goto beginning of Sample Adult, Recontact, or Back section

Split sample 2. Linkage permission question after questions for SSN: sample child

Question ID cID.051

Question Text Finally, we would like the last four digits of your Social Security Number [if sample adult has Medicare: , and the last four numbers and any letters of your Medicare number]. This information will help us link your survey data with health-related records of other government agencies, and allow us to conduct additional research without taking up your time with more questions. The National Center for Health Statistics uses this information for research purposes only Providing this information is voluntary. Federal laws authorize us to ask for this information and require us to keep it strictly private. There will be no effect on your benefits if you do not provide this

information.

* Read if necessary: The specific federal laws are the Public Health Service Act (Title 42, United States Code, Section 242K) and the Confidential Information Protection and Statistical Efficiency Act (Title V of Public Law 107-347).

* Enter '1' to continue.

Question ID cID.052

Question Text What are the last four digits of (child’s name)’s Social Security Number?

Skip Instructions SSN given, go to CID.053

SSN refused or don’t know, go to CID.055

Question ID cID.053

Question Text * Enter how the last four digits of the Social Security Number were reported.

Answer Codes 1. From memory

2. From records

Question ID cID.054

Question Text * Select one category below to indicate reporting of the last four digits of the Social

Security Number.

Answer Codes 1. In person

2. Telephone

Skip Instructions Go to beginning of Sample Adult, Recontact, or Back section

Question ID cID.055

Question Text May we try to link (child’s name)’s survey data without (child’s name)’s Social Security number?

Read if necessary: Any data obtained will be kept strictly private as required by law (Public Health Service Act, which is Title 42, United States Code, Section 242K; and the Confidential Information Protection and Statistical Efficiency Act, which is Title V of Public Law 107-347).

Answer Codes 1. Yes

2. No

Refused

Don’t know

Skip Instructions Go to beginning of Sample Adult, Recontact, or Back section