Attachment 2f Updated

Attachment 2f. New or Revised Questions in

the Basic Module

2007 New Family Health Insurance Questions

Question ID: FHI.241_00.000 Instrument Variable Name: HDHP QuestionnaireFileName: Family

QuestionText: ?[F1]

[If only one person covered by this plan:]

Is the deductible for medical care for this plan less than $1,100 or $1,100 or more? If there is a separate deductible for prescription drugs, hospitalization, or out-of-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 deductible for medical care for this plan less than $2,200 or $2,200 or more? If there is a separate deductible for prescription drugs, hospitalization, or out-of-network care, do not include those deductible amounts here.

1 Less than [fill 1: $1,100/$2,200]

2 [fill 1: $1,100/$2,200] or more

7 Refused

9 Don't know

UniverseText: All private health insurance plans

SkipInstructions: <1,R,D> [goto MGCHMD] <2> [goto HSAHRA] Page 21 of 30

Question ID: FHI.242_00.000 Instrument Variable Name: HSAHRA QuestionnaireFileName: Family

QuestionText: ?[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.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Asked of all high deductible private health insurance plans

SkipInstructions: <1,2,R,D> [goto MGCHMD]

Question ID: FHI.330_00.000 Instrument Variable Name: FSA QuestionnaireFileName: Family

QuestionText: [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.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1,2,R,D> [goto PLBORN]

2007 New Sample Adult Diabetes Question

Module 16

Section Name Adult Conditions

Part

Question ID ACN.165

Variable Name DIBPRE1

Universe HHSTAT4 = 'S' and AGE GE 18 and DIBEV=2,R,D

Universe-text Sample adults 18+ who were never told they had diabetes, or who refused or said don’t know to having been told they had diabetes

Question Text Have you EVER been told by a doctor or other health professional that you have any of the following: prediabetes, impaired fasting glucose, impaired glucose tolerance, borderline diabetes, or high blood sugar?

Answer Codes 1. Yes

2. No

Refused

Don't know

Question Type Yes/No

Field Pane Description Pre-diabetic symptoms

Fill Instructions

Special Instructions . If DIBEV=3 fill “1” in DIBPRE1

Skip Instructions <1> [goto INSLN]

<2,R,D> [goto AHAYFYR]

2007 NHIS Questionnaire - Family

Family Income

Question ID: FIN.255_00.000 Instrument Variable Name: FINC50 QuestionnaireFileName: Family

QuestionText: Was your total [fill: /family] income from all sources less than $50,000 or $50,000 or more?

1 $50,000 or more

2 Less than $50,000

7 Refused

9 Don't know

UniverseText: All families where "don't know" or "refused" was the answer for total family income (FAMINC)

SkipInstructions: <1> [goto FINC35 ]

<2> [goto FINC100

<R,D> [goto HOUSEOWN]

Question ID: FIN.260_00.000 Instrument Variable Name: FINC35 QuestionnaireFileName: Family

QuestionText: Was your total [fill: /family] income from all sources less than $35,000 or $35,000 or more?

1 Less than $35,000

2 $35,000 or more

7 Refused

9 Don't know

UniverseText: All families where "less than $50,000" was the answer for FINC50

SkipInstructions: <1> [goto FINCPOV ]

<2,R,D> [goto HOUSEOWN]

Question ID: FIN.265_00.000 Instrument Variable Name: FINCPOV QuestionnaireFileName: Family

QuestionText: Was your total [fill1: /family] income from all sources less than [fill2: fill based on poverty threshold] or [fill2: fill based on poverty threshold] or more?

1 Less than [fill2: fill based on poverty threshold]

2 [fill2: fill based on poverty threshold] or more

7 Refused

9 Don't know

UniverseText: All families where "less than $35,000" was the answer for FINC35

SkipInstructions: <1,2,R,D> [goto HOUSEOWN]

2007 NHIS Questionnaire - Family

Family Income

Question ID: FIN.270_00.000 Instrument Variable Name: FINC100 QuestionnaireFileName: Family

QuestionText: Was your total [fill1: /family] income from all sources less than $100,000 or $100,000 or more?

1 Less than $100,000

2 $100,000 or more

7 Refused

9 Don't know

UniverseText: All families where "$50,000 or more" was the answer for FINC50

SkipInstructions: <1> [goto FINC75]

<2,R,D> [goto HOUSEOWN]

Question ID: FIN.275_00.000 Instrument Variable Name: FINC75 QuestionnaireFileName: Family

QuestionText: Was your total [fill1: /family] income from all sources less than $75,000 or $75,000 or more?

1 Less than $75,000

2 $75,000 or more

7 Refused

9 Don't know

UniverseText: All families where "$50,000 or more" was the answer for FINC50

SkipInstructions: <1,2,R,D> [goto HOUSEOWN]

Revised Cellular Phone Questions (moved from Recontact to Coverage Section)

Module 02

Section Name Coverage

Part

Question ID COV.330

Variable Name TELENUM

Universe [POS2 ne 0 and START = Proceed (1)]

or

[MERGE = 1 and OUTCOME = 220 and START = P and LIVQRT ne null]

or

[LIVQRT = 1-6, 8-11 and ((OUTCOME = 220 and START = P) or (OUTCOME ne 213 - 290))]

or

[LIVQRT_SPECIFY ne null and ((OUTCOME = 220 and START = P) or (OUTCOME ne 213- 290))]

Universe-text

Question Text 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 (landline 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]

<N> [goto RH1LNGDY_1]

Hard Edits ERR_TELENUM

* Enter the entire telephone number.

* Please correct.

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 Is there at least one telephone INSIDE your home that is currently working and is not a cell phone?

Answer Codes 1. Yes

2. No

Don't Know

Refused

Question Type Yes/No

Field Pane Description Inside land line

Fill Instructions

Special Instructions

Skip Instructions <1, R, D> [goto RNOSERV]

<2> [goto RH1LNGDY_1]

Hard Edits

Soft Edits

AssocHelp H_CURWRK

Module 02

Section Name Coverage

Part

Question ID COV.332

Variable Name RNOSERV

Universe CURWRK = 1,R,D

Universe-text No phone in home that is working and not a cellular phone (or R,D to provide this information)

Question Text Not including cell phones, have your or your family been without telephone service for one week or more during the past 12 months? Do not include interruptions of phone service due to weather or natural disasters.

Answer Codes 1. Yes

2. No

Don't know

Refused

Question Type Yes/No

Field Pane Description No service-past 12 months

Fill Instructions

Special Instructions

Skip Instructions <1> [goto RH1LNGDY_1]

<2,R,D> [goto TELCEL]

Hard Edits

Soft Edits

AssocHelp

Module 02

Section Name Coverage

Part

Question ID COV.333_1

Variable Name RH1LNGDY_1

Universe TELENUM=N or CURWRK=2 or RNOSERV=1

Universe-text Respondents with no phone or who have no working land-line phone or who have been without land-line phone service for one week or more during the past 12 months.

Question Text Not including cell phones, how long were you or your family without telephone service in the past 12 months?

*Enter number for time without telephone service.

*If less than one week, enter ‘0’

Answer Codes

Question Type Integer

Field Pane Description How long-number

Fill Instructions

Special Instructions

Skip Instructions <1-365> [goto RH1LNGDY_2]

<0,R,D> [goto TELCEL]

Hard Edits

Soft Edits

AssocHelp H_RH1LNGDY

Module 02

Section Name Coverage

Part

Question ID COV.333_2

Variable Name RH1LNGDY_2

Universe RH1LNGDY_1 = 1-365

Universe-text Number given at RH1LNGDY_1

Question Text * Enter time period

Answer Codes 1. Days

2. Weeks

3. Months

Question Type Pick one answer list

Field Pane Description How long-time period

Fill Instructions

Special Instructions

Skip Instructions <1> if RH1LNGDY_1 ne 8-365, goto ERR1_RH1LNGDY_2

<2> if RH1LNGDY_1 ne 2-52, goto ERR2_RH1LNGDY_2

<3> if RH1LNGDY_1 ne 1 - 12, goto ERR3_RH1LNGDY_2

else, [goto TELCEL]

Hard Edits ERR1_RH1LNGDY_2

* Days should be in the range 8-365.

* Please correct

ERR2_RH1LNGDY_2

* Weeks should be in the range 2-52.

* Please correct.

ERR3_RH1LNGDY_2

* Months should be in the range 1-12.

* Please correct.

Soft Edits

AssocHelp H_RH1LNGDY

Module 02

Section Name COV

Part

Question ID COV.334

Variable Name TELCEL

Universe All families

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 CURWRK=1 and RNOSERV=1 [goto CELLOUT]; else if CURWRK=2 or (CURWRK=1 and RNOSERV=2,R,D) [goto NAME_FNAME (household composition section)]

Hard Edits

Soft Edits

AssocHelp

Module 21

Section Name REC

Part

Question ID REC.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

Question Type Integer

Field Pane Description # of cell phones

Fill Instructions

Special Instructions

Skip Instructions <1-10,R, D> if CURWRK=1 and RNOSERV=1 [goto CELLOUT]; else if CURWRK=1 and RNOSERV=2,R,D [goto PHONEUSE]; else if CURWRK=2 [goto NAME_FNAME]

Hard Edits

Soft Edits

AssocHelp

Module 02

Section Name COV

Part

Question ID REC.336

Variable Name CELLOUT

Universe (TELCEL = 2,R,D and CURWRK=1 and RNOSERV=1) or (WRKCEL=1-10,R,D and CURWRK=1 and RNOSERV=1)

Universe-text Families with no cell phone, or Ref/DK whether they had working cell phone and have a current working land-line that was out of service in the past 12 months, or who have a least one working cell phone or REF DK number of working cell phones and have current working land-line that was out of service in the past 12 months

Question Text During the most recent time you or your family were without telephone service, did you have a

working cell phone?

Answer Codes 1. Yes

2. No

Refused

Don’t know

Question Type Yes/No

Field Pane Description Working cell during outtage

Fill Instructions

Special Instructions

Skip Instructions <1,2,R,D> if TELCEL=1 [goto PHONEUSE]; else if TELCEL=2,R,D [goto NAME_FNAME]

Hard Edits

Soft Edits

AssocHelp

Module 02

Section Name COV

Part

Question ID REC.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 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

Question Type Pick one answer list

Field Pane Description Type of phone call

Fill Instructions

Special Instructions

Skip Instructions <1-3,R,D> [goto NAME_FNAME]

Hard Edits

Soft Edits

AssocHelp