STUDY OF COMMUNITY FAMILY LIFE
SCREENER
A. Verification of Addresses and Added Address Section
DIRECTIONS: THE PURPOSE OF THIS SECTION IS TO CHECK FOR MISSED ADDRESSES PRIOR TO SCREENING THE SAMPLED HOUSEHOLD.
SAMPLED ADDRESS NEXT ADDRESS WITHIN FRAME
_________________________ ___________________________
_________________________ ___________________________
PRE-IDENTIFIED PROBLEM: [STATISTICIANS WILL FILL ONE OF THE FOLLOWING]
1. NO PROBLEM HAS BEEN IDENTIFIED IN ADVANCE
2. APARTMENTS/CLUSTER HOMES/CONDOS/TRAILERS - RESIDENCES MAY NOT BE ARRANGED IN NUMERICAL ORDER
3. APARTMENTS/CLUSTER HOMES/CONDOS/TRAILERS WITH INCONSISTENT NUMBERING
4. NEXT ADDRESS IS THE SAME AS SAMPLED ADDRESS
SPECIAL INSTRUCTIONS: [STATISTICIANS WILL FILL ONE OF THE FOLLOWING]
CHECK FOR MISSED ADDRESSES ON OR IN THE PROPERTY OF THE SAMPLED ADDRESS. THEN CHECK FOR MISSED ADDRESSES BETWEEN THE SAMPLED ADDRESS AND THE NEXT ADDRESS.
LOOK AT THE MAIL BOXES TO DETERMINE IF “NEXT ADDRESS” IS PRESENT. LOOK FOR OTHER ADDRESSES THAT FALL NUMERICALLY (IF NOT GEOGRAPHICALLY) BETWEEN SAMPLED ADDRESS AND NEXT ADDRESS. ALSO LOOK FOR ADDRESSES THAT ARE NUMBERED DIFFERENTLY THAN THE REST.
COUNT AND LIST
THERE IS LIKELY TO BE A MISSING APT NUMBER IN EITHER THE SAMPLED ADDRESS OR THE NEXT ADDRESS. COUNT AND LIST/
A1. DID YOU FIND THE NEXT ADDRESS?
YES |
1 |
GO TO A2 |
NO |
2 |
GO TO PART B |
N/A |
3 |
GO TO PART B |
A2. DID YOU FIND AN ENTIRE MISSED STREET (I.E. A STREET THAT CROSSES PERPENDICULARLY BETWEEN THE SAMPLED ADDRESS AND THE NEXT ADDRESS)?
YES |
1 |
LIST UP TO SIX ADDRESS ON THAT MISSED STREET |
NO |
2 |
GO TO A3 |
A3. DID YOU FIND ANY MISSED ADDRESSES?
MISSED ADDRESSES INCLUDE ADDRESSES FOUND IN THE PREMISES OR ON THE PROPERTY OF THE SAMPLED ADDRESS OR BETWEEN THE SAMPLED ADDRESS.
YES |
1 |
GO TO THE ADDED RESIDENTIAL ADDRESSES REPORT AND RECORD INFORMATION THEN GO TO INTERVIEWER ASSESSMENT |
NO |
2 |
GO TO PART B |
INTERVIEWER ASSESSMENT (CIRCLE ALL THAT APPLY):
[TO BE DEVELOPED]
Added Residential Addresses Report
RECORD COMPLETE STREET ADDRESS OF ADDED RESIDENTIAL ADDRESS(ES).
(If you find any address between the sample address & the next address on the List of Addresses, contact ________________ for further guidance)
ADDED ADDRESS #1: STREET ADDRESS: _____________________________________________
TOWN: ___________________________________ ZIP CODE: _________
ADDED ADDRESS #2: STREET ADDRESS: _____________________________________________
TOWN: ___________________________________ ZIP CODE: _________
ADDED ADDRESS #3: STREET ADDRESS: ______________________________________________
TOWN: ___________________________________ ZIP CODE: _________
ADDED ADDRESS #4: STREET ADDRESS: ______________________________________________
TOWN: ___________________________________ ZIP CODE: __________
ADDED ADDRESS #5: STREET ADDRESS: ______________________________________________
TOWN: ___________________________________ ZIP CODE: _________
ADDED ADDRESS #6: STREET ADDRESS: ______________________________________________
TOWN: ___________________________________ ZIP CODE: __________
Hello, my name is _____ from RTI International in North Carolina. We are in your neighborhood conducting a study for the Administration for Children and Families. You should have received a letter explaining the study. We are asking for your help by participating in an important survey about family life in this community. Your household has been randomly selected to participate. HAND R COPY OF LETTER/ BROCHURE IF NEEDED.
B1. First, just let me verify: do you live here?
YES |
1 |
GO TO B2 |
NO |
2 |
ASK FOR ADULT RESIDENT. REPEAT INTRO. |
B2. IF NOT OBVIOUS: And are you 18 or older?
Yes |
1 |
GO TO B3 |
No |
2 |
ASK FOR ADULT RESIDENT. REPEAT INTRO. |
B3. I just need to verify — is this [READ COMPLETE ADDRESS INCLUDING CITY, STATE, AND ZIP]?
ADDRESS HERE
|
IS ADDRESS CORRECT?
YES |
1 |
GO TO B4 |
NO |
2 |
THANK R AND LOCATE CORRECT ADDRESS. |
B4. Are there any other occupied dwelling units or living quarters on this property or within these premises?
YES |
1 |
GO TO B5 |
NO |
2 |
GO TO B6 |
B5. Do these living quarters have the same mailing address (READ THE ADDESS LISTED IN B3)?
YES |
1 |
GO TO B6 |
NO |
2 |
CHANGE YOUR ANSWER TO B3 TO YES AND RECORD THIS NEW ADDRESS IN THE TABLE. THEN GO TO B6. |
B6. In order to verify the address list we used for this study, could you tell me: does anyone at this address have a residential Post Office Box?
YES |
1 |
GO TO C1 |
NO |
2 |
GO TO C1 |
C1. As mentioned, your mailing address is one of several from this area that has been randomly selected for this study about family life. The information you provide will be kept completely confidential and your participation in the study is voluntary.
In order to select a scientifically valid sample, I need to ask a few questions about the residents at this mailing address. Is there anyone living in this household who is between 18 and 49 years of age?
YES |
1 |
GO TO C3 |
NO |
2 |
GO TO C2 |
DK |
d |
|
REF |
r |
|
C2. Thank you! We are only interviewing persons between the ages of 18-49. So your household is not eligible for the study. So my supervisor may verify my work, may I please have your first name and telephone number?
FIRST NAME |
__________________________ |
|
TELEPHONE NUMBER |
|___|___|___| - |___|___|___| - |___|___|___|___| |
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DK |
d |
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REF |
r |
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END INTERVIEW |
||
C3. In total, how many people live in this household, including yourself? Please include children and anyone who spends at least 3 nights a week here.
NUMBER IN HOUSEHOLD |
|___|___| |
|
DK |
d |
|
REF |
r |
|
IF MORE THAN 9 RESIDENTS:
C4. Are all of these people related?
YES |
1 |
C5 |
NO |
2 |
THANK R AND CODE 141 – GROUP QUARTERS |
DK |
d |
|
REF |
r |
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C5. How many of the people living in this household are male?
MALES IN HOUSEHOLD |
|___|___| |
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DK |
d |
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REF |
r |
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C6. How many are female?
FEMALES IN HOUSEHOLD |
|___|___| |
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DK |
d |
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REF |
r |
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INTERIEWER: CHECK THAT THE NUMBER OF MALES AND FEMALES EQUAL THE TOTAL IN C3. IF NOT, REVIEW WITH RESPONDENT.
IF MALES IN HOUSEHOLD:
C7. In order to decide whom to interview, I need to make a list by age of the people who live here. What are the ages, from oldest to youngest, of all the males who live here? IF INFORMANT IS MALE: Please remember to include yourself.
IF LESS THAN ONE YEAR, CODE “00”
IF FEMALES IN HOUSEHOLD:
C8. What are the ages, from oldest to youngest, of the females who live here? IF INFORMANT IS FEMALE: Please remember to include yourself.
IF LESS THAN ONE YEAR, CODE “00”
A |
B |
C |
D |
ROSTER NUMBER |
Age |
Gender |
REASON EXCLUDED |
(SEE INSTRUCTION BELOW) |
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M=MALE F=FEMALE |
(SEE CODES ) |
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M F |
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M F |
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REASON
EXCLUDED 1
= Less than 18 years or older than 49 years 2
= Does not sleep here at least three nights/week 3
= Other (specify)_________________________
C9. I have listed...
INTERVIEWER: READ AGES AND GENDERS FROM ROSTER (E.G. MALE WHO IS 45)
REVIEW ROSTER FOR ACCURACY AND COMPLETENESS. MAKE NECESSARY CORRECTIONS.
C10. Is there anyone living at this address whom I have NOT listed?
PROBE: Do not include anyone who sleeps here less than three nights a week.
YES |
1 |
ADD PERSON TO ROSTER |
NO |
2 |
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DK |
d |
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REF |
r |
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C11. Just to confirm, is this primary place of residence for everyone I have listed? That is, do all of them sleep here at least three nights a week?
YES |
1 |
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NO |
2 |
FOR EACH INDIVIDUAL NOT ELIGIBLE FOR SELECTION, DRAW A LINE THROUGH HIS/HER DATA. RECORD REASON FOR EXCLUSION IN COLUMN D. |
DK |
d |
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REF |
r |
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C12. INTERVIEWER: CROSS-OUT ANY PERSONS WHO ARE 17 OR YOUNGER AND PERSONS WHO ARE 50 AND OLDER. CROSS-OUT ANY PERSONS WHO DO NOT SLEEP IN THE HOUSEHOLD AT LEAST THREE NIGHTS/WEEK.
C13. ASSIGN SEQUENTIAL ROSTER NUMBERS IN COLUMN A TO ALL ELIGIBLE RESIDENTS (THOSE WHO HAVE NOT BEEN CROSSED OUT).
ENTER THE TOTAL NUMBER OF ELIGIBLE RESIDENTS HERE:
C14. IF THE SCREENING RESPONDENT IS LISTED AS AN ELIGIBLE RESIDENT, RECORD ROSTER NUMBER HERE:
OR
IF THE SCREENING RESPONDENT (SR) IS NOT LISTED AS AN ELIGIBLE RESIDENT, CHECK
BELOW:
SR WAS EXCLUDED
C15. ARE THERE ELIGIBLE RESIDENTS LISTED ON THE ROSTER?
YES |
1 |
|
NO |
2 |
CODE 248 |
DK |
d |
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REF |
r |
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C16. USE THE TABLE BELOW TO SELECT THE RESPONDENT. CIRCLE THE NUMBER OF ELIGIBLE PERSONS IN THE FIRST ROW OF NUMBERS. DIRECTLY BELOW THE NUMBER OF ELIGIBLE PERSONS IS THE ROSTER NUMBER OF THE PERSON THAT SHOULD BE INTERVIEWED.
Respondent Selection Table
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Number of Eligible Persons (entered in C13) |
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1 |
2 |
3 |
4 |
5 |
6+ |
Interview Adult |
# |
# |
# |
# |
# |
# |
C17. I need to interview (INSERT SELECTED PERSON, E.G, THE MALE WHO IS 42) Is this person available? IF NUMBER IN HH = 1: Would that be you?
YES |
1 |
|
NO |
2 |
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DK |
d |
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REF |
r |
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IF R NOT AVAILABLE:
C18. When would be a good time for me to return to interview (you/ this person)?
SPECIFY DAY/TIME |
____________________________ |
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DK |
d |
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REF |
r |
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C19. What is (your/this person’s) first name?
NAME OF RESPONDENT |
__________________________ |
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DK |
d |
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REF |
r |
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IF SPEAKING WITH RESPONDENT, PROCEED TO MAIN INTERVIEW |
||
C20. And what is (NAME’s) telephone number so I can call to confirm?
TELEPHONE NUMBER |
|___|___|___| - |___|___|___| - |___|___|___|___| |
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DK |
d |
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REF |
r |
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D. Screening Verification
D1. So that my supervisor may verify my work, may I please have your first name and telephone number?
FIRST NAME OF SCREENING RESPONDENT_____________________________
TELEPHONE NUMBER: (______) _________-_____________
E. Event Codes
Screening Event Codes
PENDING CODES
110 Lead
Letter Mailed
118 May
be occupied
119 Access
denied
120 No
one home
121 Adult
resident not at home
122 Adult
resident unavailable
130 Appointment
made by adult resident
132 Appointment
made by non-adult resident or non-resident
140 Vacant
141 Group
Quarters (GQ)
142 Military
ONLY
143 Not
a primary residence
144 Not
a residential address
160 Refusal
LEAVE
DOOR OPEN FOR A RETURN VISIT; DISCUSS WITH FS
170 Language
barrier: Spanish IF
YOU ARE NOT A CERTIFIED BILINGUAL FI,
CONTACT
YOUR FS
171 Language
barrier: Other
175 Physically/mentally
incapable
180 Unable
to locate address TRY
POST OFFICE OR INTERNET TOOLS VIA FS
189 Other/specify
219 Access
denied
220 No
one at address/repeated attempts
222 Adult
Resident unavailable/not at home/repeated attempts
240 Vacant
GET
VERIFICATION INFORMATION FROM APT. OFFICE, NEIGHBOR,
REAL
ESTATE AGENT, POST OFFICE WORKER, ETC.
241 Group
quarters (GQ)
242 Military
ONLY
243 Not
primary residence
244 Not
a residential address
248 No
one 18-49 at address
260 Refusal
271 Language
barrier: Other
275 Physically/mentally
incapable
280 Unable
to locate address
289 Other/specify
291 Screening
Complete: One selected for interview
PROCEED TO INTERVIEW
EVENT
CODES
Interview Event Codes
319 Access
denied
320 No
one home
321 Respondent
not at home
322 Respondent
unavailable
330 Appointment
made by Respondent
332 Appointment
made by Other
335 Appointment
broken
336 Breakoff—No
appointment made
360 Refusal
by Respondent LEAVE
DOOR OPEN FOR A RETURN VISIT;
DISCUSS
WITH FS
362 Refusal
by other
365 Refusal/Breakoff
370 Language
barrier—Spanish
USE WHEN INTERVIEW NEEDS TO BE
CONDUCTED
IN SPANISH
371 Language
barrier—Other
375 Physically/mentally
incapable
377 Respondent
Incarcerated
378 Respondent
Institutionalized
380 Respondent
unlocatable
389 Other
FINAL CODES
419 Access
denied
420 No
one home after repeated attempts
422 Respondent
unavailable after repeated attempts
423 Respondent
unavailable during interview period
450 Respondent
ineligible
459 Deceased
460 Final
refusal by Respondent
462 Final
refusal by other
471 Language
barrier—Other
475 Physically/mentally
incapable
477 Respondent
incarcerated
478 Respondent
institutionalized
481 Respondent
no longer at address
489 Other
noninterview
490 Breakoff/partial
interview
491 Interview
Complete
F. Screening Record of Actions
Time |
Day |
Date |
Description |
Event Code |
Next Step |
FI ID No. |
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G. Interview Record of Actions
Time |
Day |
Date |
Description |
Event Code |
Next Step |
FI ID No. |
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ACF
Draft 4, February 2007
| File Type | application/msword |
| Author | dac |
| Last Modified By | mfucello |
| File Modified | 2007-02-26 |
| File Created | 2007-02-26 |