Screening

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]

1. 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.

2. 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.

3. COUNT AND LIST

4. 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: __________

B. Introduction

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

C. Selection of Participant

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	|___|___|___| - |___|___|___| - |___|___|___|___|
DK	d
REF	r
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

C5. How many of the people living in this household are male?

MALES IN HOUSEHOLD	|___|___|
DK	d
REF	r

C6. How many are female?

FEMALES IN HOUSEHOLD	|___|___|
DK	d
REF	r

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)		M=MALE F=FEMALE	(SEE CODES )
		M F
		M F
		M F
		M F
		M F
		M F
		M F
		M F
		M F
		M F
		M F
		M F

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
DK	d
REF	r

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
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
REF	r

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
REF	r

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

	Number of Eligible Persons (entered in C13)
	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
DK	d
REF	r

IF R NOT AVAILABLE:

C18. When would be a good time for me to return to interview (you/ this person)?

SPECIFY DAY/TIME	____________________________
DK	d
REF	r

C19. What is (your/this person’s) first name?

NAME OF RESPONDENT	__________________________
DK	d
REF	r
IF SPEAKING WITH RESPONDENT, PROCEED TO MAIN INTERVIEW

C20. And what is (NAME’s) telephone number so I can call to confirm?

TELEPHONE NUMBER	|___|___|___| - |___|___|___| - |___|___|___|___|
DK	d
REF	r

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

FINAL 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

PENDING CODES

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

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

G. Interview Record of Actions

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ACF Draft 4, February 2007 3