Attachment 2:
Screening and locating text
OMB Number 0920-0406
Expiration date 11/30/07
2007 SATH SCREENER
SCREENER PART 1: LOCATE 2001 CSHCN RESPONDENT
According to the Paperwork Reduction Act (PRA) of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 0920-0406. The time required to complete this information collection is estimated to average 3 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments about the accuracy of the time estimate(s) or suggestions for improving this form please write to: CDC Reports Clearance Officer, 1600 Clifton Road, MS-D74, Atlanta, GA 30333; call 404-639-4604; or send an email to [email protected].
The Public Health Service Act is Volume 42 of the US Code, Section 242k. The collection of information in this survey is authorized by Section 306 of this Act. The confidentiality of your responses is assured by Section 308d of this Act, and by the Confidential Information Protection and Statistical Efficiency Act.
Data collection is conducted under contract to the CDC by the National Opinion Research Center (NORC) at the University of Chicago.
INTRO_1 Hello, my name is ________________. I'm calling on behalf of the Centers for Disease Control and Prevention. May I please speak to someone who is 18 years of age or older?
YES, I AM ≥ 18 YO ………………………………….. 1 [GO TO INTRO_1A]
THIS IS A BUSINESS………………………………… 2 [GO TO PH_CONF]
NEW PERSON COMES TO PHONE……………….. 3 [GO TO INTRO_1]
LANGUAGE BARRIER
(ANY LANGUAGE OTHER THAN ENGLISH) …… 4 [GO TO TERM_BRIEF]
NO PERSON AT HOME WHO IS OVER 17 ……... 5 [GO TO S2_B]
OUT OF SCOPE 6 [GO TO THANK_YOU_OOS]
HHM ENDED CALL 7 [GO TO UNIVERSAL EXIT-T1]
ANSWERING MACHINE 8 [GO TO MSG_PENDING SCREENED]
R WILL CALL 800 LINE/VERIFY WEBSITE 9 [GO TO M1_NAME_WEB_ADD]
R ASKS FOR LETTER-MAILED 10 [GO TO UNIVERSAL EXIT-M1_NAME]
R ASKS FOR LETTER-EMAILED 11 [GO TO UNIVERSAL EXIT M1_EMAIL]
SUPERVISOR REVIEW 12 [GO TO CALL NOTES BOX]
(RAISE YOUR HAND TO GET PERMISSION BEFORE USING THIS CODE)
REFUSED …………………………………………… 99 [GO TO TERM_BRIEF]
SALZ_BUS We are interviewing only private residences. Thank you very much.
[TERMINATE INTERVIEW]
S2_B Does anyone live in your household who is over 17 years old?
YES 1 GO TO [BLANK] SCRIPT SHOWN BELOW
NO 2 GO TO PH_CONF
[BLANK] Thank you, we’ll try back another time.
PH_CONF Before I go, I’d like to confirm the phone number I have dialed. Is this area code [FILL PHONE]?
YES 1 [GO TO PH_TIME]
NO 2 [GO TO NEWPHONE]
NUMBER HAS CHANGED/
NUMBER FORWARDED 3 [GO TO NEWPHONE]
REFUSED ……………………………………………...4 [GO TO TERM_TY]
NEWPHONE Can you tell me what number I have reached?
NNN-NNN-NNNN [GO TO PH_TIME]
PH_TIME How many years have you had this telephone number (FILL “XXX-XXX-XXXX)?
LESS THAN FOUR YEARS [GO TO TERM_TY]
MORE THAN FOUR YEARS [GO TO TERM_TY ]
TERM_TY Those are all the questions I have. I’d like to thank you on behalf of the Centers for Disease Control and Prevention for the time and effort you’ve spent answering these questions. (If you would like more information about the Survey of Adult Transition and Health, please call the study's toll-free number, XXX-XXX-XXXX.)
INTRO_1A In (INTDATE-YYYY), we conducted a nationwide telephone study on children’s health with an adult at this phone number about a child who was between the ages of 14-17 years of age at the time. This child would now be approximately [FILL AGE] years old. The Centers for Disease Control and Prevention is now interested in speaking to this [FILL AGE]-year old’s [FILL RELATION] again. This study is authorized by the U.S. Public Health Service Act. It and other federal laws require us to protect your information and keep it private.
Is [he/she] available?
HUNG UP DURING INTRO 1 [GO TO UNIVERSAL EXIT-T1]
YES, CURRENTLY SPEAKING WITH HIM/HER 2 [GO TO INTRO_2001R]
YES, 2001 R COMES TO THE PHONE 3 [GO TO INTRO_2001R]
YES, 2001 R IS AVAILABLE BUT NEEDS THE IWER
TO CALL BACK SO R CAN SWITCH TO TTY 4 [GO TO RELAYNOW]
THIS PERSON NEEDS THE INTERVIEWER TO
CALL BACK LATER AND CONDUCT THE INTERVIEW
USING TTY 5 [GO TO RELAYNOW]
LANGUAGE BARRIER
(ANY LANGUAGE OTHER THAN ENGLISH) 7 [GO TO TERM_BRIEF]
NO SUCH PERSON AT THIS NUMBER 8 [GO TO PHONE_01INFO]
NO, THE PERSON YOU NEED TO SPEAK WITH IS
NOT AVAILABLE. 9 [GO TO REACH_CB]
NO, 2001 R HAS MOVED 10 [GO TO 2001R_CONT]
NO, 2001 RESPONDENT IS HOSPITALIZED,
INSTITUTIONALIZED OR INCARCERATED 11 [GO TO TERM_TY]
NO, 2001 RESPONDENT IS DECEASED 12 [GO TO F1Q]
NO, 2001 RESPONDENT IS SERVING IN THE MILITARY
OR LIVING OUTSIDE USA 13 [GO TO TERM_TY]
NO, THE PERSON DOES NOT KNOW HOW TO CONTACT
THE 2001 R 14 [GO TO REACH_5]
PERSON WANTS TO VERIFY THE LEGITIMACY OF
THE SURVEY OR NEEDS ADDITIONAL
INFORMATION 15 [GO TO UE-1_NAME_WEB]
R KNOWS 2 OR MORE POSSIBLE 2001 RESPONDENTS
WHO LIVE OR USED TO LIVE AT THIS NUMBER…16 [GO TO DOB_PROBE]
------------------SPACE---------------------
IF VOLUNTEERED: YOUTH IS SERVING IN THE MILITARY,
INCARCERATED OR LIVING OUTSIDE USA 17[GO TO WEB_OFFER]
IF VOLUNTEERED: YOUTH DOES NOT HAVE ANY CONTACT INFO
(HOMELESS, ETC.)… 18 [GO TO REACH_5]
IF VOLUNTEERED: YOUTH IS DECEASED 19 [GO TO F1Q_Y]
DON’T KNOW 77 [GO TO REACH_5]
REFUSED 99 [GO TO TERMINATE AFTER RC ATTEMPT]
RELAYNOW I have to call into the TTY machine to continue this interview. I will call you back in less than five minutes at [FILL SAMPLED PHONE XXX-XXX-XXXX]. Please stay by your TTY machine for the next five minutes. Thank you, and good bye.
RELAYCBK. When would be a good time to call back to reach you using RELAY?
__ __ : __ __
(1) AM
(2) PM
(3) NOON
(4) MIDNIGHT
(7) DON’T KNOW
(9) REFUSED
PHONE_
01INFO Do you know the person that had this phone number in 2001?
YES 1 GO TO 2001R_CONT
NO 2 GO TO PH_CONF
REACH_5 Do you know who else I can contact who might know this [FILL AGE_CALC] year-old’s / [FILL AGE_CALC] year-old’s [RELATION] contact information?
YES 1[GO TO LEAD_REACH_01
IF 2001 R LEAD; LEAD_REACH_Y IF YOUTH LEAD]
NO 2 [GO TO PH_CONF]
DON’T KNOW 77 [GO TO PH_CONF]
REFUSED 99 [GO TO PH_CONF]
REACH_CB When would be a good time to call back to reach (an adult) at this telephone number who would know of anyone who lives or used to live at this telephone number that is currently 19 to 23 years old?
__ __ : __ __
(1) AM
(2) PM
(3) NOON
(4) MIDNIGHT
(7) DON’T KNOW
(9) REFUSED
FILL CONTACT NAME AT APPOINTMENT SCREEN IF R WILL PROVIDE IT.
F1Q I’m sorry to hear that (FILL SEX-HE/SHE) passed away. Please accept my condolences.
ON-SCREEN HELP HERE FOR TRANSITION
[GO TO YOUTH_CONT]
F1Q_Y I’m sorry to hear that (FILL SEX-HE/SHE) passed away. I was calling about a study we are conducting for the Centers for Disease Control and Prevention but I will not need to continue. When did (FILL SEX-HE/SHE) pass away?
MMDDYYYY
(77) DK
(99) REF
[GO TO TERM_DTH]
TERM_DTH Thank you, and please accept my condolences. Goodbye.
DOB_
PROBE The person with whom I would like to speak would be the [FILL RELATION] of a [FILL MALE/FEMALE] child born on [FILL DOB-MMMDDYYYY]. Do you know who this might be?
TRAINING POINT: FAQ ABOUT HOW WE HAVE DOB AND WHY WE NEED TO CONFIRM IT
YES 1 [GO TO 2001R_CONT]
DON”T KNOW 77 [GO TO REACH_CB]
OMB Number 0920-0406
Expiration date 11/30/07
PATH TO COLLECT POSSIBLE 2001 RESPONDENT’S CONTACT INFORMATION
According to the Paperwork Reduction Act (PRA) of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 0920-0406. The time required to complete this information collection is estimated to average 3 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments about the accuracy of the time estimate(s) or suggestions for improving this form please write to: CDC Reports Clearance Officer, 1600 Clifton Road, MS-D74, Atlanta, GA 30333; call 404-639-4604; or send an email to [email protected].
The Public Health Service Act is Volume 42 of the US Code, Section 242k. The collection of information in this survey is authorized by Section 306 of this Act. The confidentiality of your responses is assured by Section 308d of this Act, and by the Confidential Information Protection and Statistical Efficiency Act.
Data collection is conducted under contract to the CDC by the National Opinion Research Center (NORC) at the University of Chicago.
2001R_CONT Could you please tell me the name of this [FILL CURRENT AGE] child’s [FILL RELATION]?
INTERVIEWER INSTRUCTION: IF R NOT COMFORTABLE PROVIDING NAME, ACCEPT INITIALS.
YES 1 [GO TO 2001R_NAME_A]
NO 2 [GO TO 2001R_NAME_D]
DON’T KNOW 3 [GO TO 2001R_NAME_D]
REFUSED 4 [GO TO 2001R_NAME_D]
2001R_NAME_A What is the [FILL RELATION]’s first name?
FIRST______________________________________________
2001R_NAME_B What is the [FILL RELATION]’s middle name?
MIDDLE_____________________________________________
2001R_NAME_C What is the [FILL RELATION]’s last name?
LAST_______________________________________________
2001R_NAME_D Does the [FILL RELATION] have a nickname, initials or another name that they may prefer?
NICKNAME/OTHER NAME__________________
2001R_PH Could you please tell me (FILL 2001 R_NAME_A OR FILL 2001 R_NAME_D if given)’s (FILL BLANK OR second…ninth) phone number?
YES 1 [RECORD phone number(s) IN 2001R_PH_X]
NO 2 [GO TO 2001 R_EM_X]
DON’T KNOW 77 [GO TO 2001 R_EM_X]
REFUSED 99 [GO TO 2001 R_EM_X]
2001R_
PH_X
2001 R PHONE NUMBER COLLECTION SCREEN
XXX-XXX-XXXX [GO TO 2001 R_PH_CONF]
2001R_PH_
CONF Is that a cellular telephone number?
YES 1 [GO TO 2001R_CONFHH]
NO 2 [GO TO 2001R_CONFHH]
DON’T KNOW 77 [GO TO 2001R_CONFHH]
REFUSED 99 [GO TO 2001R_CONFHH]
2001R_
CONFHH Is that number a private residence?
YES [GO TO 2001R_PH_LOOP]
NO [GO TO 2001R_PH_LOOP]
DON’T KNOW [GO TO 2001R_PH_LOOP]
REFUSED [GO TO 2001R_PH_LOOP]
2001R_PH_
LOOP Does (FILL 2001 R_NAME_A OR FILL 2001 R_NAME_D if given) have another phone number where (he/she) can be reached?
YES [GO TO NEXT 2001 R_PH]
NO [GO TO 2001R_EM_X]
DON’T KNOW [GO TO 2001R_EM_X]
REFUSED [GO TO 2001R_EM_X]
2001R
_EM_X Could you please tell me (FILL 2001 R_NAME_A OR FILL 2001 R_NAME_D if given)’s (FILL BLANK OR second…ninth) electronic mail or e-mail addresses?
YES 1 [RECORD E-MAIL ADDRESS ELEMENTS IN 2001R_MAIL_1 TO 2001R_EMAIL_9]
NO 2 [GO TO 2001R_AD_X]
DON’T KNOW 77 [GO TO 2001R_AD_X]
REFUSED 99 [GO TO 2001R_AD_X]
2001R_
EMAIL_1
through
2001R_
EMAIL_9 EMAIL ADDRESS COLLECTION SCREEN
____________________________ @ ______________________________._______
2001R_EM_ Is this email address for personal, business or school use?
CONF
PERSONAL 1 [GO TO 2001R_EM_LOOP]
BUSINESS 2 [GO TO 2001R_EM_LOOP]
SCHOOL USE 3 [GO TO 2001R_EM_LOOP]
DON’T KNOW 77 [GO TO 2001R_EM_LOOP]
REFUSED 99 [GO TO 2001R_EM_LOOP]
2001R_EM_
LOOP Does (FILL 2001 R_NAME_A OR FILL 2001 R_NAME_D if given) have another email address where (he/she) can be reached?
YES [GO TO NEXT 2001R_EM_X]
NO [GO TO 2001R_AD_X]
DON’T KNOW [GO TO 2001R_AD_X]
REFUSED [GO TO 2001R_AD_X]
2001R_AD
_X Could you please tell (FILL 2001 R_NAME_A OR FILL 2001 R_NAME_D if given)’s [FILL BLANK OR second…ninth] street address or addresses [IF 2001RPH_1 through 2001RPH_9 not equal null then FILL in case we cannot reach them by phone]?
YES 1 [GO TO 2001R_AD_ST_X]
NO 2 [CONF_INTRO_01R]
DON’T KNOW 77 [CONF_INTRO_01R]
REFUSED 99 [CONF_INTRO_01R]
2001R_AD_
ST_X What is the street address?
______________________________________________
2001R _AD_
APT_X What is the apartment number?
APT #________
2001R _AD_
CITY_X What is the city and state?
CITY__________________
2001R _AD_
STATE_X State Dropdown Menu
2001R _AD_ What is the zip code?
ZIP_X ZIP_________________ [GO TO 2001RCONYHH]
2001R
CONYHH Is that address a private residence?
YES [GO TO 2001R_AD_LOOP]
NO [GO TO 2001R_INST]
DON’T KNOW [GO TO CONF_INTRO_01R]
REFUSED [GO TO CONF_INTRO_01R]
2001R_
INST Can you describe the type of residence?
UNVERSITY/COLLEGE HOUSING (DORM) 1 [GO TO 2001R_AD_LOOP]
MILITARY BASE 2 [GO TO 2001R_AD_LOOP]
PRISON 3 [GO TO 2001R_AD_LOOP]
OTHER INSTITUTION 4 [GO TO 2001R_AD_LOOP]
DON’T KNOW 77 [GO TO 2001R_AD_LOOP]
REFUSED 99 [GO TO 2001R_AD_LOOP]
2001R_AD_
LOOP Does (FILL 2001 R_NAME_A OR FILL 2001 R_NAME_D if given) have another address where (he/she) can receive mail?
YES [GO TO NEXT 2001R_AD_X]
NO [GO TO CONF_INTRO_01R]
DON’T KNOW [GO TO CONF_INTRO_01R]
REFUSED [GO TO CONF_INTRO_01R]
CONF_INTRO_
01R I would like to confirm that I have the correct information for the person that we’ll be contacting.
[INTERVIEWER: CONFIRM ALL NAMES AND SPELLINGS WITH THE RESPONDENT. IF LAST NAMES ARE THE SAME, MAKE SURE THEY HAVE THE SAME SPELLING.]
CONF_NAME_
01R
The name I have for this person is [FILL NAME OF FROM 2001RNAME_A- 2001R_NAME_D].
Is this correct?
YES 1 [GO TO
2001R_FUTCONT
NO 2 [GO TO 2001R_CONT AND CORRECT]
2001R FUTCONT
May we contact you again if we have problems contacting this person who may have completed the 2001 interview?
YES 1 [GO TO FUTCONTNAME]
NO 2 [GO TO PH_CONF]
DON’T KNOW 77 [GO TO PH_CONF]
REFUSED 99 [GO TO PH_CONF]
FUTCONT
NAME What is your name?
NAME_________________________ [GO TO PH_CONF]
OMB Number 0920-0406
Expiration date 11/30/07
SCREENER PART 2:
OBTAIN CONTACT INFORMATION FOR SATH-ELIGIBLE RESPONDENT
FROM THE 2001 CSHCN RESPONDENT
DETERMINE IF PROXY RESPONDENT IS NEEDED TO COMPLETE THE 2007 SATH
According to the Paperwork Reduction Act (PRA) of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 0920-0406. The time required to complete this information collection is estimated to average 3 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments about the accuracy of the time estimate(s) or suggestions for improving this form please write to: CDC Reports Clearance Officer, 1600 Clifton Road, MS-D74, Atlanta, GA 30333; call 404-639-4604; or send an email to [email protected].
The Public Health Service Act is Volume 42 of the US Code, Section 242k. The collection of information in this survey is authorized by Section 306 of this Act. The confidentiality of your responses is assured by Section 308d of this Act, and by the Confidential Information Protection and Statistical Efficiency Act.
Data collection is conducted under contract to the CDC by the National Opinion Research Center (NORC) at the University of Chicago.
INTRO_
2001R (NOTE: Text in parentheses will appear if speaking with 2001 R. If 2001 R is deceased, text in parentheses will be omitted.)
In [INTDATE-YYYY] we conducted a nationwide children’s health care telephone study (with you) about a [FILL AGE] __ __ year-old child in your household. (Thank you for participating in the 2001interview.) The Centers for Disease Control and Prevention would like to add to the information (you) provided in 2001 by speaking to (this/your) child about [FILL SEX-his/her] current heath care. This child would now be [FILL AGE_CALC= ‘INTDATE MINUS DOB’ PLUS ‘CURRENTINTDATE-INTDATE’ = CURRENT AGE IN 2007’]. In appreciation, we’d like to offer [FILL SEX-him/her] $20. [FILL SEX-He/She] can be interviewed by phone, or complete the survey on the Internet. This study is authorized by the U.S. Public Health Service Act. It and other federal laws require us to protect your information and keep it private. (I’d like to continue unless you have any questions.)
INTERVIEWER INSTRUCTION: IF NO QUESTIONS, ASK THE FOLLOWING:
Can you tell me how to get in touch with this [FILL AGE_CALC]-year old?
HUNG UP DURING INTRO 1 [GO TO UE-T1]
YES, YOUTH COMES TO PHONE 2 [GO TO NEW_RESP (QUEX INTRO)]
YES, YOUTH IS OUTSIDE OF SAMPLED HH 3 [GO TO YOUTH_CONT]
YES, TWO OR MORE PEOPLE THAT AGE LIVE
OR USED TO LIVE AT THIS NUMBER 4 [GO TO DOB_PROBE_Y]
YES, YOUTH IS AVAILABLE BUT NEEDS THE IWER
TO CALL BACK SO R CAN SWITCH TO TTY 5 [GO TO RELAYNOW]
YES, YOUTH IS AVAILABLE BUT NEEDS
CURRENT RESPONDENT TO INTERPRET 6 [GO TO NEW_RESP]
NO SUCH PERSON AT THIS NUMBER 7 [GO TO REACH_5]
NO, THE PERSON YOU NEED TO SPEAK WITH IS
NOT AVAILABLE. 8 [GO TO REACH_SC_AGE]
NO, YOUTH HAS MOVED 9 [GO TO YOUTH_CONT]
NO, THE PERSON DOES NOT KNOW HOW TO CONTACT
THE YOUTH 11 [GO TO REACH_5]
NO, YOUTH IS HOSPITALIZED,
INSTITUTIONALIZED OR INCARCERATED 12 [GO TO PROXY_SCR]
NO, YOUTH IS INCAPABLE 13 [GO TO DIFF_Q]
NO, YOUTH IS SERVING IN THE MILITARY OR
LIVING OUTSIDE USA…. 13 [GO TO WEB_OFFER]
NO, YOUTH IS DECEASED 14 [GO TO F1Q_Y]
PERSON WANTS TO VERIFY THE LEGITIMACY OF
THE SURVEY OR NEEDS ADDITIONAL
INFORMATION 15 [GO TO UE-1_NAME_WEB]
DON’T KNOW 77 [GO TO REACH_5]
REFUSED 99 [GO TO TERMINATE AFTER RC ATTEMPT]
DOB_
PROBE_Y The person I would like to speak with was born on [FILL DOB-MMMDDYYYY]. Do you know who this might be?
TRAINING POINT: FAQ ABOUT HOW WE HAVE DOB AND WHY WE NEED TO CONFIRM IT.
YES 1 [GO TO INTRO_2001R “Can you tell me how to get in touch with…?”]
Don’t Know 77 [GO TO REACH_5]
REACH_SC_AGE
When would be a good time to call back to reach the [FILL AGE]-year-old?
__ __ : __ __
(1) AM
(2) PM
(3) NOON
(4) MIDNIGHT
(7) DON’T KNOW
(9) REFUSED
DIFF_Q What difficulty does [FILL HE/SHE] have that prevents [FILL him/her] from participating?
Hearing difficulty 1 [GO TO WEB_OFFER; IF
WEB DECLINED, GO TO
RELAY, RELAY DECLINED
GO TO PROXY_SCR]
Speech difficulty 2 [GO TO WEB_OFFER]
Cognitive barrier 3 [GO TO PROXY_SCR]
Physical barrier 4 [GO TO WEB_OFFER]
DK 77 [GO TO WEB_OFFER]
REFUSED 99 [GO TO PROXY_SCR]
WEB_OFFER
We have a web-based survey available. [FILL: Would you like to /Can they] complete the survey using the web?
YES 1 [GO TO WEB OPTION]
NO 2 [GO TO PROXY_SCR]
PROXY_SCR
Is the person who makes the majority of the decisions about the [FILL AGE]-year old’s health care available?
YES, CURRENTLY ON PHONE 1 [START PROXY_INT]
YES, YOUTH MAKES OWN DECISIONS 2 [GO TO WEB_OFFER]
NO, NOT AVAILABLE 3 [GO TO REACH_PROX]
REACH_
PROX Can you tell me how I could contact the person who makes the majority of the decisions about the [FILL AGE]-year old’s health care?
YES 1 [GO TO PROX_NAME_A]
NO 2 [GO TO PH_CONF]
DON’T KNOW 77 [GO TO PH_CONF]
REFUSED 99 [GO TO PH_CONF]
PROX_NAME_A What is first name of this person who makes these decisions?
FIRST______________________________________________
PROX_NAME_B What is their middle name?
MIDDLE_____________________________________________
PROX_NAME_C What is their last name?
LAST_______________________________________________
PROX_NUM Could you please tell me this person’s telephone number?
YES 1 [RECORD phone number(s) IN PROX_PH_X]
NO 2 [GO TO PH_CONF]
DON’T KNOW 77 [GO TO PH_CONF]
REFUSED 99 [GO TO PH_CONF]
PROX_PH_X
PROXY PHONE NUMBER COLLECTION SCREEN
XXX-XXX-XXXX [GO TO PROXY_PH_CONF]
PROX_PH_
CONF Is that a cellular telephone?
YES 1 [GO TO PROX_CONFHH]
NO 2 [GO TO PROX_CONFHH]
DON’T KNOW 77 [GO TO PROX_CONFHH]
REFUSED 99 [GO TO PROX_CONFHH]
PROX_
CONFHH Is that number a private residence?
YES [GO TO PROX_PH_LOOP]
NO [GO TO PROX_PH_LOOP]
DON’T KNOW [GO TO PROX_PH_LOOP]
REFUSED [GO TO PROX_PH_LOOP]
PROX_PH_
LOOP Does (FILL 2001 R_NAME_A OR FILL 2001 R_NAME_D if given) have another phone number where (he/she) can be reached?
YES [GO TO NEXT PROX_PH_X]
NO [GO TO PH_CONF]
DON’T KNOW [GO TO PH_CONF]
REFUSED [GO TO PH_CONF]
OMB Number 0920-0406
Expiration date 11/30/07
SCREENER PART 3:
COLLECT ELIGIBLE ADULT (2007 RESPONDENT) IDENTIFIERS
& LOCATING INFORMATION
According to the Paperwork Reduction Act (PRA) of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 0920-0406. The time required to complete this information collection is estimated to average 3 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments about the accuracy of the time estimate(s) or suggestions for improving this form please write to: CDC Reports Clearance Officer, 1600 Clifton Road, MS-D74, Atlanta, GA 30333; call 404-639-4604; or send an email to [email protected].
The Public Health Service Act is Volume 42 of the US Code, Section 242k. The collection of information in this survey is authorized by Section 306 of this Act. The confidentiality of your responses is assured by Section 308d of this Act, and by the Confidential Information Protection and Statistical Efficiency Act.
Data collection is conducted under contract to the CDC by the National Opinion Research Center (NORC) at the University of Chicago.
YOUTH_CONT I’d like to collect a few pieces of information in order to contact this [FILL AGE]- year old. Could you please tell me the name of the young adult?
INTERVIEWER INSTRUCTION: IF R NOT COMFORTABLE PROVIDING NAME, ACCEPT INITIALS.
YES 1 [GO TO YOUTH_NAME_A]
NO 2 [GO TO YOUTH_NAME_D]
DON’T KNOW 3 [GO TO YOUTH_NAME_D]
REFUSED 4 [GO TO YOUTH_NAME_D]
YOUTH_NAME_A What is the young adult’s first name?
FIRST______________________________________________
YOUTH_NAME_B What is the young adult’s middle name?
MIDDLE_____________________________________________
YOUTH_NAME_C What is the young adult’s last name?
LAST_______________________________________________
YOUTH_NAME_D Does the young adult have a nickname, initials or another name that they may prefer? NICKNAME/OTHER NAME__________________
YOUTH_PH Could you please tell me (FILL YOUTH_NAME_A OR FILL YOUTH_NAME_D if given)’s (FILL BLANK or second…ninth) phone number?
YES 1 [RECORD phone number(s) IN YPH_1 TO YPH_9]
NO 2 [GO TO YOUTH_EM_X]
DON’T KNOW 77 [GO TO YOUTH_EM_X]
REFUSED 99 [GO TO YOUTH_EM_X]
YPH_X YOUTH PHONE NUMBER COLLECTION SCREEN
XXX-XXX-XXXX [GO TO YOUTH_PH_CONF]
ADD PROBE: IS THERE A GOOD TIME TO CALL [FILL YOUTH_NAME_A]?
IF YES, SELECT APPOINTMENT SCREEN
YOUTH_PH_
CONF Is the phone number that you’ve just given me a cellular telephone?
YES 1 [GO TO YCONFHH]
NO 2 [GO TO YCONFHH]
DON’T KNOW 77 [GO TO YCONFHH]
REFUSED 99 [GO TO YCONFHH]
YCONFHH Is that number a private residence?
YES [GO TO YOUTH_PH_LOOP]
NO [GO TO YOUTH_PH_LOOP]
DON’T KNOW [GO TO YOUTH_PH_LOOP]
REFUSED [GO TO YOUTH_PH_LOOP]
YOUTH_PH_
LOOP Does (FILL YOUTH_NAME_A OR FILL YOUTH_NAME_D if given) have another phone number where (he/she) can be reached?
YES [GO TO NEXT YOUTH_PH]
NO [GO TO YOUTH_EM_X]
DON’T KNOW [GO TO YOUTH_EM_X]
REFUSED [GO TO YOUTH_EM_X]
YOUTH_EM
_X Could you please tell me (FILL SEXHIS/HER) (FILL BLANK OR second…ninth) electronic mail or e-mail addresses?
YES 1 [RECORD E-MAIL ADDRESS ELEMENTS IN YEMAIL_1 TO YEMAIL_9]
NO 2 [GO TO YOUTH_AD_X]
DON’T KNOW 77 [GO TO YOUTH_AD_X]
REFUSED 99 [GO TO YOUTH_AD_X]
YEMAIL_X
EMAIL ADDRESS COLLECTION SCREEN
____________________________ @ ______________________________._______
YOUTH_EM_ Is this an email address for personal, business or school use?
CONF
PERSONAL 1 [GO TO YOUTH_EM_LOOP]
BUSINESS 2 [GO TO YOUTH_EM_LOOP]
SCHOOL USE 3[GO TO YOUTH_EM_LOOP]
DON’T KNOW 77 [GO TO YOUTH_EM_LOOP]
REFUSED 99 [GO TO YOUTH_EM_LOOP]
YOUTH_EM_
LOOP Does (FILL YOUTH_NAME_A OR FILL YOUTH_NAME_D if given) have another email address where (he/she) can be reached?
YES [GO TO NEXT YOUTH_EM_X]
NO [GO TO YOUTH_AD_X]
DON’T KNOW [GO TO YOUTH_AD_X]
REFUSED [GO TO YOUTH_AD_X]
YOUTH_
AD_X Could you please tell me (HIS/HER) street address or mailing address [IF YPH_X not equal null then FILL “in case we cannot reach them by phone”]?
YES 1 [GO TO YOUTH_AD_ST_X]
NO 2 [GO TO CONF_INTRO]
DON’T KNOW 77 [GO TO CONF_INTRO]
REFUSED 99 [GO TO CONF_INTRO]
YOUTH_AD_
ST_X What is the young adult’s street address or mailing address?
______________________________________________
YOUTH_AD
APT_X What is the young adult’s apartment number?
APT #________
YOUTH_AD_
CITY_X What is the young adult’s city and state?
CITY__________________
YOUTH_AD_
STATE_X State Dropdown Menu
YOUTH_AD_ What is the young adult’s zip code?
ZIP_X ZIP_________________ [GO TO YCONYHH]
YCONYHH Is the young adult’s address you just gave me a private residence?
YES 1 [GO TO YOUTH_AD_LOOP]
NO 2 [GO TO YOUTH_INST]
DON’T KNOW 77 [GO TO YOUTH_AD_LOOP]
REFUSED 99 [GO TO YOUTH_AD_LOOP]
YOUTH_
INST Can you describe the type of residence?
UNVERSITY/COLLEGE HOUSING (DORM) 1 [GO TO YOUTH_AD_LOOP]
MILITARY BASE 2 [GO TO YOUTH_AD_LOOP]
PRISON 3 [GO TO YOUTH_AD_LOOP]
OTHER INSTITUTION 4 [GO TO YOUTH_AD_LOOP]
DON’T KNOW 77 [GO TO YOUTH_AD_LOOP]
REFUSED 99 [GO TO YOUTH_AD_LOOP]
YOUTH_AD_
LOOP Does (FILL YOUTH_NAME_A OR FILL YOUTH_NAME_D if given) have another street or mailing address where (he/she) can be reached?
YES [GO TO NEXT YOUTH_AD_X]
NO [GO TO CONF_INTRO]
DON’T KNOW [GO TO CONF_INTRO]
REFUSED [GO TO CONF_INTRO]
CONF_INTRO
I would like to confirm that I have the correct information for the young adult that we’ll be contacting.
[INTERVIEWER: CONFIRM ALL NAMES AND SPELLINGS WITH THE RESPONDENT. IF LAST NAMES ARE THE SAME, MAKE SURE THEY HAVE THE SAME SPELLING]
CONF_NAME
The name I have for the young adult is [FILL YOUTH_NAME_A- YOUTH_NAME_D].
Is this correct?
YES 1 [GO TO CONFDOB_X]
NO 2 [GO TO YOUTH_NAME_A - YOUTH_NAME_D TO MAKE CORRECTION]
CONF
DOB_X The [FILL birth date/age] I have for [FILL YOUTH_NAME_A OR FILL YOUTH_NAME_D if given] is [FILL: BIRTH DATE FROM DOB/ AGE].
(If DOB is not available, confirm age)
Is this correct?
YES 1 GO TO Y_FUTCONT
NO 2 GO TO NEWDOB_1
NEW
DOB_1 What is the correct month, day and year of birth of [FILL YOUTH_NAME_A OR FILL YOUTH_NAME_D if given]?
_____/_____/_____ (mm/dd/yyyy)
Y_
FUTCONT
May we contact you again if we have problems contacting [FILL YOUTH_NAME_A OR FILL YOUTH_NAME_D if given)?
YES 1 [GO TO 2001R_NAMECONF_A]
NO 2 [GO TO TERMINATE]
DON’T KNOW 77 [GO TO TERMINATE]
REFUSED 99 [GO TO TERMINATE]
2001R_
NAMECONF_A What is your name?
NAME______________________________________________
2001R_
PHONECONF_A And what is the best phone number to reach you?
PHONE NUMBER COLLECTION SCREEN
XXX-XXX-XXXX
OMB Number 0920-0406
Expiration date 11/30/07
SCREENER PART 4:
COLLECT IDENTIFIERS AND
LOCATING INFORMATION
FOR 2001 OR 2007 RESPONDENT LEADS
PATH TO COLLECT INFORMATION FOR
LEAD THAT KNOWS HOW TO CONTACT
THE 2007 RESPONDENT (I.E., YOUNG ADULT)
According to the Paperwork Reduction Act (PRA) of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 0920-0406. The time required to complete this information collection is estimated to average 3 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments about the accuracy of the time estimate(s) or suggestions for improving this form please write to: CDC Reports Clearance Officer, 1600 Clifton Road, MS-D74, Atlanta, GA 30333; call 404-639-4604; or send an email to [email protected].
The Public Health Service Act is Volume 42 of the US Code, Section 242k. The collection of information in this survey is authorized by Section 306 of this Act. The confidentiality of your responses is assured by Section 308d of this Act, and by the Confidential Information Protection and Statistical Efficiency Act.
Data collection is conducted under contract to the CDC by the National Opinion Research Center (NORC) at the University of Chicago.
LEAD_REACH_Y
Could you please tell me the name of the person that may know how to contact the [FILL AGE]-year-old?
INTERVIEWER INSTRUCTION: IF R NOT COMFORTABLE PROVIDING NAME, ACCEPT INITIALS.
YES 1 [GO TO LEAD_NAME_A]
NO 2 [GO TO LEAD_NAME_D]
DON’T KNOW 3 [GO TO LEAD_NAME_D]
REFUSED 4 [GO TO LEAD_NAME_D]
LEAD_NAME_A What is the [FILL RELATION]’s first name?
______________________________________________
LEAD_NAME_B What is the [FILL RELATION]’s middle name?
MIDDLE_____________________________________________
LEAD_NAME_C What is the [FILL RELATION]’s last name?
LAST_______________________________________________
LEAD_NAME_D Does the [FILL RELATION] have a nickname, initials or another name that they may prefer?
NICKNAME/OTHER NAME__________________
LEAD_PH Could you please tell me (FILL LEAD _NAME_A OR FILL LEAD _NAME_D if given)’s (FILL BLANK OR second…ninth) phone number?
YES 1 [RECORD phone number(s) IN LEAD_PH_X]
NO 2 [GO TO LEAD _EM_X]
DON’T KNOW 77 [GO TO LEAD _EM_X]
REFUSED 99 [GO TO LEAD _EM_X]
LEAD_
PH_X
LEAD R PHONE NUMBER COLLECTION SCREEN
XXX-XXX-XXXX [GO TO LEAD _PH_CONF]
LEAD_PH_
CONF Is that a cellular telephone number?
YES 1 [GO TO LEAD _CONFHH]
NO 2 [GO TO LEAD _CONFHH]
DON’T KNOW 77 [GO TO LEAD _CONFHH]
REFUSED 99 [GO TO LEAD _CONFHH]
LEAD_
CONFHH Is that number a private residence?
YES [GO TO LEAD _PH_LOOP]
NO [GO TO LEAD _PH_LOOP]
DON’T KNOW [GO TO LEAD _PH_LOOP]
REFUSED [GO TO LEAD _PH_LOOP]
LEAD_PH_
LOOP Does (FILL LEAD _NAME_A OR FILL LEAD _NAME_D if given) have another phone number where (he/she) can be reached?
YES [GO TO NEXT LEAD _PH]
NO [GO TO LEAD _EM_X]
DON’T KNOW [GO TO LEAD _EM_X]
REFUSED [GO TO LEAD _EM_X]
LEAD
_EM_X Could you please tell me (FILL LEAD R_NAME_A OR FILL LEAD R_NAME_D if given)’s (FILL BLANK OR second…ninth) electronic mail or e-mail addresses?
YES 1 [RECORD E-MAIL ADDRESS ELEMENTS IN LEAD_MAIL_1 TO LEAD_EMAIL_9]
NO 2 [GO TO LEAD_AD_X]
DON’T KNOW 77 [GO TO LEAD_AD_X]
REFUSED 99 [GO TO LEAD_AD_X]
LEAD_
EMAIL_1
through
LEAD_
EMAIL_9 EMAIL ADDRESS COLLECTION SCREEN
____________________________ @ ______________________________._______
LEAD_EM_ Is this email address for personal, business or school use?
CONF
PERSONAL 1 [GO TO LEAD_EM_LOOP]
BUSINESS 2 [GO TO LEAD_EM_LOOP]
SCHOOL USE 3 [GO TO LEAD_EM_LOOP]
DON’T KNOW 77 [GO TO LEAD_EM_LOOP]
REFUSED 99 [GO TO LEAD_EM_LOOP]
LEAD_EM_
LOOP Does (FILL LEAD _NAME_A OR FILL LEAD _NAME_D if given) have another email address where (he/she) can be reached?
YES [GO TO NEXT LEAD_EM_X]
NO [GO TO LEAD_AD_X]
DON’T KNOW [GO TO LEAD_AD_X]
REFUSED [GO TO LEAD_AD_X]
LEAD_AD
_X Could you please tell (FILL LEAD _NAME_A OR FILL LEAD _NAME_D if given)’s [FILL BLANK OR second…ninth] street address or addresses [IF LEADPH_1 through LEADRPH_9 not equal null then FILL in case we cannot reach them by phone]?
YES 1 [GO TO LEAD_AD_ST_X]
NO 2 [CONF_INTRO_LEAD]
DON’T KNOW 77 [CONF_INTRO_LEAD]
REFUSED 99 [CONF_INTRO_LEAD]
LEAD_AD_
ST_X What is the street address?
______________________________________________
LEAD _AD_
APT_X What is the apartment number?
APT #________
LEAD _AD_
CITY_X What is the city and state?
CITY__________________
LEAD _AD_
STATE_X State Dropdown Menu
LEAD _AD_ What is the zip code?
ZIP_X ZIP_________________ [GO TO LEADCONYHH]
LEAD
CONYHH Is that address a private residence?
YES [GO TO LEAD_AD_LOOP]
NO [GO TO LEAD_INST]
DON’T KNOW [GO TO CONF_INTRO_LEAD]
REFUSED [GO TO CONF_INTRO_LEAD]
LEAD_
INST Can you describe the type of residence?
UNVERSITY/COLLEGE HOUSING (DORM) 1 [GO TO LEAD_AD_LOOP]
MILITARY BASE 2 [GO TO LEAD_AD_LOOP]
PRISON 3 [GO TO LEAD_AD_LOOP]
OTHER INSTITUTION 4 [GO TO LEAD_AD_LOOP]
DON’T KNOW 77 [GO TO LEAD_AD_LOOP]
REFUSED 99 [GO TO LEAD_AD_LOOP]
LEAD_AD_
LOOP Does (FILL LEAD R_NAME_A OR FILL LEAD R_NAME_D if given) have another address where (he/she) can receive mail?
YES [GO TO NEXT LEAD_AD_X]
NO [GO TO CONF_INTRO_LEAD]
DON’T KNOW [GO TO CONF_INTRO_LEAD]
REFUSED [GO TO CONF_INTRO_LEAD]
CONF_INTRO_LEAD
I would like to confirm that I have the correct information for the person that we’ll be contacting.
[INTERVIEWER: CONFIRM ALL NAMES AND SPELLINGS WITH THE RESPONDENT.]
CONF_NAME_LEAD
The name I have for this person is [FILL NAME OF FROM LEADNAME_A- LEAD_NAME_D]. Is this correct?
YES 1 [GO TO LEAD_FUTCONT]
NO 2 [GO TO LEAD_CONT AND CORRECT]
LEAD_FUTCONT
May we contact you again if we have problems contacting this person?
YES 1 [GO TO FUTCONT_LEAD_NAME]
NO 2 [GO TO PH_CONF]
DON’T KNOW 77 [GO TO PH_CONF]
REFUSED 99 [GO TO PH_CONF]
FUTCONT_
LEAD_NAME What is your name?
NAME______________________________________________
[GO TO PH_CONF]
OMB Number 0920-0406
Expiration date 11/30/07
PATH TO COLLECT INFORMATION FOR LEAD
THAT KNOWS HOW TO CONTACT 2001 RESPONDENT
According to the Paperwork Reduction Act (PRA) of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 0920-0406. The time required to complete this information collection is estimated to average 3 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments about the accuracy of the time estimate(s) or suggestions for improving this form please write to: CDC Reports Clearance Officer, 1600 Clifton Road, MS-D74, Atlanta, GA 30333; call 404-639-4604; or send an email to [email protected].
The Public Health Service Act is Volume 42 of the US Code, Section 242k. The collection of information in this survey is authorized by Section 306 of this Act. The confidentiality of your responses is assured by Section 308d of this Act, and by the Confidential Information Protection and Statistical Efficiency Act.
Data collection is conducted under contract to the CDC by the National Opinion Research Center (NORC) at the University of Chicago.
LEAD_REACH_01
Could you please tell me the name of the person that may know how to contact the [FILL AGE]-year-old’s [RELATION]?
INTERVIEWER INSTRUCTION: IF R NOT COMFORTABLE PROVIDING NAME, ACCEPT INITIALS.
YES ………………………………………………………1 [GO TO LEAD_NAME_A_01]
NO 2 [GO TO LEAD_NAME_D_01]
DON’T KNOW 3 [GO TO LEAD_NAME_D_01]
REFUSED 4 [GO TO LEAD_NAME_D_01]
LEAD_NAME_A_01 What is the [FILL RELATION]’s first name?
______________________________________________
LEAD_NAME_B_01 What is the [FILL RELATION]’s middle name?
MIDDLE_____________________________________________
LEAD_NAME_C_01 What is the [FILL RELATION]’s last name?
LAST_______________________________________________
LEAD_NAME_D_01 Does the [FILL RELATION] have a nickname, initials or another name that they may prefer?
NICKNAME/OTHER NAME__________________
LEAD_PH_01 Could you please tell me (FILL LEAD _NAME_A_01OR FILL LEAD _NAME_D_01 if given)’s (FILL BLANK OR second…ninth) phone number?
YES 1 [RECORD phone number(s) IN LEAD_PH_X_01]
NO 2 [GO TO LEAD _EM_X_01]
DON’T KNOW 77 [GO TO LEAD _EM_X_01]
REFUSED 99 [GO TO LEAD _EM_X_01]
LEAD_
PH_X_01
LEAD R PHONE NUMBER COLLECTION SCREEN
XXX-XXX-XXXX [ GO TO LEAD _PH_CONF_01]
LEADR_PH_
CONF_01 Is that a cellular telephone number?
YES 1 [GO TO LEAD _CONFHH_01]
NO 2 [GO TO LEAD _CONFHH_01]
DON’T KNOW 77 [GO TO LEAD _CONFHH_01]
REFUSED 99 [GO TO LEAD _CONFHH_01]
LEAD_
CONFHH_01 Is that number a private residence?
YES [GO TO LEAD _PH_LOOP_01]
NO [GO TO LEAD _PH_LOOP_01]
DON’T KNOW [GO TO LEAD _PH_LOOP_01]
REFUSED [GO TO LEAD _PH_LOOP_01]
LEAD_PH_
LOOP_01 Does (FILL LEAD R_NAME_A_01 OR FILL LEAD R_NAME_D_01 if given) have another phone number where (he/she) can be reached?
YES [GO TO NEXT LEAD R_PH_01]
NO [GO TO LEAD _EM_X_01]
DON’T KNOW [GO TO LEAD _EM_X_01]
REFUSED [GO TO LEAD _EM_X_01]
LEAD
_EM_X_01 Could you please tell me (FILL LEAD_NAME_A_01 OR FILL LEAD_NAME_D_01 if given)’s (FILL BLANK OR second…ninth) electronic mail or e-mail addresses?
YES 1 [RECORD E-MAIL ADDRESS ELEMENTS IN LEAD_MAIL_1_01 TO LEAD_EMAIL_9_01
NO 2 [GO TO LEAD_AD_X_01]
DON’T KNOW 77 [GO TO LEAD_AD_X_01]
REFUSED 99 [GO TO LEAD_AD_X_01]
LEAD_
EMAIL_1_01
through
LEAD_
EMAIL_9_01 EMAIL ADDRESS COLLECTION SCREEN
____________________________ @ ______________________________._______
LEAD_EM_ Is this email address for personal, business or school use?
CONF
PERSONAL 1 [GO TO LEAD_EM_LOOP_01]
BUSINESS 2 [GO TO LEAD_EM_LOOP_01]
SCHOOL USE 3 [GO TO LEAD_EM_LOOP_01]
DON’T KNOW 77 [GO TO LEAD_EM_LOOP_01]
REFUSED 99 [GO TO LEAD_EM_LOOP_01]
LEAD_EM_
LOOP_01 Does (FILL LEAD _NAME_A OR FILL LEAD _NAME_D if given) have another email address where (he/she) can be reached?
YES [GO TO NEXT LEAD_EM_X_01]
NO [GO TO LEAD_AD_X_01]
DON’T KNOW [GO TO LEAD_AD_X_01]
REFUSED [GO TO LEAD_AD_X_01]
LEAD_AD
_X_01 Could you please tell (FILL LEAD _NAME_A OR FILL LEAD _NAME_D if given)’s [FILL BLANK OR second…ninth] street address or addresses [IF LEADPH_1 through LEADRPH_9 not equal null then FILL in case we cannot reach them by phone]?
YES 1 [GO TO LEAD_AD_ST_X_01]
NO 2 [CONF_INTRO_LEAD_01]
DON’T KNOW 77 [CONF_INTRO_LEAD_01]
REFUSED 99 [CONF_INTRO_LEAD_01]
LEAD_AD_
ST_X_01 What is the street address?
______________________________________________
LEAD _AD_
APT_X_01 What is the apartment number?
APT #________
LEAD _AD_
CITY_X_01 What is the city and state?
CITY__________________
LEAD _AD_
STATE_X _01 State Dropdown Menu
LEAD _AD_ What is the zip code?
ZIP_X_01 ZIP_________________ [GO TO LEADCONYHH]
LEAD
CONYHH_01 Is that address a private residence?
YES [GO TO LEAD_AD_LOOP_01]
NO [GO TO LEAD_INST_01]
DON’T KNOW [GO TO CONF_INTRO_LEAD_01]
REFUSED [GO TO CONF_INTRO_LEAD_01]
LEAD_
INST_01 Can you describe the type of residence?
UNVERSITY/COLLEGE HOUSING (DORM) 1 [GO TO LEAD_AD_LOOP_01]
MILITARY BASE 2 [GO TO LEAD_AD_LOOP_01]
PRISON 3 [GO TO LEAD_AD_LOOP_01]
OTHER INSTITUTION 4 [GO TO LEAD_AD_LOOP_01]
DON’T KNOW 77 [GO TO LEAD_AD_LOOP_01]
REFUSED 99 [GO TO LEAD_AD_LOOP_01]
LEAD_AD_
LOOP_01 Does (FILL LEAD R_NAME_A OR FILL LEAD R_NAME_D if given) have another address where (he/she) can receive mail?
YES [GO TO NEXT LEAD_AD_X_01]
NO [GO TO CONF_INTRO_LEAD_01]
DON’T KNOW [GO TO CONF_INTRO_LEAD_01]
REFUSED [GO TO CONF_INTRO_LEAD_01]
CONF_INTRO_LEAD_01
I would like to confirm that I have the correct information for the person that we’ll be contacting.
[INTERVIEWER: CONFIRM ALL NAMES AND SPELLINGS WITH THE RESPONDENT.]
CONF_NAME_LEAD_01
The name I have for this person is [FILL NAME OF FROM LEADNAME_A_01- LEAD_NAME_D_01].
Is this correct?
YES 1 [GO TO LEAD_FUTCONT_01
NO 2 [GO TO LEADNAME_A_01 to D_01 AND CORRECT]
LEAD_FUTCONT_01
May we contact you again if we have problems contacting this person who may have completed the LEAD interview?
YES 1 [GO TO FUTCONT_LEAD_NAME_01]
NO 2 [GO TO PH_CONF]
DON’T KNOW 77 [GO TO PH_CONF]
REFUSED 99 [GO TO PH_CONF]
FUTCONT_LEAD_NAME_01
What is your name?
NAME______________________________________________
[GO TO PH_CONF]
TERM_BRIEF
Thank you for your time (on behalf of the Centers for Disease Control).
TERMINATE Those are all the questions I have. I’d like to thank you on behalf of the Centers for Disease Control and Prevention for the time and effort you’ve spent answering these questions. If you would like more information about the Survey of Adult Transition and Health, please call the study's toll-free number, XXX-XXX-XXXX. If you have questions about your rights as a study participant, you may call 1-800-223-8118, toll-free, and leave a message asking to speak to the Chairperson of the Research Ethics Review Board. Thanks again.
UNIVERSAL EXIT (UE)
NO_CONTACT
CONTINUE 1 GO TO INTRO_1
ANSWERING MACHINE 2 GO TO MSG (OR SASERVIF NO MESSAGE LEFT)
OTHER TECHNOLOGICAL CIRCUMSTANCES 3 GO TO CALL NOTES
BOX
DISCONNECTED/NUMBER NOT ASSIGNED/ 4 GO TO CALL NOTES
BOX
CALL CAN’T BE COMPLETED
FAX/MODEM/DATA LINE. 5 TERMINATE
PRIVACY MANAGER/NO INCOMING CALLS/
CALL IS BLOCKED OR NOT ACCEPTED 7 GO TO UNIVERSAL EXIT-P1
FAST BUSY 8 TERMINATE
NUMBER CHANGED 9 TERMINATE
ENGAGED/BUSY/ALL CIRCUITS ARE BUSY 10 TERMINATE
NO REPLY/RING NO ANSWER 11 TERMINATE
SUPERVISOR REVIEW 12 GO TO CALL NOTES
BOX
RESPONDENT CALLED INTO 800 LINE 13 GO TO INTRO_1
M1_NAME_
WEB Do you have access to the internet?
Yes. 1 GO TO UNIVERSAL EXIT M1_NAME_WEB_ADD
No 2 GO TO UNIVERSAL EXIT- M1_NAME
M1_NAME_
WEB_ADD I would like to offer you the project’s web address. It provides a lot of additional project information.
FILL WEB ADDRESS
M1_EMAIL In order to email a letter to you, I will need to collect your email address. The letter will contain a toll-free number that you may call to complete the interview at your convenience.
___________@_______________._______
Continue 1 GO TO UNIVERSAL EXIT-M2
Refused to give information 2 GO TO UNIVERSAL EXIT-M3
M2 You will be receiving the letter in the next week [FILL or two (if mailed)]. It will contain a toll-free number that you may call at any time to complete the interview.
M3 Thank you very much on behalf of the Centers for Disease Control and Prevention.
M1_NAME In order to send you a letter, I will need to collect your name and mailing address. The letter will contain a toll-free number that you may call to complete the interview at your convenience. (Read if necessary: If you feel uncomfortable giving me your name, I can send the letter to "Resident".)
Continue 1 GO TO UNIVERSAL EXIT-M2
Refused to give information 2 GO TO UNIVERSAL EXIT-M3
M2 You will be receiving the letter in the next week or two. It will contain a toll-free number that you may call at any time to complete the interview. Thank you very much on behalf of the Centers for Disease Control and Prevention.
M3 Thank you very much on behalf of the Centers for Disease Control and Prevention.
T1 Did the respondent agree to a call back or say something to indicate he/she was too busy to participate? (Or do you need to code this case as a callback?)
Yes. 1 GO TO UNIVERSAL EXIT-CB1
No 2 GO TO UNIVERSAL EXIT-T2
R requested letter-emailed 5 GO TO UNIVERSAL EXIT-M1_EMAIL
R requested letter-mailed 5 GO TO UNIVERSAL EXIT-M1_NAME
R will call 800 Line/Verify website 6 GO TO UNIVERSAL EXIT-VERIFY_INFO
Take Me Off Your List 8 GO TO CALL NOTES
BOX
Out of Scope 9 GO TO CALL NOTES
BOX
R not over 17/R does not live in HH 10 GO TO CALL NOTES
BOX
Return to INTRO 11 GO TO INTRO IF T1 APPEARS DIRECTLY AFTER INTRO
T2 Did the respondent say anything other than hello before he/she hung up?
Yes 1 GO TO UNIVERSAL EXIT-T3
No 2 TERMINATE
T3 Did a respondent convey that there were no eligible children before hanging up?
Yes, No one under 25 lives in HH 1 TERMINATE
No, did not say 3 GO TO UNIVERSAL EXIT-T4
T4 Did the respondent say this number was for a nationally recognized business, an academic, health, or government institution, or a home business that is not used for personal calls?
Yes-Business 1 TERMINATE
Yes-Dorm/Prison/Hostel 2 TERMINATE
No 3 GO TO UNIVERSAL EXIT-T5
T5 Did the respondent say something to indicate that he/she refused to participate? (Or did they just hang up?)
Yes 1 GO TO UNIVERSAL EXIT-R1
No 2 GO TO UNIVERSAL EXIT-T6
T6 CODE AS GENERAL CALL BACK OR SUPERVISOR REVIEW
GENERAL CALL BACK 1 GO TO CALL NOTES BOX &TERMINATE
SUPERVISOR REVIEW 2 GO TO CALL NOTES BOX & TERMINATE
CB1 Is there …
A specific time to call back 1 GO TO APPT SCREEN
A range of time to call back 2 GO TO APPT SCREEN
Someone else gave a time to call back 3 GO TO APPT SCREEN
No specific time to call back,
said they were too busy ……………………………..4 TERMINATE
VERIFY_
INFO REFER TO FAQ/JOB AID TO ANSWER RESPONDENT QUESTIONS
Terminate the Interview (Hang up) 1 GO TO CALL NOTES BOX
Continue Interview 2 GO TO INTRO_1
R1 Was respondent male or female?
Male 1
Female 2
Could not be determined 3
R2 What was the reason for refusing? (Multiple responses possible)
Too busy/Doing something else right now 1
Interview will take too long 2
Not interested 3
No solicitation wanted/Don’t need anything/
Don’t want to buy anything 4
Requested not to be called back 5
Concerned about confidentiality 6
Won’t give information over the phone 7
Negative about government 8
Negative about surveys 9
On National Do Not Call List 10
No reason given 11
None of the above 12
R3 What questions did the respondent ask? (multiple response possible)
The study purpose 1
NORC 2
Who is sponsoring the
study (NCHS, DHHS, CDC, NIP) 3
Source of name and address on letter 4
Questioned legitimacy of study 5
The use of the data 6
The confidentiality of the data 7
Access to study results. 8
How did you get my phone number? 9
Where are you calling from? 10
No questions 11
None of the above 12
R4 Did the respondent threaten legal or governmental action or use hostile words or a hostile tone? These are refusals that are so strong that we don’t want to call them back.
Yes 1 GO TO CALL NOTES BOX
No 2 GO TO CALL NOTES BOX
P1 [BLANK]
IF A PRIVACY MANAGER ASKS YOU TO STATE YOUR NAME, SAY “On behalf of the Centers for Disease Control and Prevention.”
IF A PRIVACY MANAGER ASKS YOU TO ENTER THE NUMBER YOU ARE CALLING FROM, ENTER THE NIS TOLL-FREE NUMBER (866-999-3340).
Continue Interview 1 GO TO INTRO_1
Answering Machine 2 GO TO MSG_Y
Ring no answer 3 GO TO SASERV
Refused/ Number is invalid 4 GO TO SASERV
Take Me Off Your List 5 TERMINATE
| File Type | application/msword |
| File Title | Attachment 2: |
| Author | ziy6 |
| Last Modified By | ziy6 |
| File Modified | 2007-06-04 |
| File Created | 2007-06-04 |