Items in the CATI/CAPI/TQA Instruments that Differ From the Paper Questionnaire:
The CAPI interview begins with an introduction, confirmation that the interviewer has reached a housing unit at the correct address, and collection of any necessary location and mailing address corrections. If a CAPI interview needs to end before it is complete, the interviewer asks for a phone number (if possible) and a best time to call back to complete the interview. At the end of the CAPI interview, the interviewer thanks the respondent for their participation, informs the respondent that they may receive a call back from someone checking on their work (the ACS CAPI Reinterview program), and asks for a phone number and best time for such a call.
The CATI interview begins with verification of the phone number reached, confirmation that the interviewer has reached a housing unit at the correct address, and provides appropriate introductory information. The CATI interviewer also explains that a supervisor may be listening in on the call to monitor the interviewer's performance. If a CATI interview needs to end before it is complete, the interviewer asks for a best time to call back to complete the interview. At the end of the CATI interview, the interviewer thanks the respondent for their participation.
Respondents call the toll free number listed on the ACS paper questionnaire to obtain assistance or ask questions about the ACS. During this call, after the interviewer has verified that the respondent’s address is in the ACS sample, the interviewer encourages the respondent to complete the interview over the phone. At the beginning of the TQA interview, the interviewer enters control information, the sample address and the respondent’s telephone number into the TQA instrument. The TQA interviewer also explains that a supervisor may be listening in on the call to monitor the interviewer's performance. If a TQA interview needs to end before it is complete, the interviewer asks for a best time to call back to complete the interview. At the end of the TQA interview, the interviewer thanks the respondent for their participation and indicates in the instrument in what language the interview was completed.
Paper Questionnaire Item Number: Roster
CATI/CAPI/TQA Screen Name: FN_PG1
I am going to be asking some questions about
everyone who is living or staying at this address. First let's
create a list of the people, starting with you. What is your name?/What is the name of the next person living or staying here?
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CATI/CAPI/TQA Screen Name: FN_PG2
The following questions are to make sure this list is as complete as possible.... Does anyone else live or stay here, such as roommates, foster children, boarders, or live-in employees?
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CATI/CAPI/TQA Screen Name: FN_PG3
Is there anyone else staying here even for a short time, such as a friend or relative?
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CATI/CAPI/TQA Screen Name: AWAYNOW
The next questions are to help refine this list. I have listed...
Are any of these people away NOW for more than two months, like a college student or someone in the military?
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CATI/CAPI/TQA Screen Name: ANOTHERHOME
(Do you/Do any of these people)...
have some other place where they usually stay?
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CATI/CAPI/TQA Screen Name: MORETHANTWO
(Are/ Are you/ Is <Name>)
staying here for MORE than two months?
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CATI/CAPI/TQA Screen Name: BASIC
Now I would like to ask you some basic questions (about <Name>/about people in this household/about people in this household who are here more than two months).
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CATI/CAPI/TQA Screen Name: HHOLDER
Of the people you named, who owns or rents this place?
(What names are on the deed or lease? Is there anyone 15 years or older?)
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Paper Questionnaire Item Number: Demographic 2
CATI/CAPI/TQA Screen Name: RELT (Telephone Interviews)
How (is <Name>/ are you) related to (<HHOLDERNAME>/you)?
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1. Husband or wife 2. Son or daughter 3. Brother or sister 4. Father or mother 5. Grandchild 6. Parent-in-law 7. Son-in-law or daughter-in-law |
8. Other relative 9. Roomer or boarder 10. Housemate or roommate 11. Unmarried partner 12. Foster child 13. Other nonrelative |
CATI/CAPI/TQA Screen Name: SONDAU (Telephone Interviews)
(Is <Name>/ Are you) (your/<HHOLDERNAME>’s) biological son or daughter, adopted son or daughter, stepson or stepdaughter, OR foster son or daughter?
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1. Biological son or daughter 2. Adopted son or daughter
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3. Stepson or stepdaughter 4. Foster son or daughter
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Paper Questionnaire Item Number: Demographic 3
CATI/CAPI/TQA Screen Name: SEX
(Is <Name>/ Are you) male or female?
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1. Male 2. Female |
Paper Questionnaire Item Number: Demographic 4
CATI/CAPI/TQA Screen Name: DOBM
What is (<Name>'s/your) date of birth?
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1. January 2. February 3. March 4. April 5. May 6. June |
7. July 8. August 9. September 10. October 11. November 12. December |
CATI/CAPI/TQA Screen Name: DOBD
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CATI/CAPI/TQA Screen Name: DOBY
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CATI/CAPI/TQA Screen Name: DOBY ACTIVE SIGNAL
That makes (<Name>/you) (<Calculated age>/<Calculated age> this month/less than one year old).
Is this correct?
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CATI/CAPI/TQA Screen Name: DOBA (Asked when the month of birth is Don=t Know or Refused and a valid year of birth has been entered.)
Would you say (<Name> is /you are):
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1. <Current year - DOBY - 1> years of age 2. <Current year - DOBY> years of age 3. Neither is correct |
CATI/CAPI/TQA Screen Name: AGEASK (Asked when the year of birth is Don=t Know or Refused.)
What is your best estimate of (<Name>'s/your) age?
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CATI/CAPI/TQA Screen Name: AGERANGE (Asked when AGEASK is Don=t Know or Refused.)
(Is <Name>/Are you):
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1. less than 3 years old 2. 3 or 4 years old 3. 5 to 14 years old 4. 15 years old and older |
Paper Questionnaire Item Number: Demographic 5
CATI/CAPI/TQA Screen Name: HISA
(Please look at Card B.) (Is <Name>/Are you) of Hispanic, Latino or Spanish origin?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: HISB
(Is <Name>/ Are you) Mexican, Mexican American, or Chicano; Puerto Rican; Cuban, or of another Hispanic, Latino, or Spanish origin; for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on?
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CATI/CAPI/TQA Screen Name: HISW
What is that origin? (For example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on.)
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Paper Questionnaire Item Number: Demographic 6
CATI/CAPI/TQA Screen Name: RACT (Telephone Interviews)
CATI/CAPI/TQA Screen Name: RAC (Personal Visit Interviews)
Please look at Card C and choose one or more races. (For this survey, Hispanic origins are not races.)
(Is <Name>/Are you) White; Black, African American, or Negro; American Indian or Alaska Native; Asian; Native Hawaiian or Other Pacific Islander; or Some other race?
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11. White 12. Black, African American, or Negro 13. American Indian or Alaska Native 14. Asian 15. Native Hawaiian or Other Pacific Islander 16. Some other race |
CATI/CAPI/TQA Screen Name: RCW1
You may list one or more tribes.
What is (<Name>=s/your>) enrolled or principal tribe?
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CATI/CAPI/TQA Screen Name: RCWAG
You may choose one or more Asian groups.
(Is <Name>/Are you) Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, or another Asian group, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on?
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1. Asian Indian 2. Chinese 3. Filipino 4. Japanese 5. Korean 6. Vietnamese 7. Other Asian (For example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.) |
CATI/CAPI/TQA Screen Name: RCW3
What is that other Asian group?
(For example: Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.)
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CATI/CAPI/TQA Screen Name: RCWPG
You may choose one or more Pacific Islander groups.
(Is <Name>/Are you) Native Hawaiian; Guamanian or Chamorro; Samoan; or another Pacific Islander group, for example Fijian, Tongan, and so on?
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1. Native Hawaiian 2. Guamanian or Chamorro 3. Samoan 4. Other Pacific Islander (For example, Fijian, Tongan, and so on) |
CATI/CAPI/TQA Screen Name: RCW4
What is that other Pacific Islander group? (For example, Fijian, Tongan, and so on.)
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CATI/CAPI/TQA Screen Name: RCW2
What is (<Name>’s/your) other race group?
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Paper Questionnaire Item Number: Housing 1
CATI/CAPI/TQA Screen Name: BLD (Personal Visit Interviews)
Now I am going to ask about this place....
Using Card D, which best describes this building?
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1. Mobile home 2. One-family house detached from any other house 3. One-family house attached to one or more houses 4. Building with 2 apartments 5. Building with 3 or 4 apartments 6. Building with 5 to 9 apartments 7. Building with 10 to 19 apartments 8. Building with 20 to 49 apartments 9. Building with 50 or more apartments 10. Boat, RV, van, etc. |
CATI/CAPI/TQA Screen Name: BLDA (Telephone Interviews)
Now I am going to ask about this place....
Which best describes this building? Is it a mobile home, single family house, building with two or more apartments, boat, RV, or van?
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1. Mobile home 2. Single-family house 3. Building with two or more apartments 4. Boat, RV, van, etc. |
CATI/CAPI/TQA Screen Name: BLDB (Telephone Interviews)
Is that a detached house, or is it attached to other houses?
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1. Detached 2. Attached |
CATI/CAPI/TQA Screen Name: BLDC (Telephone Interviews)
How many apartments are there in this building?
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Paper Questionnaire Item Number: Housing 3
CATI/CAPI/TQA Screen Name: MVY
In what year did (you/<HHname>) move into this (house/apartment/mobile home/unit)?
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CATI/CAPI/TQA Screen Name: MVM
In what month was that?
(What was the month that (you/<HHNAME>) moved into this (house/apartment/ mobile home/ unit)?)
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1. January 2. February 3. March 4. April 5. May 6. June 7. July 8. August 9. September 10.October 11.November 12.December |
Paper Questionnaire Item Number: Housing 4
CATI/CAPI/TQA Screen Name: ACR
Is this (house/mobile home) on less than 1 acre, between 1 and 9.9 acres, or 10 or more acres?
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1. Less than 1 acre 2. 1 to 9.9 acres 3. 10 or more acres |
Paper Questionnaire Item Number: Housing 5
CATI/CAPI/TQA Screen Name: AGSA
IN THE PAST 12 MONTHS, were there any sales of agricultural products from this property?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: AGSB
How much were the sales?
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1. $1 - $999 2. $1,000 - $2,499 3. $2,500 - $4,999 4. $5,000 - $9,999 5. $10,000 or more |
Paper Questionnaire Item Number: Housing 6
CATI/CAPI/TQA Screen Name: BUS
Is there a medical office or business such as a store or barber shop on this property?
(A business usually has a separate outside entrance and has the appearance of a business.)
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1. Yes 2. No |
Paper Questionnaire Item Number: Housing 7a
CATI/CAPI/TQA Screen Name: EFFIC
Is this an efficiency or studio apartment?
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1. Yes 2. No |
The next questions are about the number and kinds of rooms at this place. Rooms must be separated by built-in archways or walls that extend out at least 6 inches and go from floor to ceiling.
How many separate rooms are in this (house/apartment/mobile home/unit) not counting bathrooms, porches, balconies, foyers, halls or unfinished basements?
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Paper Questionnaire Item Number: Housing 7b
CATI/CAPI/TQA Screen Name: INCLBED
Did you include bedrooms?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: BDSINC (Asked when INCLBED=1)
How many of the <<RMS> rooms> would you list as bedrooms if this (house/apartment/mobile home/unit) were for sale or rent?
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CATI/CAPI/TQA Screen Name: BDSNINC (Asked when INCLBED=2)
How many rooms would you list as bedrooms if this (house/apartment/mobile home/unit) were for sale or rent?
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Paper Questionnaire Item Number: Housing 8g
CATI/CAPI/TQA Screen Name: TEL (CAPI Personal Visit Interviews)
Does this (house/apartment/mobile home/unit) have telephone service, including cell phones, from which you can both make and receive calls?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: TEL (CAPI Telephone Interviews)
I have recorded that there is telephone service, or cell phone service, available at this (house/apartment/mobile home/unit) from which you can both make and receive calls. Is this correct?
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1. Yes 2. No |
Paper Questionnaire Item Number: Housing 9
CATI/CAPI/TQA Screen Name: VEH
How many cars, vans, and trucks of one-ton capacity or less are kept at home for use by members of this household?
(If a business vehicle is available for personal use, it should be included.)
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0. None 1. 1 2. 2 3. 3 4. 4 5. 5 6. 6 or more |
Paper Questionnaire Item Number: Housing 10
CATI/CAPI/TQA Screen Name: HFLA
To heat this (house/apartment/ mobile home/unit) which fuel do you use MOST -- Gas, electricity, fuel oil or kerosene, coal or coke, wood, solar energy or some other fuel?
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1. Gas 2. Electricity 3. Fuel oil or kerosene 4. Coal or coke 5. Wood 6. Solar energy 7. Some other fuel 8. No fuel used |
CATI/CAPI/TQA Screen Name: HFLB
Is the gas used from underground pipes serving the neighborhood?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: HFLC
Is it bottled, tank, or LP gas?
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1. Yes 2. No |
Paper Questionnaire Item Number: Housing 11a
CATI/CAPI/TQA Screen Name: ELEPAY
The next few questions deal with general utility use.... Does anyone in this household pay for electricity?
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1. Yes 2. No
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CATI/CAPI/TQA Screen Name: ELE
LAST MONTH, what was the cost of electricity for this (house/apartment/mobile home/unit)?
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CATI/CAPI/TQA Screen Name: ELEX
Are the electricity costs included in the rent or condominium fee or is there no charge for electricity?
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1. Included in rent or condominium fee 2. No charge for electricity
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Paper Questionnaire Item Number: Housing 11b
CATI/CAPI/TQA Screen Name: GASUSE
Does this household use gas?
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1. Yes 2. No
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CATI/CAPI/TQA Screen Name: GASPAY
Does anyone in this household pay for gas?
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1. Yes 2. No
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CATI/CAPI/TQA Screen Name: GAS
LAST MONTH, what was the cost of gas for this (house/apartment/mobile home/unit)?
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CATI/CAPI/TQA Screen Name: GASX
Are the gas costs included in the rent or condominium fee, or included in the electricity payment, or is there no charge for gas?
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1. Included in rent or condominium fee 2. Included with electricity payment recorded above 3. No charge for gas
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Paper Questionnaire Item Number: Housing 11c
CATI/CAPI/TQA Screen Name: WATPAY
Does anyone in this household pay for water and sewer?
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1. Yes 2. No
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CATI/CAPI/TQA Screen Name: WAT
IN THE PAST 12 MONTHS, what was the cost of the water and sewer for this (house/apartment/mobile home/unit)?
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CATI/CAPI/TQA Screen Name: WATX
Are the water and sewer costs included in the rent or condominium fee, or is there no charge for water and sewer? |
1. Included in rent or condominium fee 2. No charge for water and sewer
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Paper Questionnaire Item Number: Housing 11d
CATI/CAPI/TQA Screen Name: FULOTH
Does this household use other fuels like oil, coal, kerosene, wood, or any other fuel?
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1. Yes 2. No
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CATI/CAPI/TQA Screen Name: FULPAY
Does anyone in this household pay for other fuels like oil, coal, kerosene, wood, or any other fuel?
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1. Yes 2. No
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CATI/CAPI/TQA Screen Name: FUL
IN THE PAST 12 MONTHS, what was the cost of other fuels like oil, coal, kerosene, wood, or any other fuel for this (house/apartment/mobile home/unit)? |
CATI/CAPI/TQA Screen Name: FULX
Are the costs of the other fuels like oil, coal, kerosene, wood or any other fuel included in the rent or condominium fee or is there no charge for other fuels?
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1. Included in rent or condominium fee 2. No charge for other fuels
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Paper Questionnaire Item Number: Housing 13
CATI/CAPI/TQA Screen Name: CONX
The next few questions refer to this <house/apartment/mobile home/unit>. Is this (house/apartment/mobile home/unit) part of a condominium?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: CONPAY
Is there a condominium fee?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: CONFEE
What is the MONTHLY condominium fee?
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1. Yes 2. No |
Paper Questionnaire Item Number: Housing 14
CATI/CAPI/TQA Screen Name: TEN
(Does <HHname> or someone in this household/ Do you or someone in this household) own this (house/apartment/mobile home/unit) with a mortgage or loan including home equity loans, own it free and clear, rent it, or occupy it without having to pay rent?
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1. Own with a mortgage or loan including home equity loans 2. Own free and clear 3. Rent 4. Occupy without having to pay rent |
CATI/CAPI/TQA Screen Name: TENRENT (Asked when TEN=Don’t know or Refused)
(Does <HHname>/Do you) or someone in this household pay rent?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: TENMORT (Asked when TENRENT=2, Don’t know or Refused)
(Does <HHname>/Do you) or someone in this household pay a mortgage?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: TENTAX (Asked when TEMORT=2, Don’t know or Refused)
(Does <HHname>/Do you) or someone in this household pay real estate taxes?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: RNTTEMP (Asked for temporarily occupied or vacant units)
How much is the rent for this (house/apartment/mobile home/unit)?
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CATI/CAPI/TQA Screen Name: RNTPAY (Asked for temporarily occupied or vacant units)
How often is the rent paid?
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1. Daily 2. Weekly 3. Monthly 4. Quarterly 5. Other |
CATI/CAPI/TQA Screen Name: RNTOTH
(How often is the rent paid?)
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Paper Questionnaire Item Number: Housing 19a
CATI/CAPI/TQA Screen Name: MRGX
Earlier I recorded that there is a mortgage or loan on this property. Is it a mortgage, deed of trust, contract to purchase, or similar debt?
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1. Yes, mortgage, deed of trust, or similar debt 2. Yes, contract to purchase 3. No |
CATI/CAPI/TQA Screen Name: MRGFR
Earlier I recorded that this property is owned free and clear. Is this correct? |
1. Yes 2. No |
Paper Questionnaire Item Number: Housing 19b
CATI/CAPI/TQA Screen Name: MRG
What is the regular MONTHLY mortgage payment on this property?
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Paper Questionnaire Item Number: Housing 19c
CATI/CAPI/TQA Screen Name: MRGT
Does the regular MONTHLY mortgage payment include payments for real estate taxes?
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1. Yes, taxes included in payment 2. No, taxes paid separately or taxes not required |
Paper Questionnaire Item Number: Housing 19d
CATI/CAPI/TQA Screen Name: MRGI
Does the regular MONTHLY mortgage payment include payments for fire, hazard, or flood insurance?
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1. Yes, insurance included in payment 2. No, insurance paid separately or no insurance |
Paper Questionnaire Item Number: Housing 20a
CATI/CAPI/TQA Screen Name: SMXA
Is there a second or junior mortgage on this property?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: SMXB
Is there a home equity loan on this property?
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1. Yes 2. No |
Paper Questionnaire Item Number: Person 7
CATI/CAPI/TQA Screen Name: POBST
(Fill 1: I will now be asking a series of questions about)(Fill 2: each person within the household/ (you/<Name>)...)
The next few questions deal with (your/<Name>'s) place of birth and citizenship...
Where (were you/ was <Name>) born?
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CATI/CAPI/TQA Screen Name: POBFOR
In what country (were you/was <Name>) born?
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Paper Questionnaire Item Number: Person 8
CATI/CAPI/TQA Screen Name: CITA
(Is <Name>/Are you) a citizen of the United States?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: CITB
(Was <Name>/Were you) born abroad of U.S. citizen parent or parents, or did (he/she/you) become a citizen by naturalization?
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1. Born abroad of U.S. citizen parent or parents 2. Citizen by naturalization |
CATI/CAPI/TQA Screen Name: CITC (Asked when the response to POBST is Don=t Know or Refused, and the response to CITA indicates that the person is a United States citizen.)
You have indicated that (<Name> is/you are) a citizen, but you have not indicated where (<he/she/he or she> was/you were) born. Perhaps you could give us other general information about (<him/her>/yourself)...
(Was <Name>/Were you) born in the U.S., born in Puerto Rico, Guam, U.S. Virgin Islands or Northern Marianas, born abroad of U.S. citizen parent or parents, or did (he/she/you) become a naturalized citizen?
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1. Born in the U.S. 2. Born in Puerto Rico, Guam, U.S. Virgin Islands, or Northern Marianas 3. Born abroad of U.S. citizen parent or parents 4. Citizen by naturalization |
CATI/CAPI/TQA Screen Name: YRNAT
In what year did (<Name>/you) become a naturalized citizen of the United States?
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Paper Questionnaire Item Number: Person 10a
CATI/CAPI/TQA Screen Name: SCHA
The next questions are about schooling and education....
At any time IN THE LAST 3 MONTHS, (has <Name>/have you) attended school or college? Include only nursery or preschool, kindergarten, elementary school, home school, and schooling that leads to a high school diploma or a college degree.
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: SCHB
Was that a public school or college, a private school or college, or home school?
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1. Public school or college 2. Private school or college or home school |
Paper Questionnaire Item Number: Person 11
CATI/CAPI/TQA Screen Name: SCHL
(Using Card E,) what is the highest degree or level of school (<Name> has/ you have) COMPLETED?
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51. No schooling completed 52. Nursery school 53. Kindergarten 54. Grade 1 55. Grade 2 56. Grade 3 57. Grade 4 58. Grade 5 59. Grade 6 60. Grade 7 |
61. Grade 8 62. Grade 9 63. Grade 10 64. Grade 11 65. Grade 12, no diploma 66. Regular high school diploma 67. GED or alternative credential 68. Some college, no degree 69. Associate’s degree (for example: AA, AS)
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70. Bachelor's degree (for example: BA, BS) 71. Master's degree (for example: MA, MS, MEng, MEd, MSW, MBA) 72. Professional degree (for example: MD, DDS, DVM, LLB, JD) 73. Doctorate degree (for example: PhD, EdD) 74. Vocational or technical license <DO NOT READ> |
CATI/CAPI/TQA Screen Name: SCHLVOC (Asked when SCHL = 74.)
Other than the vocational or technical license, what is the highest degree or level of school (<Name> has/ you have) COMPLETED?
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51. No schooling completed 52. Nursery school 53. Kindergarten 54. Grade 1 55. Grade 2 56. Grade 3 57. Grade 4 58. Grade 5 59. Grade 6 60. Grade 7 61. Grade 8 62. Grade 9 |
63. Grade 10 64. Grade 11 65. Grade 12, no diploma 66. Regular high school diploma 67. GED or alternative credential 68. Some college, no degree 69. Associate’s degree (for example: AA, AS) 70. Bachelor's degree (for example: BA, BS) 71. Master's degree (for example: MA, MS, MEng, MEd, MSW, MBA) |
72. Professional degree (for example: MD, DDS, DVM, LLB, JD) 73. Doctorate degree (for example: PhD, EdD)
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CATI/CAPI/TQA Screen Name: SCHL1 (Asked when respondent has completed 12th grade, or has completed 11th grade and is not currently enrolled in school.)
Did (you/<NAME>) receive a high school diploma, a GED or alternative credential?
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1. Regular high school diploma 2. GED or alternative credential 3. No diploma or GED |
CATI/CAPI/TQA Screen Name: SCHL2 (Asked when the respondent answers that they completed high school, either with a regular diploma or GED.)
Did (you/<NAME>) complete any college credit?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: SCHL3 (Asked when respondents indicate they completed some college.)
Did (you/<NAME>) complete 1 or more years of college credit?
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1. Yes 2. No |
Paper Questionnaire Item Number: Person 14a and 14b
CATI/CAPI/TQA Screen Name: MIGA
Did (<Name>/you) live in this (house/apartment/mobile home/unit) 1 year ago?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: MIGB
Did (<Name>/ you) live in the United States, Puerto Rico, or another country?
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1. United States 2. Puerto Rico 3. Another Country 4. Yes, in the same house as Person 1 |
CATI/CAPI/TQA Screen Name: MGW1
What was the foreign country?
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CATI/CAPI/TQA Screen Name: MGW1a
What was the street address?
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CATI/CAPI/TQA Screen Name: MGW2
What was the city or town?
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CATI/CAPI/TQA Screen Name: MGW4
What was the (county/municipio)?
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CATI/CAPI/TQA Screen Name: MGST
What was the state?
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CATI/CAPI/TQA Screen Name: MGW6
What was the ZIP code?
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Paper Questionnaire Item Number: Person 15
CATI/CAPI/TQA Screen Name: HICEMPLOYER
I am now going to ask you some questions about (your/<Name>’s) health insurance and health coverage.
(Are you/Is <Name>) currently covered by health insurance through a current or former employer or union of (yours/<yours/him/her> or another family member)?
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1. Yes 2. No |
(Are you/Is <Name>) currently covered by health insurance purchased directly from an insurance company by (you/<you/him/her> or another family member)?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: HICMEDICARE
(Are you/Is <Name>) currently covered by Medicare, for people age 65 or older or people with certain disabilities?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: HICMEDICAID
(Are you/Is <Name>) currently covered by Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: HICMILITARY
(Are you/Is <Name>) currently covered by TRICARE or other military health care?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: HICVA
(Are you/Is <Name>) currently covered through the VA or have you ever used or enrolled for VA health care?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: HICINDIAN
(Are you/Is <Name>) currently covered through the Indian Health Service?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: HICOTHER
(Are you/Is <Name>) currently covered by any other health insurance or health coverage plan?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: OTHERHIC1
What is the name of the health care plan?
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Paper Questionnaire Item Number: Person 19
CATI/CAPI/TQA Screen Name: MAR
I will now be asking about (your/Name’s> marital status. (Is <Name>/Are you) married, widowed, divorced, separated, or never married? |
1. Now married 2. Widowed 3. Divorced 4. Separated 5. Never Married |
Paper Questionnaire Item Number: Person 20
CATI/CAPI/TQA Screen Name: MARHIS1
In the past 12 months, did (<Name>/you) get married?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: MARHIS2
In the past 12 months, did (<Name>/you) become a (widow/widower)?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: MARHIS3
In the past 12 months, did (<Name>/you) get divorced?
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1. Yes 2. No |
Paper Questionnaire Item Number: Person 21
CATI/CAPI/TQA Screen Name: NUMMAR
How many times (has <Name>/have you) been married? Is that once, twice, or three or more times?
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1. Once 2. Twice 3. Three or more times |
Paper Questionnaire Item Number: Person 25
CATI/CAPI/TQA Screen Name: MILA
(Has <Name>/ Have you) ever served on active duty in the U.S. Armed Forces, military Reserves, or National Guard?
Do not include training for the Reserves or National Guard but do include activation, for example, for the Persian Gulf War. |
1. Yes 2. No |
CATI/CAPI/TQA Screen Name: MILB
When (were you/ was <Name>) on active duty?
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1. Now on active duty 2. On active duty during the past 12 months, but not now 3. On active duty in the past, but not during the last 12 months |
CATI/CAPI/TQA Screen Name: MILC
(Has <Name>/ Have you) ever been in the U.S. military Reserves or the National Guard?
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1. Yes 2. No |
Paper Questionnaire Item Number: Person 26
CATI/CAPI/TQA Screen Name: MILP
(Using Card F,) please tell me each period in which (<name>/you) served on active duty, even if it was just for part of the period. |
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(including Persian Gulf War)
(August 1964 to April 1975) |
(December 1941 to December 1946)
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Paper Questionnaire Item Number: Person 27b
CATI/CAPI/TQA Screen Name: SERVICE2
What is (<Name>’s/your) service-connected disability rating? Is it:
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1. 0 percent 2. 10 or 20 percent 3. 30 or 40 percent 4. 50 or 60 percent 5. 70 percent or higher |
Paper Questionnaire Item Number: Person 28a
CATI/CAPI/TQA Screen Name: WRK
Now, I am going to ask a series of questions about employment...
LAST WEEK, did (<Name>/you) work for pay at a job or business?
(Include any work even if (he/she/you) worked only 1 hour, or helped without pay in a family business or farm for 15 hours or more, or (was/were) on active duty in the Armed Forces.)
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1. Yes 2. No |
Paper Questionnaire Item Number: Person 29a
CATI/CAPI/TQA Screen Name: PWW1
The next few questions deal with where (<Name>/you) worked LAST WEEK and how (he/she/you) got there...
LAST WEEK, at what location did (<Name>/you) work? What is the address - number and street name?
(If (he/she/you) worked at more than one address or location, give the address or location where (he/she/you) worked most LAST WEEK.
If you do not know the exact address, give a description of the location such as the building name or the nearest street or intersection.
For example: Town Center Mall, 1st National Bank Building, Reno Airport, 2nd Ave. and 4th St.)
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Paper Questionnaire Item Number: Person 29b
CATI/CAPI/TQA Screen Name: PWW2
What is the city, town or post office?
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Paper Questionnaire Item Number: Person 29d
CATI/CAPI/TQA Screen Name: PWW4
What is the county?
|
Paper Questionnaire Item Number: Person 29e
CATI/CAPI/TQA Screen Name: PWW5
What is the state?
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Paper Questionnaire Item Number: Person 29f
CATI/CAPI/TQA Screen Name: PWW6
What is the ZIP Code?
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Paper Questionnaire Item Number: Person 30
CATI/CAPI/TQA Screen Name: JWTR
(Using Card G,) LAST WEEK, how did (<Name>/ you) USUALLY get to work?
(If (he/she/you) usually used more than one method of transportation during the trip, report the one used for most of the distance.)
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1. Car, truck, or van 5. Railroad 9. Bicycle 2. Bus or trolley bus 6. Ferryboat 10. Walked 3. Streetcar or trolley car 7. Taxicab 11. Worked at home 4. Subway or elevated 8. Motorcycle 12. Other method
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Paper Questionnaire Item Number: Person 31
CATI/CAPI/TQA Screen Name: JWRI
LAST WEEK, how many people including (<Name>/yourself) usually rode to work together?
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Paper Questionnaire Item Number: Person 32
CATI/CAPI/TQA Screen Name: JWLH
LAST WEEK, what time did (<Name>/you) usually leave for work (--what hour)?
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CATI/CAPI/TQA Screen Name: JWLM
(How many minutes past that hour?)
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CATI/CAPI/TQA Screen Name: JWAM
(Was that AM or PM?)
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1. AM 2. PM |
Paper Questionnaire Item Number: Person 34B
CATI/CAPI/TQA Screen Name: NWAB
LAST WEEK, (was <Name>/were you) TEMPORARILY absent from a job or business because of vacation, temporary illness, maternity leave, other family or personal reasons, bad weather, etc? |
1. Yes 2. No |
Paper Questionnaire Item Number: Person 36
CATI/CAPI/TQA Screen Name: NWAVA
LAST WEEK, could (<Name>/you) have started a job if offered one (or returned to work if recalled)?
|
1. Yes 2. No |
CATI/CAPI/TQA Screen Name: NWAVB
Why was that?
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1. Own temporary illness 2. Going to school or some other reason |
Paper Questionnaire Item Number: Person 39
CATI/CAPI/TQA Screen Name: WKH
During the weeks worked IN THE PAST 12 MONTHS how many hours did (<Name>/you) usually work each week?
|
Paper Questionnaire Item Number: Person 40
CATI/CAPI/TQA Screen Name: COWCP (Personal Visit Interviews)
The next series of questions are about the type of business (<Name>/you) (works/work/worked) for and the type of work that (he/she/you) (does/do/did)...
Using CARD H, please pick the category that best describes who (he/she/you)(works/work/worked) for- (If (<Name>/ you) had more than 1 job, describe the one at which the most hours were worked. If (<Name>/ you) did not work last week, give information for the last job or business in the past five years.) |
1. An employee of a PRIVATE FOR PROFIT company or business, or of an individual for wages, salary, or commissions? 2. An employee of a PRIVATE NOT-FOR-PROFIT, tax-exempt, or charitable organization? 3. A local GOVERNMENT employee (city, county, etc.)? 4. A state GOVERNMENT employee? 5. An active duty U.S. Armed Forces member? 6. A federal Government employee (excluding active duty military)? 7. SELF-EMPLOYED in own NOT INCORPORATED business, professional practice, or farm? 8. SELF-EMPLOYED in own INCORPORATED business, professional practice, or farm? 9. Working WITHOUT PAY in family business or farm? |
CATI/CAPI/TQA Screen Name: COWA (Telephone Interviews)
The next series of questions are about the type of business (<Name>/you) (works/work/worked) for and the type of work that (he/she/you) (does/do/did)...
I am going to read 5 categories. Please pick the one that best describes who (he/she/you) (works/work/worked) for - a private organization or company, government, the US Armed Forces (active duty), self-employed, or working without pay in a family business.
(If (<Name>/ you) had more than 1 job, describe the one at which the most hours were worked. If (<Name>/ you) did not work last week, give information for the last job or business in the past five years.)
|
1. Private organization or company 2. Government 3. US Armed Forces (active duty) 4. Self-employed 5. Working without pay in a family business |
CATI/CAPI/TQA Screen Name: COWB (Telephone Interviews)
(Is/Was) this a non-profit organization or a for profit company?
|
1. Non-profit organization 2. For profit company |
CATI/CAPI/TQA Screen Name: COWC (Telephone Interviews)
(Is/Was) this for Local, State, or the Federal Government?
|
1. Local 2. State 3. Federal |
CATI/CAPI/TQA Screen Name: COWD (Telephone Interviews)
(Is/Was) this self-employment incorporated or not incorporated?
|
1. Incorporated 2. Not incorporated |
Paper Questionnaire Item Number: Person 41
CATI/CAPI/TQA Screen Name: INW2
What (is/was) the name of (<Name>'s/your) company, business or other employer?
|
CATI/CAPI/TQA Screen Name: INMIL (Asked when COWCP=5 or COWA=3)
Which branch of the Armed Forces (does <Name>/do you) work for?
|
1. U.S. Army 2. U.S. Navy 3. U.S. Air Force 4. U.S. Marine Corps 5. U.S. Coast Guard |
Paper Questionnaire Item Number: Person 43
CATI/CAPI/TQA Screen Name: INX4
Is this business mainly -- manufacturing, wholesale trade, retail trade or some other kind of business?
1. Manufacturing 2. Wholesale trade 3. Retail trade 4. Other (agriculture, construction, service, government, etc.)
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Paper Questionnaire Item Number: Person 46a
CATI/CAPI/TQA Screen Name: WAGX
The next few questions are about income DURING THE PAST 12 MONTHS....
Did (<Name>/you) receive any wages, salary, tips, bonuses or commissions?
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1. Yes 2. No |
CATI/CAPI/TQA Screen Name: WAG
How much did (<Name>/you) receive?
(Report amount from all jobs before any deductions for taxes, bonds or other items.)
|
Paper Questionnaire Item Number: Person 46b
CATI/CAPI/TQA Screen Name: SEMX
Did (<Name>/you) receive any self-employment income DURING THE PAST 12 MONTHS?
(Report income from own businesses (farm or non-farm) including proprietorships and partnerships.)
|
1. Yes 2. No |
CATI/CAPI/TQA Screen Name: SEM
What was the amount?
(Report net income after operating expenses. Include earnings as a tenant farmer or sharecropper.)
|
Paper Questionnaire Item Number: Person 46c
CATI/CAPI/TQA Screen Name: INTRX
(The next few questions are about income DURING THE PAST 12 MONTHS...) Did (<Name>/you) receive any interest, dividends, net rental income, royalty income, or income from estates and trusts (DURING THE PAST 12 MONTHS)? Report even small amounts credited to an account.
|
1. Yes 2. No |
CATI/CAPI/TQA Screen Name: INTR
What was the amount received?
|
Paper Questionnaire Item Number: Person 46d
CATI/CAPI/TQA Screen Name: SSX
Did (<Name>/you) receive any Social Security or Railroad Retirement benefits DURING THE PAST 12 MONTHS?
|
1. Yes 2. No |
CATI/CAPI/TQA Screen Name: SS
What was the amount?
|
Paper Questionnaire Item Number: Person 46e
CATI/CAPI/TQA Screen Name: SSIX
Did (<Name>/you) receive any Supplemental Security Income (SSI) payments DURING THE PAST 12 MONTHS?
|
1. Yes 2. No |
CATI/CAPI/TQA Screen Name: SSI
What was the amount?
|
Paper Questionnaire Item Number: Person 46f
CATI/CAPI/TQA Screen Name: PAX
Did (<Name>/you) receive any public assistance or public welfare payments from the state or local welfare office DURING THE PAST 12 MONTHS?
|
1. Yes 2. No |
CATI/CAPI/TQA Screen Name: PA
What was the amount?
(Do not include SSI.)
|
Paper Questionnaire Item Number: Person 46g
CATI/CAPI/TQA Screen Name: RETX
Did (<Name>/you) receive any retirement, survivor, or disability pensions DURING THE PAST 12 MONTHS?
|
1. Yes 2. No |
CATI/CAPI/TQA Screen Name: RET
What was the amount?
(Do not include Social Security.)
|
Paper Questionnaire Item Number: Person 46h
CATI/CAPI/TQA Screen Name: OIX
Did (<Name>/you) receive income on a REGULAR basis from any other source such as Veteran's Administration (VA) payments, unemployment compensation, child support or alimony DURING THE PAST 12 MONTHS?
|
1. Yes 2. No |
CATI/CAPI/TQA Screen Name: OI
What was the amount from all sources?
(Do not include lump sum payments such as money from an inheritance or sale of a home.)
|
Paper Questionnaire Item Number: Person 47
CATI/CAPI/TQA Screen Name: TI (Asked when a total income cannot be calculated)
What was (<Name>'s/ your) TOTAL income during the PAST 12 MONTHS?
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CATI/CAPI/TQA Screen Name: TICALC
(According to my calculations (<Name>/you) received $ (calculated income) from all income sources/ I have recorded that (<Name> has/you have) received no income) over the PAST 12 MONTHS. Is this correct?
|
1. Yes 2. No |
CATI/CAPI/TQA Screen Name: TIEST (Asked when TICALC = 2, Don’t know or Refused)
What is your best estimate of the total income (<Name>/you) received from all sources OVER THE PAST 12 MONTHS?
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| File Type | application/msword |
| File Title | Paper Questionnaire Item Number: Person 14a and 14b |
| Author | cronk001 |
| Last Modified By | dusch001 |
| File Modified | 2007-05-30 |
| File Created | 2007-03-12 |