Document
Family Socio-Demographic
ICR 200711-0920-006 · OMB 0920-0214 · Object 4996601.
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Document Metadata
| File Type | application/msword |
|---|---|
| File Title | Family Socio-Demographic |
| Author | Howard Riddick |
| Last Modified By | Writer |
| File Modified | 2006-09-29 |
| File Created | 2026-11-08 |
| Conversion State | complete |
Extracted Text
Page 1 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 Question ID: FSD.001_00.000 Instrument Variable Name: PLBORN QuestionnaireFileName: Family QuestionText: [fill: Were you/Was ALIAS] born in the United States? 1 Yes 2 No 7 Refused 9 Don't know UniverseText: All persons SkipInstructions: <1> [store "1" in CITIZEN and goto PLBORN1] <2> [goto PLBORN2] <R,D> [goto CITIZEN] Page 2 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 Question ID: FSD.002_00.000 Instrument Variable Name: PLBORN1 QuestionnaireFileName: Family QuestionText: In what state [fill: were you/was ALIAS] born? 01 Alabama 02 Alaska 03 Arizona 04 Arkansas 05 California 06 Colorado 07 Connecticut 08 Delaware 09 District of Columbia 10 Florida 11 Georgia 12 Hawaii 13 Idaho 14 Illinois 15 Indiana 16 Iowa 17 Kansas 18 Kentucky 19 Louisiana 20 Maine 21 Maryland 22 Massachusetts 23 Michigan 24 Minnesota 25 Mississippi 26 Missouri 27 Montana 28 Nebraska 29 Nevada 30 New Hampshire 31 New Jersey 32 New Mexico 33 New York 34 North Carolina 35 North Dakota 36 Ohio 37 Oklahoma 38 Oregon 39 Pennsylvania 40 Rhode Island 41 South Carolina 42 South Dakota 43 Tennessee 44 Texas 45 Utah 46 Vermont 47 Virginia 48 Washington Page 3 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 49 West Virginia 50 Wisconsin 51 Wyoming 57 United States (state unknown) UniverseText: All persons born in the United States SkipInstructions: <1-51,R,D> [goto HEADST] Page 4 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 Question ID: FSD.003_00.000 Instrument Variable Name: PLBORN2 QuestionnaireFileName: Family QuestionText: In what country [fill: were you/was ALIAS] born? * Please record country of birth. If country not found, type "ZZ" 060 AMERICAN SAMOA 061 AM SAMOA 062 BAKER ISLAND 063 GUAM 064 HOWLAND ISLAND 065 JARVIS ISLAND 066 JOHNSTON ATOLL 067 KINGMAN REEF 068 MANUA ISLANDS 069 MIDWAY ISLANDS 070 NAVASSA ISLAND 071 NORTHERN MARIANAS 072 PALMYRA ATOLL 073 PUERTO RICO 074 ROTA 075 SAIPAN 076 SAND ISLAND 077 ST CROIX 078 ST JOHN 079 ST THOMAS 080 TINIAN 081 US OUTLYING AREA 082 US VIRGIN ISLANDS 083 USVI 084 VIRGIN ISLANDS 085 WAKE ISLAND 100 ABROAD 101 ABU DHABI 102 ADEN 103 AFGHANISTAN 104 AFRICA 105 ALBANIA 106 ALBERTA 107 ALGERIA 108 ALGIERS 109 ALSACE-LORRAINE 110 AMSTERDAM 111 ANEGADA 112 ANGOLA 113 ANGUILLA 114 ANGUILLA BWI 115 ANOJOUAN 116 ANTARCTICA 117 ANTIGUA 118 ANTIGUA & BARBUDA 119 ANTIGUA WI 120 ANTILLES Page 5 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 121 ARAB PALESTINE 122 ARABIA 123 ARGENTINA 124 ARMENIA 125 ARUBA 126 ARUBA DWI 127 ARUBA NETHERLANDS 128 ASCENSION ISLAND 129 ASIA 130 ASIA MINOR 131 ASSAM 132 AT SEA 133 AUSTRALIA 134 AUSTRIA 135 AUSTRIA-HUNGARY 136 AZERBAIJAN 137 AZORES ISLANDS 138 BAHAMAS 139 BAHAMAS UK 140 BAHRAIN 141 BAJA CAL 142 BAJA CAL SUR 143 BALBOA 144 BANGLADESH 145 BARBADOS 146 BARBUDA 147 BAVARIA 148 BELARUS 149 BELFAST 150 BELGIAN CONGO 151 BELGIUM 152 BELIZE 153 BENIN 154 BERLIN 155 BERMUDA 156 BESSARABIA 157 BHUTAN 158 BOHEMIA 159 BOLIVIA 160 BONAIRE 161 BORNEO 162 BOSNIA 163 BOSNIA & HERZEGOVINA 164 BOTSWANA 165 BRASIL 166 BRAZIL 167 BRAZZAVILLE 168 BREMEN 169 BRITAIN 170 BRITISH COLUMBIA 171 BRITISH EAST AFRICA 172 BRITISH GUIANA Page 6 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 173 BRITISH GUYANA 174 BRITISH HONDURAS 175 BRITISH HONG KONG 176 BRITISH ISLES 177 BRITISH VI 178 BRITISH VIRGIN IS 179 BRITISH WEST INDIES 180 BRITISH WI 181 BRUNEI 182 BULGARIA 183 BURKINA FASO 184 BURMA 185 BURUNDI 186 BWI 187 BYELARUS 188 BYELORUSSIA 189 CAICOS ISLANDS 190 CAM PHA 191 CAM RANH 192 CAMBODIA 193 CAMEROON 194 CAN THO 195 CANADA 196 CANAL ZONE 197 CANARY ISLANDS 198 CANTON & ENDERBURY IS 199 CANTON ISLAND 200 CAPE VERDE 201 CARIBBEAN 202 CAYMAN ISLANDS 203 CENTRAL AFRICA 204 CENTRAL AFRICAN REP 205 CENTRAL AMERICA 206 CEYLON 207 CHAD 208 CHANNEL ISLANDS 209 CHIAPAS 210 CHIHUAHUA 211 CHILE 212 CHINA 213 CHINA HONG KONG 214 CHRISTMAS ISLAND 215 CHRISTMAS ISLAND, INDIAN OCEAN 216 COAHUILA 217 COLIMA 218 COLOMBIA 219 COMOROS 220 CONGO 221 COOK ISLANDS 222 CORAL SEA ISLANDS 223 CORK 224 CORSICA Page 7 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 225 COSTA RICA 226 COTE D'IVORIE 227 CRETE 228 CRIMEA 229 CRISTOBAL 230 CROATIA 231 CUBA 232 CURACAO 233 CYPRUS 234 CZ 235 CZECH REPUBLIC 236 CZECHOSLOVAKIA 237 DA LAT 238 DA NANG 239 DAKAR 240 DANZIG 241 DELHI 242 DEMO PEOPLE'S REP OF KOREA 243 DEMO REP OF CONGO 244 DENMARK 245 DISTRITO FEDERAL 246 DJIBOUTI 247 DOM REP 248 DOMINICA 249 DOMINICA BWI 250 DOMINICA WI 251 DOMINICAN REPUBLIC 252 DUBAI 253 DUBLIN 254 DURANGO 255 DUTCH EAST INDIES 256 DUTCH GUIANA 257 DUTCH INDONESIA 258 DUTCH NEW GUINEA 259 EAST PAKISTAN 260 EAST PRUSSIA 261 EASTER ISLAND 262 EASTERN AFRICA 263 ECUADOR 264 EGYPT 265 EIRE 266 EL SALVADOR 267 ENGLAND 268 EQUATORIAL GUINEA 269 ERITREA 270 ESPANA 271 ESTONIA 272 ETHIOPIA 273 EUROPA ISLAND 274 EUROPE 275 FALKLAND ISLANDS 276 FAROE ISLANDS Page 8 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 277 FEDERAL DISTRICT 278 FEDERAL REPUBLIC OF YUGOSLAVIA 279 FEDERATED STATES OF MICRONESIA 280 FIJI 281 FILIPINES 282 FINLAND 283 FOREIGN COUNTRY 284 FORMOSA 285 FRANCE 286 FRANKFURT 287 FRENCH GUIANA 288 FRENCH MOROCCO 289 FRENCH POLYNESIA 290 GABON 291 GALAPAGOS ISLANDS 292 GALWAY 293 GAMBIA 294 GAZA STRIP 295 GEORGIA 296 GERMANY 297 GHANA 298 GIA DINH 299 GIBRALTER 300 GLORIOSO ISLANDS 301 GOA 302 GRAND BAHAMA 303 GRAND CAYMAN 304 GRAND TURK 305 GREAT BRITAIN 306 GREAT COMORE 307 GREECE 308 GREENLAND 309 GRENADA 310 GUADALAJARA 311 GUADELOUPE 312 GUANAJUATO 313 GUATEMALA 314 GUERNSEY 315 GUERRERO 316 GUIANA 317 GUINEA 318 GUINEA-BISSAU 319 GUYANA 320 HA DONG 321 HAI PHONG 322 HAITI 323 HAMBURG 324 HANOI 325 HANOVER 326 HAVANA 327 HEARD & MCDONALD ISLANDS 328 HERZEGOVINA Page 9 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 329 HESSE 330 HIDALGO 331 HIGH SEAS 332 HOLLAND 333 HONDURAS 334 HONG KONG 335 HUNGARY 336 HYDERABAD 337 ICELAND 338 INDIA 339 INDONESIA 340 INTERNATIONAL WATERS 341 IRAN 342 IRAQ 343 IRELAND 344 IRIAN JAYA 345 IRISH REPUBLIC 346 ISLE OF MAN 347 ISRAEL 348 ITALY 349 IVORY COAST 350 JALISCO 351 JAMAICA 352 JAN MEYAN 353 JAPAN 354 JAVA 355 JERSEY 356 JIBUTI 357 JORDAN 358 JUAN DE NOVA ISLAND 359 JUGOSLAVIA 360 KALININGRAD 361 KAMPUCHEA 362 KASHMIR 363 KAZAKHSTAN 364 KENYA 365 KHANH HUNG 366 KINSHASA 367 KIRIBATI 368 KOREA 369 KORO ISLAND 370 KUWAIT 371 KWAJALEIN 372 KWANTUNG 373 KYRGYZSTAN 374 LABRADOR 375 LABUAN 376 LAOS 377 LATAKIA 378 LATIN AMERICA 379 LATVIA 380 LEBANON Page 10 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 381 LEEWARD ISLANDS 382 LESOTHO 383 LIBERIA 384 LIBYA 385 LIECHTENSTEIN 386 LITHUANIA 387 LOAS 388 LONDONDERRY 389 LONG XUYEN 390 LORRAINE 391 LUBECK 392 LUXEMBOURG 393 MACAO 394 MACAU 395 MACEDONIA 396 MADAGASCAR 397 MADEIRA ISLANDS 398 MAINLAND CHINA 399 MAJORCA 400 MALAGASY REPUBLIC 401 MALAWI 402 MALAYSIA 403 MALDIVES 404 MALI 405 MALLORCA 406 MALTA 407 MACHURIA 408 MANICA 409 MANILA 410 MANITOBA 411 MARSHALL ISLANDS 412 MARTINIQUE 413 MAURITANIA 414 MAURITIUS 415 MAYOTTE ISLAND 416 MELANESIA 417 MEXICO 418 MICHOACAN 419 MICRONESIA 420 MIDDLE EAST 421 MOLDAVIA 422 MOLDOVA 423 MONACO 424 MONAGAS 425 MONGOLIA 426 MONTENEGRO 427 MONTSERRAT 428 MORELOS 429 MOROCCO 430 MOZAMBIQUE 431 MY THO 432 N. IRELAND Page 11 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 433 NAM DINH 434 NAMIBIA 435 NAURU 436 NAYARIT 437 NEPAL 438 NETHERLANDS 439 NETH. ANTILLES 440 NETH. EAST INDIES 441 NEVIS ISLAND 442 NEW BRUNSWICK 443 NEW CALEDONIA 444 NEW GUINEA 445 NEW HEBRIDES 446 NEW SOUTH WALES 447 NEW ZEALAND 448 NEWFOUNDLAND 449 NHA TRANG 450 NICARAGUA 451 NIGER 452 NIGERIA 453 NIUE ISLAND 454 NORFOLK ISLAND 455 NORTH AFRICA 456 NORTH AMERICA 457 NORTH KOREA 458 NORTH VIETNAM 459 NORTHERN IRELAND 460 NORTHERN TERRITORY 461 NORWAY 462 NOVA SCOTIA 463 NUEVO LEON 464 OAXACA 465 OCEANIA 466 OKINAWA 467 OMAN 468 ONTARIO 469 OVERSEAS 470 PAKISTAN 471 PALAU 472 PALESTINE 473 PANAMA 474 PANAMA CANAL ZONE 475 PAPUA NEW GUINEA 476 PARACEL ISLANDS 477 PARAGUAY 478 PELAGOSA 479 PEOPLE'S REP. OF CHINA 480 PEOPLE'S REP. OF CONGO 481 PERSIA 482 PERU 483 PHAN THIET 484 PHILIPPINES Page 12 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 485 PITCAIRN ISLAND 486 POLAND 487 POLYNESIA 488 PONAPE 489 PORTUGAL 490 PORTUGUESE INDIA 491 PRINCE EDWARD ISLAND 492 PRINCIPE ISLAND 494 PRUSSIA 495 PUEBLA 496 PUNJAB 497 PUNJAB, INDIA 498 PUNJAB, PAKISTAN 499 QATAR 500 QUANG LONG 501 QUEBEC 502 QUEENSLAND 503 QUERETARO 504 QUI NHON 505 RACH GIA 506 RAJASTHAN 507 RED CHINA 508 REPUBLIC OF CHINA 509 REPUBLIC OF CYPRUS 510 REPUBLIC OF IRELAND 511 REPUBLIC OF KOREA 512 REPUBLIC OF PANAMA 513 REP. OF PHILIPPINES 514 REP. OF SOUTH AFRICA 515 REPUBLICA DOMINICANA 516 REUNION ISLAND 517 RHODESIA 518 ROC 519 ROK 520 ROMANIA 521 ROTTERDAM 522 RUMANIA 523 RUSSIA 524 RUSSIAN FEDERATION 525 RWANDA 526 SAIGON 527 SALVADOR 528 SAMOA 529 SAN ANDRES 530 SAN LUIS POTOSI 531 SAN MARINO 532 SAN SALVADOR 533 SAO TOME ISLAND 534 SAO TOME & PRINCIPE 535 SARAWAK 536 SASKATCHEWAN 537 SAUDI ARABIA Page 13 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 538 SAXONY 539 SCOTLAND 540 SENEGAL 541 SEOUL 542 SERBIA 543 SEYCHELLES 544 SHANGHAI 545 SHARJAH 546 SIBERIA 547 SICILY 548 SIERRA LEONE 549 SIKKIM 550 SINALOA 551 SINGAPORE 552 SLAVONIA 553 SLOVAK REPUBLIC 554 SLOVAKIA 555 SLOVENIA 556 SOLOMAN ISLANDS 557 SOMALIA 558 SONORA 559 SOUTH AFRICA 560 SOUTH AMERICA 561 SOUTH AUSTRALIA 562 SOUTH KOREA 563 SOUTH VIETNAM 564 SOUTH WALES 565 SOUTH YEMEN 566 SOUTHEAST ASIA 567 SOUTHERN AFRICA 568 SOUTHERN RHODESIA 569 SOVIET UNION 570 SPAIN 571 SPRATLEY ISLANDS 572 SRI LANKA 573 ST BARTHELEMY 574 ST BARTS 575 ST CHRISTOPHER 576 ST CHRISTOPHER-NEVIS 577 ST EUSTATIUS 578 ST HELENA 579 ST KITTS 580 ST KITTS-NEVIS 581 ST LUCIA 582 ST MAARTEN 583 ST MARTIN 584 ST PIERRE & MIQUELON 585 ST VINCENT 586 ST VINCENT & THE GRENADINES 587 SUDAN 588 SUMATRA 589 SURINAM Page 14 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 590 SURINAME 591 SVALBARD 592 SWAZILAND 593 SWEDEN 594 SWITZERLAND 595 SYRIA 596 SYRIAN ARAB REP 597 TABASCO 598 TADZHIK 599 TAHITI 600 TAIWAN 601 TAIWAN ROC 602 TAJIKISTAN 603 TAMAULIPAS 604 TANGANYIKA 605 TANGIER 606 TANZANIA 607 TASMANIA 608 THAILAND 609 THANH HOA 610 THE GRENADINES 611 TIBET 612 TIJUANA 613 TLAXCALA 614 TOBAGO 615 TOGO 616 TOGOLAND 617 TOKELAU 618 TONGA 619 TORTOISE ISLANDS 620 TORTOLA 621 TRANSVAAL 622 TRANSYLVANIA 623 TRIESTE 624 TRINIDAD 625 TRINIDAD & TOBAGO 626 TRIPOLI 627 TROMELIN ISLAND 628 TRUK 629 TUNIS 630 TUNISIA 631 TURKEY 632 TURKMENISTAN 633 TURKS & CAICOS IS 634 TURK ISLANDS 635 TUVALU 636 TUY HOA 637 UGANDA 638 UK 639 UKRAINE 640 UKRAINIA 641 UNION ISLANDS Page 15 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 642 UNION OF SOUTH AFRICA 643 UNION OF SOVIET SOCIALIST REPUBLICS 644 UNITED ARAB EMIRATES 645 UNITED KINGDOM 646 UPPER VOLTA 647 URUGUAY 648 USSR 649 USBEKISTAN 650 VANCOUVER 651 VANUATU 652 VATICAN CITY 653 VENEZUELA 654 VERACRUZ 655 VICTORIA 656 VIETNAM 657 VINH LONG 658 VUNG TAU 659 WALES 660 WALLIS & FUTUNA ISLANDS 661 WEST AFRICA 662 WEST BANK 663 WEST BENGAL 664 WEST INDIES 665 WEST PAKISTAN 666 WESTERN AUSTRALIA 667 WESTERN SAHARA 668 WESTERN SAMOA 669 WHITE RUSSIA 670 WINDWARD ISLANDS 671 WINNIPEG 672 WURZBERG 673 YAP 674 YAR 675 YEMEN 676 YEMEN ARAB REPUBLIC 677 YEREVAN 678 YUCATAN 679 YUGOSLAVIA 680 YUKON TERRITORY 681 ZACATECAS 682 ZADAR 683 ZAIRE 684 ZAMBIA 685 ZANZIBAR 686 ZIMBABWE 687 ZURICH 688 ANDORRA 689 BRITISH INDIAN OCEAN TERRITORY 690 DEUTSCHLAND 691 FRENCH SOUTHERN AND ANTARCTIC LANDS 692 GRENADINES, THE 693 KOSOVO Page 16 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 694 MYANMAR 695 NORTHWEST TERRITORY 696 NUNAVUT TERRITORY 996 Country not listed 997 Refused 999 Don't know UniverseText: All persons not born in the United States SkipInstructions: <60-85> [store "2" in CITIZEN and goto USYR] <100-696,996,R,D> [goto USYR] Question ID: FSD.004_00.000 Instrument Variable Name: USYR QuestionnaireFileName: Family QuestionText: * Read if necessary. Earlier I recorded [fill1: your/ALIAS's] date of birth as [fill2: AGEDOB@3(text version) AGEDOB@4, AGEDOB@5]. In what year did [fill3: you/ALIAS] come to the United States to stay? 1880-Current Year 1880-Current Year 9997 Refused 9999 Don't know UniverseText: All persons not born in the United States SkipInstructions: <1880-Current Year> [if USYR lt AGEDOB@5, goto ERR2_USYR; else, goto CITIZEN] <R,D> [goto USLONG] NOTE: The "*Read if necessary…Earlier I recorded…" portion of this question is included for persons with complete date of birth information. Question ID: FSD.005_00.000 Instrument Variable Name: USLONG QuestionnaireFileName: Family QuestionText: About how long [fill1: have you/has ALIAS] been in the United States? * Read if necessary: Earlier I recorded that [fill2: you are/ALIAS is] [fill3: AGE] years old. *Enter '95' for 95 or more years. *If less than 1 year given as a response, code the answer as '0'. 00-94 00-94 years 95 95+ years 97 Refused 99 Don't know UniverseText: All persons not born in the United States and refused or don't know was reported for USYR SkipInstructions: <0-95> [if USLONG gt AGE, goto ERR_USLONG; else, goto CITIZEN] <R,D> [goto CITIZEN] Page 17 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 Question ID: FSD.006_00.000 Instrument Variable Name: CITIZEN QuestionnaireFileName: Family QuestionText: (book) F20 ?[F1] [fill: Are you/Is ALIAS] a CITIZEN of the United States? 1 Yes, born in one of the 50 United States or the District of Columbia 2 Yes, born in Puerto Rico, Guam, American Virgin Islands, or other U.S. territory 3 Yes, born abroad to American parent(s) 4 Yes, U.S. citizen by naturalization 5 No, not a citizen of the United States 7 Refused 9 Don't know UniverseText: All persons not born in the United States or a United States territory SkipInstructions: <1> [if PLBORN eq 2, goto ERR1_CITIZEN; else, if PLBORN eq R, goto ERR3_CITIZEN; else, goto HEADST] <2> [if (PLBORN eq 2 or PLBORN eq R), goto ERR2_CITIZEN; else, goto HEADST] Question ID: FSD.007_00.000 Instrument Variable Name: HEADST QuestionnaireFileName: Family QuestionText: ?[F1] Is [fill: ALIAS] now attending Head Start? 1 Yes 2 No 7 Refused 9 Don't know UniverseText: All persons less than 7 years of age SkipInstructions: <1> [if no more persons less than 7 years of age, goto EDUC; else, repeat this question for the next eligible person] <2,R,D> [ goto HEADSTEV] Page 18 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 Question ID: FSD.010_00.000 Instrument Variable Name: EDUC QuestionnaireFileName: Family QuestionText: (book) F21 ?[F1] What is the HIGHEST level of school [fill: you have/ALIAS has] completed or the highest degree [fill: you have/ALIAS has] received? Please tell me the number from the card. * Enter highest level of school completed. 00 Never attended/kindergarten only 01 1st grade 02 2nd grade 03 3rd grade 04 4th grade 05 5th grade 06 6th grade 07 7th grade 08 8th grade 09 9th grade 10 10th grade 11 11th grade 12 12th grade, no diploma 13 GED or equivalent 14 High School Graduate 15 Some college, no degree 16 Associate degree: occupational, technical, or vocational program 17 Associate degree: academic program 18 Bachelor's degree (Example: BA, AB, BS, BBA) 19 Master's degree (Example: MA, MS, MEng, MEd, MBA) 20 Professional School degree (Example: MD, DDS, DVM, JD) 21 Doctoral degree (Example: PhD, EdD) 96 Child under 5 years old 97 Refused 99 Don't know UniverseText: All persons 5 years of age or older SkipInstructions: repeat for all eligible persons, then goto FMILTRY Page 19 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 Question ID: FSD.041_00.000 Instrument Variable Name: FMILTRY QuestionnaireFileName: Family QuestionText: [fill: Have you/Has any family member, that is *Read names (fill roster of people ge 18 years of age)] ever been honorably discharged from active duty in the U.S. Army, Navy, Air Force, Marine Corps, or Coast Guard? 1 Yes 2 No 7 Refused 9 Don't know UniverseText: All families with persons 18 years of age or older SkipInstructions: <1> [if only one person 18 years of age or older, store the person number in PMILTRY and goto DOINGLW; else, goto PMILTRY] <2,R,D> [goto DOINGLW] Question ID: FSD.042_00.000 Instrument Variable Name: PMILTRY QuestionnaireFileName: Family QuestionText: * Ask or verify. Enter all that apply, separate with commas. Who was this? * Indicate each family member with honorable discharge. 1 Yes 2 No 7 Refused 9 Don't know UniverseText: All families with two or more persons 18 years of age or older and at least one was honorably discharged from active duty in the U.S. Army, Navy, Air Force, Marine Corps, or Coast Guard SkipInstructions: goto DOINGLW NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing. Page 20 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 Question ID: FSD.070_00.000 Instrument Variable Name: WRKHRS QuestionnaireFileName: Family QuestionText: ?[F1] How many hours [fill: did you work LAST WEEK at ALL jobs or businesses/did ALIAS work LAST WEEK at ALL jobs or businesses/do you USUALLY work at ALL jobs or businesses/does ALIAS USUALLY work at ALL jobs or businesses]? 001-168 1-168 hours 997 Refused 999 Don't know UniverseText: All persons 18 years of age or older who were working for pay at a job or business, or working, but not for pay, at a job or business last week, or on a planned vacation from work, or on family or maternity leave, or temporarily unable to work for health reasons, or have a job/contract and off-season SkipInstructions: <1-34,R,D> [goto WRKFTALL] <35-94> [goto WRKLYR] <95-168> [goto ERR1_WRKHRS] Question ID: FSD.080_00.000 Instrument Variable Name: WRKFTALL QuestionnaireFileName: Family QuestionText: ?[F1] [fill: Do you/Does ALIAS] USUALLY work 35 hours or more per week in total at ALL jobs or businesses? 1 Yes 2 No 7 Refused 9 Don't know UniverseText: All persons 18 years of age or older who worked less than 35 hours last week or did not know/refused to answer how many hours they worked last week SkipInstructions: [goto WRKLYR] NOTE ON QUESTIONNAIRE FLOW: The instrument cycles through the appropriate questions from DOINGLW to WRKFTALL for each eligible person, then proceeds to WRKLYR. Question ID: FSD.110_00.000 Instrument Variable Name: WRKMYR QuestionnaireFileName: Family QuestionText: How many months in [fill1: last calendar year in 4-digit format] did [fill2: you/ALIAS] have at least one job or business? * If less than one month, enter '1'. 01 1 month or less 02-12 2-12 months 97 Refused 99 Don't know UniverseText: All persons 18 years of age or older who worked last year SkipInstructions: goto ERNYR Page 21 of 21 2007 NHIS Questionnaire - Family Family Socio-Demographic Document Version Date: 12-Jul-06 Question ID: FSD.120_00.000 Instrument Variable Name: ERNYR QuestionnaireFileName: Family QuestionText: ?[F1] What is your best estimate of [fill1: your/ALIAS's] earnings before taxes and deductions from ALL jobs and businesses in [fill2: last calendar year in 4-digit format]? Include hourly wages, salaries, tips and commissions. * Enter '999,995' if the reported income is greater than $999,995. 000001-999994 $1-$999,994 999995 $999,995+ 999997 Refused 999999 Don't know UniverseText: All persons 18 years of age or older who worked last year SkipInstructions: goto HIEMPOF Question ID: FSD.130_00.000 Instrument Variable Name: HIEMPOF QuestionnaireFileName: Family QuestionText: Regarding [fill1: your/ALIAS's] job or work last week, was health insurance offered to [fill2: you/ALIAS] through [fill1: your/ALIAS's] workplace? 1 Yes 2 No 7 Refused 9 Don't know UniverseText: All persons 18 years of age or older who were working for pay at a job or business, or with a job or business, but not at work, or working, but not for pay, at a family-owned job or business SkipInstructions: goto INTROINC NOTE ON QUESTIONNAIRE FLOW: The instrument cycles through the appropriate questions from WRKLYR to HIEMPOF for each eligible person, then proceeds to INTROINC.