MEPS-HC Core Interview

Medical Expenditure Panel Survey Household Component and Medical Provider Component (MEPS-HC and MEPS-MPC through 2009)

Attachment 62 -- HC Reenumeration Subsection A

MEPS-HC Core Interview

OMB: 0935-0118

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0935-0118 can be found here:

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MEPS FAMES P12R5/P13R3/P14R1 Reenumeration (RE) Section Subsection A

December 8, 2008

Reenumeration (RE) Section Subsection A

BOX_00

======

----------------------------------------------------

| CONTEXT HEADER DISPLAY INSTRUCTIONS: |

| DISPLAY PERS.FULLNAME |

----------------------------------------------------

BOX_01

======

----------------------------------------------------

| RU CLASSIFICATIONS: |

| |

| THE FOLLOWING RU CLASSIFICATIONS ARE USED |

| THROUGHOUT THE REENUMERATION SECTION IN SKIP AND |

| WORD FILL SPECIFICATIONS: |

| |

| STANDARD RU - AN RU (OTHER THAN A STUDENT RU) |

| THAT EXISTED IN THE PREVIOUS ROUND. DURING THE |

| INTERVIEW WITH THE STANDARD RU, INFORMATION MAY |

| BE OBTAINED THAT IDENTIFIES A ‘NEW RU’ OR A |

| ‘STUDENT RU’ AND A NEW CASE IS CREATED. SEE |

| DEFINITIONS BELOW. |

| |

| NEW RU - WHEN ONE OR MORE RU MEMBERS ARE |

| IDENTIFIED AS HAVING LEFT THE RU AND FORMED ONE |

| OR MORE NEW RUs, A NEW CASE IS CREATED FOR EACH |

| OF THE NEW RUs WHERE AT LEAST ONE KEY RU MEMBER |

| LIVES. IN THE CURRENT ROUND, THE CASE IS |

| CLASSIFIED AS A ‘NEW RU’ UNLESS IT SATISFIES THE |

| CONDITIONS FOR A ‘STUDENT RU’ (SEE DEFINITION |

| BELOW). IN THE NEXT ROUND, THE NEW RU WILL BE |

| RECLASSIFIED AS A ‘STANDARD RU’ SINCE IT EXISTED |

| IN THE PREVIOUS ROUND. |

| |

| STUDENT RU - WHEN AN RU MEMBER IS IDENTIFIED IN |

| A STANDARD OR NEW RU AS BEING AGE 17-23 |

| (INCLUSIVE), NEVER MARRIED, NON-MILITARY, AND |

| LIVING AWAY FROM THE STANDARD/NEW RU AT POST- |

| SECONDARY SCHOOL WITHIN THE U.S., AN RU IS |

| CREATED AND CLASSIFIED AS A ‘STUDENT RU’. THE |

| ‘STUDENT RU’ REMAINS CLASSIFIED AS A ‘STUDENT RU’ |

| UNTIL ONE OF THE CRITERIA FOR A STUDENT RU |

| CLASSIFICATION IS VIOLATED (E.G., AGE RANGE OR |

| MARITAL STATUS). (NOTE: A STUDENT RU IS ALWAYS |

| A SINGLE-PERSON RU.) |

----------------------------------------------------

| NOTE: THE NHIS ORIGINAL RUs ARE DETERMINED FROM |

| IN-HOUSE PRE-PROCESSING AND ARE CLASSIFIED AS |

| STANDARD RUs. |

----------------------------------------------------

| NOTE: REFERENCES TO THE RU-MEMBERS-ROSTER AND ‘RU |

| MEMBERS’ IN THESE SPECIFICATIONS INDICATE THE |

| ROSTER IN ITS CURRENT STATE; THAT IS, INCLUDING |

| ALL ADDITIONS TO AND DELETIONS FROM THE ROSTER |

| THAT OCCUR UP TO THE POINT AT WHICH THE REFERENCE |

| IS MADE. |

| |

| THEREFORE, IF ROUND 1, THE FIRST TIME A CASE IS |

| WORKED DURING THE ROUND, AT THE BEGINNING OF THE |

| RE SECTION, THE ROSTER INCLUDES ALL ORIGINAL NHIS |

| RU MEMBERS. IF NOT ROUND 1, THE FIRST TIME A |

| CASE IS WORKED IN THE ROUND, AT THE BEGINNING OF |

| THE RE SECTION, THE ROSTER INCLUDES ALL RU |

| MEMBERS WHO WERE ELIGIBLE OR INSTITUTIONALIZED |

| ON THE DATE OF THE PREVIOUS ROUND INTERVIEW. |

| |

| IN ALL ROUNDS, FOR A CASE THAT HAS HAD A BREAKOFF,|

| THE ROSTER INCLUDES PERSONS ELIGIBLE OR |

| INSTITUTIONALIZED AT THE END OF RE. FOR A SPLIT |

| RU, THE ROSTER INCLUDES RU MEMBERS WHO SPLIT FROM |

| THE ORIGINAL RU. |

----------------------------------------------------

RE01

====

YOU HAVE SELECTED THE {STUDENT RU} CASE FOR {FULL NAME OF

REFERENCE PERSON}. THE RU MEMBERS ARE LISTED BELOW.

[1. First Name,[Middle Name],LastName-65]

[2. First Name,[Middle Name],Last Name-65]

[3. First Name,[Middle Name],Last Name-65]

HAVE YOU SELECTED THE CORRECT CASE?

YES .................................... 1 {RE02}

IF YOU HAVE SELECTED THE WRONG CASE, CLICK ON THE BREAKOFF

LINK AT THE TOP OF THE SCREEN TO RETURN TO THE IMS.

----------------------------------------------------

| DISPLAY ‘STUDENT RU’ IF STUDENT RU. OTHERWISE, |

| USE NULL DISPLAY. |

| |

| FOR ‘{FULL NAME OF REFERENCE PERSON}’ DISPLAY THE |

| FULL NAME OF PREVIOUS ROUND REFERENCE PERSON IF |

| STANDARD RU OR STUDENT RU. DISPLAY FULL NAME OF |

| OLDEST PERSON IN RU, IF NEW RU. |

----------------------------------------------------

| START RE_ENUM MAIN BLOCK OTHERWISE (CORRECT CASE |

| SELECTED), CONTINUE WITH RE02 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY |

| OF RU-MEMBERS. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. SELECT, ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| NONE. DISPLAY ALL RU MEMBERS |

----------------------------------------------------

RE02

====

{INTERVIEWER: READ INTRODUCTION JOB AID BEFORE CODING.}

{PLEASE NOTE: THIS IS A ROUND 5 INTERVIEW. QUESTIONS ARE

ASKED AS OF DEC 31, {YEAR} RATHER THAN ‘TODAY’.}

THE RESPONDENT MUST HAVE BEEN LIVING IN THE RU ON

DEC 31, {YEAR} TO BE CODED AS AN RU MEMBER RESPONDENT.

OTHERWISE, CODE AS A PROXY.}

IS RESPONDENT:

RU MEMBER OR ........................... 1

PROXY APPROVED BY SUPERVISOR? .......... 2 {RE03}

[Code One]

HELP AVAILABLE FOR RESPONDENT RULES.

----------------------------------------------------

| DISPLAY ‘INTERVIEWER: READ INTRODUCTION JOB AID |

| BEFORE CODING.’ IF NOT ROUND 1. OTHERWISE, USE |

| NULL DISPLAY. |

| |

| DISPLAY ‘PLEASE NOTE: THIS IS A ROUND 5 |

| INTERVIEW. QUESTIONS ARE ASKED AS OF DEC 31, |

| {YEAR} RATHER THAN ‘TODAY’.’ IF ROUND 5, WHERE |

| ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL. |

| OTHERWISE, USE A NULL DISPLAY. |

| |

| DISPLAY ‘THE RESPONDENT...’ IF ROUND 5, WHERE |

| ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL. |

| OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

| IF ROUND 1 AND CODED ‘1’ (RU MEMBER) AND STANDARD |

| RU, GO TO RE05 |

----------------------------------------------------

| IF ROUND 1 AND CODED ‘1’ (RU MEMBER) AND NEW RU, |

| GO TO RE05A |

----------------------------------------------------

| IF ROUND 1 AND CODED ‘1’ (RU MEMBER) AND STUDENT |

| RU, GO TO RE05B |

----------------------------------------------------

| IF NOT ROUND 1 AND CODED ‘1’ (RU MEMBER) AND |

| STUDENT RU, GO TO RE06 AND SELECT STUDENT |

| AUTOMATICALLY BY CAPI, THEN GO TO RE09 |

----------------------------------------------------

| IF NOT ROUND 1 AND CODED ‘1’ (RU MEMBER) AND |

| STANDARD OR NEW RU, GO TO RE06 |

----------------------------------------------------

| OTHERWISE (PROXY APPROVED BY SUPERVISOR), |

| CONTINUE WITH RE03 |

----------------------------------------------------

BOX_01A

=======

OMITTED.

BOX_01B

=======

OMITTED.

RE03

====

INTERVIEWER: SINCE THIS IS AN INTERVIEW WITH A

PROXY, PLEASE EXPLAIN THE REASON(S) AN RU MEMBER

CANNOT BE THE RESPONDENT.

[Enter Text]

----------------------------------------------------

| IF ROUND 1 AND STANDARD RU, GO TO RE05 |

----------------------------------------------------

| IF ROUND 1 AND NEW RU, GO TO RE05A |

----------------------------------------------------

| IF ROUND 1 AND STUDENT RU, GO TO RE05B |

----------------------------------------------------

| OTHERWISE (NOT ROUND 1), GO TO RE07 |

----------------------------------------------------

LOOP_01

=======

OMITTED.

RE04

====

OMITTED.

END_LP01

========

OMITTED.

BOX_02

=======

OMITTED.

RE05

====

{REFERENCE PERSON’S FIRST MIDDLE AND LAST NAME}

(As I mentioned earlier,) my records show that (PERSON)’s household

took part in the National Health Interview Survey on {MONTH, DAY,

YEAR OF NHIS INTERVIEW} and, at that time, the Census Bureau

interviewer mentioned that (PERSON)’s family might be contacted

again for another health related survey.

IF NEEDED, READ ALL OR PART OF THE FOLLOWING:

This survey, the Medical Expenditure Panel Survey, is also

for the U.S. Public Health Service [specifically, the Agency for

Healthcare Research and Quality and the National Center for

Health Statistics]. The information you provide will be kept

completely confidential and private as required by law.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

---------------------------------------------------

| DISPLAY THE DATE OF NHIS INTERVIEW FOR {MONTH, |

| DAY, YEAR OF NHIS INTERVIEW}. |

---------------------------------------------------

| IN ROUND 1, THE NAME IN THE CONTEXT HEADER IS THE|

| FULL NAME OF THE NHIS REFERENCE PERSON. |

---------------------------------------------------

| IF RE02 CODED ‘1’ (RU MEMBER), GO TO RE06 |

---------------------------------------------------

| IF RE02 CODED ‘2’ (PROXY APPROVED BY SUPERVISOR),|

| GO TO RE08 |

---------------------------------------------------

RE05A

=====

{REFERENCE PERSON’S FIRST MIDDLE AND LAST NAME}

(As I mentioned earlier,) my records show that (PERSON) (were/was)

a member of a household that took part in the National Health

Interview Survey on {MONTH, DAY, YEAR OF NHIS INTERVIEW} and, at

that time, the Census Bureau interviewer mentioned that members of

that household might be contacted again for another health related

survey. Since (PERSON) (are/is) no longer living with that

household, we will interview this new household separately.

IF NEEDED, READ ALL OR PART OF THE FOLLOWING:

This survey, the Medical Expenditure Panel Survey, is also

for the U.S. Public Health Service [specifically, the Agency for

Healthcare Research and Quality and the National Center for

Health Statistics]. The information you provide will be kept

completely confidential and private as required by law.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

---------------------------------------------------

| DISPLAY THE DATE OF NHIS INTERVIEW FOR {MONTH, |

| DAY, YEAR OF NHIS INTERVIEW}. |

---------------------------------------------------

| THE NAME OF THE REFERENCE PERSON DISPLAYED IN |

| THE CONTEXT HEADER IS THE FULL NAME OF THE OLDEST|

| RU MEMBER. |

---------------------------------------------------

| IF RE02 CODED ‘1’ (RU MEMBER), GO TO RE06 |

---------------------------------------------------

| IF RE02 CODED ‘2’ (PROXY APPROVED BY SUPERVISOR),|

| GO TO RE08 |

---------------------------------------------------

RE05B

=====

{REFERENCE PERSON’S FIRST MIDDLE AND LAST NAME}

(As I mentioned earlier,) my records show that (PERSON} (were/was}

a member of a household that took part in the National Health

Interview Survey on {MONTH, DAY, YEAR OF NHIS INTERVIEW} and, at

that time, the Census Bureau interviewer mentioned that members of

that household might be contacted again for another health related

survey. Since (PERSON} (are/is) now a student and no longer living

with that household, we will interview (PERSON) separately.

IF NEEDED, READ ALL OR PART OF THE FOLLOWING:

This survey, the Medical Expenditure Panel Survey, is also

for the U.S. Public Health Service [specifically, the Agency for

Healthcare Research and Quality and the National Center for

Health Statistics]. The information you provide will be kept

completely confidential and private as required by law.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

---------------------------------------------------

| DISPLAY THE DATE OF NHIS INTERVIEW FOR {MONTH, |

| DAY, YEAR OF NHIS INTERVIEW}. |

---------------------------------------------------

| NOTE: THE NAME OF THE REFERENCE PERSON DISPLAYED|

| IN THE CONTEXT HEADER IS THE FULL NAME OF THE |

| STUDENT. |

---------------------------------------------------

| IF RE02 CODED ‘1’ (RU MEMBER), SELECT STUDENT AT |

| RE06 AUTOMATICALLY BY CAPI, THEN GO TO RE09 |

---------------------------------------------------

| IF RE02 CODED ‘2’ (PROXY APPROVED BY SUPERVISOR),|

| GO TO RE08 |

---------------------------------------------------

RE06

====

SELECT THE RESPONDENT.

|--------------|--------------|--------------|--------------|--------------|

| ROSTER. | RE06_02. | RE06_03. | RE06_04. AGE | RE06_05. |

|--------------|--------------|--------------|--------------|--------------|

|--------------|--------------|--------------|--------------|--------------|

| Name Middle | RUNTID} | Selection] | | Selection] |

|--------------|--------------|--------------|--------------|--------------|

|--------------|--------------|--------------|--------------|--------------|

HELP AVAILABLE FOR RESPONDENT RULES.

----------------------------------------------------

| IF PERSON FROM ANOTHER RU IS SELECTED AND VERIFIED|

| AS THE RESPONDENT, ADD PERSON TO |

| RU-MEMBERS-ROSTER. |

----------------------------------------------------

| DISPLAY AN ‘ADD PERSON’ OPTION ON THIS SCREEN. |

----------------------------------------------------

| IF ‘ADD PERSON’ IS SELECTED, GO TO RE08 |

----------------------------------------------------

| OTHERWISE (PERSON SELECTED AS RESPONDENT WAS |

| ALREADY IN DU IN THE PREVIOUS ROUND), |

| GO TO RE09 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: DU_MEMBERS_2 |

| |

| COL # 1 HEADER: SELECT DU MEMBER |

| INSTRUCTIONS: DISPLAY DU MEMBERS’ FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

| |

| COL # 2 HEADER: RUID |

| INSTRUCTIONS: DISPLAY RU ID (RUNT.RUNTID) |

| |

| COL # 3 HEADER: GENDER |

| INSTRUCTIONS: DISPLAY DU MEMBERS’ SEX |

| (PERS.SMPSEXR) |

| |

| COL # 4 HEADER: AGE |

| INSTRUCTIONS: DISPLAY DU MEMBERS’ AGES (PRND.AGE) |

| |

| COL # 5 HEADER: INTERVIEW COMPLETED THIS ROUND |

| INSTRUCTIONS: DISPLAY WHETHER THE DU MEMBER HAS |

| ALREADY FINISHED THE INTERVIEW THIS ROUND |

| (TEMPORARY VARIABLE) |

----------------------------------------------------

| ROSTER DEFINITION: |

| DISPLAY THE DU-MEMBERS-ROSTER FOR SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. ALL COLUMNS ARE PROTECTED; NO CHANGES ARE |

| ALLOWED AT THIS SCREEN, EXCEPT TO ADD A PERSON AT |

| THE POP-UP (RE08). |

| |

| 2. THE ‘INTERVIEW COMPLETED THIS ROUND’ COLUMN |

| DISPLAYS AN ‘X’ FOR EACH PERSON WHO HAS ALREADY |

| BEEN INTERVIEWED THIS ROUND IN THE STANDARD RU OR |

| ANOTHER RU IN THIS DU. |

| |

| 3. IF PERSON WITH AN ‘X’ IN ‘INTERVIEW COMPLETED |

| THIS ROUND’ COLUMN IS SELECTED, DISPLAY MESSAGE: |

| “PERSON CANNOT BE SELECTED. HAS ALREADY BEEN |

| INTERVIEWED WITH ANOTHER RU.” |

| |

| 4. IF AN RU MEMBER UNDER 18 IS SELECTED AS THE |

| RESPONDENT, DISPLAY MESSAGE “RESPONDENT < 18. |

| S/HE MUST BE APPROVED BY SUPERVISOR. RESELECT TO |

| VERIFY.” |

| |

| 5. IF INTERVIEWER SELECTS A PERSON FROM ANOTHER |

| RU, DISPLAY THE MESSAGE: “PERSON IS MEMBER OF |

| ANOTHER RU. VERIFY THAT PERSON JOINED OR CORRECT |

| SELECTION.” |

----------------------------------------------------

| ROSTER FILTER: |

| NONE. DISPLAY ALL. |

----------------------------------------------------

BOX_03

======

OMITTED.

RE07

====

SELECT PROXY.

[1. First Name,[Middle Name],Last

Name-65] ...............................

[2. First Name,[Middle Name],Last

Name-65] ...............................

[3. First Name,[Middle Name],Last

Name-65] ...............................

[Code One]

----------------------------------------------------

| DISPLAY A 'NEW PROXY APPROVED BY SUPERVISOR' |

| OPTION ON THIS SCREEN. |

----------------------------------------------------

| IF 'NEW PROXY APPROVED BY SUPERVISOR' IS SELECTED,|

| CONTINUE WITH RE08 |

----------------------------------------------------

| OTHERWISE, GO TO RE09 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION|

| OF PROXY. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. SELECT ALLOWED. |

| |

| 2. MULTIPLE SELECT, ADD, DELETE, AND EDIT |

| DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY THE PROXY FROM THE PREVIOUS ROUND ONLY. |

----------------------------------------------------

RE08

====

ENTER NAME OF {RU MEMBER/PROXY} RESPONDENT.

May I have your full name?

VERIFY SPELLING.

IF NO MIDDLE NAME OR INITIAL, ENTER 'NMN'.

[Enter First Name,[Middle Name],Last Name-65] .....

----------------------------------------------------

| DISPLAY ‘RU MEMBER’ IF RE02 CODED ‘1’ (RU MEMBER).|

| |

| DISPLAY ‘PROXY’ IF RE02 CODED ‘2’ (PROXY APPROVED |

| BY SUPERVISOR). |

----------------------------------------------------

| REFUSED AND DON’T KNOW DISALLOWED AT ALL FIELDS. |

----------------------------------------------------

| IF 'ADD RU MEMBER' SELECTED AT RE06, ADD PERSON |

| ENTERED AT RE08 TO RU-MEMBERS-ROSTER |

| AND |

| FLAG PERSON AS ‘RU MEMBER ADDED AT RE08’. |

----------------------------------------------------

| IF ‘NEW PROXY APPROVED BY SUPERVISOR’ CODED AT |

| RE07, ADD PERSON ENTERED AT RE08 TO PERSONS-ROSTER|

| AND |

| FLAG PERSON AS ‘PROXY ADDED AT RE08’. |

----------------------------------------------------

RE09

====

VERIFY LOCATING ADDRESS BELOW WITH RESPONDENT.

STREET ADDRESS1: {RU'S MOST RECENT ST. ADDRESS1}

STREET ADDRESS2: {RU'S MOST RECENT ST. ADDRESS2}

CITY: {RU'S MOST RECENT CITY}

STATE: {ST}

ZIP CODE: {ZIP CODE}

CORRECT ADDRESS ........................ 1 {RE10A}

SAME ADDRESS - MINOR CORRECTIONS ....... 2 {RE10}

NEW ADDRESS ............................ 3 {RE10}

[Code One]

HELP AVAILABLE FOR DEFINITION OF LOCATING ADDRESS.

----------------------------------------------------

| FOR RU’S MOST RECENT ADDRESS FIELDS, DISPLAY |

| ADDRESS INFORMATION FROM HOME TABLE. |

----------------------------------------------------

RE10

====

MAKE CORRECTIONS TO LOCATING ADDRESS BELOW.

USE TAB TO MOVE THROUGH FIELDS.

RETYPE ANY FIELDS WHICH NEED CORRECTION.

TYPE THREE Xs (XXX) TO DELETE 2ND STREET ADDRESS.

Current Info: [STREET ADDRESS1]

[STREET ADDRESS2]

[CITY]

[STATE]

[ZIP CODE]

STREET ADDRESS1: [_____________]

STREET ADDRESS2: [_____________]

CITY: [_____________]

STATE: [_____________]

ZIP CODE: [_____________]

PRESS ENTER OR SELECT NEXT PAGE TO CONTINE.

USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.

----------------------------------------------------

| REFUSED AND DON’T KNOW ALLOWED AT ALL FIELDS |

| EXCEPT STATE. |

----------------------------------------------------

| GO TO RE10A |

----------------------------------------------------

RE10A

=====

RECORD THE NAME OF THE COUNTY WHERE THIS RU IS LOCATED.

[Enter County Name -25] ......................... {RE11}

REF ............................................. -7 {RE11}

DK .............................................. -8 {RE11}

RE11

====

VERIFY TELEPHONE NUMBER BELOW WITH RESPONDENT.

USE TAB TO MOVE THROUGH FIELDS. RETYPE ANY FIELDS WHICH NEED CORRECTION.

IF NO TELEPHONE, ENTER ‘000’.

Current Info: {TELEPHONE NUMBER}

TELEPHONE NUMBER: [ ]

REF ................................... -7

DK .................................... -8

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

----------------------------------------------------

| FOR ‘TELEPHONE NUMBER’, DISPLAY THE CURRENT |

| TELEPHONE NUMBER. |

----------------------------------------------------

| IF CURRENT INFO IS NOT AVAILABLE, ENTRY IS |

| REQUIRED FOR TELEPHONE NUMBER. (REFUSED AND |

| DON’T KNOW ARE ALLOWED AT ALL FIELDS.) |

----------------------------------------------------

| IF ROUND 1 AND STANDARD SINGLE-PERSON RU OR NEW |

| SINGLE-PERSON RU (THAT IS, ANY NON-STUDENT |

| SINGLE-PERSON RU), |

| AND |

| RE02 CODED ‘1’ (RESPONDENT IS AN RU MEMBER), |

| GO TO RE47 |

----------------------------------------------------

| IF ROUND 1 AND STANDARD SINGLE-PERSON RU OR NEW |

| SINGLE-PERSON RU (THAT IS, ANY NON-STUDENT |

| SINGLE-PERSON RU) |

| AND |

| RE02 CODED ‘2’ (RESPONDENT IS A PROXY APPROVED BY |

| SUPERVISOR), GO TO RE20 |

----------------------------------------------------

| IF ROUND 1 AND MULTI-PERSON RU (WHETHER STANDARD |

| OR NEW), GO TO RE20 |

----------------------------------------------------

| IF NOT ROUND 1 AND NOT A STUDENT RU, GO TO BOX_09 |

----------------------------------------------------

| IF STUDENT RU, CONTINUE WITH RE11A |

----------------------------------------------------

RE11A

=====

{PERSON’S FIRST MIDDLE AND LAST NAME}

My records show that (PERSON) (are/is) a student at post-secondary

school. (Are/Is) (PERSON) attending school full-time or part-time?

PART-TIME .............................. 1 {BOX_03A}

FULL-TIME .............................. 2 {BOX_03A}

NOT ATTENDING SCHOOL ................... 3 {BOX_03A}

REF ................................... -7 {BOX_03A}

DK .................................... -8 {BOX_03A}

[Code One]

BOX_03A

=======

----------------------------------------------------

| IF [ROUND 1] |

| OR [STUDENT RU CREATED IN THE CURRENT ROUND] |

| OR [RE11A CODED ‘1’ (PART-TIME), ‘2’ (FULL-TIME), |

| ‘-8’ (DON’T KNOW), OR ‘-7’ (REFUSED)] |

| THEN GO TO RE12 |

| |

| OTHERWISE [ROUNDS 2-5, |

| AND RE11A CODED ‘3’ (NOT ATTENDING SCHOOL) |

| AND RU IS A STUDENT RU CREATED IN A PREVIOUS |

| ROUND], |

| CONTINUE WITH BOX_03B |

----------------------------------------------------

BOX_03B

=======

----------------------------------------------------

| RU CLASSIFICATION CHANGE: CHANGE RU |

| CLASSIFICATION FROM STUDENT RU TO STANDARD RU |

| SINCE PERSON IS NO LONGER ATTENDING SCHOOL. |

----------------------------------------------------

| GO TO RE47 |

----------------------------------------------------

RE12

====

VERIFY INFORMATION WITH RESPONDENT. CORRECT IF NECESSARY.

GENDER: 1 = MALE, 2 = FEMALE

IF AGE IS INCORRECT AND DATE OF BIRTH KNOWN, RE-ENTER DATE OF BIRTH.

IF AGE IS INCORRECT AND DATE OF BIRTH NOT KNOWN, PROBE FOR AGE AND

ENTER IF KNOWN.

{NOTE: FOR ROUND 5, AGE IS CALCULATED AS OF DEC 31, {YEAR}.}

|-----------------|------------------|----------------|---------------|

|-----------------|------------------|----------------|---------------|

|-----------------|------------- ----|----------------|---------------|

----------------------------------------------------

| DISPLAY ‘NOTE: FOR ROUND 5, AGE IS CALCULATED AS |

| OF DEC 31, {YEAR}.’ IF ROUND 5, WHERE ‘YEAR’ IS |

| THE SECOND CALENDAR YEAR OF THE PANEL. OTHERWISE,|

| USE A NULL DISPLAY. |

----------------------------------------------------

| ‘REFUSED’ AND ‘DON’T KNOW’ ALLOWED IN ALL COLUMNS |

| EXCEPT ‘RU MEMBER’ COLUMN. |

----------------------------------------------------

| BECAUSE THIS IS A STUDENT RU, THERE IS ONLY ONE |

| RU MEMBER AND ONLY ONE ROW IN THE MATRIX. |

----------------------------------------------------

| FOR ROUND 5, AGE IS CALCULATED AS OF DECEMBER 31, |

| {YEAR}, WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR |

| OF THE PANEL. ALL AGE SKIPS (THROUGHOUT THE |

| QUESTIONNAIRE) WILL BE BASED ON THIS AGE. |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_2 |

| |

| COL # 1 HEADER: RU MEMBER |

| INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

| |

| COL # 2 HEADER: GENDER |

| INSTRUCTIONS: DISPLAY RU MEMBERS’ SEX |

| (PERS.SMPSEXR) |

| |

| COL # 3 HEADER: DATE OF BIRTH |

| INSTRUCTIONS: DISPLAY RU MEMBERS’ DATES OF BIRTH |

| (PERS.SMPDOBMM, PERS.SMPDOBDD, PERS.SMPDOBYY) |

| |

| COL # 4 HEADER: AGE |

| INSTRUCTIONS: DISPLAY RU MEMBERS’ AGES (PRND.AGE) |

----------------------------------------------------

| ROSTER DEFINITION: |

| DISPLAY THE RU-MEMBERS-ROSTER FOR VERIFICATION AND|

| CORRECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. THE NAME COLUMN IS PROTECTED; NO CHANGES ARE |

| ALLOWED. |

| |

| 2. GENDER, DATE OF BIRTH, AND AGE (WHEN AGE IS NOT|

| CALCULATED BY CAPI) CAN BE EDITED. |

| |

| 3. REPLACING ‘REAL’ DATA WITH -7 OR -8 IS |

| DISALLOWED. IF THE INTERVIEWER TRIES TO DO SO, |

| DISPLAY THE MESSAGE “DO NOT REPLACE EXISTING |

| INFORMATION WITH REFUSED OR DON’T KNOW.” |

| |

| 4. IF DATE OF BIRTH IS CHANGED, CAPI WILL |

| CALCULATE THE NEW AGE AUTOMATICALLY AND DISPLAY |

| THE AGE IN THE AGE COLUMN. |

| |

| 5. SELECT, ADD, AND DELETE DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER FOR |

| THIS STUDENT; NO FILTER. |

----------------------------------------------------

BOX_04

=======

----------------------------------------------------

| IF STUDENT RU NOT CREATED THIS ROUND AND AGE |

| > 23, CONTINUE WITH BOX_05 |

----------------------------------------------------

| OTHERWISE, GO TO RE13 |

----------------------------------------------------

BOX_05

=======

----------------------------------------------------

| RU CLASSIFICATION CHANGE: CHANGE RU |

| CLASSIFICATION FROM STUDENT RU TO STANDARD RU |

| SINCE STUDENT IS OUTSIDE OF DESIGNATED STUDENT RU |

| AGE RANGE. |

----------------------------------------------------

| GO TO RE47 |

----------------------------------------------------

RE13

====

{PERSON’S FIRST MIDDLE AND LAST NAME}

My records show that {as of December 31, {YEAR}} (PERSON)

{(have/has)/had} never been married.

Is that correct?

YES .................................... 1 {RE14}

NO ..................................... 2 {RE13OV}

REF ................................... -7 {RE14)

DK .................................... -8 {RE14}

---------------------------------------------------

| DISPLAY ‘as of December 31, {YEAR}’ IF ROUND 5, |

| WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE |

| PANEL. OTHERWISE, USE A NULL DISPLAY. |

| DISPLAY (have/has) IF NOT ROUND 5. IF ROUND 5, |

| DISPLAY ‘had’. |

---------------------------------------------------

RE13OV

======

{(Are/Is)/On December 31, {YEAR}, (were/was)} (PERSON) {now}

married, widowed, divorced, or separated?

MARRIED ................................ 1 {BOX_06}

WIDOWED ................................ 2 {BOX_06}

DIVORCED ............................... 3 {BOX_06}

SEPARATED .............................. 4 {BOX_06}

REF ................................... -7 {BOX_06}

DK .................................... -8 {BOX_06}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

----------------------------------------------------

| DISPLAY ‘(Are/Is)’ IF NOT ROUND 5. DISPLAY ‘On |

| December 31, {YEAR}, (were/was)’ IF ROUND 5, WHERE|

| ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL. |

| DISPLAY ‘now’ IF NOT ROUND 5. OTHERWISE, (IF |

| ROUND 5), USE A NULL DISPLAY. |

----------------------------------------------------

BOX_06

======

----------------------------------------------------

| IF ROUND 1, OR IF ROUND 2-5 AND STUDENT RU WAS |

| IDENTIFIED DURING ANOTHER INTERVIEW IN THIS ROUND,|

| CONTINUE WITH RE14 |

----------------------------------------------------

| IF ROUND 2-5, AND STUDENT RU WAS IDENTIFIED IN |

| PREVIOUS ROUND, THEN RU CLASSIFICATION CHANGE: |

| CHANGE RU CLASSIFICATION FROM STUDENT RU TO |

| STANDARD RU SINCE STUDENT’S MARITAL STATUS HAS |

| CHANGED SINCE PREVIOUS ROUND AND IS NO LONGER |

| ‘NEVER MARRIED’. THEN GO TO RE47 |

----------------------------------------------------

RE14

====

{PERSON’S FIRST MIDDLE AND LAST NAME}

{(Are/Is)/(Were/Was)} (PERSON) on full-time active duty with the

Armed Forces of the United States {on December 31, {YEAR}}?

YES .................................... 1 {RE15}

NO ..................................... 2 {RE18A}

REF ................................... -7 {RE18A)

DK .................................... -8 {RE18A}

HELP AVAILABLE FOR DEFINITION OF FULL-TIME ACTIVE DUTY.

----------------------------------------------------

| DISPLAY ‘(Are/Is)’ IF NOT ROUND 5. DISPLAY |

| ‘(Were/Was)’ IF ROUND 5. DISPLAY ‘on December 31, |

| {YEAR}’ IF ROUND 5, WHERE ‘YEAR’ IS THE SECOND |

| CALENDAR YEAR OF THE PANEL. OTHERWISE, USE A NULL |

| DISPLAY. |

----------------------------------------------------

RE15

====

{PERSON’S FIRST MIDDLE AND LAST NAME}

On what date did (PERSON) enter full-time active duty service

in the Armed Forces?

[Enter Month, Day, Year-4] ............ {RE16}

REF ................................... -7 {RE16}

DK .................................... -8 {RE16}

HELP AVAILABLE FOR DEFINITION OF FULL-TIME ACTIVE DUTY.

----------------------------------------------------

| REMOVE PERSON FROM THE RU-MEMBERS-ROSTER AND FLAG |

| PERSON AS REMOVED AT RE15. PERSON IS INELIGIBLE |

| FOR DATA COLLECTION IN THIS ROUND. |

----------------------------------------------------

BOX_07

======

OMITTED.

RE16

====

At this time, we are only collecting information about persons

who are not on full-time active duty with the Armed Forces of

the United States. Therefore, that is all the information we

need.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

RE17

====

Thank you for your participation in this important study.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

RE17A

=====

INTERVIEWER: THERE ARE NO ELIGIBLE INDIVIDUALS REMAINING IN

THIS RU. PLEASE REPORT THIS SITUATION TO YOUR SUPERVISOR.

PRESS ENTER OR SELECT NEXT PAGE TO END THE INTERVIEW.

RE17B

=====

INTERVIEWER: DID YOU COMPLETE THIS INTERVIEW IN-PERSON OR BY

TELEPHONE? (YOU MUST HAVE SUPERVISOR APPROVAL PRIOR TO

INTERVIEWING BY TELEPHONE.)

IN-PERSON ............................. 1 {BOX_27}

TELEPHONE ............................. 2 {BOX_27}

[Code One]

RE18

====

OMITTED.

RE18A

=====

{PERSON’S FIRST MIDDLE AND LAST NAME}

(Have/Has) (PERSON) ever been honorably discharged from active

duty in the U.S. Army, Navy, Air Force, Marine Corps, or Coast

Guard?

YES .................................... 1 {BOX_27}

NO ..................................... 2 {BOX_27}

REF ................................... -7 {BOX_27}

DK .................................... -8 {BOX_27}

BOX_08

======

OMITTED.

BOX_09

======

----------------------------------------------------

| IF ON DATE OF PREVIOUS ROUND INTERVIEW AT LEAST |

| ONE KEY RU MEMBER WAS CODED AS INSTITUTIONALIZED |

| IN A HEALTH CARE FACILITY (RE36 = 1 OR 2 -OR- |

| RE19 = 1), CONTINUE WITH LOOP_02 |

----------------------------------------------------

| IF STANDARD SINGLE-PERSON RU OR NEW SINGLE-PERSON |

| RU (THAT IS, ANY NON-STUDENT SINGLE-PERSON RU), |

| AND RE02 CODED ‘1’ (RESPONDENT IS AN RU MEMBER), |

| GO TO RE47 |

----------------------------------------------------

| OTHERWISE, GO TO RE20 |

----------------------------------------------------

LOOP_02

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK |

| BOX_09A-END_LP02 |

----------------------------------------------------

| LOOP DEFINITION: LOOP_02 COLLECTS INFORMATION |

| TO DETERMINE THE LOCATION AND ELIGIBILITY OF KEY |

| RU MEMBERS WHO WERE INSTITUTIONALIZED AT A HEALTH |

| CARE FACILITY ON THE DATE OF THE PREVIOUS ROUND |

| INTERVIEW. THIS LOOP CYCLES ON RU MEMBERS WHO |

| MEET ALL OF THE FOLLOWING CONDITIONS: |

| - PERSON IS KEY |

| - PERSON WAS INSTITUTIONALIZED AT A HEALTH CARE |

| FACILITY ON THE DATE OF THE PREVIOUS ROUND |

| INTERVIEW (RE36 = 1 OR 2 -OR- RE19 = 1). |

----------------------------------------------------

BOX_09A

=======

----------------------------------------------------

| IF PERSON BEING ASKED ABOUT IS AN RU MEMBER |

| RESPONDENT (RE02 = 1), CODE ‘NO’ AT RE19 |

| AUTOMATICALLY BY CAPI, THEN CONTINUE WITH |

| BOX_09B |

----------------------------------------------------

| OTHERWISE, CONTINUE WITH RE19 |

----------------------------------------------------

RE19

====

{PERSON’S FIRST MIDDLE AND LAST NAME}

My records indicate that (PERSON) was institutionalized in a health

care facility at the time of the last interview. {Is/On December 31,

{YEAR}, was} (PERSON) still institutionalized in a health care facility?

YES .................................... 1 {END_LP02}

NO ..................................... 2 {BOX_09B}

REF ................................... -7 {END_LP02}

DK .................................... -8 {END_LP02}

HELP AVAILABLE FOR DEFINITION OF INSTITUTIONALIZED IN A HEALTH

CARE FACILITY.

----------------------------------------------------

| DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘On December|

| 31, {YEAR}, was’ IF ROUND 5, WHERE ‘YEAR’ IS THE |

| SECOND CALENDAR YEAR OF THE PANEL. |

----------------------------------------------------

BOX_09B

=======

----------------------------------------------------

| IF PERSON BEING ASKED ABOUT IS AN RU MEMBER |

| RESPONDENT (RE02 = 1), CODE ‘LIVING WITH THIS |

| FAMILY’ AT RE19A AUTOMATICALLY BY CAPI, THEN |

| CONTINUE WITH RE19B |

----------------------------------------------------

| OTHERWISE, CONTINUE WITH RE19A |

----------------------------------------------------

| SINCE THE NUMBER OF PEOPLE WHO ENTER AND LEAVE AN |

| INSTITUTION IS SO SMALL, WE WILL INSTRUCT THE |

| INTERVIEWER TO MAKE A COMMENT ABOUT INDIVIDUALS |

| WHO ARE NOT ACCOMMODATED BY THIS SERIES (E.G., |

| PERSON IS THE RESPONDENT, BUT LEFT INSTITUTION |

| AFTER 12/31/{YEAR}), WHERE ‘YEAR’ IS THE SECOND |

| CALENDAR YEAR OF THE PANEL. |

----------------------------------------------------

RE19A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

IF RESPONDENT VOLUNTEERS THAT PERSON IS DECEASED, CODE ‘3’

WITHOUT ASKING.

{Is/On December 31, {YEAR}, was} (PERSON) {now} living here with

this family, or {does/did} (PERSON) have a usual place of

residence somewhere else?

LIVING WITH THIS FAMILY ................ 1 {RE19B}

USUAL PLACE OF RESIDENCE

SOMEWHERE ELSE ....................... 2 {RE19D}

DECEASED ............................... 3 {RE19C}

REF ................................... -7 {RE19D}

DK .................................... -8 {RE19D}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

----------------------------------------------------

| DISPLAY ‘Is’ AND ‘does’ IF NOT ROUND 5. DISPLAY |

| ‘On December 31, {YEAR}, was’ AND ‘did’ IF ROUND |

| 5, WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE|

| PANEL. DISPLAY ‘now’ IF NOT ROUND 5. OTHERWISE, |

| USE A NULL DISPLAY. |

----------------------------------------------------

| IF CODED ‘1’ (LIVING WITH THIS FAMILY), FLAG |

| PERSON WITH THE NUMBER OF THE ROUND PERSON |

| REJOINED RU, THEN CONTINUE WITH RE19B |

----------------------------------------------------

RE19B

=====

{PERSON’S FIRST MIDDLE AND LAST NAME}

On what date did (PERSON) leave the health care facility?

[Enter Month Day Year-4] .............. {RE19BOV}

REF ................................... -7 {RE19BOV}

DK .................................... -8 {RE19BOV}

HELP AVAILABLE FOR DEFINITION OF LEAVE THE HEALTH CARE FACILITY.

----------------------------------------------------

| NOTE: THE DATE ENTERED HERE DETERMINES THE START |

| OF THE REFERENCE PERIOD FOR THIS PERSON. |

----------------------------------------------------

| HARD CHECK: |

| EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR |

| BEFORE 12/31/{YEAR}, WHERE ‘YEAR’ IS THE SECOND |

| CALENDAR YEAR OF THE PANEL. IF A DATE AFTER |

| 12/31/{YEAR} IS ENTERED, DISPLAY THE FOLLOWING |

| MESSAGE: “DATE MUST BE ON OR BEFORE 12/31/{YEAR}.|

| IF LEFT INSTITUTION AFTER 12/31/{YEAR}, BACK-UP |

| AND RE-CODE RE19 TO ‘YES’.” |

----------------------------------------------------

RE19BOV

=======

{PERSON’S FIRST MIDDLE AND LAST NAME}

On what date did (PERSON) return to live with this family?

[Enter Month Day Year-4] .............. {END_LP02}

REF ................................... -7 {END_LP02}

DK .................................... -8 {END_LP02}

HELP AVAILABLE FOR DEFINITION OF LEAVE THE HEALTH CARE FACILITY.

----------------------------------------------------

| HARD CHECK: |

| EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR |

| BEFORE 12/31/{YEAR}, WHERE ‘YEAR’ IS THE SECOND |

| CALENDAR YEAR OF THE PANEL. IF A DATE AFTER |

| 12/31/{YEAR} IS ENTERED, DISPLAY THE FOLLOWING |

| MESSAGE: “DATE MUST BE ON OR BEFORE 12/31/{YEAR}.|

| IF JOINED RU AFTER 12/31/{YEAR}, BACK-UP AND |

| RE-CODE RE19A.” |

----------------------------------------------------

RE19C

=====

{PERSON’S FIRST MIDDLE AND LAST NAME}

On what date did (PERSON) leave the health care facility?

[Enter Month Day Year-4] .............. {RE19COV}

REF ................................... -7 {RE19COV}

DK .................................... -8 {RE19COV}

HELP AVAILABLE FOR DEFINITION OF LEAVE THE HEALTH CARE FACILITY.

----------------------------------------------------

| NOTE: THE DATE ENTERED HERE DETERMINES THE START |

| OF THE REFERENCE PERIOD FOR THIS PERSON. |

----------------------------------------------------

| HARD CHECK: |

| EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR |

| BEFORE 12/31/{YEAR}, WHERE ‘YEAR’ IS THE SECOND |

| CALENDAR YEAR OF THE PANEL. IF A DATE AFTER |

| 12/31/{YEAR} IS ENTERED, DISPLAY THE FOLLOWING |

| MESSAGE: “DATE MUST BE ON OR BEFORE 12/31/{YEAR}.|

| IF LEFT INSTITUTION AFTER 12/31/{YEAR}, BACK-UP |

| AND RE-CODE RE19 TO ‘YES’.” |

----------------------------------------------------

RE19COV

=======

{PERSON’S FIRST MIDDLE AND LAST NAME}

On what date did (PERSON) die?

[Enter Month Day Year-4] .............. {END_LP02}

REF ................................... -7 {END_LP02}

DK .................................... -8 {END_LP02}

HELP AVAILABLE FOR DEFINITION OF LEAVE THE HEALTH CARE FACILITY.

----------------------------------------------------

| HARD CHECK: |

| EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR |

| BEFORE 12/31/{YEAR}, WHERE ‘YEAR’ IS THE SECOND |

| CALENDAR YEAR OF THE PANEL. IF A DATE AFTER |

| 12/31/{YEAR} IS ENTERED, DISPLAY THE FOLLOWING |

| MESSAGE: “DATE MUST BE ON OR BEFORE 12/31/{YEAR}.|

| IF DIED AFTER 12/31/{YEAR}, BACK-UP AND RE-CODE |

| RE19A.” |

----------------------------------------------------

RE19D

=====

{PERSON’S FIRST MIDDLE AND LAST NAME}

On what date did (PERSON) leave the health care facility?

[Enter Month Day Year-4] .............. {RE19E}

REF ................................... -7 {RE19E}

DK .................................... -8 {RE19E}

HELP AVAILABLE FOR DEFINITION OF LEAVE THE HEALTH CARE FACILITY.

----------------------------------------------------

| THE DATE ENTERED HERE DETERMINES THE START OF THE |

| REFERENCE PERIOD FOR THIS PERSON. |

----------------------------------------------------

| HARD CHECK: |

| EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR |

| BEFORE 12/31/{YEAR}, WHERE ‘YEAR’ IS THE SECOND |

| CALENDAR YEAR OF THE PANEL. IF A DATE AFTER |

| 12/31/{YEAR} IS ENTERED, DISPLAY THE FOLLOWING |

| MESSAGE: “DATE MUST BE ON OR BEFORE 12/31/{YEAR}.|

| IF LEFT INSTITUTION AFTER 12/31/{YEAR}, BACK-UP |

| AND RE-CODE RE19 TO ‘YES’.” |

----------------------------------------------------

RE19E

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

Where {is (PERSON) now/was (PERSON) on December 31, {YEAR}}?

INSTITUTIONALIZED IN A HEALTH CARE

FACILITY ............................. 1 {RE19F}

INSTITUTIONALIZED IN A NON-HEALTH CARE

FACILITY ............................. 2 {RE19I}

STUDENT UNDER 24 LIVING AWAY AT SCHOOL

IN GRADES 1-12 ....................... 3 {RE19I}

STUDENT UNDER 24 LIVING AWAY AT

POST-SECONDARY SCHOOL ................ 4 {RE19F}

ANOTHER HOUSEHOLD - CURRENTLY NOT FULL-

TIME MILITARY ........................ 5 {RE19F}

ANOTHER HOUSEHOLD/MILITARY FACILITY -

CURRENTLY FULL-TIME MILITARY ......... 6 {RE19H}

REF .................................... -7 {RE19F}

DK ..................................... -8 {RE19F}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

----------------------------------------------------

| DISPLAY ‘is (PERSON) now’ IF NOT ROUND 5. DISPLAY|

| ‘was (PERSON) on December 31, {YEAR}’, WHERE |

| ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL, |

| IF ROUND 5. |

----------------------------------------------------

| HARD CHECK: |

| DISALLOW FINAL ENTRY OF CODE ‘1’ |

| (INSTITUTIONALIZED IN HEALTH CARE FACILITY). IF |

| INTERVIEWER ENTERS CODE ‘1’, DISPLAY THE FOLLOWING|

| MESSAGE “VERIFY FACILITY TYPE. IF HEALTH CARE |

| FACILITY, USE BACK UP TO CORRECT RE19 TO YES.” |

----------------------------------------------------

RE19F

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

{Is/Was} (PERSON) living within the U.S. or outside the U.S.

{on December 31, {YEAR}}?

WITHIN U.S. .......................... 1

OUTSIDE U.S. ......................... 2

REF ................................. -7

DK .................................. -8

HELP AVAILABLE FOR DEFINITION OF LIVING WITHIN/OUTSIDE U.S.

----------------------------------------------------

| DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘Was’ IF |

| ROUND 5. DISPLAY ‘on December 31, {YEAR}’, WHERE |

| ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL, |

| IF ROUND 5. OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

-----------------------------------------------------

| IF PERSON CODED ‘4’ (STUDENT UNDER 24 LIVING AWAY |

| AT POST-SECONDARY SCHOOL AT RE19E), CONTINUE |

| WITH RE19G |

-----------------------------------------------------

| OTHERWISE, GO TO RE19I |

-----------------------------------------------------

RE19G

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

{(Are/Is)/On December 31, {YEAR}, (were/was)} (PERSON) attending ...

grades 1-12, ........................... 1

a college or university, or ............ 2 {RE19I}

some other training school after high

school? .............................. 3 {RE19I}

REF ................................... -7 {RE19I}

DK .................................... -8 {RE19I}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

----------------------------------------------------

| DISPLAY ‘(Are/Is)’ IF NOT ROUND 5. DISPLAY ‘On |

| ‘December 31, {YEAR}, (were/was)’ IF ROUND 5, |

| WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE |

| PANEL. |

----------------------------------------------------

| HARD CHECK: |

| DISALLOW FINAL ENTRY OF CODE ‘1’ (GRADES 1-12). IF|

| INTERVIEWER ENTERS CODE ‘1’, DISPLAY THE FOLLOWING|

| MESSAGE: “JUMPBACK TO CORRECT RE19E TO STUDENT < |

| 24 LIVING AWAY AT SCHOOL GRADES 1-12).” |

----------------------------------------------------

RE19H

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

{Is/Was} (PERSON) living in another household or in a military

facility {on December 31, {YEAR}}?

ANOTHER HOUSEHOLD ................... 1 {RE19HOV}

MILITARY FACILITY ................... 2 {RE19HOV}

REF ................................ -7 {RE19HOV}

DK ................................. -8 {RE19HOV}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

----------------------------------------------------

| DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘Was’ IF |

| ROUND 5. DISPLAY ‘on December 31, {YEAR}’ IF |

| ROUND 5, WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR |

| OF THE PANEL. OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

RE19HOV

=======

{Is/Was} (PERSON) living within the U.S. or outside the U.S.

{on December 31, {YEAR}}?

WITHIN U.S. ......................... 1 {RE19I}

OUTSIDE U.S. ........................ 2 {RE19I}

REF ................................ -7 {RE19I}

DK ................................. -8 {RE19I}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

----------------------------------------------------

| DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘Was’ IF |

| ROUND 5. DISPLAY ‘on December 31, {YEAR}’ IF |

| ROUND 5, WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR |

| OF THE PANEL. OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

RE19I

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

On what date did (PERSON) {enter the non-health care facility/start

living away at school/start living in another household/start living

at a military facility/leave the United States}?

[Enter Month,Day,Year-4] .............. {END_LP02}

REF ................................... -7 {END_LP02}

DK .................................... -8 {END_LP02}

----------------------------------------------------

| DISPLAY ‘enter the non-health care facility’ IF |

| RE19E CODED ‘2’ (INSTITUTIONALIZED IN NON-HEALTH |

| CARE FACILITY). |

| |

| DISPLAY ‘start living away at school’ IF RE19E |

| CODED ‘3’ (STUDENT UNDER 24 LIVING AWAY AT SCHOOL |

| IN GRADES 1-12) OR IF RE19E CODED ‘4’ (STUDENT |

| UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL) |

| AND RE19F CODED ‘1’ (WITHIN U.S.), ‘-7’ (REFUSED),|

| OR ‘-8’ (DON’T KNOW). |

| |

| DISPLAY ‘start living in another household’ IF |

| [RE19E CODED ‘5’ (ANOTHER HOUSEHOLD - CURRENTLY |

| NOT FT MILITARY) AND RE19F CODED ‘1’ (WITHIN |

| U.S.), ‘-7’ (REFUSED), OR ‘-8’ (DON’T KNOW)] OR |

| [RE19E CODED ‘6’ (ANOTHER HOUSEHOLD/MILITARY |

| FACILITY - CURRENTLY FULL-TIME MILITARY) AND RE19H|

| CODED ‘1’ (ANOTHER HOUSEHOLD), ‘-7’ (REFUSED), OR |

| ‘-8’ (DON’T KNOW) AND RE19HOV CODED ‘1’ (WITHIN |

| U.S.), ‘-7’ (REFUSED), OR ‘-8’ (DON’T KNOW)] OR |

| [RE19E CODED ‘RF’ (REFUSED) OR ‘DK’ (DON’T KNOW)].|

| |

| DISPLAY ‘start living at a military facility’ IF |

| RE19E CODED ‘6’ (ANOTHER HOUSEHOLD/MILITARY |

| FACILITY - CURRENTLY FULL-TIME MILITARY AND RE19H |

| CODED ‘2’ (MILITARY FACILITY) AND RE19HOV CODED |

| ‘1’ (WITHIN U.S.), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |

| KNOW). |

| |

| DISPLAY ‘leave the U.S.’ IF RE19E CODED ‘4’ |

| (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY |

| SCHOOL) AND RE19F CODED ‘2’ (OUTSIDE U.S.) OR IF |

| RE19E CODED ‘5’ (ANOTHER HOUSEHOLD - CURRENTLY |

| NOT FULL-TIME MILITARY) AND RE19F CODED ‘2’ |

| (OUTSIDE U.S.) OR IF RE19E CODED ‘6’ (ANOTHER |

| HOUSEHOLD/MILITARY FACILITY - CURRENTLY FULL-TIME |

| MILITARY) AND RE19HOV CODED ‘2’ (OUTSIDE U.S.). |

----------------------------------------------------

| HARD CHECK: |

| EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR |

| BEFORE 12/31/{YEAR}, WHERE ‘YEAR’ IS THE SECOND |

| CALENDAR YEAR OF THE PANEL. IF A DATE AFTER |

| 12/31/{YEAR} IS ENTERED, DISPLAY THE FOLLOWING |

| MESSAGE: “DATE MUST BE ON OR BEFORE 12/31/{YEAR}.|

| IF DATE IS AFTER 12/31/{YEAR}, BACK-UP AND RE-CODE|

| RE19A.” |

----------------------------------------------------

END_LP02

========

----------------------------------------------------

| CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER |

| THAT MEETS THE CONDITIONS STATED IN THE LOOP |

| DEFINITION. |

----------------------------------------------------

| IF NO MORE PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_02 AND CONTINUE WITH BOX_09C |

----------------------------------------------------

BOX_09C

=======

----------------------------------------------------

| IF STANDARD SINGLE-PERSON RU (THAT IS NON-STUDENT)|

| AND RE02 IS CODED ‘1’ (RU MEMBER), GO TO RE47 |

----------------------------------------------------

| OTHERWISE, CONTINUE WITH RE20 |

----------------------------------------------------

RE20

====

{INTERVIEWER: IF ALL RU MEMBERS DEAD OR INSTITUTIONALIZED,

CODE NO WITHOUT ASKING.}

Before we begin the health interview, {I'd like to ask some

questions about this household./I’d like you to think about the

people living here on December 31, {YEAR}, regardless of whether

they are living here now.}

My records indicate that {on {DATE OF PREVIOUS ROUND INTERVIEW},}

the people listed on this form (HAND HOUSEHOLD SUMMARY) {were/are

living together as a family. {Do/Did} (READ NAMES BELOW) still live

together as a family {on December 31, {YEAR}}?

[1. First Name,[Middle Name],Last Name-65]

[2. First Name,[Middle Name],Last Name-65]

[3. First Name,[Middle Name],Last Name-65]

YES .................................... 1 {BOX_22AAA}

NO ..................................... 2 {RE21}

REF ................................... -7 {BOX_22AAA}

DK .................................... -8 {BOX_22AAA}

----------------------------------------------------

| DISPLAY INTERVIEWER INSTRUCTION IF RESPONDENT IS |

| A PROXY. OTHERWISE, USE NULL DISPLAY. |

----------------------------------------------------

| DISPLAY ‘I’d like to ... this household.’ IF NOT |

| ROUND 5. DISPLAY ‘I’d like you ... here now.’, |

| WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE |

| PANEL, IF ROUND 5. |

| |

| DISPLAY ‘on {DATE OF PREVIOUS ROUND INTERVIEW}’ |

| IF STANDARD RU. OTHERWISE, USE NULL DISPLAY. |

| |

| FOR ‘{DATE OF PREVIOUS ROUND INTERVIEW}’, DISPLAY |

| DATE OF NHIS INTERVIEW IF ROUND 1. OTHERWISE, |

| DISPLAY DATE OF PREVIOUS ROUND MEPS INTERVIEW. |

| |

| DISPLAY ‘were’ IF STANDARD RU. OTHERWISE, |

| DISPLAY ‘are’. |

| |

| DISPLAY ‘Do’ IF NOT ROUND 5. DISPLAY ‘Did’ IF |

| ROUND 5. |

| |

| DISPLAY ‘on December 31, {YEAR}’ IF ROUND 5, WHERE|

| ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL. |

| OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

| IF RE20 CODED ‘1’ (YES), ‘-7’ (REFUSED), OR ‘-8’ |

| (DON’T KNOW), CODE RE21 AS ‘1’ (IN RU) FOR ALL |

| RU MEMBERS AUTOMATICALLY BY CAPI, AND GO TO |

| BOX_22AAA |

----------------------------------------------------

| OTHERWISE (RE20 CODED ‘2’ (NO)), CONTINUE WITH |

| RE21 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY |

| OF RU-MEMBERS. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. SELECT, ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| IF ROUND 1, DISPLAY PERSONS WHO WERE NOT ADDED TO |

| THE ROSTER THIS ROUND. IF NOT ROUND 1, DISPLAY |

| PERSONS WHO WERE NOT ADDED TO THE ROSTER THIS |

| ROUND AND PERSONS WHO WERE NOT INSTITUTIONALIZED |

| ON DATE OF PREVIOUS ROUND’S INTERVIEW. |

----------------------------------------------------

BOX_10

======

OMITTED.

BOX_11

======

OMITTED.

RE21

====

Who {is/was} not living here with the family {on December 31, {YEAR}}?

CHANGE RU STATUS AS NECESSARY TO: IN RU, LEFT RU, INCORRECTLY

LISTED IN RU DURING {NHIS/PREVIOUS ROUND}.

|------------------------------------|------------------------------------|

| ROSTER. RU MEMBER | RE21_02. RU STATUS |

|------------------------------------|------------------------------------|

| 1. First Name Middle Name Last | [Enter RU Status] |

| Name-35 | |

|------------------------------------|------------------------------------|

| 2. First Name Middle Name Last | [Enter RU Status] |

| Name-35 | |

|------------------------------------|------------------------------------|

| 3. First Name Middle Name Last | [Enter RU Status] |

| Name-35 | |

|------------------------------------|------------------------------------|

HELP AVAILABLE FOR HH MEMBERSHIP RULES.

----------------------------------------------------

| DISPLAY ‘is’ IF NOT ROUND 5. DISPLAY ‘was’ IF |

| ROUND 5. DISPLAY ‘on December 31, {YEAR}’, WHERE |

| ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL, |

| IF ROUND 5. OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

-----------------------------------------------------

| DISPLAY ‘NHIS’ IF ROUND 1. OTHERWISE, DISPLAY |

| ‘PREVIOUS ROUND’. |

-----------------------------------------------------

----------------------------------------------------

| REFUSED AND DON’T KNOW DISALLOWED. |

----------------------------------------------------

| IF ROUND 1 AND PERSON’S RU STATUS CODED '3' |

| (INCORRECTLY LISTED IN RU DURING {NHIS/PREVIOUS |

| INTERVIEW}) AT RE21, REMOVE PERSON FROM RU- |

| MEMBERS-ROSTER AND FLAG PERSON AS ‘NOT IN RU - |

| INCORRECTLY LISTED IN RU DURING NHIS.’ IF NOT |

| ROUND 1 AND PERSON’S RU STATUS CODED ‘3’ AT RE21, |

| FLAG PERSON AS ‘NOT IN RU - INCORRECTLY LISTED IN |

| RU DURING PREVIOUS INTERVIEW.’ PERSON IS |

| INELIGIBLE AND OUT-OF-SCOPE. NO FURTHER |

| INFORMATION WILL BE COLLECTED FOR PERSON. |

----------------------------------------------------

| IF RU STATUS CODED ‘2’ (LEFT RU) FOR AT LEAST ONE |

| RU MEMBER, CONTINUE WITH LOOP_04 |

----------------------------------------------------

| OTHERWISE (NO RU MEMBER CODED ‘2’ (LEFT RU) AND |

| AT LEAST ONE RU MEMBER CODED ‘3’ (INCORRECTLY |

| LISTED IN RU DURING NHIS/PREVIOUS INTERVIEW)), GO |

| TO BOX_22 |

----------------------------------------------------

| HARD CHECK: |

| IF RESPONDENT IS SELECTED, DISPLAY THE FOLLOWING |

| ERROR MESSAGE: “THE RESPONDENT CANNOT BE MARKED |

| HERE AS HAVING LEFT THE RU.” |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_3 |

| |

| COL # 1 HEADER: RU MEMBER |

| INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

| |

| COL # 2 HEADER: RU STATUS |

| INSTRUCTIONS: DISPLAY THE RU MEMBERS’ RU STATUS |

| (PRND.INRUSTAT) |

----------------------------------------------------

| ROSTER DEFINITION: |

| DISPLAY THE RU-MEMBERS-ROSTER FOR ENTRY. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. THE RU MEMBERS COLUMN IS PROTECTED; NO CHANGES |

| ARE ALLOWED. |

| |

| 2. EACH ROW INITIALLY HAS RU STATUS SET TO ‘1’. |

| |

| 3. SELECT, ADD, EDIT, AND DELETE OF PERSONS |

| DISALLOWED. |

| |

| 4. INTERVIEWERS SHOULD NOT BE ALLOWED TO LEAVE THE|

| SCREEN IF NO PERSON’S RU STATUS IS UPDATED FROM |

| ‘1’. IF THE INTERVIEWER ATTEMPTS TO LEAVE THE |

| SCREEN WITHOUT MAKING ANY UPDATES, DISPLAY THE |

| MESSAGE “IF EVERYONE IS STILL IN RU, BACKUP TO |

| CORRECT PREVIOUS SCREEN.” |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL PERSONS NOT ADDED THIS ROUND. |

----------------------------------------------------

BOX_11A

======

OMITTED.

BOX_12

======

OMITTED.

RE22

====

OMITTED.

RE23

====

OMITTED.

BOX_13

======

OMITTED.

LOOP_02

=======

USED ELSEWHERE.

RE24

====

OMITTED.

RE25

====

OMITTED.

END_LP02

========

USED ELSEWHERE.

BOX_14

======

OMITTED.

RE26

====

OMITTED.

RE27

=====

OMITTED.

BOX_15

======

OMITTED.

RE28

====

OMITTED.

RE29

====

OMITTED.

BOX_16

======

OMITTED.

RE30

====

OMITTED.

RE31

====

OMITTED.

BOX_17

======

OMITTED.

LOOP_03

=======

OMITTED.

RE32

====

OMITTED.

RE33

====

OMITTED.

BOX_18

======

OMITTED.

RE34

====

OMITTED.

END_LP03

========

OMITTED.

BOX_19

======

OMITTED.

LOOP_04

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK |

| RE35-END_LP04 |

----------------------------------------------------

| LOOP DEFINITION: LOOP_04 DETERMINES THE LOCATION |

| OF RU MEMBERS WHO HAVE LEFT THE RU AND THE DATE |

| SUCH PERSONS LEFT. THIS INFORMATION IS USED TO |

| DETERMINE WHETHER SUCH PERSONS ARE ELIGIBLE FOR |

| THIS INTERVIEW (THAT IS, REMAIN ON THE RU-MEMBERS-|

| ROSTER) AND TO DEFINE THE REFERENCE PERIOD, IF |

| ANY, FOR SUCH PERSONS. THIS LOOP CYCLES ON RU |

| MEMBERS WHO MEET THE FOLLOWING CONDITION: |

| - PERSON LEFT RU (RU STATUS CODED ‘2’) |

----------------------------------------------------

BOX_20

======

OMITTED.

RE35

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

Why {(are/is)/was} (PERSON) no longer living here with this

family {on December 31, {YEAR}}?

DECEASED ................................ 1 {RE41}

INSTITUTIONALIZED ....................... 2 {RE36}

STUDENT UNDER 24 LIVING AWAY AT SCHOOL

IN GRADES 1-12 ....................... 3 {RE41}

STUDENT UNDER 24 LIVING AWAY AT

POST-SECONDARY SCHOOL ................ 4 {RE37}

MOVED - CURRENTLY NOT IN MILITARY ....... 5 {RE37}

MOVED - CURRENTLY ON FULL-TIME ACTIVE

DUTY IN ARMED FORCES ................. 6 {RE38}

REF .................................... -7 {RE41}

DK ..................................... -8 {RE41}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

----------------------------------------------------

| DISPLAY ‘(are/is)’ IF NOT ROUND 5. DISPLAY ‘was’ |

| IF ROUND 5. DISPLAY ‘on December 31, {YEAR}’ IF |

| ROUND 5, WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR |

| OF THE PANEL. OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

RE36

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

What type of institution {is/was} (PERSON) living in

{now/on December 31, {YEAR}}?

NURSING HOME ........................ 1 {RE40}

OTHER LONG-TERM HEALTH CARE

INSTITUTION (EXCLUDE COMMUNITY

BASED HOSPITAL) ................... 2 {RE40}

OTHER NON-HEALTH CARE INSTITUTION ... 3 {RE41}

REF ................................ -7 {RE40}

DK ................................. -8 {RE40}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

----------------------------------------------------

| DISPLAY ‘is’ IF NOT ROUND 5. DISPLAY ‘was’ IF |

| ROUND 5. DISPLAY ‘now’ IF NOT ROUND 5. DISPLAY |

| ‘on December 31, {YEAR}’ IF ROUND 5, WHERE ‘YEAR’ |

| IS THE SECOND CALENDAR YEAR OF THE PANEL. |

----------------------------------------------------

RE37

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

{Is/Was} (PERSON) living within the U.S. or outside the U.S.

{on December 31, {YEAR}}?

WITHIN U.S. .......................... 1 {RE41}

OUTSIDE U.S. ......................... 2 {RE41}

REF ................................. -7 {RE41}

DK .................................. -8 {RE41}

[Code One]

HELP AVAILABLE FOR DEFINITION OF LIVING WITHIN/OUTSIDE U.S.

----------------------------------------------------

| DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘Was’ IF |

| ROUND 5. DISPLAY ‘on December 31, {YEAR}’, WHERE |

| ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL, |

| IF ROUND 5. OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

| IF RE35 CODED ‘4’ (STUDENT AWAY AT POST-SECONDARY |

| SCHOOL) |

| AND |

| RE37 CODED ‘1’ (WITHIN U.S.), ‘-7’ (REFUSED), OR |

| ‘-8’ (DON’T KNOW), |

| FLAG PERSON AS A ‘NEW STUDENT’. |

----------------------------------------------------

| IF RE35 CODED ‘5’ (MOVED - CURRENTLY NOT IN |

| MILITARY) |

| AND |

| RE37 CODED ‘1’ (WITHIN U.S.), ‘-7’ (REFUSED), OR |

| ‘-8’ (DON’T KNOW), |

| FLAG PERSON AS A ‘NON-MILITARY MOVER IN U.S.’ |

----------------------------------------------------

RE38

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

{Is/Was} (PERSON) living in another household or in a military

facility {on December 31, {YEAR}}?

ANOTHER HOUSEHOLD ................... 1 {RE38OV}

MILITARY FACILITY ................... 2 {RE41}

REF ................................ -7 {RE38OV}

DK ................................. -8 {RE38OV}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

----------------------------------------------------

| DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘Was’ IF |

| ROUND 5. DISPLAY ‘on December 31, {YEAR}’, WHERE |

| ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL, |

| IF ROUND 5. OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

RE38OV

======

{Is/Was} (PERSON) living within the U.S. or outside the U.S.

{on December 31, {YEAR}}?

WITHIN U.S. ......................... 1 {RE41}

OUTSIDE U.S. ........................ 2 {RE41}

REF ................................ -7 {RE41}

DK ................................. -8 {RE41}

[Code One]

----------------------------------------------------

| DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘Was’ IF |

| ROUND 5. DISPLAY ‘on December 31, {YEAR}’, WHERE |

| ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL, |

| IF ROUND 5. OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

| IF CODED ‘1’ (WITHIN U.S.), ‘-7’ (REFUSED), OR |

| ‘-8’ (DON’T KNOW), FLAG PERSON AS ‘FULL-TIME |

| MILITARY IN U.S. AND NOT ON MILITARY FACILITY’ |

----------------------------------------------------

BOX_21

======

OMITTED.

RE39

====

OMITTED.

RE40

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

Please give me the name and address of the nursing home or long

term care facility where (PERSON) {is/was} living {now/on

December 31, {YEAR}}.

PLACE NAME: [_____________]

STREET ADDRESS1: [_____________]

STREET ADDRESS2: [_____________]

CITY: [_____________]

STATE: [_____________]

ZIP CODE: [_____________]

USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.

----------------------------------------------------

| DISPLAY ‘is’ IF NOT ROUND 5. DISPLAY ‘was’ IF |

| ROUND 5. DISPLAY ‘now’ IF NOT ROUND 5. DISPLAY |

| ‘on December 31, {YEAR}’, WHERE ‘YEAR’ IS THE |

| SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5. |

----------------------------------------------------

| CODES '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE |

| ALLOWED ON EACH FORM ITEM. |

----------------------------------------------------

| GO TO RE41 |

----------------------------------------------------

RE41

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

On what date did (PERSON) {die/enter the institution/start

living away at school/move/leave the U.S./leave the

household}?

[Enter Month,Day,Year-4] .............. {END_LP04}

REF ................................... -7 {END_LP04}

DK .................................... -8 {END_LP04}

----------------------------------------------------

| DISPLAY ‘die’ IF RE35 CODED ‘1’ (DECEASED). |

| |

| DISPLAY ‘enter the institution’ IF RE35 CODED ‘2’ |

| (INSTITUTIONALIZED). |

| |

| DISPLAY ‘start living away at school’ IF RE35 |

| CODED ‘3’ (STUDENT UNDER 24 LIVING AWAY AT SCHOOL |

| IN GRADES 1-12) OR ‘4’ (STUDENT UNDER 24 LIVING |

| AWAY AT POST-SECONDARY SCHOOL). |

| |

| DISPLAY ‘move’ IF RE35 CODED ‘5’ (MOVED - |

| CURRENTLY NOT IN MILITARY) AND RE37 CODED ‘1’ |

| (WITHIN U.S.), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |

| KNOW) OR IF RE35 CODED ‘6’ (MOVED - CURRENTLY |

| FULL-TIME ACTIVE DUTY IN THE ARMED FORCES). |

| |

| DISPLAY ‘leave the U.S.’ IF RE35 CODED ‘5’ |

| (MOVED - CURRENTLY NOT IN MILITARY) AND RE37 |

| CODED ‘2’ (OUTSIDE U.S.). |

| |

| DISPLAY ‘leave the household’ IF RE35 CODED ‘-7’ |

| (REFUSED) OR ‘-8’ (DON’T KNOW). |

----------------------------------------------------

| IF DATE IS PRIOR TO 01/01/{YEAR}, WHERE ‘YEAR’ IS |

| THE FIRST CALENDAR YEAR OF THE PANEL, AND PERSON |

| MEETS ONE OF THE FOLLOWING SETS OF CONDITIONS: |

| - RE35 CODED ‘1’ (DECEASED), ‘2’ |

| (INSTITUTIONALIZED), ‘-7’ (REFUSED), OR ‘-8’ |

| (DON’T KNOW) |

| OR |

| - (RE35 CODED ‘4’ (STUDENT UNDER 24 LIVING AWAY |

| AT POST-SECONDARY SCHOOL) OR ‘5’ (MOVED - |

| CURRENTLY NOT IN MILITARY)) |

| AND |

| RE37 CODED ‘2’ (OUTSIDE U.S.) |

| OR |

| - RE35 CODED ‘6’ (MOVED - CURRENTLY ON FULL-TIME |

| ACTIVE DUTY IN ARMED FORCES) |

| AND |

| RE38 CODED ‘2’ (MILITARY FACILITY) |

| OR |

| - RE35 CODED ‘6’ (MOVED - CURRENTLY ON FULL-TIME |

| ACTIVE DUTY IN ARMED FORCES) |

| AND |

| (RE38 CODED ‘1’ (ANOTHER HOUSEHOLD), ‘-7’ |

| (REFUSED), OR ‘-8’ (DON’T KNOW)) |

| AND |

| RE38OV CODED ‘2’ (OUTSIDE U.S.) |

| |

| REMOVE PERSON FROM THE RU-MEMBERS-ROSTER AND |

| FLAG PERSON AS REMOVED AT RE41. PERSON IS OUT 0F |

| SCOPE AND INELIGIBLE. INFORMATION WILL NOT BE |

| COLLECTED FOR THIS PERSON. |

----------------------------------------------------

-----------------------------------------------------

| IF PERSON IS FLAGGED DURING THIS INTERVIEW AS ONE |

| OF THE FOLLOWING: |

| - ‘NEW STUDENT’ (THAT IS, RE35 CODED ‘4’ (STUDENT |

| UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL) |

| AND (RE37 CODED ‘1’ (WITHIN U.S.), ‘-7’ |

| (REFUSED), OR ‘-8’ (DON’T KNOW))) |

| OR |

| - ‘NON-MILITARY MOVER IN U.S.’ (THAT IS, RE35 |

| CODED ‘5’ (MOVED - CURRENTLY NOT IN MILITARY) |

| AND (RE37 CODED ‘1’ (WITHIN U.S.), ‘-7’ |

| (REFUSED), OR ‘-8’ (DON’T KNOW))) |

| OR |

| - ‘FULL-TIME MILITARY IN U.S. AND NOT ON MILITARY |

| FACILITY’ (THAT IS, RE35 CODED ‘6’ (MOVED - |

| CURRENTLY ON FULL-TIME ACTIVE DUTY IN ARMED |

| FORCES) AND (RE38 CODED ‘2’ (ANOTHER HOUSEHOLD),|

| ‘-7’ (REFUSED), OR ‘-8’ (DON’T KNOW)) AND |

| (RE38OV CODED ‘1’ (WITHIN U.S.), ‘-7’ (REFUSED),|

| OR ‘-8’(DON’T KNOW)), |

| |

| REMOVE PERSON FROM RU-MEMBERS-ROSTER AND FLAG |

| PERSON AS REMOVED AT RE41. THE RE SECTION WILL |

| COLLECT LOCATING AND OTHER PERTINENT INFORMATION |

| FOR PERSON BUT PERSON WILL NOT BE INCLUDED IN THIS |

| INTERVIEW AFTER THE RE SECTION. INFORMATION FOR |

| PERSON MAY BE COLLECTED AS PART OF ANOTHER RU. |

-----------------------------------------------------

----------------------------------------------------

| IF DATE IS = OR AFTER 01/01/{YEAR} AND PERSON |

| MEETS ONE OF THE FOLLOWING SETS OF CONDITIONS: |

| - RE35 CODED ‘1’ (DECEASED) |

| OR |

| - RE35 CODED ‘2’ (INSTITUTIONALIZED) |

| OR |

| - (RE35 CODED ‘4’ (STUDENT UNDER 24 LIVING AWAY |

| AT POST-SECONDARY SCHOOL) OR ‘5’ (MOVED - |

| CURRENTLY NOT IN MILITARY)) |

| AND |

| RE37 CODED ‘2’ (OUTSIDE U.S.) |

| OR |

| - RE35 CODED ‘6’ (MOVED - CURRENTLY ON FULL-TIME |

| ACTIVE DUTY IN ARMED FORCES) |

| AND |

| RE38 CODED ‘2’ (MILITARY FACILITY) |

| OR |

| - RE35 CODED ‘6’ (MOVED - CURRENTLY ON FULL-TIME |

| ACTIVE DUTY IN ARMED FORCES) |

| AND |

| (RE38 CODED ‘1’ (ANOTHER HOUSEHOLD), ‘-7’ |

| (REFUSED), OR ‘-8’ (DON’T KNOW)) |

| AND |

| RE38OV CODED ‘2’ (OUTSIDE U.S.) |

| OR |

| - RE35 CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T KNOW) |

| |

| FLAG PERSON AS ‘REMOVE FROM RU BEFORE NEXT ROUND’.|

| INFORMATION MAY BE COLLECTED FOR PERSON DURING |

| THIS ROUND UP UNTIL THE DATE PERSON LEFT THE RU. |

| (PERSON’S REFERENCE PERIOD WILL END ON DATE PERSON|

| LEFT THE RU.) CAPI DETERMINES WHETHER OR NOT TO |

| INCLUDE PERSON IN THE INTERVIEW BASED ON PERSON’S |

| ELIGIBILITY WHICH IS ASSESSED BEFORE RE85. |

----------------------------------------------------

| HARD CHECK: |

| EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR |

| BEFORE 12/31/{YEAR}, WHERE ‘YEAR’ IS THE SECOND |

| CALENDAR YEAR OF THE PANEL. IF A DATE AFTER |

| 12/31/{YEAR} IS ENTERED, DISPLAY THE FOLLOWING |

| MESSAGE: “DATE MUST BE ON OR BEFORE 12/31/{YEAR}.|

| IF LEFT RU AFTER 12/31/{YEAR}, BACK-UP AND |

| RE-CODE RE21.” |

----------------------------------------------------

END_LP04

========

----------------------------------------------------

| CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER |

| WHO MEETS THE CONDITIONS STATED IN THE LOOP |

| DEFINITION. |

----------------------------------------------------

| IF NO MORE PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_04 AND CONTINUE WITH BOX_22 |

----------------------------------------------------

BOX_22

======

----------------------------------------------------

| IF ALL RU MEMBERS LEFT THE RU AND ARE NOT ELIGIBLE|

| FOR THE STUDY AS PART OF ANY RU (THEREFORE, |

| LOCATING INFORMATION IS NOT REQUIRED); THAT IS: |

| - IF THE RU-MEMBERS-ROSTER IS EMPTY |

| AND |

| - NO ONE IS FLAGGED AS A ‘NEW STUDENT’ THIS |

| INTERVIEW |

| AND |

| - NO ONE IS FLAGGED AS A ‘NON-MILITARY MOVER IN |

| U.S.’ THIS INTERVIEW |

| AND |

| - NO ONE IS FLAGGED AS ‘FULL-TIME MILITARY IN |

| U.S. AND NOT ON MILITARY FACILITY’ THIS |

| INTERVIEW, |

| CONTINUE WITH RE42A |

----------------------------------------------------

| IF AT LEAST ONE RU MEMBER IS CURRENTLY LIVING IN |

| THE RU (THAT IS, IF AT LEAST ONE PERSON ON THE |

| CURRENT RU-MEMBERS-ROSTER MEETS ALL OF THE |

| FOLLOWING CONDITIONS: |

| - NOT DECEASED (RE35 IS NOT CODED ‘1’) |

| AND |

| - NOT INSTITUTIONALIZED (RE35 IS NOT CODED ‘2’) |

| AND |

| - NOT A STUDENT OR NON-MILITARY MOVER LIVING |

| OUTSIDE THE U.S. (RE37 IS NOT CODED ‘2’) |

| AND |

| - NOT ON FULL-TIME ACTIVE DUTY AND LIVING AT A |

| MILITARY FACILITY (RE38 IS NOT CODED ‘2’) |

| AND |

| - NOT ON FULL-TIME ACTIVE DUTY AND LIVING OUTSIDE|

| THE U.S. (RE38OV IS NOT CODED ‘2’) |

| AND |

| - NOT LEFT RU FOR UNKNOWN REASON (RE35 IS NOT |

| CODED ‘-7’ OR ‘-8’), |

| GO TO BOX_22AAA |

----------------------------------------------------

| OTHERWISE, IF ROUND 1 (THAT IS, EITHER THE |

| RU-MEMBERS-ROSTER INCLUDES ONLY PERSONS WHO HAVE |

| LEFT THE RU SINCE START DATE OR (THE RU-MEMBERS- |

| ROSTER IS EMPTY AND AT LEAST ONE REMOVED PERSON |

| IS FLAGGED AS ‘NEW STUDENT’ OR ‘NON-MILITARY |

| MOVER IN U.S.’ OR ‘FULL-TIME MILITARY IN U.S. |

| AND NOT ON MILITARY FACILITY’)), GO TO BOX_24A |

----------------------------------------------------

| OTHERWISE, IF NOT ROUND 1 (THAT IS, EITHER THE |

| RU-MEMBERS-ROSTER INCLUDES ONLY PERSONS WHO HAVE |

| LEFT THE RU SINCE START DATE OR (THE RU-MEMBERS- |

| ROSTER IS EMPTY AND AT LEAST ONE REMOVED PERSON |

| IN FLAGGED AS ‘NEW STUDENT’ OR ‘NON-MILITARY |

| MOVER IN U.S.’ OR ‘FULL-TIME MILITARY IN U.S. |

| AND NOT ON MILITARY FACILITY’)), GO TO RE57A |

----------------------------------------------------

RE42A

=====

INTERVIEWER: THERE ARE NO ELIGIBLE INDIVIDUALS REMAINING IN THIS

RU. PLEASE REPORT THIS SITUATION TO YOUR SUPERVISOR.

PRESS ENTER OR SELECT NEXT PAGE TO END THE INTERVIEW.

RE42B

=====

INTERVIEWER: DID YOU COMPLETE THIS INTERVIEW IN-PERSON OR BY

TELEPHONE? (YOU MUST HAVE SUPERVISOR APPROVAL PRIOR TO

INTERVIEWING BY TELEPHONE.)

IN-PERSON ............................. 1 {BOX_27}

TELEPHONE ............................. 2 {BOX_27}

[Code One]

BOX_22AAA

=========

----------------------------------------------------

| IF PREVIOUS ROUND REFERENCE PERSON (OR NHIS |

| REFERENCE PERSON IF ROUND 1) IS STILL IN RU ON |

| DATE OF INTERVIEW (OR AS OF DECEMBER 31, {YEAR}, |

| WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE |

| PANEL, IF ROUND 5), THAT IS IF PREVIOUS ROUND |

| REFERENCE PERSON MEETS BOTH OF THE FOLLOWING |

| CONDITIONS: |

| - PERSON = > 16 YEARS OLD OR AGE CATEGORY 4-9 |

| AND |

| - STILL LIVING IN THE RU AT THE DATE OF THE |

| CURRENT INTERVIEW (THAT IS, NOT CODED ANY OF |

| THE FOLLOWING: |

| - DECEASED OR INSTITUTIONALIZED (RE35 CODED |

| ‘1’ OR ‘2’) |

| OR |

| - STUDENT OR NON-MILITARY LIVING OUTSIDE THE |

| U.S. (RE37 CODED ‘2’) |

| OR |

| - CURRENTLY ON FULL-TIME ACTIVE DUTY AND |

| LIVING AT A MILITARY FACILITY (RE38 CODED |

| ‘2’) |

| OR |

| - CURRENTLY ON FULL-TIME ACTIVE DUTY AND |

| LIVING OUTSIDE U.S. (RE38OV CODED ‘2’) |

| OR |

| - LEFT RU FOR UNKNOWN REASON (RE35 CODED ‘-7’ |

| OR ‘-8’) |

| |

| THEN FLAG PREVIOUS ROUND REFERENCE PERSON |

| (OR NHIS REFERENCE PERSON IF ROUND 1) AS CURRENT |

| ROUND REFERENCE PERSON AND GO TO BOX_22AA |

----------------------------------------------------

| OTHERWISE, CONTINUE WITH RE42 |

----------------------------------------------------

RE42

====

Of all the people who {live/lived} in this household {on December 31,

{YEAR}}, {does/did} anyone own or rent this home?

YES .................................... 1 {RE43}

NO ..................................... 2 {RE44}

REF ................................... -7 {RE44}

DK .................................... -8 {RE44}

HELP AVAILABLE FOR DEFINITION OF OWNS/RENTS HOME.

----------------------------------------------------

| DISPLAY ‘live’ IF NOT ROUND 5. DISPLAY ‘lived’ |

| IF ROUND 5. |

| DISPLAY ‘does’ IF NOT ROUND 5. DISPLAY ‘did’ IF |

| ROUND 5. |

| DISLAY ‘on December 31, {YEAR}’, WHERE ‘YEAR’ IS |

| THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.|

| OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

RE43

====

Of the people in this family who {live/lived} here {now/on

December 31, {YEAR}}, who {owns/owned} or {rents/rented} this home?

IF NAME GIVEN NOT LISTED, PROBE TO DETERMINE IF NEW RU MEMBER

(I.E., RELATED) OR PERSON NOT IN RU.

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.

TO LEAVE, PRESS ESC.

[1. First Name,[Middle Name],Last Name-65]

[2. First Name,[Middle Name],Last Name-65]

[3. First Name,[Middle Name],Last Name-65]

[Code One]

HELP AVAILABLE FOR DEFINITION OF OWNS/RENTS HOME.

----------------------------------------------------

| DISPLAY ‘live’ AND ‘now’ AND ‘owns’ AND ‘rents’ |

| IF NOT ROUND 5. DISPLAY ‘lived’ AND ‘on December |

| 31, {YEAR}’, WHERE ‘YEAR’ IS THE SECOND CALENDAR |

| YEAR OF THE PANEL, IF ROUND 5 AND ‘owned’ AND |

| ‘rented’ IF ROUND 5. |

----------------------------------------------------

| DISPLAY ‘PERSON NOT IN RU’ AS THE LAST ENTRY ON |

| THIS ROSTER. |

----------------------------------------------------

| IF ‘PERSON NOT IN RU’ SELECTED, CONTINUE WITH |

| RE44 |

----------------------------------------------------

| OTHERWISE (CURRENT RU MEMBER SELECTED), |

| GO TO BOX_22AA |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS THE RU-MEMBERS-ROSTER FOR |

| SELECTION OF THE PERSON WHO OWNS OR RENTS THE |

| HOME. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. SELECT ALLOWED. |

| |

| 2. MULTIPLE SELECT, ADD, DELETE, AND EDIT |

| DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING |

| CRITERIA: |

| |

| PERSON >= 16 YEARS OLD OR AGE CATEGORY 4-9 |

| INCLUSIVE |

| AND |

| PERSON IS STILL LIVING IN THE RU AT THE DATE OF |

| THE CURRENT INTERVIEW. THAT IS, THE PERSON IS NOT |

| CODED ANY OF THE FOLLOWING: |

| - DECEASED OR INSTITUTIONALIZED (RE35 CODED |

| ‘1’ OR ‘2’) |

| OR |

| - STUDENT OR NON-MILITARY LIVING OUTSIDE THE |

| U.S. (RE37 CODED ‘2’) |

| OR |

| - CURRENTLY ON FULL-TIME ACTIVE DUTY AND |

| LIVING AT A MILITARY FACILITY (RE38 CODED |

| ‘2’) |

| OR |

| - CURRENTLY ON FULL-TIME ACTIVE DUTY AND |

| LIVING OUTSIDE THE U.S. (RE38OV CODED ‘2’) |

| OR |

| - LEFT RU FOR UNKNOWN REASON (RE35 CODED ‘-7’ |

| OR ‘-8’) |

----------------------------------------------------

RE44

====

Of all the people in this family who {live/lived} here {now/on

December 31, {YEAR}}, who {is/was} considered the head of household?

|--------------|--------------|--------------|--------------|--------------|

| ROSTER. | RE51_02. | RE51_03. | RE51_04. AGE | RE51_05. |

|--------------|--------------|--------------|--------------|--------------|

|--------------|--------------|--------------|--------------|--------------|

|--------------|--------------|--------------|--------------|--------------|

|--------------|--------------|--------------|--------------|--------------|

[Code One]

HELP AVAILABLE FOR DEFINITION OF HEAD OF HOUSEHOLD.

----------------------------------------------------

| DISPLAY ‘live’ AND ‘now’ AND ‘is’ IF NOT ROUND 5. |

| DISPLAY ‘lived’ AND ‘on December 31, {YEAR}’, |

| WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE |

| PANEL, AND ‘was’ IF ROUND 5. |

----------------------------------------------------

| DISPLAY ‘ADD RU MEMBER’ AS AN OPTION ON THIS |

| SCREEN. |

----------------------------------------------------

| IF PERSON FROM ANOTHER RU SELECTED AND VERIFIED |

| AS THE HEAD OF HOUSEHOLD, ADD PERSON TO |

| RU-MEMBERS-ROSTER. |

----------------------------------------------------

| IF ‘ADD RU MEMBER’ SELECTED, CONTINUE WITH RE45 |

| (NOTE THAT RE45 IS ACTUALLY A POP-UP ON RE44.) |

----------------------------------------------------

| OTHERWISE (CURRENT DU MEMBER SELECTED), |

| GO TO BOX_22AA |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: DU_MEMBERS_2 |

| |

| COL # 1 HEADER: SELECT DU MEMBER |

| INSTRUCTIONS: DISPLAY DU MEMBERS’ FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

| |

| COL # 2 HEADER: RUID |

| INSTRUCTIONS: DISPLAY RU ID (RUNT.RUNTID) |

| |

| COL # 3 HEADER: GENDER |

| INSTRUCTIONS: DISPLAY THE DU MEMBERS’ SEX |

| (PERS.SMPSEXR) |

| |

| COL # 4 HEADER: AGE |

| INSTRUCTIONS: DISPLAY DU MEMBERS’ AGES (PRND.AGE) |

| |

| COL # 5 HEADER: INTERVIEW COMPLETED THIS ROUND |

| INSTRUCTIONS: DISPLAY WHETHER THE DU MEMBER HAS |

| ALREADY FINISHED THE INTERVIEW THIS ROUND |

| (TEMPORARY VARIABLE) |

----------------------------------------------------

| ROSTER DEFINITION: |

| DISPLAY THE DU-MEMBERS-ROSTER FOR SELECTION OF |

| HEAD OF HOUSEHOLD. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. ALL COLUMNS ARE PROTECTED; NO CHANGES ARE |

| ALLOWED AT THIS SCREEN. |

| |

| 2. THE ‘INTERVIEW COMPLETED THIS ROUND’ COLUMN |

| DISPLAYS AN ‘X’ FOR EACH PERSON WHO HAS ALREADY |

| BEEN INTERVIEWED THIS ROUND IN THE STANDARD RU OR |

| ANOTHER RU IN THIS DU. |

| |

| 3. IF PERSON WITH AN ‘X’ IN ‘INTERVIEW COMPLETED |

| THIS ROUND’ COLUMN IS SELECTED, DISPLAY MESSAGE: |

| “PERSON CANNOT BE SELECTED. HAS ALREADY BEEN |

| INTERVIEWED WITH ANOTHER RU.” |

| |

| 4. IF AN RU MEMBER UNDER 16 IS SELECTED AS THE |

| HEAD OF HOUSEHOLD, DISPLAY MESSAGE “HEAD OF |

| HOUSEHOLD < 16. S/HE MUST BE APPROVED BY |

| SUPERVISOR. RESELECT TO VERIFY.” |

| |

| 5. IF INTERVIEWER SELECTS A PERSON FROM ANOTHER |

| RU, DISPLAY THE MESSAGE: “PERSON IS MEMBER OF |

| ANOTHER RU. VERIFY THAT PERSON JOINED OR CORRECT |

| SELECTION.” |

| |

| 6. IF INTERVIEWER SELECTS PERSON WHO HAS LEFT THE |

| RU, DISPLAY THE MESSAGE: “SELECTION IS |

| INAPPROPRIATE. MAKE ANOTHER SELECTION.” |

----------------------------------------------------

| ROSTER FILTER: |

| NONE. DISPLAY ALL DU MEMBERS. |

----------------------------------------------------

RE45

====

ENTER NAME OF NEW RU MEMBER WHO OWNS OR RENTS HOME OR IS HEAD

OF HOUSEHOLD.

VERIFY SPELLING.

IF NO MIDDLE NAME OR INITIAL, ENTER 'NMN'.

[Enter First Name,[Middle Name],Last Name-65] {BOX_22AA}

----------------------------------------------------

| REFUSED AND DON’T KNOW DISALLOWED AT ALL FIELDS. |

----------------------------------------------------

| ADD PERSON TO RU-MEMBERS-ROSTER AND FLAG PERSON |

| AS ‘NEW RU MEMBER ADDED AT RE45’. |

----------------------------------------------------

BOX_22AA

========

----------------------------------------------------

| IF AT LEAST ONE PERSON ON THE RU-MEMBERS-ROSTER |

| IS AN ORIGINAL RU MEMBER WHO IS STILL LIVING IN |

| THE RU AT THE TIME OF THE CURRENT INTERVIEW; THAT |

| IS, IF AT LEAST ONE RU MEMBER MEETS THE FOLLOWING |

| CONDITIONS: |

| - NOT ADDED TO THE RU THIS ROUND |

| AND |

| - NOT CODED ANY OF THE FOLLOWING: |

| - DECEASED OR INSTITUTIONALIZED (RE35 CODED |

| ‘1’ OR ‘2’) |

| OR |

| - STUDENT OR NON-MILITARY LIVING OUTSIDE THE |

| U.S. (RE37 CODED ‘2’) |

| OR |

| - CURRENTLY ON FULL-TIME ACTIVE DUTY AND |

| LIVING AT A MILITARY FACILITY (RE38 CODED |

| ‘2’) |

| OR |

| - CURRENTLY ON FULL-TIME ACTIVE DUTY AND |

| LIVING OUTSIDE U.S. (RE38OV CODED ‘2’) |

| OR |

| - LEFT RU FOR UNKNOWN REASON (RE35 CODED ‘-7’ |

| OR ‘-8’), |

| CONTINUE WITH RE46 |

----------------------------------------------------

| OTHERWISE, GO TO BOX_24A |

----------------------------------------------------

RE46

====

{REFERENCE PERSON’S FIRST MIDDLE AND LAST NAME}

{Please think about the household composition as of December 31,

{YEAR} for the next few questions.} {Is/Was} there anyone else

{other than you} related to (REFERENCE PERSON) who {is/was}

living here {now/on December 31, {YEAR}} as part of this family and

who is not listed on this form? (HAND HOUSEHOLD SUMMARY) That

is, other than (READ NAMES BELOW)? Do not include anyone {who was}

staying here temporarily who usually {lives/lived} somewhere

else. By related we mean by blood, marriage, living together as

married, adoption or foster care relationship.

[1. First Name,[Middle Name],Last Name-65]

[2. First Name,[Middle Name],Last Name-65]

[3. First Name,[Middle Name],Last Name-65]

YES .................................... 1 {RE48}

NO ..................................... 2 {RE50}

REF ................................... -7 {RE50}

DK .................................... -8 {RE50}

HELP AVAILABLE FOR DEFINITION OF LIVING TOGETHER AS

MARRIED/PARTNER RELATIONSHIPS.

----------------------------------------------------

| DISPLAY ‘Please .. questions.’ IF ROUND 5, WHERE |

| ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL. |

| OTHERWISE, USE A NULL DISPLAY. |

| |

| DISPLAY ‘Is’ AND ‘is’ AND ‘now’ IF NOT ROUND 5. |

| DISPLAY ‘Was’ AND ‘was’ AND ‘on December 31, |

| {YEAR}’, WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR |

| OF THE PANEL, IF ROUND 5. |

| |

| DISPLAY ‘who was’ IF ROUND 5. OTHERWISE, USE A |

| NULL DISPLAY. |

| |

| DISPLAY ‘lives’ IF ROUND 1-4. DISPLAY ‘lived’ IF |

| ROUND 5. |

| |

| DISPLAY ‘other than you’ IF RESPONDENT FLAGGED AS |

| ‘NEW RU MEMBER ADDED AT RE08 (RE06 POP-UP)’ OR IF |

| A PREVIOUS ROUND INSTITUTIONALIZED RU MEMBER HAS |

| RETURNED TO THE RU AND IS THE RESPONDENT. |

| OTHERWISE, USE A NULL DISPLAY. |

| |

| FOR CONTEXT HEADER, DISPLAY CURRENT ROUND |

| REFERENCE PERSON. |

----------------------------------------------------

| IF NOT ROUND 1 AND CE05A WAS CODED ‘1’ (YES) IN |

| THE PREVIOUS ROUND, DISPLAY THE FOLLOWING MESSAGE:|

| “SOMEONE IN RU WAS PREGNANT DURING THE PREVIOUS |

| ROUND. IF BABY WAS BORN AND IS LIVING IN THE RU, |

| PLEASE BE SURE TO ADD HIM/HER.” |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY |

| OF RU-MEMBERS. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. DISPLAY ONLY. |

| |

| 2. SELECT, ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY PERSONS WHO WERE NOT ADDED TO THE ROSTER |

| THIS ROUND. |

----------------------------------------------------

RE47

====

{PERSON’S FIRST MIDDLE AND LAST NAME}

We would like to include the other members of (PERSON)’s household

who are related to (PERSON) in this interview.

{Is/Was} there anyone else related to (PERSON) living here

{now/on December 31, {YEAR}}? Do not include anyone staying

here temporarily who usually lives somewhere else. By related

we mean by blood, marriage, living together as married,

adoption, or foster care relationship.

YES .................................... 1 {RE48}

NO ..................................... 2 {RE50}

REF ................................... -7 {RE50}

DK .................................... -8 {RE50}

HELP AVAILABLE FOR DEFINITION OF LIVING TOGETHER AS MARRIED.

----------------------------------------------------

| DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘Was’ IF |

| ROUND 5. DISPLAY ‘now’ IF NOT ROUND 5. DISPLAY |

| ‘on December 31, {YEAR}’, WHERE ‘YEAR’ IS THE |

| SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5. |

----------------------------------------------------

| IF NOT ROUND 1 AND CE05A WAS CODED ‘1’ (YES) IN |

| THE PREVIOUS ROUND, DISPLAY THE FOLLOWING MESSAGE:|

| “SOMEONE IN RU WAS PREGNANT DURING THE PREVIOUS |

| ROUND. IF BABY WAS BORN AND IS LIVING IN THE RU, |

| PLEASE BE SURE TO ADD HIM/HER.” |

----------------------------------------------------

RE48

====

{INTERVIEWER: IF ALL PERSONS WHO HAVE JOINED THE RU ARE ALREADY

SELECTED, BACKUP AND CHANGE PREVIOUS SCREEN TO ‘NO’.}

Who else {is/was} related and living here {now/on December 31, {YEAR}}?

PROBE: Anyone else?

|--------------|--------------|--------------|--------------|--------------|

| ROSTER. | RE48_02. | RE48_03. | RE48_04. AGE | RE48_05. |

|--------------|--------------|--------------|--------------|--------------|

|--------------|--------------|--------------|--------------|--------------|

|--------------|--------------|--------------|--------------|--------------|

|--------------|--------------|--------------|--------------|--------------|

----------------------------------------------------

| DISPLAY AN 'ANY NEW RU MEMBERS NOT LISTED' OPTION |

| AS THE LAST SELECTABLE ROW ON THE ROSTER. |

----------------------------------------------------

| DISPLAY ‘is’ IF NOT ROUND 5. DISPLAY ‘was’ IF |

| ROUND 5. DISPLAY ‘now’ IF NOT ROUND 5. DISPLAY |

| ‘on December 31, {YEAR}’, WHERE ‘YEAR’ IS THE |

| SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5. |

----------------------------------------------------

| DISPLAY ‘INTERVIEWER...’ IF NOT ROUND 1. |

| OTHERWISE, USE NULL DISPLAY. |

----------------------------------------------------

| IF A PERSON FROM ANOTHER RU VERIFIED AND |

| SELECTED AS THE RESPONDENT, ADD THAT PERSON TO |

| THE RU-MEMBERS-ROSTER. |

----------------------------------------------------

| IF ‘ANY NEW RU MEMBERS NOT LISTED' IS SELECTED, |

| CONTINUE WITH RE49 |

----------------------------------------------------

-----------------------------------------------------

| OTHERWISE, GO TO RE50 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: DU_MEMBERS_2 |

| |

| COL # 1 HEADER: SELECT DU MEMBER |

| INSTRUCTIONS: DISPLAY DU MEMBERS’ FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

| |

| COL # 2 HEADER: RUID |

| INSTRUCTIONS: DISPLAY RU ID (RUNT.RUNTID) |

| |

| COL # 3 HEADER: GENDER |

| INSTRUCTIONS: DISPLAY THE DU MEMBERS’ SEX |

| (PERS.SMPSEXR) |

| |

| COL # 4 HEADER: AGE |

| INSTRUCTIONS: DISPLAY DU MEMBERS’ AGES (PRND.AGE) |

| |

| COL # 5 HEADER: INTERVIEW COMPLETED THIS ROUND |

| INSTRUCTIONS: DISPLAY WHETHER THE DU MEMBER HAS |

| ALREADY FINISHED THE INTERVIEW THIS ROUND |

| (TEMPORARY VARIABLE) |

----------------------------------------------------

| ROSTER DEFINITION: |

| DISPLAY THE DU-MEMBERS-ROSTER FOR SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. ALL COLUMNS ARE PROTECTED; NO CHANGES ARE |

| ALLOWED AT THIS SCREEN, EXCEPT TO ADD AN RU MEMBER|

| AT THE POP-UP (RE49). |

| |

| 2. THE ‘INTERVIEW COMPLETED THIS ROUND’ COLUMN |

| DISPLAYS AN ‘X’ FOR EACH PERSON WHO HAS ALREADY |

| BEEN INTERVIEWED THIS ROUND IN THE STANDARD RU OR |

| ANOTHER RU IN THIS DU. |

| |

| 3. IF PERSON WITH AN ‘X’ IN ‘INTERVIEW COMPLETED |

| THIS ROUND’ COLUMN IS SELECTED, DISPLAY MESSAGE: |

| “PERSON CANNOT BE SELECTED. HAS ALREADY BEEN |

| INTERVIEWED WITH ANOTHER RU.” |

| |

| 4. IF INTERVIEWER SELECTS A PERSON FROM ANOTHER |

| RU FOR WHOM AN INTERVIEW HAS NOT YET BEEN |

| COMPLETED, DISPLAY THE MESSAGE: “PERSON IS MEMBER |

| OF ANOTHER RU. VERIFY THAT PERSON JOINED OR |

| CORRECT SELECTION.” |

| |

| 5. IF INTERVIEWER SELECTS PERSON WHO HAS LEFT THE |

| RU, DISPLAY THE MESSAGE: “SELECTION IS |

| INAPPROPRIATE. MAKE ANOTHER SELECTION.” |

| |

| 6. IF INTERVIEWER TRIES TO LEAVE THE SCREEN |

| WITHOUT MAKING A SELECTION, DISPLAY THE MESSAGE: |

| “IF NO NEW PERSON HAS JOINED THE RU, BACKUP TO |

| CORRECT PREVIOUS SCREENS.” |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL DU MEMBERS; NO FILTER. |

----------------------------------------------------

RE49

====

Please give me the name of each new related person who {is/was}

living with this household {on December 31, {YEAR}}.

PROBE: Anyone else?

ENTER NAMES. VERIFY SPELLING. IF NO MIDDLE NAME OR INITIAL,

ENTER 'NMN'.

|------------------------------------|------------------------------------|

| ROSTER. RU MEMBER | RE49_02. IN RU NOW? |

|------------------------------------|------------------------------------|

| 1. First Name Middle Name Last | [Display Selection] |

| Name-35 | |

|------------------------------------|------------------------------------|

| 2. First Name Middle Name Last | [Display Selection] |

| Name-35 | |

|------------------------------------|------------------------------------|

| 3. First Name Middle Name Last | [Display Selection] |

| Name-35 | |

|------------------------------------|------------------------------------|

----------------------------------------------------

| DISPLAY ‘is’ IF NOT ROUND 5. DISPLAY ‘was’ IF |

| ROUND 5. DISPLAY ‘on December 31, {YEAR}’, WHERE |

| ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL, |

| IF ROUND 5. OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

| DISPLAY AN ‘ADD RU MEMBER’ OPTION AT THIS SCREEN. |

----------------------------------------------------

| IF PERSON IS ADDED AT RE49, ADD PERSON TO RU- |

| MEMBERS-ROSTER AND FLAG PERSON AS ADDED AT RE49 |

----------------------------------------------------

| CONTINUE WITH RE50 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_4 |

| |

| COL # 1 HEADER: RU MEMBER |

| INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

| |

| COL # 2 HEADER: IN RU NOW? |

| INSTRUCTIONS: DISPLAY THE RU MEMBERS’ RU STATUS |

| (PRND.INRUSTAT) |

----------------------------------------------------

| ROSTER DEFINITION: |

| DISPLAY THE RU-MEMBERS-ROSTER FOR ENTRY. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE ADD ALLOWED. |

| |

| 2. LIMITED DELETE ALLOWED. ALLOW INTERVIEWERS TO |

| DELETE ONLY THOSE PERSONS WHO WERE ADDED AT THIS |

| SCREEN. |

| |

| 3. LIMITED EDIT ALLOWED. ALLOW INTERVIEWERS TO |

| EDIT ONLY THOSE PERSONS WHO WERE ADDED AT THIS |

| SCREEN. |

| |

| 4. EACH ROW INITIALLY HAS ‘IN RU NOW?’ SET TO |

| ‘YES’ FOR EACH PERSON CODED ‘1’ (IN RU) AT RE21 OR|

| ADDED TO RU DURING THIS INTERVIEW. |

| |

| 5. ‘IN RU NOW?’ COLUMN IS PROTECTED. |

| |

| 6. AUTOMATICALLY DISPLAY ‘YES’ FOR ‘IN RU NOW?’ |

| FOR PERSON(S) ADDED AT THIS SCREEN. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL MEMBERS OF THE RU; NO FILTER. |

----------------------------------------------------

RE50

====

Have we missed anyone? For example, babies born or adopted

{since/between} {DATE OF PREVIOUS ROUND INTERVIEW} {and December

31, {YEAR}}, anyone related who usually {lives/lived} here but

{is/was} traveling, away on business, or in the hospital?

YES .................................... 1 {RE51}

NO ..................................... 2

REF ................................... -7

DK .................................... -8

----------------------------------------------------

| DISPLAY ‘since’ AND ‘lives’ AND ‘is’ IF NOT ROUND |

| 5. DISPLAY ‘between’ AND ‘lived’ AND ‘was’ IF |

| ROUND 5. |

| |

| FOR ‘{DATE OF PREVIOUS ROUND INTERVIEW}’ DISPLAY |

| DATE OF NHIS INTERVIEW IF ROUND 1. OTHERWISE, |

| DISPLAY DATE OF PREVIOUS ROUND MEPS INTERVIEW. |

| |

| DISPLAY ‘and December 31, {YEAR}’, WHERE ‘YEAR’ IS|

| THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.|

| OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

| IF ROUND 1 AND RE50 CODED ‘2’ (NO), ‘-7’ |

| (REFUSED), OR ‘-8’ (DON’T KNOW), GO TO RE53 |

----------------------------------------------------

| IF NOT ROUND 1 AND RE50 CODED ‘2’ (NO), ‘-7’ |

| (REFUSED), OR ‘-8’ (DON’T KNOW), GO TO BOX_24A |

----------------------------------------------------

| OTHERWISE (RE50 CODED ‘1’ (YES)), CONTINUE WITH |

| RE51 |

----------------------------------------------------

RE51

====

Who else {is/was} related and living here {now/on December 31, {YEAR}}?

PROBE: Anyone else?

|--------------|--------------|--------------|--------------|--------------|

| ROSTER. | RE51_02. | RE51_03. | RE51_04. AGE | RE51_05. |

|--------------|--------------|--------------|--------------|--------------|

|--------------|--------------|--------------|--------------|--------------|

|--------------|--------------|--------------|--------------|--------------|

|--------------|--------------|--------------|--------------|--------------|

----------------------------------------------------

| DISPLAY 'ANY NEW RU MEMBERS NOT LISTED' AS THE |

| LAST ENTRY ON THIS ROSTER. |

----------------------------------------------------

| DISPLAY ‘is’ IF NOT ROUND 5. DISPLAY ‘was’ IF |

| ROUND 5. DISPLAY ‘now’ IF NOT ROUND 5. DISPLAY |

| ‘on December 31, {YEAR}’, WHERE ‘YEAR’ IS THE |

| SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5. |

----------------------------------------------------

| ADD EACH PERSON SUCCESSFULLY SELECTED TO THE |

| RU-MEMBERS-ROSTER AND FLAG PERSON AS ADDED AT |

| RE51. |

----------------------------------------------------

| IF ‘ANY NEW RU MEMBERS NOT LISTED' SELECTED, |

| CONTINUE WITH RE52 |

----------------------------------------------------

| IF ROUND 1 AND ‘ADD RU MEMBER’ NOT SELECTED, GO TO|

| RE53 |

----------------------------------------------------

| OTHERWISE, GO TO BOX_24A |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: DU_MEMBERS_2 |

| |

| COL # 1 HEADER: SELECT DU MEMBER |

| INSTRUCTIONS: DISPLAY DU MEMBERS’ FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

| |

| COL # 2 HEADER: RUID |

| INSTRUCTIONS: DISPLAY RU ID (RUNT.RUNTID) |

| |

| COL # 3 HEADER: GENDER |

| INSTRUCTIONS: DISPLAY THE DU MEMBERS’ SEX |

| (PERS.SMPSEXR) |

| |

| COL # 4 HEADER: AGE |

| INSTRUCTIONS: DISPLAY DU MEMBERS’ AGES (PRND.AGE) |

| |

| COL # 5 HEADER: INTERVIEW COMPLETED THIS ROUND |

| INSTRUCTIONS: DISPLAY WHETHER THE DU MEMBER HAS |

| ALREADY FINISHED THE INTERVIEW THIS ROUND |

| (TEMPORARY VARIABLE) |

----------------------------------------------------

| ROSTER DEFINITION: |

| DISPLAY THE DU-MEMBERS-ROSTER FOR SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. ALL COLUMNS ARE PROTECTED; NO CHANGES ARE |

| ALLOWED AT THIS SCREEN. |

| |

| 2. THE ‘INTERVIEW COMPLETED THIS ROUND’ COLUMN |

| DISPLAYS AN ‘X’ FOR EACH PERSON WHO HAS ALREADY |

| BEEN INTERVIEWED THIS ROUND IN THE STANDARD RU OR |

| ANOTHER RU IN THIS DU. |

| |

| 3. IF PERSON WITH AN ‘X’ IN ‘INTERVIEW COMPLETED |

| THIS ROUND’ COLUMN IS SELECTED, DISPLAY MESSAGE: |

| “PERSON CANNOT BE SELECTED. HAS ALREADY BEEN |

| INTERVIEWED WITH ANOTHER RU.” |

| |

| 4. IF INTERVIEWER SELECTS A PERSON WHO HAS LEFT |

| THE RU OR A CURRENT RU MEMBER, DISPLAY THE |

| MESSAGE: “SELECTION IS INAPPROPRIATE. MAKE ANOTHER|

| SELECTION.” |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL RU MEMBERS; NO FILTER. |

----------------------------------------------------

RE52

====

Please give me the name of each new related person who {is/was}

living with this household {on December 31, {YEAR}}.

PROBE: Anyone else?

ENTER NAMES. VERIFY SPELLING. IF NO MIDDLE NAME OR INITIAL,

ENTER 'NMN'.

|------------------------------------|------------------------------------|

| ROSTER. RU MEMBER | RE52_02. IN RU NOW? |

|------------------------------------|------------------------------------|

| 1. First Name Middle Name Last | [Display Selection] |

| Name-35 | |

|------------------------------------|------------------------------------|

| 2. First Name Middle Name Last | [Display Selection] |

| Name-35 | |

|------------------------------------|------------------------------------|

| 3. First Name Middle Name Last | [Display Selection] |

| Name-35 | |

|------------------------------------|------------------------------------|

----------------------------------------------------

| DISPLAY ‘ADD RU MEMBER’ AS AN OPTION ON THIS |

| SCREEN. |

----------------------------------------------------

| DISPLAY ‘is’ IF NOT ROUND 5. DISPLAY ‘was’ IF |

| ROUND 5. DISPLAY ‘on December 31, {YEAR}’, WHERE |

| ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL, |

| IF ROUND 5. OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

| ADD ENTERED PERSONS TO RU-MEMBERS-ROSTER AND FLAG |

| PERSONS AS ADDED TO RU AT RE52. |

----------------------------------------------------

| IF ROUND 1, CONTINUE WITH RE53 |

----------------------------------------------------

| OTHERWISE, GO TO BOX_24A |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_4 |

| |

| COL # 1 HEADER: RU MEMBER |

| INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

| |

| COL # 2 HEADER: IN RU NOW? |

| INSTRUCTIONS: DISPLAY THE RU MEMBERS’ RU STATUS |

| (PRND.INRUSTAT) |

----------------------------------------------------

| ROSTER DEFINITION: |

| DISPLAY THE RU-MEMBERS-ROSTER FOR ENTRY OF NEW RU |

| MEMBERS. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE ADD ALLOWED. |

| |

| 2. LIMITED DELETE ALLOWED. ALLOW INTERVIEWERS TO |

| DELETE ONLY THOSE PERSONS WHO WERE ADDED AT THIS |

| SCREEN. |

| |

| 3. LIMITED EDIT ALLOWED. ALLOW INTERVIEWERS TO |

| EDIT ONLY THOSE PERSONS WHO WERE ADDED AT THIS |

| SCREEN. |

| |

| 4. EACH ROW INITIALLY HAS ‘IN RU NOW?’ SET TO |

| ‘YES’ FOR EACH PERSON CODED ‘1’ (IN RU) AT RE21 OR|

| ADDED TO RU DURING THIS INTERVIEW. |

| |

| 5. ‘IN RU NOW?’ COLUMN IS PROTECTED. |

| |

| 6. AUTOMATICALLY DISPLAY ‘YES’ FOR ‘IN RU NOW?’ |

| FOR PERSON(S) ADDED AT THIS SCREEN. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL RU MEMBERS; NO FILTER. |

----------------------------------------------------

RE53

====

{REFERENCE PERSON’S FIRST MIDDLE AND LAST NAME}

Are there any children or young people under 24 years of age

related to (REFERENCE PERSON) who are not listed on this form (HAND

HOUSEHOLD SUMMARY) and who usually live here but are currently

living away from home in the U.S., never married, going to school?

Please include any new member you may have just mentioned who is

under 24, never married, and living away from home going to school

in the U.S.

YES .................................... 1 {RE54}

NO ..................................... 2 {BOX_24}

REF ................................... -7 {BOX_24}

DK .................................... -8 {BOX_24}

----------------------------------------------------

| FOR CONTEXT HEADER, DISPLAY CURRENT ROUND |

| REFERENCE PERSON. |

----------------------------------------------------

RE54

====

Who is under 24, never married, and living away at school in

the U.S.?

PROBE: Anyone else?

|--------------|--------------|--------------|--------------|--------------|

| ROSTER. | RE54_02. | RE54_03. | RE54_04. | RE54_05. |

|--------------|--------------|--------------|--------------|--------------|

|--------------|--------------|--------------|--------------|--------------|

|--------------|--------------|--------------|--------------|--------------|

|--------------|--------------|--------------|--------------|--------------|

----------------------------------------------------

| DISPLAY 'ANY NEW RU MEMBERS NOT LISTED' AS AN |

| OPTION ON THIS SCREEN. |

----------------------------------------------------

| ADD EACH SUCCESSFULLY SELECTED PERSON TO THE RU- |

| MEMBERS-ROSTER AND FLAG PERSON AS ADDED TO THE RU |

| AT RE54. |

----------------------------------------------------

| IF ‘ANY NEW RU MEMBERS NOT LISTED' SELECTED, |

| CONTINUE WITH RE55 |

----------------------------------------------------

| OTHERWISE, GO TO BOX_22A |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: DU_MEMBERS_2 |

| |

| COL # 1 HEADER: SELECT DU MEMBER |

| INSTRUCTIONS: DISPLAY DU MEMBERS’ FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

| |

| COL # 2 HEADER: RUID |

| INSTRUCTIONS: DISPLAY RU ID (RUNT.RUNTID) |

| |

| COL # 3 HEADER: GENDER |

| INSTRUCTIONS: DISPLAY THE DU MEMBERS’ SEX |

| (PERS.SMPSEXR) |

| |

| COL # 4 HEADER: AGE |

| INSTRUCTIONS: DISPLAY DU MEMBERS’ AGES (PRND.AGE) |

| |

| COL # 5 HEADER: INTERVIEW COMPLETED THIS ROUND |

| INSTRUCTIONS: DISPLAY WHETHER THE DU MEMBER HAS |

| ALREADY FINISHED THE INTERVIEW THIS ROUND |

| (TEMPORARY VARIABLE) |

----------------------------------------------------

| ROSTER DEFINITION: |

| DISPLAY THE DU-MEMBERS-ROSTER FOR SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. RU MEMBERS, RUID, GENDER, AND AGE COLUMNS ARE |

| PROTECTED; NO CHANGES ARE ALLOWED. |

| |

| 2. IF NEW RU, AN ‘X’ WILL BE DISPLAYED IN THE |

| INTERVIEW COMPLETED THIS ROUND FOR EACH PERSON WHO|

| HAS ALREADY BEEN INTERVIEWED IN ANOTHER RU IN THE |

| DU. |

| |

| 3. IF PERSON WITH AN ‘X’ IN ‘INTERVIEW COMPLETED |

| THIS ROUND’ COLUMN IS SELECTED, DISPLAY MESSAGE: |

| “PERSON CANNOT BE SELECTED. HAS ALREADY BEEN |

| INTERVIEWED WITH ANOTHER RU.” |

| |

| 4. IF INTERVIEWER SELECTS A PERSON WHO HAS LEFT |

| THIS RU OR A CURRENT RU MEMBER, DISPLAY THE |

| MESSAGE: “SELECTION IS INAPPROPRIATE. MAKE ANOTHER|

| SELECTION.” |

| |

| 5. IF GENDER OR AGE HAS NOT BEEN COLLECTED, |

| DISPLAY ‘--' IN APPROPRIATE CELLS. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL DU MEMBERS; NO FILTER. |

----------------------------------------------------

RE55

====

Please give me the name of each new related person who is

a student, under 24, never married, and living away at school.

PROBE: Anyone else?

ENTER NAMES. VERIFY SPELLING. IF NO MIDDLE NAME OR INITIAL,

ENTER 'NMN'.

|------------------------------------|------------------------------------|

| ROSTER. RU MEMBER | RE55_02. IN RU NOW? |

|------------------------------------|------------------------------------|

| 1. First Name Middle Name Last | [Display Selection] |

| Name-35 | |

|------------------------------------|------------------------------------|

| 2. First Name Middle Name Last | [Display Selection] |

| Name-35 | |

|------------------------------------|------------------------------------|

| 3. First Name Middle Name Last | [Display Selection] |

| Name-35 | |

|------------------------------------|------------------------------------|

----------------------------------------------------

| DISPLAY ‘ADD RU MEMBER’ AS AN OPTION ON THIS |

| SCREEN. |

----------------------------------------------------

| ADD PERSONS TO THE RU-MEMBERS-ROSTER AND FLAG |

| PERSONS AS ADDED TO THE RU AT RE55. |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_4 |

| |

| COL # 1 HEADER: RU MEMBER |

| INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

| |

| COL # 2 HEADER: IN RU NOW? |

| INSTRUCTIONS: DISPLAY THE RU MEMBERS’ RU STATUS |

| (PRND.INRUSTAT) |

----------------------------------------------------

| ROSTER DEFINITION: |

| DISPLAY THE RU-MEMBERS-ROSTER FOR ENTRY OF NEW RU |

| MEMBERS. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE ADD ALLOWED. |

| |

| 2. LIMITED DELETE ALLOWED. ALLOW INTERVIEWERS TO |

| DELETE ONLY THOSE PERSONS WHO WERE ADDED AT THIS |

| SCREEN. |

| |

| 3. LIMITED EDIT ALLOWED. ALLOW INTERVIEWERS TO |

| EDIT ONLY THOSE PERSONS WHO WERE ADDED AT THIS |

| SCREEN. |

| |

| 4. EACH ROW INITIALLY HAS ‘IN RU NOW?’ SET TO |

| ‘YES’ FOR EACH PERSON CODED ‘1’ (IN RU) AT RE21 OR|

| ADDED TO RU DURING THIS INTERVIEW. |

| |

| 5. ‘IN RU NOW?’ COLUMN IS PROTECTED. |

| |

| 6. AUTOMATICALLY DISPLAY ‘YES’ FOR ‘IN RU NOW?’ |

| FOR PERSON(S) ADDED AT THIS SCREEN. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL RU MEMBERS; NO FILTER. |

----------------------------------------------------

BOX_22A

=======

----------------------------------------------------

| IF AT LEAST ONE PERSON ADDED TO THE RU-MEMBERS- |

| ROSTER AT RE54 OR RE55, CONTINUE WITH LOOP_05 |

----------------------------------------------------

| OTHERWISE, GO TO BOX_24 |

----------------------------------------------------

LOOP_05

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK |

| RE56-END_LP05 |

----------------------------------------------------

| LOOP DEFINITION: LOOP_05 COLLECTS INFORMATION |

| THAT CAPI REQUIRES TO DETERMINE THE KEYNESS AND |

| ELIGIBILITY OF PERSONS WHO WERE ADDED TO THE RU |

| AT RE54 OR RE55. THIS LOOP CYCLES ON RU MEMBERS |

| WHO MEET THE FOLLOWING CONDITION: |

| - NEW RU MEMBER < 24, NEVER MARRIED, LIVING AWAY |

| AT SCHOOL (SELECTED AT RE54 OR ADDED AT RE55) |

----------------------------------------------------

| NOTE: AT THE END OF THE LOOP, CAPI REMOVES FROM |

| THE RU-MEMBERS-ROSTER ANY NEW RU MEMBER WHO IS |

| ADDED AT RE54 OR RE55 AND WHO IS FLAGGED AS |

| ‘NEW STUDENT’ OR ‘NON-MILITARY MOVER IN U.S.’ |

| DURING THE COURSE OF THE LOOP. THE RE SECTION |

| WILL COLLECT LOCATING AND OTHER PERTINENT |

| INFORMATION FOR SUCH PERSONS BUT THEY WILL NOT BE |

| INCLUDED IN THIS INTERVIEW BEYOND THE RE SECTION. |

| |

| IMMEDIATELY AFTER LOOP_05 ENDS, CAPI WILL REMOVE |

| FROM THE RU-MEMBERS-ROSTER ANY NEW RU MEMBER WHO |

| IS FLAGGED AS ‘SAMPLEABLE AT NHIS’ DURING THE |

| COURSE OF THE LOOP. NO INFORMATION WILL BE |

| COLLECTED FOR SUCH PERSONS. |

| |

| NEW RU MEMBERS WHO ARE NOT ‘NEW STUDENT’, ‘NON- |

| MILITARY MOVER IN U.S.’, OR ‘SAMPLEABLE AT NHIS’ |

| REMAIN ON THE RU-MEMBERS-ROSTER AFTER LOOP_05. |

----------------------------------------------------

RE56

====

{PERSON’S FIRST MIDDLE AND LAST NAMES}

(Are/Is) (PERSON) attending ...

grades 1-12, ........................... 1 {RE56A}

a college or university, or ............ 2 {RE56A}

some other training school

after high school? .................. 3 {RE56A}

REF ................................... -7 {RE56A}

DK .................................... -8 {RE56A}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

RE56A

=====

{PERSON’S FIRST MIDDLE AND LAST NAMES}

Where (were/was) (PERSON) living when this household participated

in the National Health Interview Survey on {MONTH, DAY, YEAR OF

NHIS INTERVIEW}?

PERSON WAS ...

INSTITUTIONALIZED ................. 1 {BOX_23A}

STUDENT < 24, LIVING AWAY,

POST-SECONDARY SCHOOL.......... 2 {RE56B}

PERSON WAS NOT FT MILITARY AT TIME

OF NHIS AND WAS ...

LIVING IN U.S. .................... 3 {RE56B}

LIVING OUTSIDE U.S. ............... 4 {BOX_23A}

PERSON WAS FT MILITARY AT TIME OF NHIS

AND WAS ...

LIVING AT A MILITARY FACILITY ..... 5 {BOX_23A}

LIVING OUTSIDE U.S................. 6 {BOX_23A}

LIVING IN ANOTHER HOUSEHOLD IN U.S. 7 {RE56B}

PERSON WAS ...

LIVING WITH THIS FAMILY (PERSON LEFT

OFF NHIS ROSTER) .............. 8 {BOX_23A}

OTHER ............................ 91 {RE56B}

REF ................................... -7 {RE56B}

DK .................................... -8 {RE56B}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

----------------------------------------------------

| FOR {MONTH...}, DISPLAY THE NHIS INTERVIEW DATE. |

----------------------------------------------------

| NOTE: THE RESPONSE CATEGORY ‘LIVING WITH THIS |

| FAMILY (PERSON LEFT OFF NHIS ROSTER)’ INCLUDES |

| PERSONS WHO WERE LIVING AWAY AT SCHOOL IN GRADES |

| 1 - 12. |

----------------------------------------------------

| IF CODED ONE OF THE FOLLOWING: |

| - ‘1’ (INSTITUTIONALIZED), |

| OR |

| - ‘4’ (NOT FT MILITARY AT TIME OF NHIS AND LIVING|

| OUTSIDE U.S.), |

| OR |

| - ‘5’ (FT MILITARY AT TIME OF NHIS AND LIVING |

| AT A MILITARY FACILITY), |

| OR |

| - ‘6’ (FT MILITARY AT TIME OF NHIS AND LIVING |

| OUTSIDE U.S.), |

| OR |

| - ‘8’ (LIVING WITH THIS FAMILY BUT LEFT OFF NHIS |

| ROSTER), |

| FLAG PERSON AS ‘NOT SAMPLEABLE AT NHIS’ (PERSON |

| HAD NO POSSIBILITY OF BEING INCLUDED IN THE NHIS |

| SAMPLE). |

| |

| IF CODED ANY OTHER CODE (INCLUDING ‘-7’ (REFUSED) |

| AND ‘-8’ (DON’T KNOW), FLAG PERSON AS ‘SAMPLEABLE |

| AT NHIS.’ (PERSON HAD POSSIBILITY OF BEING |

| INCLUDED IN THE NHIS SAMPLE.) |

----------------------------------------------------

| IF PERSON MEETS BOTH OF THE FOLLOWING CONDITIONS: |

| - PERSON IS FLAGGED AS ‘NOT SAMPLEABLE AT NHIS’ |

| (SEE PREVIOUS BOX) |

| AND |

| - PERSON IS ATTENDING (COLLEGE OR UNIVERSITY) OR |

| (SOME OTHER TRAINING SCHOOL AFTER HIGH SCHOOL) |

| (THAT IS, RE56 IS CODED ‘2’ OR ‘3’ FOR PERSON),|

| FLAG PERSON AS A ‘NEW STUDENT’. |

----------------------------------------------------

| IF PERSON MEETS BOTH OF THE FOLLOWING CONDITIONS: |

| - PERSON IS FLAGGED AS ‘NOT SAMPLEABLE AT NHIS’ |

| (SEE BOX ABOVE) |

| AND |

| - RE56 IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T |

| KNOW) FOR PERSON, |

| FLAG PERSON AS ‘NON-MILITARY MOVER IN U.S.’ |

----------------------------------------------------

RE56B

=====

{PERSON’S FIRST MIDDLE AND LAST NAME}

At the time of the National Health Interview Survey on

{MONTH, DAY, YEAR OF NHIS INTERVIEW}, (were/was) (PERSON)

17 to 23 years old?

YES .................................... 1

NO ..................................... 2 {END_LP05}

REF ................................... -7 {END_LP05}

DK .................................... -8 {END_LP05}

----------------------------------------------------

| FOR {MONTH...}, DISPLAY THE NHIS INTERVIEW DATE. |

----------------------------------------------------

| IF CODED ‘1’ (YES) |

| AND |

| RE56A CODED ‘2’ (STUDENT UNDER 24 LIVING AWAY AT |

| POST-SECONDARY SCHOOL), |

| CONTINUE WITH RE56C |

----------------------------------------------------

| IF CODED ‘1’ (YES) |

| AND |

| RE56A NOT CODED ‘2’ (STUDENT UNDER 24 LIVING AWAY |

| AT POST-SECONDARY SCHOOL), |

| GO TO BOX_23A |

----------------------------------------------------

RE56C

=====

{PERSON’S FIRST MIDDLE AND LAST NAME}

At the time of the National Health Interview Survey on {MONTH,

DAY, YEAR OF NHIS INTERVIEW} were either of (PERSON)’s parents

living in this household?

YES .................................... 1 {BOX_23A}

NO ..................................... 2 {BOX_23A}

REF ................................... -7 {BOX_23A}

DK .................................... –8 {BOX_23A}

----------------------------------------------------

| FOR {MONTH...}, DISPLAY THE NHIS INTERVIEW DATE. |

----------------------------------------------------

| IF CODED ‘1’ (YES), FLAG PERSON AS ‘A NEW STUDENT’.|

----------------------------------------------------

BOX_23A

=======

----------------------------------------------------

| IF PERSON MEETS EITHER OF THE FOLLOWING |

| CONDITIONS: |

| - FLAGGED AS A ‘NEW STUDENT’ (SEE BOX ON RE56A |

| AND RE56C) |

| OR |

| - FLAGGED AS ‘NON-MILITARY MOVER IN U.S.’ (SEE |

| BOX ON RE56A) |

| |

| REMOVE PERSON FROM RU-MEMBERS-ROSTER. |

| THE RE SECTION WILL COLLECT LOCATING AND OTHER |

| PERTINENT INFORMATION FOR PERSON BUT PERSON WILL |

| NOT BE INCLUDED IN THIS INTERVIEW AFTER THE RE |

| SECTION. INFORMATION FOR PERSON MAY BE COLLECTED |

| AS PART OF ANOTHER RU. |

----------------------------------------------------

END_LP05

========

----------------------------------------------------

| CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER |

| WHO MEETS THE CONDITIONS STATED IN THE LOOP |

| DEFINITION. |

----------------------------------------------------

| IF NO MORE PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_05 AND CONTINUE WITH BOX_23 |

----------------------------------------------------

BOX_23

======

----------------------------------------------------

| IF NO ONE ON THE RU-MEMBERS-ROSTER IS FLAGGED |

| AS ‘SAMPLEABLE AT NHIS’, GO TO BOX_24 |

----------------------------------------------------

| OTHERWISE, CONTINUE WITH RE56D |

----------------------------------------------------

RE56D

=====

{PERSON’S FIRST MIDDLE LAST NAME}

At the time we are only collecting information about some of

the students you just now identified. Therefore, the remaining

questions will not be asked about (READ NAMES BELOW).

[1. First Name,[Middle Name],Last Name-65]

[2. First Name,[Middle Name],Last Name-65]

[3. First Name,[Middle Name],Last Name-65]

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

----------------------------------------------------

| REMOVE ALL PERSONS WHO ARE FLAGGED AS ‘SAMPLEABLE |

| AT NHIS’ (THAT IS, ALL RU MEMBERS DISPLAYED AT |

| RE56D) FROM THE RU-MEMBERS-ROSTER. SUCH PERSONS |

| ARE NOT ELIGIBLE FOR THIS INTERVIEW AND ARE |

| NOT KEY. INFORMATION WILL NOT BE COLLECTED FOR |

| SUCH PERSONS AS PART OF THIS OR ANY OTHER RU. |

----------------------------------------------------

| GO TO BOX_24 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. DISPLAY ONLY. |

| |

| 2. SELECT, ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO |

| ARE FLAGGED AS ‘SAMPLEABLE AT NHIS’. SEE BOX ON |

| RE56A. |

----------------------------------------------------

BOX_24A

=======

-------------------------------------------------

| IF ROUND 1, GO TO BOX_25A |

-------------------------------------------------

| OTHERWISE (ROUNDS 2 – 5), CONTINUE WITH RE57A |

-------------------------------------------------

RE57A

=====

VERIFY DISPLAYED INFORMATION.

ASK APPROPRIATE QUESTION FOR EACH BLANK FIELD.

SELECT GENDER.

IF NOT OBVIOUS, ASK: Is (READ NAME BELOW) male or female?

What is (READ NAME BELOW)'s date of birth?

ENTER MM/DD/YYYY.

VERIFY AGE - IF AGE IS INCORRECT, RE-ENTER DATE OF BIRTH.

IF DATE OF BIRTH UNKNOWN, PROBE FOR AGE AND ENTER IF KNOWN.

{NOTE: FOR ROUND 5, AGE IS CALCULATED AS OF DEC 31, {YEAR}.}

|-----------------|-----------------|-----------------|-------------------|

|-----------------|-----------------|-----------------|----------------- |

|-----------------|-----------------|-----------------|-------------------|

|-----------------|-----------------|-----------------|-------------------|

|-----------------|-----------------|-----------------|-------------------|

----------------------------------------------------

| DISPLAY ‘NOTE: FOR ROUND 5, AGE IS CALCULATED AS |

| OF DEC 31, {YEAR}.’, WHERE ‘YEAR’ IS THE SECOND |

| CALENDAR YEAR OF THE PANEL, IF ROUND 5. OTHERWISE,|

| USE A NULL DISPLAY. |

----------------------------------------------------

| REFUSED AND DON’T KNOW ALLOWED. |

----------------------------------------------------

| FOR ROUND 5, AGE IS CALCULATED AS OF DECEMBER 31, |

| {YEAR}, WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR |

| OF THE PANEL. ALL AGE SKIPS (THROUGHOUT THE |

| QUESTIONNAIRE) WILL BE BASED ON THIS AGE. |

----------------------------------------------------

| IF THE INTERVIEWER ENTERS AN AGE THAT CONTRADICTS |

| THE DOB, CAPI WILL STILL CALCULATE THE AGE BASED |

| ON DOB WHEN THE INTERVIEWER LEAVES THE SCREEN. NO |

| ERROR MESSAGE IS DISPLAYED. |

----------------------------------------------------

| IF AGE MISSING FOR ANY RU MEMBER, CONTINUE WITH |

| LOOP_06A |

----------------------------------------------------

| OTHERWISE, GO TO BOX_26 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_2 |

| |

| COL # 1 HEADER: RU MEMBER |

| INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

| |

| COL # 2 HEADER: GENDER |

| INSTRUCTIONS: DISPLAY RU MEMBERS’ SEX |

| (PERS.SMPSEXR) |

| |

| COL # 3 HEADER: DATE OF BIRTH |

| INSTRUCTIONS: DISPLAY RU MEMBERS’ DATES OF BIRTH |

| (PERS.SMPDOBMM, PERS.SMPDOBDD, PERS.SMPDOBYY) |

| |

| COL # 4 HEADER: AGE |

| INSTRUCTIONS: DISPLAY RU MEMBERS’ AGES (PRND.AGE) |

----------------------------------------------------

| ROSTER DEFINITION: |

| DISPLAY THE RU-MEMBERS-ROSTER FOR VERIFICATION AND|

| CORRECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. PRESENT BLANK FIELDS FOR ALL MISSING DATA |

| ITEMS. ENABLE MOVEMENT ON SCREEN SO THAT |

| INTERVIEWER CAN ENTER/UPDATE GENDER, DATE OF BIRTH|

| AND AGE FOR ALL PERSONS BY ROW. |

| |

| 2. THE NAME COLUMN IS PROTECTED; NO CHANGES ARE |

| ALLOWED. |

| |

| 3. GENDER, DATE OF BIRTH, AND AGE (WHEN AGE IS NOT|

| CALCULATED BY CAPI) CAN BE EDITED. |

| |

| 4. REPLACING ‘REAL’ DATA WITH -7 OR -8 IS |

| DISALLOWED. IF THE INTERVIEWER TRIES TO DO SO, |

| DISPLAY THE MESSAGE “DO NOT REPLACE EXISTING |

| INFORMATION WITH REFUSED OR DON’T KNOW.” |

| |

| 5. IF DATE OF BIRTH IS CHANGED, CAPI WILL |

| CALCULATE THE NEW AGE AUTOMATICALLY AND DISPLAY |

| THE AGE IN THE AGE COLUMN. |

| |

| 6. SELECT, ADD, AND DELETE DISALLOWED IN ALL |

| COLUMNS. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL RU MEMBERS; NO FILTER. |

----------------------------------------------------

LOOP_06A

========

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK |

| RE57B-END_LP06A |

----------------------------------------------------

| LOOP DEFINITION: LOOP_06A COLLECTS AGE ESTIMATE |

| FOR RU MEMBERS WHOSE AGE IS MISSING. THIS LOOP |

| CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING |

| CONDITION: |

| - PERSON’S AGE MISSING FROM RE57A |

----------------------------------------------------

RE57B

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

PROBE FOR RESPONDENT'S BEST ESTIMATE OF AGE.

{(Are/Is)/As of December 31, {YEAR}, (were/was)} (PERSON)...

Less than 1 year old, .................. 1 {END_LP06A}

1 - 4, ................................. 2 {END_LP06A}

5 - 15, ................................ 3 {END_LP06A}

16 - 23, ............................... 4 {END_LP06A}

24 - 34, ............................... 5 {END_LP06A}

35 - 44, ............................... 6 {END_LP06A}

45 - 54, ............................... 7 {END_LP06A}

55 - 64, or ............................ 8 {END_LP06A}

65 years or older? ..................... 9 {END_LP06A}

REF ................................... -7 {RE57C}

DK .................................... -8 {RE57C}

[Code One]

----------------------------------------------------

| DISPLAY ‘(Are/Is)’ IF NOT ROUND 5. DISPLAY ‘As of|

| December 31, {YEAR}’, WHERE ‘YEAR’ IS THE SECOND |

| CALENDAR YEAR OF THE PANEL, AND ‘(were/was)’ IF |

| ROUND 5. |

----------------------------------------------------

RE57C

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

ENTER YOUR BEST GUESS FOR (PERSON)'S AGE {AS OF DECEMBER 31, {YEAR}}.

LESS THAN 1 YEAR OLD ................... 1 {END_LP06A}

1 - 4 ................................. 2 {END_LP06A}

5 - 15 ................................ 3 {END_LP06A}

16 - 23 ................................ 4 {END_LP06A}

24 - 34 ................................ 5 {END_LP06A}

35 - 44 ................................ 6 {END_LP06A}

45 - 54 ................................ 7 {END_LP06A}

55 - 64 ................................ 8 {END_LP06A}

65 YEARS OR OLDER ...................... 9 {END_LP06A}

[Code One]

----------------------------------------------------

| DISPLAY ‘As of December 31, {YEAR}’, WHERE ‘YEAR’ |

| IS THE SECOND CALENDAR YEAR OF THE PANEL, IF |

| ROUND 5. OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

| REFUSED AND DON’T KNOW DISALLOWED. |

----------------------------------------------------

END_LP06A

=========

----------------------------------------------------

| CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER |

| THAT MEETS THE CONDITIONS STATED IN THE LOOP |

| DEFINITION. |

----------------------------------------------------

| IF NO MORE PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_06A AND GO TO BOX_26 |

----------------------------------------------------

BOX_24

======

---------------------------------------------------

| IF AT LEAST ONE PERSON IN THE RU-MEMBERS-ROSTER |

| MEETS BOTH OF THE FOLLOWING CONDITIONS: |

| - ADDED TO THE RU THIS ROUND |

| AND |

| - NOT A DU MEMBER AT THE TIME OF NHIS (THAT IS, |

| A NEW RU MEMBER NOT SELECTED FROM THE |

| DU-MEMBERS-ROSTER), |

| CONTINUE WITH RE57 |

---------------------------------------------------

| OTHERWISE, GO TO BOX_25A |

---------------------------------------------------

BOX_25

======

OMITTED.

RE57

====

ASK APPROPRIATE QUESTION FOR EACH BLANK FIELD.

IF NOT OBVIOUS, ASK: Is (READ NAME BELOW) male or female?

What is (READ NAME BELOW)'s date of birth?

ENTER MM/DD/YYYY.

VERIFY AGE - IF AGE IS INCORRECT, RE-ENTER DATE OF BIRTH.

IF DATE OF BIRTH UNKNOWN, PROBE FOR AGE AND ENTER IF KNOWN.

|-----------------|-----------------|-----------------|-------------------|

|-----------------|-----------------|-----------------|----------------- |

|-----------------|-----------------|-----------------|-------------------|

|-----------------|-----------------|-----------------|-------------------|

|-----------------|-----------------|-----------------|-------------------|

----------------------------------------------------

| REFUSED AND DON’T KNOW ALLOWED IN ALL FIELDS. |

----------------------------------------------------

| IF AGE NOT MISSING FOR ANY NEW RU MEMBER WHO WAS |

| NOT A DU MEMBER IN PREVIOUS ROUND (THAT IS, AGE |

| NOT MISSING AT RE57)), |

| GO TO BOX_25A |

----------------------------------------------------

| OTHERWISE (AGE IS MISSING FOR ANY NEW RU MEMBER |

| WHO WAS NOT A DU MEMBER IN PREVIOUS ROUND (THAT |

| IS, AGE IS MISSING AT RE57)), |

| CONTINUE WITH LOOP_06 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_2 |

| |

| COL # 1 HEADER: RU MEMBER |

| INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

| |

| COL # 2 HEADER: GENDER |

| INSTRUCTIONS: DISPLAY RU MEMBERS’ SEX |

| (PERS.SMPSEXR) |

| |

| COL # 3 HEADER: DATE OF BIRTH |

| INSTRUCTIONS: DISPLAY RU MEMBERS’ DATES OF BIRTH |

| (PERS.SMPDOBMM, PERS.SMPDOBDD, PERS.SMPDOBYY) |

| |

| COL # 4 HEADER: AGE |

| INSTRUCTIONS: DISPLAY RU MEMBERS’ AGES (PRND.AGE) |

----------------------------------------------------

| ROSTER DEFINITION: |

| DISPLAY THE RU-MEMBERS-ROSTER FOR ENTRY OF MISSING|

| DATA. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. PRESENT BLANK FIELDS FOR ALL MISSING DATA |

| ITEMS. ENABLE MOVEMENT ON SCREEN SO THAT |

| INTERVIEWER CAN ENTER/UPDATE GENDER, DATE OF BIRTH|

| AND AGE FOR ALL PERSONS BY ROW. |

| |

| 2. THE NAME COLUMN IS PROTECTED; NO CHANGES ARE |

| ALLOWED. |

| |

| 3. GENDER, DATE OF BIRTH, AND AGE (WHEN AGE IS NOT|

| CALCULATED BY CAPI) CAN BE EDITED. |

| |

| 4. REPLACING ‘REAL’ DATA WITH -7 OR -8 IS |

| DISALLOWED. IF THE INTERVIEWER TRIES TO DO SO, |

| DISPLAY THE MESSAGE “DO NOT REPLACE EXISTING |

| INFORMATION WITH REFUSED OR DON’T KNOW.” |

| |

| 5. IF DATE OF BIRTH IS CHANGED, CAPI WILL |

| CALCULATE THE NEW AGE AUTOMATICALLY AND DISPLAY |

| THE AGE IN THE AGE COLUMN. |

| |

| 6. SELECT, ADD, AND DELETE DISALLOWED IN ALL |

| COLUMNS. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY NEW RU MEMBERS ADDED IN THE CURRENT ROUND |

| WHO WERE NOT SELECTED FROM THE DU-MEMBERS-ROSTER. |

----------------------------------------------------

LOOP_06

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK |

| RE58-END_LP06 |

----------------------------------------------------

| LOOP DEFINITION: LOOP_06 COLLECTS AN AGE ESTIMATE|

| FOR NEW RU MEMBERS WHOSE AGE IS MISSING. THIS |

| LOOP CYCLES ON ALL RU MEMBERS WHO MEET THE |

| FOLLOWING CONDITION: |

| - PERSON’S AGE IS MISSING AT RE57 |

----------------------------------------------------

RE58

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

PROBE FOR RESPONDENT'S BEST ESTIMATE OF AGE.

(Are/Is) (PERSON)...

Less than 1 year old, .................. 1 {END_LP06}

1 - 4, ................................. 2 {END_LP06}

5 - 15, ................................ 3 {END_LP06}

16 - 23, ............................... 4 {END_LP06}

24 - 34, ............................... 5 {END_LP06}

35 - 44, ............................... 6 {END_LP06}

45 - 54, ............................... 7 {END_LP06}

55 - 64, or ............................ 8 {END_LP06}

65 years or older? ..................... 9 {END_LP06}

REF ................................... -7 {RE59}

DK .................................... -8 {RE59}

[Code One]

RE59

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

ENTER YOUR BEST GUESS FOR (PERSON)'S AGE.

LESS THAN 1 YEAR OLD ................... 1 {END_LP06}

1 - 4 ................................. 2 {END_LP06}

5 - 15 ................................ 3 {END_LP06}

16 - 23 ................................ 4 {END_LP06}

24 - 34 ................................ 5 {END_LP06}

35 - 44 ................................ 6 {END_LP06}

45 - 54 ................................ 7 {END_LP06}

55 – 64 ................................ 8 {END_LP06}

65 YEARS OR OLDER ...................... 9 {END_LP06}

[Code One]

END_LP06

========

----------------------------------------------------

| CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER |

| WHO MEETS THE CONDITIONS STATED IN THE LOOP |

| DEFINITION. |

----------------------------------------------------

| IF NO MORE PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_06 AND CONTINUE WITH BOX_25A |

----------------------------------------------------

BOX_25A

=======

----------------------------------------------------

| IF ROUND 1 AND AT LEAST ONE PERSON ON THE |

| RU-MEMBERS-ROSTER WAS A MEMBER OF THE RU OR DU AT |

| THE DATE OF THE NHIS INTERVIEW, |

| OR |

| IF AT LEAST ONE PERSON REMOVED FROM THE RU- |

| MEMBERS-ROSTER THIS ROUND MEETS BOTH OF THE |

| FOLLOWING CONDITIONS: |

| - PERSON WAS A MEMBER OF THE RU OR DU AT THE DATE|

| OF THE NHIS INTERVIEW |

| AND |

| - PERSON IS FLAGGED AS A ‘NEW STUDENT’, |

| CONTINUE WITH LOOP_07 |

----------------------------------------------------

| OTHERWISE, GO TO BOX_26 |

----------------------------------------------------

LOOP_07

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE DU MEMBERS-ROSTER, ASK |

| RE60-END_LP07 |

----------------------------------------------------

| LOOP DEFINITION: LOOP_07 UPDATES NAME, GENDER, |

| BIRTH DATE, AND AGE OF BOTH CURRENT RU MEMBERS WHO|

| WERE MEMBERS OF THE RU OR DU AT THE TIME OF NHIS |

| AND PERSONS WHO ARE FLAGGED AS ‘NEW STUDENT’. |

| THIS LOOP CYCLES ON ALL DU MEMBERS WHO MEET ANY |

| ONE OF THE FOLLOWING CONDITIONS: |

| - PERSON IS A CURRENT MEMBER OF THIS RU AND WAS |

| A MEMBER OF THIS RU AT THE TIME OF NHIS |

| OR |

| - PERSON IS A CURRENT MEMBER OF THIS RU AND WAS A|

| MEMBER OF THE DU AT THE TIME OF NHIS |

| OR |

| - PERSON WAS REMOVED FROM THE RU-MEMBERS-ROSTER |

| DURING THIS INTERVIEW AND IS FLAGGED AS A |

| ‘NEW STUDENT’ |

----------------------------------------------------

RE60

====

{PERSON’S FIRST MIDDLE AND LAST NAME}

Let’s review some information about (PERSON). Please look at

this form (HAND HOUSEHOLD SUMMARY) and tell me if (PERSON)’s

name is spelled correctly.

VERIFY FULL NAME BELOW WITH RESPONDENT.

USE TAB TO MOVE THROUGH FIELDS. RETYPE ANY FIELDS

WHICH NEED CORRECTION.

IF NO MIDDLE NAME OR INITIAL, ENTER ‘NMN’.

Current Info: [NHIS FIRST NAME]

[NHIS MIDDLE NAME]

[NHIS LAST NAME]

FIRST NAME[_________________]

MIDDLE NAME[_________________]

LAST NAME[_________________]

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

----------------------------------------------------

| FOR NHIS FIRST NAME, MIDDLE NAME, AND LAST NAME, |

| DISPLAY THE PERSON’S NAME AS RECORDED IN THE NHIS.|

----------------------------------------------------

| REFUSED AND DON’T KNOW ALLOWED AT ALL FIELDS. |

| HOWEVER, DO NOT ALLOW INTERVIEWER TO CHANGE ‘REAL |

| DATA’ TO ‘-7’ (REFUSED) OR ‘-8’ (DON’T KNOW). |

----------------------------------------------------

| GO TO RE61 |

----------------------------------------------------

RE61

====

{PERSON’S FIRST MIDDLE AND LAST NAME}

ASK IF NOT OBVIOUS: I have (PERSON) recorded as (READ GENDER

BELOW). Is that correct?

MAKE CORRECTIONS TO GENDER BELOW.

IF CORRECTION IS NECESSARY, SELECT APPROPRIATE CODE.

IF NO CORRECTION IS NECESSARY, PRESS ENTER.

Current Info: [NHIS GENDER]

MALE ................................. 1 {RE62}

FEMALE ............................... 2 {RE62}

REF .................................. -7 {RE62}

DK ................................... -8 {RE62}

----------------------------------------------------

| FOR ‘NHIS GENDER’, DISPLAY THE PERSON’S GENDER AS |

| RECORDED IN THE NHIS. |

----------------------------------------------------

| REFUSED AND DON’T KNOW ALLOWED. HOWEVER, DO NOT |

| ALLOW INTERVIEWER TO CHANGE ‘REAL DATA’ TO ‘-7’ |

| (REFUSED) OR ‘-8’ (DON’T KNOW). |

----------------------------------------------------

RE62

====

{PERSON’S FIRST MIDDLE AND LAST NAME}

I have recorded that (PERSON) was born on (READ DATE BELOW).

Is that correct?

VERIFY BIRTHDATE BELOW WITH RESPONDENT.

USE TAB TO MOVE THROUGH FIELDS. IF ANY CORRECTIONS ARE

NEEDED, RETYPE ENTIRE DATE.

Current Info: [NHIS DATE OF BIRTH]

[Enter Month,Day,Year-4] ............ {RE63}

REF ................................. -7 {RE64}

DK .................................. -8 {RE64}

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

----------------------------------------------------

| FOR ‘NHIS DATE OF BIRTH’, DISPLAY THE PERSON’S |

| DATE OF BIRTH AS RECORDED IN THE NHIS. |

----------------------------------------------------

| REFUSED AND DON’T KNOW ALLOWED. HOWEVER, DO NOT |

| ALLOW INTERVIEWER TO CHANGE ‘REAL DATA’ TO ‘-7’ |

| (REFUSED) OR ‘-8’ (DON’T KNOW). |

----------------------------------------------------

| IF CURRENT INFO IS NOT AVAILABLE, ENTRY FOR DATE |

| OF BIRTH IS REQUIRED. (REF AND DK ARE ALLOWED.) |

----------------------------------------------------

| IF ANY FIELD IN DATE OF BIRTH CODED ‘-7’ (REFUSED)|

| OR ‘-8’ (DON’T KNOW), GO TO RE64 |

----------------------------------------------------

| OTHERWISE, CONTINUE WITH RE63 |

----------------------------------------------------

RE63

====

{PERSON’S FIRST MIDDLE AND LAST NAME}

So (PERSON) is {AGE CALCULATED FROM DATE OF BIRTH AT RE62} years

old. Is that correct?

YES ..................................... 1 {END_LP07}

NO ...................................... 2

REF .................................... -7 {RE65}

DK ..................................... -8 {RE65}

----------------------------------------------------

| IF CODED ‘2’ (NO), DISPLAY MESSAGE: “IF AGE |

| INCORRECT, BACKUP AND CORRECT DATE OF BIRTH AT |

| PREVIOUS SCREEN.” |

----------------------------------------------------

RE64

====

{PERSON’S FIRST MIDDLE AND LAST NAME}

How old (are/is) (PERSON)?

[Enter Age] ........................... {END_LP07}

REF ................................... -7 {RE65}

DK .................................... -8 {RE65}

RE65

====

{PERSON’S FIRST MIDDLE AND LAST NAME}

PROBE FOR RESPONDENT’S BEST ESTIMATE OF AGE.

(Are/Is) (PERSON)...

Less than 1 year old, .................. 1 {END_LP07}

1 - 4, ................................ 2 {END_LP07}

5 - 15, ............................... 3 {END_LP07}

16 - 23, ............................... 4 {END_LP07}

24 - 34, ............................... 5 {END_LP07}

35 - 44, ............................... 6 {END_LP07}

45 - 54, ............................... 7 {END_LP07}

55 - 64, or ............................ 8 {END_LP07}

65 years or older? ..................... 9 {END_LP07}

REF ................................... -7 {RE66}

DK .................................... -8 {RE66}

[Code One]

RE66

====

{PERSON’S FIRST MIDDLE AND LAST NAME}

ENTER YOUR BEST GUESS FOR (PERSON)’S AGE.

LESS THAN 1 YEAR OLD ................... 1 {END_LP07}

1 - 4 ................................. 2 {END_LP07}

5 - 15 ................................ 3 {END_LP07}

16 - 23 ................................ 4 {END_LP07}

24 - 34 ................................ 5 {END_LP07}

35 - 44 ................................ 6 {END_LP07}

45 - 54 ................................ 7 {END_LP07}

55 - 64 ................................ 8 {END_LP07}

65 YEARS OR OLDER ...................... 9 {END_LP07}

[Code One]

END_LP07

========

----------------------------------------------------

| CYCLE ON NEXT PERSON IN RU-MEMBERS-ROSTER WHO |

| MEETS THE CONDITIONS STATED IN THE LOOP |

| DEFINITION. |

----------------------------------------------------

| IF NO MORE PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_07 AND CONTINUE WITH BOX_26 |

----------------------------------------------------

BOX_26

======

----------------------------------------------------

| IF ROUND 1 AND AT LEAST ONE RU MEMBER MEETS |

| ALL THE FOLLOWING CONDITIONS: |

| - ADDED TO THE RU THIS ROUND |

| AND |

| - NOT A NEWBORN (THAT IS, NOT BORN BETWEEN NHIS |

| INTERVIEW DATE AND DATE OF THE CURRENT |

| INTERVIEW), |

| GO TO LOOP_08 |

----------------------------------------------------

| IF NOT ROUND 1 AND AT LEAST ONE RU MEMBER MEETS |

| ALL OF THE FOLLOWING CONDITIONS: |

| - ADDED TO THE RU THIS ROUND |

| AND |

| - NOT IN ANOTHER RU AT THE END OF THE PREVIOUS |

| ROUND |

| AND |

| - NOT A NEWBORN (THAT IS, NOT BORN BETWEEN |

| 1/1/{YEAR}, WHERE ‘YEAR’ IS THE FIRST |

| CALENDAR YEAR OF THE PANEL, AND THE DATE OF |

| THE CURRENT INTERVIEW), CONTINUE WITH |

| LOOP_07A |

----------------------------------------------------

| OTHERWISE, GO TO BOX_27 |

----------------------------------------------------

LOOP_07A

========

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK |

| RE66A-END_LP07A |

----------------------------------------------------

| LOOP DEFINITION: LOOP_07A COLLECTS INFORMATION |

| ON THE LOCATION OF NEW RU MEMBERS ON 1/1/{YEAR}, |

| WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE |

| PANEL, TO DETERMINE THEIR KEYNESS AND ELIGIBILITY.|

| THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE |

| FOLLOWING CONDITIONS: |

| - ADDED TO RU IN CURRENT ROUND |

| AND |

| - NOT IN ANOTHER RU AT THE END OF THE PREVIOUS |

| ROUND |

| AND |

| - NOT NEWBORN (THAT IS, NOT BORN BETWEEN |

| 1/1/{YEAR}, WHERE ‘YEAR’ IS THE FIRST |

| CALENDAR YEAR OF THE PANEL, AND THE DATE OF |

| THE CURRENT INTERVIEW) |

----------------------------------------------------

RE66A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

On what date did (PERSON) start living with the family?

[Enter Month,Day,Year-4] ..............

REF ................................... -7 {RE66C}

DK .................................... -8 {RE66C}

----------------------------------------------------

| IF DATE IS LESS THAN OR EQUAL TO THE PREVIOUS |

| ROUND INTERVIEW DATE, CONTINUE WITH RE66B |

----------------------------------------------------

| OTHERWISE, GO TO RE66C |

----------------------------------------------------

| HARD CHECK: |

| EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR |

| BEFORE 12/31/{YEAR}, WHERE ‘YEAR’ IS THE SECOND |

| CALENDAR YEAR OF THE PANEL. IF A DATE AFTER |

| 12/31/{YEAR} IS ENTERED, DISPLAY THE FOLLOWING |

| MESSAGE: “DATE MUST BE ON OR BEFORE 12/31/{YEAR}.|

| IF PERSON JOINED RU AFTER 12/31/{YEAR}, BACKUP TO |

| RE49/RE52 AND REVIEW ENTRIES.” |

----------------------------------------------------

RE66B

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

Let me make sure that I have entered this date correctly. I

have recorded that (PERSON) began living with this family on

{RE66A DATE.}. That is before the interview on {DATE OF PREVIOUS

ROUND INTERVIEW}. Is that correct?

YES .................................... 1 {RE66C}

NO ..................................... 2

REF ................................... -7 {RE66C}

DK .................................... -8 {RE66C}

[Code One]

----------------------------------------------------

| FOR ‘DATE OF PREVIOUS ROUND INTERVIEW’, DISPLAY |

| DATE OF PREVIOUS ROUND MEPS INTERVIEW. |

----------------------------------------------------

| FOR ‘RE66A DATE’, DISPLAY DATE ENTERED AT RE66A. |

----------------------------------------------------

| IF CODED '2' (NO), DISPLAY MESSAGE: “BACKUP AND |

| CORRECT DATE PERSON JOINED RU AT PREVIOUS SCREEN.”|

----------------------------------------------------

BOX_26A

=======

OMITTED.

RE66C

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

On January 1, {YEAR}, was (PERSON) living in an institution?

YES .................................... 1 {RE66G}

NO ..................................... 2 {RE66D}

REF ................................... -7 {RE66D}

DK .................................... -8 {RE66D}

HELP AVAILABLE FOR DEFINITION FOR LIVING IN AN INSTITUTION.

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY): DISPLAY FIRST CALENDAR YEAR OF |

| PANEL FOR ‘YEAR’. |

----------------------------------------------------

RE66D

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

On January 1, {YEAR}, was (PERSON) living outside the United

States?

YES .................................... 1 {END_LP07A}

NO ..................................... 2

REF ................................... -7

DK .................................... -8

HELP AVAILABLE FOR DEFINITION OF LIVING OUTSIDE U.S.

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY): DISPLAY FIRST CALENDAR YEAR OF |

| PANEL FOR ‘YEAR’. |

----------------------------------------------------

| IF CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |

| KNOW) AND PERSON < 18 YEARS OLD, GO TO RE66F |

----------------------------------------------------

| OTHERWISE, (I.E., CODED ‘2’ (NO), ‘-7’ (REFUSED), |

| OR ‘-8’ (DON’T KNOW) AND PERSON > OR = 18 YEARS |

| OLD) CONTINUE WITH RE66E |

----------------------------------------------------

RE66E

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

On January 1, {YEAR}, was (PERSON) serving on full-time active

duty in the Armed Forces?

YES .................................... 1 {END_LP07A}

NO ..................................... 2 {RE66F}

REF ................................... -7 {RE66F}

DK .................................... -8 {RE66F}

HELP AVAILABLE FOR DEFINITION OF FULL-TIME MILITARY.

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY): DISPLAY FIRST CALENDAR YEAR OF |

| PANEL FOR ‘YEAR’. |

----------------------------------------------------

RE66F

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

Where (were/was) (PERSON) living on January 1, {YEAR}?

NOT YET BORN ............................ 1 {END_LP07A}

INSTITUTIONALIZED ....................... 2 {RE66G}

STUDENT UNDER 24 LIVING AWAY AT SCHOOL

IN GRADES 1-12 ....................... 3 {END_LP07A}

STUDENT UNDER 24 LIVING AWAY AT

POST-SECONDARY SCHOOL ................ 4 {RE66J}

ANOTHER HOUSEHOLD - NOT FULL-TIME

MILITARY ON 1/1/{YEAR} ............... 5 {END_LP07A}

ANOTHER HOUSEHOLD/MILITARY FACILITY -

FULL-TIME MILITARY ON 1/1/{YEAR} ..... 6 {RE66K}

LIVING WITH THIS FAMILY (PERSON LEFT

OFF ROSTER LAST INTERVIEW) ........... 7 {END_LP07A}

OTHER .................................. 91 {RE66FOV}

REF .................................... -7 {END_LP07A}

DK ..................................... -8 {END_LP07A}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY): DISPLAY FIRST CALENDAR YEAR OF |

| PANEL FOR ‘YEAR’. |

----------------------------------------------------

RE66FOV

=======

OTHER:

[Enter Other Specify] ................. {END_LP07A}

REF ................................... -7 {END_LP07A}

DK .................................... -8 {END_LP07A}

RE66G

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

What type of institution (were/was) (PERSON) living in on

January 1, {YEAR}?

NURSING HOME ........................ 1 {RE66H}

OTHER LONG-TERM HEALTH CARE

INSTITUTION (EXCLUDE COMMUNITY

BASED HOSPITAL) ................... 2 {RE66H}

OTHER NON-HEALTH CARE INSTITUTION ... 3 {END_LP07A}

REF ................................ -7 {RE66H}

DK ................................. -8 {RE66H}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY): DISPLAY THE FIRST CALENDAR YEAR OF|

| PANEL FOR ‘YEAR’. |

----------------------------------------------------

RE66H

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

Please give me the name and address of the nursing home or long

term care facility where (PERSON) (were/was) on January 1, {YEAR}?

NAME: [_____________]

STREET ADDRESS1: [_____________]

STREET ADDRESS2: [_____________]

CITY: [_____________]

STATE: [_____________]

ZIP CODE: [_____________]

USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY): DISPLAY THE FIRST CALENDAR YEAR OF|

| PANEL FOR ‘YEAR’. |

----------------------------------------------------

| CODES '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE |

| ALLOWED ON EACH FORM ITEM. |

----------------------------------------------------

| GO TO END_LP07A |

----------------------------------------------------

RE66I

=====

OMITTED.

RE66J

=====

{PERSON’S FIRST MIDDLE AND LAST NAME}

Were either of (PERSON)’S parents living in this household on

January 1, {YEAR}?

YES .................................... 1 {END_LP07A}

NO ..................................... 2 {END_LP07A}

REF ................................... -7 {END_LP07A}

DK .................................... -8 {END_LP07A}

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY): DISPLAY THE FIRST CALENDAR YEAR OF|

| PANEL FOR ‘YEAR’. |

----------------------------------------------------

RE66K

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

(Were/Was) (PERSON) living in another household or in a military

facility on January 1, {YEAR}?

ANOTHER HOUSEHOLD ................... 1 {END_LP07A}

MILITARY FACILITY ................... 2 {END_LP07A}

REF ................................ -7 {END_LP07A}

DK ................................. -8 {END_LP07A}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY): DISPLAY THE FIRST CALENDAR YEAR OF|

| PANEL FOR ‘YEAR’. |

----------------------------------------------------

RE66KOV

=======

OMITTED.

END_LP07A

=========

----------------------------------------------------

| CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER |

| THAT MEETS THE CONDITIONS STATED IN THE LOOP |

| DEFINITION. |

----------------------------------------------------

| IF NO MORE PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_07A AND GO TO BOX_27 |

----------------------------------------------------

LOOP_08

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK |

| RE67-END_LP08 |

----------------------------------------------------

| LOOP DEFINITION: LOOP_08 COLLECTS INFORMATION |

| ON THE LOCATION AT THE TIME OF NHIS OF NEW RU |

| MEMBERS WHO ARE NOT NEWBORN TO DETERMINE THEIR |

| KEYNESS AND ELIGIBILITY. THIS LOOP CYCLES ON RU |

| MEMBERS WHO MEET BOTH OF THE FOLLOWING CONDITIONS:|

| - ADDED TO RU IN CURRENT ROUND |

| AND |

| - NOT NEWBORN (THAT IS, NOT BORN BETWEEN THE |

| NHIS INTERVIEW DATE AND THE DATE OF THE |

| CURRENT INTERVIEW) |

----------------------------------------------------

RE67

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

On what date did (PERSON) start living with the family

{before leaving to live at school}?

[Enter Month,Day,Year-4] ..............

REF ................................... -7 {RE73}

DK .................................... -8 {RE73}

----------------------------------------------------

| DISPLAY ‘before leaving to live at school’ IF |

| PERSON IS A STUDENT LIVING AWAY AT SCHOOL |

| (SELECTED AT RE54 OR ADDED AT RE55). OTHERWISE, |

| USE NULL DISPLAY. |

----------------------------------------------------

| IF DATE < PREVIOUS ROUND INTERVIEW DATE, |

| CONTINUE WITH RE68 |

----------------------------------------------------

| IF DATE = OR > PREVIOUS ROUND INTERVIEW DATE, |

| GO TO RE73 |

----------------------------------------------------

RE68

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

Let me make sure that I have entered this date correctly. I

have recorded that (PERSON) began living with this family on

{RE67 DATE.}. That is before the interview on {MONTH, DAY, YEAR

OF NHIS INTERVIEW}. Is that correct?

YES .................................... 1

NO ..................................... 2

REF ................................... -7 {RE73}

DK .................................... -8 {RE73}

[Code One]

----------------------------------------------------

| FOR ‘RE67 DATE’, DISPLAY DATE ENTERED AT RE67. |

| |

| FOR ‘MONTH...’, DISPLAY DATE OF NHIS INTERVIEW. |

----------------------------------------------------

| IF CODED '2' (NO), DISPLAY MESSAGE: “BACKUP |

| AND CORRECT DATE PERSON JOINED RU AT PREVIOUS |

| SCREEN.” |

----------------------------------------------------

| IF RE68 CODED ‘1’ (YES), CODE RE73 ‘7’ (LIVING |

| WITH THIS FAMILY (PERSON LEFT OFF NHIS ROSTER)) |

| AUTOMATICALLY BY CAPI AND GO TO END_LP08 |

----------------------------------------------------

BOX_26A

=======

USED ELSEWHERE.

RE69

====

OMITTED.

RE70

====

OMITTED.

RE71

====

OMITTED.

RE72

====

OMITTED.

RE73

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

Where (were/was) (PERSON) living when this household

participated in the National Health Interview Survey on

{MONTH, DAY, YEAR OF NHIS INTERVIEW}?

NOT YET BORN ............................ 1 {END_LP08}

INSTITUTIONALIZED ....................... 2 {RE73A}

STUDENT UNDER 24 LIVING AWAY AT

SCHOOL GRADES 1-12 ...... .......... 3 {END_LP08}

STUDENT UNDER 24 LIVING AWAY AT

POST-SECONDARY SCHOOL ................ 4 {RE73B}

ANOTHER HH - NOT FT MILITARY AT NHIS .... 5 {RE73B}

ANOTHER HH/MILITARY FACILITY - FT

MILITARY AT NHIS ...... .......... 6 (RE73C)

LIVING WITH THIS FAMILY - PERSON LEFT

OFF NHIS ROSTER .................... 7 {END_LP08}

OTHER .................................. 91 {RE73OV}

REF .................................... -7 {END_LP08}

DK ..................................... -8 {END_LP08}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

----------------------------------------------------

| FOR ‘MONTH...’, DISPLAY DATE OF NHIS INTERVIEW. |

----------------------------------------------------

RE73OV

======

{PERSON'S FIRST MIDDLE AND LAST NAME}

OTHER:

[Enter Other Specify] ................. {END_LP08}

REF ................................... -7 {END_LP08}

DK .................................... -8 {END_LP08}

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

RE73A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

What type of institution (were/was) (PERSON) living in on

{MONTH, DAY, YEAR OF NHIS INTERVIEW}?

NURSING HOME ........................ 1 {RE74}

OTHER LONG-TERM HEALTH CARE

INSTITUTION (EXCLUDE COMMUNITY

BASED HOSPITAL) ................... 2 {RE74}

OTHER NON-HEALTH CARE INSTITUTION ... 3 {END_LP08}

REF ................................ -7 {RE74}

DK ................................. -8 {RE74}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

----------------------------------------------------

| FOR ‘MONTH...’, DISPLAY DATE OF NHIS INTERVIEW. |

----------------------------------------------------

RE73B

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

(Were/Was) (PERSON) living within the U.S. or outside the U.S.

on {MONTH, DAY, YEAR OF NHIS INTERVIEW}?

WITHIN U.S. .......................... 1

OUTSIDE U.S. ......................... 2

REF ................................. -7

DK .................................. -8

HELP AVAILABLE FOR DEFINITION OF LIVING WITHIN/OUTSIDE U.S.

----------------------------------------------------

| FOR ‘MONTH...’, DISPLAY DATE OF NHIS INTERVIEW. |

----------------------------------------------------

| IF RE73 CODED '4' (STUDENT UNDER 24 LIVING AWAY |

| AT POST-SECONDARY SCHOOL), GO TO RE75 |

----------------------------------------------------

| OTHERWISE, GO TO END_LP08 |

----------------------------------------------------

RE73C

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

(Were/Was) (PERSON) living in another household or in a military

facility on {MONTH, DAY, YEAR OF NHIS INTERVIEW}?

ANOTHER HOUSEHOLD ................... 1 {RE73COV}

MILITARY FACILITY ................... 2 {END_LP08}

REF ................................ -7 {RE73COV}

DK ................................. -8 {RE73COV}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

----------------------------------------------------

| FOR ‘MONTH...’, DISPLAY DATE OF NHIS INTERVIEW. |

----------------------------------------------------

RE73COV

=======

{PERSON'S FIRST MIDDLE AND LAST NAME}

Was that household within the U.S. or outside the U.S.?

WITHIN U.S. ......................... 1 {END_LP08}

OUTSIDE U.S. ........................ 2 {END_LP08}

REF ................................ -7 {END_LP08}

DK ................................. -8 {END_LP08}

[Code One]

RE74

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

Please give me the name and address of the nursing home or long

term care facility where (PERSON) (were/was) living at the time

of the National Health Interview Survey on {MONTH, DAY, YEAR OF

NHIS INTERVIEW}?

NAME: [_____________]

STREET ADDRESS1: [_____________]

STREET ADDRESS2: [_____________]

CITY: [_____________]

STATE: [_____________]

ZIP CODE: [_____________]

USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.

----------------------------------------------------

| FOR ‘MONTH...’, DISPLAY DATE OF NHIS INTERVIEW. |

----------------------------------------------------

| CODES '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE |

| ALLOWED ON EACH FORM ITEM. |

----------------------------------------------------

| GO TO END_LP08 |

----------------------------------------------------

RE75

====

{PERSON’S FIRST MIDDLE AND LAST NAME}

At the time of the National Health Interview Survey on {MONTH,

DAY, YEAR OF NHIS INTERVIEW}, were either of (PERSON)’s

parents living in this household?

YES .................................... 1 {END_LP08}

NO ..................................... 2 {END_LP08}

REF ................................... -7 {END_LP08}

DK .................................... -8 {END_LP08}

----------------------------------------------------

| FOR ‘MONTH...’, DISPLAY DATE OF NHIS INTERVIEW. |

----------------------------------------------------

END_LP08

========

----------------------------------------------------

| CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER |

| WHO MEETS THE CONDITIONS STATED IN THE LOOP |

| DEFINITION. |

----------------------------------------------------

| IF NO MORE PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_08 AND CONTINUE WITH BOX_27 |

----------------------------------------------------

BOX_27

======

----------------------------------------------------

| CONTINUE WITH REENUMERATION-B (RE-B) SUBSECTION |

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3-123

File Type	application/msword
File Title	MEPS Reenumeration Subsection A - P12R5/P13R3/P14R1
Subject	RE-A Section Item Specifications
Author	Agency for Healthcare Research and Quality
Last Modified By	wcarroll
File Modified	2009-07-10
File Created	2009-07-10