Form Quality Control Qu Quality Control Qu Quality Control Questions

Attachment D

Reinterview Questions

For original interviews:

Did an interviewer contact you on or about [Fill: INTDATE] and ask questions about

your household’s economic situation?

1. Yes

2. No

Did the interviewer visit in person or call on the telephone?

1. Personal visit only

2. Telephone call only

3. Both - Interviewer visited and called

Was the interviewer polite and professional?

1. Yes

2. No

About how long did the interview last?

____ hours ____ minutes

Did the interviewer use a laptop computer?

1. Yes

2. No

Line No.	Name	Relationship	Age	Sex
[Fill: LNO]	[Fill: FNAME LNAME]	[Fill: REL]	[Fill: AGE]	[Fill: SEX]
•	•	•	•	•
•	•	•	•	•
Our records indicate that ♦Read above name(s) in blue♦ was/were living or staying at
[Fill: ADDRESS] on [Fill: INTDATE]. Is this correct?
1. Yes 2. No

Line No.	Name	Relationship	Age	Sex
[Fill: LNO]	[Fill: FNAME LNAME]	[Fill: REL]	[Fill: AGE]	[Fill: SEX]
•	•	•	•	•
•	•	•	•	•
♦Enter the line number of the household member(s) (above name(s) in blue) who wasn’t/weren’t living or staying at the household on [Fill: INTDATE].
[Fill: LNO]. [Fill: FNAME LNAME] • • • • • •

Line No.	Name	Relationship	Age	Sex
[Fill: LNO]	[Fill: FNAME LNAME]	[Fill: REL]	[Fill: AGE]	[Fill: SEX]
•	•	•	•	•
•	•	•	•	•
Have I missed any household member who was living or staying at this household on [Fill: INTDATE]. Do not include persons who have a usual residence elsewhere.
1. Yes 2. No

Line No.	Name	Relationship	Age	Sex
[Fill: LNO]	[Fill: FNAME LNAME]	[Fill: REL]	[Fill: AGE]	[Fill: SEX]
•	•	•	•	•
•	•	•	•	•
♦ Enter the name of each missing household member who was living or staying at this household on [Fill:INTDATE]. ♦ Press Enter after each name and again after last name to continue.

Did the interviewer ask you questions about your recent work activities?

1. Yes

2. No

Did the interviewer ask you questions about your health insurance?

1. Yes

2. No

For original noninterviews:

Did an interviewer visit or call regarding:

[Fill: ADDRESS]?

1. Yes

2. No

Did the interviewer visit in person or call on the telephone?

1. Personal visit only

2. Telephone call only

3. Both - Interviewer visited and called

Was the interviewer polite and professional?

1. Yes

2. No

Did the interviewer use a laptop computer?

1. Yes

2. No

Our records show that on [Fill: INTDATE],

[Fill: ADDRESS]

was [Fill: ORIOUT’s description].

Is this information correct?

1. Yes

2. No