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Various Demographic Pretesting Activities
ICR 201006-0607-004 · OMB 0607-0725 · Object 24164201.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Various Demographic Pretesting Activities |
| Author | hende361 |
| Last Modified By | Writer |
| File Modified | 2010-09-08 |
| File Created | 2026-10-14 |
| Conversion State | complete |
Extracted Text
AHS Cognitive Interviewing Questionnaire: Healthy Homes, Home Accessibility, and Mortgage Modules
Final Version: 9-8-10
1. NAME Now I will ask you some questions about the people who live here.
What are the names of all persons living or staying here? Start with the name of the person, or one of the persons, who owns or rents this home.
2. AGE What is [your/NAME’s] age?
2b. REL (Enter ‘0’ without asking for the person on Line 1)
What is [your/NAME’s] relationship to [fill name of person on Line 1 of the Household Roster]?
1. Spouse 7. Foster Child
2. Unmarried Partner 8. Housemate/Roommate
3. Child 9. Roomer/Boarder
4. Grandchild 10. Other Non-relative
5. Parent 11. Dk
6. Other Relative 12. Ref
3. TENURE Is your home…
(Read categories until “yes” reply is received)
1. Owned?
2. Rented?
3. Occupied without payment of rent?
4. OWNER In whose name is this home [fill with answer to TENURE]?
(Place an asterisk (*) next to owners’/renters’ name on Household Roster)
5. STYPE Are your living quarters in a…
(Read categories until “yes” reply is received)
1. 1 unit building, detached from any other building?
2. 1 unit building, attached to one or more buildings?
3. Building with two or more apartments?
4. Manufactured/Mobile Home?
6. FLOORS How many stories are there in your home including finished attics and basements?
1. ________________________________
7. BEDRMS How many bedrooms are in your home?
(Enter 10 for 10 or more bedrooms)
1. _________________________________
8. BATHS How many full bathrooms are in your home?
(Enter 10 for 10 or more bathrooms)
1. __________________________________
9. BRKDNINTRO The next series of questions are about problems that some people have experienced with their homes. We are interested in knowing if you have experienced these types of problems too.
10. EVROD
Have you ever seen signs of mice or rats INSIDE your home?
(Exclude rats/mice kept as pets or snake food or otherwise deliberately brought inside.)
1.
Yes
2.
No
Dk
Ref
-Skip to 14. EROACH
3.
4.
11. M3ROD
Was that in the last 3 months that is, since [fill date three months prior]?
1.
Yes
2.
No
Dk
Ref
-Skip to 13. RATMICE
3.
4.
12. RATFREQ
How often have you seen any evidence of mice or rats in your home since [fill date three months prior]? Would you say it was daily, weekly, monthly, or a few times a year?
1.
Daily
2.
Weekly
3.
Monthly
4.
A few times a year
5.
Dk
6.
Ref
13. RATMICE
Was it a rat, a mouse, or aren't you sure what it was?
(Mark all that apply)
1.
Rat
2.
Mouse
3.
Not Sure
4.
Dk
5.
Ref
14. EROACH
Have you ever seen signs of live or dead cockroaches or cockroach feces INSIDE your home?
1.
Yes
2.
No
Dk
Ref
3.
4.
15. M3ROACH
Was that within the last 3 months that is, since [fill date three months prior]?
1.
Yes
2.
No
Dk
Ref
3.
4.
16. ROACHFRQ
How often have you seen any live or dead cockroaches or cockroach feces INSIDE your home since [fill date three months prior]? Would you say it was daily, weekly, monthly, or a few times a year?
1.
Daily
Weekly
Monthly
A few times a year
Dk
Ref
2.
3.
4.
5.
6.
17. MAJR1
When the owner has to do MAJOR maintenance or repairs:
Do they start quickly enough?
1.
Yes usually
2.
Not usually
3.
Very mixed
4.
Haven't needed any
-Skip to 20. MINR1
5.
Landlord not responsible for maintenance
-Skip to 23. BLDMNT
6.
Dk
7.
Ref
18. MAJR2
Do they solve the problem quickly once they start?
1.
Yes
2.
No
3.
Mixed
4.
Dk
5.
Ref
19. MAJR3
Are they polite and considerate of your home?
1.
Yes
2.
No
3.
Mixed
4.
Dk
5.
Ref
20. MINR1
For MINOR maintenance or repairs:
Do they start quickly enough?
1.
Yes usually
2.
Not usually
3.
Very mixed
4.
Haven't needed any
5.
Landlord not responsible for maintenance -Skip to 23. BLDMNT
6.
Dk
7.
Ref
21. MINR2
Do they solve the problem quickly once they start?
1.
Yes
2.
No
3.
Mixed
4.
Dk
5.
Ref
22. MINR3
Are they polite and considerate of your home?
1.
Yes
2.
No
3.
Mixed
4.
Dk
5.
Ref
23. BLDMNT
On maintenance of the building, are you completely satisfied, partly satisfied, or dissatisfied?
1.
Completely satisfied
2.
Partly satisfied
3.
Dissatisfied
4.
Landlord not responsible for this maintenance
5.
Dk
6.
Ref
24. GRDMNT
On maintenance of the grounds, are you completely satisfied, partly satisfied, or dissatisfied?
1.
Completely satisfied
2.
Partly satisfied
3.
Dissatisfied
4.
Landlord not responsible for this maintenance
5.
Dk
6.
Ref
25. HHMINTRO We now have some questions about the health of your home.
27. MOLD In the last 12 months, was there mold covering an area greater than or equal to the size of an 8” x 11” piece of paper in any of the following rooms in your home…
(Read bold categories and mark all that apply)
1. Kitchen?
2. Bathroom(s)?
3. Bedroom(s)?
4. Living Room?
5. Basement?
6. None of the above?
7. Dk
8. Ref
28. MUST In the last 12 months, how often have you noticed any musty smells inside your home? Would you say it was daily, weekly, a few times a year or never? (Musty smells are smells of dampness, mold, or mildew.)
1. Daily
2. Weekly
3. Monthly
4. A few times a year
5. Never
6. Dk
7. Ref
29. SMKR Do any members of your household smoke tobacco inside your home?
1. Yes -Skip to 32. HHSAFE
2. No
3. Dk
4. Ref
30. SMKVIS Do any visitors to your household smoke tobacco inside your home?
1. Yes -Skip to 32. HHSAFE
2. No
3. Dk
4. Ref
31. SECSMK In the last 12 months, how often has second hand smoke entered inside your home from somewhere else in or around the building? Would you say it was daily, weekly, monthly, a few times a year or never?
1. Daily
2. Weekly
3. Monthly
4. A few times a year
5. Never
6. Dk
7. Ref
32. HHSAFE Does your household have any of the following…
(Read bold categories and mark all that apply)
1. Working exhaust in all the bathrooms?
2. All bathtubs and showers have non-slip surfaces such as mats, non-slip coatings or tiles?
3. Window guards on all second floor or higher windows?
4. Water stain or water damage anywhere inside the home?
5. Condensation on windows?
6. Cords on any windows, blinds or other window coverings?
7. None of the above?
8. Dk
9. Ref
38. SMOKE Do you currently have a working smoke detector inside your home?
1. Yes
2. No
3. Dk -Skip to 41. FIREX
4. Ref
39. SMOKPWR Is your smoke detector powered by electricity, batteries or both?
1. Electricity -Skip to 41. FIREX
2. Batteries
3. Both
4. Dk - Skip to 41. FIREX
5. Ref
40. BATTERY Have the batteries in your smoke detector been replaced in the past 6 months?
1. Yes
2. No
3. Dk
4. Ref
41. FIREX Do you have a fire extinguisher in your home that was purchased or recharged in the last 2 years?
1. Yes
2. No
3. Dk
4. Ref
42. SPRNKLR Is there a fire sprinkler system inside your home?
1. Yes
2. No
3. Dk
4. Ref
43. MONOX Do you have a working carbon monoxide detector inside your home?
1. Yes
2. No
3. Dk
4. Ref
44. COPWR Is your carbon monoxide detector powered by electricity, batteries or both?
1. Electricity
2. Batteries
3. Both
4. Dk
5. Ref
45. COBATT Have the batteries in your smoke detector been replaced in the past 6 months?
1. Yes
2. No
3. Dk
4. Ref
46. H2OMF Do you have access to the water heater for your unit?
1. Yes
2. No
3. Dk -Skip to 49. H2HRT
4. Ref
47. H2OHT Have you ever checked the temperature of your hot water?
1. Yes
2. No
3. Dk -Skip to 49. H2HRT
4. Ref
48. H2OT What was the temperature of your hot water?
1. Less than 120 F
2. 120-124 F
3. 125 F
4. Higher than 125 F
5. Dk
6. Ref
49. H2HRT In the last 6 months, has anyone been scalded by hot water in your home?
(Being scalded means to be burned by hot water or steam.)
1. Yes
2. No
3. Dk
4. Ref
50. H2MED Did the scalding require medical attention?
1. Yes
2. No
3. Dk
4. Ref
51. NOHHKID Do any children 4 years or younger visit your home on a regular basis?
1. Yes
2. No
3. Dk -Skip to 54. EXTC
4. Ref
52. OUTLET Do all, some, or none of the electrical outlets in your home have child tamper-resistant outlet covers?
1. All
2. Some
3. None
4. Dk
5. Ref
53. CHEMSTOR Are all some or none of the chemicals, pesticides, cleaning supplies and medicines stored out of the reach of young children?
1. All
2. Some
3. None
4. Dk
5. Ref
54. EXTC Do you use extension cords at home?
1. Yes
2. No
3. Dk -Skip to 56. POOLACC
4. Ref
55. EXTCOND Are any of the extension cords used in the home cracked or worn?
1. Yes
2. No
3. Dk
4. Ref
56. POOLACC Do you have access to an outdoor swimming pool on your property?
If apartment building: (This includes a swimming pool anywhere on the grounds.)
1. Yes
2. No
3. Dk -Skip to 58. STAIRS
4. Ref
57. POOLFEN Is there a fence at least 4 feet tall that goes around all the way around the pool with a gate that closes and latches automatically? (Fences around the yard do not count. Do not include trees, foliage, and other shrubbery. A wall of the home cannot count as a side of the fence unless there is no way to access the pool area in that wall (i.e. no doors, windows, or openings of any kind).)
1. Yes
2. No
3. Dk
4. Ref
58. STAIRS Does your home have any stairs inside, such as stairs to upstairs, basement, attic, etc.? Stairs are sets of three or more steps.
1. Yes
2. No
3. Dk - Skip to 65. DSBINTRO
4. Ref
59. STAIRRL Are the railings on all or some of these stairs firmly attached or are none of them firmly attached? (Firmly attached means secured strongly enough to be used with complete confidence.)
1. All of them
2. Some of them
3. None of them
4. Dk
5. Ref
60. STAIRMIS Are there any missing or broken railings on these stairs?
1. Yes
2. No
3. Dk
4. Ref
61. STAIRBRK Are any of the steps missing or broken on these stairs?
1. Yes
2. No
3. Dk
4. Ref
62. STAIRCOV Do the steps on these stairs have any type of nonslip covering such as fixed carpets, nonslip coatings, etc.?
1. Yes
2. No
3. Dk
4. Ref
63. STAIRLGT Is there lighting at the top and bottom of all the stairs, of some of the stairs or none of the stairs? (Is there enough lighting to see the top and bottom of the stairs at all times of the day.)
1. All of them
2. Some of them
3. None of them
4. Dk
5. Ref
64. STAIRGAT Are there gates on all of these stairs, some of these stairs, or on none of these stairs?
1. All of them
2. Some of them
3. None of them
4. Dk
5. Ref
65. DSBINTRO
With this next set of questions, we want to learn about the health of the household members.
65b. HLTH
Would you say that your health in general is excellent, very good, fair, or poor?
1. Excellent
2. Very Good
3. Fair
4. Poor
5. Dk
6. Ref
65c.ASTHMA
65d.ASTHEMR
65e.UND18INJ
66. HEARING
Has a doctor or other health professional ever told you that any of your children have asthma?
1. Yes
2. No
3. Dk -Skip to 66. HEARING
4. Ref
During the last 12 months, did [fill name of youngest household member with asthma] have to visit an emergency room because of [his/her] asthma?
1. Yes
2. No
3. Dk
4. Ref
During the past three months, that is since [fill date three months prior] has anyone in the household under 18 had an injury where any part of the body was hurt and required medical attention?
1. Yes
2. No
3. Dk
4. Ref
Now, thinking about everyone in your household. Is anyone in the household deaf or do they have serious difficulty hearing even when wearing a hearing aid?
1. Yes
2. No
3. Dk - Skip to 69. SEEING
4. Ref
67. HEARDIFF
(Is anyone in this household deaf or do they have serious difficulty hearing even when wearing a hearing aid?)
Who is that?
(Mark all that apply)
(Probe:) Anyone else?
69. SEEING
Is anyone in this household blind or do they have serious difficulty seeing, even when wearing glasses?
1. Yes
2. No
3. Dk - Skip to 72. MEMRY
4. Ref
70. SEEDIFF
(Is anyone in this household blind or do they have serious difficulty seeing, even when wearing glasses?)
Who is that?
(Mark all that apply)
(Probe:) Anyone else?
72. MEMRY
(Please answer this next set of questions for all household members that are five years old and over.)
Because of a physical, mental, or emotional condition, does anyone in this household have serious difficulty concentrating, remembering, or making decisions?
1. Yes
2. No
3. Dk - Skip to 75. WALKING
4. Ref
73. MEMDIFF
(Please answer this next set of questions for all household members that are five years old and over.)
(Because of a physical, mental, or emotional condition, does anyone in this household have serious difficulty concentrating, remembering, or making decisions?)
Who is that?
(Mark all that apply)
(Probe:) Anyone else?
75. WALKING
(Please answer this next set of questions for all household members that are five years old and over.)
Does anyone in this household have serious difficulty walking or climbing stairs?
1. Yes
2. No
3. Dk - Skip to 78. SELFCARE
4. Ref
76. WALKDIFF
(Please answer this next set of questions for all household members that are five years old and over.)
(Does anyone in this household have serious difficulty walking or climbing stairs?)
Who is that?
(Mark all that apply)
(Probe:) Anyone else?
78. SELFCARE
(Please answer this next set of questions for all household members that are five years old and over.)
Does anyone in this household have serious difficulty dressing or bathing?
1. Yes
2. No
3. Dk - Skip to 81. ERRANDS
4. Ref
79. CAREDIFF
(Please answer this next set of questions for all household members that are five years old and over.)
(Does anyone in this household have serious difficulty dressing or bathing?)
Who is that?
(Mark all that apply)
(Probe:) Anyone else?
81. ERRANDS
(Please answer this next question for all household members who are 15 years old or over.)
Because of a physical, mental, or emotional condition, does anyone in this household have difficulty doing errands alone such as visiting a doctor's office or shopping?
1. Yes
2. No
3. Dk - Skip to 93. HWRKPROB
4. Ref
82. ERRNDIFF
(Please answer this next question for all household members who are 15 years old or over.)
(Because of a physical, mental, or emotional condition, does anyone in this household have difficulty doing errands alone such as visiting a doctor's office or shopping?)
Who is that?
(Mark all that apply)
(Probe:) Anyone else?
93. HWRKPROB
(Please answer this next set of questions for all household members that are fifteen years old and over.)
Does anyone in the household have difficulty doing laundry?
1. Yes
2. No
3. Dk - Skip to 98. SPLEDWHAT
4. Ref
94. HWRKWHO
(Please answer this next set of questions for all household members that are fifteen years old and over.)
(Does anyone in this household have difficulty doing laundry?)
Who is that?
(Mark all that apply)
(Probe:) Anyone else?
98. SPLEDWHAT
Please answer this question for everyone in the household. Does anyone in the household use any of the following equipment?
(Read bold categories and mark all that apply)
1. Manually operated wheelchair?
2. Motorized wheelchair, cart or scooter?
3. Chairlift?
4. Crutches?
5. Cane or walker?
6. Something else?
7. None of the above?
8. Dk
9. Ref
99a.Without assistance, does anyone in the household over five years of age have problems with any of the following:
1. Reaching kitchen cabinets
2. Opening kitchen cabinets
3. Turning the stove on and off
4. Using kitchen counters
5. Getting to the bathroom
6. Using the sink
7. Turning the faucets on or off
8. Getting into or out of the bathtub
9. Getting into or out of the walk-in shower
99b. Without the use of any special equipment, does anyone in the household over five years of age have problems with any of the following:
1. Stooping, kneeling, or bending?
2. Reaching over their head?
3. Using their fingers to grasp small objects?
100. HMDINTRO
Now I have some questions about certain convenience and safety features you might have in your home.
101. RAMPS
Does your home currently have any of the following features:
Ramps inside your home?
102. ELEVATE
(Does your home currently have any of the following features :)
An elevator inside your home?
(If apartment building, probe :) This is inside of your apartment, not just inside the apartment building?
103. ENTBD
(Does your home currently have any of the following features :)
Bedroom on the entry level?
104. ENTBTH
(Does your home currently have any of the following features :)
Bathroom on the entry level?
105. HNDRLS
(Does your home currently have any of the following features :)
Handrails or grab bars on both sides of any of the stairs or steps inside your home?
106. BATHRLS
(Does your home currently have any of the following features :)
Handrails or grab bars in any of your bathrooms, such as in the shower or bathtub area?
107. OTHERRLS
(Does your home currently have any of the following features :)
Handrails or grab bars in any other areas of your home?
108. BRSEATS
(Does your home currently have any of the following features :)
Built-in seats in the shower area of the bathroom?
109. RTOILET
(Does your home currently have any of the following features :)
Raised toilets?
110. HANDLE
(Does your home currently have any of the following features :)
Door handles instead of knobs on all doors?
111. SKLEVERS
(Does your home currently have any of the following features :)
Handles or levers for any sink faucets instead of knobs on any faucets?
112. XWDOOR
(Does your home currently have any of the following features :)
Extra wide doors or hallways?
113. HIOUTLET
(Does your home currently have any of the following features :)
Wheelchair accessible electrical outlets, that is outlets positioned slightly higher than standard?
114. LSWITCH
(Does your home currently have any of the following features :)
Wheelchair accessible electrical switches, that is switches positioned slightly lower than standard?
115. LOWCAB
(Does your home currently have any of the following features :)
Wheelchair accessible kitchen cabinets?
116. KITRAY
(Does your home currently have any of the following features :)
Kitchen cabinets with rollout trays or lazy susans?
117. CLCTRL
(Does your home currently have any of the following features :)
Wheelchair accessible climate controls?
118. BTWCHAIR
(Does your home currently have any of the following features :)
Bathroom designed to allow wheelchair access?
119. KITWCHAIR
(Does your home currently have any of the following features :)
Kitchen designed to allow wheelchair access?
120. CTRWCHAIR
(Does your home currently have any of the following features :)
Wheelchair accessible countertops?
121. LEVEL
(Does your home currently have any of the following features :)
All areas on the same level, meaning no steps between rooms?
122. AUDIBLE
(Does your home currently have any of the following features :)
Visual strobe light system to indicate doorbell, telephone, smoke, or carbon monoxide detectors?
123. MODYESINTRO
Now I have some questions about the use of features you have in your home.
125. RAMPSYES
Earlier you reported that you have ramps in the home. Does anyone in the household currently use the ramps in the home on a regular basis because of a physical limitation?
1. Yes
2. No
3. Dk
4. Ref
127. ELEVATEYES
Earlier you reported that you have an elevator in the home. Does anyone in the household currently use the elevator in the home on a regular basis because of a physical limitation?
1. Yes
2. No
3. Dk
4. Ref
129. ENTBDYES
Earlier you reported that you have an entry level bedroom in the home. Does anyone in the household currently use the entry level bedroom in the home on a regular basis because of a physical limitation?
1. Yes
2. No
3. Dk
4. Ref
131. ENTBTHYES
Earlier you reported that you have an entry level bathroom in the home. Does anyone in the household use the entry level bathroom in the home on a regular basis because of a physical limitation?
1. Yes
2. No
3. Dk
4. Ref
133. HNDRLSYES
Earlier you reported that you have handrails or grab bars in the home. Does anyone in the household use the handrails or grab bars on both sides of the stairs or steps inside your home on a regular basis because of a physical limitation?
1. Yes
2. No
3. Dk
4. Ref
135. BTHRLSYES
Earlier you reported that you have handrails or grab bars in the bathroom. Does anyone in the household use the handrails or grab bars in the bathroom, such as the shower or bathtub area on a regular basis because of a physical limitation?
1. Yes
2. No
3. Dk
4. Ref
137. OTHRLSYES
Earlier you reported that you have other rails in the home. Does anyone in the household use handrails or grab bars in other areas of your home on a regular basis because of a physical limitation?
1. Yes
2. No
3. Dk
4. Ref
155. NROWNR
Is the ownership of the home shared with anyone NOT living here?
1.
Yes
2.
No
3.
Dk
4.
Ref
156. NRPAYM
Are some of the mortgage or utility costs paid by someone NOT living here?
1.
Yes
2.
No
3.
Dk
4.
Ref
157. MORTINTRO
The next questions are about mortgages and other loans that are secured by the property.
Please refer to your mortgage loan statement or any additional records that you may have regarding the mortgages on the property.
158. REGMOR
How many mortgages of any type do you have on this property? Include all regular mortgages, home equity credit lines, or any loan that is secured by the value of this home.
1. _________________________________
159. MGTYPE
What type of mortgage is the loan…
(Read bold categories)
1.
Regular Mortgage? For example: fixed rate loans, adjustable rate loans, or any loan where a fixed amount was borrowed and must be repaid at pre-determined intervals?
2.
Home Equity Lump Sum Loan?
3.
Home Equity Line of Credit?
4.
Dk
5.
Ref
160. MATBUY
Did you get the mortgage the same date you bought your home?
1.
Yes – Skip to 163. PMT
2.
No
3.
Dk
4.
Ref
161. YRMOR
What year did you get the mortgage?
(Enter year from 1900 to 2010)
1.
_________________________________
162. MNMOR
What month did you get the mortgage?
1.
_________________________________
163. PMT
Looking at your statement, how much is the current payment on the mortgage?
(Include as much Principal, Interest, Taxes, and Insurance (PITI) as they pay.)
(Enter 9998 for $9,998 or more)
1.
_________________________________
164. UNPBAL
Looking at your statement, what is the amount that you still owe on the mortgage? That is, what is the unpaid principal balance?
(Enter 9999998 for $9,999,998 or more)
1.
_________________________________
165. INTW
Looking at your statement, what is the current interest rate on the mortgage?
(For example 6 1/4%: Enter 6 here and fraction on next screen)
1.
_________________________________
166. INTF
(Looking at your statement, what is the interest rate on the mortgage? - Fraction)
(Round down to nearest 1/8 percent)
0.
0 - no fraction
1.
1/8 (.125%)
2.
1/4 (.25%)
3.
3/8 (.375%)
4.
1/2 (.5%)
5.
5/8 (.625%)
6.
3/4 (.75%)
7.
7/8 (.875%)
8.
Dk
9.
Ref
167. REFI
Did this mortgage refinance a previous mortgage?
1.
Yes
2.
No
3.
Dk
4.
Ref
168. REFNREAS
Homeowners refinance for many reasons. I am now going to read you a list of reasons people give for refinancing. Please tell me if any of these reasons apply to you. Did you refinance to…
(Read bold categories)
(Enter all that apply, separate with commas)
1.
To get a lower interest rate?
2.
To permanently reduce the mortgage payment?
3.
To reduce the payment period for the mortgage?
4.
To receive cash or increase the outstanding balance of the loan?
5.
For the option to suspend or temporarily reduce mortgage payments?
6.
Anything else? — Continue to 169. OTRFSP
7.
Dk
8.
Ref
169. OTRFSP
Please specify other reasons for refinancing
1.
_________________________________
170. LNFNBR
Did you select the financial institution that refinanced this mortgage because the company called you on the telephone or sent you a solicitation in the mail?
1.
Yes
2.
No
3.
Dk
4.
Ref
171. CASH
When you refinanced this mortgage how much cash did you receive?
(Enter 999998 for $999,998 or more)
1.
_________________________________
172. ADDTNS
What percentage of this mortgage was used for additions, improvements or repairs to the home?
1.
_________________________________
173. PERUS1
What percentage of this loan was used for the purchase of the home or additions, improvements or repairs to this home?
1.
_________________________________
174. TERM2
From the date that you obtained this mortgage, how many years did you have to pay it off?
(Enter 0 if it varies)
1.
_________________________________
175. AMRTZ
At your current payments, how much longer will it take to pay off the loan?
1.
_________________________________
176a. PMTPARTS
Looking at your statement, which of the following are included in your payment…
(Read bold categories)
(Enter all that apply, separate with commas)
1.
Principal?
2.
Interest?
3.
Property Taxes?
4.
Homeowners Insurance (Insurance that protects homeowners in case of fire or other accidental damage to the home, robberies, and third party injuries on the premises)?
5.
FHA/VA Insurance? — Continue to 176b. FHVAAMT
6.
Private Mortgage Insurance or PMI (Insurance that a lender generally requires a home buyer to obtain if the down payment made by the home buyer is below a certain percentage)?
7.
Dk
8.
Ref
176b. FHVAAMT
How much was the Federal Housing/Veterans Administration Insurance or FHA/VA payment in the last calendar year?
(Enter 999998 for $999,998 or more)
1. __________________________________
177. PMIAMT
How much was the private mortgage insurance or PMI payment in the last calendar year?
(Enter 999998 for $999,998 or more)
1.
_________________________________
178. OTHPMT
Does your payment include anything else I have not mentioned?
1.
Yes
2.
No
3.
Dk
4.
Ref
179. OTHPMTSP
What else is included in your payment for the loan?
1.
_________________________________
180. AMTM
How much were these other charges last calendar year?
(Exclude property tax, homeowners insurance and PMI)
(Enter 9999998 for $9,999,998 or more)
1.
_________________________________
181. PMTF
How often do you make a payment on your loan…
(Read bold categories)
1.
Once a month?
2.
Twice a month?
3.
Every two weeks?
4.
Something else? — Continue to 182. PMTFSP
5.
Dk
6.
Ref
182. PMTFSP
Specify how often you make a payment on your loan.
1.
_________________________________
183. PMTCHYR
Over the last 12 months, has the amount of your loan payment increased or decreased by any amount?
1.
Yes
2.
No
3.
Dk
4.
Ref
184. WHYPMTCH
Payments change for many reasons. I am now going to read you a list of reasons why mortgage payments change. Please tell me if any of these reasons applied to you over the last 12 months…
(Read bold categories)
(Enter all that apply, separate with commas)
1.
Property taxes or homeowners insurance changed?
2.
The adjustable interest rate changed?
3.
The minimum allowable payment increased?
4.
Mortgage changed from fixed rate to adjustable rate or vice versa?
5.
Mortgage changed from interest only to interest plus payment in order to reduce mortgage balance?
6.
Mortgage no longer allows you to decide how much to pay?
7.
Mortgage was refinanced?
8.
Lender modified mortgage to prevent foreclosure?
9.
Anything else?
10.
Dk
11.
Ref
185. VARMSP
Please specify other reason(s) why the mortgage payment changed over the last 12 months.
1.
_________________________________
186. PMTINC
Over the last 12 months, did the total mortgage payment increase or decrease as a result of these changes?
1.
Increase
2.
Decrease
3.
Dk
4.
Ref
187. PMTCHAMT
Over the last 12 months, how much (in dollars) did the mortgage payment [increase/decrease], overall?
(Enter 9998 for $9,998 or more)
1.
_________________________________
188. SHOCK
Was the increase in the mortgage payment so great as to make it difficult to afford the new payment?
1.
Yes
2.
No
3.
Dk
4.
Ref
189. RULEINTRO
Now we have a series of questions about how your mortgage works. Previously we asked you to look at your mortgage statement and answer questions about the payment you make on your mortgage and how much of that regular payment is charged to principal, interest, and other charges. Now we want to know the terms and conditions that are used to calculate these payments. The terms may not be on your mortgage statement. We are asking you to remember how your lender described your mortgage when you signed your mortgage documents.
190. MORTIN
Is the mortgage an FHA, VA, Rural Housing Service/Rural Development
mortgage, or none of these?
1.
FHA
2.
VA
3.
Rural Housing Service/Rural Development
4.
None of these
5.
Dk
6.
Ref
191. SUBMOR
There are State and local government programs that provide low cost mortgages. Did you get the mortgage/loan through a State or local government program that provides low cost mortgages?
1.
Yes – Skip to 195. MORGTYPE1
2.
No
3.
Dk
4.
Ref
192. BANK
Did you borrow money from a bank or organization OR from an individual?
1.
Bank or Organization – Skip to 193. DOC
2.
Individual – Skip to 194. SELL
3.
Dk
4.
Ref
193. DOC
Were you able to get this mortgage without the lender verifying your income, assets, and debts?
1.
Yes
2.
No
3.
Dk
4.
Ref
194. SELL
Was that the former owner of the home?
1.
Yes
2.
No
3.
Dk
4.
Ref
195. MORGTYPE1
What type of mortgage is this loan…
(Read bold categories)
1.
Fixed rate mortgage?
2.
Adjustable rate mortgage?
3.
Hybrid adjustable rate mortgage?
4.
Renegotiable rate (rollover) mortgage?
5.
Balloon mortgage (includes interest-only loans)?
6.
Graduated payment mortgage?
7.
Assumable mortgage?
8.
Payment option mortgage?
9.
None of the above?
10.
Dk
11.
Ref
196. MORGTYPE3
What type of mortgage is this loan…
(Read bold categories)
1.
Seller take back mortgage?
2.
Wraparound mortgage?
3.
Land contract mortgage?
4.
None of the above?
5.
Dk
6.
Ref
199. MORGTYPE
200. MORGCHK1
I need to verify,
A fixed rate mortgage is a long-term (usually 15-30 years) loan with a fixed interest rate. With this type of loan, the principal and interest payments remain the same until the debt is paid in full.
Does this describe your mortgage?
1.
Yes
2.
No
3.
Dk
4.
Ref
201. MORGCHK2
I need to verify,
An adjustable rate mortgage is a long-term (usually 15-30 years) loan with an interest rate that rises or falls in conjunction with a reference rate. The starting interest rate for this type of loan is generally less than conventional loans, and there are usually interest rate caps that prevent huge fluctuations in monthly payments.
Does this describe your mortgage?
1.
Yes
2.
No
3.
Dk
4.
Ref
202. MORGCHK3
I need to verify,
A renegotiable rate (rollover) mortgage is a loan with an interest rate and monthly payments that are constant for several years, with possible changes thereafter. Interest rates are usually fixed for 3-5 years, which gives the borrower more payment stability than with typical adjustable rate mortgages.
Does this describe your mortgage?
1.
Yes
2.
No
3.
Dk
4.
Ref
203. MORGCHK4
I need to verify,
A balloon mortgage is a loan with a large payment due at the end of the mortgage’s term. For some balloon mortgages, the monthly payments satisfy only the interest charges, and the entire principal must be paid off or refinanced at the end of the term (usually 5-7 years).
Does this describe your mortgage?
1.
Yes
2.
No
3.
Dk
4.
Ref
204. MORGCHK5
I need to verify,
A graduated payment mortgage is a long-term (usually 15 or 30 years) loan with low initial monthly payments that gradually rise (usually during the first 5-10 years) and eventually level off for the duration of the mortgage’s term.
Does this describe your mortgage?
1.
Yes
2.
No
3.
Dk
4.
Ref
205. MORGCHK6
I need to verify,
An assumable mortgage is a loan that permits the home buyer to take over the seller’s existing mortgage with the bank’s approval.
Does this describe your mortgage?
1.
Yes
2.
No
3.
Dk
4.
Ref
206. MORGCHK7
I need to verify,
A seller take back mortgage is a loan in which the seller lends funds to the buyer to purchase of the property. The seller earns interest on the debt and uses the property as collateral in case of default, just as a traditional financial institution would.
Does this describe your mortgage?
1.
Yes
2.
No
3.
Dk
4.
Ref
207. MORGCHK8
I need to verify,
A wraparound mortgage is a loan in which the buyer makes payments to the seller who forwards a portion to the financial institution that holds the original mortgage.
Does this describe your mortgage?
1.
Yes
2.
No
3.
Dk
4.
Ref
208. MORGCHK9
I need to verify,
A land contract is a seller-financed loan in which the seller retains the original mortgage-the transfer of the title does not occur until the loan is completely repaid.
Does this describe your mortgage?
1.
Yes
2.
No
3.
Dk
4.
Ref
209. MORGCHK13
I need to verify,
A hybrid adjustable rate mortgage is a long-term (usually 15-30 years) loan that has a period with a fixed rate, usually 2 to 7 years, followed by a period where the interest rate rises or falls in conjunction with a reference rate.
Does this describe your mortgage?
1.
Yes
2.
No
3.
Dk
4.
Ref
210. MORGCHK14
I need to verify,
A payment option mortgage is an adjustable rate mortgage with interest rates and payments that change frequently. Borrowers are offered options for their loan payment amount. These options can include interest-only payments or “minimum” payments that are usually less than the interest–only payment. This minimum payment option results in a growing loan balance, which is termed “negative amortization.”
Does this describe your mortgage?
1.
Yes
2.
No
3.
Dk
4.
Ref
210b. MORGTYPE4
So, what type of mortgage is it…
(Read bold categories)
1.
Fixed rate mortgage?
2.
Adjustable rate mortgage?
3.
Hybrid adjustable rate mortgage?
4.
Renegotiable rate (rollover) mortgage?
5.
Balloon mortgage (includes interest-only loans)?
6.
Graduated payment mortgage?
7.
Assumable mortgage?
8.
Payment option mortgage?
9.
Seller take back mortgage?
10.
Wraparound mortgage?
11.
Land contract mortgage?
12.
Something else?
13.
Dk
14.
Ref
211. MRGTYPSP
Please specify other mortgage loan type.
1.
_________________________________
212. BALLNTRM
From the time you took out your mortgage, how many years before the final balloon payment is due?
1.
_________________________________
213. BALLNAMT
What will the final balance due or balloon payment be?
(Enter 9999998 for $9,999,998 or more)
1.
_________________________________
214. AMMORT1
How much was left to pay off when you assumed the mortgage?
(Enter 9999998 for $9,999,998 or more)
1.
_________________________________
215. TERM1
How many years remained on the mortgage when you assumed it?
1.
_________________________________
216. AMMORT2
How much was borrowed?
1.
_________________________________
217. MGREAS
Homeowners choose mortgages for many reasons. I am now going to read you a list of reasons people give for choosing mortgages. Please tell me if any of these reasons apply to you. Did you select this type of mortgage because…
(Read bold categories)
(Enter all that apply, separate with commas)
1.
the interest rate was lower, more reasonable, or the best available rate?
2.
of the size of (monthly) payments or payment amount?
3.
of the amount of upfront costs for the loan (for example: amount of points, loan fees, closing costs, or settlement costs)?
4.
you thought interest rates would decline in the future so payments would go down?
5.
it was easier to get credit (for example: requiring less information or collateral; less stringent rules for giving credit; getting credit approval faster; no red tape)?
6.
Anything else?
7.
Dk
8.
Ref
218. MGREASSP
Please specify the other reason(s) why you chose this type of mortgage for the first loan.
1.
_________________________________
219. FRSTTERM
From the time you took out the mortgage, how many years did your principal and interest payments remain fixed?
1.
_________________________________
221. ADJDPEND
The interest rate on an adjustable rate mortgage typically rises or falls in conjunction with another interest rate, which is known as the reference rate. What is the reference rate for your loan?
(Read bold categories)
1.
Prime (interest) Rate?
2.
Treasury Bill/Bond Rate (T-Bill rate)?
3.
LIBOR (London Interbank Offered Rate)?
4.
None of the above: Changes on specified schedule but doesn’t depend on another rate?
5.
Something else?
6.
Dk
7.
Ref
222. ADJDPNSP
Please specify the reference rate.
1.
_________________________________
223. ADJRATEF
How often can your interest rate change…
(Read bold categories)
(Code without asking if already mentioned)
1.
More frequent than monthly?
2.
Monthly?
3.
Quarterly?
4.
Twice per year; every six months?
5.
Yearly?
6.
A longer period than yearly?
7.
Dk
8.
Ref
224. ADJRATEO
Specify how frequently your interest rate can change.
1.
_________________________________
225. MAXADJ
Is there a limit to the number of times your interest rate can change over the course of the loan?
1.
Yes
2.
No
3.
Dk
4.
Ref
226. MAXADJTM
How many times is that?
1.
_________________________________
227. ADJFIX
For what period is/was the interest rate fixed…
(Read bold categories)
1.
One month?
2.
More than one, up to six months?
3.
More than six months but less than one year?
4.
One year?
5.
Two years?
6.
Three years?
7.
More than three years?
8.
Dk
9.
Ref
228. ORIGINTW
What was the original interest rate on the mortgage?
(For example 6 1/4%: Enter 6 here and fraction on next screen)
1.
_________________________________
229. ORIGINTF
(What was the original interest rate on the mortgage? – Fraction)
(Round down to nearest 1/8 percent)
0.
0 - no fraction
1.
1/8 (.125%)
2.
1/4 (.25%)
3.
3/8 (.375%)
4.
1/2 (.5%)
5.
5/8 (.625%)
6.
3/4 (.75%)
7.
7/8 (.875%)
8.
Dk
9.
Ref
230. MAXINTW
What is the highest the interest rate can go up to over the life of the mortgage?
(We want the highest rate allowed, not the maximum amount by which the rate could increase over a specified period.)
(For example 6 1/4%: Enter 6 here and fraction on next screen)
1.
_________________________________
231. MAXINTF
(What is the highest the rate can go up to over the life of the mortgage? - Fraction)
(Round down to nearest 1/8 percent)
0.
0 - no fraction
1.
1/8 (.125%)
2.
1/4 (.25%)
3.
3/8 (.375%)
4.
1/2 (.5%)
5.
5/8 (.625%)
6.
3/4 (.75%)
7.
7/8 (.875%)
8.
Dk
9.
Ref
232. HECR
What is your total credit limit on the line of credit?
(Enter 9999998 for $9,999,998 or more)
1.
_________________________________
233. HEBAL
Do you now have an outstanding loan borrowed against the line of credit?
1.
Yes
2.
No
3.
Dk
4.
Ref
234. IMPROV
Did you use any of the funds for additions, improvements or repairs to this home?
1.
Yes
2.
No
3.
Dk
4.
Ref
235. RAM
Some people take out a special mortgage called a
Reverse Annuity Mortgage or Home Equity Conversion
Mortgage that borrows against the equity in their
homes to give them retirement money or income.
Some of these loans do not have to be paid back
during the owner's lifetime because it will be paid
back by the sale of the home if you move out or when the estate is
settled. Some provide monthly income over a specified
period of time, after which it must be paid back.
Do you have this type of mortgage?
1.
Yes
2.
No
3.
Dk
4.
Ref