Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

DIINTROA

DIINTROA

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No Entry

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Field 1:

DIINT

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40

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DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

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Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

The next two questions are about ethnicity and race.

Int. Instr II:

INPUT FIELDS / ROUTING

10:14:27 AM Tuesday, July 29, 2008

Page 1 of 23

DIINTROA
DIINT

Field1:
Cheshire Name:

( DIQ1040 )

TEMP

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TContinueEMPTY
1
No
No

Number Label
1 Continue

FieldSize:
Min Value:
Max Value:
Mask:

Route
DI1A - HISPORIG ( DIQ1050 )

English text: CONTINUE
Attribute
Empty

Route
DI1A - HISPORIG ( DIQ1050 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

10:14:29 AM Tuesday, July 29, 2008

Page 2 of 23

DI1A

DI1A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HISPORIG

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Yes

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50

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Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

[Are you/Is (SP)] of Hispanic or Latino origin?

Int. Instr II:

INPUT FIELDS / ROUTING

10:14:30 AM Tuesday, July 29, 2008

Page 3 of 23

DI1A
HISPORIG

Field1:
Cheshire Name:

( DIQ1050 )

HOME.HISPORIG

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
DI2A - RACECODE ( DIQ1060 )

English text: YES
No

DI2A - RACECODE ( DIQ1060 )

English text: NO
Attribute
Don't know

Route
DI2A - RACECODE ( DIQ1060 )

Refusal

DI2A - RACECODE ( DIQ1060 )

BACKGROUND VARIABLE ASSIGNMENTS

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TECHNICAL NOTES

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10:14:32 AM Tuesday, July 29, 2008

Page 4 of 23

DI2A

DI2A

Page Order # :

Design Screen Type:

Code All

Fields:

Field 1:

RACECODE

Field 2:

RACEOS

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No
Yes
Yes

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No

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Enable Functions:

60

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Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

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Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

SHOW CARD DI

Question Text:

Looking at this card, what is [your/(SP's)] race?

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

10:14:34 AM Tuesday, July 29, 2008

Page 5 of 23

DI2A
RACECODE

Field1:
Cheshire Name:

( DIQ1060 )

NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HOME.RACEAI
2=HOME.RACEAS
3=HOME.RACEAA
4=HOME.RACENH
5=HOME.RACEWH
91=HOME.RACEOTH

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TRace
6
No
No

Number Label
1 AmIndAlaskaNative

FieldSize:
Min Value:
Max Value:
Mask:

Route
DI3INTRO - DIINT3 ( DIQ1110 )

2

English text: AMERICAN INDIAN OR ALASKA NATIVE
Asian
DI3INTRO - DIINT3 ( DIQ1110 )

3

English text: ASIAN
BlackOrAfricanAm

4

English text: BLACK OR AFRICAN AMERICAN
NatHawOrOthPacIsl
DI3INTRO - DIINT3 ( DIQ1110 )

5

English text: NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER
White
DI3INTRO - DIINT3 ( DIQ1110 )

91

English text: WHITE
AnotherRace

DI3INTRO - DIINT3 ( DIQ1110 )

DI2A - RACEOS ( DIQ1080 )

English text: ANOTHER RACE
Attribute
Don't know

Route
DI3INTRO - DIINT3 ( DIQ1110 )

Refusal

DI3INTRO - DIINT3 ( DIQ1110 )

10:14:40 AM Tuesday, July 29, 2008

Page 6 of 23

DI2A

Field2:
Cheshire Name:

RACEOS

( DIQ1080 )

HOME.RACEOS

Item Text display:

Display (SPECIFY) in same blue font used for interviewer
instructions

Item Text:

ANOTHER RACE (SPECIFY)

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String
TOthrspec
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
DI3INTRO - DIINT3 ( DIQ1110 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

10:14:41 AM Tuesday, July 29, 2008

Page 7 of 23

DI3INTRO

DI3INTRO

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No Entry

Fields:

Field 1:

DIINT3

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90

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Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

The next two questions are about education and income.

Int. Instr II:

INPUT FIELDS / ROUTING

10:14:42 AM Tuesday, July 29, 2008

Page 8 of 23

DI3INTRO
DIINT3

Field1:
Cheshire Name:

( DIQ1110 )

TEMP

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TContinueEMPTY
1
No
No

Number Label
1 Continue

FieldSize:
Min Value:
Max Value:
Mask:

Route
DI3A - SPDEGRCV ( DIQ1130 )

English text: CONTINUE
Attribute
Empty

Route
DI3A - SPDEGRCV ( DIQ1130 )

BACKGROUND VARIABLE ASSIGNMENTS

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10:14:43 AM Tuesday, July 29, 2008

Page 9 of 23

DI3A

DI3A

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

SPDEGRCV

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110

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "completed" in BOLD.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

SHOW CARD DI1A

Question Text:

What is the highest degree or level of school [you have/(SP) has]

completed?

Int. Instr II:
INPUT FIELDS / ROUTING

10:14:46 AM Tuesday, July 29, 2008

Page 10 of 23

DI3A

10:14:51 AM Tuesday, July 29, 2008

Page 11 of 23

DI3A
SPDEGRCV

Field1:
Cheshire Name:

( DIQ1130 )

HRND.SPDEGRCV

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TSpdegrcv
1
No
No

Number Label
1 NoSchComp
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
DI4INTRO - DIINT4 ( DIQ1150 )

English text: NO SCHOOLING COMPLETED
NursSchTo8thGrade
DI4INTRO - DIINT4 ( DIQ1150 )

4

English text: NURSERY SCHOOL TO 8TH GRADE
Grade9th12thNoDip
DI4INTRO - DIINT4 ( DIQ1150 )
English text: 9TH-12TH GRADE, NO DIPLOMA
HghSchGradDipEq
DI4INTRO - DIINT4 ( DIQ1150 )

5

English text: HIGH SCHOOL GRADUATE (HIGH SCHOOL DIPLOMA OR THE EQUIVALENT)
VocTecBusCertDip
DI4INTRO - DIINT4 ( DIQ1150 )

6

English text: VOCATIONAL/TECHNICAL/BUSINESS/TRADE SCHOOL CERTIFICATE OR
DIPLOMA (BEYOND THE HIGH SCHOOL LEVEL)
CollegeNoDegree
DI4INTRO - DIINT4 ( DIQ1150 )

7

English text: SOME COLLEGE, BUT NO DEGREE
AssociateDegree
DI4INTRO - DIINT4 ( DIQ1150 )

3

8
9

English text: ASSOCIATE DEGREE
BachelorsDegree
English text: BACHELOR'S DEGREE
MastProfDoctDeg

DI4INTRO - DIINT4 ( DIQ1150 )
DI4INTRO - DIINT4 ( DIQ1150 )

English text: MASTER'S, PROFESSIONAL OR DOCTORATE DEGREE
Attribute
Don't know

Route
DI4INTRO - DIINT4 ( DIQ1150 )

Refusal

DI4INTRO - DIINT4 ( DIQ1150 )

10:15:01 AM Tuesday, July 29, 2008

Page 12 of 23

DI3A
BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

10:15:01 AM Tuesday, July 29, 2008

Page 13 of 23

DI4INTRO

DI4INTRO

Page Order # :

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No Entry

Fields:

Field 1:

DIINT4

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130

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DISPLAY INSTRUCTIONS:
Context header display:

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Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

In studies like this, people are sometimes grouped together

according to income.

Int. Instr II:
INPUT FIELDS / ROUTING

10:15:02 AM Tuesday, July 29, 2008

Page 14 of 23

DI4INTRO
DIINT4

Field1:
Cheshire Name:

( DIQ1150 )

TEMP

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TContinueEMPTY
1
No
No

Number Label
1 Continue

FieldSize:
Min Value:
Max Value:
Mask:

Route
DI4 - SPINC25K ( DIQ1160 )

English text: CONTINUE
Attribute
Empty

Route
DI4 - SPINC25K ( DIQ1160 )

BACKGROUND VARIABLE ASSIGNMENTS

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HARD EDIT CHECKS

TECHNICAL NOTES

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10:15:04 AM Tuesday, July 29, 2008

Page 15 of 23

DI4

DI4

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

SPINC25K

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140

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP or SP's spouse is the respondent, and SP is married, display
"your and your spouse's".
Else if PROXY is the respondent, and SP is married, display "(SP'S)
and (his/her) spouse's".
Else display "[your/(SP's)]".
Always display "(SSI)" in second sentence in parenthesis.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

10:15:06 AM Tuesday, July 29, 2008

Was [your and your spouse's/(SP's) and (his/her)
spouse's/[your/(SP's)]] total income during the past 12 months less
than $25,000 or $25,000 or more, before taxes? Include income
from jobs, Social Security, Railroad Retirement, other retirement
income, Supplemental Security Income (SSI), pensions, interest,
Page 16 of 23

DI4
and any other sources.
[PROBE IF NECESSARY: In estimating [your/(SP's)] total income,
you can respond for all of the past 12 months, or provide a one
month estimate.]
[EXPLAIN IF NECESSARY: Income is important in analyzing the
information we collect. For example, this information helps us learn
whether persons in one income group use certain types of medical
care services or have certain medical conditions more or less often
than those in another group.]
Int. Instr II:

INPUT FIELDS / ROUTING

SPINC25K

Field1:
Cheshire Name:

( DIQ1160 )

HRND.SPINC25K

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TSpinc25k
1
No
No

Number Label
1 LessThan25000
2
3
4

English text: LESS THAN $25,000/YEAR
GreaterEqualTo25000
English text: $25,000 OR MORE/YEAR
LessThan2080Month
English text: LESS THAN $2080/MONTH
GreaterEqualTo2080Month

FieldSize:
Min Value:
Max Value:
Mask:

Route
DI5A - SPINCLET ( DIQ1165 )
DI5A - SPINCLET ( DIQ1165 )
DI5A - SPINCLET ( DIQ1165 )
DI5A - SPINCLET ( DIQ1165 )

English text: $2080/MONTH OR MORE
Attribute
Don't know

Route
BOX DI3 - (DIQ1175 )

Refusal

BOX DI3 - (DIQ1175 )

BACKGROUND VARIABLE ASSIGNMENTS
10:15:10 AM Tuesday, July 29, 2008

Page 17 of 23

DI4

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

239

SPMarriedFallRnd

SP is married =
IN13 - SPMARSTA = 1/Married. Stored on HRND where
HRND.HRNDRND = current round.
*Applicable to Fall Round only.

240

SpouseIsRespondent

SP's spouse is the respondent =
There is a ROST where ROST.ROSTREL = 2/Spouse &
(ROST.ROSTNUM = MRES.RROSTNUM on MRES
where MRES.MRESRND = current round).

DESIGN NOTES

10:15:10 AM Tuesday, July 29, 2008

Page 18 of 23

DI5A

DI5A

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 0:

SPINCLET

Enable Functions:

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155

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP or SP's spouse is the respondent, and SP is married, display
"your and your spouse's".
Else if PROXY is the respondent, and SP is married, display "(SP'S)
and (his/her) spouse's".
Else display "[your/(SP's)]".
If DI4 - HRND.SPINC25K = 2/GreaterEqualTo25000 or
4/GreaterEqualTo2080Month display "DI2".
Else display "DI3".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:

SHOW CARD (DI2/DI3)

Question Text:

Looking at this card, which letter best represents [your and your
spouse's/(SP's) and (his/her) spouse's/[your/(SP's)]] total income
before taxes during the past 12 months? Include income from jobs,

10:15:12 AM Tuesday, July 29, 2008

Page 19 of 23

DI5A
Social Security, Railroad Retirement, other retirement income, and
the other sources of income we just talked about.
[EXPLAIN IF NECESSARY: Income is important in analyzing the
information we collect. For example, this information helps us learn
whether persons in one income group use certain types of medical
care services or have certain medical conditions more or less often
than those in another group.]
Int. Instr II:

INPUT FIELDS / ROUTING

10:15:18 AM Tuesday, July 29, 2008

Page 20 of 23

DI5A
SPINCLET

Field0:

( DIQ1165 )

Cheshire Name:
Item Text display:

If DI4 - HRND.SPINC25K = 1/LessThan25000 or

3/LessThan2080Month, do not display response options

6 - 9 (F - I).

Else do not display response options 1 - 5 (A - E).

Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated

Tspinclet
1
No
No

Number Label
1 ALESSThan5000

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX DI3 - (DIQ1175 )

3

English text: A
B5000To9999
English text: B
C10000To14999

4

English text: C
D15000To19999

BOX DI3 - (DIQ1175 )

5

English text: D
E20000To24999

BOX DI3 - (DIQ1175 )

6

English text: E
F25000To29999

BOX DI3 - (DIQ1175 )

7

English text: F
G30000To39999

BOX DI3 - (DIQ1175 )

8

English text: G
H40000To49000

BOX DI3 - (DIQ1175 )

9

English text: H
I50000OrOver

BOX DI3 - (DIQ1175 )

2

BOX DI3 - (DIQ1175 )
BOX DI3 - (DIQ1175 )

English text: I
Attribute
Don't know

Route
BOX DI3 - (DIQ1175 )

Refusal

BOX DI3 - (DIQ1175 )

10:15:24 AM Tuesday, July 29, 2008

Page 21 of 23

DI5A
BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

10:15:24 AM Tuesday, July 29, 2008

Page 22 of 23

BOX DI3

BOX DI3

Page Order # :

160

BOX INSTRUCTIONS
( DIQ1175 )

GO TO NEXT SECTION. .

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

10:15:24 AM Tuesday, July 29, 2008

Page 23 of 23