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

BOX IN1

BOX IN1

Page Order # :

40

BOX INSTRUCTIONS
( INQ1040 )

GO TO IN1AA - ATDOOR ( INQ1065 ).

ASSIGNMENTS
The very first time a case is accessed, we will set MRES.MRESBDAT to the first date of the
interview.
In addition, we will check to see if case is a restart case and set restart database flag.
See detailed instructions below.

MRESBDAT

If first time case is accessed, set MRES.MRESBDAT

= today's date.

EVRESTRT

If Restart Case, set MRES.EVRESRT = 1/Yes.

LASTRESP

If Restart Case, set LASTRESP =
MRES.RROSTNUM.

LASTSTATUS

If Restart Case, set LASTSTATUS = SPAISTATUS.

TECHNICAL NOTES

DESIGN NOTES

4:45:15 PM Wednesday, January 28, 2009

Page 1 of 94

IN1AA

IN1AA

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No Entry

Fields:

Field 1:

ATDOOR

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65

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DISPLAY INSTRUCTIONS:
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TEXT:

Context Header:
Int. Instr I:

REVIEW WITH THE RESPONDENT THE FOLLOWING
IMPORTANT FACTS FROM THE "AT-THE-DOOR" SHEET:

Question Text:

All survey information will be kept in strict confidence under the laws
prescribed by the Privacy Act of 1974.
Medicare benefits will not be affected in any way by survey
responses or participation.

Int. Instr II:

REFER TO THE "AT-THE-DOOR" SHEET IF THE RESPONDENT
NEEDS ADDITIONAL REASSURANCE.

4:45:16 PM Wednesday, January 28, 2009

Page 2 of 94

IN1AA
INPUT FIELDS / ROUTING
ATDOOR

Field1:
Cheshire Name:

( INQ1065 )

TEMP

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
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Lookup File Name:

Enumerated
TContinueEMPTY
1
No
No

Number Label
1 Continue

FieldSize:
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Max Value:
Mask:

Route
IN2 - VERIFYSP ( INQ1070 )

English text: CONTINUE
Attribute
Empty

Route
IN2 - VERIFYSP ( INQ1070 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:45:18 PM Wednesday, January 28, 2009

Page 3 of 94

IN2

IN2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

VERIFYSP

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70

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display SP's name.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

VERIFY THE SP’S NAME. IS THE SP’S NAME CORRECT AND
COMPLETE?
FIRST NAME: (SP'S FIRST NAME)

Question Text:

MIDDLE INITIAL: (SP'S MIDDLE INITIAL)
LAST NAME: (SP'S LAST NAME)
Int. Instr II:

INPUT FIELDS / ROUTING

4:45:19 PM Wednesday, January 28, 2009

Page 4 of 94

IN2
( INQ1070 )

VERIFYSP

Field1:
Cheshire Name:

TEMP

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
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Enumerated
TYesNo

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1
No
No

Number Label
1 Yes
2

Route
BOX IN1A - (INQ1110 )

English text: YES
No

IN3 - ROSTFNAM ( INQ1090 )

English text: NO

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
12

SPName

SP's name =
Stored on ROST where ROST.ROSTNUM='01'.
First Name: ROST.ROSTFNAM
Middle Initials: ROST.ROSTMINI
Last Name: ROST.ROSTLNAM

DESIGN NOTES

4:45:20 PM Wednesday, January 28, 2009

Page 5 of 94

IN3

IN3

Page Order # :

Design Screen Type:

Text

Fields:

Field 1:

ROSTFNAM

Field 2:

ROSTMINI

Field 3:

ROSTLNAM

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TEXT:
Context Header:
Int. Instr I:

MAKE ALL NECESSARY CORRECTIONS TO THE SP'S NAME.

Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING

4:45:21 PM Wednesday, January 28, 2009

Page 6 of 94

IN3

Field1:
Cheshire Name:
Item Text display:

ROSTFNAM

( INQ1090 )

ROST.ROSTFNAM
Display SP's first name, ROST.ROSTFNAM, in input field.
Allow field to be updated.

Item Text:
Label:

Label Position:

FIRST NAME:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String
TRostlnam
1
No
No

Number Label
1 [Continuous answer.]
Field2:
Cheshire Name:
Item Text display:

ROSTMINI

FieldSize:
Min Value:
Max Value:
Mask:

25

Route
IN3 - ROSTMINI ( INQ1091 )
( INQ1091 )

ROST.ROSTMINI
Display SP'S middle initial, ROST.ROSTMINI, in input
field. Allow field to be updated.

Item Text:
Label:

Label Position:

MIDDLE INITIAL:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String
TMini
1
No
No

Number Label
1 [Continuous answer.]

4:45:24 PM Wednesday, January 28, 2009

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Min Value:
Max Value:
Mask:

2

Route
IN3 - ROSTLNAM ( INQ1092 )

Page 7 of 94

IN3
( INQ1092 )

ROSTLNAM

Field3:
Cheshire Name:
Item Text display:

ROST.ROSTLNAM
Display SP'S last name, ROST.ROSTLNAM, in input field.
Allow field to be updated.

Item Text:
Label:

Label Position:

LAST NAME:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String
TRostlnam

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]

25

Route
BOX IN1A - (INQ1110 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
12

SPName

SP's name =
Stored on ROST where ROST.ROSTNUM='01'.
First Name: ROST.ROSTFNAM
Middle Initials: ROST.ROSTMINI
Last Name: ROST.ROSTLNAM

DESIGN NOTES

4:45:25 PM Wednesday, January 28, 2009

Page 8 of 94

BOX IN1A

BOX IN1A

Page Order # :

110

BOX INSTRUCTIONS
( INQ1110 )

IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO IN4 - SPPROXY (
INQ1290 ).
ELSE GO TO INS1 - SPAISTATUS ( INQ1120 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:45:25 PM Wednesday, January 28, 2009

Page 9 of 94

INS1

INS1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

SPAISTATUS

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120

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DISPLAY INSTRUCTIONS:
Context header display:

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Display "CURRENTLY" in bold.

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TEXT:

Context Header:

Int. Instr I:

IS THE SP CURRENTLY:

Question Text:

Int. Instr II:

INPUT FIELDS / ROUTING

4:45:26 PM Wednesday, January 28, 2009

Page 10 of 94

INS1
SPAISTATUS

Field1:
Cheshire Name:

( INQ1120 )

TEMP

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
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Lookup File Name:

Enumerated
TTSpalive
1
No
No

Number Label
1 Alive

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX INS1 - (INQ1260 )

2

English text: ALIVE AND NOT INSTITUTIONALIZED
AliveAndInstitute
INS2 - SPINSTMM ( INQ1130 )

3

English text: ALIVE AND INSTITUTIONALIZED
Deceased
INS3 - SPDIEMM ( INQ1170 )

4

English text: DECEASED - DIED IN COMMUNITY
DeceasedInInstitute
INS2 - SPINSTMM ( INQ1130 )
English text: DECEASED - DIED IN INSTITUTION

BACKGROUND VARIABLE ASSIGNMENTS
The SP's status variable is MRES.SPALIVE. Because the interviewer needs additional
help determining how to code MRES.SPALIVE when the SP is deceased, we have created
a "temporary" variable, SPAISTATUS, that includes a 4th option, DECEASED - DIED IN
INSTITUTION. If the SP died in an institute, we consider the SP's status as "Alive and
Institutionalized", not "Deceased". MRES.SPALIVE is coded based on the response to
INS1 - SPAISTATUS. There are some skip patterns in IN that are based on INS1 ­
SPAISTATUS, however, the remaining instrument flow depends on MRES.SPALIVE. See
variable assignment instructions below.
SPALIVE

If INS1 - SPAISTATUS = 4/DeceasedInInstitute, set
MRES.SPALIVE=2/AliveAndInstitute.
Else set MRES.SPALIVE=SPAISTATUS.

SOFT EDIT CHECKS
Edit #1
If restart case and last SPAISTATUS = 2/AliveAndInstitute or
4/DeceasedInInstitute, then INS1 - SPAISTATUS ^= 1/Alive.
If not true, display message “THE SP’s STATUS CHANGED FROM
“INSTITUTIONALIZED” TO “NOT INSTITUTIONALIZED”. VERIFY
THAT CURRENT STATUS IS CORRECT. IF CORRECT, ENTER
COMMENT TO EXPLAIN CHANGE.”

4:45:29 PM Wednesday, January 28, 2009

Page 11 of 94

INS1
Edit #2
If restart case and last SPAISTATUS = 3/Deceased, then INS1 ­
SPAISTATUS ^= 1/Alive.
If not true, display message “THE SP’s STATUS CHANGED FROM
“DIED IN COMMUNITY” TO “ALIVE”.VERIFY THAT CURRENT
STATUS IS CORRECT. IF CORRECT, ENTER COMMENT TO
EXPLAIN CHANGE.”
Edit #3
If restart case and last SPAISTATUS = 3/Deceased, then INS1 ­
SPAISTATUS ^= 2/AliveAndInstitute.
If not true, display message “THE SP’s STATUS CHANGED FROM
“DIED IN COMMUNITY” TO “INSTITUTIONALIZED”. VERIFY THAT
CURRENT STATUS IS CORRECT. IF CORRECT, ENTER
COMMENT TO EXPLAIN CHANGE.”
Edit #4
If restart case and last SPAISTATUS = 3/Deceased, then INS1 ­
SPAISTATUS ^= 4/DeceasedInInstitute.
If not true, display message “THE SP’s STATUS CHANGED FROM
“DIED IN COMMUNITY” TO “DIED IN INSTITUTION”. VERIFY THAT
CURRENT STATUS IS CORRECT. IF CORRECT, ENTER
COMMENT TO EXPLAIN CHANGE.”
Edit #5

INS1 - SPAISTATUS ^= 3/Deceased.

If not true, display message “PLEASE VERIFY THAT SP WAS IN
THE COMMUNITY AT THE TIME OF DEATH.”
Edit #6

INS1 - SPAISTATUS ^= 4/DeceasedInInstitute.

If not true, display message “PLEASE VERIFY THAT SP WAS
INSTITUTIONALIZED AT THE TIME OF DEATH."
HARD EDIT CHECKS

TECHNICAL NOTES
133

LastStatus

When it's a restart interview, the last SPAISTATUS is
stored on LASTSTATUS at BOX IN1 and is used to
compare the status of the SP collected before the
breakoff to the current status of the SP.

42

RestartInterview

If this is a restart interview =
MRES.EVRESTRT=1/Yes on MRES where
MRES.MRESRND = current round.

DESIGN NOTES

4:45:29 PM Wednesday, January 28, 2009

Page 12 of 94

INS2

INS2

Page Order # :

Design Screen Type:

Date

Fields:

Field 1:

SPINSTMM

Field 2:

SPINSTDD

Field 3:

SPINSTYY

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

What was the first date since (REFERENCE DATE) that (SP)
entered the facility?
[EXPLAIN IF NECESSARY: By "facility" we mean a place that
provides long term care. By "first date" we mean the earliest date
that an SP enters any facility and does not enter a hospital or return
home.]

4:45:31 PM Wednesday, January 28, 2009

Page 13 of 94

INS2
IF MORE THAN ONE DATE, ENTER THE EARLIEST.

Int. Instr II:
INPUT FIELDS / ROUTING

SPINSTMM

Field1:
Cheshire Name:

( INQ1130 )

MRES.SPINSTMM

Item Text display:
Item Text:
Label:
Label Position:

MM
Under

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

Integer
TMonthInt
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
INS2 - SPINSTDD ( INQ1140 )

Refusal

INS2 - SPINSTDD ( INQ1140 )

4:45:34 PM Wednesday, January 28, 2009

FieldSize:
Min Value:
Max Value:
Mask:

2
01
12

Route
INS2 - SPINSTDD ( INQ1140 )

Page 14 of 94

INS2
SPINSTDD

Field2:
Cheshire Name:

( INQ1140 )

MRES.SPINSTDD

Item Text display:
Item Text:
Label:
Label Position:

DD
Under

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

Integer
TDayDKRF
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
INS2 - SPINSTYY ( INQ1150 )

Refusal

INS2 - SPINSTYY ( INQ1150 )

Field3:
Cheshire Name:

SPINSTYY

FieldSize:
Min Value:
Max Value:
Mask:

2
1
31

Route
INS2 - SPINSTYY ( INQ1150 )

( INQ1150 )

MRES.SPINSTYY

Item Text display:
Item Text:
Label:
Label Position:

YY
Under

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

Integer
TYear2
1
No
No

Number Label
1 [Continuous answer.]

4:45:37 PM Wednesday, January 28, 2009

FieldSize:

Min Value:
Max Value:
Mask:

00

99

Route
BOX INSA - (INQ1160 )

Page 15 of 94

INS2
BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

If MRES.INTTYPE = 7/SupSmp1stTimeUtil or

10/SumSmp1stTimeUtilSkipped, then date entered at INS2,

SPINSTMM, SPINSTDD, SPINSTYY, is on or after 1/1/current year.

If not true, display message “DATE ENTERED IS BEFORE
JANUARY OF THIS YEAR. PLEASE VERIFY.” INVOLVES
SPINSTMM, SPINSTDD, SPINSTYY.
See general specs for date comparison logic.
HARD EDIT CHECKS
Edit #1

Date of Institutionalization, SPINSTMM/SPINSTDD/SPINSTYY,

should be on or between (REFERENCE DATE) and (TODAY).

If not true, display message "INVALID DATE. DATE MUST BE ON

OR BETWEEN (REFERENCE DATE) AND (TODAY)."

TECHNICAL NOTES

DESIGN NOTES

4:45:37 PM Wednesday, January 28, 2009

Page 16 of 94

BOX INSA

BOX INSA

Page Order # :

140

BOX INSTRUCTIONS
( INQ1160 )

IF (INS1 - SPAISTATUS = 4/DeceasedInInstitute) AND (UTILIZATION IS
BEING COLLECTED FOR THE FIRST TIME IN THIS ROUND AND
PREVIOUS ROUND WAS NOT FACILITY INTERVIEW) AND (SP'S DATE OF
INSTITUTIONALIZATION ENTERED AT INS2 IS BEFORE JANUARY 1 OF
THE CURRENT YEAR), GO TO INS3 - SPDIEMM ( INQ1170 ).
ELSE GO TO BOX INSA1 - (INQ1200 ).

ASSIGNMENTS

TECHNICAL NOTES
10

FirstUtilizationNotFac

Utilization being collected for the first time in this round
and previous round was not facility interview =
(MRES.INTTYPE=7/SupSmp1stTimeUtil or
MRES.NTTYPE=10/SupSmp1stTimeUtilSkipped) on
MRES where MRES.MRESRND = current round.

273

SPDateOfInstitute

SP's Date of Institutionalization =
On MRES where MRES.MRESRND = current round:
Month = MRES.SPINSTMM
Day = MRES.SPINSTDD
Year = MRES.SPINSTYY

DESIGN NOTES

4:45:37 PM Wednesday, January 28, 2009

Page 17 of 94

INS3

INS3

Page Order # :

Design Screen Type:

Date

Fields:

Field 1:

SPDIEMM

Field 2:

SPDIEDD

Field 3:

SPDIEYY

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TEXT:
Context Header:

(REFERENCE DATE) - (TODAY)

Int. Instr I:
Question Text:

On what date did (SP) die?

Int. Instr II:
INPUT FIELDS / ROUTING

4:45:39 PM Wednesday, January 28, 2009

Page 18 of 94

INS3
SPDIEMM

Field1:
Cheshire Name:

( INQ1170 )

MRES.SPDIEMM

Item Text display:
Item Text:
Label:
Label Position:

MM
Under

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

Integer
TMonthInt
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
INS3 - SPDIEDD ( INQ1180 )

Refusal

INS3 - SPDIEDD ( INQ1180 )

4:45:42 PM Wednesday, January 28, 2009

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2
01
12

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INS3 - SPDIEDD ( INQ1180 )

Page 19 of 94

INS3
SPDIEDD

Field2:
Cheshire Name:

( INQ1180 )

MRES.SPDIEDD

Item Text display:
Item Text:
Label:
Label Position:

DD
Under

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

Integer
TDayDKRF
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
INS3 - SPDIEYY ( INQ1190 )

Refusal

INS3 - SPDIEYY ( INQ1190 )

Field3:
Cheshire Name:

SPDIEYY

FieldSize:
Min Value:
Max Value:
Mask:

2
1
31

Route
INS3 - SPDIEYY ( INQ1190 )

( INQ1190 )

MRES.SPDIEYY

Item Text display:
Item Text:
Label:
Label Position:

YY
Under

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

Integer
TYear2
1
No
No

Number Label
1 [Continuous answer.]

4:45:45 PM Wednesday, January 28, 2009

FieldSize:

Min Value:
Max Value:
Mask:

00

99

Route
BOX INSA1 - (INQ1200 )

Page 20 of 94

INS3
BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

If MRES.INTTYPE = 7/SupSmp1stTimeUtil or

10/SumSmp1stTimeUtilSkipped, then date entered at INS3,

SPDIEMM/SPDIEDD/SPDIEYY, is on or after 1/1/current year.

If not true, display message “DATE ENTERED IS BEFORE
JANUARY OF THIS YEAR. PLEASE VERIFY.” INVOLVES
SPDIEMM, SPDIEDD, SPDIEYY.
See general specs for date comparison logic.
HARD EDIT CHECKS
Edit #1

If MRES.INTTYPE = 7/SupSmp1stTimeUtil or

10/SumSmp1stTimeUtilSkipped, and INS1 - SPAISTATUS =

4/DeceasedInInstitute, then date entered at INS3,

SPDIEMM/SPDIEDD/SPDIEYY, is on or after date entered at INS2,

SPINSTMM/SPINSTDD/SPINSTYY.

If not true, display message “INVALID ENTRY. DATE ENTERED
CANNOT BE PRIOR TO DATE OF INSTITUTIONALIZATION.”
INVOLVES SPDIEMM, SPDIEDD, SPDIEYY, SPINSTMM,
SPINSTDD, SPINSTYY.
Edit #2
Date of Death, SPDIEMM/SPDIEDD/SPDIEYY, should be on or
between (REFERENCE DATE) and (TODAY).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY)."
TECHNICAL NOTES

DESIGN NOTES

4:45:45 PM Wednesday, January 28, 2009

Page 21 of 94

BOX INSA1

BOX INSA1

4:45:45 PM Wednesday, January 28, 2009

Page Order # :

160

Page 22 of 94

BOX INSA1
BOX INSTRUCTIONS
( INQ1200 )

IF (INS1 - SPAISTATUS = 3/Deceased) AND (UTILIZATION IS BEING
COLLECTED FOR THE FIRST TIME IN THIS ROUND AND PREVIOUS
ROUND WAS NOT FACILITY INTERVIEW) AND (SP'S DATE OF DEATH
ENTERED AT INS3 IS BEFORE JANUARY 1 OF THE CURRENT YEAR), GO
TO INS3A - DEASDATE ( INQ1210 ).
ELSE IF (INS1 - SPAISTATUS = 4/DeceasedInInstiute) AND (UTILIZATION IS
BEING COLLECTED FOR THE FIRST TIME IN THIS ROUND AND
PREVIOUS ROUND WAS NOT FACILITY INTERVIEW) AND (SP'S DATE OF
INSTITUTIONALIZATION ENTERED AT INS2 AND SP'S DATE OF DEATH
ENTERED AT INS3 ARE BOTH PRIOR TO JANUARY 1 OF CURRENT
YEAR), GO TO INS3A - DEASDATE ( INQ1210 ).
ELSE IF(INS1 - SPAISTATUS = 4/DeceasedInInstiute) AND (UTILIZATION IS
BEING COLLECTED FOR THE FIRST TIME IN THIS ROUND AND
PREVIOUS ROUND WAS NOT FACILITY INTERVIEW) AND (SP'S DATE OF
INSTITUTIONALIZATION ENTERED AT INS2 IS PRIOR TO JANUARY 1 OF
CURRENT YEAR) AND (SP'S DATE OF DEATH ENTERED AT INS3 IS ON
OR AFTER JANUARY 1 OF CURRENT YEAR), GO TO INS3A1 - INSTDATE
( INQ1221 ).
ELSE IF (INS1 - SPAISTATUS = 2/AliveAndInstitute) AND (UTILIZATION IS
BEING COLLECTED FOR THE FIRST TIME IN THIS ROUND AND
PREVIOUS ROUND WAS NOT FACILITY INTERVIEW) AND (SP'S DATE OF
INSTITUTIONALIZATION ENTERED AT INS2 IS BEFORE JANUARY 1 OF
THE CURRENT YEAR), GO TO INS3A1 - INSTDATE ( INQ1221 ).
ELSE GO TO BOX INS1 - (INQ1260 ).

ASSIGNMENTS

TECHNICAL NOTES
10

FirstUtilizationNotFac

Utilization being collected for the first time in this round
and previous round was not facility interview =
(MRES.INTTYPE=7/SupSmp1stTimeUtil or
MRES.NTTYPE=10/SupSmp1stTimeUtilSkipped) on
MRES where MRES.MRESRND = current round.

273

SPDateOfInstitute

SP's Date of Institutionalization =
On MRES where MRES.MRESRND = current round:
Month = MRES.SPINSTMM
Day = MRES.SPINSTDD
Year = MRES.SPINSTYY

274

SPDateOfDeath

SP's Date of Death =
On MRES where MRES.MRESRND = current round:
Month = MRES.SPDIEMM
Day = MRES.SPDIEDD
Year = MRES.SPDIEYY

DESIGN NOTES

4:45:45 PM Wednesday, January 28, 2009

Page 23 of 94

INS3A

INS3A

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

DEASDATE

Enable Functions:

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JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

170

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display the date of death from INS3 ­
SPDIEMM/SPDIEDD/SPDIEYY in "Month DD, YYYY" format.

Question display:

Display the word "NOT" in the second sentence in Bold.

Multi Field display:

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

TEXT:
Context Header:

DATE OF DEATH: (DATE OF DEATH)

Int. Instr I:

YOU HAVE ENTERED THAT THE SP, (SP), DIED BEFORE
JANUARY 1ST OF THIS YEAR. IF THIS IS NOT CORRECT, GO
TO THE PREVIOUS PAGE AND ENTER THE CORRECT DATE AT
INS3.
IF THIS IS CORRECT, YOU WILL NOT BE CONDUCTING THE
COMMUNITY INTERVIEW WITH THE RESPONDENT. GO TO THE
NEXT PAGE TO END THE INTERVIEW. THIS CASE WILL BE
CODED A 44 ON THE RECORD OF CALLS. DISCUSS THE CASE
WITH YOUR SUPERVISOR.

Question Text:
4:45:46 PM Wednesday, January 28, 2009

Page 24 of 94

INS3A
Int. Instr II:

INPUT FIELDS / ROUTING

DEASDATE

Field1:
Cheshire Name:

( INQ1210 )

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
INS3B - INTHANK ( INQ1230 )

English text: CONTINUE
Attribute
Empty

Route
INS3B - INTHANK ( INQ1230 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:45:48 PM Wednesday, January 28, 2009

Page 25 of 94

INS3A1

INS3A1

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

INSTDATE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

180

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display the date of institutionalization from INS2 ­
SPINSTMM/SPINSTDD/SPINSTYY in "Month DD, YYYY" format.

Question display:

Display the word "NOT" in the second sentence in Bold.

Multi Field display:

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

TEXT:
Context Header:

DATE OF INSTITUTIONALIZATION: (DATE OF
INSTITUTIONALIZATION)

Int. Instr I:

YOU HAVE ENTERED THAT THE SP, (SP), WAS
INSTITUTIONALIZED BEFORE JANUARY 1ST OF THIS YEAR. IF
THIS IS NOT CORRECT, GO TO THE PREVIOUS PAGE AND
ENTER THE CORRECT DATE AT INS2.
IF THIS IS CORRECT, YOU WILL NOT BE CONDUCTING THE
COMMUNITY INTERVIEW WITH THE RESPONDENT. THIS CASE
WILL BE CODED A 14 ON THE RECORD OF CALLS. DISCUSS
THE CASE WITH YOUR SUPERVISOR.

Question Text:
4:45:49 PM Wednesday, January 28, 2009

Page 26 of 94

INS3A1
AFTER CLICKING "NEXT PAGE", YOU WILL RETURN TO THE
IMS.

Int. Instr II:

INPUT FIELDS / ROUTING
INSTDATE

Field1:
Cheshire Name:

( INQ1221 )

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
INS3B - INTHANK ( INQ1230 )

English text: CONTINUE
Attribute
Empty

Route
INS3B - INTHANK ( INQ1230 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:45:51 PM Wednesday, January 28, 2009

Page 27 of 94

INS3B

INS3B

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

INTHANK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

190

Roster Name:
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:

I would like to thank you for your time and cooperation during this
interview. We may be contacting you in the future for further
information.

Int. Instr II:
INPUT FIELDS / ROUTING

4:45:52 PM Wednesday, January 28, 2009

Page 28 of 94

INS3B
INTHANK

Field1:
Cheshire Name:

( INQ1230 )

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
BOX INSB1 - (INQ1250 )

English text: CONTINUE
Attribute
Empty

Route
BOX INSB1 - (INQ1250 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:45:54 PM Wednesday, January 28, 2009

Page 29 of 94

BOX INSB1

BOX INSB1

Page Order # :

210

BOX INSTRUCTIONS
( INQ1250 )

GO TO END1 - INTLANG ( END1005 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:45:54 PM Wednesday, January 28, 2009

Page 30 of 94

BOX INS1

BOX INS1

Page Order # :

220

BOX INSTRUCTIONS
( INQ1260 )

IF SP IS DECEASED OR INSTITUTIONALIZED, SET RESPONDENT TO
PROXY AND GO TO IN4A - PERSON_PROXY ( INQ1305 ).
ELSE GO TO IN4 - SPPROXY ( INQ1290 ).

ASSIGNMENTS
MRES.SPALIVE is set at INS1. If MRES.SPALIVE =
2/AliveAndInstitute or 3/Deceased, set
MRES.SPPROXY=2/Proxy.

SPPROXY

TECHNICAL NOTES
8

DeceasedInst

SP deceased or institutionalized =
MRES.SPALIVE=2/AliveAndInstitute or 3/Deceased on
MRES where MRES.MRESRND = current round.

DESIGN NOTES

4:45:54 PM Wednesday, January 28, 2009

Page 31 of 94

IN4

IN4

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

SPPROXY

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

250

Roster Name:
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:

WILL THIS INTERVIEW BE CONDUCTED WITH THE SAMPLE
PERSON OR WITH A PROXY?

Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING

4:45:55 PM Wednesday, January 28, 2009

Page 32 of 94

IN4
SPPROXY

Field1:
Cheshire Name:

( INQ1290 )

MRES.SPPROXY

Item Text display:
Item Text:
Label:

Label Position:

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

Enumerated
TSpproxy
1
No
No

Number Label
1 Sp
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX INS2A - (INQ1300 )

English text: SAMPLE PERSON
Proxy

IN4A - PERSON_PROXY ( INQ1305 )

English text: PROXY

BACKGROUND VARIABLE ASSIGNMENTS
If respondent is the SP, code respondent number. See detailed instructions below.
RROSTNUM

If IN4 - SPPROXY=1/SP, set
MRES.RROSTNUM='01' for SP.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:45:56 PM Wednesday, January 28, 2009

Page 33 of 94

BOX INS2A

BOX INS2A

Page Order # :

260

BOX INSTRUCTIONS
( INQ1300 )

IF SP IS IN THE EXIT SAMPLE, GO TO BOX INS4A - (INQ1470 ).
ELSE GO TO BOX INS5 - (INQ1520 ).

ASSIGNMENTS

TECHNICAL NOTES
16

ExitSample

SP is in the Exit Sample =
(MRES.INTTYPE = 8/ExitInterviewHadPrev or
9/ExitInterviewSkipPrev) on MRES where
MRES.MRESRND = current round.

DESIGN NOTES

4:45:56 PM Wednesday, January 28, 2009

Page 34 of 94

IN4A

IN4A

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_PROXY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Name:

Person Roster

Roster Type:

Single Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
Yes

Grid Functions:

Add Line
Delete Line

No
No

270

Display as ' Add a Person '
Display as ' Edit a Person '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Roster/Grid Instructions:

Display all persons from Person Roster, except SP. Do not display
SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

First Name

Display ROST.ROSTFNAM.

2

Last Name

Display ROST.ROSTLNAM.

3

Relationship to SP

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:

Int. Instr I:

SELECT OR ADD THE NAME/RELATIONSHIP OF THE PROXY TO

4:45:57 PM Wednesday, January 28, 2009

Page 35 of 94

IN4A
THE SP FOR THIS INTERVIEW.
Question Text:
SELECT OR ADD ONLY ONE PERSON.

Int. Instr II:
INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PERSON_PROXY

( INQ1305 )

TEMP

Item Text display:
Item Text:
Label:

Label Position:

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

String
TRostPick8
1

No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:

8

Route
BOX INS2AA - (INQ1335 )

BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on ROST:

ROST key = ROST.ROSTBASE + ROST.ROSTNUM

ROST.ROSTNUM = Number of person selected at IN4A.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

Person selected at Person Roster is the current respondent. Store the respondent number

on MRES.RROSTNUM. See instructions below.

RROSTNUM

MRES.RROSTNUM=ROST.ROSTNUM of person
selected as proxy at IN4A.

ROSTREAS

If person added to person roster, set
ROST.ROSTREAS =2/PotentialProxy.

4:45:58 PM Wednesday, January 28, 2009

Page 36 of 94

IN4A
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:45:58 PM Wednesday, January 28, 2009

Page 37 of 94

BOX INS2AA

BOX INS2AA

Page Order # :

275

BOX INSTRUCTIONS
( INQ1335 )

IF PERSON IS ADDED AT IN4A, GO TO BOX INS2A-1 - (INQ1360 ).
ELSE GO TO IN5 - VRFYPROX ( INQ1340 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:45:58 PM Wednesday, January 28, 2009

Page 38 of 94

IN5

IN5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

VRFYPROX

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

280

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display proxy’s name and relationship to SP.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

I would like to verify your name and relationship to (SP). I have you
listed as [READ NAME AND RELATIONSHIP LISTED BELOW]. Is
that correct?
FIRST NAME: (PROXY'S FIRST NAME)
LAST NAME: (PROXY'S LAST NAME)
RELATIONSHIP: (PROXY'S RELATIONSHIP TO SP)

Int. Instr II:
4:45:58 PM Wednesday, January 28, 2009

Page 39 of 94

IN5
INPUT FIELDS / ROUTING
( INQ1340 )

VRFYPROX

Field1:
Cheshire Name:

TEMP

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

Enumerated
TYesNo

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Route
BOX INS2A-1 - (INQ1360 )

Number Label
1 Yes
2

English text: YES
No
English text: NO

IN6 - ROSTFNAM ( INQ1350 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
15

ProxyName

Proxy's name and relationship =
Stored on ROST where
ROST.ROSTNUM=MRES.RROSTNUM.
First Name: ROST.ROSTFNAM
Last Name: ROST.ROSTLNAM
Relationship: ROST.ROSTREL.
If ROST.ROSTREL=91/OtherRelative or 92/OtherNonRelative, Relationship=ROST.ROSTREOS.

DESIGN NOTES

4:46:00 PM Wednesday, January 28, 2009

Page 40 of 94

IN6

IN6

Page Order # :

Design Screen Type:

Text

Fields:

Field 1:

ROSTFNAM

Field 2:

ROSTLNAM

Field 3:

ROSTREL

Field 4:

ROSTREOS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No

No

No

No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

290

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Always display Question text in brackets.

Multi Field display:

Vertical Alignment
Display Field 1, 2 and 3 at one time. Display Field 4, Other Specify,
if previously collected ROST.ROSTREL = 91/OtherRelative or
92/OtherNonRelative.

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[What is your correct name and relationship to (SP)?]

Int. Instr II:

4:46:02 PM Wednesday, January 28, 2009

Page 41 of 94

IN6
INPUT FIELDS / ROUTING

Field1:
Cheshire Name:
Item Text display:

ROSTFNAM

( INQ1350 )

ROST.ROSTFNAM
Display Proxy's first name, ROST.ROSTFNAM, in input
field. Allow field to be updated.

Item Text:
Label:

Label Position:

FIRST NAME:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String
TRostlnam
1
No
No

Number Label
1 [Continuous answer.]
Field2:
Cheshire Name:
Item Text display:

ROSTLNAM

FieldSize:
Min Value:
Max Value:
Mask:

25

Route
IN6 - ROSTLNAM ( INQ1351 )
( INQ1351 )

ROST.ROSTLNAM
Display Proxy's last name, ROST.ROSTLNAM, in input
field. Allow field to be updated.

Item Text:
Label:

Label Position:

LAST NAME:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String
TRostlnam
1
No
No

Number Label
1 [Continuous answer.]

4:46:05 PM Wednesday, January 28, 2009

FieldSize:
Min Value:
Max Value:
Mask:

25

Route
IN6 - ROSTREL ( INQ1352 )

Page 42 of 94

IN6
ROSTREL

Field3:
Cheshire Name:
Item Text display:

( INQ1352 )

ROST.ROSTREL
Display Description text for Proxy's relationship code,

ROST.ROSTREL. Allow field to be updated.

Do not display option 1/SamplePerson.

Item Text:
Label:

Label Position:

RELATIONSHIP:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TRelaship
1
No
No

Number Label
1 SamplePerson

FieldSize:
Min Value:
Max Value:
Mask:

Route
DO NOT DISPLAY

2

English text: SAMPLE PERSON
Spouse

BOX INS2A-1 - (INQ1360 )

3

English text: SPOUSE
Son

BOX INS2A-1 - (INQ1360 )

5

English text: SON
Daughter
English text: DAUGHTER
Brother

6

English text: BROTHER
Sister

4

8

English text: SISTER
Father
English text: FATHER
Mother

9

English text: MOTHER
SonLaw

7

10
11

English text: SON-IN-LAW
DaughterLaw
English text: DAUGHTER-IN-LAW
Grandson

BOX INS2A-1 - (INQ1360 )
BOX INS2A-1 - (INQ1360 )
BOX INS2A-1 - (INQ1360 )
BOX INS2A-1 - (INQ1360 )
BOX INS2A-1 - (INQ1360 )
BOX INS2A-1 - (INQ1360 )
BOX INS2A-1 - (INQ1360 )
BOX INS2A-1 - (INQ1360 )

English text: GRANDSON

4:46:19 PM Wednesday, January 28, 2009

Page 43 of 94

IN6

12

Granddaughter

BOX INS2A-1 - (INQ1360 )

13

English text: GRANDDAUGHTER
Nephew

BOX INS2A-1 - (INQ1360 )

14

English text: NEPHEW
Niece

BOX INS2A-1 - (INQ1360 )

50

English text: NIECE
Partner

BOX INS2A-1 - (INQ1360 )

51

English text: PARTNER/ROOMMATE
Friendneighbor

BOX INS2A-1 - (INQ1360 )

52

English text: FRIEND/NEIGHBOR
Boarder

BOX INS2A-1 - (INQ1360 )

53

English text: BOARDER
NurseAide

BOX INS2A-1 - (INQ1360 )

54

English text: NURSE/NURSE'S AIDE
LegalOfficer

BOX INS2A-1 - (INQ1360 )

55

English text: LEGAL/FINANCIAL OFFICER
Guardian

BOX INS2A-1 - (INQ1360 )

91

English text: GUARDIAN
OtherRelative

IN6 - ROSTREOS ( INQ1353 )

92

English text: OTHER RELATIVE
OtherNonRelative
English text: OTHER NON-RELATIVE

Attribute
Don't know

Route
BOX INS2A-1 - (INQ1360 )

Refusal

BOX INS2A-1 - (INQ1360 )

4:46:27 PM Wednesday, January 28, 2009

IN6 - ROSTREOS ( INQ1353 )

Page 44 of 94

IN6
( INQ1353 )

ROSTREOS

Field4:
Cheshire Name:
Item Text display:

ROST.ROSTREOS
If Proxy's ROST.ROSTREL=91/OtherRelative or
92/OtherNon-relative , display Proxy's relationship other
specify text, ROST.ROSTREOS. Allow updates to field.
Display "(SPECIFY)" in the same blue font used for
interviewer instructions.

Item Text:

OTHER (SPECIFY)

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String
TOthrspec

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]

30

Route
BOX INS2A-1 - (INQ1360 )

BACKGROUND VARIABLE ASSIGNMENTS
If any part of name or relationship is updated, update Proxy's name and relationship on
ROST where ROST.ROSTNUM = MRES.RROSTNUM (respondent number). Store
changes to ROST on ADDR where ADDR.ADDRRNDC = current round and
ADDR.ADDRROST = Proxy's ROST.ROSTNUM. See detailed instructions below.
ROSTSEX

If IN6 - ROSTREL is updated and person's sex,
ROST.ROSTSEX, no longer matches relationship,
update ROST.ROSTSEX to match
ROST.ROSTREL. See general specifications for
setting ROST.ROSTSEX.

ROSTREOS

If IN6 - ROSTREL updated and (last
ROST.ROSTREL = 91/OtherRelative or
92/OtherNon-Relative) and (updated IN6 ­
ROSTREL ^=91/OtherRelative and IN6 - ROSTREL
^= 92/OtherNon-Relative), set
ROST.ROSTREOS=EMPTY.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
15

ProxyName

4:46:28 PM Wednesday, January 28, 2009

Proxy's name and relationship =

Stored on ROST where

Page 45 of 94

IN6
ROST.ROSTNUM=MRES.RROSTNUM.

First Name: ROST.ROSTFNAM

Last Name: ROST.ROSTLNAM

Relationship: ROST.ROSTREL.

If ROST.ROSTREL=91/OtherRelative or 92/OtherNon-

Relative, Relationship=ROST.ROSTREOS.

DESIGN NOTES

4:46:28 PM Wednesday, January 28, 2009

Page 46 of 94

BOX INS2A-1

BOX INS2A-1

Page Order # :

300

BOX INSTRUCTIONS
( INQ1360 )

IF SP IS INSTITUTIONALIZED, SET REASON WHY RESPONDENT IS
PROXY TO "SP IS INSTITUTIONALIZED" AND GO TO BOX INS3 (INQ1440 ).
ELSE IF SP IS DECEASED, SET REASON WHY RESPONDENT IS PROXY
TO "SP IS DECEASED" AND GO TO BOX INS3 - (INQ1440 ).
ELSE GO TO IN6A - WHYPROXY ( INQ1370 ).

ASSIGNMENTS
WHYPROXY

IF MRES.SPALIVE is set at INS1. If MRES.SPALIVE
= 2/AliveAndInstitute, set WHYPROXY to only
include 7/SPIsInstitute.
Else if MRES.SPALIVE=3/Deceased, set
WHYPROXY to only include 6/SPIsDeceased.

TECHNICAL NOTES
40

SPInstitute

SP is institutionalized =
MRES.SPALIVE=2/AliveAndInstitute on MRES where
MRES.MRESRND = current round.

41

SPDeceased

SP is deceased =
MRES.SPALIVE=3/Deceased on MRES where
MRES.MRESRND = current round.

DESIGN NOTES

4:46:28 PM Wednesday, January 28, 2009

Page 47 of 94

IN6A

IN6A

Page Order # :

Design Screen Type:

Code All

Fields:

Field 1:

WHYPROXY

Field 2:

PNSPOS

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

310

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

WHY IS A PROXY RESPONDENT NECESSARY?

Question Text:

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

4:46:30 PM Wednesday, January 28, 2009

Page 48 of 94

IN6A

4:46:35 PM Wednesday, January 28, 2009

Page 49 of 94

IN6A
WHYPROXY

Field1:
Cheshire Name:

( INQ1370 )

NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1/SpNotCapable=MRES.PNSPNAP

2/PsychiatricDisorder=MRES.PNSPNAM

3/MedicalRecords=MRES.PNSPNOK

4/SpInHospital=MRES.PNSPINH

5/LanguageProblem=MRES.PNSPLAN

6/SpIsDeceased=MRES.PNSPDED

7/SpIsInstitute=MRES.PNSPINS

8/SpNotAvailable=MRES.PNSPUNA

9/CodeReasonWhy=MRES.PNSPPAP

91/Pnspoth=MRES.PNSPOTH

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TWhyProxy
10
No
No

FieldSize:
Min Value:
Max Value:
Mask:

Number Label
1 SpNotCapable
2

Route
BOX INS2B - (INQ1400 )
English text: SP NOT CAPABLE PHYSICALLY/SICK/BLIND/CAN’T SPEAK/HEAR
PsychiatricDisorder
BOX INS2B - (INQ1400 )

3

English text: SP NOT CAPABLE MENTALLY/POOR MEMORY/PSYCHIATRIC DISORDER
MedicalRecords
BOX INS2B - (INQ1400 )

4

English text: SP UNABLE TO PROVIDE INFORMATION REGARDING MEDICAL RECORDS
SpInHospital
BOX INS2B - (INQ1400 )

5

English text: SP IN HOSPITAL
LanguageProblem

BOX INS2B - (INQ1400 )

English text: LANGUAGE PROBLEM

4:46:42 PM Wednesday, January 28, 2009

Page 50 of 94

IN6A

6

SpIsDeceased

BOX INS2B - (INQ1400 )

7

English text: SP IS DECEASED
SpIsInstitute

BOX INS2B - (INQ1400 )

8

English text: SP IS INSTITUTIONALIZED
SpNotAvailable

BOX INS2B - (INQ1400 )

9

English text: SP NOT AVAILABLE THIS ROUND
CodeReasonWhy
BOX INS2B - (INQ1400 )

91

English text: AUTHORIZED PROXY MUST ANSWER QUESTIONS FOR SP (CODE REASON
WHY)
Pnspoth
IN6A - PNSPOS ( INQ1390 )
English text: OTHER

Field2:
Cheshire Name:

PNSPOS

( INQ1390 )

MRES.PNSPOS

Item Text display:

Display "(SPECIFY)" in the same blue font used for

interviewer instructions.

Item Text:

OTHER (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
BOX INS2B - (INQ1400 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
Edit #1:

WHYPROXY ^= 6/SPIsDeceased.

If not true, display message: "REASON FOR PROXY DOES NOT

MATCH CURRENT SP STATUS. PLEASE SELECT ANOTHER

REASON OR UPDATE STATUS OF SP."

4:46:46 PM Wednesday, January 28, 2009

Page 51 of 94

IN6A
Edit #2:

WHYPROXY ^= 7/SPIsInstitute.

If not true, display message: "REASON FOR PROXY DOES NOT

MATCH CURRENT SP STATUS. PLEASE SELECT ANOTHER

REASON OR UPDATE STATUS OF SP."

TECHNICAL NOTES

DESIGN NOTES

4:46:46 PM Wednesday, January 28, 2009

Page 52 of 94

BOX INS2B

BOX INS2B

Page Order # :

320

BOX INSTRUCTIONS
( INQ1400 )

IF RESPONSE TO IN6a - WHYPROXY ONLY INCLUDES
9/CodeReasonWhy, GO TO IN6B - PNSPVB ( INQ1410 ).
ELSE GO TO BOX INS3 - (INQ1440 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:46:46 PM Wednesday, January 28, 2009

Page 53 of 94

IN6B

IN6B

Page Order # :

Design Screen Type:

Verbatim Text

Fields:

Field 1:

PNSPVB

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

330

Roster Name:
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:

BRIEFLY EXPLAIN WHY PROXY MUST ANSWER QUESTIONS.

Question Text:

Int. Instr II:

INPUT FIELDS / ROUTING

4:46:47 PM Wednesday, January 28, 2009

Page 54 of 94

IN6B

Field1:
Cheshire Name:

PNSPVB

( INQ1410 )

NONE
REPLACES CHESHIRE VARIALBLES:
MRES.PNSPVB1
MRES.PNSPVB2
MRES.PNSPVB3

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Open
TOpen270
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

135

Route
BOX INS3 - (INQ1440 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:46:47 PM Wednesday, January 28, 2009

Page 55 of 94

BOX INS3

BOX INS3

Page Order # :

340

BOX INSTRUCTIONS
( INQ1440 )

IF SP IS IN THE SUPPLEMENTAL SAMPLE AND IN6A - WHYPROXY =
6/SPIsDeceased, GO TO IN6B1 - SUPPDIED ( INQ1445 ).
ELSE IF SP IS IN THE SUPPLEMENTAL SAMPLE AND IN6A - WHYPROXY
= 7/SPIsInstitute, GO TO IN6B2 - SUPPINST ( INQ1450 ).
ELSE IF SP IS IN THE EXIT SAMPLE AND SP IS NOT DECEASED, GO TO
BOX INS4A - (INQ1470 ).
ELSE GO TO BOX INS5 - (INQ1520 ).

ASSIGNMENTS

TECHNICAL NOTES
16

ExitSample

SP is in the Exit Sample =
(MRES.INTTYPE = 8/ExitInterviewHadPrev or
9/ExitInterviewSkipPrev) on MRES where
MRES.MRESRND = current round.

59

SPStatus

SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.

DESIGN NOTES

4:46:47 PM Wednesday, January 28, 2009

Page 56 of 94

IN6B1

IN6B1

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

SUPPDIED

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

345

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "NOT" in second sentence in bold.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

YOU HAVE ENTERED THAT THE SP, (SP), IS DECEASED. IF
THIS IS NOT CORRECT, GO TO THE PREVIOUS PAGE AND
CORRECT YOUR RESPONSE AT IN6A.
WE DO NOT CONDUCT A COMMUNITY INTERVIEW WHEN THE
SUPPLEMENTAL SAMPLE SP IS DECEASED. IF WHAT YOU
HAVE ENTERED IS CORRECT, YOU WILL NOT BE CONDUCTING
THE INTERVIEW WITH THE RESPONDENT. GO TO THE NEXT
PAGE TO END THE INTERVIEW. THE CASE WILL BE CODED A
44 ON THE RECORD OF CALLS. DISCUSS THE CASE WITH
YOUR SUPERVISOR.

Question Text:
4:46:48 PM Wednesday, January 28, 2009

Page 57 of 94

IN6B1
Int. Instr II:

INPUT FIELDS / ROUTING

SUPPDIED

Field1:
Cheshire Name:

( INQ1445 )

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
IN6B3 - INTHANK2 ( INQ1455 )

English text: CONTINUE
Attribute
Empty

Route
IN6B3 - INTHANK2 ( INQ1455 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:46:50 PM Wednesday, January 28, 2009

Page 58 of 94

IN6B2

IN6B2

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

SUPPINST

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

350

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "NOT" in second sentence in Bold.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

YOU HAVE ENTERED THAT THE SP, (SP), IS
INSTITUTIONALIZED. IF THIS IS NOT CORRECT, GO TO THE
PREVIOUS PAGE AND CORRECT YOUR RESPONSE AT IN6A.
WE DO NOT CONDUCT A COMMUNITY INTERVIEW WHEN THE
SUPPLEMENTAL SAMPLE SP IS INSTITUTIONALIZED. IF WHAT
YOU HAVE ENTERED IS CORRECT, YOU WILL NOT BE
CONDUCTING THE INTERVIEW WITH THE RESPONDENT. GO
TO THE NEXT PAGE TO END THE INTERVIEW. THE CASE WILL
BE CODED A 14 ON THE RECORD OF CALLS. DISCUSS THE
CASE WITH YOUR SUPERVISOR.

Question Text:
4:46:51 PM Wednesday, January 28, 2009

Page 59 of 94

IN6B2
Int. Instr II:

INPUT FIELDS / ROUTING

SUPPINST

Field1:
Cheshire Name:

( INQ1450 )

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
IN6B3 - INTHANK2 ( INQ1455 )

English text: CONTINUE
Attribute
Empty

Route
IN6B3 - INTHANK2 ( INQ1455 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:46:53 PM Wednesday, January 28, 2009

Page 60 of 94

IN6B3

IN6B3

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

INTHANK2

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

355

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

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:

I would like to thank you for your time and cooperation during this
interview. We may be contacting you in the future for further
information.

Int. Instr II:
INPUT FIELDS / ROUTING

4:46:54 PM Wednesday, January 28, 2009

Page 61 of 94

IN6B3
INTHANK2

Field1:
Cheshire Name:

( INQ1455 )

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
BOX INS3A - (INQ1465 )

English text: CONTINUE
Attribute
Empty

Route
BOX INS3A - (INQ1465 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:46:56 PM Wednesday, January 28, 2009

Page 62 of 94

BOX INS3A

BOX INS3A

Page Order # :

365

BOX INSTRUCTIONS
( INQ1465 )

GO TO END1 - INTLANG ( END1005 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:46:56 PM Wednesday, January 28, 2009

Page 63 of 94

BOX INS4A

BOX INS4A

Page Order # :

370

BOX INSTRUCTIONS
( INQ1470 )

IF THIS IS A RESTART INTERVIEW AND CURRENT RESPONDENT IS THE
SAME AS THE LAST RESPONDENT AT THE TIME OF THE BREAKOFF, GO
TO BOX INS5 - (INQ1520 ).
ELSE IF THIS IS A RESTART INTERVIEW AND CURRENT RESPONDENT
IS NOT THE SAME AS THE LAST RESPONDENT AT THE TIME OF THE
BREAKOFF, GO TO INS6A - EXITINFR ( INQ1490 ).
ELSE GO TO INS6 - EXITINFO ( INQ1480 ).

ASSIGNMENTS

TECHNICAL NOTES
42

RestartInterview

If this is a restart interview =
MRES.EVRESTRT=1/Yes on MRES where
MRES.MRESRND = current round.

43

SameResp

When it's a restart interview, the last respondent #,
RROSTNUM, is stored on LASTRESP at BOX IN1 and is
used to compare the respondent information collected
before the last breakoff to the current respondent
information.

16

ExitSample

SP is in the Exit Sample =
(MRES.INTTYPE = 8/ExitInterviewHadPrev or
9/ExitInterviewSkipPrev) on MRES where
MRES.MRESRND = current round.

DESIGN NOTES
Only SPs in the Exit Sample get BOX INS4A, INS6, INS6A.

4:46:56 PM Wednesday, January 28, 2009

Page 64 of 94

INS6

INS6

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

EXITINFO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

380

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

In the first paragraph:
If respondent is proxy, display “for (SP)” .
Else do not display.
In the third paragraph:
If respondent is SP, display “with you”.
Else display “for (SP)”.

Multi Field display:

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

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

As you know from all of the interviews that we have conducted [for
(SP)], the Medicare Current Beneficiary Survey has been collecting
data from over 100,000 beneficiaries since 1991. Data from the
study have been extremely useful to many researchers who are
looking at the availability and the cost of medical care for people

4:46:57 PM Wednesday, January 28, 2009

Page 65 of 94

INS6
such as [you/(SP)].
At this time, the survey is going to start interviewing some new
beneficiaries and we will stop interviewing some of the people who
have been with the survey for quite some time. [You are/(SP) is] one
of the people that we will no longer interview.
Therefore, this will be the last interview that will be conducted [with
you/for (SP)]. I will not collect any new health care visit information.
However, I will collect outstanding medical cost information and we
will ask a series of income and assets questions. This will be a
shorter interview, different from most of the others conducted [for
(SP)].
Int. Instr II:

INPUT FIELDS / ROUTING

EXITINFO

Field1:
Cheshire Name:

( INQ1480 )

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
BOX IN8 - (INQ1695 )

English text: CONTINUE
Attribute
Empty

Route
BOX IN8 - (INQ1695 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

4:46:59 PM Wednesday, January 28, 2009

Page 66 of 94

INS6
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'.

19

ExitNotSkip

If SP is in the Exit Sample and previous round interview
not skipped =
MRES.INTTYPE=8/ExitInterviewHadPrev on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:46:59 PM Wednesday, January 28, 2009

Page 67 of 94

INS6A

INS6A

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

EXITINFR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

390

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If respondent is the SP, display “with you”.
Else display “for (SP).”
If SP is in the Exit Sample and previous round interview was not
skipped, display “This interview will be shorter than….".
Else do not display.

Multi Field display:

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

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

At this time, the survey is going to start interviewing some new
beneficiaries and we will stop interviewing some of the people who
have been with the survey for quite some time. [You are/(SP) is] one
of the people that we will no longer interview.
Therefore, this will be the last interview that will be conducted [with

4:47:00 PM Wednesday, January 28, 2009

Page 68 of 94

INS6A
you/for (SP)]. (This interview will be shorter than previous
interviews. Outstanding medical cost information will be collected,
and a final income and assets series will be completed.)
Int. Instr II:
INPUT FIELDS / ROUTING
( INQ1490 )

EXITINFR

Field1:
Cheshire Name:

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
BOX INS5 - (INQ1520 )

English text: CONTINUE
Attribute
Empty

Route
BOX INS5 - (INQ1520 )

BACKGROUND VARIABLE ASSIGNMENTS

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.

4:47:03 PM Wednesday, January 28, 2009

Page 69 of 94

INS6A
MRES.RROSTNUM='01'.
19

ExitNotSkip

If SP is in the Exit Sample and previous round interview
not skipped =
MRES.INTTYPE=8/ExitInterviewHadPrev on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:47:03 PM Wednesday, January 28, 2009

Page 70 of 94

BOX INS5

BOX INS5

Page Order # :

420

BOX INSTRUCTIONS
( INQ1520 )

IF THIS IS A RESTART INTERVIEW, GO TO BOX CEBEG - (CEQ1005 ).
ELSE IF (SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP IS NEW FROM
FACILITY), GO TO IN8 - CHEKBRTH ( INQ1530 ).
ELSE IF IT'S A FALL ROUND, GO TO BOX IN6 - (INQ1660 ).
ELSE GO TO BOX IN8 - (INQ1695 ).

ASSIGNMENTS

TECHNICAL NOTES
16

ExitSample

SP is in the Exit Sample =
(MRES.INTTYPE = 8/ExitInterviewHadPrev or
9/ExitInterviewSkipPrev) on MRES where
MRES.MRESRND = current round.

98

FallRound

If the remainder of (Current round divided by 3) = 1, then
it is a Fall round.

42

RestartInterview

If this is a restart interview =
MRES.EVRESTRT=1/Yes on MRES where
MRES.MRESRND = current round.

9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

25

NewFromFacility

SP is new from facility (i.e. all previous round interviews
were in a facility) =
MRES.INTTYPE=2/NewFromFacility on MRES where
MRES.MRESRND = current round.

DESIGN NOTES

4:47:03 PM Wednesday, January 28, 2009

Page 71 of 94

IN8

IN8

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

CHEKBRTH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

430

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display date of birth from CMS records,
BASE.SPDOBMM/BASE.SPDOBDD/BASE.SPDOBYY, in "Month
DD, YYYY" format.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

I have [your/(SP’s)] date of birth listed as (CMS BIRTH DATE). Is

that correct?

Int. Instr II:

INPUT FIELDS / ROUTING

4:47:04 PM Wednesday, January 28, 2009

Page 72 of 94

IN8
( INQ1530 )

CHEKBRTH

Field1:
Cheshire Name:

TEMP

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
IN10 - CHEKAGE ( INQ1600 )

English text: YES
No

IN9 - HHDOBMM ( INQ1540 )

English text: NO
Attribute
Don't know

Route
IN11 - ROSTSEX ( INQ1620 )

Refusal

IN11 - ROSTSEX ( INQ1620 )

BACKGROUND VARIABLE ASSIGNMENTS
IF IN8 - CHEKBRTH = 1/Yes, update date of birth on ROST with CMS date of birth. Update

ROST where ROST.ROSTNUM='01' for SP:

HHDOBMM

ROST.HHDOBMM=BASE.SPDOBMM.

HHDOBDD

ROST.HHDOBDD=BASE.SPDOBDD.

HHDOBYY

ROST.HHDOBYY=BASE.SPDOBYY.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
21

CMSBirthDate

CMS birth date for SP =
BASE.SPDOBMM, BASE.SPDOBDD, BASE.SPDOBYY.

DESIGN NOTES

4:47:06 PM Wednesday, January 28, 2009

Page 73 of 94

IN9

IN9

Page Order # :

Design Screen Type:

Date

Fields:

Field 1:

HHDOBMM

Field 2:

HHDOBDD

Field 3:

HHDOBYY

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No

No

No

No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

440

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Horizontal Alignment
Display all Fields at one time.

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

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

What is [your/(SP’s)] date of birth?

Int. Instr II:
INPUT FIELDS / ROUTING

4:47:08 PM Wednesday, January 28, 2009

Page 74 of 94

IN9
HHDOBMM

Field1:
Cheshire Name:

( INQ1540 )

ROST.HHDOBMM

Item Text display:
Item Text:
Label:
Label Position:

MM
Under

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

Integer
TMonthInt
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
IN9 - HHDOBDD ( INQ1550 )

Refusal

IN9 - HHDOBDD ( INQ1550 )

4:47:12 PM Wednesday, January 28, 2009

FieldSize:
Min Value:
Max Value:
Mask:

2
01
12

Route
IN9 - HHDOBDD ( INQ1550 )

Page 75 of 94

IN9
HHDOBDD

Field2:
Cheshire Name:

( INQ1550 )

ROST.HHDOBDD

Item Text display:
Item Text:
Label:
Label Position:

DD
Under

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

Integer
TDayDKRF
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
IN9 - HHDOBYY ( INQ1560 )

Refusal

IN9 - HHDOBYY ( INQ1560 )

4:47:15 PM Wednesday, January 28, 2009

FieldSize:
Min Value:
Max Value:
Mask:

2
1
31

Route
IN9 - HHDOBYY ( INQ1560 )

Page 76 of 94

IN9
HHDOBYY

Field3:
Cheshire Name:
Item Text display:

( INQ1560 )

ROST.HHDOBYY
Allow 2 or 4-digit year to be entered.

Item Text:
Label:
Label Position:

YYYY
Under

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

Integer
Tyear4DKRF
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
BOX IN3A - (INQ1565 )

Refusal

BOX IN3A - (INQ1565 )

FieldSize:
Min Value:
Max Value:
Mask:

4
1870
2009

Route
BOX IN3A - (INQ1565 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
Edit #1

IN9 - HHDOBYY should be on or between (current year - 110) and

(current year -7).

If not true, display message: "BIRTH YEAR SHOULD BE ON OR

BETWEEN (CURRENT YEAR -110) AND (CURRENT YEAR - 7).

PLEASE REENTER."

Display calculated values of (current year - 110) and (current year ­
7).

TECHNICAL NOTES

DESIGN NOTES

4:47:17 PM Wednesday, January 28, 2009

Page 77 of 94

BOX IN3A

BOX IN3A

Page Order # :

445

BOX INSTRUCTIONS
( INQ1565 )

IF SP'S DATE OF BIRTH MONTH, DAY OR YEAR COLLECTED AT IN9 = DK
OR RF, GO TO IN11 - ROSTSEX ( INQ1620 ).
ELSE GO TO IN10 - CHEKAGE ( INQ1600 ).

ASSIGNMENTS

TECHNICAL NOTES
101

SPDateofBirth

SP's Date of Birth is stored on ROST where
ROST.ROSTNUM='01'.
Month: ROST.HHDOBMM
Day: ROST.HHDOBDD
Year: ROST.HHDOBYY

DESIGN NOTES

4:47:17 PM Wednesday, January 28, 2009

Page 78 of 94

IN10

IN10

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

CHEKAGE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

450

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Calculate SP's age based on SP's date of birth and today's date.
See general specifications for calculating age. Display calculated
age.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

That makes [you/(SP)] (AGE) today. Is that correct?

Int. Instr II:

INPUT FIELDS / ROUTING

4:47:17 PM Wednesday, January 28, 2009

Page 79 of 94

IN10
( INQ1600 )

CHEKAGE

Field1:

TEMP

Cheshire Name:
Item Text display:
Item Text:
Label:

Label Position:

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

Enumerated
TYesNo

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 Yes
2

Route
IN11 - ROSTSEX ( INQ1620 )

English text: YES
No

IN9 - HHDOBMM ( INQ1540 )

English text: NO

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
101

SPDateofBirth

SP's Date of Birth is stored on ROST where
ROST.ROSTNUM='01'.
Month: ROST.HHDOBMM
Day: ROST.HHDOBDD
Year: ROST.HHDOBYY

DESIGN NOTES

4:47:19 PM Wednesday, January 28, 2009

Page 80 of 94

IN11

IN11

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

ROSTSEX

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

460

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display gender from CMS files, BASE.SPSEX.

If BASE.SPSEX=1/Male, display "MALE".
Else if BASE.SPSEX =2/Female, display "FEMALE".

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:

THE SP IS LISTED AS A (MALE/FEMALE). IF SEX IS OBVIOUS,
CODE BELOW WITHOUT ASKING. IF SEX IS NOT OBVIOUS,
ASK:

Question Text:

[Are you/Is (SP)] male or female?

Int. Instr II:
INPUT FIELDS / ROUTING

4:47:20 PM Wednesday, January 28, 2009

Page 81 of 94

IN11
ROSTSEX

Field1:

Cheshire Name:

Item Text display:

( INQ1620 )

ROST.ROSTSEX
DK and RF are valid attributes for ROST.ROSTSEX and
ENUM.HHPSEX in the Cheshire Database.
ROST.ROSTSEX is collected at IN11. ENUM.HHPSEX is
collected at ENS5 and EN4 and is then written to
ROST.ROSTSEX.
ENS5 and EN4 are specified with DK and RF as valid
response alternatives. However, we do not allow DK and
RF when collecting SP's gender. Therefore, IN11 is
specified with a hard edit, disallowing DK and RF.

Item Text:

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TSex
1
No
No

Number Label
1 Male
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX IN4 - (INQ1630 )

English text: MALE
Female

BOX IN4 - (INQ1630 )

English text: FEMALE
Attribute
Don't know

Route
Edits disallow DK.

Refusal
Edits disallow RF.
BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
Edit #1

IN11 - ROSTSEX ^= DK and ^= RF.

If not true, display message "INVALID RESPONSE. PLEASE

REENTER."

4:47:22 PM Wednesday, January 28, 2009

Page 82 of 94

IN11
TECHNICAL NOTES
102

CMSGender

CMS gender =
BASE.SPSEX.

DESIGN NOTES

4:47:22 PM Wednesday, January 28, 2009

Page 83 of 94

BOX IN4

BOX IN4

Page Order # :

470

BOX INSTRUCTIONS
( INQ1630 )

IF NOT MISSING GENDER FROM CMS FILES AND SP'S GENDER FROM
CMS DOES NOT MATCH GENDER ENTERED AT IN11 - ROSTSEX, GO TO
IN12 - CHNGSEX ( INQ1640 ).
ELSE GO TO BOX IN6 - (INQ1660 ).

ASSIGNMENTS

TECHNICAL NOTES
102

CMSGender

CMS gender =
BASE.SPSEX.

DESIGN NOTES

4:47:22 PM Wednesday, January 28, 2009

Page 84 of 94

IN12

IN12

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

CHNGSEX

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

480

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display gender from CMS files in first display, BASE.SPSEX:
If BASE.SPSEX = 1/Male, display "MALE"
Else if BASE.SPSEX = 2/Female, display "FEMALE".
Display gender entered at IN11 in second display:
If IN11 - ROSTSEX = 1/Male, display "MALE"
Else if IN11 - ROSTSEX = 2/Female, display "FEMALE".

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

YOU JUST CHANGED SP’S SEX FROM (MALE/FEMALE) TO

(FEMALE/MALE). DID YOU INTEND TO DO THAT?

Question Text:

4:47:23 PM Wednesday, January 28, 2009

Page 85 of 94

IN12
Int. Instr II:
INPUT FIELDS / ROUTING
( INQ1640 )

CHNGSEX

Field1:
Cheshire Name:

TEMP

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

Enumerated
TYesNo

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Route
BOX IN6 - (INQ1660 )

Number Label
1 Yes
2

English text: YES
No

IN11 - ROSTSEX ( INQ1620 )

English text: NO

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
102

CMSGender

CMS gender =
BASE.SPSEX.

DESIGN NOTES

4:47:24 PM Wednesday, January 28, 2009

Page 86 of 94

BOX IN6

BOX IN6

Page Order # :

500

BOX INSTRUCTIONS
( INQ1660 )

IF SP'S AGE IS > 16, DK OR RF, GO TO IN13 - SPMARSTA ( INQ1670 ).
ELSE GO TO BOX IN8 - (INQ1695 ).

ASSIGNMENTS

TECHNICAL NOTES
103

SPAge

SP's AGE is calculated based on SP's
ROST.HHDOBMM, ROST.HHDOBDD, ROST.HHDOBYY
and TODAY and is stored on ENUM.HHPAGE where
ENUM.ENUMRND = current round and
ENUM.ENUMROST = 01.

DESIGN NOTES

4:47:24 PM Wednesday, January 28, 2009

Page 87 of 94

IN13

IN13

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

SPMARSTA

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

510

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If INS1 - SPAISTATUS = 3/Deceased or 4/DeceasedInInstitute,
display "Was (SP)".
Else if (Supplemental Sample) and Proxy interview, display "Is (SP)".
Else if (Supplementa Sample) and SP interview, display "Are you".
Else if (not Supplemental Sample) and Proxy interview, display "Is
(SP) currently".
Else display "Are you currently".

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[Are you/Is (SP)/Was (SP)/Is (SP) currently/Are you currently]

married, widowed, divorced, separated, or never married?

Int. Instr II:

4:47:26 PM Wednesday, January 28, 2009

Page 88 of 94

IN13
INPUT FIELDS / ROUTING
SPMARSTA

Field1:
Cheshire Name:

( INQ1670 )

HRND.SPMARSTA

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

Enumerated
TSpmarsta
1
No
No

Number Label
1 Married

3

English text: MARRIED
Widowed
English text: WIDOWED
Divorced

4

English text: DIVORCED
Separated

2

5

English text: SEPARATED
NeverMarried
English text: NEVER MARRIED

Attribute
Don't know

Route
BOX IN7 - (INQ1680 )

Refusal

BOX IN7 - (INQ1680 )

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX IN7 - (INQ1680 )
BOX IN7 - (INQ1680 )
BOX IN7 - (INQ1680 )
BOX IN7 - (INQ1680 )
BOX IN7 - (INQ1680 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1
If HRND.SPMARSTA = 1/Married, 2/Widowed, 3/Divorced, or
4/Separated the last time it was asked, then IN13 - SPMARSTA
should ^=5/NeverMarried.
If not true, display message: “UNLIKELY RESPONSE. SP WAS
(MARRIED/WIDOWED/DIVORCED/SEPARATED) DURING A
PREVIOUS ROUND. PLEASE VERIFY. [PROBE GENTLY TO
4:47:30 PM Wednesday, January 28, 2009

Page 89 of 94

IN13
CONFIRM RESPONSE.]"
Display instructions for error message:
If last HRND.SPMARSTA = 1/Married, display "MARRIED".

Else if last HRND.SPMARSTA = 2/Widowed, display "WIDOWED".

Else if last HRND.SPMARSTA = 3/Divorced, display "DIVORCED".

Else if last HRND.SPMARSTA = 4/Separated, display

"SEPARATED".

HARD EDIT CHECKS

TECHNICAL NOTES
104

LastMaritalStatus

SP's last marital status is stored on the most recent
HRND where (HRND.HRNDRND < current round and
HRND.SPMARSTA ^= empty).

9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

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'.

DESIGN NOTES

4:47:30 PM Wednesday, January 28, 2009

Page 90 of 94

BOX IN7

BOX IN7

Page Order # :

520

BOX INSTRUCTIONS
( INQ1680 )

IF (SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP IS NEW FROM
FACILITY), GO TO IN14 - SPCHNLNM ( INQ1690 ).
ELSE GO TO BOX IN8 - (INQ1695 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

25

NewFromFacility

SP is new from facility (i.e. all previous round interviews
were in a facility) =
MRES.INTTYPE=2/NewFromFacility on MRES where
MRES.MRESRND = current round.

DESIGN NOTES

4:47:30 PM Wednesday, January 28, 2009

Page 91 of 94

IN14

IN14

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

SPCHNLNM

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

530

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

NOTE: Do not use global display fill logic for "[do you/does (SP)/did
(SP)]". Instead, use the following logic:
If INS1 - SPAISTATUS = 3/Deceased or 4/DeceasedInInstitute,
display "did (SP)".
Else if respondent is a proxy, display "does (SP)".
Else display "do you".

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Including natural, adopted, and stepchildren, how many living

children [did (SP)/does (SP)/do you] have?

Int. Instr II:

4:47:31 PM Wednesday, January 28, 2009

Page 92 of 94

IN14
INPUT FIELDS / ROUTING
SPCHNLNM

Field1:
Cheshire Name:

( INQ1690 )

HRND.SPCHNLNM

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

Integer
TSpchnlnm
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
BOX IN8 - (INQ1695 )

Refusal

BOX IN8 - (INQ1695 )

FieldSize:
Min Value:
Max Value:
Mask:

0
12

Route
BOX IN8 - (INQ1695 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:47:33 PM Wednesday, January 28, 2009

Page 93 of 94

BOX IN8

BOX IN8

Page Order # :

540

BOX INSTRUCTIONS
( INQ1695 )

GO TO NEXT SECTION .

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:47:33 PM Wednesday, January 28, 2009

Page 94 of 94