Address Verification and Household Enumeration Questionn

Attachment 3. CATI/CAPI Address Verification and Household Enumeration Questionnaire

1. ADDRESS VERIFICATION SECTION

1. May I speak to someone who is 18 years of age or older?

YES 1 GO TO INTRODUCTION FOR ASSIGNED MODE

NO – SET APPT 2 SET APPOINTMENT

NO – NO ONE 18+ 3

1a. Just to confirm, is there anyone living in this household who is 18 years of age or older?

YES 1

NO 2 GO TO Q9 AND EXIT INTERVIEW

1b. May I speak to the household member who is 18 years of age?

YES 1 GO TO Q2 (THIS PERSON IS HH R)

NO 2 EXIT/TRY TO ARRANGE FOLLOW-UP

INTERVIEWER NOTES:

1. ALL household members are 17 years of age or younger  Stop the interview. This is an ineligible household.

2. At least 1 household member is 18 or older  Screening must be completed with someone 18 or older.

2. For survey purposes, I need to confirm that I have the correct address. Is it [FILL ADDRESS]?

YES 1

NO 2 GO TO Q8 AND LOCATE RIGHT ADDRESS

3. Are there any other living quarters at this address or within this structure, such as a separate apartment with a separate entrance?

YES 1

NO 2 GO TO Q5

3a. How many additional living quarters are at this address?

[FILL ADDRESS FOR REFERENCE]

ENTER NUMBER [RANGE 1-4]

4. Do the occupants of the other living quarters live and eat separately from the residents of this household? PROBE IF NEEDED: In other words, do the occupants live on their own or do they share common space and food?

YES, OCCUPANTS LIVE SEPARATELY 1

NO, OCCUPANTS SHARE COMMON SPACE/ FOOD 2 GO TO Q5

4a. Do the occupants or intended occupants of the additional living quarters have direct access from the outside or through a common hall?

YES 1

NO 2

4b. How many occupants live in the separate living quarters?

ENTER NUMBER [RANGE 1-9]

5. Are you the person or one of the persons living at this address who owns or rents this home?

[FILL ADDRESS FOR REFERENCE]

YES 1 GO TO Q7 – DESIGNATED HH R

NO 2

6. For verification purposes, we need to collect your name and relationship to the person(s) who own(s) or rent(s) this home.

_____________________ REFERENCE PERSON NAME

_____________________ REFERENCE PERSON RELATIONSHIP

6a. Thank you for verifying those address questions. Can I now speak to the person or one of the persons who owns or rents this home?

YES 1 [ADMINISTER INTRODUCTION, EXPLAIN PURPOSE,

AND CAPTURE CONTACTING INFORMATION AT Q7

FOR THE PERSON WHO OWNS OR RENTS HOME]

NO 2 [SET APPOINTMENT OR ATTEMPT TO CONVERT

REFUSAL].

7. For verification purposes, we need to collect some brief contacting information. All information collected is completely confidential and will not be recorded or associated with your answers. Confidentiality of all answers to questions in this survey is protected under Federal law, U.S. Code, Title 13, Section 9 and 214.

Name (BCNAME_CV) – HOUSEHOLD RESPONDENT NAME

Title (BCTITL_CV) – HOUSEHOLD RESPONDENT TITLE

Phone Number (BCNUM_CV)

8. Thank you for answering our questions, but I have the wrong address. Have a nice day/evening.

9. Thank you for answering our questions, but we are only interviewing adults age 18 and older for this study. Have a nice day/evening.

2. CATI/CAPI HOUSEHOLD ENUMERATION SECTION

Now I would like to ask you a few questions about you and your household.

1. Including yourself, how many people 18 years of age or older are living or staying at this address? [FOR HOUSEHOLDS WITH ADDITIONAL LIVING QUARTERS – Q3=YES; FILL]: Please do not include persons who reside in separate living quarters at this address.

[FILL ADDRESS FOR REFERENCE]

ENTER NUMBER (UP TO 10 ADULTS)

ONSCREEN INTERVIEWER HELP TEXT:

• INCLUDE all persons 18 years of age or older, currently living at this address;

• INCLUDE all persons 18 years of age or older who usually live at this address, but who are temporarily away for reasons such as visiting friends or relatives, traveling for their jobs, or in “general” hospitals;

• INCLUDE any lodgers, servants, hired hands, and other persons who usually live at this address.

• DO NOT INCLUDE any persons who live in another dwelling unit at this address or within this structure, such as a separate apartment with a separate entrance.

2. Please provide the following information about yourself:

A

B

C

D

E

F

What is your first and last name?


What was your age at your last birthday?


What is your current marital
status?


What is your sex?



Are you Hispanic or Latino?


What is your race?
(Please select one or more.)


(Please enter)

First Name

Last Name

Age
(in years)

₁Married

₂Widowed

₃Divorced

₄Separated

₅Never married

₁ Male

₂Female

₁ Yes

₂ No

₁ White

₂ Black or African American

₃ Asian

₄ Native Hawaiian or other Pacific Islander

₅ American Indian or Alaska Native

3. [IF MORE THAN ONE ADULT IN THE HOUSEHOLD, ADMINISTER NEXT QUESTION TO HOUSEHOLD REPONDENT ONLY.] Now I have some questions about the other adults age 18 and older in your household. Let's start with the oldest and work down to the youngest adult in this household.

A

B

C

D

What is [his/her] first and last name?


What is [his/her] relationship to you?


What was [his/her] age at [his/her] last birthday?


What is [his/her] sex?



(Please print)

First Name

Last Name

₁Husband/Wife

₂Son/Daughter

₃Father/Mother

₄Brother/Sister

₅Other Relative

₆Not a Relative

Age
(in years)

₁ Male

₂Female

4. You’ve named the following individuals (confirm names in grid). Is there anybody else 18 years of age or older living or staying at this address?

YES 1 GO TO HHLD_AGE AND CORRECT COUNT; ENTER NEW INFO

NO 2 GO TO Q HHR_12-17

5. How many children 12-17 years of age are living or staying at this address? Please enter 0 if there are no children 12-17 years of age at this address.

CHILDREN 12-17 YEARS OF AGE

6. How many children under 12 years of age are living or staying at this address?

CHILDREN UNDER 12 YEARS OF AGE

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