Form 6.1 Survey

OMB #: 0925-0593

OMB Expiration Date: 07/31/ 2013

Tracing Interview, Phase 2e

Tracing Interview

Event:	All
Participant:	Pregnant Woman, Non-Pregnant Woman, Mother, Father, Caregiver
Respondent:	Pregnant Woman, Non-Pregnant Woman, Mother, Father, Caregiver
Domain:	Questionnaire
Type of Document:	Interview
Allowable Mode:	In Person, Telephone, Mail, Web
Allowable Method:	CAPI/CATI
Recruitment Groups:	EH, PB, HI, LI, PBS
Version:	1.0
Release:	MDES 3.0

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Tracing Interview

TABLE OF CONTENTS

Tracing Interview

1

Tracing Interview

(TIME_STAMP_TR_ST) PROGRAMMER INSTRUCTION:

• INSERT DATE/TIME STAMP

TR001. The next set of questions asks about different ways we might be able to keep in touch with you. Please remember that all the information you provide is confidential and will not be provided to anyone outside the National Children’s Study.

PROGRAMMER INSTRUCTIONS:

• IF EVENT_TYPE = BIRTH, 3 MONTH, 9 MONTH, 18 MONTH, OR 24 MONTH, GO STREET_ADDRESS_VARIABLES.

• OTHERWISE, IF EVENT_TYPE = PREGNANCY SCREENING, PRE-PREGNANCY VISIT, PREGNANCY VISIT 1, PREGNANCY VISIT 2, 6 MONTH, 12 MONTH, 30 MONTH, OR 36 MONTH, GO TO PLAN_MOVE.

TR010/(STREET_ADDRESS_VARIABLES). Let me confirm your street address. I have it as {PARENT/CAREGIVER’S ADDRESS}/{What is your street address?}.

INTERVIEWER INSTRUCTION:

• MAKE CORRECTIONS TO ADDRESS AS NEEDED.

• PROBE AND ENTER AS MUCH INFORMATION AS RESPONDENT KNOWS.

__________________________________________________

(ADDRESS_1) ADDRESS 1 - STREET/PO BOX

(ADDRESS_2) ADDRESS 2

(UNIT) UNIT

(CITY) CITY

|___|___| |___|___|___|___|___| |___|___|___|___

STATE ZIP CODE ZIP+4

(STATE) (ZIP) (ZIP4)

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF STREET ADDRESS VARIABLES COLLECTED PREVIOUSLY FOR (R_FNAME)(R_MNAME)(R_LNAME) AND VALID STREET ADDRESS PROVIDED, PRELOAD VALID STREET ADDRESS FROM MOST RECENT INTERVIEW AND DISPLAY “Let me confirm your street address. I have it as {PARENT/CAREGIVER’S ADDRESS}”.

• OTHERWISE, IF STREET ADDRESS VARIABLES NOT COLLECTED PREVIOUSLY FOR (R_FNAME)(R_MNAME)(R_LNAME) OR VALID STREET ADDRESS IS NOT AVAILABLE, DISPLAY “What is your street address?”.

• ALLOW INTERVIEWER TO MAKE CORRECTIONS OR ADD NEW ADDRESS INFORMATION.

TR020/(PLAN_MOVE). Do you plan on moving from your present address in the next few months?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF PLAN_MOVE = 1, GO TO WHERE_MOVE.

• OTHERWISE, IF PLAN_MOVE = 2, -1, OR -2, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING DATE_MOVE.

TR030/(WHERE_MOVE). Do you know where you will be moving?

YES 1

NO 2 (WHEN_MOVE)

REFUSED -1 (WHEN_MOVE)

DON’T KNOW -2 (WHEN_MOVE)

TR040/(MOVE_INFO). What is the address of your new home?

ADDRESS KNOWN 1

OUT OF THE COUNTRY 2 (WHEN_MOVE)

PO BOX ADDRESS ONLY 3

REFUSED -1 (WHEN_MOVE)

DON’T KNOW -2 (WHEN_MOVE)

TR050/(NEW_ADDRESS_ID). ENTER ADDRESS

INTERVIEWER INSTRUCTION:

• PROBE AND ENTER AS MUCH INFORMATION AS RESPONDENT KNOWS.

(NEW_ADDRESS1) ADDRESS 1 - STREET/PO BOX

(NEW_ADDRESS2) ADDRESS 2

(NEW_UNIT) UNIT

(NEW_CITY) CITY

|___|___| |___|___|___|___|___| |___|___|___|___

STATE ZIP CODE ZIP+4

(NEW_STATE) (NEW_ZIP) (NEW_ZIP4)

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTION:

• IF DU_ELIG_CONFIRM COLLECTED IN PREGNANCY SCREENER (DURING CURRENT OR PREVIOUS INTERVIEW) AND DU_ELIG_CONFIRM = 3 AND NEW INFORMATION IS RECORDED IN STREET ADDRESS VARIABLES OR NEW_ADDRESS_ID, UPDATE DU_ELIG_CONFIRM TO REFLECT THIS INFORMATION.

TR060/(WHEN_MOVE). Do you know when you will be moving?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF WHEN_MOVE = 1, GO TO DATE_MOVE.

• OTHERWISE, IF WHEN_MOVE = 2, -1, OR -2, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING DATE_MOVE.

TR070/(DATE_MOVE). When will you move?

MONTH:

|___|___|

M M

REFUSED -1

DON’T KNOW -2

YEAR:

|___|___|___|___|

Y Y Y Y

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• FORMAT DATE_MOVE AS YYYYMM.

• IF HOME_PHONE COLLECTED PREVIOUSLY FOR (R_FNAME)(R_MNAME)(R_LNAME) AND VALID RESPONSE PROVIDED, GO TO HOME_PHONE_CONFIRM.

• OTHERWISE, GO TO HOME_PHONE.

TR080/(HOME_PHONE_CONFIRM). Let me confirm your home phone number. I have it as {HOME PHONE NUMBER}. Is this correct?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

RESPONDENT NO LONGER HAS A HOME PHONE -7

PROGRAMMER INSTRUCTIONS:

• PRELOAD HOME PHONE NUMBER FROM MOST RECENT INTERVIEW FOR (R_FNAME)(R_MNAME)(R_LNAME).

• IF HOME_PHONE_CONFIRM = 1, -1, OR -7, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING HOME_PHONE.

• OTHERWISE, IF HOME_PHONE_CONFIRM =2 OR -2, GO TO HOME_PHONE.

TR090/(HOME_PHONE). What is your home phone number?

INTERVIEWER INSTRUCTION:

• ENTER PHONE NUMBER AND CONFIRM.

|___|___|___| - |___|___|___| - |___|___|___|___|

REFUSED -1

DON’T KNOW -2

RESPONDENT HAS NO HOME PHONE -7

PROGRAMMER INSTRUCTIONS:

• IF CELL_PHONE COLLECTED PREVIOUSLY FOR CURRENT (R_FNAME)(R_MNAME)(R_LNAME) AND VALID RESPONSE PROVIDED, GO TO CELL_PHONE_CONFIRM.

• OTHERWISE, GO TO CELL_PHONE.

TR100/(CELL_PHONE_CONFIRM). Let me confirm your cell phone number. I have it as {CELL PHONE NUMBER}. Is this correct?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

RESPONDENT NO LONGER HAS A CELL PHONE -7

PROGRAMMER INSTRUCTIONS:

• PRELOAD CELL PHONE NUMBER FROM MOST RECENT INTERVIEW FOR CURRENT (R_FNAME)(R_MNAME)(R_LNAME).

• IF CELL_PHONE_CONFIRM = 1 AND CELL_PHONE_2 COLLECTED PREVIOUSLY AND VALID RESPONSE PROVIDED, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CELL_PHONE_2.

• IF CELL_PHONE_CONFIRM = -1 OR -7, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CELL_PHONE_4.

• IF CELL_PHONE_CONFIRM = 2 OR -2, GO TO CELL_PHONE.

• OTHERWISE, GO TO CELL_PHONE_2.

TR110/(CELL_PHONE). What is your cell phone number?

INTERVIEWER INSTRUCTION:

• ENTER PHONE NUMBER AND CONFIRM.

|___|___|___| - |___|___|___| - |___|___|___|___|

REFUSED -1

DON’T KNOW -2

RESPONDENT HAS NO CELL PHONE ...-7

PROGRAMMER INSTRUCTIONS:

• IF VALID RESPONSE PROVIDED, GO TO CELL_PHONE_2.

• OTHERWISE, IF CELL_PHONE = -1, -2, OR -7, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CELL_PHONE_4.

TR120/(CELL_PHONE_2). May we use your personal cell phone to make future study appointments or for appointment reminders?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

TR130/(CELL_PHONE_3). Do you send and receive text messages on your personal cell phone?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF CELL_PHONE_3 = 2, -1, OR -2, OR

• IF CELL_PHONE_4 COLLECTED PREVIOUSLY AND VALID RESPONSE PROVIDED, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CELL_PHONE_4.

• OTHERWISE, GO TO CELL_PHONE_4.

TR140/(CELL_PHONE_4). May we send text messages to make future study appointments or for appointment reminders?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF EVENT = PRE-PREGNANCY VISIT, PREGNANCY VISIT 1, PREGNANCY VISIT 2, 6 MONTH, OR 12 MONTH:

  • IF EMAIL COLLECTED PREVIOUSLY AND VALID RESPONSE PROVIDED, GO TO EMAIL_CONFIRM.

  • OTHERWISE, GO TO EMAIL.

• OTHERWISE, IF EVENT = PREGNANCY SCREENING, 3 MONTH, 9 MONTH, 18 MONTH, 24 MONTH, 30 MONTH, OR 36 MONTH, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING PREV_CITIES_ADDRESS.

• IF EVENT = BIRTH, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CONTACT_PHONE_3.

TR150/(EMAIL_ CONFIRM). Let me confirm your email address. I have it as {EMAIL ADDRESS}. Is this correct?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

RESPONDENT NO LONGER HAS AN EMAIL ACCOUNT -7

PROGRAMMER INSTRUCTIONS:

• PRELOAD EMAIL ADDRESS FROM MOST RECENT INTERVIEW FOR CURRENT (R_FNAME)(R_MNAME)(R_LNAME).

• IF EMAIL_CONFIRM = 1 AND EMAIL_APPT COLLECTED PREVIOUSLY AND VALID RESPONSE PROVIDED, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING EMAIL_APPT.

• IF EMAIL_CONFIRM = -1 OR -7, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING EMAIL_QUEST.

• IF EMAIL_CONFIRM = 2 OR -2, GO TO EMAIL.

• OTHERWISE, GO TO EMAIL_APPT.

TR160/(EMAIL). What is the best email address to reach you?

ENTER E-MAIL ADDRESS:

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• SHOW EXAMPLE OF VALID EMAIL ADDRESS SUCH AS [email protected].

• IF EMAIL = -1, -2, OR -7, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING EMAIL_QUEST.

• IF EMAIL_APPT COLLECTED PREVIOUSLY AND VALID RESPONSE PROVIDED, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING EMAIL_APPT.

• OTHERWISE, GO TO EMAIL_APPT.

TR170/(EMAIL_APPT). May we use your personal email address to make future Study appointments or send appointment reminders?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF EMAIL_APPT = 2, -1, OR -2, OR

• IF EMAIL_QUEST COLLECTED PREVIOUSLY AND VALID RESPONSE PROVIDED, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING EMAIL_QUEST.

• OTHERWISE, GO TO EMAIL_QUEST.

TR180/(EMAIL_QUEST). May we use your personal email address for questionnaires that you can answer over the internet?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF EVENT_TYPE = PRE-PREGNANCY VISIT, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CONTACT_PHONE_3.

• IF EVENT = PREGNANCY VISIT 1, PREGNANCY VISIT 2, 6 MONTH, OR 12 MONTH, AND:

• VALID CONTACT INFORMATION PROVIDED PREVIOUSLY FOR (R_FNAME)(R_MNAME)(R_LNAME), GO TO COMM_CONTACT.

• OTHERWISE, GO TO TR190.

• OTHERWISE, IF EVENT_TYPE = 18 MONTH, 24 MONTH, 30 MONTH, OR 36 MONTH, GO TO TIME_STAMP_TR_ET.

TR190. Sometimes if people move or change their telephone number we have difficulty reaching them. We would like the name and contact information for a relative who does not live with you but would always know how to reach you. (CONTACT_1)

TR200/(COMM_CONTACT). In the past, we asked for contact information for three relatives or friends not living with you who would know where you could be reached in case we have trouble contacting you. Has that information changed since our last visit?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF COMM_CONTACT = 1, GO TO CONTACT_1.

• OTHERWISE, IF COMM_CONTACT = 2, -1, OR -2, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CONTACT_PHONE_3.

TR210/(CONTACT_1). Could I have the name of a relative not currently living with you who should know where you could be reached in case we have trouble contacting you?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

DOES NOT HAVE ANY RELATIVES -7

PROGRAMMER INSTRUCTIONS:

• IF CONTACT_1 = 1, GO TO (CONTACT_FNAME_1)(CONTACT_LNAME_1).

• IF CONTACT_1 = 2, -1, OR -2, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CONTACT_PHONE_3.

• OTHERWISE, IF CONTACT_1 = -7, GO TO CONTACT_FRND.

TR220/(CONTACT_FRND). Could you give me the name and contact information for a friend who does not live with you but would always know how to reach you?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF CONTACT_FRND = 1, GO TO (CONTACT_FNAME_1)(CONTACT_LNAME_1).

• OTHERWISE, IF CONTACT_FRND = 2, -1, OR -2, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CONTACT_PHONE_3.

TR230/(CONTACT_FNAME_1)/(CONTACT_LNAME_1). What is this person’s name?

INTERVIEWER INSTRUCTIONS:

• IF RESPONDENT DOES NOT WANT TO PROVIDE NAME OF CONTACT, ASK FOR INITIALS

• CONFIRM SPELLING OF FIRST AND LAST NAMES.

_________________________ _________________________

FIRST NAME LAST NAME

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTION:

• LIMIT FREE TEXT TO 255 CHARACTERS.

TR240/(CONTACT_RELATE_1). What is [his/her] relationship to you?

MOTHER/FATHER 1 (CONTACT_ADDR_1)

BROTHER/SISTER 2 (CONTACT_ADDR_1)

AUNT/UNCLE 3 (CONTACT_ADDR_1)

GRANDPARENT 4 (CONTACT_ADDR_1)

NEIGHBOR 5 (CONTACT_ADDR_1)

FRIEND 6 (CONTACT_ADDR_1)

OTHER -5

REFUSED -1 (CONTACT_ADDR_1)

DON’T KNOW -2 (CONTACT_ADDR_1)

TR250/(CONTACT_RELATE1_OTH).

SPECIFY _____________________________

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTION:

• LIMIT FREE TEXT TO 255 CHARACTERS.

TR260/(CONTACT_ADDR_1). What is [his/her] address?

INTERVIEWER INSTRUCTIONS:

• PROMPT AS NECESSARY TO COMPLETE INFORMATION

____________________________________________________

STREET (C_ADDR1_1)/(C_ADDR_2_1)/(C_UNIT_1)

____________________________________________________

CITY (C_CITY_1)

|___|___| |___|___|___|___|___|

STATE ZIP CODE

(C_STATE_1) (C_ZIPCODE_1) (C_ZIP4_1)

REFUSED -1

DON’T KNOW -2

TR270/(CONTACT_PHONE_1). What is [his/her] telephone number?

INTERVIEWER INSTRUCTION:

• IF CONTACT HAS NO TELEPHONE, ASK FOR TELEPHONE NUMBER WHERE HE/SHE RECEIVES CALLS.

|___|___|___|___|___|___|___|___|___|___|

PHONE NUMBER

REFUSED -1

DON’T KNOW -2

CONTACT HAS NO TELEPHONE -7

TR280/(CONTACT_FNAME_2) (CONTACT_LNAME_2). Now I’d like to collect information on a second contact who does not currently live with you. What is this person’s name?

INTERVIEWER INSTRUCTIONS:

• IF RESPONDENT DOES NOT WANT TO PROVIDE NAME OF CONTACT, ASK FOR INITIALS.

• CONFIRM SPELLING OF FIRST AND LAST NAMES.

______________ __________________

FIRST NAME LAST NAME

REFUSED -1

DON’T KNOW -2

NO SECOND CONTACT PROVIDED -7

PROGRAMMER INSTRUCTIONS:

• IF VALID RESPONSE PROVIDER FOR (CONTACT_FNAME_2)(CONTACT_LNAME_2), GO TO (CONTACT_RELAT_2).

• OTHERWISE, IF (CONTACT_FNAME_2)(CONTACT_LNAME_2) = 2, -1, OR -2, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CONTACT_PHONE_3.

TR290/(CONTACT_RELATE_2). What is [his/her] relationship to you?

MOTHER/FATHER 1 (CONTACT_ADDR_2)

BROTHER/SISTER 2 (CONTACT_ADDR_2)

AUNT/UNCLE 3 (CONTACT_ADDR_2)

GRANDPARENT 4 (CONTACT_ADDR_2)

NEIGHBOR 5 (CONTACT_ADDR_2)

FRIEND 6 (CONTACT_ADDR_2)

OTHER -5

REFUSED -1 (CONTACT_ADDR_2)

DON’T KNOW -2 (CONTACT_ADDR_2)

TR300/(CONTACT_RELATE2_OTH).

SPECIFY _____________________________

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTION:

• LIMIT FREE TEXT TO 255 CHARACTERS.

TR310/(CONTACT_ADDR_2). What is [his/her] address?

INTERVIEWER INSTRUCTIONS:

• PROMPT AS NECESSARY TO COMPLETE INFORMATION

_____________________________________________________

STREET (C_ADDR1_2)/(C_ADDR_2_2)/(C_UNIT_2)

_____________________________________________________

CITY (C_CITY_2)

|___|___| |___|___|___|___|___|

STATE ZIP CODE

(C_STATE_2) (C_ZIPCODE_2) (C_ZIP4_2)

REFUSED -1

DON’T KNOW -2

TR320/(CONTACT_PHONE_2). What is his/her telephone number?

INTERVIEWER INSTRUCTION:

• IF CONTACT HAS NO TELEPHONE, ASK FOR TELEPHONE NUMBER WHERE HE/SHE RECEIVES CALLS

|___|___|___|___|___|___|___|___|___|___|

PHONE NUMBER

REFUSED -1

DON’T KNOW -2

CONTACT HAS NO TELEPHONE -7

TR330/(CONTACT_FNAME_3) (CONTACT_LNAME_3). Now I’d like to collect information on a third contact who does not currently live with you. What is this person’s name?

INTERVIEWER INSTRUCTIONS:

• IF RESPONDENT DOES NOT WANT TO PROVIDE NAME OF CONTACT, ASK FOR INITIALS

• CONFIRM SPELLING OF FIRST AND LAST NAMES.

______________ __________________

FIRST NAME LAST NAME

REFUSED -1

DON’T KNOW -2

NO THIRD CONTACT PROVIDED -7

PROGRAMMER INSTRUCTIONS:

• IF VALID RESPONSE PROVIDER FOR (CONTACT_FNAME_3)(CONTACT_LNAME_3), GO TO (CONTACT_RELAT_3).

• OTHERWISE, IF (CONTACT_FNAME_3)/(CONTACT_LNAME_3) = 2, -1, -2, OR -7 GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CONTACT_PHONE_3.

TR340/(CONTACT_RELATE_3). What is [his/her] relationship to you?

MOTHER/FATHER 1 (CONTACT_ADDR_3)

BROTHER/SISTER 2 (CONTACT_ADDR_3)

AUNT/UNCLE 3 (CONTACT_ADDR_3)

GRANDPARENT 4 (CONTACT_ADDR_3)

NEIGHBOR 5 (CONTACT_ADDR_3)

FRIEND 6 (CONTACT_ADDR_3)

OTHER -5

REFUSED -1 (CONTACT_ADDR_3)

DON’T KNOW -2 (CONTACT_ADDR_3)

TR350/(CONTACT_RELATE3_OTH).

SPECIFY _____________________________

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTION:

• LIMIT FREE TEXT TO 255 CHARACTERS.

TR360/(CONTACT_ADDR_3). What is [his/her] address?

INTERVIEWER INSTRUCTIONS:

• PROMPT AS NECESSARY TO COMPLETE INFORMATION

_____________________________________________________

STREET (C_ADDR1_3)/(C_ADDR_2_3)/(C_UNIT_3)

_____________________________________________________

CITY (C_CITY_3)

|___|___| |___|___|___|___|___|

STATE ZIP CODE

(C_STATE_3) (C_ZIPCODE_3) (C_ZIP4_3)

REFUSED -1

DON’T KNOW -2

TR370/(CONTACT_PHONE_3). What is [his/her] telephone number?

INTERVIEWER INSTRUCTION:

• IF CONTACT HAS NO TELEPHONE, ASK FOR TELEPHONE NUMBER WHERE HE/SHE RECEIVES CALLS

|___|___|___|___|___|___|___|___|___|___|

PHONE NUMBER

REFUSED -1

DON’T KNOW -2

CONTACT HAS NO TELEPHONE -7

PROGRAMMER INSTRUCTIONS:

• IF EVENT_TYPE = PRE-PREGNANCY VISIT, OR

• EVENT_TYPE = PREGNANCY VISIT 1 AND PRE-PREGNANCY VISIT NOT SET TO COMPLETE,

• OR EVENT_TYPE = BIRTH AND PRE-PREGNANCY VISIT AND PREGNANCY VISIT 1 NOT SET TO COMPLETE, GO TO PREV_CITY.

• OTHERWISE, GO TO TIME_STAMP_TR_ET.

TR380/(PREV_CITY). In the past three years have you lived in any city or town other than {CITY}?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTUCTIONS:

• PRELOAD CITY FROM MOST RECENT INTERVIEW FOR (R_FNAME)(R_MNAME)(R_LNAME).

• IF PREV_CITY = 1, GO TO (PREV_CITIES_ADDRESS).

• OTHERWISE, IF PREV_CITY = 2, -1, OR -2, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING (PREV_CITIES_ADDRESS).

TR390/(PREV_CITIES_ADDRESS). In what cities or towns did you live?

INTERVIEW INSTRUCTION:

• RECORD THE THREE MOST RECENT CITIES/TOWNS AND STATES IN WHICH PARTICIPANT HAS LIVED.

_______________________ _______________________

PREVIOUS CITY 1 PREVIOUS STATE 1

(CITY_PREV1) (STATE_PREV1)

_______________________ _______________________

PREVIOUS CITY 2 PREVIOUS STATE 2

(CITY_PREV2) (STATE_PREV2)

_______________________ _______________________

PREVIOUS CITY 3 PREVIOUS STATE 3

(CITY_PREV3) (STATE_PREV3)

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• DO NOT ALLOW CITY_PREV2 OR STATE_PREV2 TO BE FILLED UNLESS CITY_PREV1 AND/OR STATE_PREV1 FILLED.

• DO NOT ALLOW CITY_PREV3 OR STATE_PREV3 TO BE FILLED UNLESS CITY_PREV2 AND STATE_PREV2 FILLED.

• IF (DR_LICENSE_STATE)/ (DR_LICENSE_NUM) SET TO COMPLETE FOR (R_FNAME)(R_MNAME)(R_LNAME), GO TO TIME_STAMP_TR_ET.

• IF (DR_LICENSE_STATE)/ (DR_LICENSE_NUM) NOT SET TO COMPLETE FOR CURRENT (R_FNAME)(R_MNAME)(R_LNAME), GO TO (DR_LICENSE_STATE)/(DR_LICENSE_NUM).

TR400/(DR_LICENSE_STATE)/(DR_LICENSE_NUM). What is your driver’s license number? Again, this will only be used to help us stay in touch with you if you move.

INTERVIEWER INSTRUCTION:

• RECORD STATE AND LICENSE NUMBER FOR RESPONDENT.

|___|___|

STATE

|___|___|___|___|___|___|___|___|___|___|___|___|___|

LICENSE NUMBER

REFUSED -1

DON’T KNOW -2

DOES NOT HAVE A DRIVER’S LICENSE -7

PROGRAMMER INSTRUCTIONS:

• DISPLAY EXAMPLE OF VALID LICENSE NUMBER FOR STATE ENTERED.

• DISPLAY APPROPRIATE NUMBER OF ALPHA AND NUMERIC VALUES FOR LICENSE NUMBER PER LICENSE FORMAT FOR STATE ENTERED.

• DISPLAY HARD EDIT ERROR IF INTERVIEWER ATTEMPTS TO ENTER VALUE OUTSIDE LICENSE FORMAT FOR STATE ENTERED (E.G., FOR MARYLAND, FORMAT SHOULD BE 1 ALPHA FOLLOWED BY 12 NUMERIC)

(TIME_STAMP_TR_ET) PROGRAMMER INSTRUCTION:

• INSERT DATE/TIME STAMP

Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593*). Do not return the completed form to this address