Attachment H

Attachment H
QFT Housing Unit and Group Quarters Unit
Screening Questions

NATIONAL SURVEY ON
DRUG USE AND HEALTH
QUESTIONNAIRE FIELD TEST
SCREENING APPLICATION SPECIFICATIONS

Contract No. HHSS283200800004C
RTI Project No. 0211838

Authors:
Beth Riggsbee
Tennyson Chen

Project Director:
Tom Virag

Prepared for:
Substance Abuse and Mental Health Services Administration
Rockville, MD 20857

Prepared by:
RTI International

May 2012

QUESTIONNAIRE FIELD TEST
NATIONAL SURVEY ON
DRUG USE AND HEALTH
SCREENING APPLICATION
SPECIFICATIONS
Contract No. HHSS283200800004C
RTI Project No. 0211838

Authors:
Beth Riggsbee
Tennyson Chen

Project Director:
Tom Virag

Prepared for:

Substance Abuse and Mental Health Services Administration
Rockville, MD 20857

Prepared by:
RTI International

May 2012

Section 1
HU Screening

Section 2
GQU Screening

Section 3
Select Case Screen Options

Section 4
Record of Calls

Section 5
Screening and Interview
Refusals

Section 6
Verification

Section 7
QFT FI Debriefing

Table of Contents
Section

Page

1.

HU Screening ..................................................................................................................... 1-1

2.

GQU Screening .................................................................................................................. 2-1

3.

Select Case Screen Options ................................................................................................ 3-1

4.

Record of Calls ................................................................................................................... 4-1

5.

Screening and Interview Refusals ...................................................................................... 5-1

6.

Verification......................................................................................................................... 6-1

7.

QFT FI Debriefing ............................................................................................................. 7-1

NSDUH QFT Screening Application Specifications
Section 1
HU Screening
Document Format:
 Screen names bolded
 Screen/question/instructional text designated by black and red text and non-italicized text in
parenthesis (Upper-lower black text to be read, red upper case text is instructions to FI)
 Fills designated by parenthesis and italics
 Logic designated by brackets
 Text of instructional message boxes provided in bracketed logic
 Response categories underlined

The line number and address are located at the top of each screen. Tap the address to see DU ADDRESS
box, an enlarged display of the line number and address. If a case is an Added DU, the DU ADDRESS
box displays the link line number.

SDU CHARACTERISTIC
DU ADDRESS (LARGE FONT)
CHECK ALL THAT APPLY. TAP “?” FOR ADDITIONAL INFORMATION.
1. House/Single Unit
2. Multi-unit, 2-9 units
3. Multi-unit, 10-49 units
4. Multi-unit, 50+ units
5. Military Base
6. Student Housing
7. Native American Tribal Land
8. Senior Housing/Assisted Living
9. Other GQU
10. Empty Lot
Continue [If at least one item selected, CONTROLLED ACCESS TYPE. If no items selected,
CONFLICT- You must provide a SDU Characteristic, Ok, SDU CHARACTERISTIC]
FIatWrongAddress [SELECT CASE]

1-1

CONTROLLED ACCESS TYPE [IF SDU CHARACTERISTIC NE BLANK]
DU ADDRESS (LARGE FONT)
CHECK ALL THAT APPLY. TAP “?” FOR ADDITIONAL INFORMATION.
1. None
2. Guard/Door Person/Staff/Manager
3. Locked main entrance/gate, no intercom/buzzer
4. Locked main entrance/gate with intercom/buzzer, no unit address labels
5. Locked main entrance/gate with intercom/buzzer, with unit address labels
Continue [If at least one item selected, STUDY INTRODUCTION. If no items selected, CONFLICTYou must provide a Controlled Access Type, Ok, CONTROLLED ACCESS TYPE] [Physical
Feature Data (SDU CHARACTERISTIC and CONTROLLED ACCESS TYPE) from this initial
visit to the DU is saved and transmitted to RTI during next transmission, regardless of the
outcome of the ROC (pending or final).]
FIatWrongAddress [SELECT CASE]

STUDY INTRODUCTION [IF CONTROLLED ACCESS TYPE NE BLANK]
Hello, my name is (FI NAME) with RTI International in North Carolina. We are conducting a
nationwide study sponsored by the U.S. Department of Health and Human Services.
[IF NOT ADDED DU] You should have received a letter explaining the study.
[IF NOT ADDED DU] HAND R COPY OF LETTER IF NEEDED
[IF ADDED DU] HAND R LEAD LETTER, ALLOW TIME TO READ
Continue [IDENTIFY SR]

IDENTIFY SR [IF STUDY INTRODUCTION = CONTINUE]
First, just let me verify: do you live here?
IF NOT OBVIOUS:
And are you 18 or older?
IF NO TO EITHER, ASK FOR AN ADULT RESIDENT, TAP BACK ARROW, AND BEGIN
AGAIN.
SR Available [ADDRESS VERIFICATION]
SR Not Available [EXIT SCREENING: “ARE YOU SURE YOU WANT TO EXIT
SCREENING?” IF Yes, RECORD OF CALLS. IF No, IDENTIFY SR.]

1-2

ADDRESS VERIFICATION [IF IDENTIFY SR = SR AVAILABLE]
I just need to verify -- is this
STREET: (NUMBER AND STREET)
CITY: (CITY)
STATE: (STATE)
ZIP: (ZIP)
Address Is Correct – Continue [INFORMED CONSENT]
Need to Edit Address [EDIT ADDRESS]
FI At Wrong Address [SELECT CASE]

EDIT ADDRESS [IF ADDRESS VERIFICATION = NEED TO EDIT ADDRESS]
TAP THE ITEM YOU NEED TO EDIT
ST. # (NUMBER)
STREET: (STREET)
CITY: (CITY)
STATE: (STATE)
ZIP: (ZIP)
Update [SAVE UPDATED ADDRESS, THEN INFORMED CONSENT]

INFORMED CONSENT [IF ADDRESS VERIFICATION = ADDRESS IS CORRECTCONTINUE OR EDIT ADDRESS = UPDATE]
GIVE PERSON STUDY DESCRIPTION AND SAY
Please read this statement. It describes the survey and the legislation that assures the
confidentiality of any information you provide. It also explains that your answers are used for
statistical purposes only and that your participation is voluntary. If anyone is selected for the full
interview, that person will receive $30 in cash after the interview is completed.
Continue [MISSED DUs]

MISSED DUs [IF INFORMED CONSENT = CONTINUE]
FOR REGULAR HUs SUCH AS INDIVIDUAL HOUSES, TOWNHOUSES, DUPLEXES,
TRAILERS, COTTAGES
Are there any other living quarters within this structure or on this property, such as a separate
apartment with a separate entrance?
Yes [MISSED DU ADDRESS]
[IF MISSED DU: CANNOT ADD UNIT
“YOU CANNOT ADD A MISSED DU
FROM A DU THAT HAS BEEN ADDED”
MISSED DUs]

1-3

No [OCCUPANCY]

FOR APARTMENT/CONDO HUs: DON'T ASK, JUST TAP "APT/CONDO" (BELOW) TO
CONTINUE.
APT/CONDO [OCCUPANCY]

MISSED DU ADDRESS [IF MISSED DUs = YES]
RECORD STREET ADDRESS OR DESCRIPTION OF UNIT
STREET
NUMBER:
STREET
NAME:
Update [OCCUPANCY]

Cancel [CANCEL DU: “ARE YOU SURE
YOU WANT TO CANCEL ADDITION OF THIS DU?
IF Yes, OCCUPANCY. IF No, MISSED DU
ADDRESS.]

OCCUPANCY [IF MISSED DUs = NO OR MISSED DU ADDRESS = UPDATE OR
CANCEL MISSED DU = YES]
(Have/Will) you or anyone else in this household (lived/live) here for most of the time during the
months of September, October, and November?
Yes [TOTAL SDU MEMBERS]

No [OCCUPANCY – CONFIRMATION: YOUR
‘NO’ RESPONSE WILL CONCLUDE THIS
SCREENING AND FINALIZE THIS CASE. DO YOU
WANT TO CHANGE YOUR ANSWER? (‘YES’
WILL CONTINUE SCREENING. ‘NO’ WILL
FINALIZE THE CASE.) IF Yes, TOTAL SDU
MEMBERS. IF No, VERIFICATION.]

TOTAL SDU MEMBERS [IF OCCUPANCY= YES]
(Including yourself), how many people in this household (lived/will live) here for most of the time
during the months of September, October, and November? (Do not include anyone who
(lived/will live) at school or somewhere else for most of the time during the months of September,
October, and November.)
ENTER NUMBER 1-20 [MEMBERS 12 OR OLDER]
[IF 1 TOTAL SDU MEMBERS = 1, ONLY HOUSEHOLD MEMBER: “CONFIRM
RESPONSE: IS THERE ONLY 1 PERSON IN THIS HOUSEHOLD?” IF No, TOTAL
SDU MEMBERS. IF Yes, ONLY ELIGIBLE HH MEMBER: “Is that you?” IS
THIS SCREENING RESPONDENT THE ONE ELIGIBLE RESIDENT OF THE DU?
IF No, HOUSEHOLDER AGE USING ‘THIS PERSON’ FILL. IF Yes,
HOUSEHOLDER AGE USING ‘YOUR’ FILL.]

1-4

MEMBERS 12 OR OLDER [IF TOTAL SDU MEMBERS NE BLANK AND >1]
Of these (TOTAL SDU MEMBERS) people, how many are now age 12 or older?
ENTER SUBSET OF TOTAL SDU MEMBERS [ROSTER INTRO]
[IF MEMBERS 12 OR OLDER = 1, ONLY ELIGIBLE MEMBER: “CONFIRM
RESPONSE: IS THERE ONLY 1 PERSON AGE 12 OR OLDER IN THIS
HOUSEHOLD?” IF No, MEMBERS 12 OR OLDER. IF Yes, ROSTER: “IS THIS
SCREENING RESPONDENT THE ONE ELIGIBLE RESIDENT OF THE DU?” IF
No, HOUSEHOLDER AGE USING ‘THIS PERSON’ FILL. IF Yes,
HOUSEHOLDER AGE USING ‘YOUR’ FILL.]

ROSTER INTRO [IF MEMBERS 12 OR OLDER NE 1 OR BLANK]
Next I'll ask a few questions about the people who live here. Let's start with the person or one of
the persons living here who owns or rents this home. We'll refer to this person as the
householder.
Continue [HOUSEHOLDER AGE]

HOUSEHOLDER AGE [IF ROSTER INTRO NE BLANK OR ROSTER NE BLANK OR
CONFIRM ROSTER FOR HOUSEHOLDER = NO]
Please tell me the age of this person on his or her last birthday.
IF SR IS HOUSEHOLDER:
Please tell me your age on your last birthday.
ENTER AGE [SCREENING RESPONDENT]
ChangeSR [CHANGE SR: DO YOU WANT TO CHANGE THE SR, IF No,
HOUSEHOLDER AGE. IF Yes, THIS PERSON: IS THIS PERSON THE SR? IF
Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS THIS
PERSON THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE
CONFIRM RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT
CHANGE AND = No, PERSON NE SCREENING RESPONDENT. IF RESPONSE
DOES NOT CHANGE AND = Yes, PERSON = SCREENING RESPONDENT.]

SCREENING RESPONDENT [IF HOUSEHOLDER AGE NE BLANK OR IF
AGE NE BLANK AND SCREENING RESPONDENT NE YES]
IS THIS (HOUSEHOLDER AGE/AGE) YEAR OLD PERSON THE SCREENING
RESPONDENT? IF UNSURE ASK: “Is that you?”
Yes [SETS LANGUAGE FOR SUBSEQUENT ROSTER QUESTIONS USING
‘YOU/YOUR’]
No [SETS LANGUAGE FOR SUBSEQUENT ROSTER QUESTIONS USING
‘THIS PERSON.’]

1-5

[IF HOUSEHOLDER, HOUSEHOLDER GENDER OTHERWISE, RELATION]
HOUSEHOLDER GENDER [IF SCREENING RESPONDENT NE BLANK FOR
HOUSEHOLDER]
ASK ONLY IF NOT OBVIOUS
Is this person male or female?
Male
Female
[HOUSEHOLDER HISPANIC]
ChangeSR [CHANGE SR: DO YOU WANT TO CHANGE THE SR, IF No,
HOUSEHOLDER GENDER. IF Yes, THIS PERSON: IS THIS PERSON THE SR?
IF Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS THIS
PERSON THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE
CONFIRM RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT
CHANGE AND = No, PERSON NE SCREENING RESPONDENT. IF RESPONSE
DOES NOT CHANGE AND = Yes, PERSON = SCREENING RESPONDENT.]

HOUSEHOLDER HISPANIC [IF HOUSEHOLDER GENDER NE BLANK]
(Are you/Is he/Is she/Is this person) of Hispanic, Latino or Spanish origin?
(That is, do any of these groups describe (your/his/her/their) national origin or ancestry – Puerto
Rican, Cuban, Cuban-American, Mexican, Mexican-American, Chicano, Central or South
American, or origin in some other Spanish-speaking country?)
Yes
No
[HOUSEHOLD RACE]
ChangeSR [CHANGE SR: DO YOU WANT TO CHANGE THE SR, IF No,
HOUSEHOLDER HISPANIC. IF Yes, THIS PERSON: IS THIS PERSON THE SR?
IF Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS THIS
PERSON THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE
CONFIRM RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT
CHANGE AND = No, PERSON NE SCREENING RESPONDENT. IF RESPONSE
DOES NOT CHANGE AND = Yes, PERSON = SCREENING RESPONDENT.]

HOUSEHOLDER RACE [IF HOUSEHOLDER HISPANIC NE BLANK]
(Are you/Is he/Is she/Is this person) White, Black or African American, American Indian or
Alaska Native, Native Hawaiian or other Pacific Islander, or Asian?
White
Black or African American
American Indian or Alaska Native
Native Hawaiian/other Pacific Islander
Asian
Other
(CHECK ALL THAT APPLY)

1-6

[HOUSEHOLDER MILITARY OR IF HOUSEHOLDER AGE NE 17-65 CONFIRM
ROSTER]
ChangeSR [CHANGE SR: DO YOU WANT TO CHANGE THE SR, IF No,
HOUSEHOLDER RACE. IF Yes, THIS PERSON: IS THIS PERSON THE SR? IF
Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS THIS
PERSON THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE
CONFIRM RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT
CHANGE AND = No, PERSON NE SCREENING RESPONDENT. IF RESPONSE
DOES NOT CHANGE AND = Yes, PERSON = SCREENING RESPONDENT.]

HOUSEHOLDER MILITARY [IF HOUSEHOLDER RACE NE BLANK AND
HOUSEHOLDER AGE = 17-65 AND SCREENING
RESPONDENT = NO FOR THIS MEMBER]
(Are you/Is he/Is she/Is this person) currently on active duty in the United States military?
Yes
No
Unknown
Refused
[CONFIRM ROSTER]
ChangeSR [CHANGE SR: DO YOU WANT TO CHANGE THE SR, IF No,
HOUSEHOLDER MILITARY. IF Yes, THIS PERSON: IS THIS PERSON THE
SR? IF Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS
THIS PERSON THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE:
PLEASE CONFIRM RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES
NOT CHANGE AND = No, PERSON NE SCREENING RESPONDENT. IF
RESPONSE DOES NOT CHANGE AND = Yes, PERSON = SCREENING
RESPONDENT.]

HOUSEHOLDER MILITARY [IF HOUSEHOLDER RACE NE BLANK AND
HOUSEHOLDER AGE = 17-65 AND SCREENING
RESPONDENT = YES FOR THIS MEMBER]
(Are you/Is he/Is she/Is this person) currently on active duty in the United States military?
Yes
No
Refused
[CONFIRM ROSTER]
ChangeSR [CHANGE SR: DO YOU WANT TO CHANGE THE SR, IF No,
HOUSEHOLDER MILITARY. IF Yes, THIS PERSON: IS THIS PERSON THE
SR? IF Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS
THIS PERSON THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE:
PLEASE CONFIRM RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES
NOT CHANGE AND = No, PERSON NE SCREENING RESPONDENT. IF
RESPONSE DOES NOT CHANGE AND = Yes, PERSON = SCREENING
RESPONDENT.]

1-7

CONFIRM ROSTER [IF HOUSEHOLDER MILITARY NE BLANK OR IF
HOUSEHOLDER AGE NE 17-65 AND HOUSEHOLDER RACE NE BLANK]
I have listed (a, IF SR: you as a) (AGE) year old (GENDER) householder. (She is/He is/IF SR:
You are (RACE), (HISPANIC), and (is/is not/IF SR: are/are not) on active duty in the United
States military.
Is that correct?
Yes [OTHER MEMBERS] [IF ROSTER NE BLANK , THEN VERIFY ROSTER DATA]
No [HOUSEHOLDER AGE]

OTHER MEMBERS [IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER ≥ 2]
READ TO RESPONDENT:
Now I need some general information about (the other person/all of the other people) in this
household who (is/are) 12 years old or older. [IF MEMBERS 12 OR OLDER >2] Let's start with
the oldest and work down to the youngest.
Continue [AGE]

AGE [IF OTHER MEMBERS NE BLANK OR CONFIRM ROSTER = NO]
[IF MEMBERS 12 OR OLDER = 2] Please tell me the age of this person on his or her last
birthday.
[IF MEMBERS 12 OR OLDER > 2 HH MEMBERS] Please tell me the age of the (oldest/next
oldest) person on his or her last birthday.
ENTER AGE [IF ANY SCREENING RESPONDENT = YES, RELATION. IF ALL
SCREENING RESPONDENT = BLANK OR NO, SCREENING
RESPONDENT]
ChangeSR [CHANGE SR: DO YOU WANT TO CHANGE THE SR, IF No,
AGE. IF Yes, THIS PERSON: IS THIS PERSON THE SR? IF Yes OR No,
CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS THIS PERSON THE
SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE CONFIRM
RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT CHANGE AND
= No, PERSON NE SCREENING RESPONDENT. IF RESPONSE DOES NOT
CHANGE AND = Yes, PERSON = SCREENING RESPONDENT.]

RELATION [IF AGE NE BLANK AND ANY SCREENING RESPONDENT =YES]
[IF SCREENING RESPONDENT = YES FOR THIS MEMBER] How are you related to the
householder?
[IF SCREENING RESPONDENT = YES FOR HOUSEHOLDER] How is this person related to
you, the householder?
[IF SCREENING RESPONDENT = NO FOR THIS MEMBER AND SCREENING
RESPONDENT = NO FOR HOUSEHOLDER] How is this person related to the householder?

1-8

Husband
Wife
Son (includes step)
Daughter (includes step)
Son-in-law/Daughter-in-law
Brother (includes step)
Sister (includes step)
Brother-in-law/Sister-in-law
Parent/Guardian (incl. step)
Parent-in-law (incl. step)
Aunt/Uncle
Nephew/Niece
Grandparent
Grandchild
Cousin
Ex-Spouse
Live-in Partner
Friend/Roommate
Tenant/Boarder/Exch Student
Other relative
Other Non-relative
Relationship Unspecified
[IF RELATION = HUSBAND, WIFE, SON, DAUGHTER, BROTHER OR SISTER
HISPANIC, OTHERWISE GENDER]
ChangeSR [CHANGE SR: DO YOU WANT TO CHANGE THE SR, IF No,
RELATION. IF Yes, THIS PERSON: IS THIS PERSON THE SR? IF Yes OR No,
CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS THIS PERSON THE
SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE CONFIRM
RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT CHANGE AND
= No, PERSON NE SCREENING RESPONDENT. IF RESPONSE DOES NOT
CHANGE AND = Yes, PERSON = SCREENING RESPONDENT.]

GENDER [IF RELATION NE HUSBAND, WIFE, SON, DAUGHTER, BROTHER OR SISTER]
ASK ONLY IF NOT OBVIOUS
Is this person male or female?
Male
Female
Refused
[HISPANIC]
ChangeSR [CHANGE SR: DO YOU WANT TO CHANGE THE SR, IF No,
GENDER. IF Yes, THIS PERSON: IS THIS PERSON THE SR? IF Yes OR No,
CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS THIS PERSON THE
SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE CONFIRM
RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT CHANGE AND
= No, PERSON NE SCREENING RESPONDENT. IF RESPONSE DOES NOT
CHANGE AND = Yes, PERSON = SCREENING RESPONDENT.

1-9

HISPANIC [IF GENDER NE BLANK]
(Are you/Is he/Is she/Is this person) of Hispanic, Latino or Spanish origin?
(That is, do any of these groups describe (your/his/her/their) national origin or ancestry – Puerto
Rican, Cuban, Cuban-American, Mexican, Mexican-American, Chicano, Central or South
American, or origin in some other Spanish-speaking country?)
Yes
No
Unknown
Refused
[RACE]
ChangeSR [CHANGE SR: DO YOU WANT TO CHANGE THE SR, IF No,
HISPANIC. IF Yes, THIS PERSON: IS THIS PERSON THE SR? IF Yes OR No,
CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS THIS PERSON THE
SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE CONFIRM
RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT CHANGE AND
= No, PERSON NE SCREENING RESPONDENT. IF RESPONSE DOES NOT
CHANGE AND = Yes, PERSON = SCREENING RESPONDENT.]

RACE [IF HISPANIC NE BLANK]
(Are you/Is he/Is she/Is this person) White, Black or African American, American Indian or
Alaska Native, Native Hawaiian or other Pacific Islander, or Asian?
White
Black or African American
American Indian or Alaska Native
Native Hawaiian/other Pacific Islander
Asian
Other
Unknown
Refused
(CHECK ALL THAT APPLY)
[IF AGE 17-65, MILITARY, OTHERWISE CONFIRM ROSTER]
ChangeSR [CHANGE SR: DO YOU WANT TO CHANGE THE SR, IF No,
RACE. IF Yes, THIS PERSON: IS THIS PERSON THE SR? IF Yes OR No,
CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS THIS PERSON THE
SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE CONFIRM
RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT CHANGE AND
= No, PERSON NE SCREENING RESPONDENT. IF RESPONSE DOES NOT
CHANGE AND = Yes, PERSON = SCREENING RESPONDENT.]

1-10

MILITARY [IF RACE NE BLANK AND AGE 17-65 AND SCREENING RESPONDENT = NO
FOR THIS MEMBER]
(Are you/Is he/Is she/Is this person) currently on active duty in the United States military?
Yes
No
Unknown
Refused
[CONFIRM ROSTER]
ChangeSR [CHANGE SR: DO YOU WANT TO CHANGE THE SR, IF No,
MILITARY. IF Yes, THIS PERSON: IS THIS PERSON THE SR? IF Yes OR No,
CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS THIS PERSON THE
SR? IF RESPONSE CHANGES, CONFIRM CHANGE: PLEASE CONFIRM
RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES NOT CHANGE AND
= No, PERSON NE SCREENING RESPONDENT. IF RESPONSE DOES NOT
CHANGE AND = Yes, PERSON = SCREENING RESPONDENT.

MILITARY [IF HOUSEHOLDER RACE NE BLANK AND HOUSEHOLDER AGE = 17-65 AND
SCREENING RESPONDENT = YES FOR THIS MEMBER]
(Are you/Is he/Is she/Is this person) currently on active duty in the United States military?
Yes
No
Refused
[CONFIRM ROSTER]
ChangeSR [CHANGE SR: DO YOU WANT TO CHANGE THE SR, IF No,
HOUSEHOLDER MILITARY. IF Yes, THIS PERSON: IS THIS PERSON THE
SR? IF Yes OR No, CONFIRM CHANGE: PLEASE CONFIRM RESPONSE. IS
THIS PERSON THE SR? IF RESPONSE CHANGES, CONFIRM CHANGE:
PLEASE CONFIRM RESPONSE. IS THIS PERSON THE SR? IF RESPONSE DOES
NOT CHANGE AND = No, PERSON NE SCREENING RESPONDENT. IF
RESPONSE DOES NOT CHANGE AND = Yes, PERSON = SCREENING
RESPONDENT.]

CONFIRM ROSTER [IF AGE 17-65 AND MILITARY IS NE BLANK, OTHERWISE
RACE NE BLANK]
I have listed a (AGE) year old (RELATIONSHIP). (He/She) is (RACE), (HISPANIC) [IF AGE
17-65] and (is/is not) on active duty the United States military.
Is that correct?
Yes [AGE FOR NEXT HH MEMBER, OTHERWISE VERIFY ROSTER DATA]
No [AGE]

1-11

VERIFY ROSTER DATA [IF CONFIRM ROSTER = YES ]
Rel (Relationship)
SR (Y for Screening Respondent)
A (Age)
[UPON TAPPING ON ANY ROSTER LINE, SHOW REMAINING COLUMNS]
G (Gender: M, F, R)
H (Hispanic: Y, N, U, R)
R (Race: W, B, I, P, A, O)
M (Military: Y, N, U, R)
E (Eligibility: E, I)
[IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER=1]
DO NOT READ TO RESPONDENT. WHEN READY, TAP CONTINUE TO MAKE
SELECTION.
TO MAKE CORRECTIONS: TAP THE ROSTER LINE THAT YOU WANT TO EDIT, THEN
TAP 'FUNCTIONS' AND 'EDIT.'
[IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER>=2]
I need to make sure this list is accurate. I have listed...
[READ AGES AND RELATIONSHIPS ROSTERED].
TO MAKE CORRECTIONS: TAP THE ROSTER LINE THAT YOU WANT TO EDIT, THEN
TAP 'FUNCTIONS' AND 'EDIT.'
[FUNCTIONS TO ADD ROSTER MEMBERS AND/OR EDIT ROSTER DATA]
Continue [START SELECTION]

START SELECTION
THE PROGRAM WILL START THE SELECTION PROCESS. ARE YOU SURE YOU ARE
READY TO MAKE THE SELECTIONS?
Yes [RESPONDENT SELECTION]
No [VERIFY ROSTER DATA]

1-12

RESPONDENT SELECTION [START SELECTION = YES]
Interview A
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Relation: (Relationship to householder, BLANK)
Age: (AGE, BLANK)
Race: (W, B, I, P, A, O, BLANK)

Sex: (M, F, BLANK)
Hispanic: (Y, N, BLANK)

Interview B
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Relation: (Relationship to householder, BLANK)
Age: (AGE, BLANK)
Race: (W, B, I, P, A, O, BLANK)

Sex: (M, F, BLANK)
Hispanic: (Y, N, BLANK)

1-13

This page intentionally left blank.

1-14

NSDUH QFT Screening Application Specifications
Section 2
GQU Screening
Document Format:
 Screen names bolded
 Screen/question/instructional text designated by black and red text and non-italicized text in
parenthesis (Upper-lower black text to be read, red upper case text is instructions to FI)
 Fills designated by parenthesis and italics
 Logic designated by brackets
 Text of instructional message boxes provided in bracketed logic
 Response categories underlined

SDU CHARACTERISTIC
DU ADDRESS (LARGE FONT)
CHECK ALL THAT APPLY. TAP “?” FOR ADDITIONAL INFORMATION.
1. House/Single Unit
2. Multi-unit, 2-9 units
3. Multi-unit, 10-49 units
4. Multi-unit, 50+ units
5. Military Base
6. Student Housing
7. Native American Tribal Land
8. Senior Housing/Assisted Living
9. Other GQU
10. Empty Lot
Continue [If at least one item selected, CONTROLLED ACCESS TYPE. If no items selected,
CONFLICT- You must provide a SDU Characteristic, Ok, SDU CHARACTERISTIC]
FIatWrongAddress [SELECT CASE]

2-1

CONTROLLED ACCESS TYPE [IF SDU CHARACTERISTIC NE BLANK]
DU ADDRESS (LARGE FONT)
CHECK ALL THAT APPLY. TAP “?” FOR ADDITIONAL INFORMATION.
1. None
2. Guard/Door Person/Staff/Manager
3. Locked main entrance/gate, no intercom/buzzer
4. Locked main entrance/gate with intercom/buzzer, no unit address labels
5. Locked main entrance/gate with intercom/buzzer, with unit address labels
Continue [If at least one item selected, STUDY INTRODUCTION. If no items selected,
CONFLICT- You must provide a Controlled Access Type, Ok, CONTROLLED
ACCESS TYPE] [Physical Feature Data (SDU CHARACTERISTIC and
CONTROLLED ACCESS TYPE) from this initial visit to the DU is saved and
transmitted to RTI during next transmission, regardless of the outcome of the ROC
(pending or final).]
FIatWrongAddress [SELECT CASE]

STUDY INTRODUCTION [IF CONTROLLED ACCESS TYPE NE BLANK]
Hello, my name is (FI NAME) with RTI International in North Carolina. We are conducting a
nationwide study sponsored by the U.S. Department of Health and Human Services.
You should have received a letter explaining the study.
Continue [IDENTIFY SR]

IDENTIFY SR [IF STUDY INTRODUCTION = CONTINUE]
First, just let me verify: do you live here?
IF NOT OBVIOUS:
And are you 18 or older?
IF NO TO EITHER, ASK FOR AN ADULT RESIDENT, TAP BACK ARROW, AND BEGIN
AGAIN.
SR Available [ADDRESS VERIFICATION]
SR Not Available [EXIT SCREENING: “ARE YOU SURE YOU WANT TO EXIT
SCREENING?” IF Yes, RECORD OF CALLS. IF No,
IDENTIFY SR.]

2-2

ADDRESS VERIFICATION [IF IDENTIFY SR = SR AVAILABLE]
I just need to verify -- is this
STREET: (NUMBER AND STREET)
CITY: (CITY)
STATE: (STATE)
ZIP: (ZIP)
Address Is Correct – Continue [INFORMED CONSENT]
Need to Edit Address [EDIT ADDRESS]
FI At Wrong Address [SELECT CASE]

EDIT ADDRESS [IF ADDRESS VERIFICATION = NEED TO EDIT ADDRESS]
TAP THE ITEM YOU NEED TO EDIT
ST. # (NUMBER)
STREET: (STREET)
CITY: (CITY)
STATE: (STATE)
ZIP: (ZIP)
Update [SAVE UPDATED ADDRESS, THEN INFORMED CONSENT]

INFORMED CONSENT [IF ADDRESS VERIFICATION = ADDRESS IS CORRECTCONTINUE OR EDIT ADDRESS = UPDATE]
GIVE PERSON STUDY DESCRIPTION AND SAY
Please read this statement. It describes the survey and the legislation that assures the
confidentiality of any information you provide. It also explains that your answers are used for
statistical purposes only and that your participation is voluntary. If anyone is selected for the full
interview, that person will receive $30 in cash after the interview is completed.
Continue [TRANSIENT]

TRANSIENT [IF INFORMED CONSENT = CONTINUE]
INTERVIEWER: IS THIS GQU A TRANSIENT SHELTER?
Yes [UNIT TYPE]
No [OCCUPANCY]

2-3

UNIT TYPE [IF TRANSIENT = YES]
ARE THE LISTED UNIT…
ROOMS [TOTAL GQU MEMBERS]
BEDS, OR [ROSTER #1]
PERSONS? [ROSTER #1]

OCCUPANCY [IF TRANSIENT = NO]
(Did/Will) you or anyone else in this room live here for most of the time during the
months of September, October, and November?
Yes [TOTAL GQU MEMBERS]

No [OCCUPANCY – CONFIRMATION:
YOUR ‘NO’ RESPONSE WILL
CONCLUDE THIS SCREENING
AND FINALIZE THIS CASE. DO
YOU WANT TO CHANGE YOUR
ANSWER? (‘YES’ WILL CONTINUE
SCREENING. ‘NO’ WILL FINALIZE THE
CASE.) IF Yes, TOTAL GQU MEMBERS. IF
No, VERIFICATION.]

TOTAL GQU MEMBERS [IF OCCUPANCY = YES OR IF UNIT TYPE = ROOMS]
[IF TRANSIENT = YES AND UNIT TYPE = ROOMS] (Including yourself) How many people
are staying in this room?
[IF TRANSIENT = NO] (Including yourself) How many people (lived/will live) in this room for
most of the time during the months of September, October, and November?
ENTER NUMBER 1-20 [MEMBERS 12 OR OLDER]
[IF TOTAL GQU MEMBERS = 1, ONLY MEMBER: CONFIRM RESPONSE: IS
THERE ONLY 1 PERSON LIVING HERE? IF No, TOTAL GQU MEMBERS. IF
Yes AND UNIT TYPE = ROOMS, ROSTER #1 AGE. IF Yes AND TRANSIENT =
NO, ROSTER: IS THIS SCREENING RESPONDENT THE ONE ELIGIBLE
RESIDENT OF THE DU? IF Yes, ROSTER #1 AGE USING ‘YOUR’ FILL. IF No,
ROSTER #1 AGE USING ‘THIS PERSON’ FILL].

MEMBERS 12 OR OLDER [IF TOTAL GQU MEMBERS NE BLANK AND >1]
[IF TRANSIENT = YES] How many of these [TOTAL GQU MEMBERS] people are now age 12
or older.
[IF TRANSIENT = NO] Of these [TOTAL GQU MEMBERS] people, how many are now age 12
or older?
ENTER SUBSET OF TOTAL GQU MEMBERS ROSTER # AGE

2-4

[IF MEMBERS 12 OR OLDER = 1, ONLY ELIGIBLE MEMBER: “CONFIRM
RESPONSE: IS THERE ONLY 1 PERSON AGE 12 OR OLDER IN THIS UNIT?” IF
No, MEMBERS 12 OR OLDER. IF Yes AND UNIT TYPE = ROOMS ROSTER # 1
AGE. IF Yes AND TRANSIENT = NO, ROSTER: IS THIS SCREENING
RESPONDENT THE ONE ELIGIBLE RESIDENT OF THE DU? IF Yes, ROSTER #1
AGE USING ‘YOUR’ FILL. IF No, ROSTER #1 AGE USING ‘THIS PERSON’
FILL].

ROSTER #1 AGE [IF MEMBERS 12 OR OLDER NE BLANK OR TOTAL GQU MEMBERS = 1
OR IF UNIT TYPE = BEDS OR PERSONS]
Please tell me your age on your last birthday.
ENTER AGE [ROSTER #1 NAME]

ROSTER #1 NAME [IF ROSTER #1 AGE NE BLANK]
What is your first name?
ENTER FIRST NAME [ROSTER #1 GENDER]

ROSTER #1 GENDER [IF ROSTER #1 NAME NE BLANK]
ASK ONLY IF NOT OBVIOUS
Is this person male or female?
Male
Female
[ROSTER #1 HISPANIC]

ROSTER #1 HISPANIC [IF ROSTER #1 GENDER NE BLANK]
Are you of Hispanic, Latino or Spanish origin?
(That is, do any of these groups describe your national origin or ancestry – Puerto Rican, Cuban,
Cuban-American, Mexican, Mexican-American, Chicano, Central or South American, or origin
in some other Spanish-speaking country?)
Yes
No
[ROSTER #1 RACE]

2-5

ROSTER #1 RACE [IF ROSTER #1 HISPANIC NE BLANK]
Are you White, Black or African American, American Indian or Alaska Native, Native Hawaiian
or other Pacific Islander, or Asian?
White
Black or African American
American Indian or Alaska Native
Native Hawaiian/other Pacific Islander
Asian
Other
(CHECK ALL THAT APPLY)
[ROSTER #1 MILITARY OR IF ROSTER #1 AGE NE 17-65 CONFIRM ROSTER]

ROSTER #1 MILITARY [IF ROSTER #1 RACE NE BLANK AND ROSTER #1 AGE = 17-65]
Are you currently on active duty in the United States military?
Yes
No
Refused
[CONFIRM ROSTER]

CONFIRM ROSTER [IF ROSTER #1 MILITARY NE BLANK OR IF
ROSTER #1 AGE NE 17-65 AND ROSTER #1 RACE NE
BLANK]
I have listed you as a (AGE) year old (GENDER) resident. You are (RACE), (HISPANIC) [IF
AGE =17-65] and (are/are not) on active duty in the United States military.
Is that correct?
Yes [IF MEMBERS 12 OR OLDER ≥ 2 OTHER MEMBERS. IF UNIT TYPE = BEDS OR
PERSONS OR UNIT TYPE = ROOMS AND TOTAL GQU MEMBERS OR MEMBERS
12 OR OLDER =1 VERIFY ROSTER DATA]
No [ROSTER #1 AGE]

2-6

OTHER MEMBERS [IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER ≥ 2]
READ TO RESPONDENT:
Now I need some general information about (the other person/all of the other people) who
(is/are) 12 years old or older. [IF MEMBERS 12 OR OLDER >2] Let's start with the oldest and
work down to the youngest.
Continue [AGE]

AGE [IF OTHER MEMBERS NE BLANK OR CONFIRM ROSTER = NO]
[IF MEMBERS 12 OR OLDER = 2] Please tell me the age of this person on his or her last
birthday.
[IF MEMBERS 12 OR OLDER > 2 HH MEMBERS] Please tell me the age of the (oldest/next
oldest) person on his or her last birthday.
ENTER AGE [NAME]

NAME [IF AGE NE BLANK]
What is this person’s first name?
ENTER FIRST NAME [GENDER]

GENDER [IF NAME NE BLANK]
ASK ONLY IF NOT OBVIOUS
Is this person male or female?
Male
Female
Refused
[HISPANIC]

2-7

HISPANIC [IF GENDER NE BLANK]
(Is he/Is she/Is this person) of Hispanic, Latino or Spanish origin?
(That is, do any of these groups describe (his/her/their) national origin or ancestry – Puerto
Rican, Cuban, Cuban-American, Mexican, Mexican-American, Chicano, Central or South
American, or origin in some other Spanish-speaking country?)
Yes
No
Unknown
Refused
[RACE]

RACE [IF HISPANIC NE BLANK]
(Is he/Is she/Is this person) White, Black or African American, American Indian or Alaska
Native, Native Hawaiian or other Pacific Islander, or Asian?
White
Black or African American
American Indian or Alaska Native
Native Hawaiian/other Pacific Islander
Asian
Other
Unknown
Refused
(CHECK ALL THAT APPLY)
[IF AGE 17-65, MILITARY, OTHERWISE CONFIRM ROSTER]

MILITARY [IF RACE NE BLANK AND AGE 17-65]
(Is he/Is she/Is this person) currently on active duty in the United States military?
Yes
No
Unknown
Refused
[CONFIRM ROSTER]

2-8

CONFIRM ROSTER [IF AGE 17-65 AND MILITARY IS NE BLANK, OTHERWISE
RACE NE BLANK]
I have listed a (AGE) year old (GENDER) resident. (He/She) is (RACE), (HISPANIC) [IF AGE
17-65] and (is/is not) on active duty in the United States military.
Is that correct?
Yes [AGE FOR NEXT GQU MEMBER, OTHERWISE VERIFY ROSTER DATA]
No [AGE]

VERIFY ROSTER DATA [IF CONFIRM ROSTER = YES]
Name (First Name)
SR (Y for Screening Respondent)
A (Age)
[UPON TAPPING ON ANY ROSTER LINE, SHOW REMAINING COLUMNS]
G (Gender: M, F, R)
H (Hispanic: Y, N, U, R)
R (Race: W, B, I, P, A, O)
M (Military: Y, N, U, R)
E (Eligibility: E, I)
[IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER=1]
DO NOT READ TO RESPONDENT. WHEN READY, TAP CONTINUE TO MAKE
SELECTION.
TO MAKE CORRECTIONS: TAP THE ROSTER LINE THAT YOU WANT TO EDIT, THEN
TAP 'FUNCTIONS' AND 'EDIT.'
[IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER>=2]
I need to make sure this list is accurate. I have listed...
[READ LIST OF OCCUPANTS’ AGES AND NAMES].
TO MAKE CORRECTIONS: TAP THE ROSTER LINE THAT YOU WANT TO EDIT, THEN
TAP 'FUNCTIONS' AND 'EDIT.'
[FUNCTIONS TO ADD ROSTER MEMBERS AND/OR EDIT ROSTER DATA]
Continue [START SELECTION]

2-9

START SELECTION
THE PROGRAM WILL START THE SELECTION PROCESS. ARE YOU SURE YOU ARE
READY TO MAKE THE SELECTIONS?
Yes [RESPONDENT SELECTION]
No [VERIFY ROSTER DATA]

RESPONDENT SELECTION [START SELECTION = YES]
Interview A
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Name: (First Name, BLANK)
Age: (AGE, BLANK)
Race: (W, B, I, P, A, O, BLANK)

Sex: (M, F, BLANK)
Hispanic: (Y, N, BLANK)

Interview B
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Name: (First Name, BLANK)
Age: (AGE, BLANK)
Race: (W, B, I, P, A, O, BLANK)

Sex: (M, F, BLANK)
Hispanic: (Y, N, BLANK)

2-10

NSDUH QFT Screening Application Specifications
Section 3
Select Case Screen Options
Document Format:
 Screen/menu names bolded
 Screen/question/instructional text designated by black and red text and non-italicized text in
parenthesis (Upper-lower black text to be read, red upper case text is instructions to FI)
 Fills designated by parentheses and italics
 Logic designated by brackets
 Text of instructional message boxes provided in bracketed logic
 Response categories underlined
 Explanatory text in italics.

Select Case screen contains the date, time, battery level, CaseID, (list of cases), Address, Results for S
(Screening), A (Interview A), and B (Interview) and menus detailed below.

ACTIONS MENU [SELECT CASE, CASE ID, ACTIONS]
Items on the Actions Menu are case specific. First a case is selected on the screen, then the action from
the Actions Menu is selected.
Screen DU
Go To Record Of Calls
View Selections/Roster
Edit Address
Add Missed DU
Place Case On Hold/Take Case Off Hold
[IF NO CASE SELECTED: NO CASE SELECTED: “TAP ON A CASE TO SELECT IT.”
OK, SELECT CASE]

SCREEN DU [SELECT CASE, CASEID, ACTIONS, SCREEN DU]
[IF INITIAL ENTRY (NO PHYSICAL FEATURE DATA ENTERED), SDU
CHARACTERISTIC – FOR DETAILS, SEE SECTIONS 1-4]
[IF PHYSICAL FEATURE DATA ENTERED, STUDY INTRODUCTION – FOR
DETAILS, SEE SECTIONS 1-4]
[IF SCREENING COMPLETED, RE-OPEN CASE DISPLAYS ON ACTIONS
MENU. RE-OPENING CONFIRMATION: “THIS CASE HAS ALREADY BEEN
COMPLETED. DO YOU WISH TO RE-OPEN THIS CASE? IF No, SELECT CASE.
IF Yes, CASE RE-OPEN CODE: “ENTER THE CODE TO RE-OPEN THIS CASE,
THEN TAP ‘OK’ TO CONTINUE.” ENTER CORRECT CODE, OK, SDU
CHARACTERISTIC]

3-1

GO TO RECORD OF CALLS [SELECT CASE, CASEID, ACTIONS, GO TO
RECORD OF CALLS]
[IF NO PHYSICAL FEATURE DATA ENTERED, NO ROC RECORD: “THERE ARE NO
PREVIOUS CALL RECORDS FOR THIS CASE. IF YOU WANT TO ENTER A CALL
RECORD, CLOSE THIS BOX AND TAP ‘SCREEN DU’ TO ENTER THE REQUIRED
PHYSICAL FEATURE DATA BEFORE ENTERING A CALL RECORD.” OK – FOR
DETAILS SEE SECTIONS 1-4]
[IF PHYSICAL FEATURE DATA ENTERED ENTERED, RECORD OF CALLS – FOR
DETAILS SEE SECTION 6]

VIEW SELECTIONS/ROSTER [SELECT CASE, CASEID, ACTIONS,
VIEW SELECTIONS/ROSTER]
[IF PENDING SCREENING: NO SELECTION: “SCREENING HAS NOT BEEN
COMPLETED FOR THIS CASE. THERE IS NO SELECTION TO VIEW.” OK,
SELECT CASE.]
[IF CASE COMPLETED WITH FINAL RESULT CODE NE TO 30, 31, 32: NO
SELECTION: “THERE ARE NO SELECTIONS TO DISPLAY FOR THIS CASE. IT
WAS SCREENED AS CODE (RESULT CODE)”: OK, NO ROSTER RECORDS:
“THERE ARE NO ROSTER RECORDS FOR THIS CASE.” OK, SELECT CASE.]
[IF CASE COMPLETED WITH FINAL RESULT CODE = 30, 31, 32, RESPONDENT
SELECTION]

RESPONDENT SELECTION [IF CASE COMPLETED WITH FINAL
RESULT CODE = 30, 31, 32]
Interview A
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Relation: (Relationship to householder, BLANK)
Age: (AGE, BLANK)
Race: (W, B, I, P, A, O, BLANK)

Sex: (M, F, BLANK)
Hispanic: (Y, N, BLANK)

Interview B
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Relation: (Relationship to householder, BLANK)
Age: (AGE, BLANK)
Race: (W, B, I, P, A, O, BLANK)
Done [SELECT CASE]
Roster [HOUSEHOLD ROSTER]
ROC [RECORD OF CALLS]

3-2

Sex: (M, F, BLANK)
Hispanic: (Y, N, BLANK)

HOUSEHOLD ROSTER [IF RESPONDENT SELECTION = ROSTER]
Rel (Relationship)
SR (Y for Screening Respondent)
A (Age)
G (Gender: M, F, R)
H (Hispanic: Y, N, U, R)
R (Race: W, B, I, P, A, O)
M (Military: Y, N, U, R)
E (Eligibility: E, I)
Done [SELECT CASE]
Sels [RESPONDENT SELECTION]

EDIT ADDRESS [SELECT CASE, CASEID, ACTIONS, EDIT ADDRESS]
[EDIT ADDRESS – FOR DETAILS, SEE SECTIONS 1-4]

ADD MISSED DU [SELECT CASE , CASEID, ACTIONS ADD MISSED DU]
[MISSED DU ADDRESS – FOR DETAILS, SEE SECTION 1]
[IF CASE SELECTED IS MISSED DU: CANNOT ADD UNIT: “YOU CANNOT
ADD A MISSED DU FROM A DU THAT HAS BEEN ADDED.” OK, SELECT
CASE.]
[IF ATTEMPTING TO ADD A DU TO A GQU: CALL FS: “IF THERE ARE
MISSED GROUP QUARTERS UNITS IN THE STRUCTURE, OBTAIN
INFORMATION ABOUT ALL MISSED UNITS THEN CALL YOUR FS.”

PLACE CASE ON HOLD [SELECT CASE, TAP CASEID, ACTIONS,
PLACE CASE ON HOLD]
This menu option toggles between “Place Case On Hold” and “Take Case Off Hold,”
depending on the on-hold status of the case. When a case is on hold, data for that case are
transmitted, but are not pulled into the control system—the data is maintained in a separate
location to be accessed, as necessary. This allows putting a case ‘On Hold’ for
troubleshooting.
[IF CASE NOT ON HOLD, PLACE CASE ON HOLD: “ARE YOU SURE YOU
WANT TO PUT CASE (CASEID) ON HOLD?” IF No, SELECT CASE WITH CASE
NOT ON HOLD. IF Yes, CASE ON HOLD: “CASE (CASEID) HAS BEEN PUT ON
HOLD.” OK, SELECT CASE WITH ‘H’ NEXT TO CASEID.]
[IF CASE ON HOLD, TAKE CASE OFF HOLD, SELECT CASE WITH ‘H’ NEXT
TO CASEID REMOVED AND CASE NOT ON HOLD.]

3-3

ADMIN MENU [SELECT CASE, ADMIN]
Items on Admin Menu are administrative.
Set Name and Id
Enter PT&E Data
View Transmitted PT&E Data
Reconcile Missed DUs
Reload Training Cases
Erase Training Cases
Reset iPAQ
Utilities
Call Distribution

SET NAME AND ID [SELECT CASE, ADMIN, SET NAME AND ID]
NSDUH SYSTEM CONFIGURATION [SELECT CASE, ADMIN,
SET NAME AND ID]
Government ID: (Government ID issued to iPAQ)
FIID: (RTI FI ID Number)
Name: (FI Name to be used on Study Introduction screen)
Done [SELECT CASE]

ENTER PT&E DATA [SELECT CASE, TAP ADMIN, ENTER PT&E DATA]
[IF THERE ARE NO PT&E RECORDS ENTERED FOR THE WEEK, ADD PT&E:
“THERE ARE CURRENTLY NO UNTRANSMITTED PT&E RECORDS. DO YOU
WANT TO ADD ONE?” IF No, SELECT CASE. IF Yes, PT&E DATA.

PT&E DATA [SELECT CASE, ADMIN, ENTER PT&E, ADD PT&E =
YES]
PT&E WEEK: (Payroll week beginning date)
QUARTER: 1 2, 3, 4 (Current quarter selected as default)
FS (Drop-down list of FS names who have hired FI)
TASK (Drop-down list of possible task numbers)
HRS: (.25-99.99)
MILES: (1-999)
EXP: (.01-1500)

NOTES: (Text entry field)

Done [CHECKS FOR COMPLETE DATA ENTRY, ANOTHER
PT&E: ‘DO YOU HAVE ANOTHER PT&E SUMMARY RECORD
TO ENTER?” IF No, PTE SUMMARY. IF Yes, PT&E DATA FOR
NEW ENTRY.
Cancel [CANCEL ENTRY: “ARE YOU SURE YOU WANT TO

3-4

CANCEL THE ENTRY OF THIS RECORD?” IF Yes, PTE
SUMMARY. IF No, PT&E DATA.
Clear [PT&E DATA WITH ENTRY CLEARED.]

PTE SUMMARY
WEEK (First date of work week)
Q (Quarter: 1, 2, 3, 4)
FS (FS Name)
TSK (Task number)
HRS (Hours)
MI (Miles)
EXP (Expenses)
FSID (FS ID)
Notes (Notes)
TAP ON A LINE TO SELECT IT AND VIEW ITS NOTES
WEEK:
FS:
TASK:
HRS:
EXP:

QUARTER:
NOTES:

Done [SELECT CASE]
Functions [ADD, EDIT, DELETE, TRANSMITTED PT&E]
ADD [PT&E DATA]
EDIT [IF NO LINE SELECTED, SELECT PT&E: TAP A
LINE TO SELECT A PT&E.” OK]
[IF LINE SELECTED: PT&E DATA.]
DELETE [IF NO LINE SELECTED, SELECT PT&E: “TAP
A LINE TO SELECT A PT&E.” OK]
[IF LINE SELECTED, DELETE CONFIRMATION: “ARE
YOU SURE YOU WANT TO DELETE THIS PT&E
RECORD?” IF No, PTE SUMMARY. IF Yes, PT&E
DELETED: “THIS PT&E RECORD HAS BEEN DELETED.”
OK. PTE SUMMARY WITH RECORD DELETED.]
TRANSMITTED PT&E [IF NO TRANSMITTED PT&E
RECORDS, NO RECORD: “THERE IS
CURRENTLY NO TRANSMITTED PTE RECORDS
TO VIEW.” OK, PTE SUMMARY.]
[IF TRANSMITTED PT&E RECORD(S), PTE SUMMARY
WITHOUT OPTION TO ADD, EDIT, DELETE.]

3-5

VIEW TRANSMITTED PT&E DATA [SELECT CASE, ADMIN,
VIEW TRANSMITTED PT&E DATA]
[IF NO TRANSMITTED PT&E RECORDS, NO RECORD: “THERE IS
CURRENTLY NO TRANSMITTED PTE RECORD.” OK, SELECT CASE.
[IF TRANSMITTED PT&E RECORD(S): PTE SUMMARY WITHOUT
OPTION TO ADD, EDIT, DELETE.]

PTE SUMMARY (WITHOUT OPTION TO ADD, EDIT,
DELETE)
WEEK (First date of work week)
Q (Quarter: 1, 2, 3, 4)
FS (FS Name)
TSK (Task number)
HRS (Hours)
MI (Miles)
EXP (Expenses)
FSID (FS ID)
Notes (Notes)
TAP ON A LINE TO SELECT IT AND VIEW ITS NOTES
WEEK:
FS:
TASK:
HRS:
EXP:

QUARTER:
NOTES:

Done [SELECT CASE]
Functions [ADD, EDIT, DELETE, UN-TRANSMITTED PT&E]
UN-TRANSMITTED PT&E [SELECT CASE, VIEW
TRANSMITTED PT&E, FUNCTIONS, UN-TRANSMITTED PT&E]
[PT&E SUMMARY WITH ADD, EDIT, DELETE OPTIONS]

RECONCILE MISSED DUS [SELECT CASE, ADMIN, RECONCILE MISSED
DUS]
[IF NO MISSED DUs TO BE RECONCILED, NO MISSED DUs: “THERE ARE NO
MISSED DUs TO RECONCILE.” OK, SELECT CASE.]
[IF MISSED DUs TO BE RECONCILED, SEGMENTS AND MISSED DUs]

SEGMENTS AND MISSED DUs [SELECT CASE, RECONCILE MISSED
DUs]

3-6

SEGMENT (SEGID)
STREET ADDRESS (MISSED DU STREET ADDRESS)
TAP ON A LINE TO SELECT SEGMENT
Reconcile [RECONCILATION CONFIRMATION: “YOU WILL
BE REQUIRED TO RECONCILE ALL DUs WITHIN THE
SELECTED SEGMENTS. ARE YOU READY TO PROCEED?” IF
No, SEGMENTS AND MISSED DUs. IF Yes, MDU-SEGMENT
KIT CHECK.]
Exit [SELECT CASE]

MDU-SEGMENT KIT CHECK [SEGMENTS AND MISSED DUs =
RECONCILE AND RECONCILATION CONFIRMATION = YES]
Link: (line number and address of link line case)
INTERVIEWER: CONSULT YOUR SEGMENT KIT AND ANSWER THE
FOLLOWING QUESTION(S):
IS THE UNIT THAT YOU ARE ATTEMPTING TO ADD
(Missed DU Street Address)
ALREADY ON THE HANDWRITTEN LIST OF DWELLING UNITS?
(MAKE SURE YOU ARE LOOKING AT THE FULL LIST OF DWELLING
UNITS, NOT THE SELECTED DU LIST.)
Yes (UNIT NOT ADDED) [IF ANOTHER MISSED DU, NEXT
MISSED DU: “PLEASE ANSWER THE FOLLOWING QUESTIONS
TO RECONCILE THE NEXT MISSED DU.” OK, MDU-SEGMENT
KIT CHECK FOR NEXT MISSED DU.]
[IF NO OTHER MISSED DU, SELECT CASE]
No [MDU GEOGRAPHIC INTERVAL]
Exit [SELECT CASE]

MDU-GEOGRAPHIC INTERVAL [MDU-SEGMENT KIT CHECK =
NO]
Link: (line number and address of link line case)
IS THE MISSED UNIT LOCATED WITHIN THE SDU OR IN THE
GEOGRAPHIC INTERVAL BETWEEN THE SDU AND THE NEXT LISTED
LINE AS WELL AS LOCATED WITHIN THE SEGMENT BOUNDARIES?
(IF THE SDU IS THE LAST ONE LISTED ON A MAP PAGE, TAP THE Info
BUTTON FOR FURTHER INSTRUCTIONS.)
REFER TO YOUR FI MANUAL AND YOUR SEGMENT MAPS OR CALL
YOUR FS IF YOU ARE UNSURE WHETHER THIS UNIT SHOULD BE

3-7

ADDED. IF YOU CANNOT DO THAT RIGHT NOW, TAP THE Exit
BUTTON TO EXIT THIS SCREEN. YOU CAN RECONCILE THIS DU
LATER.
Yes (UNIT ADDED) [MDU-ADDRESS VERIFICATION]
No (UNIT NOT ADDED) [IF ANOTHER MISSED DU, NEXT
MISSED DU: “PLEASE ANSWER THE FOLLOWING QUESTIONS
TO RECONCILE THE NEXT MISSED DU.” OK, MDU-SEGMENT
KIT CHECK FOR NEXT MISSED DU.]
[IF NO OTHER MISSED DU, SELECT CASE]
Exit [SELECT CASE]

MDU-ADDRESS VERIFICATION
Link: (line number and address of link line case)
THIS UNIT WILL BE ADDED TO THE SAMPLE. PLEASE VERIFY THE
INFORMATION BELOW. TAP ANY LINE TO EDIT IT.
ST. NO: (street number)
STREET: (street name)
CITY: (city)
STATE: (state)
ZIP: (zip code)
CASE #: (CaseID assigned to Added DU)
Update [IF ADDITIONAL MISSED DUs TO RECONCILE,
RECONCILE NEXT: “THE ADDED DU HAS BEEN
SUCCESFULLY RECONCILED. PLEASE ANSWER THE
FOLLOWING
QUESTIONS TO RECONCILE THE NEXT MISSED DU.” OK,
MDU-SEGMENT KIT CHECK FOR NEXT MISSED DU]
[IF NO ADDITIONAL MISSED DUs TO RECONCILE, SELECT
CASE]
Exit [SELECT CASE, WITH RECONCILIATION PENDING]

RELOAD TRAINING CASES [SELECT CASE, ADMIN, RELOAD TRAINING
CASES]
RE-LOAD TRAINING CASES: “ARE YOU SURE YOU WANT TO REMOVE
AND RELOAD ALL TRAINING CASES? ONCE IT STARTS, IT MAY TAKE
AWHILE TO FINISH.” IF No, SELECT CASE. IF Yes, SELECT CASE WITH
TRAINING CASES REMOVED AND RELOADED.

ERASE TRAINING CASES [SELECT CASE, ADMIN, ERASE TRAINING
CASES]
ERASE TRAINING CASES: “ARE YOU SURE YOU WANT TO
ERASE ALL TRAINING CASES?” IF No, SELECT CASE. IF Yes, SELECT CASE
WITH TRAINING CASES REMOVED.

3-8

RESET IPAQ [SELECT CASE, ADMIN, RESET IPAQ]
RESET: “ARE YOU SURE YOU WANT TO RESET THE HANDHELD DEVICE?”
IF No, SELECT CASE. IF Yes, DEVICE SAVES DATA TO STORAGE CARD AND
RESETS, TODAY]

UTILITIES [ON SELECT CASE SCREEN TAP ADMIN, UTILITIES]
DATABASE UTILITIES
USE WITH CAUTION. IF YOU ARE UNSURE ABOUT HOW TO USE THIS
APPLICATION, PLEASE CONTACT YOUR FIELD SUPERVISOR OR THE
TECHNICAL SUPPORT GROUP.
REMOVE COMPLETED CASES: This function will remove all cases that have
been screened, and for which final interview codes have been entered for all
selected respondents.
This function allows the FI to refresh his/her case list by removing all cases on
iPAQ that have been completed, have complete Access Data entered, and all
final data successfully transmitted to RTI. FI obtains FS approval before using
this function.
REMOVE ALL CASES: USE WITH EXTREME CAUTION!!! This function
will remove ALL cases, and their associated data from your handheld device.
This function should only be used as directed by your field supervisor and RTI.
This function prepares the iPAQ to receive the next quarter’s cases by removing
all current final/transmitted cases from the iPAQ, then allowing the iPAQ to pick
up the next quarter’s cases upon a subsequent transmission. This function was
moved to the CMS, but this feature to initiate the process was left on the iPAQ as
a troubleshooting option.
Commit [IF SELECT REMOVE COMPLETED CASES AND
COMMIT, REMOVE COMPLETED CASES: “THIS WILL
REMOVE ALL CASES THAT HAVE BEEN COMPLETED AND
TRANSMITTED TO RTI. DO YOU WANT TO PROCEED?” IF NO,
DATABASE UTILITIES. IF Yes, ARE YOU SURE?: “ARE YOU
SURE YOU WANT TO REMOVE YOUR COMPLETED CASES?” IF
No, DATABASE UTILITIES. IF Yes, PLEASE BE PATIENT:
“THIS MAY TAKE A FEW MINUTES. IF YOU CURRENTLY
HAVE LOTS OF CASES ON YOUR HANDHELD DEVICE, IT WILL
TAKE LONGER. PLEASE BE PATIENT.” OK, COMPLETED
CASES REMOVED: “ALL COMPLETED CASES THAT HAVE
BEEN TRANSMITTED TO RTI HAVE BEEN REMOVED.” OK
DATABASE UTILITIES.]
[IF SELECT REMOVE ALL CASES AND COMMIT, ACCESS
CODE ENTRY: PLEASE USE THE KEYPAD TO ENTER YOUR
CASE DELETION ACCESS CODE. TAP ‘OK’ WHEN YOU ARE
DONE.” IF Cancel OR INCORRECT CODE ENTERED, INVALID

3-9

ACCESS CODE: “YOU HAVE ENTERED AN INVALID ACCESS
CODE. PLEASE CONTACT YOUR FIELD SUPERVISOR TO
OBTAIN A VALID ACCESS CODE.” OK DATABASE UTILITIES.
IF OK AND CORRECT CODE ENTERED, REMOVE ALL CASES:
“THIS WILL REMOVE ALL YOUR CASES. DO YOU WANT TO
PROCEED? IF No, DATABASE UTILITIES. IF Yes, ARE YOU
SURE: “ARE YOU SURE YOU WANT TO REMOVE ALL YOUR
CASES? IF YOU ARE UNSURE, PLEASE TAP ‘NO’ AND
CONTACT YOUR FS FOR INSTRUCTIONS. IF No, DATABASE
UTILITIES. IF Yes, BEGIN REMOVING CASES: “THIS
PROCESS WILL TAKE SEVERAL MINUTES. IF YOU HAVE A
LARGE NUMBER OF CASES ON YOUR HANDHELD DEVICE, IT
WILL TAKE LONGER. PLEASE BE PATIENT. TAP ‘YES’ TO
BEGIN REMOVING CASES. TAP ‘NO’ TO EXIT WITHOUT
REMOVING CASES.” IF No, DATABASE UTILITIES. IF Yes,
ALL CASES REMOVED: “ALL YOUR CASES HAVE BEEN
SUCCESSFULLY REMOVED. PLEASE TRANSMIT NOW TO
NOTIFY RTI THAT YOUR CASES HAVE BEEN REMOVED.” OK,
DATABASE UTILITIES.]
Exit [SELECT CASE]

CALL DISTRIBUTION [SELECT CASE, ADMIN, CALL DISTRIBUTION]
This optional case management feature can be used to view past work patterns based on ROC
data and to determine the times/days when contact has not been attempted at SDUs.
CALL DISTRIBUTION
Link: (line number and address of link line case)

SELECT A CASE OR SEGMENT (Drop-down list of cases and segments
that have associated ROC data entered. FI chooses desired selection
criteria.) [IF SELECT ALL CASES ROC INFORMATION ON ALL
CASES IS DISPLAYED. IF SELECT AN INDIVIDUAL CASE, ONLY
ROC DATA FROM THAT CASE DISPLAYED. IF SELECT AN
INDIVIDUAL SEGMENT, ROC DATA FROM CASES WITHIN THAT
SEGMENT ONLY IS DISPLAYED.]
SCREENING RECORDS ONLY (Drop-down list of selection criteria to
customize ROC data displayed.) [IF SELECT ALL ROC TYPE
RECORDS, ALL ROCS ENTERED DISPLAY. IF SELECT
SCREENING RECORDS ONLY, ONLY SCREENING RECORDS
DISPLAY. IF SELECT INTERIVEW A OR B RECORDS ONLY,
ONLY INTERVIEW A AND B RECORDS DISPLAY. IF SELECT
INTERVIEW A RECORDS ONLY, ONLY INTERVIEW A ROCS
DISPLAY. IF SELECT INTERVIEW B RECORDS ONLY, ONLY
INTERVIEW B ROCS DISPLAY. IF SELECT CHOOSE ROC
CODE(S), A DROP DOWN LIST OF ALL ROC CODES APPEARS TO
CHOOSE FROM.]
3-10

DATE RANGE (INCLUSIVE)
BEGIN DATE: [SELECT A DATE] Calendar appears allowing
beginning date selection to narrow down the ROC results ACCEPT
chooses the date entered [CALL DISTRIBUTION], CANCEL, [CALL
DISTRIBUTION].)
END DATE: [SELECT A DATE] Calendar appears allowing
beginning date selection to narrow down the ROC results ACCEPT
chooses the date entered [CALL DISTRIBUTION], CANCEL, [CALL
DISTRIBUTION].)
Su
M
Tu
W
Th
F
Sa
All

6A-10A 10A-12P 12P-4P 4P-6P 6P-10P 10P-6A All
-

? [HELP – CALL DISTRIBUTION] (Information screen providing
helpful instructions for proper use.)
Close [CALL DISTRIBUTION]
Done [SELECT CASE]
Refresh (Refreshes displayed data based on most recent selection criteria
entered.) [IF NO CASE SELECTED, “PLEASE SELECT A CASE OR
SEGMENT FROM THE LIST THEN TAP “REFRESH”]
OK [CALL DISTRIBUTION]
ROC [IF CASE SELECTED, RECORD OF CALLS]
VIEW MENU [SELECT CASE, VIEW]
View allows an FI to view all cases in his/her assignment or various subgroups of cases on Select Case
screen for purposes of case management. View can be used in conjunction with Sort for a variety of
combinations.
Pending Cases (All Screening and Interview cases with Result Codes 00-09, 50-59)
Pending Screenings (All Screening cases with Result Codes 00-09)
Pending Interviews (All Interview cases with Result Codes 50-59)
Group Quarters Units (All GQU cases)
All Cases (All cases)
Final Screenings (Screening cases with Result Codes 10-32)
Final Interviews (Interview cases with Result Codes 70-79)
Added DUs (All added DUs)
On Hold Cases (All cases on hold)

3-11

SORT MENU [SELECT CASE, SORT]
Sort is a case management feature that list cases in varying orders on the Select Case screen. Sort can be
used in combination with View for a variety of combinations.
By Case ID (Alphanumerical order by CaseID)
By Street (Alphanumerical order by street name within segment and number)
By SCR Code (Numerical order by Screening Result Code)
By Int A Code (Numerical order by Interview A Result Code)
By Int B Code (Numerical order by Interview B Result Code)
By ROC Date, Asc (Ascending date order using most recent Record of Calls entry)
By ROC Date, Desc (Descending date order using most recent Record of Calls entry)

CAL [SELECT CASE, CAL]
This optional calendar can be used to post work and personal appointments to help with time
management and scheduling of interview appointments.

APPOINTMENT-LIST
DAY: (current date with link to calendar to select a date)
[IF SELECT A DATE, Accept CHANGES DATE,
Cancel MAINTAINS CURRENT DATE,
Left/Right Arrows SELECT MONTH]

(Day of Week)

DATES WITH APPOINTMENTS: (list of dates with appointments)
TIME (appointment time)
APPT. TYPE (Interview-A, Interview-B, Screening, S/I Other, Other)
DUID (Case ID)
T (Data Type = S, A, B)
Description (text entry with comments describing appointment)
Created Date (appointment created date)
TAP ON A LINE TO SELECT AND VIEW IT
TIME:
DUID:
DESC:

TYPE:

ADDR:
CREATED ON:
Done [SELECT CASE]
New [APPOINTMENT-NEW]
Edit [IF RECORD SELECTED, APPOINTMENT-EDIT]
[IF NO RECORD SELECTED: SELECT RECORD: ‘PLEASE
SELECT A RECORD BEFORE EDITING IT.” OK,
APPOINTMENT-LIST]
Delete [IF RECORD SELECTED, DELETE CONFIRMATION: “ARE
YOU SURE YOU WANT TO DELETE THIS (TYPE) APPOINTMENT
AT (DATE/TIME)?” IF Yes, APPOINTMENT-LIST WITH
APPOINTMENT DELETED. IF No, APPOINTMENT–LIST WITH

3-12

APPOINTMENT NOT DELETED]
[IF NO RECORD SELECTED: SELECT RECORD: “PLEASE
SELECT A RECORD BEFORE EDITING IT.” OK,
APPOINTMENT-LIST]

APPOINTMENT-NEW
DAY: (current date with link to calendar to select a date)
[IF SELECT A DATE,
Accept CHANGES DATE,
Cancel MAINTAINS CURRENT DATE,
Left/Right Arrows SELECT MONTH]

(Day of Week)

TIME: HOUR (1-12)
MINUTE (00, 05, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55)
AM/PM (AM, PM)
DESC: (text entry of comments describing appointment)
TYPE: (Options for Interview-A, Interview-B, Screening, S/I Other, Other)
DUID: (CaseID for Interview-A, Interview-B, S/I Other, and Screening)
Commit [CHECKS FOR COMPLETE DATA ENTRY, SAVES
APPOINTMENT ENTRY, APPOINTMENT- LIST]
Cancel [APPOINTMENT-LIST WITHOUT SAVING APPOINTMENT ENTRY]

APPOINTMENT–EDIT [APPOINTMENT-LIST, EDIT]
DAY: (current date with link to calendar to select a date)
[IF SELECT A DATE,
Accept CHANGES DATE,
Cancel MAINTAINS CURRENT DATE,
Left/Right Arrows SELECT MONTH]

(Day of Week)

TIME: HOUR (1-12)
MINUTE (00, 05, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55)
AM/PM (AM, PM)
DESC: (text entry with comments describing appointment)
TYPE: (Options for Interview-A, Interview-B, Screening, S/I Other, Other)
DUID: (CaseID for Interview-A, Interview-B, S/I Other, and Screening)
Commit [APPOINTMENT–LIST WITH EDITS SAVED]
Cancel [APPOINTMENT–LIST]
APPOINTMENTS [NSDUH SCREENER-PASSWORD, PASSWORD ENTRY,
CONTINUE ARROW AND APPOINTMENTS SCHEDULED FOR CURRENT DAY]
“THERE ARE SCHEDULED APPOINTMENTS TODAY. PLEASE CHECK
THE CALENDAR.” OK, SELECT CASE.

QUIT [ON SELECT CASE SCREEN TAP QUIT] [TODAY]
3-13

This page left blank intentionally.

3-14

NSDUH QFT Screening Application Specifications
Section 4
Record of Calls
Document Format:
 Screen names bolded
 Screen/question/instructional text designated by black and red text and non-italicized text in
parenthesis (Upper-lower black text to be read, red upper case text is instructions to FI)
 Fills designated by parentheses and italics
 Logic designated by brackets
 Text of instructional message boxes provided in bracketed logic
 Response categories underlined

RECORD OF CALLS [SELECT CASE, CASE ID, ACTIONS, GO TO RECORD OF
CALLS OR ON ANY SUBSEQUENT SCREEN EXIT OR VERIFICATION, DONE OR
RESPONDENT SELECTION, DONE]
T (Data Type: S, A, B)
Rslt (Result Code)
Date (Date ROC entered)
Day (Day of the week ROC entered)
Time: (Time of day ROC entered)
TAP ANY LINE TO DISPLAY ITS COMMENTS
Done [SELECT CASE]
Functions [ADD, EDIT, DELETE, VIEW COMMENTS, VIEW LETTERS (IF
LETTERS REQUESTED), VIEW REFUSALS (IF CODE = 07, 17, 57, 58, 77, 78),
VIEW OTHER SPECIFY (IF CODE = 09, 23)]
Ver [IF VERIFICATION INFORMATION AVAILABLE, VERIFICATION.]
[IF NO VERIFICATION INFORMATION AVAILABLE, NO VERIFICATION
INFORMATION: “THERE IS NO VERIFICATION INFORMATION ON FILE.” OK,
RECORD OF CALLS]
Sels [RESPONDENT SELECTION]
Cal [APPOINTMENT-LIST -FOR DETAILS SEE SECTION 5]
CD [CALL DISTRIBUTION -FOR DETAILS SEE SECTION 5]

4-1

FUNCTIONS MENU [RECORD OF CALLS, FUNCTIONS]
Add [CHOOSE ROC TYPE]
Edit [IF ROC EVENT SELECTED, SCREENING CALL RECORD]
[IF NO ROC EVENT SELECTED, SELECT RECORD: “TO EDIT ANY
RECORD, TAP ON IT. THEN TAP “Functions” AT THE BOTTOM OF THE
SCREEN, THEN TAP “Edit.” OK, RECORD OF CALLS]
Delete [IF UNTRANSMITTED, NON-SYSTEM-GENERATED ROC EVENT (NE 26,
30, 31, 32), DELETES EVENT, RECORD OF CALLS]
[IF TRANSMITTED, SYSTEM GENERATED ROC EVENT (26, 30, 31, 32),
RECORD TRANSMITTED: “THIS ROC RECORD HAS BEEN
TRANSMITTED OR IT WAS A SYSTEM GENERATED EVENT. YOU
CANNOT DELETE IT.” OK, RECORD OF CALLS]
[IF NO ROC EVENT SELECTED, SELECT RECORD: “TO DELETE ANY
RECORD, TAP ON IT. THEN TAP “Functions” AT THE BOTTOM OF THE
SCREEN, THEN TAP “Delete.”” OK, RECORD OF CALLS]
View Comments [ROC COMMENTS]
Function to view all ROC event comments for an individual case.
ROC COMMENTS
(Date, time, Day of week, Result Code, Comment text)
Done [RECORD OF CALLS]
View Refusals [IF CODE 07, 17, 57, 58, 77, 78, REFUSAL REPORT -FOR DETAILS
SEE SECTION 7]
View Other Specify [IF CODE 09, 23, OTHER, SPECIFY]
View Letters [IF LETTER SENT, LETTERS]

LETTERS [IF REFUSAL LETTER HAS BEEN SENT
AND IF RECORD OF CALLS = CALL RECORD SELECTED,
FUNCTIONS, VIEW LETTERS]
(Date letter requested – letter code – result code – FS that submitted
request)
Done [RECORD OF CALLS]

CHOOSE ROC TYPE [IF CODE = 10-23, 30-32, RECORD OF CALLS, ROC EVENT,
FUNCTIONS, ADD]
WHICH TYPE OF CALL RECORD DO YOU WANT TO ENTER?
S [SCREENING CALL RECORD]
A [INT. CALL RECORD-A]
B [INT. CALL RECORD-B]
Cancel [RECORD OF CALLS]

4-2

SCREENING CALL RECORD [IF AT COMPLETION OF SCREENING PROCESS
RESPONDENT SELECTION = DONE OR IF RECORD OF CALLS = FUNCTIONS, ADD,
CHOOSE ROC TYPE, S]
RESULT (01-23, 26, 29)
COMMENTS: (text entry)
DO NOT CHANGE ROC DATE/TIME UNLESS INSTRUCTED BY TECH SUPPORT
OR FS.
DATE: (Date ROC event entered)
DAY: (Day of week ROC event entered)
TIME: HOUR (1-12)
MINUTE (00-59)
AM/PM (AM, PM)
Commit [IF CODE = 32, INTERVIEW EVENT: “REMEMBER TO ENTER CALL
RECORDS FOR INTERVIEWS A AND B.” OK, RECORD OF CALLS.]
[IF CODE = 31, INTERVIEW EVENT: “REMEMBER TO ENTER INTERVIEW
CALL RECORD FOR INTERVIEW A.” OK, RECORD OF CALLS]
[IF CODE = 10, 13, 18, 26, OR 30, VERIFICATION]
[IF 07 OR 17, REFUSAL REPORT -FOR DETAILS SEE SECTION 7]
[IF 09 OR 23, OTHER, SPECIFY]
[IF 56 OR 76, OTHER LANGUAGE]
[IF 04, 14, 54 OR 74, INCAPABLE, SPECIFY]
Cancel [ARE YOU SURE?: “ARE YOU SURE YOU WANT TO CANCEL THIS CALL
RECORD?” IF Yes, SELECT CASE. IF No, SCREENING CALL RECORD]

INTERVIEW CALL RECORD [RECORD OF CALLS, FUNCTIONS, ADD, CHOOSE
ROC TYPE, A OR B]
RESULT (50-59, 70-79)
COMMENTS: (text entry)
DO NOT CHANGE ROC DATE/TIME UNLESS INSTRUCTED BY TECH SUPPORT
OR FS.
DATE: (Date ROC event entered)
DAY: (Day of week ROC event entered)
TIME: HOUR (1-12) MINUTE (00-59) AM/PM (AM, PM)
Commit [SAVES DATA, RECORD OF CALLS]
[IF 57, 58, 77, 78, REFUSAL REPORT -FOR DETAILS SEE SECTION 7]
[IF 59 OR 79, OTHER, SPECIFY]
Cancel [ARE YOU SURE?: “ARE YOU SURE YOU WANT TO CANCEL THIS CALL
RECORD?” Yes, SELECT CASE, No, INT. CALL RECORD-A OR B]
OTHER, SPECIFY [SCREENING CALL RECORD = RESULT CODE 09]
CODE 09: OTHER SPECIFY CATEGORIES

4-3

Screening breakoff
Selected wrong line number
Added in error
Safety issue
Controlled access
Possible vacant
Possible vacation/not primary residence
GQU is institution
Other listing problem
Need to discuss with FS
Something else, Specify
Done [RECORD OF CALLS]

OTHER, SPECIFY [SCREENING CALL RECORD = FINAL RESULT CODE 23]
CODE 23: OTHER SPECIFY CATEGORIES
Added in error
Safety issue
GQU is institution
Something else, Specify
Done [RECORD OF CALLS]

OTHER, SPECIFY [INTERVIEW A CALL RECORD OR INTERVIEW B CALL RECORD
= RESULT CODE 59]
CODE 59: OTHER SPECIFY CATEGORIES
R moved
R under age 12
R in military
R rostered in error
R deceased
Interviewed wrong person
Screened wrong line
Safety issue
Controlled access
Need to discuss with FS
Something else, Specify
Done [RECORD OF CALLS]

OTHER, SPECIFY [INTERVIEW A CALL RECORD OR INTERVIEW B CALL RECORD
= RESULT CODE 79]
CODE 79: OTHER SPECIFY CATEGORIES

4-4

R moved
R under age 12
R in military
R rostered in error
R deceased
Interviewed wrong person
Screened wrong line
Safety issue
Controlled access
Something else, Specify
Done [RECORD OF CALLS]

OTHER LANGUAGE [SCREENING CALL RECORD = 06 OR 16, INTERVIEW A CALL
RECORD OR INTERVIEW B CALL RECORD = 56 OR 76]
OTHER LANGUAGE CATEGORIES
CHOOSE ONE
Arabic
Chinese
French
German
Italian
Korean
Polish
Portuguese
Russian
Tagalog
Vietnamese
Other, Specify [OTHER LANGUAGE SPECIFY]
Done [RECORD OF CALLS]
Comments [OTHER LANGUAGE SPECIFY]

OTHER LANGUAGE SPECIFY [OTHER LANGUAGE = OTHER, SPECIFY]
SPECIFY OTHER LANGUAGE OR ENTER COMMENTS:
Done [OTHER LANGUAGE]

INCAPABLE, SPECIFY [SCREENING CALL RECORD = 04 OR 14, INTERVIEW A CALL
RECORD OR INTERVIEW B CALL RECORD = 54 OR 74]
CODE [fill with 04 or 14 or 54 or 74]: INCAPABLE CATEGORIES
(CHOOSE ONE)

4-5

Physically Incapable
Mentally Incapable
Done [RECORD OF CALLS]

4-6

NSDUH QFT Screening Application Specifications
Section 5
Screening and Interview Refusal
Document Format:
 Screen names bolded
 Screen/question/instructional text designated by black and red text and non-italicized text in
parenthesis (Upper-lower black text to be read, red upper case text is instructions to FI)
 Fills designated by parentheses and italics
 Logic designated by brackets
 Text of instructional message boxes provided in bracketed logic
 Response categories underlined

REFUSAL REPORT [IF SCREENING CALL RECORD = 07 P REFUSAL OR
IF SCREENING CALL RECORD = 17 F REFUSAL AND ALREADY HAS A PENDING
REFUSAL ENTERED OR IF INTERVIEW CALL RECORD = 57 P REFUSAL OR IF
INTERVIEW CALL RECORD = 58 P PARENTAL REFUSAL OR IF INTERVIEW CALL
RECORD = 77 F REFUSAL AND ALREADY HAS A PENDING REFUSAL ENTERED OR
IF INTERVIEW CALL RECORD = 78 F PARENTAL REFUSAL AND ALREADY HAS A
PENDING REFUSAL ENTERED]
[IF SCREENING CALL RECORD = 17 F REFUSAL AND DOES NOT ALREADY HAVE A
PENDING REFUSAL ENTERED: RESULT CODE ERROR: “TRY AT LEAST ONE
MORE TIME BEFORE ASSIGNING THIS FINAL CODE.” OK. SCREENING CALL
RECORD]
[IF INTERVIEW CALL RECORD = 77 F REFUSAL AND DOES NOT ALREADY HAVE A
PENDING REFUSAL ENTERED, OR IF INTERVIEW CALL RECORD = 78 F PARENTAL
REFUSAL AND DOES NOT ALREADY HAVE A PENDING REFUSAL ENTERED:
RESULT CODE ERROR: “TRY AT LEAST ONE MORE TIME BEFORE ASSIGNING
THIS FINAL CODE.” OK. INTERVIEW CALL RECORD]
REASON FOR REFUSAL (CHECK ONLY ONE)
Too busy/no time/did too many already
Surveys/Govt. invasive/teen exposure
Clarify confidentiality, legitimacy, selection
“Nothing in it for me”/Uncooperative
Gatekeeper/Parent/HH member disallow
Welfare/INS concern
Too ill/house messy/not dressed
Need to discuss with FS [REFUSAL COMMENTS]
Done [SAVES REASON FOR
REFUSAL, RECORD OF CALLS]

5-1

Comments [REFUSAL COMMENTS]

REFUSAL COMMENTS [IF REFUSAL REPORT = COMMENTS, OR IF REASON FOR
REFUSAL = NEED TO DISCUSS WITH FS]
COMMENTS: (text entry)
Done [SAVES COMMENTS ENTERED, REFUSAL REPORT]

Screening and Interview Refusal Functions on ROC
1. View refusal report or edit refusal report prior to transmission:
REFUSAL REPORT [IF RECORD OF CALLS = CALL RECORD HIGHLIGHTED,
FUNCTIONS, VIEW REFUSALS]
REASON FOR REFUSAL (CHECK ONLY ONE)
Too busy/no time/did too many already
Surveys/Govt. invasive/teen exposure
Clarify confidentiality, legitimacy, selection
“Nothing in it for me”/Uncooperative
Gatekeeper/Parent/HH member disallow
Welfare/INS concern
Too ill/house messy/not dressed
Need to discuss with FS [REFUSAL COMMENTS]
Done [IF EDITED (BEFORE
TRANSMISSION) SAVES
REASON FOR REFUSAL, THEN
RECORD OF CALLS]

Comments [REFUSAL COMMENTS]

2. View Refusal and Unable to Contact letter data:
LETTERS [IF REFUSAL LETTER HAS BEEN SENT AND IF RECORD OF
CALLS = CALL RECORD HIGHLIGHTED, FUNCTIONS, VIEW LETTERS]
(Date letter requested – letter code – result code – FS that submitted request)
Done [RECORD OF CALLS]

5-2

NSDUH QFT Screening Application Specifications
Section 6
Verification
Document Format:
 Screen names bolded
 Screen/question/instructional text designated by black and red text and non-italicized text
in parenthesis (Upper-lower black text to be read, red upper case text is instructions to FI)
 Fills designated by parentheses and italics
 Logic designated by brackets
 Text of instructional message boxes provided in bracketed logic
 Response categories underlined

VERIFICATION [IF SCREENING RESULT CODE = 10, 13, 18, 22, 26 OR IF
RESPONDENT SELECTION = ‘NONE’ FOR BOTH A AND B INTERVIEW]
FIRST NAME: (Screening Respondent’s first name)
Not Avail.
Ref.
PHONE: (Area code and phone number)
Home
Cell
Work
Not Avail.
Ref.
NOTES TO VERIFICATION CALLER: (Text field for notes about best
times to call screening respondent or clarification about work number if
caller has to go through an operator.)
So that my supervisor may check the quality of my work, may I please have your
first name and telephone number? CONFIRM NUMBER WITH R.
Done [CHECKS FOR COMPLETE DATA ENTRY, SCREENING
CALL RECORD]
Clear [VERIFICATION WITH ENTRY CLEARED]

6-1

This page intentionally left blank.

6-2

NSDUH QFT Screening Application Specifications
Section 7
FI Debriefing Questions
Document Format:
 Screen names bolded
 Screen/question/instructional text designated by black and red text and non-italicized text in
parenthesis (Upper-lower black text to be read, red upper case text is instructions to FI)
 Fills designated by parentheses and italics
 Logic designated by brackets
 Text of instructional message boxes provided in bracketed logic
 Response categories underlined

QFTDBF1 [IF SCREENING CALL RECORD = RESULT CODE 30, 31 or 32]
THESE QUESTIONS ARE FOR YOU TO ANSWER. DO NOT READ TO THE R.
Did the respondent remember receiving the Lead Letter?
YES
NO
Next [QFTDBF2]
QFTDBF2 [IF QFTDBF1 NE BLANK]
What comments, if any, did the respondent make about the Lead Letter or in response to the Lead
Letter? Check all that apply
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.

THE RESPONDENT DID NOT MAKE ANY COMMENTS ABOUT THE LEAD LETTER
R WAS LOOKING FORWARD TO YOUR VISIT/BEEN WAITING FOR YOU
R WAS INTERESTED IN THE STUDY
R WOULD LIKE TO PARTICIPATE IN THE STUDY
R DO NOT BELIEVE THE GOVERNMENT IS PAYING $30/WASTE OF TAX DOLLARS
THE LETTER ANSWERED THE R’S QUESTIONS/CONCERNS
R DID NOT WANT SOMEONE COMING TO MY HOME WITHOUT MY PERMISSION
R WAS CONFUSED BY THE LETTER
THE LETTER DID NOT ANSWER ALL OF THE R’S QUESTIONS/CONCERNS
R DOES NOT BELIEVE THE SURVEY IS CONFIDENTIAL
R THOUGHT THIS WAS A SCAM
R DOES NOT OPEN ANYTHING ADDRESSED TO “RESIDENT”
OTHER

Next [RECORD OF CALLS]

7-1

INTERVIEW DEBRIEFING QUESTIONS:
THESE QUESTIONS ARE FOR YOU TO ANSWER. DO NOT READ TO THE R.
QFTDBF3 [IF INTERVIEW A CALL RECORD OR INTERVIEW B CALL RECORD = RESULT
CODE 70]
When did you give the respondent (or parent/guardian of youth respondent) the Q&A Brochure?
1. BEFORE THE INTERVIEW
2. DURING THE INTERVIEW
3. AT THE END OF THE INTERVIEW
Next [QFTDBF3a]
QFTDBF3a [IF QFTDB3 NE BLANK]
What comments, if any, did the respondent (or parent/guardian) make about the Q&A Brochure?
Check all that apply
1. THERE WERE NO COMMENTS ABOUT THE Q&A BROCHURE
2. THE BROCHURE DID NOT ANSWER ALL OF THE RESPONDENT’S QUESTIONS ABOUT
THE STUDY.
3. THE BROCHURE ADDRESSED THE RESPONDENT’S QUESTIONS
4. RESPONDENT WAS CONFUSED BY THE BROCHURE.
5. THE BROCHURE ENCOURAGED THE RESPONDENT TO PARTICIPATE.
6. OTHER
Next [QFTDBF4]
QFTDBF4 [IF QFTDBF3a NE BLANK]
Did you conduct this interview at the respondent’s home, either inside or outside?
YES
NO
Next [IF QFTDBF4=YES, GO TO QFTDBF6]
QFTDBF5 [IF QFTDBF4=NO]
Where did you conduct this interview?
1. AT THE RESPONDENT’S WORKPLACE
2. AT THE HOME OF THE RESPONDENT’S RELATIVE OR FRIEND
3. IN SOME TYPE OF CONFERENCE ROOM IN A RESIDENCE HALL, SCHOOL OR
APARTMENT COMPLEX
4. AT A LIBRARY

7-2

5. IN SOME TYPE OF COMMON AREA, SUCH AS A LOBBY, HALLWAY, STAIRWELL, OR
LAUNDRY ROOM
6. SOME OTHER PLACE
Next [IF QFTDBF5=6, GO TO QFTDBF5a]
QFTDBF5a [IFQFTDBF5=6]
Where did the interview take place?
ALLOW 140 CHARACTERS
Next [QFTDBF6]
QFTDBF6 [IF QFTDBF4=YES; OR QFTDBF5=1, 2, 3, 4, OR 5; OR QFTDBF5a NE BLANK]
Please indicate how private the interview was. Do not count yourself or a project observer as another
person in the room.
1. COMPLETELY PRIVATE – NO ONE WAS IN THE ROOM OR COULD OVERHEAR ANY
PART OF THE INTERVIEW
2. MINOR DISTRACTIONS – PERSON(S) IN THE ROOM OR LISTENING LESS THAN 1/3 OF
THE TIME
3. PERSON(S) IN THE ROOM OR LISTENING ABOUT 1/3 OF THE TIME
4. SERIOUS INTERRUPTIONS OF PRIVACY MORE THAN HALF THE TIME
5. CONSTANT PRESENCE OF OTHER PERSON(S)
Next [IF QFTDBF6=1, GO TO QFTDBF9; IF QFTDBF6 NE1, GO TO QFTDBF7]
QFTDBF7 [IF QFTDBF6 NE1]
Not including yourself or project observers, other people present or listening to the interview were:
Check all that apply
1.
2.
3.
4.
5.
6.
7.

PARENT(S)
SPOUSE
LIVE-IN PARTNER/BOYFRIEND/GIRLFRIEND
OTHER ADULT RELATIVE(S)
OTHER ADULT(S)
CHILD(REN) UNDER 15
OTHER

Next [IF QFTDBF7=1, 2, 3, 4, 5, OR 6, GO TO QFTDBF9]
QFTDBF8 [IF QFTDBF7=7]

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Please enter a description of the other person(s) present or listening to the interview. This description may
be relationship to the respondent if you have this information, or simply the gender and estimated age.
ALLOW 140 CHARACTERS
Next [QFTDBF9]
QFTDBF9 [IF QFTDBF6=1; OR IF QFTDBF7=1, 2, 3, 4, 5, OR 6; OR IF QFTDBF8 NE BLANK]
Did the respondent make any comments about the interview being too long?
YES
NO
Next [QFTDBF10]
QFTDBF10 [IF QFTDBF9 NE BLANK]
Did the respondent have any questions or comments about the Prescription Drug questions in the ACASI
section of the questionnaire?
YES
NO
Next [IF QFTDBF10 =NO, GO TO QFTDBF11]
QFTDBF10a [IF QFTDBF10= YES]
Please describe the respondent’s comments about the Prescription Drug questions.
ALLOW 140 CHARACTERS
Next [QFTDBF11]
QFTDBF11 [IF QFTDBF10 = NO OR QFTDBF10a NE BLANK]
Did the respondent have any questions or comments about the on-screen calendars in the ACASI section
of the questionnaire? If the respondent asked how to access the calendar at any time during the ACASI
portion of the interview, select “YES.”
YES
NO
Next [IF QFTDBF11=NO, GO TO QFTDBF12]
QFTDBF11a [IF QFTDBF11 = YES]
What comments did the respondent make about the on-screen calendars? Check all that apply
1. THE RESPONDENT ASKED HOW TO ACCESS THE CALENDAR.

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2.
3.
4.
5.
6.

THE RESPONDENT ASKED HOW TO CLOSE THE CALENDAR.
THE RESPONDENT DID NOT SEE THE REFERENCE DATES ON THE CALENDAR.
THE CALENDAR HELPED THE RESPONDENT ANSWER THE QUESTION.
THE CALENDAR COVERED THE QUESTIONS OR THE IMAGES ON THE SCREEN.
OTHER

Next [QFTDBF12]
QFTDBF12 [IF QFTDBF11=NO; OR IF QFTDBF11a NE BLANK]
Did the respondent have trouble understanding any other questions asked during the interview?
YES
NO
Next [IF QFTDBF12=NO, GO TO QFTDBF13]
QFTDBF12a [IF QFTDBF12=YES]
Enter the screen name and a brief description of what the respondent found confusing. If you do not
know the screen name, please provide as much information as possible.
ALLOW 140 CHARACTERS
Next [QFTDBF13]
QFTDBF13 [IF QFTDBF12=NO OR QFTDBF12a NE BLANK]
Was a proxy used for the income and health insurance questions?
YES
NO
Next [IF QFTDBF13=NO, GO TO RECORD OF CALLS]
QFTDBF14 [IF QFTDBF13=YES]
Did the respondent have any questions or concerns about his/ her answers being revealed to the proxy?
YES
NO
Next [QFTDBF15]
QFTDBF15 [IF QFTDBF14 NE BLANK]
Did the respondent have any other questions or comments about the proxy interview?
YES
NO
Next [IF QFTDBF15 =NO, GO TO QFTDBF16]

7-5

QFTDBF15a [IF QFTDBF15=YES]
Please describe the other questions or comments the respondent had about the proxy interview.
ALLOW 140 CHARACTERS
Next [QFTDBF16]
QFTDBF16 [IF QFTDBF15 =NO; OR QFTDBF15a NE BLANK]
Were there any problems with the proxy’s understanding of the ACASI tutorial?
YES
NO
Next [IF QFTDBF16 =NO, GO TO QFTDBF17]
QFTDBF16a [IF QFTDBF16=YES]
Which of the following describes the problems with the proxy’s understanding of the tutorial?
Check all that apply
1. THE PROXY DID NOT UNDERSTAND HOW TO ANSWER THE QUESTIONS.
2. THE PROXY DID NOT KNOW WHY HE/SHE WAS ASKED TO ANSWER THESE
QUESTIONS
3. OTHER
Next [IF QFTDBF16a=1 OR 2, GO TO QFTDBF17]
QFTDBF16b [IF QFTDBF16a=3]
Please describe the other problems with the proxy’s understanding of the tutorial.
ALLOW 140 CHARACTERS
Next [QFTDBF17]
QFTDBF17 [IF QFTDBF16a=1 OR 2; OR QFTDBF16b NE BLANK]
Were there any problems with the proxy’s use of ACASI to answer the income and health insurance
questions?
YES
NO
Next [IF QFTDBF17= NO, GO TO RECORD OF CALLS]

7-6

QFTDBF17a [IF QFTDBF17=YES]
Which of the following describes the problems with the proxy’s use of ACASI in answering the income
and health insurance questions? Check all that apply.
1.
2.
3.
4.

THE PROXY DID NOT KNOW THE ANSWERS TO THE QUESTIONS
THE PROXY DID NOT KNOW HOW TO ENTER HIS/HER ANSWERS TO THE QUESTIONS
THE PROXY REFUSED TO ANSWER SOME QUESTIONS
THE PROXY DID NOT KNOW WHY HE/SHE WAS ASKED TO ANSWER THESE
QUESTIONS
5. OTHER
Next [RECORD OF CALLS]

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