Form 5.1 Survey

OMB #: 0925-0593

OMB Expiration Date: 07/31/2013

Participant Verification Questionnaire, Phase 2e

Participant Verification Questionnaire

Event:	All Events
Participant: Respondent:	Child Parent/Caregiver
Domain:	Questionnaire
Type of Document: Allowable Mode: Allowable Method:	Interview In person, Telephone, Web, Mail Interviewer-Administered, CATI/CAPI
Recruitment Groups: Version: Release:	EH, PB, HI, LI, PBS 1.0 MDES 3.0

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Participant Verification Questionnaire

TABLE OF CONTENTS

PARTICIPANT VERIFICATION 1

Participant Verification

(TIME_STAMP_PV_ST) PROGRAMMER INSTRUCTION:

• INSERT DATE/TIME STAMP

PV001. In the next set of questions we will verify your contact information.

PV002/(MULT_CHILD). IS THERE MORE THAN ONE CHILD IN THIS HOUSEHOLD ELIGIBLE FOR THE {EVENT_TYPE} INTERVIEW TODAY?

INTERVIEWER INSTRUCTION:

• DO NOT ADMINISTER THIS ITEM TO THE PARENT/CAREGIVER.

YES 1

NO 2 (PV006)

PROGRAMMER INSTRUCTION:

• PRELOAD AND DISPLAY EVENT_TYPE.

• IF MULT_CHILD =2, SET CHILD_QNUM=1.

PV003/(CHILD_NUM). HOW MANY CHILDREN IN THIS HOUSEHOLD ARE ELIGIBLE FOR THE {EVENT_TYPE} INTERVIEW TODAY?

INTERVIEWER INSTRUCTION:

• DO NOT ADMINISTER THIS ITEM TO THE PARENT/CAREGIVER.

|___|___|

NUMBER OF CHILDREN

PROGRAMMER INSTRUCTION:

• PRELOAD AND DISPLAY EVENT_TYPE.

PV004/(CHILD_QNUM). WHICH NUMBER CHILD IS THIS QUESTIONNAIRE FOR?

INTERVIEWER INSTRUCTION:

• DO NOT ADMINISTER THIS ITEM TO THE PARENT/CAREGIVER.

|___|___|

NUMBER

PROGRAMMER INSTRUCTION:

• CHILD_QNUM CANNOT BE GREATER THAN CHILD_NUM.

PV006. First, we’d like to make sure we have your name recorded correctly.

PROGRAMMER INSTRUCTIONS:

• IF (R_FNAME)(R_MNAME)(R_LNAME) COLLECTED FOR PARENT/CAREGIVER DURING PREVIOUS INTERVIEW AND VALID RESPONSE PROVIDED, GO TO NAME_CONFIRM.

• IF CHILD_NUM > 1 AND (R_FNAME)(R_MNAME)(R_LNAME) COLLECTED FOR PREVIOUS CHILD_QNUM, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING PERSON_DOB.

• OTHERWISE, GO TO (R_FNAME) (R_MNAME) (R_LNAME).

PV007/(NAME_CONFIRM). Is your name {PARENT/CAREGIVER NAME}?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• PRELOAD PARENT/CAREGIVER’S NAME AS COLLECTED IN MOST RECENT INTERVIEW.

• IF NAME_CONFIRM = 2,-1, or -2, GO TO (R_FNAME)(R_MNAME)(R_LNAME).

• OTHERWISE, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING (R_FNAME)(R_MNAME) (R_LNAME).

PV008/(R_FNAME)(R_MNAME) (R_LNAME). What is your full legal name?

INTERVIEWER INSTRUCTIONS:

• IF PARENT/CAREGIVER REFUSES TO PROVIDE INFORMATION, RE-STATE CONFIDENTIALITY PROTECTIONS, ASK FOR INITIALS OR SOME OTHER NAME HE OR SHE WOULD LIKE TO BE CALLED.

• CONFIRM SPELLING OF FIRST, MIDDLE, AND LAST NAME IF NOT PREVIOUSLY COLLECTED.

________________

FIRST NAME

REFUSED -1

DON’T KNOW -2

________________

MIDDLE NAME

REFUSED -1

DON’T KNOW -2

________________

LAST NAME

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF EVENT_TYPE = PREGNANCY VISIT 1, OR

• IF EVENT_TYPE = BIRTH, AND PREGNANCY VISIT 1 NOT SET TO COMPLETE, GO TO MAIDEN_NAME.

• OTHERWISE, GO PROGRAMMER INSTRUCTIONS FOLLOWING (NICKNAME_1)/ (NICKNAME_2).

PV008A/(MAIDEN_NAME). What is your maiden name?

_______________________________________

MAIDEN NAME

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTION:

• LIMIT TEXT TO 255 CHARACTERS.

PV008B/(NICKNAMES). Do you go by any other names or nicknames?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF NICKNAMES = 1, GO TO (NICKNAME_1)/(NICKNAME_2).

• OTHERWISE, IF NICKNAMES = 2, -1, OR -2, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING (NICKNAME_1)/(NICKNAME_2).

PV008C/(NICKNAME_1)/(NICKNAME_2).

INTERVIEWER INSTRUCTION:

• RECORD UP TO 2 NICKNAMES

NICKNAME 1 __________________________________

NICKNAME 2 __________________________________

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• LIMIT TEXT TO 255 CHARACTERS PER NICKNAME.

• DO NOT ALLOW NICKNAME_2 TO BE FILLED UNLESS NICKNAME_1 FILLED.

• IF PERSON_DOB COMPLETED DURING PREVIOUS INTERVIEW FOR CURRENT (R_FNAME)(R_MNAME)(R_LNAME) AND VALID RESPONSE PROVIDED, GO TO PV010A.

• OTHERWISE, GO TO PERSON_DOB.

PV010/(PERSON_DOB). What is your date of birth?

INTERVIEWER INSTRUCTIONS:

• IF PARENT/CAREGIVER REFUSES TO PROVIDE INFORMATION, RE-STATE CONFIDENTIALITY PROTECTIONS AND THAT DOB IS REQUIRED

• ENTER A TWO DIGIT-MONTH, TWO-DIGIT DAY, AND A FOUR-DIGIT YEAR

• IF RESPONSE WAS DETERMINED TO BE INVALID, ASK QUESTION AGAIN AND PROBE FOR VALID RESPONSE

MONTH	DAY	YEAR
|___|___|	|___|___|	|___|___|___|___|
M M	D D	Y Y Y Y

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• FORMAT PERSON_DOB AS YYYYMMDD.

• IF EVENT_TYPE = PREGNANCY VISIT 1, PREGNANCY VISIT 2, OR FATHER, GO TO TIME_STAMP_PV_ET.

• IF EVENT_TYPE ≠ PREGNANCY VISIT 1, PREGNANCY VISIT 2, OR FATHER, AND CHILD_NUM = 1:

  • IF (C_FNAME)(C_LNAME) NOT COLLECTED DURING PREVIOUS INTERVIEW OR VALID RESPONSE NOT PROVIDED, AND/OR

  • IF CHILD_DOB NOT COLLECTED DURING PREVIOUS INTERVIEW OR VALID RESPONSE NOT PROVIDED, GO TO PV010A.

  • OTHERWISE, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CHILD_DOB.

• IF EVENT_TYPE ≠ PREGNANCY VISIT 1, PREGNANCY VISIT 2, OR FATHER, AND CHILD_NUM > 1:

  • IF (C_FNAME)(C_LNAME) NOT COLLECTED DURING PREVIOUS INTERVIEW OR VALID RESPONSE NOT PROVIDED, AND/OR

  • IF CHILD_DOB NOT COLLECTED DURING PREVIOUS INTERVIEW OR VALID RESPONSE NOT PROVIDED, GO TO PV010A.

  • OTHERWISE, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CHILD_DOB.

  • IF SAME_CONTACT_MULT_CHILD = 1, -1, OR -2 OR IF MULT_CHILD_DIFF = -1 OR -2 FOR CURRENT CHILD_QNUM:

    • LOOP THROUGH PV010A (IF APPLICABLE), (C_FNAME)(C_LNAME), CHILD_DOB (IF APPLICABLE), AND CHILD_SEX (IF APPLICABLE) AND THEN GO TO PROGRAMMER INSTRUCTIONS FOLLOWING SA_PHONE.

  • IF SAME_CONTACT_MULT_CHILD = 2 FOR CURRENT CHILD_QNUM, LOOP THROUGH PV010A (IF APPLICABLE), (C_FNAME)(C_LNAME), CHILD_DOB (IF APPLICABLE), AND CHILD_SEX (IF APPLICABLE), AND THEN:

    • IF MULT_CHILD_DIFF = 1 OR ANY COMBINATION OF 1 AND 2 THROUGH 8, ASK RESP_REL FOR CHILD_QNUM BEFORE GOING TO PROGRAMMER INSTRUCTIONS FOLLOWING SA_PHONE FOR CHILD_QNUM.

    • IF MULT_CHILD_DIFF = 2 OR ANY COMBINATION OF 2 AND 1, 3, 4, 5, 6, 7, OR 8, ASK (G_FNAME)(G_MNAME)(G_LNAME) FOR CHILD_QNUM BEFORE GOING TO PROGRAMMER INSTRUCTIONS FOLLOWING SA_PHONE FOR CHILD_QNUM.

    • IF MULT_CHILD_DIFF = 3 OR ANY COMBINATION OF 3 AND 1, 2, 4, 5, 6, 7, OR 8, ASK (P_FNAME)(P_MNAME)(P_LNAME) AND P_CARE_REL FOR CHILD_QNUM BEFORE GOING TO PROGRAMMER INSTRUCTIONS FOLLOWING SA_PHONE FOR CHILD_QNUM.

    • IF MULT_CHILD_DIFF = 4 OR ANY COMBINATION OF 4 AND 1, 2, 3, 5, 6, 7, OR 8, ASK OCARE_CHILD AND (IF OCARE_CHILD =1), (O_FNAME)(O_MNAME)(O_LNAME) AND O_CARE_REL FOR CHILD_QNUM BEFORE GOING TO PROGRAMMER INSTRUCTIONS FOLLOWING SA_PHONE FOR CHILD_QNUM.

    • IF MULT_CHILD_DIFF = 5, OR ANY COMBINATION OF 5 AND 1, 2, 3, 4, 6, 7, OR 8, ASK PV051, CHILD_TIME, AND CHILD PRIMARY ADDRESS VARIABLES FOR CHILD_QNUM BEFORE GOING TO PROGRAMMER INSTRUCTIONS FOLLOWING SA_PHONE FOR CHILD_QNUM.

    • IF MULT_CHILD_DIFF = 6 OR ANY COMBINATION OF 6 AND 1, 2, 3, 4, 5, 7, AND 8, ASK CHILD PA_PHONE FOR CHILD_QNUM BEFORE GOING TO PROGRAMMER INSTRUCTIONS FOLLOWING SA_PHONE FOR CHILD_QNUM.

    • IF MULT_CHILD_DIFF = 7 OR ANY COMBINATION OF 7 AND 1, 2, 3, 4, 5, 6, AND 8, ASK PV059 AND CHILD SECONDARY ADDRESS VARIABLES FOR CHILD_QNUM BEFORE GOING TO PROGRAMMER INSTRUCTIONS FOLLOWING SA_PHONE FOR CHILD_QNUM.

    • IF MULT_CHILD_DIFF = 8 OR ANY COMBINATION OF 8, AND 1 THROUGH 7, ASK SA_PHONE FOR CHILD_QNUM BEFORE GOING TO PROGRAMMER INSTRUCTIONS FOLLOWING SA_PHONE FOR CHILD_QNUM.

PV010A. We would like to make sure we have the child’s correct name {and birth date}.

PROGRAMMER INSTRUCTIONS:

• IF CHILD_DOB NOT COLLECTED PREVIOUSLY OR VALID RESPONSE NOT PROVIDED, “DISPLAY “and birth date”.

• IF (C_FNAME)(C_LNAME) COLLECTED DURING PREVIOUS INTERVIEW AND VALID RESPONSE PROVIDED, PRELOAD C_FNAME FROM PREVIOUS INTERVIEW, AND GO TO PROGRAMMER INSTRUCTIONS FOLLOWING (C_FNAME)/(C_LNAME).

• OTHERWISE, GO TO (C_FNAME)/(C_LNAME).

PV012/(C_FNAME)(C_LNAME). What is the child’s full name?

INTERVIEWER INSTRUCTIONS:

• IF PARENT/CAREGIVER REFUSES TO PROVIDE INFORMATION, RE-STATE CONFIDENTIALITY PROTECTIONS, ASK FOR INITIALS OR SOME OTHER NAME TO CALL THE CHILD.

• CONFIRM SPELLING OF FIRST NAME IF NOT PREVIOUSLY COLLECTED AND OF LAST NAME.

• LIMIT TEXT TO 255 CHARACTERS.

_____________________ _____________________

FIRST NAME LAST NAME

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF PARENT/CAREGIVER DOESN’T KNOW OR REFUSES TO PROVIDE NAME, INITIALS OR IDENTIFIER (I.E., C_FNAME AND C_LNAME = -1 OR -2), DISPLAY “the child” FOR C_FNAME In remainder of INSTRUMENT.

• IF CHILD_DOB COLLECTED DURING PREVIOUS INTERVIEW AND VALID DATE OF BIRTH PROVIDED, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CHILD_DOB.

• OTHERWISE, GO TO CHILD_DOB.

PV014/(CHILD_DOB). What is {C_FNAME/the child}’s date of birth?

INTERVIEWER INSTRUCTIONS:

• IF PARENT/CAREGIVER REFUSES TO PROVIDE INFORMATION, RE-STATE CONFIDENTIALITY PROTECTIONS AND THAT DOB IS REQUIRED

• ENTER A TWO-DIGIT MONTH, TWO-DIGIT DAY, AND A FOUR-DIGIT YEAR.

• IF RESPONSE WAS DETERMINED TO BE INVALID, ASK QUESTION AGAIN AND PROBE FOR VALID RESPONSE.

MONTH: |___|___|

M M

DAY: |___|___|

D D

YEAR: |___|___|___|___|

Y Y Y Y

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• INCLUDE A SOFT EDIT/WARNING IF CALCULATED AGE IS LESS THAN OR GREATER THAN VISIT WINDOW RANGE IN MONTHS FOR APPROPRIATE VISIT.

• FORMAT CHILD_DOB AS YYYYMMDD.

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

• OTHERWISE, GO TO CHILD_SEX.

PV015/(CHILD_SEX). What is the child’s sex?

MALE 1

FEMALE 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF CHILD_SEX = 1, DISPLAY “he” AND “him” THROUGHOUT THE INSTRUMENT.

• IF CHILD_SEX = 2, DISPLAY “she” AND “her” THROUGHOUT THE INSTRUMENT.

• IF CHILD_SEX = -1 OR -2, DISPLAY “they” AND “them” THROUGHOUT THE INSTRUMENT.

• IF RESP_REL COLLECTED PREVIOUSLY FOR CURRENT (R_FNAME) (R_LNAME) AND VALID RESPONSE PROVIDED, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING RESP_REL.

• OTHERWISE, GO TO RESP_REL.

PV016/(RESP_REL). What is your relationship to {C_FNAME/the child}?

MOTHER 1

FATHER 2

SISTER 3

BROTHER 4

GIRLFRIEND OR PARTNER OF CHILD'S PARENT 5

BOYFRIEND OR PARTNER OF CHILD'S PARENT 6

GRANDMOTHER 7

GRANDFATHER 8

AUNT 9

UNCLE 10

FEMALE COUSIN 11

MALE COUSIN 12

OTHER FEMALE RELATIVE 13

OTHER MALE RELATIVE 14

OTHER FEMALE NON-RELATIVE 15

OTHER MALE NON-RELATIVE 16

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF RESP_GUARD COLLECTED DURING PREVIOUS INTERVIEW WITH (R_FNAME)(R_MNAME)(R_LNAME) AND VALID RESPONSE PROVIDED, GO TO RESP_GUARD_CONF.

• OTHERWISE, IF RESP_GUARD NOT COLLECTED DURING PREVIOUS INTEVIEW WITH (R_FNAME)(R_MNAME)(R_LNAME) OR VALID RESPONSE NOT PROVIDED, GO RESP_GUARD.

PV017/(RESP_GUARD_CONF). Just to confirm, {are you/is (G_FNAME)/(G_MNAME)/(G_LNAME)} still the guardian of {C_FNAME/the child}?

YES 1 (PV030)

NO 2 (G_FNAME)/(G_MNAME)/(G_LNAME)

REFUSED -1 (G_FNAME)/(G_MNAME)/(G_LNAME)

DON’T KNOW -2 (G_FNAME)/(G_MNAME)/(G_LNAME)

PROGRAMMER INSTRUCTIONS:

• IF (R_FNAME)(R_MNAME)(R_LNAME) FOR CURRENT INTERVIEW = (G_FNAME)(G_MNAME) (G_LNAME), DISPLAY, “are you”.

• OTHERWISE, DISPLAY “is (G_FNAME)(G_MNAME)(G_LNAME)”.

PV018/(RESP_GUARD). Are you {C_FNAME’s/the child’s} legal guardian?

YES 1 (PV030)

NO 2

REFUSED -1

DON’T KNOW -2

PV019/(G_FNAME)/(G_MNAME)/(G_LNAME). What is the full name of {C_FNAME/the child}’s legal guardian?

________________

FIRST NAME

REFUSED -1

DON’T KNOW -2

________________

MIDDLE NAME

REFUSED -1

DON’T KNOW -2

________________

LAST NAME

REFUSED -1

DON’T KNOW -2

PV030. The Study wants to include adults important in the child’s life, that is, those persons in caregiving roles for {C_FNAME/the child}.

PROGRAMMER INSTRUCTION:

• IF RESP_PCARE COLLECTED DURING PREVIOUS INTERVIEW FOR CURRENT (R_FNAME)(R_MNAME)(R_LNAME) AND VALID RESPONSE PROVIDED, PRELOAD RESP_CARE, AND GO TO PROGRAMMER INSTRUCTIONS FOLLOWING RESP_CARE.

• OTHERWISE, GO TO RESP_CARE.

pv031/(RESP_PCARE). Are you the primary caregiver for {C_FNAME/the child}? By primary caregiver, we mean the person who spends most of the time with the child and has responsibility for taking care of the child on a daily basis. This does not include babysitters or childcare providers. We will ask more about these later on.

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF RESP_PCARE = 1 FOR CURRENT OR PREVIOUS INTERVIEW, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING (P_FNAME)(P_MNAME)(P_LNAME).

• OTHERWISE, GO TO (P_FNAME)(P_MNAME)(P_LNAME).

PV035/(P_FNAME)(P_MNAME)(P_LNAME). What is the full name of {C_FNAME/the child}’s primary caregiver?

INTERVIEWER INSTRUCTION:

• READ IF NECESSARY: [By primary caregiver we mean the person who spends most of the time with the child and has responsibility for taking care of the child on a daily basis. This does not include babysitters or childcare providers.]

________________

FIRST NAME

REFUSED -1

DON’T KNOW -2

________________

MIDDLE NAME

REFUSED -1

DON’T KNOW -2

________________

LAST NAME

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF OCARE_CHILD COLLECTED DURING PREVIOUS INTERVIEW AND VALID RESPONSE PROVIDED, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING OCARE_CHILD.

• OTHERWISE, GO TO OCARE_CHILD.

PV037/(PCARE_REL). What is the relationship of the primary caregiver to {C_FNAME/the child}?

INTERVIEWER INSTRUCTION:

• READ IF NECESSARY: [By primary caregiver we mean the person who spends most of the time with the child and has responsibility for taking care of the child on a daily basis.]

MOTHER 1

FATHER 2

SISTER 3

BROTHER 4

GIRLFRIEND OR PARTNER OF CHILD'S PARENT 5

BOYFRIEND OR PARTNER OF CHILD'S PARENT 6

GRANDMOTHER 7

GRANDFATHER 8

AUNT 9

UNCLE 10

FEMALE COUSIN 11

MALE COUSIN 12

OTHER FEMALE RELATIVE 13

OTHER MALE RELATIVE 14

OTHER FEMALE NON-RELATIVE 15

OTHER MALE NON-RELATIVE 16

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF OCARE_CHILD COLLECTED DURING PREVIOUS INTERVIEW AND OCARE_CHILD = 1, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING OCARE_CHILD.

• OTHERWISE, GO TO OCARE_CHILD.

PV042/(OCARE_CHILD). Besides {yourself/the primary caregiver}, is there another person that you consider to be {C_FNAME/the child}’s other caregiver? By other caregiver we mean the person who after the primary caregiver spends the most time with the child. This does not include babysitters or childcare providers. We will ask more about these later on.

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF RESP_PCARE = 1, DISPLAY “yourself”.

• OTHERWISE, DISPLAY “the primary caregiver”.

• IF OCARE_CHILD = 1 FOR PREVIOUS INTERVIEW AND (O_FNAME)(O_MNAME))(O_LNAME) COLLECTED DURING PREVIOUS INTERVIEW AND VALID RESPONSE PROVIDED, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING (O_FNAME)(O_MNAME)(O_LNAME).

• IF OCARE_CHILD = 2, -1, OR -2 FOR CURRENT INTERVIEW, GO TO PV051.

• OTHERWISE, GO TO (O_FNAME)/(O_MNAME)/(O_LNAME).

PV044/(O_FNAME)/(O_MNAME)/(O_LNAME). What is the full name of {C_FNAME/the child}’s other caregiver?

INTERVIEWER INSTRUCTION:

• READ IF NECESSARY: [By other caregiver we mean the person who after the primary caregiver spends the most time with the child. This does not include babysitters or childcare providers.]

________________

FIRST NAME

REFUSED -1

DON’T KNOW -2

________________

MIDDLE NAME

REFUSED -1

DON’T KNOW -2

________________

LAST NAME

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF OCARE_REL COLLECTED DURING PREVIOUS INTERVIEW AND VALID RESPONSE PROVIDED, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING OCARE_REL.

• OTHERWISE, GO TO OCARE_REL.

PV050/(OCARE_REL). What is the relationship of the other caregiver to {C_FNAME/the child}?

INTERVIEWER INSTRUCTION:

• READ IF NECESSARY: [By other caregiver we mean the person who after the primary caregiver spends the most time with the child. This does not include babysitters or childcare providers.]

MOTHER 1

FATHER 2

SISTER 3

BROTHER 4

GIRLFRIEND OR PARTNER OF CHILD'S PARENT 5

BOYFRIEND OR PARTNER OF CHILD'S PARENT 6

GRANDMOTHER 7

GRANDFATHER 8

AUNT 9

UNCLE 10

FEMALE COUSIN 11

MALE COUSIN 12

OTHER FEMALE RELATIVE 13

OTHER MALE RELATIVE 14

OTHER FEMALE NON-RELATIVE 15

OTHER MALE NON-RELATIVE 16

REFUSED -1

DON’T KNOW -2

PV051. Now I’d like you to think about {C_FNAME/the child}’s primary address. By primary address, we mean the location where the child lives most of the time.

PROGRAMMER INSTRUCTIONS:

• IF CHILD_TIME COLLECTED DURING PREVIOUS INTERVIEW AND VALID RESPONSE PROVIDED, PRELOAD CHILD_TIME, AND GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CHILD_TIME.

• OTHERWISE GO TO CHILD_TIME.

PV052/(CHILD_TIME). Does {C_FNAME/the child} {still} live here full-time, or does {he/she} {still} split {his/her} time between here and some other place?

FULL-TIME 1

SPLITS TIME 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF CHILD_TIME COLLECTED PREVIOUSLY AND CHILD_TIME = 1, -1, OR -2 DURING MOST RECENT, DISPLAY FIRST OCCURRENCE OF “still.”

• IF CHILD_TIME COLLECTED PREVIOUSLY AND CHILD_TIME = 2 DURING MOST RECENT INTERVIEW, DISPLAY SECOND OCCURRENCE OF “still.”

• IF CHILD PRIMARY ADDRESS VARIABLES COLLECTED PREVIOUSLY AND VALID RESPONSE PROVIDED, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING CHILD PRIMARY ADDRESS VARIABLES.

• OTHERWISE, IF CHILD PRIMARY ADDRESS VARIABLES NOT COLLECTED PREVIOUSLY OR VALID RESPONSE NOT PROVIDED, GO TO CHILD PRIMARY ADDRESS VARIABLES.

PV055/(CHILD PRIMARY ADDRESS VARIABLES). What is {C_FNAME/the child}’s primary address?

INTERVIEWER INSTRUCTIONS:

• READ AS NECESSARY: [By primary address, we mean the location where the child lives most of the time.]

• ADD NEW ADDRESS INFORMATION OR MAKE ANY CORRECTIONS TO ADDRESS, AS PROVIDED BY THE PARENT/CAREGIVER.

__________________________________________________

(C_ADDRESS_1) ADDRESS 1 - STREET/PO BOX

REFUSED -1

DON’T KNOW -2

(C_ADDRESS_2) ADDRESS 2

REFUSED -1

DON’T KNOW -2

(C_UNIT) UNIT

REFUSED -1

DON’T KNOW -2

CITY (C_CITY)

REFUSED -1

DON’T KNOW -2

|___|___|

STATE (C_STATE)

REFUSED -1

DON’T KNOW -2

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

ZIP CODE ZIP+4

(C_ZIP) (C_ZIP4)

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF PA_PHONE COLLECTED DURING PREVIOUS INTERVIEW AND VALID PHONE NUMBER PROVIDED, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING PA_PHONE.

• OTHERWISE, GO PA_PHONE.

PV057/(PA_PHONE). What is the phone number at {C_FNAME/the child}’s primary address?

INTERVIEWER INSTRUCTIONS:

• READ AS NECESSARY: [By primary address, we mean the location where the child lives most of the time.]

• ENTER PHONE NUMBER AND CONFIRM.

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

REFUSED -1

DON’T KNOW -2

NO HOME NUMBER -7

PROGRAMMER INSTRUCTIONS:

• IF CHILD_TIME = 1, -1, OR -2 AND:

  • CHILD_NUM = 1, OR

  • IF CHILD_NUM > 1, AND CHILD_QNUM = CHILD_NUM

    • GO TO TIME_STAMP_PV_ET.

  • IF CHILD_NUM > 1, AND CHILD_QNUM < CHILD_NUM, GO TO SAME_CONTACT_MULT_CHILD.

• OTHERWISE, GO TO PV059.

PV059. Now I would like you to think about {C_FNAME/the child}’s secondary address. By secondary address I mean where does {C_FNAME/the child} lives when {he/she} is not at {his/her} primary address.

PV063/(CHILD SECONDARY ADDRESS VARIABLES). {Let me confirm {C_FNAME/the child}’s secondary address./What is {C_FNAME/the child}’s secondary address?}

INTERVIEWER INSTRUCTION:

• ADD NEW ADDRESS INFORMATION OR MAKE ANY CORRECTIONS TO ADDRESS, AS PROVIDED BY THE PARENT/CAREGIVER.

__________________________________________________

ADDRESS 1 - STREET/PO BOX (S_ADDRESS_1)

REFUSED -1

DON’T KNOW -2

CHILD HAS NO SECONDARY ADDRESS -7

ADDRESS 2 (S_ADDRESS_2)

REFUSED -1

DON’T KNOW -2

UNIT (S_UNIT)

REFUSED -1

DON’T KNOW -2

CITY (S_CITY)

REFUSED -1

DON’T KNOW -2

|___|___|

STATE (S_STATE)

REFUSED -1

DON’T KNOW -2

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

ZIP CODE ZIP+4 (S_ZIP) (S_ZIP4)

REFUSED -1

DON’T KNOW -2

CHILD HAS NO SECONDARY ADDRESS -7

PROGRAMMER INSTRUCTIONS:

• IF CHILD SECONDARY ADDRESS VARIABLES COLLECTED PREVIOUSLY FOR (C_FNAME)(C_LNAME) AND VALID STREET ADDRESS PROVIDED, PRELOAD VALID STREET ADDRESS FROM MOST RECENT INTERVIEW AND DISPLAY “Let me confirm {C_FNAME/the child}’s secondary address. I have it as {CHILD’S SECONDARY ADDRESS}”.

• IF CHILD SECONDARY ADDRESS VARIABLES NOT COLLECTED PREVIOUSLY FOR (C_FNAME)(C_LNAME) OR VALID STREET ADDRESS NOT PROVIDED, DISPLAY “What is {C_FNAME/the child}’s secondary address?”.

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

• IF CHILD SECONDARY RESIDENCE ADDRESS VARIABLES = -7, AND

  • IF CHILD_TIME = 1, -1, OR -2, AND

  • IF CHILD_NUM = 1, OR

  • IF CHILD_NUM > 1, AND CHILD_QNUM = CHILD_NUM

    • GO TO TIME_STAMP_PV_ET.

  • OTHERWISE, IF CHILD_NUM > 1, AND CHILD_QNUM < CHILD_NUM, GO TO SAME_CONTACT_MULT_CHILD.

• OTHERWISE, IF CHILD SECONDARY ADDRESS VARIABLES FOR CURRENT INTERVIEW ≠ -7, AND

  • IF SA_PHONE COLLECTED DURING PREVIOUS INTERVIEW AND VALID PHONE NUMBER PROVIDED, GO TO SA_PHONE_CONFIRM.

  • IF SA_PHONE NOT COLLECTED DURING PREVIOUS INTERVIEW OR VALID PHONE NUMBER NOT PROVIDED, GO TO SA_PHONE.

PV063A/(SA_PHONE_CONFIRM). Let me confirm the phone number at {C_FNAME/the child}’s secondary address. I have it as {SECONDARY PHONE NUMBER}. Is this correct?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• PRELOAD SECONDARY PHONE NUMBER FROM MOST RECENT INTERVIEW.

• IF SA_PHONE_CONFIRM =1 AND

  • IF CHILD_NUM = 1, GO TO TIME_STAMP_PV_ET.

  • IF CHILD_QNUM > 1, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING SA_PHONE.

• OTHERWISE, GO TO SA_PHONE.

PV064/(SA_PHONE). What is phone number at the {C_FNAME/the child}’s secondary address?

INTERVIEWER INSTRUCTION:

• ENTER PHONE NUMBER AND CONFIRM.

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

REFUSED -1

DON’T KNOW -2

NO HOME NUMBER -7

PROGRAMMER INSTRUCTIONS:

• IF CHILD_NUM = 1, OR

• IF CHILD_NUM > 1, AND CHILD_QNUM = CHILD_NUM GO TO TIME_STAMP_PV_ET.

• OTHERWISE, IF CHILD_NUM > 1, AND CHILD_QNUM < CHILD_NUM, GO TO SAME_CONTACT_MULT_CHILD.

PV065/(SAME_CONTACT_MULT_CHILD). Is the legal guardian, primary and other caregiver, and primary and secondary address and phone information the same for {OTHER CHILD/the child} as it is for {CHILD 1/the child}?

YES 1

NO 2

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• FOR “OTHER CHILD”, DISPLAY C_FNAME OF CHILD_QNUM WHERE CHILD_QNUM = LOOP NUMBER + 1.

• FOR “CHILD 1”, DISPLAY C_FNAME OF CHILD_QNUM = 1.

• IF SAME_CONTACT_MULT_CHILD = 1, -1, OR -2, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING PERSON_DOB FOR NEXT CHILD_QNUM.

• OTHERWISE, IF SAME_CONTACT_MULT_CHILD = 2, GO TO MULT_CHILD_DIFF.

PV070/(MULT_CHILD_DIFF). What information is different?

INTERVIEWER INSTRUCTION:

• SELECT ALL THAT APPLY.

RESPONDENT RELATIONSHIP 1 (CHILD_QNUM)

LEGAL GUARDIAN 2 (CHILD_QNUM)

PRIMARY CAREGIVER 3 (CHILD_QNUM)

OTHER CAREGIVER 4 (CHILD_QNUM)

PRIMARY ADDRESS 5 (CHILD_QNUM)

PRIMARY PHONE NUMBER 6 (CHILD_QNUM)

SECONDARY ADDRESS 7 (CHILD_QNUM)

SECONDARY PHONE NUMBER 8 (CHILD_QNUM)

REFUSED -1 (CHILD_QNUM)

DON’T KNOW -2 (CHILD_QNUM)

(TIME_STAMP_PV_ET) PROGRAMMER INSTRUCTION:

• INSERT DATE/TIME STAMP

Public reporting burden for this collection of information is estimated to average 5 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.