36.2 Survey

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

54M Questionnaire– Adult, Phase 2g

OMB Specification

54M Questionnaire - Adult

Event Category:	Time-Based
Event:	54M
Administration:	N/A
Instrument Target:	Primary Caregiver
Instrument Respondent:	Primary Caregiver
Domain:	Questionnaire
Document Category:	Questionnaire
Method:	Data Collector Administered
Mode (for this instrument*):	In-Person, CAI; Phone, CAI
OMB Approved Modes:	In-Person, CAI; Phone, CAI; Web-Based, CAI
Estimated Administration Time:	5 minutes
Multiple Child/Sibling Consideration:	Per Event
Special Considerations:	N/A
Version:	1.0
MDES Release:	4.0

*This instrument is OMB-approved for multi-mode administration but this version of the instrument is designed for administration in this/these mode(s) only.

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54M Questionnaire - Adult

TABLE OF CONTENTS

GENERAL PROGRAMMER INSTRUCTIONS: 1

PARENTING (PARENTAL MODERNITY SCALE) 3

CULTURAL VALUES 9

RELIGIOUS AFFILIATION 18

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54M Questionnaire - Adult

GENERAL PROGRAMMER INSTRUCTIONS:

WHEN PROGRAMMING INSTRUMENTS, VALIDATE FIELD LENGTHS AND TYPES AGAINST THE MDES TO ENSURE DATA COLLECTION RESPONSES DO NOT EXCEED THOSE OF THE MDES. SOME GENERAL ITEM LIMITS USED ARE AS FOLLOWS:

DATA ELEMENT FIELDS	MAXIMUM CHARACTERS PERMITTED	DATA TYPE	PROGRAMMER INSTRUCTIONS
ADDRESS AND EMAIL FIELDS	100	CHARACTER
UNIT AND PHONE FIELDS	10	CHARACTER
_OTH AND COMMENT FIELDS	255	CHARACTER	Limit text to 255 characters
FIRST NAME AND LAST NAME	30	CHARACTER	Limit text to 30 characters
ALL ID FIELDS	36	CHARACTER
ZIP CODE	5	NUMERIC
ZIP CODE LAST FOUR	4	NUMERIC
CITY	50	CHARACTER
DOB AND ALL OTHER DATE FIELDS (E.G., DT, DATE, ETC.)	10	NUMERIC CHARACTER	DISPLAY AS MM/DD/YYYY STORE AS YYYY-MM-DD HARD EDITS: MM MUST EQUAL 01 TO 12 DD MUST EQUAL 01 TO 31 YYYY MUST BE BETWEEN 1900 AND CURRENT YEAR.
TIME VARIABLES	TWO-DIGIT HOUR AND TWO-DIGIT MINUTE, AM/PM DESIGNATION	NUMERIC	HARD EDITS: HOURS MUST BE BETWEEN 00 AND 12; MINUTES MUST BE BETWEEN 00 AND 59

Instrument Guidelines for Participant and Respondent IDs:

PRENATALLY, THE P_ID IN THE MDES HEADER IS THAT OF THE PARTICIPANT (E.G. THE NON-PREGNANT WOMAN, PREGNANT WOMAN, OR THE FATHER).

POSTNATALLY, A RESPONDENT ID WILL BE USED IN ADDITION TO THE PARTICIPANT ID BECAUSE SOMEBODY OTHER THAN THE PARTICIPANT MAY BE COMPLETING THE INTERVIEW. FOR EXAMPLE, THE PARTICIPANT MAY BE THE CHILD AND THE RESPONDENT MAY BE THE MOTHER, FATHER, OR ANOTHER CAREGIVER. THEREFORE, MDES VERSION 2.2 AND ALL FUTURE VERSIONS CONTAIN A R_P_ID (RESPONDENT PARTICIPANT ID) HEADER FIELD FOR EACH POST-BIRTH INSTRUMENT. THIS WILL ALLOW ROCs TO INDICATE WHETHER THE RESPONDENT IS SOMEBODY OTHER THAN THE PARTICIPANT ABOUT WHOM THE QUESTIONS ARE BEING ASKED.

A REMINDER:

ALL RESPONDENTS MUST BE CONSENTED AND HAVE RECORDS IN THE PERSON, PARTICIPANT, PARTICIPANT_CONSENT AND LINK_PERSON_PARTICIPANT TABLES, WHICH CAN BE PRELOADED INTO EACH INSTRUMENT. ADDITIONALLY, IN POST-BIRTH QUESTIONNAIRES WHERE THERE IS THE ABILITY TO LOOP THROUGH A SET OF QUESTIONS FOR MULTIPLE CHILDREN, IT IS IMPORTANT TO CAPTURE AND STORE THE CORRECT CHILD P_ID ALONG WITH THE LOOP INFORMATION. IN THE MDES VARIABLE LABEL/DEFINITION COLUMN, THIS IS INDICATED AS FOLLOWS: EXTERNAL IDENTIFIER: PARTICIPANT ID FOR CHILD DETAIL.

PARENTING (PARENTAL MODERNITY SCALE)

(TIME_STAMP_PPM_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

• PRELOAD PARTICIPANT ID (P_ID) AND RESPONDENT ID (R_P_ID) FOR ADULT CAREGIVER

PPM01000. These next questions include some statements other parents have made about rearing and educating children. For each statement, please tell me how you feel in general, not just about your own child.  

PPM02000/(PARENT_PRETEND). Parents should go along with the game when their child is pretending something.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

PPM03000/(OBEY_TEACHER). Children should always obey the teacher.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

PPM04000/(FORCE_CORRECT). Children will not do the right thing unless they must.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.
Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

PPM05000/(TEACH_OBEDIENCE). The most important thing to teach children is absolute obedience to whoever is in authority.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.
Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

PPM06000/(OBEY_PARENTS). Children should always obey their parents.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

PPM07000/(TEACH_RIGHT). Children will be bad unless they are taught what is right.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

PPM08000/(PERMIT_DISAGREE). Children should be allowed to disagree with their parents if they feel their own ideas are better.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

PPM09000/(PERSPEC_RIGHT). Children have a right to their own point of view and should be allowed to express it.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

PPM10000/(OK_DISAGREE_PARENT). It’s all right for a child to disagree with his or her parents.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.) (modified)

PPM11000/(CONSIDER_IDEAS). A child’s ideas should be seriously considered in making family decisions.

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
MILDLY DISAGREE	2
NOT SURE	3
MILDLY AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

Parental Modernity Scale (Schaefer, E. S., & Edgerton, M. (1985). Parent and child correlates of parental modernity. In I. E.

Sigel (Ed.), Parental belief systems: The psychological consequences for children (pp. 287-318). Hillsdale, NJ: Erlbaum.)

(TIME_STAMP_PPM_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

CULTURAL VALUES

(TIME_STAMP_CV_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

CV01000. In this part of the interview, I will be reading you several statements.  For each statement, please tell me how much you agree or disagree [using the responses shown on this card].  Do you have any questions?  

 

The first few questions are about how people interact with each other. 

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, READ THE BRACKETED [] TEXT ALOUD. 

• IF NOT USING SHOWCARDS, DO NOT READ THE BRACKETED [] TEXT ALOUD.

CV02000/(FRIENDLY_PEOPLE). I am friendly toward people when I first meet them.

INTERVIEWER INSTRUCTIONS

• IF PARENT/CAREGIVER HAS QUESTIONS, CLARIFY RESPONSES AS NEEDED.?

• SAY INTRODUCTORY TEXT “How strongly do you agree or disagree with the statement…” AS NEEDED.

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• ?IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
DISAGREE	2
NEITHER DISAGREE NOR AGREE	3
AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

New

CV03000/(ASK_ABOUT_FAM). When I see people I have known for a long time, I usually ask how their family is doing. 

INTERVIEWER INSTRUCTIONS

• IF PARENT/CAREGIVER HAS QUESTIONS, CLARIFY RESPONSES AS NEEDED.?

• SAY INTRODUCTORY TEXT “How strongly do you agree or disagree with the statement…” AS NEEDED.

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
DISAGREE	2
NEITHER DISAGREE NOR AGREE	3
AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

New 

CV04000/(DR_KNOW_PT). Doctors should take the time to get to know their patients more personally.

INTERVIEWER INSTRUCTIONS

• IF PARENT/CAREGIVER HAS QUESTIONS, CLARIFY RESPONSES AS NEEDED.?

• SAY INTRODUCTORY TEXT “How strongly do you agree or disagree with the statement…” AS NEEDED.

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
DISAGREE	2
NEITHER DISAGREE NOR AGREE	3
AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

New 

CV05000. The next few questions ask about masculinity or maleness. 

CV06000/(MAN_NO_EMOT). A man should not show emotions.

INTERVIEWER INSTRUCTIONS

• IF PARENT/CAREGIVER HAS QUESTIONS, CLARIFY RESPONSES AS NEEDED.?

• SAY INTRODUCTORY TEXT “How strongly do you agree or disagree with the statement…” AS NEEDED.

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
DISAGREE	2
NEITHER DISAGREE NOR AGREE	3
AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

New 

CV07000/(MAN_RESP_FAM). A man’s #1 responsibility is his family.

INTERVIEWER INSTRUCTIONS

• IF PARENT/CAREGIVER HAS QUESTIONS, CLARIFY RESPONSES AS NEEDED.?

• SAY INTRODUCTORY TEXT “How strongly do you agree or disagree with the statement…” AS NEEDED.

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
DISAGREE	2
NEITHER DISAGREE NOR AGREE	3
AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

New 

CV08000/(MEN_WORK). Men work and women stay home to do housework and care for their children.

INTERVIEWER INSTRUCTIONS

• IF PARENT/CAREGIVER HAS QUESTIONS, CLARIFY RESPONSES AS NEEDED.?

• SAY INTRODUCTORY TEXT “How strongly do you agree or disagree with the statement…” AS NEEDED.

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
DISAGREE	2
NEITHER DISAGREE NOR AGREE	3
AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

New

CV09000. Now, I have some statements about how people relate to each other.  

CV10000/(WORK_BETTER). It is important that I do my work better than others.

INTERVIEWER INSTRUCTIONS

• ?IF PARENT/CAREGIVER HAS QUESTIONS, CLARIFY RESPONSES AS NEEDED.?

• SAY INTRODUCTORY TEXT “How strongly do you agree or disagree with the statement…” AS NEEDED.

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
DISAGREE	2
NEITHER DISAGREE NOR AGREE	3
AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

New

CV11000/(TENSE_OTHER_BETTER). When another person does better than I do, I get tense.

INTERVIEWER INSTRUCTIONS

• IF PARENT/CAREGIVER HAS QUESTIONS, CLARIFY RESPONSES AS NEEDED.?

• SAY INTRODUCTORY TEXT “How strongly do you agree or disagree with the statement…” AS NEEDED.

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
DISAGREE	2
NEITHER DISAGREE NOR AGREE	3
AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

New 

CV12000/(DUTY_FAMILY). It is my duty to take care of my family, even when I have to sacrifice what I want.

INTERVIEWER INSTRUCTIONS

• ?IF PARENT/CAREGIVER HAS QUESTIONS, CLARIFY RESPONSES AS NEEDED.?

• SAY INTRODUCTORY TEXT “How strongly do you agree or disagree with the statement…” AS NEEDED.

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
DISAGREE	2
NEITHER DISAGREE NOR AGREE	3
AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

New

CV13000/(RESPECT_GROUPS). It is important to me that I respect the decisions made by groups I belong to.

INTERVIEWER INSTRUCTIONS

• IF PARENT/CAREGIVER HAS QUESTIONS, CLARIFY RESPONSES AS NEEDED.?

• SAY INTRODUCTORY TEXT “How strongly do you agree or disagree with the statement…” AS NEEDED.

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
STRONGLY DISAGREE	1
DISAGREE	2
NEITHER DISAGREE NOR AGREE	3
AGREE	4
STRONGLY AGREE	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

New

CV14000. In the next part of the interview, I’ll ask you some questions about how you think about the present and future.  For these questions, I’ll be asking you how often you think in the way described by the statements I’ll read to you.  [Please use the responses shown on this card for these questions.]

INTERVIEWER INSTRUCTIONS

• IF USING SHOWCARDS, READ THE BRACKETED [] TEXT ALOUD.

• IF NOT USING SHOWCARDS, DO NOT READ THE BRACKETED [] TEXT ALOUD.

CV15000/(LIFE_CURRENT). I focus on what is currently happening in my life.

INTERVIEWER INSTRUCTIONS

• ASK: “How often do you think in this way?” AS NEEDED.

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
NEVER	1
RARELY	2
SOMETIMES	3
OFTEN	4
ALWAYS	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

New 

CV16000/(LIFE_TODAY). I think about where I am today in my life.

INTERVIEWER INSTRUCTIONS

• ASK: “How often do you think in this way?” AS NEEDED.

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
NEVER	1
RARELY	2
SOMETIMES	3
OFTEN	4
ALWAYS	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

New 

CV17000/(LIVE_PRESENT). I live my life in the present.

INTERVIEWER INSTRUCTIONS

• ASK: “How often do you think in this way?” AS NEEDED.

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
NEVER	1
RARELY	2
SOMETIMES	3
OFTEN	4
ALWAYS	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

New 

CV18000/(THINK_FUTURE). I think about what the future has in store.

INTERVIEWER INSTRUCTIONS

• ASK: “How often do you think in this way?” AS NEEDED.

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
NEVER	1
RARELY	2
SOMETIMES	3
OFTEN	4
ALWAYS	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

New 

CV19000/(FOCUS_FUTURE). I focus on my future.

INTERVIEWER INSTRUCTIONS

• ASK: “How often do you think in this way?” AS NEEDED.

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
NEVER	1
RARELY	2
SOMETIMES	3
OFTEN	4
ALWAYS	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

New

CV20000/(IMAGINE_TOMORROW). I imagine what tomorrow will bring for me.

INTERVIEWER INSTRUCTIONS

• ASK: “How often do you think in this way?” AS NEEDED.

• IF USING SHOWCARDS, DO NOT READ RESPONSE OPTIONS AND REFER TO APPROPRIATE SHOWCARD.

• IF NOT USING SHOWCARDS, READ RESPONSE OPTIONS.

Label	Code	Go To
NEVER	1
RARELY	2
SOMETIMES	3
OFTEN	4
ALWAYS	5
REFUSED	-1
DON’T KNOW	-2

SOURCE

New 

(TIME_STAMP_CV_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

RELIGIOUS AFFILIATION

(TIME_STAMP_RA_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

RA01000. These next questions are about your religious faith.

RA02000/(CURRENT_REL_PREF). What is your religious preference?

Label	Code	Go To
PROTESTANT	1	PROTEST_DENOM
CATHOLIC	2	TIME_STAMP_RA_ET
MORMON	3	TIME_STAMP_RA_ET
JEHOVAH’S WITNESS	4	TIME_STAMP_RA_ET
GREEK/RUSSIAN/EASTERN ORTHODOX	5	TIME_STAMP_RA_ET
JEWISH	6	TIME_STAMP_RA_ET
BUDDHIST	7	TIME_STAMP_RA_ET
MUSLIM	8	TIME_STAMP_RA_ET
HINDU	9	TIME_STAMP_RA_ET
AGNOSTIC	10	TIME_STAMP_RA_ET
ATHEIST	11	TIME_STAMP_RA_ET
OTHER	-5
NONE	-7	TIME_STAMP_RA_ET
REFUSED	-1	TIME_STAMP_RA_ET
DON’T KNOW	-2	TIME_STAMP_RA_ET

SOURCE

Panel Study of Income Dynamics 2013

RA02100/(CURRENT_REL_PREF_OTH). SPECIFY: ________________________________________

Label	Code	Go To
REFUSED	-1
DON'T KNOW	-2

SOURCE

​Panel Study of Income Dynamics 2013

RA03000/(PROTEST_DENOM). What denomination is that?

Label	Code	Go To
BAPTIST	1	TIME_STAMP_RA_ET
LUTHERN	2	TIME_STAMP_RA_ET
METHODIST/AFRICAN METHODIST	3	TIME_STAMP_RA_ET
PRESBYTERIAN	4	TIME_STAMP_RA_ET
EPISCOPALIAN	5	TIME_STAMP_RA_ET
PROTESTANT, UNSPECIFIED	6	TIME_STAMP_RA_ET
PENTECOSTAL/ASSEMBLY OF GOD	7	TIME_STAMP_RA_ET
OTHER	-5
REFUSED	-1	TIME_STAMP_RA_ET
DON’T KNOW	-2	TIME_STAMP_RA_ET

SOURCE

Panel Study of Income Dynamics 2013

RA04000/(PROTEST_DENOM_OTH). SPECIFY    __________________________

Label	Code	Go To
REFUSED	-1
DON'T KNOW	-2

SOURCE

Panel Study of Income Dynamics 2013

(TIME_STAMP_RA_ET).

PROGRAMMER INSTRUCTIONS

• 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.