Form Scripts

2015 NSDUH, Supporting Statement
Attachment M – Screening Questions

2015 NATIONAL SURVEY ON
DRUG USE AND HEALTH
SCREENING APPLICATION SPECIFICATIONS

Contract No. HHSS283201300001C
RTI Project No. 0213984

Authors:
Patty LeBaron
Gretchen McHenry
Tennyson Chen

Project Director:

Tom Virag

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

Prepared by:
RTI International

January 2014

2015 NATIONAL SURVEY ON
DRUG USE AND HEALTH
SCREENING APPLICATION
SPECIFICATIONS
Contract No. HHSS283201300001C
RTI Project No. 0213984

Authors:
Patty LeBaron
Gretchen McHenry
Tennyson Chen

Project Director:

Tom Virag

Prepared for:

Substance Abuse and Mental Health Services Administration
Rockville, MD 20857

Prepared by:
RTI International

January 2014

2015 NATIONAL SURVEY ON DRUG USE AND HEALTH
SCREENING APPLICATION UPDATES
The following updates have been made to the 2015 NSDUH Screening Application:
•
•
•

As necessary, dates were updated in the screening program.
Response options in the Spanish screener have been translated into
Spanish.
Interviewer Debriefing items were edited.

Table of Contents
Screening Application Updates........................................................................................................ i
Section

Page

1.

HU Screening, English ....................................................................................................... 1-1

2.

HU Screening, Spanish ...................................................................................................... 2-1

3.

GQU Screening, English .................................................................................................... 3-1

4.

GQU Screening, Spanish.................................................................................................... 4-1

5.

Select Case Screen Options ................................................................................................ 5-1

6.

Record of Calls ................................................................................................................... 6-1

7.

Screening and Interview Refusals ...................................................................................... 7-1

8.

Verification......................................................................................................................... 8-1

9.

FI Debriefing Questions ..................................................................................................... 9-1

NSDUH DR Screening Application Specifications
Section 1
HU Screening - English
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 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. Touch 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.

STUDY INTRODUCTION
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
Next [IDENTIFY SR]

IDENTIFY SR [IF STUDY INTRODUCTION = NEXT]
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, TOUCH “PREVIOUS,” 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.]

ADDRESS VERIFICATION [IF IDENTIFY SR = SR AVAILABLE]
1-1

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

EDIT ADDRESS [IF ADDRESS VERIFICATION = NEED TO EDIT ADDRESS]
TOUCH THE ITEM YOU NEED TO EDIT
STREET # (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.
Next [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]

1-2

No [OCCUPANCY]

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

MISSED DU ADDRESS [IF MISSED DUs = YES]
RECORD STREET ADDRESS OR DESCRIPTION OF UNIT
STREET #:
STREET:
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 (CURRENT QUARTER)?
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 (CURRENT QUARTER)? (Do not include anyone who (lived/will live) at
school or somewhere else for most of the time during the months of (CURRENT QUARTER).)
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.]

1-3

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.
Next [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]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, 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.’]

1-4

[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]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, 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]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, 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

1-5

Asian
Other
(CHECK ALL THAT APPLY)
[HOUSEHOLDER MILITARY OR IF HOUSEHOLDER AGE NE 17-65 CONFIRM
ROSTER]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, 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]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, 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]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, CHANGE SR: DO YOU WANT TO
CHANGE THE SR, IF No, HOUSEHOLDER MILITARY. IF Yes, THIS PERSON: IS

1-6

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 HOUSEHOLDER MILITARY NE BLANK OR IF
HOUSEHOLDER AGE NE 17-65 AND HOUSEHOLDER RACE NE BLANK]
[IF RACE, HISPANIC, AND/OR MILITARY IS ‘OTHER’, ‘DK’, OR ‘REF’ OMIT
RESPECTIVE FILLS FROM CONFIRM ROSTER SCREEN.]
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.
Next [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]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, 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.]

1-7

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?
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]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, 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

1-8

[HISPANIC]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, 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.

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]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, 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]

1-9

[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, 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.]

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]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, 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.

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]
[TO CHANGE THE SR, TOUCH FUNCTIONS MENU, 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]

1-10

[IF RACE, HISPANIC, AND/OR MILITARY IS ‘OTHER’, ‘DK’, OR ‘REF’ OMIT
RESPECTIVE FILLS FROM CONFIRM ROSTER SCREEN.]
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]

VERIFY ROSTER DATA [IF CONFIRM ROSTER = YES ]
Relation (Relationship)
A (Age)
SR (Y for Screening Respondent)
[UPON TOUCHING ON ANY ROSTER LINE, SELECT SHOW DETAILS, SHOW ALL ROSTER
INFORMATION]
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, TOUCH NEXT TO MAKE
SELECTION.
TO MAKE CORRECTIONS: TOUCH AND HOLD THE ROSTER LINE THAT YOU WANT
TO EDIT, THEN TOUCH 'EDIT' FROM THE POP-UP MENU.
[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: TOUCH AND HOLD THE ROSTER LINE THAT YOU WANT
TO EDIT, THEN TOUCH 'EDIT’ FROM THE POP-UP MENU.
[FUNCTIONS TO ADD ROSTER MEMBERS AND/OR EDIT ROSTER DATA]
Next [START SELECTION]

START SELECTION
THE PROGRAM WILL START THE SELECTION PROCESS. ARE YOU SURE YOU ARE
READY TO MAKE THE SELECTIONS?

1-11

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)
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)

1-12

NSDUH DR Screening Application Specifications
Section 2
HU Screening - Spanish
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.

STUDY INTRODUCTION
(Buenas noches/Buenas tardes/Buenos días). Mi nombre es (FI NAME) y trabajo para RTI
International en Carolina del Norte. Estamos llevando a cabo un estudio nacional patrocinado por
el Departamento de Salud y Servicios Humanos de los Estados Unidos.
[IF NOT ADDED DU] Usted ha de debe haber recibido una carta explicándole el estudio.
[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]
Primero, déjeme verificar: ¿vive usted aquí?
IF NOT OBVIOUS:
Y ¿tiene 18 años de edad o más?
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.]

2-1

ADDRESS VERIFICATION [IF IDENTIFY SR = SR AVAILABLE]
Solamente necesito confirmar que ésta es
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 ENTREGUE A LA PERSONA LA
DESCRIPCIÓN DEL ESTUDIO Y DIGA LO SIGUIENTE:
Por favor lea esta declaración, la cual describe la encuesta y la legislación que asegura la
confidencialidad de cualquier información que usted nos dé. También explica que sus respuestas
son usadas con propósitos estadísticos únicamente y que su participación es voluntaria. Si
alguien es seleccionado(a) para participar en la entrevista en su totalidad, dicha persona recibirá
$30 dólares en efectivo después de haber completado la entrevista.
Continue [MISSED DUs]

2-2

MISSED DUs [IF INFORMED CONSENT = CONTINUE]
FOR REGULAR HUs SUCH AS INDIVIDUAL HOUSES, TOWNHOUSES, DUPLEXES,
TRAILERS, COTTAGES
¿Hay alguna otra vivienda dentro de esta casa o propiedad, tal como un apartamento separado con
entrada aparte?
Yes Sí [MISSED DU ADDRESS]
[IF MISSED DU: CANNOT
ADD UNIT “YOU CANNOT
ADD A MISSED DU FROM
A DU THAT HAS BEEN ADDED”
MISSED DUs]

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.]

2-3

OCCUPANCY [IF MISSED DUs = NO OR MISSED DU ADDRESS = UPDATE OR
CANCEL MISSED DU = YES]
(¿Vivió /¿Vivirá) usted o alguna otra persona en esta vivienda la mayor parte del tiempo durante
los meses de (CURRENT QUARTER)?
Yes Sí [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]
(Incluyéndose a sí mismo), ¿cuántas personas (vivieron/vivirán) en esta vivienda la mayor parte
del tiempo durante los meses de (CURRENT QUARTER)? (No incluya a nadie que (vivió/vivirá)
en la escuela o en otro lugar la mayor parte del tiempo durante los meses de (CURRENT
QUARTER).)

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, 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.]

MEMBERS 12 OR OLDER [IF TOTAL SDU MEMBERS NE BLANK AND >1]
De estas (TOTAL SDU MEMBERS) personas, ¿cuántas tienen 12 años o más actualmente?
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.]

2-4

ROSTER INTRO [IF MEMBERS 12 OR OLDER NE 1 OR BLANK]
Ahora le haré unas cuantas preguntas acerca de las personas que viven aquí. Empecemos con la
persona o una de las personas que vive aquí, quien es el dueño o la dueña de la casa o que paga
por el alquiler de la misma. Nos referiremos a esta persona como la cabeza de la familia.
Continue [HOUSEHOLDER AGE]

HOUSEHOLDER AGE [IF ROSTER INTRO NE BLANK OR ROSTER NE BLANK OR
CONFIRM ROSTER FOR HOUSEHOLDER = NO]
Por favor dígame la edad de esta persona en su último cumpleaños.
IF SR IS HOUSEHOLDER:
Por favor dígame su edad en su último cumpleaños.
ENTER AGE REGISTRE LA EDAD [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?
Yes [SETS LANGUAGE FOR SUBSEQUENT ROSTER QUESTIONS USING
‘YOU/YOUR’]
No [SETS LANGUAGE FOR SUBSEQUENT ROSTER QUESTIONS USING
‘THIS PERSON.’]
[IF HOUSEHOLDER, HOUSEHOLDER GENDER OTHERWISE, RELATION]

HOUSEHOLDER GENDER [IF SCREENING RESPONDENT NE BLANK FOR
HOUSEHOLDER]
ASK ONLY IF NOT OBVIOUS
¿Es esta persona hombre o mujer?
Male Hombre
Female Mujer
[HOUSEHOLDER HISPANIC]

2-5

HOUSEHOLDER HISPANIC [IF HOUSEHOLDER GENDER NE BLANK]
¿Es (usted/él/ella/esta persona) de origen hispano, latino o español?
(Es decir que su origen nacional o descendencia se puede describir como puertorriqueño, cubano,
cubano-americano, mexicano, mexicano-americano, chicano, centro o sudamericano, o es
nativo(a) de otro país donde se habla español?)
Yes Sí
No
[HOUSEHOLD RACE]

HOUSEHOLDER RACE [IF HOUSEHOLDER HISPANIC NE BLANK]
¿Es (usted/él/ella/esta persona) de raza blanca, negra o afro-americana, indígena americana o
nativo(a) de Alaska, nativo(a) de Hawaii o de otra isla del pacífico, o asiática?
White Blanca
Black or African American Negra o afro-americana
American Indian or Alaska Native Indígena americana o nativo(a) de Alaska
Native Hawaiian/other Pacific Islander Nativo(a) de Hawaii o de otra isla del pacífico
Asian Asiática
Other Otra raza
(CHECK ALL THAT APPLY)
[HOUSEHOLDER MILITARY OR IF HOUSEHOLDER AGE NE 17-65 CONFIRM
ROSTER]

HOUSEHOLDER MILITARY [IF HOUSEHOLDER RACE NE BLANK AND
HOUSEHOLDER AGE = 17-65 AND SCREENING RESPONDENT = NO FOR THIS
MEMBER]
¿Está (usted/él/ella/esta persona) actualmente en servicio activo en las fuerzas armadas de los
Estados Unidos?
Yes Sí
No
Unknown No sabe
Refused Se rehúsa
[CONFIRM ROSTER]

2-6

HOUSEHOLDER MILITARY [IF HOUSEHOLDER RACE NE BLANK AND
HOUSEHOLDER AGE = 17-65 AND SCREENING RESPONDENT = YES FOR THIS
MEMBER]
¿Está (usted/él/ella/esta persona) actualmente en servicio activo en las fuerzas armadas de los
Estados Unidos?
Yes Sí
No
Refused Se rehúsa
[CONFIRM ROSTER]

CONFIRM ROSTER [IF HOUSEHOLDER MILITARY NE BLANK OR IF
HOUSEHOLDER AGE NE 17-65 AND HOUSEHOLDER RACE NE BLANK]
There are four translation variations. English is also provided here for clarification.
1. SCREENING RESPONDENT AGE 17- 65
ENGLISH:
I have listed you as a (AGE) year old (GENDER) resident. You are (RACE),
(HISPANIC), and (are/are not) on active duty in the United States military.
SPANISH:
(MALE:Lo)(FEMALE: La) he anotado a usted, (GENDER: una joven/una mujer/un
joven/un hombre/una persona) de (AGE) años de edad. (Usted) es de raza (RACE:
blanca, negra o afro-americana, indígena americana o nativo(a) de Alaska, nativo(a) de
Hawaii o de otra isla del pacífico, asiática). (HISPANIC: Usted es hispana / Usted es
hispano/ Usted no es hispana / Usted no es hispano) (MILITARY: y está en servicio
activo en las fuerzas armadas de los Estados Unidos. / y no está en servicio activo en las
fuerzas armadas de los Estados Unidos.).
2. SCREENING RESPONDENT UNDER AGE 17 OR OVER AGE 65
ENGLISH:
I have listed you as a (AGE) year old (GENDER) resident. You are (RACE), and (not)
(HISPANIC).
SPANISH:
(MALE:Lo)(FEMALE: La) he anotado a usted, (GENDER: una joven/una mujer/un
joven/un hombre/una persona) de (AGE) años de edad. (Usted) es de raza (RACE:
blanca, negra o afro-americana, indígena americana o nativo(a) de Alaska, nativo(a) de
Hawaii o de otra isla del pacífico, asiática). (HISPANIC: Usted es hispana / Usted es
hispano/ Usted no es hispana / Usted no es hispano).

3. OTHER MEMBERS AGES 17- 65
ENGLISH:

2-7

I have listed a (AGE) year old (GENDER) resident. (She/He) is (RACE), (HISPANIC)
and (is/is not) on active duty in the United States military.
SPANISH:
He anotado (GENDER) de (AGE) años de edad. (Ella/Él) es de raza (RACE). (Ella/Él)
(es/no es) (HISPANIC) y (está/no está) en servicio activo en las fuerzas armadas de los
Estados Unidos.
SPANISH GENDER/RELATIONSHIP DESCRIPTIONS:
He anotado (GENDER: una joven/una mujer/un joven/un hombre/una persona) de
(AGE) años de edad. (Ella /Él /Esta persona) es de raza (RACE: blanca, negra o afroamericana, indígena americana o nativo(a) de Alaska, nativo(a) de Hawaii o de otra isla
del pacífico, asiática). (HISPANIC: Ella es hispana / Él es hispano/Esta persona es
hispana / Ella no es hispana / Él no es hispano/Esta persona no es hispana)
(MILITARY: y está en servicio activo en las fuerzas armadas de los Estados Unidos. / y
no está en servicio activo en las fuerzas armadas de los Estados Unidos.).
4. OTHER MEMBERS UNDER AGE 17- OR OVER AGE 65
ENGLISH:
I have listed a (AGE) year old (GENDER) resident. (She/He) is (RACE), and (not)
(HISPANIC).
SPANISH:
He anotado (GENDER: una joven/una mujer/un joven/un hombre/una persona) de
(AGE) años de edad. (Ella/Él) es de raza (RACE: blanca, negra o afro-americana,
indígena americana o nativo(a) de Alaska, nativo(a) de Hawaii o de otra isla del
pacífico, asiática). (HISPANIC: Ella es hispana / Él es hispano/ Ella no es hispana / Él
no es hispano).
¿Es esto correcto?
Yes Sí [OTHER MEMBERS] [IF ROSTER NE BLANK , VERIFY ROSTER DATA]
No [HOUSEHOLDER AGE]

2-8

OTHER MEMBERS [IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER ≥ 2]
READ TO RESPONDENT:
[IF MEMBERS 12 OR OLDER =2] Ahora necesito información general sobre la otra persona en
este hogar que tenga 12 años de edad o más.
[IF MEMBERS 12 OR OLDER >2] Ahora necesito información general sobre todas las otras
personas en este hogar que tengan 12 años de edad o más. Empecemos con la persona mayor
hasta llegar a la persona menor.
CONTINUE [AGE]

AGE [IF OTHER MEMBERS NE BLANK OR CONFIRM ROSTER = NO]
[IF MEMBERS 12 OR OLDER = 2] Por favor dígame la edad de esta persona en su último
cumpleaños.
[IF MEMBERS 12 OR OLDER > 2 HH MEMBERS] Por favor dígame la edad de la (persona
mayor/siguiente persona) en su último cumpleaños.
ENTER AGE REGISTRE LA EDAD [IF ANY SCREENING RESPONDENT = YES,
RELATION. IF ALL
SCREENING RESPONDENT = BLANK OR NO, SCREENING RESPONDENT]

2-9

RELATION [IF AGE NE BLANK AND ANY SCREENING RESPONDENT =YES]
[IF SCREENING RESPONDENT = YES FOR THIS MEMBER] ¿Cuál es su parentesco con la
cabeza de la familia?
[IF SCREENING RESPONDENT = YES FOR HOUSEHOLDER] ¿Qué parentesco tiene esta
persona con usted, la cabeza de la familia?
[IF SCREENING RESPONDENT = NO FOR THIS MEMBER] ¿Qué parentesco tiene esta
persona con la cabeza de la familia?
Husband Esposo
Wife Esposa
Son (includes step) Hijo (incluye hijo adoptivo)
Daughter (includes step) Hija (incluye hija adoptiva)
Son-in-law/Daughter-in-law Yerno/Nuera
Brother (includes step) Hermano (incluye hermano adoptivo)
Sister (includes step) Hermana (incluye hermana adoptiva)
Brother-in-law/Sister-in-law Cuñado(a)
Parent/Guardian (incl. step) Padre o madre/Tutor(a) (incluye padrastro/madrastra)
Parent-in-law (incl. step) Suegro(a)
Aunt/Uncle Tía(o)
Nephew/Niece Sobrino(a)
Grandparent Abuelo(a)
Grandchild Nieto(a)
Cousin Primo(a)
Ex-Spouse Ex-esposo(a)
Live-in Partner Pareja conviviente
Friend/Roommate Amigo(a)/Compañero(a) de casa o de cuarto
Tenant/Boarder/Exch Student Inquilino(a)/Pensionista/Intercambio estudiantil
Other relative Otro pariente
Other Non-relative Otra persona que no es pariente
Relationship Unspecified No se especificó la relación
[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.]

2-10

GENDER [IF RELATION NE HUSBAND, WIFE, SON, DAUGHTER, BROTHER OR SISTER]
ASK ONLY IF NOT OBVIOUS
¿Es esta persona hombre o mujer?
Male Hombre
Female Mujer
Refused Se rehúsa
[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.

HISPANIC [IF GENDER NE BLANK]
¿Es (usted/él/ella/esta persona) de origen hispano, latino o español?
(Es decir que su origen nacional o descendencia se puede describir como puertorriqueño, cubano,
cubano-americano, mexicano, mexicano-americano, chicano, centro o sudamericano, o es
nativo(a) de otro país donde se habla español?)
Yes Sí
No
Refused Se rehúsa
[RACE]

RACE [IF HISPANIC NE BLANK]
¿Es (usted/él/ella/esta persona) de raza blanca, negra o afro-americana, indígena americana o
nativo(a) de Alaska, nativo(a) de Hawaii o de otra isla del pacífico, o asiática?
White Blanca
Black or African American Negra o afro-americana
American Indian or Alaska Native Indígena americana o nativo(a) de Alaska
Native Hawaiian/other Pacific Islander Nativo(a) de Hawaii o de otra isla del pacífico
Asian Asiática
Other Otra raza
Unknown No sabe
Refused Se rehúsa
(CHECK ALL THAT APPLY)

2-11

[IF AGE 17-65, MILITARY, OTHERWISE CONFIRM ROSTER]

MILITARY [IF RACE NE BLANK AND AGE 17-65 AND SCREENING RESPONDENT =
NO FOR THIS MEMBER]
¿Está (usted/él/ella/esta persona) actualmente en servicio activo en las fuerzas armadas de los
Estados Unidos?
Yes Sí
No
Unknown No sabe
Refused Se rehúsa
[CONFIRM ROSTER]

HOUSEHOLDER MILITARY [IF HOUSEHOLDER RACE NE BLANK AND
HOUSEHOLDER AGE = 17-65 AND SCREENING RESPONDENT = YES FOR THIS
MEMBER]
¿Está (usted/él/ella/esta persona) actualmente en servicio activo en las fuerzas armadas de los
Estados Unidos?
Yes Sí
No
Refused Se rehúsa
[CONFIRM ROSTER]

CONFIRM ROSTER [IF AGE 17-65 AND MILITARY IS NE BLANK, OTHERWISE
RACE NE BLANK]
There are four translation variations. English is also provided here for clarification.
1. SCREENING RESPONDENT AGE 17- 65
ENGLISH:
I have listed you as a (AGE) year old (GENDER) resident. You are (RACE),
(HISPANIC), and (are/are not) on active duty in the United States military.
SPANISH:
(MALE:Lo)(FEMALE: La) he anotado a usted, (GENDER: una joven/una mujer/un
joven/un hombre/una persona) de (AGE) años de edad. (Usted) es de raza (RACE:
blanca, negra o afro-americana, indígena americana o nativo(a) de Alaska, nativo(a) de
Hawaii o de otra isla del pacífico, asiática). (HISPANIC: Usted es hispana / Usted es
hispano/ Usted no es hispana / Usted no es hispano) (MILITARY: y está en servicio
activo en las fuerzas armadas de los Estados Unidos. / y no está en servicio activo en las
fuerzas armadas de los Estados Unidos).

2-12

2. SCREENING RESPONDENT UNDER AGE 17 OR OVER AGE 65
ENGLISH:
I have listed you as a (AGE) year old (GENDER) resident. You are (RACE), and (not)
(HISPANIC).
SPANISH:
(MALE:Lo)(FEMALE: La) he anotado a usted, (GENDER: una joven/una mujer/un
joven/un hombre/una persona) de (AGE) años de edad. (Usted) es de raza (RACE:
blanca, negra o afro-americana, indígena americana o nativo(a) de Alaska, nativo(a) de
Hawaii o de otra isla del pacífico, asiática). (HISPANIC: Usted es hispana / Usted es
hispano/ Usted no es hispana / Usted no es hispano).
3. OTHER MEMBERS AGES 17- 65
ENGLISH:
I have listed a (AGE) year old (GENDER) resident. (She/He) is (RACE), (HISPANIC)
and (is/is not) on active duty in the United States military.
SPANISH:
He anotado (GENDER) de (AGE) años de edad. (Ella/Él) es de raza (RACE). (Ella/Él)
(es/no es) (HISPANIC) y (está/no está) en servicio activo en las fuerzas armadas de los
Estados Unidos.
SPANISH GENDER/RELATIONSHIP DESCRIPTIONS:
He anotado (GENDER: una joven/una mujer/un joven/un hombre/una persona) de
(AGE) años de edad. (Ella /Él /Esta persona) es de raza (RACE: blanca, negra o afroamericana, indígena americana o nativo(a) de Alaska, nativo(a) de Hawaii o de otra isla
del pacífico, asiática). (HISPANIC: Ella es hispana / Él es hispano/Esta persona es
hispana / Ella no es hispana / Él no es hispano/Esta persona no es hispana)
(MILITARY: y está en servicio activo en las fuerzas armadas de los Estados Unidos. / y
no está en servicio activo en las fuerzas armadas de los Estados Unidos).

2-13

4. OTHER MEMBERS UNDER AGE 17- OR OVER AGE 65
ENGLISH:
I have listed a (AGE) year old (GENDER) resident. (She/He) is (RACE), and (not)
(HISPANIC).
SPANISH:
He anotado (GENDER: una joven/una mujer/un joven/un hombre/una persona) de
(AGE) años de edad. (Ella/Él) es de raza (RACE: blanca, negra o afro-americana,
indígena americana o nativo(a) de Alaska, nativo(a) de Hawaii o de otra isla del
pacífico, asiática). (HISPANIC: Ella es hispana / Él es hispano/ Ella no es hispana / Él
no es hispano).
¿Es esto correcto?
Yes Sí [AGE FOR NEXT HH MEMBER, OTHERWISE VERIFY ROSTER DATA]
No [AGE]

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]
Necesito asegurarme que la lista está correcta. He anotado...
[READ AGES AND RELATIONSHIPS ROSTERED].
TO MAKE CORRECTIONS: TAP THE ROSTER LINE THAT YOU WANT TO EDIT, THEN
TAP 'FUNCTIONS' AND 'EDIT.'
Continue [START SELECTION]

START SELECTION
2-14

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)
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)

2-15

NSDUH DR Screening Application Specifications
Section 3
GQU Screening - English
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 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

STUDY INTRODUCTION
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.
Next [IDENTIFY SR]

IDENTIFY SR [IF STUDY INTRODUCTION = NEXT]
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, TOUCH “PREVIOUS”, 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.]

3-1

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 [INFORMED CONSENT]
Need to Edit Address [EDIT ADDRESS]
FI At Wrong Address [SELECT CASE]

EDIT ADDRESS [IF ADDRESS VERIFICATION = NEED TO EDIT ADDRESS]
TOUCH THE ITEM YOU NEED TO EDIT
STREET #: (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.
Next [TRANSIENT]

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

3-2

UNIT TYPE [IF TRANSIENT = YES]
ARE THE LISTED UNITS…
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 (CURRENT QUARTER)?
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 (CURRENT QUARTER)?
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

3-3

[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]

3-4

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]
[IF RACE, HISPANIC, AND/OR MILITARY IS ‘OTHER’, ‘DK’, OR ‘REF’ OMIT
RESPECTIVE FILLS FROM CONFIRM ROSTER SCREEN.]
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]

3-5

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.
Next [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]

3-6

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]

3-7

CONFIRM ROSTER [IF AGE 17-65 AND MILITARY IS NE BLANK, OTHERWISE
RACE NE BLANK]
[IF RACE, HISPANIC, AND/OR MILITARY IS ‘OTHER’, ‘DK’, OR ‘REF’ OMIT
RESPECTIVE FILLS FROM CONFIRM ROSTER SCREEN.]
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)
A (Age)
SR (Y for Screening Respondent)
[UPON TOUCHING ON ANY ROSTER LINE, SHOW SELECT SHOW DETAILS, ALL ROSTER
INFORMATION]
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, TOUCH NEXT TO MAKE
SELECTION.
TO MAKE CORRECTIONS: TOUCH AND HOLD THE ROSTER LINE THAT YOU WANT
TO EDIT, THEN TOUCH 'EDIT' FROM THE POP-UP MENU.
[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: TOUCH AND HOLD THE ROSTER LINE THAT YOU WANT
TO EDIT, THEN TOUCH 'EDIT' FROM THE POP-UP MENU.
[FUNCTIONS TO ADD ROSTER MEMBERS AND/OR EDIT ROSTER DATA]
Next [START SELECTION]

3-8

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)

3-9

NSDUH DR Screening Application Specifications
Section 4
GQU Screening - Spanish
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

STUDY INTRODUCTION
(Buenas noches/ Buenas tardes/Buenos días). Mi nombre es (FI NAME) " y trabajo para RTI
International en Carolina del Norte. Estamos llevando a cabo un estudio nacional patrocinado por
el Departamento de Salud y Servicios Humanos de los Estados Unidos.
Usted ha de haber recibido una carta explicándole el estudio.
Continue [IDENTIFY SR]

IDENTIFY SR [IF STUDY INTRODUCTION = CONTINUE]
Primero, déjeme verificar: ¿vive usted aquí?
IF NOT OBVIOUS:
Y ¿tiene 18 años de edad o más?
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.]

4-1

ADDRESS VERIFICATION [IF IDENTIFY SR = SR AVAILABLE]
Solamente necesito confirmar que ésta es
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 ENTREGUE A LA PERSONA LA
DESCRIPCIÓN DEL ESTUDIO Y DIGA LO SIGUIENTE:
Por favor lea esta declaración, la cual describe la encuesta y la legislación que asegura la
confidencialidad de cualquier información que usted nos dé. También explica que sus respuestas
son usadas con propósitos estadísticos únicamente y que su participación es voluntaria. Si
alguien es seleccionado(a) para participar en la entrevista en su totalidad, dicha persona recibirá
$30 dólares en efectivo después de haber completado la entrevista.
Continue [TRANSIENT]

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

4-2

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

OCCUPANCY [IF TRANSIENT = NO]
(¿Vivió/ ¿Vivirá) usted o alguna otra persona en este cuarto la mayor parte del tiempo durante los
meses de (CURRENT QUARTER)?
Yes Sí [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] (Incluyéndose a sí mismo), ¿cuántas
personas viven en este cuarto?
[IF TRANSIENT = NO] (Incluyendose a sí mismo), ¿cuántas personas (vivieron/vivirán) en este
cuarto la mayor parte del tiempo entre los meses de (CURRENT QUARTER)?
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].

4-3

MEMBERS 12 OR OLDER [IF TOTAL GQU MEMBERS NE BLANK AND >1]
[IF TRANSIENT = YES] ¿Cuántas de estas [TOTAL GQU MEMBERS] personas tienen 12 años
o más de edad actualmente?"
[IF TRANSIENT = NO] De estas [TOTAL GQU MEMBERS] personas, ¿cuántas tienen 12 años o
más actualmente?
ENTER SUBSET OF TOTAL GQU MEMBERS ROSTER # 1 AGE
[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]
Por favor dígame su edad en su último cumpleaños.
ENTER AGE REGISTRE LA EDAD [ROSTER #1 NAME]

ROSTER #1 NAME [IF ROSTER #1 AGE NE BLANK]
¿Cuál es su nombre (sin apellido)?
ENTER FIRST NAME REGISTRE EL PRIMER NOMBRE [ROSTER #1 GENDER]

ROSTER #1 GENDER [IF ROSTER #1 NAME NE BLANK]
ASK ONLY IF NOT OBVIOUS
¿Es esta persona hombre o mujer?
Male Hombre
Female Mujer
[ROSTER #1 HISPANIC]

4-4

ROSTER #1 HISPANIC [IF ROSTER #1 GENDER NE BLANK]
¿Es usted de origen hispano, latino o español?
(Es decir que su origen nacional o descendencia se puede describir como puertorriqueño, cubano,
cubano-americano, mexicano, mexicano-americano, chicano, centro o sudamericano, o es
nativo(a) de otro país donde se habla español?)
Yes Sí
No
[ROSTER #1 RACE]

ROSTER #1 RACE [IF ROSTER #1 HISPANIC NE BLANK]
¿Es usted de raza blanca, negra o afro-americana, indígena americana o nativo(a) de Alaska,
nativo(a) de Hawaii o de otra isla del pacífico, o asiática?
(CHECK ALL THAT APPLY)
White Blanca
Black or African American Negra o afro-americana
American Indian or Alaska Native Indígena americana o nativo(a) de Alaska
Native Hawaiian/other Pacific Islander Nativo(a) de Hawaii o de otra isla del pacífico
Asian Asiática
Other Otra raza
[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]
¿Está usted actualmente en servicio activo en las fuerzas armadas de los Estados Unidos?
Yes Sí
No
Refused Se rehúsa
[CONFIRM ROSTER]

4-5

CONFIRM ROSTER [IF ROSTER #1 MILITARY NE BLANK OR IF ROSTER #1 AGE
NE 17-65 AND ROSTER #1 RACE NE BLANK]
There are two translation variations. English is also provided here for clarification.
1. ROSTER #1 AGE 17- 65
ENGLISH:
I have listed you as a (AGE) year old (GENDER) resident. You are (RACE),
(HISPANIC), and (are/are not) on active duty in the United States military.
SPANISH:
(MALE:Lo)(FEMALE: La) he anotado a usted, (GENDER: una joven/una mujer/un
joven/un hombre/una persona) de (AGE) años de edad. (Usted) es de raza (RACE:
blanca, negra o afro-americana, indígena americana o nativo(a) de Alaska, nativo(a) de
Hawaii o de otra isla del pacífico, asiática). (HISPANIC: Usted es hispana / Usted es
hispano/ Usted no es hispana / Usted no es hispano) (MILITARY: y está en servicio
activo en las fuerzas armadas de los Estados Unidos. / y no está en servicio activo en las
fuerzas armadas de los Estados Unidos).
2. ROSTER #1 UNDER AGE 17 OR OVER AGE 65
ENGLISH:
I have listed you as a (AGE) year old (GENDER) resident. You are (RACE), and (not)
(HISPANIC).
SPANISH:
(MALE:Lo)(FEMALE: La) he anotado a usted, (GENDER: una joven/una mujer/un
joven/un hombre/una persona) de (AGE) años de edad. (Usted) es de raza (RACE:
blanca, negra o afro-americana, indígena americana o nativo(a) de Alaska, nativo(a) de
Hawaii o de otra isla del pacífico, asiática). (HISPANIC: Usted es hispana / Usted es
hispano/ Usted no es hispana / Usted no es hispano).
¿Es esto correcto?
Yes Sí [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]

4-6

OTHER MEMBERS [IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER ≥ 2]
READ TO RESPONDENT:
[IF MEMBERS 12 OR OLDER >2] Ahora necesito información general sobre todas las otras
personas que tengan 12 años de edad o más. Empecemos con la persona mayor hasta llegar a la
persona menor.
[IF MEMBERS 12 OR OLDER = 2] Ahora necesito información general sobre la otra persona
que tenga 12 años de edad o más.
Continue [AGE]

AGE [IF OTHER MEMBERS NE BLANK OR CONFIRM ROSTER = NO]
[IF MEMBERS 12 OR OLDER = 2] Por favor dígame la edad de esta persona en su último
cumpleaños.
[IF MEMBERS 12 OR OLDER > 2 HH MEMBERS] Por favor dígame la edad de la (persona
mayor/siguiente persona) en su último cumpleaños.
ENTER AGE REGISTRE LA EDAD [NAME]

NAME [IF AGE NE BLANK]
¿Cuál es el nombre (sin apellido) de esta persona?
ENTER FIRST NAME REGISTRE EL PRIMER NOMBRE [GENDER]

GENDER [IF NAME NE BLANK]
ASK ONLY IF NOT OBVIOUS
¿Es esta persona hombre o mujer?
Male Hombre
Female Mujer
Refused Se rehúsa
[HISPANIC]

4-7

HISPANIC [IF GENDER NE BLANK]
¿Es (él/ella/esta persona) de origen hispano, latino o español?
(Es decir que su origen nacional o descendencia se puede describir como puertorriqueño, cubano,
cubano-americano, mexicano, mexicano-americano, chicano, centro o sudamericano, o es
nativo(a) de otro país donde se habla español?)
Yes Sí
No
Unknown No sabe
Refused Se rehúsa
[RACE]

RACE [IF HISPANIC NE BLANK]
¿Es (él/ella/esta persona) de raza blanca, negra o afro-americana, indígena americana o nativo(a)
de Alaska, nativo(a) de Hawaii o de otra isla del pacífico, o asiática?
White Blanca
Black or African American Negra o afro-americana
American Indian or Alaska Native Indígena americana o nativo(a) de Alaska
Native Hawaiian/other Pacific Islander Nativo(a) de Hawaii o de otra isla del pacífico
Asian Asiática
Other Otra raza
Unknown No sabe
Refused Se rehúsa
(CHECK ALL THAT APPLY)
[IF AGE 17-65, MILITARY, OTHERWISE CONFIRM ROSTER]

MILITARY [IF RACE NE BLANK AND AGE 17-65]
¿Está (él/ella/esta persona) actualmente en servicio activo en las fuerzas armadas de los Estados
Unidos?
Yes Sí
No
Unknown No sabe
Refused Se rehúsa
[CONFIRM ROSTER]

4-8

CONFIRM ROSTER [IF AGE 17-65 AND MILITARY IS NE BLANK, OTHERWISE
RACE NE BLANK]
There are two translation variations. English is also provided here for clarification.
1. OTHER MEMBERS AGES 17- 65
ENGLISH:
I have listed a (AGE) year old (GENDER) resident. (She/He) is (RACE), (HISPANIC)
and (is/is not) on active duty in the United States military.
SPANISH:
He anotado (GENDER: una joven/una mujer/un joven/un hombre/una persona) de
(AGE) años de edad. (Ella /Él /Esta persona) es de raza (RACE: blanca, negra o afroamericana, indígena americana o nativo(a) de Alaska, nativo(a) de Hawaii o de otra isla
del pacífico, asiática). (HISPANIC: Ella es hispana / Él es hispano/Esta persona es
hispana / Ella no es hispana / Él no es hispano/Esta persona no es hispana)
(MILITARY: y está en servicio activo en las fuerzas armadas de los Estados Unidos. / y
no está en servicio activo en las fuerzas armadas de los Estados Unidos).
2. OTHER MEMBERS UNDER AGE 17- OR OVER AGE 65
ENGLISH:
I have listed a (AGE) year old (GENDER) resident. (She/He) is (RACE), and (not)
(HISPANIC).
SPANISH:
He anotado (GENDER: una joven/una mujer/un joven/un hombre/una persona) de
(AGE) años de edad. (Ella/Él) es de raza (RACE: blanca, negra o afro-americana,
indígena americana o nativo(a) de Alaska, nativo(a) de Hawaii o de otra isla del
pacífico, asiática). (HISPANIC: Ella es hispana / Él es hispano/ Ella no es hispana / Él
no es hispano).
¿Es esto correcto?
Yes Sí [AGE FOR NEXT GQU MEMBER, OTHERWISE VERIFY ROSTER DATA]
No [AGE]

4-9

VERIFY ROSTER DATA [IF CONFIRM ROSTER = YES]
Name (First Name)
SR (Y for Screening Respondent)
A (Age)
[UPON TAPPING 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]
Necesito asegurarme que la lista está correcta. He anotado...
[READ LIST OF OCCUPANTS’ AGES AND NAMES].
TO MAKE CORRECTIONS: TAP THE ROSTER LINE THAT YOU WANT TO EDIT, THEN
TAP 'FUNCTIONS' AND 'EDIT.'
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]

4-10

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)

4-11

NSDUH DR Screening Application Specifications
Section 5
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 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 [ TOUCH AND HOLD CASE UNTIL ACTIONS MENU APPEARS]
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/Re-Open Case
Go To Record Of Calls
View Selections
View Roster
Edit Address
Add Missed DU
Place Case On Hold/Take Case Off Hold
View Verification Information
Add Appointment
View Call Distribution

View Letters
SCREEN DU [TOUCH CASE, ACTIONS MENU, SCREEN DU]
[IF SCREENING COMPLETED, RE-OPEN CASE DISPLAYS ON ACTIONS
MENU. RE-OPENING CONFIRMATION: “CASE (CASEID) 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 TOUCH ‘OK’ TO CONTINUE.” ENTER CORRECT CODE, OK, SDU
CHARACTERISTIC]

GO TO RECORD OF CALLS [TOUCH CASE, ACTIONS MENU, GO TO RECORD OF
CALLS – FOR DETAILS SEE SECTION 6]

VIEW SELECTIONS [TOUCH CASE, ACTIONS MENU, VIEW SELECTIONS]
5-12

RESPONDENT SELECTION [IF CASE COMPLETED WITH FINAL
RESULT CODE = [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)

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

Done [SELECT CASE]
Roster [VERIFY ROSTER DATA]
ROC [RECORD OF CALLS]

VIEW ROSTER [TOUCH CASE, ACTIONS MENU, VIEW ROSTER]
[IF CASE COMPLETED WITH FINAL RESULT CODE = 30, 31, 32, VERIFY
ROSTER DATA]
[VERIFY ROSTER DATA – FOR DETAILS, SEE SECTIONS 1& 2]
Done [SELECT CASE]
Selections [RESPONDENT SELECTION]

EDIT ADDRESS [TOUCH CASE, ACTIONS MENU, EDIT ADDRESS]
[EDIT ADDRESS – FOR DETAILS, SEE SECTIONS 1 & 2]

ADD MISSED DU [TOUCH CASE ACTIONS MENU, 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: MISSED GQU: “YOU CANNOT
ADD MISSED GROUP QUARTERS UNITS (GQUS). YOU CAN ONLY ADD A
MISSED HOUSING UNIT THAT IS ASSOCIATED WITH A SELECTED LINE IN A
GROUP QUARTERS STRUCTURE. ARE YOU CERTAIN THE UNIT YOU WANT
TO ADD IS A HOUSING UNIT AND NOT A GROUP QUARTERS UNIT?”]

5-13

Yes [READY TO ADD: “DO YOU WANT TO ADD AN HU LINKED TO CASE
(CASEID)?” IF Yes, MISSED DU ADDRESS. IF No, SELECT CASE]
No [CALL FS: “IF THERE ARE MISSED GROUP QUARTERS UNITS IN THE
STRUCTURE, OBTAIN INFORMATION ABOUT ALL MISSED UNITS THEN
CALL YOUR FS.” OK, SELECT CASE.]

PLACE CASE ON HOLD [TOUCH CASE, ACTIONS MENU, 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, SELECT CASE WITH ‘On Hold’ NEXT TO CASEID.]
[IF CASE ON HOLD, TAKE CASE OFF HOLD: “ARE YOU SURE YOU WANT TO
TAKE CASE (CASEID) OFF HOLD?” IF No, SELECT CASE WITH CASE ON
HOLD. IF Yes, SELECT CASE WITH ‘On Hold” REMOVED AND CASE NOT ON
HOLD.]

VIEW VERIFICATION INFORMATION [IF VERIFICATION INFORMATION
AVAILABLE, VERIFICATION.]

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

NEW APPOINTMENT
SHOW CALENDAR WHEN DONE? (check box)
CASE: (Case ID)
FROM: (current date with link to calendar to select a beginning date) (time of day)
[IF SELECT A DIFFERENT DATE, Set CHANGES DATE,
Cancel MAINTAINS CURRENT DATE]
IF SELECT A DIFFERENT TIME, Set CHANGES TIME,
Cancel MAINTAINS CURRENT TIME]
TO: (current date with link to calendar to select a ending date) (time of day)
[IF SELECT A DIFFERENT DATE, Set CHANGES DATE,
Cancel MAINTAINS CURRENT DATE]
IF SELECT A DIFFERENT TIME, Set CHANGES TIME,
Cancel MAINTAINS CURRENT TIME]
ALL DAY? (check box)
REMINDER: (Drop-down box with incremental time choices Once reminder is set,
calendar icon appears at bottom of Select Case Screen allowing for easy access to
appointments)
TYPE: (Drop-down box with: Select Type, Screening, Interview A, Interview B, S/I
Other, Other)

5-14

DESCRIPTION: (text entry with comments describing appointment)
Done [CALENDAR with Pop Up containing appointment information. SEND VIA: not
to be used; EDIT: EDIT EVENT where changes can be easily made.] This calendar is an
interactive stock tablet tool that allows calendar viewing by day, week, month and list.
Touching the day on the calendar will show any entered appointments. New
appointments can be added, and appointments for the current day display at the bottom
of the screen.
Cancel [SELECT CASE]

VIEW CALL DISTRIBUTION [SELECT CASE, ACTIONS,VIEW 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.]
DATE RANGE (INCLUSIVE)
BEGIN DATE: [SELECT A DATE] Date appears allowing beginning
date selection to narrow down the ROC results SET chooses the date
entered [CALL DISTRIBUTION], CANCEL, [CALL
DISTRIBUTION].)
END DATE: [SELECT A DATE] Date appears allowing beginning
date selection to narrow down the ROC results SET chooses the date
entered [CALL DISTRIBUTION], CANCEL, [CALL
DISTRIBUTION].)
5-15

Su
M
Tu
W
Th
F
Sa
All

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

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 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)
ADMINISTRATIVE TOOLS MENU [SELECT CASE, FUNCTIONS, ADMINISTRATIVE
TOOLS]

Items on Administrative Tools 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

SET NAME AND ID [SELECT CASE, FUNCTIONS, ADMINISTRATIVE TOOLS, SET
NAME AND ID]

NSDUH SYSTEM IDENTIFICATION [SELECT CASE, ADMINISTRATIVE
TOOLS, SET NAME AND ID]
Government ID: (Government ID issued to iPAQ)
FIID: (RTI FI ID Number)
First Name: (FI First Name to be used on Study Introduction screen)
Last Name: (FI Last Name to be used on Study Introduction screen)

5-16

Save [SELECT CASE]
Cancel [SELECT CASE]

ENTER PT&E DATA [SELECT CASE, FUNCTIONS, ADMINISTRATIVE TOOLS,
ENTER PT&E DATA]

PT&E DATA [SELECT CASE, FUNCTIONS, ADMINISTRATIVE TOOLS, ENTER PT&E,
ADD]
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)
Hours: (.25-99.99)
Miles: (1-999)
Expense: (.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
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)
Quarter (Quarter: 1, 2, 3, 4)
Task (Task number)
FS (FS Name)
Hours (Hours)
Miles (Miles)
Expenses (Expenses)
Notes (Notes)
WEEK:
FS:
TASK:
HRS:
EXP:

QUARTER:

NOTES:

Done [SELECT CASE]
Add [PT&E DATA]
Transmitted? [IF NO TRANSMITTED PT&E RECORDS, “NO
TRANSMITTED PT&E RECORDS FOUND” TOUCH
“Transmitted?” AGAIN TO DISPLAY UNTRANSMITTED
RECORDS. IF NO UNTRANSMITTED PT&E RECORDS,

5-17

“NO UNTRANSMITTED PT&E RECORDS FOUND” TOUCH
“Transmitted?” AGAIN TO DISPLAY TRANSMITTED
RECORDS.
IF TRANSMITTED PT&E RECORD(S), PTE SUMMARY
WITHOUT OPTION TO ADD, EDIT, DELETE.
IF UNTRANSMITTED PT&E RECORD(S), PTE SUMMARY
WITH ADD, EDIT, DELETE OPTIONS.]
EDIT [PT&E SUMMARY: TOUCH AND HOLD LINE TO SELECT,
ACTIONS, EDIT, PT&E DATA.]
DELETE [PT&E SUMMARY: TOUCH AND HOLD LINE TO
SELECT, ACTIONS, DELETE. PT&E DELETE CONFIRMATION:
“ARE YOU SURE YOU WANT TO DELETE THIS PT&E RECORD?”
IF No, PTE SUMMARY. IF Yes, PTE SUMMARY WITH RECORD
DELETED.]

VIEW TRANSMITTED PT&E DATA [SELECT CASE, FUNCTIONS,
ADMINISTRATIVE TOOLS, 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)
Quarter (Quarter: 1, 2, 3, 4)
Task (Task number)
FS (FS Name)
Hours (Hours)
Miles (Miles)
Expense (Expenses)
Notes (Notes)
WEEK:
FS:
TASK:
HRS:
EXP:

QUARTER:

NOTES:

Done [SELECT CASE]
Add [PT&E DATA]
Transmitted? [IF NO TRANSMITTED PT&E RECORDS, “NO
TRANSMITTED PT&E RECORDS FOUND” TOUCH
“Transmitted?” AGAIN TO DISPLAY UNTRANSMITTED
RECORDS. IF NO UNTRANSMITTED PT&E RECORDS,
“NO UNTRANSMITTED PT&E RECORDS FOUND” TOUCH

5-18

“Transmitted?” AGAIN TO DISPLAY TRANSMITTED
RECORDS.
IF TRANSMITTED PT&E RECORD(S), PTE SUMMARY
WITHOUT OPTION TO ADD, EDIT, DELETE.
IF UNTRANSMITTED PT&E RECORD(S), PTE SUMMARY
WITH ADD, EDIT, DELETE OPTIONS.]

RECONCILE MISSED DUS [SELECT CASE, FUNCTIONS, ADMINISTRATIVE
TOOLS, 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, FUNCTIONS,
ADMINISTRATIVE TOOLS, RECONCILE MISSED DUs]
SEGMENT (SEGID)
STREET ADDRESS (MISSED DU STREET ADDRESS)
TO RECONCILE A SEGMENT: TOUCH AND HOLD ON THE LINE, THEN
TOUCH ‘RECONCILE’ FROM THE POP-UP MENU.
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

5-19

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 SDU CHECK]
Exit [SELECT CASE]

MDU-GEOGRAPHIC INTERVAL SDU CHECK [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 ON THE SDU PROPERTY, AS WELL AS LOCATED WITHIN THE
SEGMENT BOUNDARIES?
(IF THE SDU IS THE LAST ONE LISTED ON A MAP PAGE, TAP THE Help
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
ADDED. IF YOU CANNOT DO THAT RIGHT NOW, TOUCH 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. TOUCH ANY LINE TO EDIT IT.
STREET #: (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,

5-20

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, FUNCTIONS, ADMINISTRATIVE
TOOLS,RELOAD TRAINING CASES]
RE-LOAD TRAINING CASES: “ARE YOU SURE YOU WANT TO REMOVE
AND RELOAD ALL TRAINING CASES?” IF No, SELECT CASE. IF Yes,
SELECT CASE WITH TRAINING CASES REMOVED AND RELOADED.

ERASE TRAINING CASES [SELECT CASE, FUNCTIONS, ADMINISTRATIVE
TOOLS, 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.

VIEW/SORT MENU [SELECT CASE, FUNCTIONS, VIEW/SORT]
View/Sort is a case management feature that allows an FI to view and sort cases in his/her assignment by
subgroups and varying orders on the Select Case screen. The View and Sort options can be used in a
variety of combinations.

VIEW/SORT PREFERENCES
To modify the View and Sort options, Touch “View” and “Sort” then select an option from the
list.
To go back to “SELECT CASE”, touch the Done button.
View [VIEW]
Sort [SORT]
Done [SELECT CASE]

VIEW
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)

5-21

Cancel [VIEW/SORT PREFERENCES]

SORT
By Case ID (Alphanumerical order by CaseID)
By Street (Alphanumerical order by street name within segment and number)
By Screening Code (Numerical order by Screening Result Code)
By Interview A Code (Numerical order by Interview A Result Code)
By Interview B Code (Numerical order by Interview B Result Code)
By ROC Date, Ascending (Ascending date order using most recent Record of Calls entry)
By ROC Date, Descending (Descending date order using most recent Record of Calls entry)
Cancel [VIEW/SORT PREFERENCES]

CALL DISTRIBUTION [SELECT CASE, FUNCTIONS, CALL DISTRIBUTION] (See Call
Distribution explanation under Actions Menu above)

ADD APPOINTMENT [SELECT CASE, FUNCTIONS, ADD APPOINTMENT] (See Add
Appointment explanation under Actions Menu above)
CALENDAR [SELECT CASE, FUNCTIONS, CALENDAR] (See Calendar explanation within the Add
Appointment portion under Actions Menu above)
TRANSMIT [SELECT CASE, FUNCTIONS, TRANSMIT]
TRANSMISSION LOG
Done [SELECT CASE]
Transmit [BEGINS DATA TRANSMISSION]

5-22

NSDUH DR Screening Application Specifications
Section 6
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 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 [TOUCH CASE, ACTIONS MENU, GO TO RECORD OF CALLS
OR ON ANY SUBSEQUENT SCREEN EXIT OR VERIFICATION, DONE OR
RESPONDENT SELECTION, DONE]
Type (Data Type: S, A, B)
Result (Result Code)
Date/time (Date, time, and day of the week ROC entered)
Done [SELECT CASE]
Add [IF CODE = PENDING SCREENING CODE, SCREENING CALL RECORD. FOR
PENDING INTERVIEW CODES, CHOOSE ROC TYPE]
CD [IF CALL RECORD ENTERED, CALL DISTRIBUTION FOR DETAILS SEE
SECTION 5]
Roster [IF CODE = 22, 25, 26, 30, 31, OR 32, VERIFY ROSTER DATA FOR DETAILS
SEE SECTION 1]
Selections [If CODE = 31 or 32, RESPONDENT SELECTION]

ACTIONS MENU [RECORD OF CALLS, TOUCH AND HOLD CASE UNTIL ACTIONS
MENU APPEARS]
Edit [IF ROC EVENT SELECTED, SCREENING CALL RECORD or
INTERIVEW CALL RECORD]
Delete [IF UNTRANSMITTED, NON-SYSTEM-GENERATED ROC EVENT (NE 26,
30, 31, 32), DELETES EVENT, RECORD OF CALLS]
View Refusal [IF CODE 07, 17, 57, 58, 77, 78, REFUSAL REPORT -FOR DETAILS
SEE SECTION 7]
View Other Specify [IF CODE 09, 23, 59, or 79, CODE [fill with 09, 23, 59, or 79]:
OTHER SPECIFY CATEGORIES]

FUNCTIONS MENU [RECORD OF CALLS, FUNCTIONS]
Add [IF PENDING CODE, CALL RECORD]
6-1

Call Distribution [IF ROCs ENTERED, CALL DISTRIBUTION]
View Roster [IF CODE = 22, 25, 26, 30, 31, OR 32, VERIFY ROSTER DATA]
View Selections [IF CODE 31 OR 32 RESPONDENT SELECTION]
Add Appointment [NEW APPOINTMENT]
Calendar [CALENDAR]
View Verification Information [IF CODE 10, 13, 18, 26, OR 30, VERIFICATION]
Help [HELP]
CHOOSE ROC TYPE [IF CODE = 32, RECORD OF CALLS, ADD]
WHICH TYPE OF CALL RECORD DO YOU WANT TO ENTER?
Screening [SCREENING CALL RECORD]
Interview A [INTERVIEW A CALL RECORD]
Interview B [INTERVIEW B CALL RECORD]
Cancel [RECORD OF CALLS]

SCREENING CALL RECORD [IF AT COMPLETION OF SCREENING PROCESS
RESPONDENT SELECTION = DONE OR IF RECORD OF CALLS = ADD]
RESULT (01-23, 26, 29)
COMMENTS: (text entry)
DO NOT CHANGE ROC DATE/TIME UNLESS INSTRUCTED BY TECH SUPPORT
OR FS.
DAY/DATE: (Day of week and Date 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, 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.

6-2

DAY/DATE: (Day of week and Date 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]

CODE 09: OTHER SPECIFY CATEGORIES [SCREENING CALL RECORD =
RESULT CODE 09]
OTHER SPECIFY CATEGORIES
Screening breakoff
Selected wrong line number
Added in error
Safety issue
Controlled access
Possible vacant
Possible vacation/not primary residence
GQU is institution (ONLY ACTIVE FOR GQU CASES)
Other listing problem
Need to discuss with FS
Something else, Specify
Done [RECORD OF CALLS]

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

CODE 59: OTHER SPECIFY CATEGORIES [INTERVIEW A CALL RECORD OR
INTERVIEW B CALL RECORD = RESULT 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

6-3

Need to discuss with FS
Something else, Specify
Done [RECORD OF CALLS]

CODE 79: OTHER SPECIFY CATEGORIES [INTERVIEW A CALL RECORD OR
INTERVIEW B CALL RECORD = RESULT CODE 79]
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
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]
LANGUAGE CATEGORIES
Arabic
Chinese
French
German
Italian
Korean
Polish
Portuguese
Russian
Tagalog
Vietnamese
Other, Specify
Specify other language or comments: (text entry)
Done [RECORD OF CALLS]
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
Physically Incapable
Mentally Incapable
Done [RECORD OF CALLS]

6-4

NSDUH DR Screening Application Specifications
Section 7
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 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
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
Comment: (text entry)
Done [SAVES REASON FOR REFUSALAND COMMENTS ENTERED, RECORD OF
CALLS]

7-1

Screening and Interview Refusal Functions on ROC
1. View refusal report or edit refusal report prior to transmission:
REFUSAL REPORT [IF RECORD OF CALLS = TOUCH AND HOLD CALL RECORD, ACTION
MENU, VIEW REFUSAL]
Reason for refusal
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
Comment: (text entry)
Done [IF EDITED (BEFORE TRANSMISSION) SAVES REASON FOR REFUSAL AND
COMMENTS ENTERED, THEN RECORD OF CALLS]

7-2

NSDUH DR Screening Application Specifications
Section 8
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 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]
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.
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.)

Done [CHECKS FOR COMPLETE DATA ENTRY, RECORD OF CALLS]
Clear [VERIFICATION WITH ENTRY CLEARED]
Span [Question text appears in Spanish “Para que mi supervisor pueda revisar la calidad
de mi trabajo, ¿me podría dar su primer nombre y su número de teléfono?” and button
changes to Eng]

8-1

This page intentionally left blank.

8-2

NSDUH DR Screening Application Specifications
Section 9
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 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
INTERVIEW DEBRIEFING QUESTIONS:
THESE QUESTIONS ARE FOR YOU TO ANSWER. DO NOT READ TO THE R.
FIDBF1
Did you conduct this interview at the respondent’s home, either inside or outside?
YES
NO
Next [IF FIDBF1=YES, GO TO FIDBF3]
FIDBF2 [IF FIDBF1=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
5. IN SOME TYPE OF COMMON AREA, SUCH AS A LOBBY, HALLWAY, STAIRWELL,
OR LAUNDRY ROOM
6. SOME OTHER PLACE
Next [IF FIDBF2=6, GO TO FIDBF2a]
FIDBF2a [IF FIDBF2=6]
Where did the interview take place?
ALLOW 140 CHARACTERS

9-1

Next [FIDBF3]
FIDBF3
Please estimate for how much of the ACASI interview the respondent had their headphones on.
0.
1.
2.
3.
4.

NONE/R TOOK HEADPHONES OFF IMMEDIATELY
LESS THAN HALF OF THE ACASI INTERVIEW
ABOUT HALF OF THE ACASI INTERVIEW
MORE THAN HALF OF THE ACASI INTERVIEW
ALL OF THE ACASI INTERVIEW

Next [FIDBF4]
FIDBF4
How cooperative was the respondent?
1.
2.
3.
4.

VERY COOPERATIVE
FAIRLY COOPERATIVE
NOT VERY COOPERATIVE
OPENLY HOSTILE

FIDBF5
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 FIDBF5=1, GO TO FIDBF8; IF FIDBF5 NE1, GO TO FIDBF6]
FIDBF6 [IF FIDBF5 NE1]
Not including yourself or project observers, who were the other people present or listening to the
interview?
Check all that apply
1.
2.
3.
4.
5.

PARENT(S)
SPOUSE
LIVE-IN PARTNER/BOYFRIEND/GIRLFRIEND
OTHER ADULT RELATIVE(S)
OTHER ADULT(S)
9-2

6. CHILD(REN) UNDER 15
7. OTHER
Next [IF FIDBF6=1, 2, 3, 4, 5, OR 6, GO TO FIDBF8]
FIDBF7 [IF FIDBF6=7]
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 [FIDBF8]
FIDBF8 [IF FIDBF5=1; OR IF FIDBF6=1, 2, 3, 4, 5, OR 6; OR IF FIDBF7 NE BLANK]
Did the respondent make any comments about the interview being too long?
YES
NO
Next [FIDBF9]
FIDBF9
Did the respondent have trouble understanding any questions asked during the interview?
YES
NO
Next [IF FIDBF9=NO, GO TO FIDBF10]
FIDBF9a [IF FIDBF9=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 [FIDBF10]
FIDBF10
How often did this respondent let you know what his or her answers were as he or she completed
the ACASI portion of the interview?
1. NONE OF THE TIME – I DO NOT KNOW WHAT ANY OF THE ANSWERS ARE
2. A LITTLE OF THE TIME – I KNOW WHAT A FEW OF THE ANSWERS ARE
9-3

3. SOME OF THE TIME – I KNOW WHAT SOME OF THE ANSWERS ARE
4. A LOT OF THE TIME – I KNOW WHAT A LOT OF THE ANSWERS ARE
5. ALL OF THE TIME – I KNOW WHAT ALL OF THE ANSWERS ARE
Next [FIDBF11]
FIDBF11
Please note anything else you think would be helpful for the interpretation and understanding of
this interview.
ALLOW 250 CHARACTERS
Next [RECORD OF CALLS]

9-4

2015 NSDUH, Supporting Statement
Attachment G – Tablet Screening Video Script

TABLET SCREENING VIDEO SCRIPT
To serve people across the United States, the National Survey on Drug Use and Health collects data on
substance use, mental health and other health-related issues that are used by local, state, and national
agencies to support education, treatment and prevention programs.
For this survey, households nationwide just like yours are scientifically selected at random and then
visited by a professional interviewer.
During this visit, the interviewer asks a few general questions to determine if anyone in your household
will complete an interview. Those completing the full interview will receive $30 cash.
To protect your privacy, you record most of your answers into a computer. The interviewer never sees
or hears them. Your answers are combined with those from thousands of others, and are reported only
as overall statistics.
You cannot be replaced so your participation is very important.
Feel free to ask the interviewer any questions you have or visit nsduhweb.rti.org for more information.
(Approx. run time: 50 seconds)

2015 NSDUH, Supporting Statement
Attachment H – Parental Introductory Script

PARENTAL INTRODUCTORY SCRIPT
This script is read to parents/guardian by field interviewers prior to speaking with any youth respondents
selected for the NSDUH interview. Field interviewers will access this script electronically from the tablets
used for screening.

If one youth is selected to complete an interview:
Your (AGE) year-old child has been selected for an interview. I would like to talk with him/her to see if
he/she is interested in participating in this study which asks about tobacco, alcohol, and drug use or
non-use and other health related issues. If your child is interested, I will give both of you more
information and ask for permission to complete the interview. Is he/she available?

If two youths are selected to complete an interview:
Your (AGE) year-old and (AGE) year-old children have been selected for an interview. I would like to talk
with them to see if they are interested in participating in this study which asks about tobacco, alcohol,
and drug use or non-use and other health related issues. If they are interested, I will give all of you more
information and ask for permission to complete the interview. Are they available?