12.4 Survey

Continuation of National Children's Study Vanguard (Pilot) Study Data Collection: Study Visits through 60-Months

6MonthQuestionnaireHousehold

6-Month Interview

OMB: 0925-0593

Document [docx]
Download: docx | pdf

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

6M Questionnaire - Household, Phase 2g

OMB Specification


6M Questionnaire - Household


Event Category:

Time-Based

Event:

6M

Administration:

N/A

Instrument Target:

Child's Primary Residence

Instrument Respondent:

Primary Caregiver

Domain:

Questionnaire

Document Category:

Questionnaire

Method:

Data Collector Administered

Mode (for this instrument*):

In-Person, CAI;
Phone, CAI

OMB Approved Modes:

In-Person, CAI;
Phone, CAI;
Web-Based, CAI

Estimated Administration Time:

3 minutes

Multiple Child/Sibling Consideration:

Per Event

Special Considerations:

N/A

Version:

1.0

MDES Release:

4.0


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


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6M Questionnaire - Household



TABLE OF CONTENTS





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6M Questionnaire - Household



GENERAL PROGRAMMER INSTRUCTIONS:

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


DATA ELEMENT FIELDS

MAXIMUM CHARACTERS PERMITTED

DATA TYPE

PROGRAMMER INSTRUCTIONS

ADDRESS AND EMAIL FIELDS

100

CHARACTER


UNIT AND PHONE FIELDS

10

CHARACTER


_OTH AND COMMENT FIELDS

255

CHARACTER

  • Limit text to 255 characters

FIRST NAME AND LAST NAME

30

CHARACTER

  • Limit text to 30 characters

ALL ID FIELDS

36

CHARACTER


ZIP CODE

5

NUMERIC


ZIP CODE LAST FOUR

4

NUMERIC


CITY

50

CHARACTER


DOB AND ALL OTHER DATE FIELDS (E.G., DT, DATE, ETC.)

10

NUMERIC


CHARACTER



  • DISPLAY AS MM/DD/YYYY

  • STORE AS YYYY-MM-DD

  • HARD EDITS:

MM MUST EQUAL 01 TO 12

DD MUST EQUAL 01 TO 31

YYYY MUST BE BETWEEN 1900 AND CURRENT YEAR.

TIME VARIABLES

TWO-DIGIT HOUR AND TWO-DIGIT MINUTE, AM/PM DESIGNATION

NUMERIC

  • HARD EDITS:

HOURS MUST BE BETWEEN 00 AND 12;

MINUTES MUST BE BETWEEN 00 AND 59


Instrument Guidelines for Participant and Respondent IDs:

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


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



A REMINDER:

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





FINANCIAL SECURITY


(TIME_STAMP_FS_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

  • PRELOAD PRIMARY RESIDENCE ID (VARIABLE NAME) AND RESPONDENT ID (R_P_ID) FOR ADULT CAREGIVER.

  • PRELOAD MULT_CHILD FROM PARTICIPANT VERIFICATION, SCHEDULING, & TRACING QUESTIONNAIRE.

  • IF MULT_CHILD IN PARTICIPANT VERFICATION, SCHEDULING & TRACING QUESTIONNAIRE = 1, DISPLAY “the children” IN APPROPRIATE FIELDS THROUGHOUT THE INSTRUMENT

  • IF MULT_CHILD IN PARTICIPANT VERFICATION, SCHEDULING & TRACING QUESTIONNAIRE = 2, DISPLAY “the child” IN APPROPRIATE FIELDS THROUGHOUT THE INSTRUMENT.


FS01000/(AFFORD_HOME). At this time, do you feel you are able to afford a home suitable for yourself and your family?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Pregnancy Infection and Nutrition Study (PINS)


FS02000/(AFFORD_FURNITURE). Do you feel you are able to afford the furniture or household equipment that you need? 


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Pregnancy Infection and Nutrition Study (PINS)


FS03000/(AFFORD_CAR). Do you feel you are able to afford the kind of car you need?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Pregnancy Infection and Nutrition Study (PINS)


FS04000/(AFFORD_FOOD). At this time, do you have enough money for the kinds of food you think you and your family should have?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Pregnancy Infection and Nutrition Study (PINS)


FS05000/(AFFORD_MED_CARE). Do you have enough money for the kind of medical care you and your family should have?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

2



SOURCE

Pregnancy Infection and Nutrition Study (PINS)


FS06000/(AFFORD_CLOTHING). At this time, do you have enough money for the kind of clothing you and your family should have?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Pregnancy Infection and Nutrition Study (PINS)


FS07000/(AFFORD_LEISURE). Do you have enough money for the leisure activities you and your family want?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

Pregnancy Infection and Nutrition Study (PINS)


FS08000/(DIFF_PAY_BILLS). How difficult is it for you and your family to pay your bills? Would you say it is…


Label

Code

Go To

Very difficult

1


Somewhat difficult

2


Not very difficult

3


Not difficult at all

4


REFUSED

-1


DON’T’ KNOW

-2



SOURCE

Pregnancy Infection and Nutrition Study (PINS)


FS09000/(MONEY_END_MONTH). At the end of the month, how much money would you say you end up with?


Label

Code

Go To

Not enough money

1


Just enough money

2


Some money left over

3


A lot of money left over

4


REFUSED

-1


DON’T’ KNOW

-2



SOURCE

Pregnancy Infection and Nutrition Study (PINS)


(TIME_STAMP_FS_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP



LANGUAGE USE


(TIME_STAMP_LU_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


LU01000. These next questions are about the primary language spoken at home or to {the child/children}.


LU02000/(LANGUAGE_NON_ENG). Is any language other than English regularly spoken in your home?


Label

Code

Go To

YES

1


NO

2

TIME_STAMP_LU_ET

REFUSED

-1

TIME_STAMP_LU_ET

DON'T KNOW

-2

TIME_STAMP_LU_ET


SOURCE

Early Childhood Longitudinal Study, Kindergarten Cohort Spring Parent Interview


LU03000/(LANGUAGE_TYPE). What languages other than English are spoken in your home? 


INTERVIEWER INSTRUCTIONS

  • LANGUAGES ARE LISTED IN ALPHABETICAL ORDER EXCEPT FOR SPANISH. 


Label

Code

Go To

SPANISH

1


ARABIC

2


BENGALI

3


CHINESE (INCLUDING MANDARIN, CANTONESE)

4


FARSI (PERSIAN)

5


FRENCH

6


FRENCH CREOLE

7


GERMAN

8


GREEK

9


HINDI

10


ITALIAN

11


KOREAN

12


POLISH

13


PORTUGUESE

14


PUNJABI

15


RUSSIAN

16


TAGALOG

17


VIETNAMESE

18


URDU

19


SIGN LANGUAGE

20


OTHER

-5


REFUSED

-1


DON’T KNOW

-2



SOURCE

Early Childhood Longitudinal Study, Kindergarten Cohort Fall Parent Interview (modified) 


PROGRAMMER INSTRUCTIONS

  • IF LANGUAGE_TYPE = 1 THROUGH 20, -1, OR -2, GO TO PRIMARY_LANGUAGE.

  • IF LANGUAGE_TYPE = -5 OR ANY COMBINATION OF 1 THROUGH 20 AND -5, GO TO LANGUAGE_TYPE_OTH.


LU04000/(LANGUAGE_TYPE_OTH). SPECIFY: ____________________________________________


SOURCE

Early Childhood Longitudinal Study, Kindergarten Cohort Fall Parent Interview (modified) 


LU05000/(PRIMARY_LANGUAGE). What is the primary language spoken in your home? 


INTERVIEWER INSTRUCTIONS

  • LANGUAGES ARE LISTED IN ALPHABETICAL ORDER EXCEPT FOR ENGLISH AND SPANISH. 


Label

Code

Go To

ENGLISH

1

TIME_STAMP_LU_ET

SPANISH

2

ENGLISH_REGULAR

ARABIC

3

ENGLISH_REGULAR

BENGALI

4

ENGLISH_REGULAR

CHINESE (INCLUDING MANDARIN, CANTONESE)

5

ENGLISH_REGULAR

FARSI (PERSIAN)

6

ENGLISH_REGULAR

FRENCH

7

ENGLISH_REGULAR

FRENCH CREOLE

8

ENGLISH_REGULAR

GERMAN

9

ENGLISH_REGULAR

GREEK

10

ENGLISH_REGULAR

HINDI

11

ENGLISH_REGULAR

ITALIAN

12

ENGLISH_REGULAR

KOREAN

13

ENGLISH_REGULAR

POLISH

14

ENGLISH_REGULAR

PORTUGUESE

15

ENGLISH_REGULAR

PUNJABI

16

ENGLISH_REGULAR

RUSSIAN

17

ENGLISH_REGULAR

TAGALOG

18

ENGLISH_REGULAR

VIETNAMESE

19

ENGLISH_REGULAR

URDU

20

ENGLISH_REGULAR

SIGN LANGUAGE

21

ENGLISH_REGULAR

OTHER

-5


REFUSED

-1

TIME_STAMP_LU_ET

DON’T KNOW

-2

TIME_STAMP_LU_ET


SOURCE

Early Childhood Longitudinal Study, Kindergarten Cohort Fall Parent Interview (modified) 


LU06000/(PRIMARY_LANGUAGE_OTH). SPECIFY: ____________________________________________


SOURCE

Early Childhood Longitudinal Study, Kindergarten Cohort Fall Parent Interview (modified) 


LU07000/(ENGLISH_REGULAR). Is English also regularly spoken in your home?


Label

Code

Go To

YES

1


NO

2


REFUSED

-1


DON'T KNOW

-2



SOURCE

High School Longitudinal Study of 2009, First Follow-Up Questionnaire


LU08000/(CHILD_LANGUAGE). What language do you usually speak to {the child/children} in your home?


Label

Code

Go To

ENGLISH

1

NONENGLISH_FREQ

SPANISH

2

NONENGLISH_FREQ

ARABIC

3

NONENGLISH_FREQ

BENGALI

4

NONENGLISH_FREQ

CHINESE (INCLUDING MANDARIN, CANTONESE)

5

NONENGLISH_FREQ

FARSI (PERSIAN)

6

NONENGLISH_FREQ

FRENCH

7

NONENGLISH_FREQ

FRENCH CREOLE

8

NONENGLISH_FREQ

GERMAN

9

NONENGLISH_FREQ

GREEK

10

NONENGLISH_FREQ

HINDI

11

NONENGLISH_FREQ

ITALIAN

12

NONENGLISH_FREQ

KOREAN

13

NONENGLISH_FREQ

POLISH

14

NONENGLISH_FREQ

PORTUGUESE

15

NONENGLISH_FREQ

PUNJABI

16

NONENGLISH_FREQ

RUSSIAN

17

NONENGLISH_FREQ

TAGALOG

18

NONENGLISH_FREQ

VIETNAMESE

19

NONENGLISH_FREQ

URDU

20

NONENGLISH_FREQ

SIGN LANGUAGE

21

NONENGLISH_FREQ

OTHER

-5


REFUSED

-1

LANG_CHILD_SPEAK

DON’T KNOW

-2

LANG_CHILD_SPEAK


SOURCE

High School Longitudinal Study (HSLS) of 2009, First Follow-Up Questionnaire (modified) 


LU09000/(CHILD_LANGUAGE_OTH). SPECIFY: ___________________________________________


SOURCE

High School Longitudinal Study (HSLS) of 2009, First Follow-Up Questionnaire (modified) 


LU10000/(NONENGLISH_FREQ). How often do you use a language other than English when speaking to {the child/the children}? Would you say…


INTERVIEWER INSTRUCTIONS

  • PROBE “We just need to know in general?”


Label

Code

Go To

Never

1


Sometimes

2


Often

3


Very often

4


REFUSED

-1


DON’T KNOW

-2



SOURCE

Early Childhood Longitudinal Program, Birth Cohort 9-Month Parent Interview (modified) 


LU11000/(LANG_CHILD_SPEAK). What language does {the child/children} usually speak to you in your home?


Label

Code

Go To

ENGLISH

1

TIME_STAMP_LU_ET

SPANISH

2

OTHER_LANG_FREQ

ARABIC

3

OTHER_LANG_FREQ

BENGALI

4

OTHER_LANG_FREQ

CHINESE (INCLUDING MANDARIN, CANTONESE)

5

OTHER_LANG_FREQ

FARSI (PERSIAN)

6

OTHER_LANG_FREQ

FRENCH

7

OTHER_LANG_FREQ

FRENCH CREOLE

8

OTHER_LANG_FREQ

GERMAN

9

OTHER_LANG_FREQ

GREEK

10

OTHER_LANG_FREQ

HINDI

11

OTHER_LANG_FREQ

ITALIAN

12

OTHER_LANG_FREQ

KOREAN

13

OTHER_LANG_FREQ

POLISH

14

OTHER_LANG_FREQ

PORTUGUESE

15

OTHER_LANG_FREQ

PUNJABI

16

OTHER_LANG_FREQ

RUSSIAN

17

OTHER_LANG_FREQ

TAGALOG

18

OTHER_LANG_FREQ

VIETNAMESE

19

OTHER_LANG_FREQ

URDU

20

OTHER_LANG_FREQ

SIGN LANGUAGE

21

OTHER_LANG_FREQ

OTHER

-5


REFUSED

-1

TIME_STAMP_LU_ET

DON’T KNOW

2

TIME_STAMP_LU_ET


SOURCE

High School Longitudinal Study (HSLS) of 2009, First Follow-Up Questionnaire (modified) 


LU12000/(LANG_CHILD_SPEAK_OTH). SPECIFY: ____________________________________________


SOURCE

High School Longitudinal Study (HSLS) of 2009, First Follow-Up Questionnaire (modified) 


LU13000/(OTHER_LANG_FREQ). How often does {the child/children} use this language when speaking to you? Would you say…


INTERVIEWER INSTRUCTIONS

  • PROBE “We just need to know in general?”


Label

Code

Go To

Rarely

1


Sometimes

2


Often

3


Very often

4


All the time

5


REFUSED

-1


DON’T KNOW

-2



SOURCE

New


(TIME_STAMP_LU_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


Public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593*). Do not return the completed form to this address.

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