Form 21.1 Survey

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Participant Verification & Tracing Questionnaire, Phase 2g

OMB Specification

Participant Verification & Tracing Questionnaire

Event Category:	Trigger-Based, PV1, PV2, Pre-Natal Father, Post-Natal Father, Secondary Residence; Time-Based, Birth, 3M, 6M, 9M, 12M, 18M, 24M, 30M, 36M, 42M, 48M, 54M, 60M
Event:	PV1, PV2, Pre-Natal Father, Birth, Post-Natal Father, 3M, 6M, 9M, 12M, 18M, 24M, 30M, 36M, 42M, 48M, 54M, 60M, Secondary Residence
Administration:	Pre-Natal Father, PV1; Post-Natal Father, 9M, 18M; Secondary Residence, 36M, 48M, 60M
Instrument Target:	Pregnant Woman (PV1, PV2); Father/Father Figure (Pre-Natal, Post-Natal); Biological Mother (Birth); Primary Caregiver (3M, 6M, 9M, 12M, 18M, 24M, 30M, 36M, 42M, 48M, 54M, 60M); Child's Secondary Residence (Secondary Residence)
Instrument Respondent:	Pregnant Woman (PV1, PV2); Father/Father Figure (Pre-Natal, Post-Natal); Biological Mother (Birth); Primary Caregiver (3M, 6M, 9M, 12M, 18M, 24M, 30M, 36M, 42M, 48M, 54M, 60M); Secondary Residence Caregiver (Secondary Residence)
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
Estimated Administration Time:	7 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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Participant Verification & Tracing Questionnaire

TABLE OF CONTENTS

GENERAL PROGRAMMER INSTRUCTIONS: 1

INSTRUMENT PROGRAMMING GUIDELINES 3

PARTICIPANT VERIFICATION 6

TRACING VERIFICATION 12

ADDITIONAL PROGRAMMING INSTRUCTIONS 16

APPENDIX 1: GRID 1 - PARTICIPANT RELATIONSHIP VERIFICATION 17

APPENDIX 2: GRID 2 - ADDRESS AND CONTACT INFORMATION VERIFICATION 22

APPENDIX 3: GRID 3 - TRACING CONTACT INFORMATION 27

APPENDIX 4: GRID 4 – TRACING MOVE INFORMATION 31

APPENDIX 5: BANNER DISPLAY SPECIFICATIONS 35

APPENDIX 6: LINK_PERSON_PARTICIPANT RELATIONSHIP CODE REVISIONS 36

APPENDIX 7: EXAMPLE GRID 1 - PARTICIPANT RELATIONSHIP VERIFICATION 38

APPENDIX 8: EXAMPLE GRID 2 - ADDRESS AND CONTACT INFORMATION VERIFICATION 39

APPENDIX 9: EXAMPLE GRID 3 - TRACING CONTACT VERIFICATION 40

APPENDIX 10: EXAMPLE GRID 4 – TRACING MOVE INFORMATION 41

APPENDIX 11: USE CASE EXAMPLES 42

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Participant Verification & Tracing Questionnaire

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.

INSTRUMENT PROGRAMMING GUIDELINES

(TIME_STAMP_IPG_ST).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

IPG01000.

DATA COLLECTOR INSTRUCTIONS

This instrument is administered at the beginning of an Event window, and consolidates collection and verification of Participant Verification, Household Roster, and Tracing data elements in one instrument to reduce participant burden and more rigorously link participant data to the appropriate Operational Data Element (ODE) Tables in the MDES.  

 

Specific ODEs will be preloaded and cross-referenced to the instrument variables in this section (See Appendix 1 through Appendix 4 for examples of ODE/Variable mapping Tables). The ODEs will be displayed in a grid format to provide the staff member completing this instrument (data collector) with a comprehensive display of the participant information that will be verified.  (See Appendix 7 through Appendix 10 for example grids).  

 

This PVT instrument will be routinely administered over the phone but may be administered in-person if it cannot be completed at the time of scheduling the event. It is designed to be completed by the data collector by using good interviewer technique rather than standard questions and scripts to confirm the applicable data. 

 

The instrument will be used for each of 4 groups of events listed below with programming and data collector instructions specific for each:

 

• Post-Natal Events (including Birth),

• Secondary Residence Event,

• Father/Father-Figure Events, and

• Pregnancy Visits 1 and 2 Events.

 

Post Natal Events (including Birth):

For these events, the instrument is designed to verify the participant(s) and relationships to the child, the household roster of the primary residence of the child, and the tracing information. 

 

The first grid used for these events is the Participant Relationship Verification Grid.  The information displayed in this grid includes: Person ID, Name, Nickname, Sex, Date of Birth, Consent Status, Relationship to the Child, Multi-Birth, Marital Status (of Primary Caregiver), Caregiver Type, Legal Guardian, Secondary Residence Caregiver, Father/ Father-Figures, Active Status for NCS Participant and Household Association, and Household Residence Rank. 

 

The grid will be sorted by Household Residence Rank to allow the data collector to see all persons who have a relationship to the child listed by primary household, secondary household, and other households.  The data collector will review the information with the participant, confirm key variables, update missing variables, and edit/correct information that is incorrect or missing.  A field on each row of the grid will be flagged by the data collector if a change was made to a specific row and the data on this row will be updated in the ODE tables. 

 

The second grid for these events is the Address and Contact Information Verification Grid that will display all active participants associated with the NCS child or children sorted by Household Residence Rank.  This grid will be used to confirm or edit primary residence mailing and street address, along with contact information for the Primary Caregiver and NCS Child/Children.  The address and contact information is also confirmed or edited for the members of the household roster and the Legally Authorized Representative. 

 

If the Primary Caregiver confirms that the child has a Secondary Residence, then the address and contact information will be collected for the Secondary Residence Caregiver.  (The roster for the Secondary Residence will not be collected with these events but will be collected during the Secondary Residence Event.)

 

If the Primary Caregiver identifies the NCS Child’s Father and/or Father Figure(s), the contact information will be collected for the identified people.  (A Father/Father-Figure Event will be completed at specific time periods with the identified people.)

 

Tracing Contact Information Grid and Tracing Move Information Grid will be displayed, verified, and edited as needed. 

 

Secondary Resident Event:

A Secondary Residence Event will take place if the Primary Caregiver indicates that the NCS Child/Children has/have a secondary residence.  For this event, the instrument is designed to verify the Secondary Residence Caregiver’s address and contact information along with the members of the secondary household roster and their relationship to the child.

 

The first grid used for this event is the Participant Relationship Verification Grid.  This grid is used to display, confirm, edit the household roster of the NCS child’s secondary residence along with their date of birth, and relationship to the child.  If the Legally Authorized Representative or Father/Father-Figure is a member of the secondary household roster, his/her information will be displayed for verification.

 

The second grid displayed for this event is the Address and Contact Information Verification Grid that displays the address and contact information for the secondary residence for verification/editing.

 

Father/Father-Figure Event:

A Father/Father-Figure Event will take place if the father and father figures are identified by the NCS Child/Children’s Primary Caregiver.  For this event, the instrument is designed to verify the contact information and address(es) of the father and father-figures along with their 

relationship to the NCS Child/Children.  (Note: Father and/or Father-Figures may be associated with primary, secondary or other address).

 

The first grid used for this event is the Participant Relationship Verification Grid.  This grid is used to display, confirm, edit the NCS child’s father/father-figures along with their date of birth, and relationship to the child. 

 

The second grid displayed for this event is the Address and Contact Information Verification Grid that displays the address and contact information for the father/father-figure for verification/editing.

 

 

Pregnancy Visit 1 and 2 Events:

For these events, the instrument is designed to collect or verify the contact information and address(es) for the pregnant woman from the Sibling Cohort.  (This woman is the biological mother of the NCS child/children). 

 

The first grid used for these events is the Participant Relationship Verification Grid.  This grid is used to display, confirm, edit the pregnant woman’s name, date of birth, and marital status. 

 

The second grid displayed for these events is the Address and Contact Information Verification Grid that displays the street and mailing address (beginning and end dates) along with contact information. 

 

In the Tracing Verification Section, contact information from three relatives or friends of the Primary Caregiver is verified with each administration of this instrument, and information about any planned moves is collected.       

 

Tracing Contact information is collected in the Tracing Contact Verification Table (Grid 3) and move information is collected in Tracing Move Information (Grid 4).  To reduce NCS Participant burden and facilitate contact verification, a report summarizing the previously collected contact information will be mailed to the Participant for reference prior to PVT instrument administration.   

(TIME_STAMP_IPG_ET).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

PARTICIPANT VERIFICATION

(TIME_STAMP_PV_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

• UPDATE ODE-INSTRUMENT VARIABLE MAP AS SPECIFIED IN APPENDIX 1 THROUGH APPENDIX 4.

• GENERATE HEADER DISPLAY AS SPECIFIED IN APPENDIX 5.

• DISPLAY HEADER THROUGHOUT INSTRUMENT.    

• ​ENABLE EDIT IN GRIDS FOR ALL FIELDS EXCEPT KEY FIELDS (DOB, SEX).

• SET ALL GRID FIELDS AS READ-ONLY 

• GET C_P_ID OF NCS CHIILD AND JOIN TABLES NEEDED FOR GRIDS USING ONLY ACTIVE LINK_PERSON_PARTICIPANT RECORDS.

• IF “REVISE / ADD ROW FLAG” SELECTED BY DATA COLLECTOR IN GRIDS 1 OR 2 OR IF “REVISE FLAG”  SELECTED IN GRIDS 3 OR 4, ENABLE EDIT IN ASSOCIATED ROWS FOR ALL FIELDS EXCEPT NCS CHILD’S KEY FIELDS (DOB, SEX).

• DISPLAY THREE BLANK ROWS AFTER GRIDS 1 AND 2, SET AS READ-ONLY.

• IF "REVISE / ADD ROW FLAG" SELECTED BY DATA COLLECTOR IN GRIDS, ENABLE EDIT IN ROW.

• CREATE NEW HH_ID AND ASSOCIATE "PERSON" THAT MOVED IN OR OUT WITH NCS CHILD/MULTI-BIRTH CHILDREN WITH NEW HH_ID ​AS APPROPRIATE.

INTERVIEWER INSTRUCTIONS

• REVIEW GRID TABLES FOR MISSING DATA USING GOOD INTERVIEW TECHNIQUE

• PROMPT FOR ANSWERS OR CONFIRMATION THROUGHOUT INTERVIEW.

• UPDATE GRID TABLES AS APPROPRIATE THROUGHOUT INSTRUMENT BY SELECTING THE “REVISE / ADD ROW FLAG” COLUMN AS APPROPRIATE.

• FOR CHANGES IN KEY ITEMS (DOB OR SEX), RECORD REVISIONS ON HARDCOPY “KEY ITEM UPDATE FORM” FOR IMS UPDATE AFTER INSTRUMENT COMPLETION.

• FOR BIRTH AND POST-NATAL EVENTS, VERIFY THE FOLLOWING INFORMATION IN THIS ORDER:

• FIRST, VERIFY THE CHILD CONSENT.

• SECOND, VERIFY THE PRIMARY CAREGIVER.

• THIRDLY, VERIFY THE LEGALLY AUTHORIZED REPRESENTATIVE.

• IF UNABLE TO CONFIRM CHILD CONSET OR IF THERE WAS A CHANGE IN THE PRIMARY CAREGIVER AND/OR THE LEGALLY AUTHORIZED REPRESENTATIVE, VERIFY AND/OR COLLECT THE NEW PRIMARY CAREGIVER AND LEGALLY AUTHORIZED REPRESENTATIVE NAME, ADDRESS AND CONTACT INFORMATION AND END INTERVIEW.

• IF CONSENT IS IN PLACE FOR THE CHILD, THE PRIMARY CAREGIVER, AND THE LEGALLY AUTHORIZED REPRESENTATIVE, PROCEED WITH INSTRUMENT.

PV01000.

PROGRAMMER INSTRUCTIONS

• DISPLAY DATA COLLECTOR INSTRUCTIONS BASED ON EVENT AS FOLLOWS:

• IF EVENT_TYPE = 18, 23, 24, 26, 27, 30, 31, 36, 37, 38, TBD42M, TBD48M, TBD54M, OR TBD 60M), DISPLAY PV01500.

• IF EVENT_TYPE = TBD (SECONDARY RESIDENCE), DISPLAY PV02000.

• IF EVENT_TYPE = TBD (PRE-NATAL FATHER OR POST-NATAL FATHER), DISPLAY PV03000.

• IF EVENT_TYPE = 13 OR 15, DISPLAY PV04000 (PV1 OR PV2).

PV01500.

INTERVIEWER INSTRUCTIONS

FOR POST-NATAL EVENTS, INCLUDING BIRTH:

 

• The Participant Relationship Verification Grid (Grid 1) lists all active participants associated with the NCS child or children, sorted by address and is used to confirm names, DOB, relationship, add additional members, study and household association status.

• At a minimum, relationship information is required for:

• NCS child/children associated with primary address

• Primary Caregiver for NCS Child (PCG is associated with primary address)

• Legally Authorized Representative associated with either the primary, secondary or other address

• Primary household roster

• If identified by the Primary Caregiver, the following information may be displayed:

• Secondary Caregiver associated with either the primary, secondary or other address

• Secondary Residence Caregiver associated with secondary address

• Father-Figure associated  either the primary, secondary or other address 

• The Address and Contact Information Verification Grid (Grid 2) lists all active participants associated with the NCS child or children sorted by address and is used to confirm street and mailing address information including beginning and end dates as well as various contact information and preferences.

• At a minimum, the following information is required:

• Primary residence mailing and street address and contact information verification for Primary Caregiver and NCS child/children.

• Primary residence mailing and street address and contact information verification for primary residence household roster (in addition to PCG and NCS child).

• Legally Authorized Representative mailing and street address and contact information verification.

• If identified by the Primary Caregiver, the following information may be included:

• Secondary Residence Caregiver mailing and street addresses and contact information (PCG/SCG doesn’t need to confirm secondary residence roster).

• Father-Figure(s) contact information 

PV02000.

INTERVIEWER INSTRUCTIONS

FOR SECONDARY RESIDENCE EVENT:
 

• The Participant Relationship Verification Grid (Grid1) lists all active participants associated with the NCS child or children (CHILD_ PARTICIPANT_ ORGANIZATION_ LINKAGE.PARTICIPANTS_STATUS = 3) associated with the secondary address (HH_RANK = 2) and is used to confirm names, DOB, relationship, add additional members, study and household association status for the Secondary Residence Caregiver and secondary residence household roster.

• At a minimum, relationship information is required for:

• Secondary Residence Caregiver

• Secondary Residence household roster

• If identified by the Primary Caregiver, the following information may be displayed:

• Father-Figure or Legally Authorized Representative associated with Secondary Residence

 

• The Address and Contact Information Verification Grid (Grid 2) Grid lists all active participants associated with the NCS child or children (CHILD_ PARTICIPANT_ ORGANIZATION_ LINKAGE .PARTICIPANTS _STATUS = 3) associated with the secondary address (HH_RANK = 2) and is used to confirm street and mailing address information including beginning and end dates as well as various contact information.

• At a minimum, the following information is required:

• Secondary Residence household roster information, mailing address and contact information. 

PV03000.

INTERVIEWER INSTRUCTIONS

FOR FATHER-FATHER-FIGURE EVENTS:

 

• The Participant Relationship Verification Grid (Grid 1) lists all active participants associated with the NCS child or children (CHILD_ PARTICIPANT_ ORGANIZATION_ LINKAGE.PARTICIPANTS _STATUS = 3) identified by the Primary Caregiver as the NCS Child’s Father and/or Father-Figures (Father_Figure Flag =1), and is used to confirm names, DOB, relationship, study and household association status.
  
  

• At a minimum, relationship information is required for:

• Father and any Father-Figures identified by the Primary Caregiver.

• (Note:  Father and/or Father-Figures may be associated with primary, secondary or other address).    

 

• The Address and Contact Information Verification Grid (Grid 2) lists all active participants associated with the NCS child or children (CHILD_ PARTICIPANT_ ORGANIZATION_ LINKAGE .PARTICIPANTS _STATUS = 3) where Father-Figure Flag = 1 and is used to confirm street and mailing address information including beginning and end dates as well as various contact information.
  
  

• At a minimum, the following information is required:

• Mailing and street address and contact information verification for all Father or Father-Figures.

• (Note:  Father and/or Father-Figures may be associated with primary, secondary or other address).   

PV04000.

DATA COLLECTOR INSTRUCTIONS

FOR PREGNANCY VISIT 1 OR PREGNANCY VISIT 2 EVENTS:

• The Participant Relationship Verification Grid (Grid 1) lists the consented, pregnant woman from the Sibling Cohort (who is also the biological mother of the initial NCS child/children) and is used to confirm the pregnant woman’s name, DOB, marital status in the primary residence. 

• The Address and Contact Information Verification Grid (Grid 2) is used to confirm the street and mailing address information including beginning and end dates as well as various contact information of the biological mother/Sibling Cohort pregnant woman. 

PV05000.

PROGRAMMER INSTRUCTIONS

• DISPLAY “Participant Relationship Verification Grid “.

 

• GENERATE AND DISPLAY GRID 1 AS SPECIFIED IN APPENDIX 1 WHERE:

• CHILD_PARTICIPANT_ORGANIZATION_LINKAGE.PARTICIPANTS_STATUS = 3 AND  EVENT_TYPE = 18, 23, 24, 26, 27, 30, 31, 36, 37, 38, TBD42M, TBD48M, TBD54M, OR TBD 60M), SORTED BY HH_RANK IN THE FOLLOWING ORDER: PRIMARY, SECONDARY, OTHER.

• CHILD_PARTICIPANT_ORGANIZATION_LINKAGE.PARTICIPANTS_STATUS = 3, HH_RANK = 2 AND  EVENT_TYPE = TBD (SECONDARY RESIDENCE) .

• CHILD_PARTICIPANT_ORGANIZATION_LINKAGE.PARTICIPANTS_STATUS = 3 AND EVENT_TYPE = 19 (PRE-NATAL FATHER) OR TBD (POST-NATAL FATHER) AND PERSON ASSOCIATED WITH NCS CHILD C_P_ID WHERE FATHER_FIGURE_FLAG = 1.

• CHILD_PARTICIPANT_ORGANIZATION_LINKAGE.PARTICIPANTS_STATUS = 3, RELATION = 2, AND EVENT_TYPE = 13 OR 15 (PV1 AND PV2).

 

• IMMEDIATELY BELOW GRID 1, DISPLAY “Address and Contact Information Verification Grid” .

 

• GENERATE AND DISPLAY GRID 2 AS SPECIFIED IN APPENDIX 2 WHERE:

• CHILD_PARTICIPANT_ORGANIZATION_LINKAGE.PARTICIPANTS_STATUS = 3 AND  EVENT_TYPE = 18, 23, 24, 26, 27, 30, 31, 36, 37, 38, TBD42M, TBD48M, TBD54M, OR TBD 60M), AND ALL HH_IDs ASSOCIATED WITH CHILD'S C_P_ID, SORTED BY HH_RANK IN THE FOLLOWING ORDER: PRIMARY, SECONDARY, OTHER.

• CHILD_PARTICIPANT_ORGANIZATION_LINKAGE.PARTICIPANTS_STATUS = 3 AND EVENT_TYPE = TBD (SECONDARY RESIDENCE) AND ALL HH_IDs ASSOCIATED WITH CHILD'S C_P_ID WHERE CHILD SECONDARY ADDRESS = 1 AND HH_RANK = 2.

• CHILD_PARTICIPANT_ORGANIZATION_LINKAGE.PARTICIPANTS_STATUS = 3 AND EVENT_TYPE = TBD (PRE-NATAL FATHER OR POST-NATAL FATHER) AND HH_IDs ASSOCIATED WITH NCS CHILD C_P_ID WHERE FATHER_FIGURE_FLAG = 1.

• CHILD_PARTICIPANT_ORGANIZATION_LINKAGE.PARTICIPANTS_STATUS = 3, RELATION = 2, AND EVENT_TYPE = 13 OR 15 (PV1 AND PV2) AND RELATIONSHIP = SELF (INSTRUMENT TARGET = PREGNANT WOMAN).
  ​

• HIGHLIGHT ROWS WHERE PRIMARY CAREGIVER FLAG = 1 OR SECONDARY RESIDENCE CAREGIVER FLAG = 1 USING A DIFFERENT BACKGROUND COLOR FOR EACH.

•  DISPLAY PV01500.

• IF EVENT_TYPE = TBD (SECONDARY RESIDENCE), 19 (PRE-NATAL FATHER), TBD (POST-NATAL FATHER), 13 (PV1), OR 15 (PV2), GO TO CELL_PERMISSIONS.

 

• IF EVENT_TYPE = 18, 23, 24, 26, 27, 30, 31, 36, 37, 38, TBD42M, TBD48M, TBD54M, OR TBD 60M) AND 

• MULTI_BIRTH_ID ≠ NULL, GO TO AND DISPLAY MULTIPLES_SAME.

• OTHERWISE GO TO SECONDARY_RESIDENCE_CG_FLAG.

PV06000/(MULTIPLES_SAME). IS RELATIONSHIP AND ADDRESS INFORMATION IN GRID 1 AND GRID 2 THE SAME FOR EACH OF THE MULTIPLE CHILDREN?

Label	Code	Go To
YES	1
NO	2

PROGRAMMER INSTRUCTIONS

• IF MULTIPLES_SAME = 1, CREATE LINK_CONTACT_RECORD ASSOCIATING CHILDREN TO “EVENT”.

• IF MULTIPLES_SAME = 2, UPDATE GRIDS WITH RELATIONSHIP AND PRIMARY ADDRESS FOR EACH CHILD.

PV07000/(SECONDARY_RESIDENCE_CG_FLAG). DOES CHILD HAVE A SECONDARY RESIDENCE?

Label	Code	Go To
YES	1
NO	2

PV08000/(FF_FLAG). DID PRIMARY CAREGIVER IDENTIFY A FATHER OR FATHER-FIGURE?

INTERVIEWER INSTRUCTIONS

• IF BIOLOGICAL FATHER IS IDENTIFIED AS FATHER-FIGURE, SET FATHER-FIGURE FLAG TO 1 FOR BIOLOGICAL FATHER IN GRID.

Label	Code	Go To
YES	1
NO	2

PV09000/(CHILD_LOG_SEND). DOES PARTICIPANT NEED ANOTHER CHILD HEALTH CARE LOG?

Label	Code	Go To
YES	1
NO	2

PV10000/(CELL_PERMISSION). ​MAY WE USE PARTICIPANT'S CELL PHONE TO MAKE FUTURE STUDY APPOINTMENTS OR FOR APPOINTMENT REMINDERS?

Label	Code	Go To
YES	1
NO	2

PV11000/(TEXT_PERMISSION). MAY WE SEND TEXT MESSAGES TO MAKE FUTURE STUDY APPOINTMENTS OR FOR APPOINTMENT REMINDERS?

Label	Code	Go To
YES	1
NO	2

PV12000/(EMAIL_PERMISSION). MAY WE USE EMAIL ADDRESS TO SEND MESSAGES TO MAKE FUTURE STUDY APPOINTMENTS OF FOR APPOINTMENT REMINDERS?

Label	Code	Go To
YES	1
NO	2

PV13000/(CONTACT_PREF). WHAT IS PARTICIPANT'S PREFERRED METHOD OF CONTACT?

Label	Code	Go To
HOME PHONE	1	TIME_STAMP_PV_ET
CELL PHONE	2	TIME_STAMP_PV_ET
WORK PHONE	3	TIME_STAMP_PV_ET
EMAIL	4	TIME_STAMP_PV_ET
OTHER	-5

PV14000/(CONTACT_PREF_OTH). WHAT IS PARTICIPANT'S PREFERRED METHOD OF CONTACT?

 

SPECIFY:  _______________________________________________________________

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

(TIME_STAMP_PV_ET).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

TRACING VERIFICATION

(TIME_STAMP_TV_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

• IF EVENT ≠ PV1, PV2  OR BIRTH OR IF PRIMARY_CAREGIVER_FLAG FOR R_P_ID ≠ 1, GO TO TIME_STAMP_TV_ET.

• DISPLAY “Tracing Contact Verification Table”

 

• GENERATE AND DISPLAY GRID 3 AS SPECIFIED IN APPENDIX 3.

• SET ALL GRID FIELDS AS READ-ONLY

• IF CONTACT_REMAINS_ACTIVE = YES (1), ENABLE EDIT FOR ALL ROWS WHERE “REVISE FLAG” WAS SELECTED.

• SET CURRENT DATE TO CONTACT_ CONF FOR UNIQUE TRACING_CONTACT_ID.

• IF CONTACT_REMAINS_ACTIVE = NO (2),

• SET CURRENT DATE TO CONTACT_ END FOR UNIQUE TRACING_CONTACT_ID.

• ADD NEW CONTACT OPTION, GENERATE NEW UNIQUE TRACING_CONTACT_ID AND ENABLE EDIT IN “NEW / REVISED CONTACT INFORMATION COLUMN FIELDS ASSOCIATED WITH NEW TRACING_CONTACT_ID.

 

• IF NUMBER OF UNIQUE CONTACT IDS <3, DISPLAY “NOTE:  LESS THAT 3 TRACING CONTACTS WERE COLLECTED”.  

TV01000/(PLAN_MOVE). ​DOES {PREGNANT WOMAN/PRIMARY CAREGIVER} PLAN TO MOVE FROM PRESENT ADDRESS IN THE NEXT FEW MONTHS? 

DATA COLLECTOR INSTRUCTIONS

TRACING CONTACT VERIFICATION TABLE:

• In the Tracing Verification Section, contact information from three relatives or friends of the Primary Caregiver is verified with each administration of this instrument, and the Primary Caregiver is asked if a move is planned, and if so, information about the move is collected.   

• Contact information is collected in Grid 3 and move information is collected in Grid 4. 

• To reduce NCS Participant burden and facilitate contact verification, a report summarizing the previously supplied relative/friend contact information will be generated and mailed to the respondent for reference prior to PVT instrument administration.  

• The following Tracing Contact Verification Table (Grid 3) lists the previously provided contact information for verification.  The data collector first verifies if that the contact is still active and verifies contact information.  If the Participant report that the contact is no longer active, the data collector requests new contact information for a total of three contacts.   

PROGRAMMER INSTRUCTIONS

• IF EVENT = PV1 OR PV2, DISPLAY “PREGNANT WOMAN”.

• OTHERWISE, DISPLAY “PRIMARY CAREGIVER” THROUGHOUT INSTRUMENT.

• IF PLAN_MOVE = 2, -1, OR -2 AND PREV_CITY IS = NULL, GO TO PREV_CITY.

• IF PLAN_MOVE = 2, -1, OR -2 AND PREV_CITY IS ≠ NULL, GO TO SATISFACTION_COMMENT.

Label	Code	Go To
YES	1
NO	2
REFUSED	-1
DON'T KNOW	-2

TV02000/(WHEN_MOVE). ​DOES {PREGNANT WOMAN/PRIMARY CAREGIVER} KNOW DATE OF MOVE?

Label	Code	Go To
YES	1
NO	2
REFUSED	-1
DON'T KNOW	-2

PROGRAMMER INSTRUCTIONS

• IF WHEN_MOVE = 1, GO TO DATE_MOVE.

• IF WHEN_MOVE = 2, -1, OR -2, GO TO WHERE_MOVE.

TV03000. ​DATE WHEN {PREGNANT WOMAN/PRIMARY CAREGIVER} PLANS TO MOVE (MONTH AND YEAR).

(DATE_MOVE_MM) ​

MONTH:

|___|___|

  M    M

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

(DATE_MOVE_YYYY) YEAR:

|___|___|___|___|

  Y     Y     Y     Y

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

TV04000/(WHERE_MOVE). DOES {PREGNANT WOMAN/PRIMARY CAREGIVER} KNOW WHERE THEY WILL BE MOVING?

Label	Code	Go To
YES	1
NO	2
REFUSED	-1
DON'T KNOW	-2

PROGRAMMER INSTRUCTIONS

• IF WHERE_MOVE = 1, GO TO TR05000.

• IF WHERE_MOVE = 2, -1, OR -2 AND PREV_CITY IS = NULL, GO TO PREV_CITY.

• OTHERWISE, IF PLAN_MOVE = 2, -1, OR -2 AND PREV_CITY IS ≠ NULL, GO TO SATISFACTION_COMMENT.

TV05000.

DATA COLLECTOR INSTRUCTIONS

Tracing Move Information Grid:

• If the Pregnant Woman or Primary Caregiver is planning on moving, the street and mailing address information is collected in the Tracing Move Information. 

• To reduce NCS Participant burden and facilitate accurate address data, if the new street address is the same as the new mailing address, the data collector is given the option of selecting a “pick-box” that will programmatically update the mailing address information.

• The Pregnant Woman or Primary Caregiver is also asked for any additional information they wish to share about their child or with their experience with the NCS Study.      

PROGRAMMER INSTRUCTIONS

• DISPLAY “Tracing Move Information”.

• GENERATE AND DISPLAY GRID 4  AS DEFINED IN APPENDIX 4.  

• IF PARTICIPANT SELECTS PICK-BOX INDICATING THAT THE STREET ADDRESS IS THE SAME AS THE MAILING ADDRESS, UPDATE ADDRESS VARIABLES ASSOCIATED WITH ADDRESS_TYPE = 2 WITH DATA IN ADDRESS VARIABLES ASSOCIATED WITH ADDRESS_TYPE = 1 IN GRID 4. 

• TBD -  ANY TYPES OF CONFIRMATION/FURTHER ACTIONS BETWEEN ROCS.

• IF PREV_CITY IS ≠ NULL, GO TO SATISFACTION_COMMENT.

TV06000/(PREV_CITY). ​HAS PRIMARY CAREGIVER LIVED IN ANY CITY OR TOWN OTHER THAN {CITY} IN THE PAST THREE YEARS?  

Label	Code	Go To
YES	1
NO	2	SATISFACTION_COMMENT
REFUSED	-1	SATISFACTION_COMMENT
DON'T KNOW	-2	SATISFACTION_COMMENT

TV07000/(PREV_CITIES_ADDRESS). IN WHAT OTHER CITIES OR TOWNS DID PRIMARY CAREGIVER LIVE?  

INTERVIEWER INSTRUCTIONS

• RECORD THE THREE MOST RECENT CITIES/TOWNS AND STATES IN WHICH  PARTICIPANT HAS LIVED.

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

(CITY_PREV1) _______________________ 

     PREVIOUS CITY 1                                    

(STATE_PREV1) _______________________            

PREVIOUS STATE 1            

(CITY_PREV2) _______________________             

    PREVIOUS CITY 2                          

                            

(STATE_PREV2) _______________________

      PREVIOUS STATE 2

    

(CITY_PREV3) _______________________              

    PREVIOUS CITY 3                           

(STATE_PREV3) _______________________

         PREVIOUS STATE 3

TV08000/(SATISFACTION_COMMENT). ANYTHING ELSE PRIMARY CAREGIVER WOULD LIKE TO TELL US ABOUT CHILD OR EXPERIENCE WITH THE NCS?

 

SPECIFY:  _________________________________________________________________________________

 

__________________________________________________________________________________________

 

__________________________________________________________________________________________

 

__________________________________________________________________________________________

(TIME_STAMP_TV_ET).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

ADDITIONAL PROGRAMMING INSTRUCTIONS

(TIME_STAMP_API_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

• IF PART OF MULTI_BIRTH AND BOTH CHILDREN ARE PARTICIPANTS, CREATE LINK_CONTACT RECORD LINKING THIS INSTRUMENT TO BOTH CHILDREN.

• ​PASS DATA FROM INSTRUMENT TABLE/VARIABLES BACK TO ODE TABLES AND STORE TO PERMIT EVALUATION OVER TIME.  

DATA COLLECTOR INSTRUCTIONS

• UPDATE CONTACT RECORDS PER PROTOCOL (SEE APPENDIX ?).  THIS CALL WOULD BE RECORDED AS A CONTACT REASON:  SCHEDULE EVENT ACTIVITY AND THE APPOINTMENT DATE AND TIME WOULD BE ADDED TO THE CONTACT RECORD.  THIS COULD THEN BE USED TO SEE HOW MANY OF THE ACTUAL APPOINTMENT CONTACTS OCCURRED AT THE ORIGINAL.

(TIME_STAMP_API_ET).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

APPENDIX 1: GRID 1 - PARTICIPANT RELATIONSHIP VERIFICATION

MDES ODE TABLES AND RELATED VARIABLES					PVT INSTRUMENT TABLE
Table Name	Variable Name	Req?	Variable Label/Definition	Format Constraint	Instrument Variable Name	Display Label	Display Value	Display in Grid 1
PARTICIPANT	P_ID	Y	Unique Identifier: NCS Child Participant ID Should Link to Person_ID in PERSON table via the PERSON-PARTICIPANT LINKAGE Table	Cannot be null. Any string of numbers and/or characters.	C_P_ID
PARTICIPANT	P_ID	Y	Unique identifier: Participant ID. Should Link to Person_ID in PERSON table via the PERSON-PARTICIPANT LINKAGE Table	Cannot be null. Any string of numbers and/or characters.	P_ID
PERSON	PERSON_ID	Y	Unique Identifier: PERSON_ID (of informant)	Cannot be null. Any string of numbers and/or characters.	PERSON_ID	Unique Person ID		X
PERSON	FIRST_NAME	N	First Name	Reserved for future use. This field is considered PII and should be left NULL.	FIRST_NAME	First Name		X
PERSON	MIDDLE_NAME	N	Middle Name	Reserved for future use. This field is considered PII and should be left NULL.	MIDDLE_NAME	Middle Name		X
PERSON	LAST_NAME	N	Last Name	Reserved for future use. This field is considered PII and should be left NULL.	LAST_NAME	Last Name		X
PERSON??	NICKNAME	N	Nickname	Any string of numbers and/or characters.	NICKNAME	Nickname		X
PERSON	SEX	Y	Person's sex	1 (Male) 2 (Female) 3 (Both) -6 (Unknown) -4 (Missing in Error)	SEX	Sex	If 1 display M; 2 display F, otherwise null	X
PERSON	PERSON_DOB	N	Person's Date of Birth	YYYY-MM-DD. For missing values use "9" prefix followed by: -1 (Refused) -6 (Unknown) e.g., 9111-96-96 (Refused Year, Don't Know Month and Day) 2009-91-91 (Refused Month and Day)	PERSON_DOB	DOB		X
					DERIVED AGE	Derived Age	Derive age from DOB; if missing values allow users to edit DOB. If 60 months or greater display age in years, otherwise display age in Month
PARTICIPANT_ CONSENT	CONSENT_ FORM_TYPE	Y	Type of consent form used for consent for Phase 2.	1 (Pregnant Woman Consent) 2 (Non-Pregnant Woman Consent) 3 (Father Consent) 4 (Child Consent Birth to 6-Months 5 (Child Consent 6-Months to Age of Majority 6 (New Adult Consent) 7 (Low Intensity Consent) -7 (Not Applicable) -4 (Missing in Error)	CONSENT_ FORM_TYPE
PARTICIPANT_ CONSENT	CONSENT_ GIVEN	Y	Consent was given for this consent type	1 (Yes) 2 (No) -4 (Missing in Error)	CONSENT_ GIVEN
					DERIVED_ CONSENT_ VALUE	Consent	Pull latest consent_date record, if 18 or older and consent form_Type = 6 and consent_given -1, display Y; if 0 - 72 months and consent type if 4 and consent_Given = 1 display Y; if 73 months and consent_type = 6 and consent_given = 1 display Y	X
LINK_PERSON_PARTICIPANT	RELATION	Y	Person's PERSON_PARTCPNT_ RELTNS HP to Study Participant (P_ID)		RELATION	Relationship to child	Insert drop-down pick list of subset of codes used in PVT for HH Roster.	X
LINK_PERSON_PARTICIPANT	RELATION_OTH	N	Text field to describe other PERSON_PARTCPNT_ RELATNSHP	Any string of numbers and/or characters. -7 (Not Applicable)	RELATION_ OTH			X
LINK_PERSON_PARTICIPANT	MULTI_BIRTH_ID	N	Group ID for Multi-Birth babies.	Any string of numbers and/or characters.	MULTI_BIRTH_ ID	Multi-Birth	Display "Y" if there is any value in this field	X
LINK_PERSON_PARTICIPANT??	MARITAL_STATUS_PCG	N	Indicates if Primary Caregiver is married.	1 (Married) 2 (Not married but living together with a partner) 3 (Never Been Married) 4 (Divorced) 5 (Separated) 6 (Widowed) -1 (Refused) -2 (Don't Know) -3 (Legitimate Skip)	MARITAL_STATUS	Marital Status	If 1 display M; otherwise, display null.	X
LINK_PERSON_PARTICIPANT	PRIMARY_ CAREGIVER_ FLAG	Y	Indication if the person associated to the child is a primary caregiver	1 (Yes) 2 (No) -4 (Missing in Error)	PRIMARY_CAREGIVER_FLAG
LINK_PERSON_PARTICIPANT	SECONDARY_ CAREGIVER_ FLAG	Y	Indication if the person associated to the child is a secondary caregiver	1 (Yes) 2 (No) -4 (Missing in Error)	SECONDARY_ CAREGIVER_ FLAG
					DERIVED_CG_ TYPE	CG Type	Display P if PCG 1 and S if SCG = 1	X
LINK_PERSON_PARTICIPANT	LEGAL_GUARDIAN	Y	Indication if the person associated to the child is the Legally Authorized Representative	1 (Yes) 2 (No)	LEGAL_GUARDIAN	LAR	If 1 display Y; save as 2 of changed to “N”	X
LINK_PERSON_PARTICIPANT	SECONDARY_ RESIDENCY_CG	Y	Indication if the person associated to the child is a secondary residence caregiver.	1 (Yes)	SECONDARY_ RESIDENCY_CG	Secondary Residence CG	If 1 display Y	X
LINK_PERSON_PARTICIPANT	FF_FLAG	Y	Indication if the person associated to the child is a secondary residence caregiver.	1 (Yes)	FF_FLAG	Father / Father Figure	If 1 display Y	X
LINK_PERSON_PARTICIPANT	IS_ACTIVE	Y	Is PERSON_PARTICIPANT link active?	1 (Yes) 2 (No) -4 (Missing in Error)	IS_ACTIVE	Participant Association Active	IF 1 display Yes; 2 display No	X
LINK_PERSON_HOUSEHOLD	PERSON_HH_ID	Y	Unique Identifier	Any string of numbers and/or characters	PERSON_HH_ID
LINK_PERSON_HOUSEHOLD	HH_ID	Y	External Identifier: Household Unit ID Link to Household table	Cannot be null. Any string of numbers and/or characters.	HH_ID
LINK_PERSON_HOUSEHOLD	IS_ACTIVE	Y	Is PERSON_HH link active	1 (Yes) 2 (No) -4 (Missing in Error)	IS_ACTIVE	HH Association Active	IF 1 display Yes; 2 display No	X
LINK_PERSON_HOUSEHOLD	HH_RANK	Y	Differentiates links when multiple PERSON_HH links are active	1 (Primary) 2 (Secondary) 3 (Invalid) 4 (Duplicate) 5 (Other) -4 (Missing in Error)	HH_RANK	HH Residence Rank	If 1 display Primary; if 2 display Secondary	X
LINK_PERSON_HOUSEHOLD??	CHILD_LOG_SEND	Y	Identifies when Health Log should be sent to Primary Care Giver.	1 (Yes) 2 (No) -4 (Missing in Error)	CHILD_LOG_SEND		Use as trigger in IMS to send new child Health Care Log.

APPENDIX 2: GRID 2 - ADDRESS AND CONTACT INFORMATION VERIFICATION

MDES ODE TABLES AND RELATED VARIABLES					PVT INSTRUMENT TABLE
Table Name	Variable Name	Req?	Variable Label/Definition	Format Constraint	Instrument Variable Name	Display Label	Display Value	Display in Grid #2
ADDRESS	ADDRESS_ID	Y	Unique Identifier for Household Address	Any string of numbers and/or characters	ADDRESS_ID	Unique Address ID		X
ADDRESS	PERSON_ID	N	External Identifier: Person ID Link to Person table.	Any string of numbers and/or characters
PARTICIPANT	P_ID	Y	Unique Identifier: NCS Child Participant ID Should Link to Person_ID in PERSON table via the PERSON-PARTICIPANT LINKAGE Table	Cannot be null. Any string of numbers and/or characters.	C_P_ID
PARTICIPANT	P_ID	Y	Unique identifier: Participant ID. Should Link to Person_ID in PERSON table via the PERSON-PARTICIPANT LINKAGE Table	Cannot be null. Any string of numbers and/or characters.	P_ID
PERSON	PERSON_ID	Y	Unique Identifier: PERSON_ID (of informant)	Cannot be null. Any string of numbers and/or characters.	PERSON_ID	Unique Person ID
PERSON	FIRST_NAME	N	First Name	Reserved for future use. This field is considered PII and should be left NULL.	FIRST_NAME	First Name		X
LINK_PERSON_PARTICIPANT	IS_ACTIVE	Y	Is PERSON_PARTICIPANT link active?	1 (Yes) 2 (No) -4 (Missing in Error)	IS_ACTIVE	Active Participant
LINK_PERSON_HOUSEHOLD	PERSON_HH_ID	Y	Unique Identifier	Any string of numbers and/or characters	PERSON_HH_ID
LINK_PERSON_HOUSEHOLD	HH_ID	Y	External Identifier: Household Unit ID Link to Household table	Cannot be null. Any string of numbers and/or characters.	HH_ID
LINK_PERSON_HOUSEHOLD	IS_ACTIVE	Y	Is PERSON_HH link active	1 (Yes) 2 (No) -4 (Missing in Error)	IS_ACTIVE	Active HH Association	IF 1 display Yes; 2 display No
LINK_PERSON_HOUSEHOLD	HH_RANK	Y	Differentiates links when multiple PERSON_HH links are active	1 (Primary) 2 (Secondary) 3 (Invalid) 4 (Duplicate) 5 (Other) -4 (Missing in Error)	HH_RANK	HH Residence Rank	If 1 display Primary; if 2 display Secondary	X
ADDRESS	ADDRESS_TYPE	Y	Type of Address	1 (Home/Residential) 2 (Business) 3 (School) 4 (Mailing address) 5 (Military) -5 (Other) -6 (Unknown) -4 (Missing in Error)	ADDRESS_TYPE	Address Type	Sort and display in GRID 2 in following order: 1 followed by 4; if 1 display “street”; if 4 display “Mailing”	X
ADDRESS	ADDRESS_TYPE_OTH	N	Other Address Type	Any string of numbers and/or characters -7 (Not Applicable)	ADDRESS_TYPE_OTH
ADDRESS	ADDRESS_1	N	Street Address Line 1	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)	ADDRESS_1	Address1 – Street/PO Box		X
ADDRESS	ADDRESS_2	N	Street Address Line 2	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)	ADDRESS_2	Address (Line 2)		X
ADDRESS	UNIT	N	Unit/Apt/Floor/Lot Number	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -6 (Unknown) -7 (Not Applicable)	UNIT	Apt / Unit Number		X
ADDRESS	CITY	N	CITY	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -6 (Unknown) -7 (Not Applicable)	CITY	City / Town		X
ADDRESS	STATE	Y	STATE	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -6 (Unknown) -7 (Not Applicable)	STATE	State		X
ADDRESS	ZIP	N	ZIP CODE		ZIP	Zip Code		X
ADDRESS	ZIP4	N	ZIP CODE + 4		ZIP4	Zip + 4 (if known)		X
TELEPHONE	PERSON_ID	N	External Identifier: Person ID Link to Person table.	Any string of numbers and/or characters
TELEPHONE	PHONE_TYPE	Y	Type of phone number	1 (Home/Landline) 2 (Work) 3 (Cell) 4 (Fax) 5 (Friend/Relative) 5 (Other) -1 (Refused) -6 (Unknown) -4 (Missing in Error)	PHONE_TYPE
TELEPHONE	PHONE_NBR	N	Phone number	-1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)	PHONE_NBR	PHONE_NBR	IF PHONE_TYPE = 1, DISPLAY “Home Phone”; IF PHONE_TYPE = 3, DISPLAY “Cell Phone”; IF PHONE_TYPE = 2, DISPLAY “Business Phone”	X
TELEPHONE	PHONE_INFO_COLLECT_ DATE	N	Date phone info collected	YYYY-MM-DD	PHONE_INFO_COLLECT_ DATE		Set = date of administration
TELEPHONE	CELL_PERMISSION	Y	OK to use Person's personal cell phone to make future study appointments or for appointment reminders?	1 (Yes) 2 (No) -4 (Missing in Error) -7 (Not Applicable)	CELL_PERMISSION
TELEPHONE	TEXT_PERMISSION	Y	OK to send text messages to make future study appointments or for appointment reminders?	1 (Yes) 2 (No) -6 (Unknown) -7 (Not applicable) -4 (Missing in Error)	TEXT_PERMISSION
EMAIL	EMAIL_ID	Y	Unique Identifier: Identifier for specific email record	Any string of numbers and/or characters
EMAIL	PERSON_ID	N	External Identifier: Person ID Link to Person table.	Any string of numbers and/or characters
EMAIL	EMAIL	N	Actual email address	Reserved for Future Use. This field is considered PII and should be left NULL.	EMAIL	EMAIL		X
TELEPHONE	CONTACT_PREF		Preferred contact method Link to EMAIL Table and Person Table.	1 (Home) 2 (Cell 3 (Work) 4 (Email) 5 (In-Person) 6 (Mail) 7(Text Message) -5 (other)	CONTACT_PREF	Preferred Contact Method	If Home, set = 1;if Cell, set = 2; if Work, set = 3; if Email, set = 4; if In-Person, set = 5; if Mail, set = 6; if Text Message, set = 7.	X
TELEPHONE	CONTACT_PREF_OTH	N	Preferred contact method	Any string of numbers and/or characters -7 (Not Applicable)	CONTACT_PREF_OTH			X
ADDRESS	ADDRESS_START_DATE	N	Date when address became effective for PERSON, INSTITUTE, or PROVIDER	YYYY-MM-DD For missing values use “9” prefix followed by: 6 (Unknown), 4(Missing in Error) e.g. 2009-96-96 (Unknown Month and Day) 9666-96-96 (Unknown date)	ADDRESS_START_DATE	Address Start Date		X
ADDRESS	ADDRESS_END_DATE	N	Last date at which the address is effective	YYYY-MM-DD For missing values use “9” prefix followed by: 6 (Unknown), e.g. 2009-96-96 (Unknown Month and Day) 9666-96-96 (Unknown date)	ADDRESS_END_DATE	Address End Date		X

APPENDIX 3: GRID 3 - TRACING CONTACT INFORMATION

MDES ODE TABLES AND RELATED VARIABLES					PVT INSTRUMENT TABLE			Display in “EXISTING CONTACT INFORMATION” column of Grid 3
Table Name	Variable Name	Req?	Variable Label/Definition	Format Constraint	Instrument Variable Name	Display Label	Display Value
TRACING_INT	TRACING_CONTACT_ID	Y	Unique Tracing Contact ID number.	Any string of numbers and/or characters	TRACING_CONTACT_ID	Unique Tracing ID		X
TRACING_INT	PERSON_ID	N	External Identifier: Person ID Link to Person table.	Any string of numbers and/or characters
TRACING_INT	HH_ID	Y	External identifier: Household ID	Cannot be null. Any string of numbers and/or characters.
TRACING_INT	P_ID	N	External identifier: Participant ID Link to Participant table.	Any string of numbers and/or characters
TRACING_INT	ADDRESS_ID	N	External Identifier. Link to Address table.	Any string of numbers and/or characters.
TRACING_INT	CONTACT_FRND	Y	Can participant provide contact information of a friend?	1 (Yes) 2 (No) -1 (Refused) -2 (Don't Know) -3 (Legitimate Skip) -4 (Missing in Error)
TRACING_INT	CONTACT_FNAME		Tracing contact’s first name	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -2 (Don't Know) -3(Legitimate Skip)	CONTACT_FNAME	First Name		X
TRACING_INT	CONTACT_LNAME		Tracing Contact’s last name	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -2 (Don't Know) -3(Legitimate Skip)	CONTACT_LNAME	Last Name		X
TRACING_INT	ADDRESS_1	N	Street Address Line 1 Link to Address table.	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)	ADDRESS_1	Address 1 - Street/PO Box		X
TRACING_INT	ADDRESS_2	N	Street Address Line 2 Link to Address table.	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)	ADDRESS_2	Address (Line 2)		X
TRACING_INT	UNIT	N	Unit/Apt/Floor/Lot Number Link to Address table.	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)	UNIT	Apt / Unit Number		X
TRACING_INT	CITY	N	City Link to Address table.	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)	CITY	City / Town		X
TRACING_INT	STATE	Y	State Link to Address table.	Reserved for Future Use. This field is considered PII. Allowable values are: -1 (Refused) -2 (Don't Know) -3 (Legitimate Skip) -4 (Missing in Error)	STATE	STATE		X
TRACING_INT	ZIP	N	Zip Code Link to Address table.	Any string of numbers and/or characters -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)	ZIP	Zip Code		X
TRACING_INT	ZIP4	N	Zip Code + 4 Link to Address table.	Any string of numbers and/or characters -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)	ZIP4	Zip + 4 (IF KNOWN)		X
TRACING_INT	PHONE_TYPE	Y	Type of phone number	1 (Home/Landline) 2 (Work) 3 (Cell) 4 (Fax) 5 (Friend/Relative) 5 (Other) -1 (Refused) -6 (Unknown) -4 (Missing in Error)	PHONE_TYPE
TRACING_INT	PHONE_NBR	N	Phone number	-1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)	PHONE_NBR	PHONE_NBR	IF PHONE_TYPE = 1, DISPLAY “Home Phone”; IF PHONE_TYPE = 3, DISPLAY “Cell Phone”;	X
TRACING_INT	PHONE_INFO_COLLECT_ DATE	N	Date phone info collected	YYYY-MM-DD	PHONE_INFO_COLLECT_ DATE		Set = date of administration
TRACING_INT	HOME_PHONE	N	Tracing Contact’s home phone number	Reserved for Future Use. This field is considered	HOME_PHONE	Home Phone		X
TRACING_INT	CELL_PHONE	N	Tracing Contact’s cell phone number	Reserved for Future Use. This field	CELL_PHONE	Cell Phone		X
TRACING_INT	EMAIL	N	Tracing Contact’s Email	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip) -7 (No email account)	EMAIL	EMAIL		X
TRACING_INT	CONTACT_RELAT_PCG	Y	Tracing Contact’s relationship to primary care giver	SEE APPX 7	RELATIONSHIP_CHILD	Relationship		X
TRACING_INT	CONTACT_CONF	Y	Last date at which the contact information was confirmed	YYYY-MM-DD For missing values use “9” prefix followed by: 6 (Unknown), e.g. 2009-96-96 (Unknown Month and Day) 9666-96-96 (Unknown date)	CONTACT_CONF	Last Confirmed Date	Set = current date
TRACING_INT	CONTACT_END	Y	Date at which the contact information ended (made inactive).	YYYY-MM-DD For missing values use “9” prefix followed by: 6 (Unknown), e.g. 2009-96-96 (Unknown Month and Day) 9666-96-96 (Unknown date)	CONTACT_END	Last Confirmed Date	Set = current date
TRACING_INT	CONTACT_REMAINS_ACTIVE	Y	Participant verifies that contact is still active	1 (Yes) 2 (No) -1 (Refused) -2 (Don't Know) -3 (Legitimate Skip) -4 (Missing in Error)	CONTACT_REMAINS_ACTIVE	CONTACT_REMAINS_ACTIVE	IF CONTACT_REMAINS_ACTIVE = 1, ENABLE EDIT FOR ROWS SELECTED IN “REVISE FLAG” COLUMN FOR EXISTING UNIQUE TRACING_ CONTACT_ID. IF CONTACT_REMAINS_ACTIVE = 2, GENERATE NEW UNIQUE TRACING_CONTACT_ID AND ENABLE EDIT FOR COLUMN “NEW / REVISED CONTACT INFORMATION”.

APPENDIX 4: GRID 4 – TRACING MOVE INFORMATION

MDES ODE TABLES AND RELATED VARIABLES					PVT INSTRUMENT TABLE
Table Name	Variable Name	Req?	Variable Label/Definition	Format Constraint	Instrument Variable Name	Display Label	Display Value	Display in Grid 4
TRACING_INT	PLAN_MOVE	Y	Is the person planning a residential move in the next few months? Link to Person table.	1 (Yes) 2 (No) -1 (Refused) -2 (Don't Know) -3 (Legitimate Skip) -4 (Missing in Error)	PLAN_MOVE
TRACING_INT	WHEN_MOVE	Y	Does Participant know when she will be moving?	1 (Yes) 2 (No) -1 (Refused) -2 (Don't Know) -3 (Legitimate Skip) -4 (Missing in Error)	WHEN_MOVE
TRACING_INT	DATE_MOVE	N	Date of planned move	YYYY-MM For missing values use “9” prefix followed by: 1 (Refused) 2 (Don’t Know) 3 (Legitimate Skip), e.g. 9111-92 (Refused Year, Don’t Know Month) 2009-91 (Refused Month) 9333-93 (Legitimate Skip)	DATE_MOVE
TRACING_INT	WHERE_MOVE	Y	Is new address known?	1 (Yes) 2 (No) -1 (Refused) -2 (Don't Know) -3 (Legitimate Skip) -4 (Missing in Error)	WHERE_MOVE
TRACING_INT	MOVE_INFO	Y	Information on new address provided when planning a residential move in the next 3-6 months	1 (Address known) 2 (Out of the country) 3 (PO Box Address only) -1 (Refused) -2 (Don't Know) -3 (Legitimate Skip) -4 (Missing in Error)
TRACING_INT	NEW_ADDRESS_ID	N	External Identifier: Unique identifier for NEW address record Link to Address table.	Any string of numbers and/or characters
ADDRESS	ADDRESS_TYPE	Y	Type of Address	1 (Home/Residential) 2 (Business) 3 (School) 4 (Mailing address) 5 (Military) -5 (Other) -6 (Unknown) -4 (Missing in Error)	ADDRESS_TYPE		If entered under “New/Revised Street Address”, ADDRESS_TYPE = 1; if entered under “New Mailing Address”, ADDRESS_TYPE = 4
ADDRESS	ADDRESS_SAME	N	Pick box to determine if new mailing address is the same as the home address.	1 (Yes) 2 (No) -1 (Refused) -2 (Don't Know) -3 (Legitimate Skip) -4 (Missing in Error)	ADDRESS_SAME		If = 1, update address variables based on ADDRESS_TYPE = 1.
ADDRESS	ADDRESS_TYPE_OTH	N	Other Address Type	Any string of numbers and/or characters -7 (Not Applicable)	ADDRESS_TYPE_OTH	Address Type
TRACING_INT	NEW_ADDRESS1	N	New Address Street Line 1 Link to Address table.	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)	NEW_ADDRESS1	Address 1 – Street/PO Box		X
TRACING_INT	NEW_ADDRESS2	N	New Address Street Line 2 Link to Address table.	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)	NEW_ADDRESS2	Address (Line 2)		X
TRACING_INT	NEW_UNIT	N	New Address Unit/Apt/Floor/Lot Number Link to Address table.	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)	NEW_UNIT	Apt / Unit Number		X
TRACING_INT	NEW_CITY	N	New Address City Link to Address table.	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)	NEW_CITY	City		X
TRACING_INT	NEW_STATE	Y	New Address State Link to Address table.	Reserved for Future Use. This field is considered PII. Allowable values are: -1 (Refused) -2 (Don't Know) -3 (Legitimate Skip) -4 (Missing in Error)	NEW_STATE	State		X
TRACING_INT	NEW_ZIP	N	New Address Zip Code Link to Address table.	Any string of numbers and/or characters -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)	NEW_ZIP	Zip Code		X
TRACING_INT	NEW_ZIP4	N	New Address Zip Code + 4 Link to Address table.	Any string of numbers and/or characters -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)	NEW_ZIP4	Zip + 4 (if known)		X
TRACING_INT	PREV_CITY	Y	Has participant lived in another city in past three years?	1 (Yes) 2 (No) -1 (Refused) -2 (Don't Know) -3 (Legitimate Skip) -4 (Missing in Error)
TRACING_INT	CITY_PREV1	N	First previous city	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)
TRACING_INT	STATE_PREV1	Y	First previous state	Reserved for Future Use. This field is considered PII. Allowable values are: -1 (Refused) -2 (Don't Know) -3 (Legitimate Skip) -4 (Missing in Error)
TRACING_INT	CITY_PREV2	N	Second previous city	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)
TRACING_INT	STATE_PREV2	Y	Second previous state	Reserved for Future Use. This field is considered PII. Allowable values are: -1 (Refused) -2 (Don't Know) -3 (Legitimate Skip) -4 (Missing in Error)
TRACING_INT	CITY_PREV3	N	Third previous city	Reserved for Future Use. This field is considered PII and should be left NULL or contain the following values: -1 (Refused) -2 (Don’t Know) -3 (Legitimate Skip)
TRACING_INT	STATE_PREV3	Y	Third previous state	Reserved for Future Use. This field is considered PII. Allowable values are: -1 (Refused) -2 (Don't Know) -3 (Legitimate Skip) -4 (Missing in Error)

APPENDIX 5: BANNER DISPLAY SPECIFICATIONS

PROGRAMMER INSTRUCTIONS:

• PRELOAD EVENT_TYPE .

• DISPLAY HEADER BANNER THROUGHOUT INSTRUMENT WITH ALL TEXT BOLD AND LIGHT BLUE BACKGROUND.

• IF EVENT ≠ PV1 OR PV2, DISPLAY THE FOLLOWING BANNER:

  • DISPLAY “Scheduling Event: “ followed by EVENT_TYPE CODE TEXT.

  • DISPLAY “Child Participant: ” followed by CFIRST_NAME ASSOCIATED WITH C_P_ID FROM APPENDIX 1.

  • DISPLAY “Child Age: ” followed by DERIVED_AGE FROM APPENDIX 1.

  • DISPLAY “Primary Caregiver: ” followed by FIRST_NAME WHERE PRIMARY_CAREGIVER_FLAG = 1 FROM APPENDIX 1.

  • DISPLAY “Multi-Child Event: ” followed by “YES” if MULTI_BIRTH_ID ≠ NULL IN APPENDIX 1.

Scheduling Event: 36 MONTH
Child Participant: Sofia Martinez Primary Caregiver: Elena Lopez	Child Age: 35 Months Multi-Child Event: No

• IF EVENT = PV1 OR PV2, DISPLAY THE FOLLOWING BANNER:

  • DISPLAY “Scheduling Event: “ followed by EVENT_TYPE CODE TEXT.

  • DISPLAY “Pregnant NCS Participant: ” followed by FIRST_NAME of R_P_ID.

Scheduling Event: PV1
Pregnant NCS Participant: Elena Lopez

APPENDIX 6: LINK_PERSON_PARTICIPANT RELATIONSHIP CODE REVISIONS

Current Link_Person_Participant Relationship Codes:

1 = Participant/Self

2 = Biological Mother

3 = Non-Biological Mother <Refer to replacement Codes Below>

4 = Biological Father

5 = Non-Biological Father <Refer to replacement Codes Below>

6 = Spouse

7 = Partner/Significant Other

8 = Child

9 = Sibling

10 = Grandparent

11 = Other Relative

12 = Friend

13 = Neighbor

14 = Co-Worker

15 = Caregiver

16 = Teacher

17 = Primary Child Care Provider

18 – Other Child Care Provider

19 = Aunt

20 = Uncle

21 = Cousin

22 = Other Non-Relative

Additional M3.4 Relationship Codes:

23 = Adoptive Mother (to Replace Non-Biological Father and Mother)

24 = Adoptive Father (to Replace Non-Biological Father and Mother)

25 = Social Mother (to Replace Non-Biological Father and Mother)

26 = Social Father (to Replace Non-Biological Father and Mother)

27 = Step Mother (to Replace Non-Biological Father and Mother)

28 = Step Father (to Replace Non-Biological Father and Mother)

29 = Step Brother

30 = Step Sister

31 = Adoptive Brother

32 = Adoptive Sister

33 = Grandmother

34 = Grandfather

Subset of Codes used in PVT Instrument:

1 = Participant/Self 2 = Biological Mother 4 = Biological Father 7 = Partner/Significant Other 8 = Child 9 = Sibling 11 = Other Relative 19 = Aunt 20 = Uncle 21 = Cousin 22 – Other Non-Relative 23 = Adoptive Mother

24 = Adoptive Father 25 = Social Mother 26 = Social Father 27 = Step Mother 28 = Step Father 29 = Step Brother 30 = Step Sister 31 = Adoptive Brother 32 = Adoptive Sister 33 = Grandmother 34 = Grandfather

APPENDIX 7: EXAMPLE GRID 1 - PARTICIPANT RELATIONSHIP VERIFICATION

APPENDIX 8: EXAMPLE GRID 2 - ADDRESS AND CONTACT INFORMATION VERIFICATION

APPENDIX 9: EXAMPLE GRID 3 - TRACING CONTACT VERIFICATION

REVISE FLAG	TRACING CONTACT 1.	EXISTING CONTACT INFORMATION	NEW / REVISED CONTACT INFORMATION	CONTACT REMAINS ACTIVE
N/A	UNIQUE TRACING CONTACT ID
	LAST NAME
	FIRST NAME
	ADDRESS 1 – STREET/PO BOX
	ADDRESS (Line 2)
	APT/UNIT #
	CITY/TOWN
	STATE
	ZIP
	ZIP + 4 (if known)
	PHONE (HOME)
	PHONE (MOBILE)
	EMAIL ADDRESS
	RELATIONSHIP
REVISE FLAG	TRACING CONTACT 2.	EXISTING CONTACT INFORMATION	NEW / REVISED CONTACT INFORMATION	CONTACT REMAINS ACTIVE
N/A	UNIQUE TRACING CONTACT ID
	LAST NAME
	FIRST NAME
	ADDRESS 1 – STREET/PO BOX
	ADDRESS (Line 2)
	APT/UNIT #
	CITY/TOWN
	STATE
	ZIP
	ZIP + 4 (if known)
	PHONE (HOME)
	PHONE (MOBILE)
	EMAIL ADDRESS
	RELATIONSHIP
REVISE FLAG	TRACING CONTACT 3.	EXISTING CONTACT INFORMATION	NEW / REVISED CONTACT INFORMATION	CONTACT REMAINS ACTIVE
N/A	UNIQUE TRACING CONTACT ID
	LAST NAME
	FIRST NAME
	ADDRESS 1 – STREET/PO BOX
	ADDRESS (Line 2)
	APT/UNIT #
	CITY/TOWN
	STATE
	ZIP
	ZIP + 4 (If known)
	PHONE (HOME)
	PHONE (MOBILE)
	EMAIL ADDRESS
	RELATIONSHIP

APPENDIX 10: EXAMPLE GRID 4 – TRACING MOVE INFORMATION

REVISE FLAG		NEW STREET ADDRESS
	ADDRESS 1 – STREET/PO BOX
	ADDRESS (LINE 2)
	CITY/TOWN
	APT/UNIT #
	STATE
	ZIP CODE
	ZIP + 4 (If known)
MAILING ADDRESS SAME AS STREET ADDRESS
		Yes
REVISE FLAG		NEW MAILING ADDRESS
	ADDRESS 1 – STREET/PO BOX
	ADDRESS (LINE 2)
	CITY/TOWN
	APT/UNIT #
	STATE
	ZIP CODE
	ZIP + 4 (If known)

APPENDIX 11: USE CASE EXAMPLES

Use Case 1 – Scenario 1: Primary Caregiver/Biological Mother Sue Smith re-consents with ROC and next event is 24M. Susan is married to Sam, the Biological Father and secondary caregiver. Both Susan and Sam are Legally Authorized Representatives (LAR), and an au-pair (Dana Jones) is living in the primary residence. The following Participant Verification Table grid and Address and Contact Information Verification grid reflect this scenario.

Participant Verification

REVISE / ADD ROW FLAG

Unique Person ID

First Name

Middle Name

Last Name

Nickname

Sex

DOB

Consent

Relationship to Child

Multi-Birth

Marital Status

CG Type

LAR

Secondary Residence CG

Father / Father Figure

Participant Association Active

HH Association Active

HH Residence Rank

11111

Jane

Ann

Smith

F

3/7/2011

Y

Self

Y

Yes

Yes

Primary

12222

Jill

Marie

Smith

F

3/7/2011

Y

Sibling

Y

Yes

Yes

Primary

13333

Susan

May

Smith

Sue

F

5/9/1986

Y

Biological Mother

M

P

Y

Yes

Yes

Primary

14444

Sam

Smith

M

8/22/1985

Y

Biological Father

M

S

Y

Yes

Yes

Primary

15555

James

Eugene

Smith

Jimmy

M

12/17/2008

Sibling

Yes

Yes

Primary

16666

Dana

Custis

Jones

F

6/13/1970

Other Non-Relative

Yes

Yes

Primary

Address and Contact Information Verification

REVISE / ADD ROW FLAG

Unique Address ID

First Name

HH Rank

Address Type

Address 1 - Street/PO Box

Address (Line 2)

Apt / Unit Number

City / Town

State

Zip

Zip + four (if known)

Home Phone

Cell Phone

Business Phone

Email Address

Preferred Contact Method

Address Start Date

Address End Date

21111

Jane

Primary

Street

135 Bayview Lane

Jackson

GA

30233

12/12/2010

22222

Jill

Primary

Street

135 Bayview Lane

Jackson

GA

30233

12/12/2010

23333

Susan

Primary

Street

135 Bayview Lane

Jackson

GA

30233

111-111-1111

222-222-2222

[email protected]

Home

12/12/2010

24444

Sam

Primary

Street

135 Bayview Lane

Jackson

GA

30233

111-111-1111

333-333-3333

12/12/2010

25555

Sam

Primary

Work

PO Box 415

Jackson

GA

30233

444-444-4444

[email protected]

Email

12/12/2010

26666

James

Primary

Street

135 Bayview Lane

Jackson

GA

30233

12/12/2010

27777

Dana

Primary

Street

135 Bayview Lane

Jackson

GA

30233

4/1/2011

Use Case 1 – Scenario 2: One year later, parents’ divorce and the au-pair is no longer active with the NCS participant or primary household. The Primary Caregiver, Susan, reports that the children spend time with the Father Sam in a secondary residence and that Sam remains a Legally Authorized Representative (LAR). To update the Participant Verification grid, enable editing of the Father’s record by selecting the “REVISE/ADD ROW FLAG” and set the “Secondary Residence CG” field to “Yes” and the “HH Association Active” field to “No”. To update the au-pair status, enable editing by selecting the “REVISE/ADD ROW FLAG” and set both the “Participant Association Active” field and the “HH Association Active” fields to “No”. To update the Address and Contact Information Verification grid to record the Father’s (Sam) new Secondary Residence address, enable editing by selecting the “REVISE/ADD ROW FLAG” in the rows associated with the previous primary address and enter the ending address date. Revise the row associated with Sam’s work to reference a Secondary (rather than Primary) address, and add a new row for collection of Sam’s new address and contact information in the Secondary address. To update the au-pair status in the Participant Verification Table, enter the address end date. The Participant Verification Table grid and Address and Contact Information Verification grid has been modified to reflect these updates, with text changes in red font, and edited cells highlighted beige.

Participant Verification

REVISE / ADD ROW FLAG

Unique Person ID

First Name

Middle Name

Last Name

Nickname

Sex

DOB

Consent

Relationship to Child

Multi-Birth

Marital Status

CG Type

LAR

Secondary Residence CG

Father / Father Figure

Participant Association Active

HH Association Active

HH Residence Rank

11111

Jane

Ann

Smith

F

3/7/2011

Y

Self

Y

Yes

Yes

Primary

12222

Jill

Marie

Smith

F

3/7/2011

Y

Sibling

Y

Yes

Yes

Primary

13333

Susan

May

Smith

Sue

F

5/9/1986

Y

Biological Mother

M

P

Y

Yes

Yes

Primary

X

14444

Sam

Smith

M

8/22/1985

Y

Biological Father

S

Y

Y

Yes

No

Primary

15555

James

Eugene

Smith

Jimmy

M

12/17/2008

Sibling

Yes

Yes

Primary

X

16666

Dana

Custis

Jones

F

6/13/1970

Other Non-Relative

No

No

Primary

Address and Contact Information Verification

REVISE / ADD ROW FLAG

Unique Address ID

First Name

HH Rank

Address Type

Address 1 - Street/PO Box

Address (Line 2)

Apt / Unit Number

City / Town

State

Zip

Zip + four (if known)

Home Phone

Cell Phone

Business Phone

Email Address

Preferred Contact Method

Address Start Date

Address End Date

21111

Jane

Primary

Street

135 Bayview Lane

Jackson

GA

30233

3/7/2011

22222

Jill

Primary

Street

135 Bayview Lane

Jackson

GA

30233

3/7/2011

23333

Susan

Primary

Street

135 Bayview Lane

Jackson

GA

30233

111-111-1111

222-222-2222

[email protected]

Home

12/12/2010

X

24444

Sam

Primary

Street

135 Bayview Lane

Jackson

GA

30233

111-111-1111

333-333-3333

12/12/2010

7/7/2014

X

25555

Sam

Secondary

Work

PO Box 415

Jackson

GA

30233

444-444-4444

[email protected]

Email

12/12/2010

26666

James

Primary

Street

135 Bayview Lane

Jackson

GA

30233

12/12/2010

X

27777

Dana

Primary

Street

135 Bayview Lane

Jackson

GA

30233

4/1/2011

1/30/2014

X

31111

Sam

Secondary

Street

202 Longview Dr.

13

Jackson

GA

30233

555-555-5555

666-666-6666

10/12/2014

Use Case 1 – Scenario 3: Two years later, Mike moves into the primary residence and Susan (the Biological Mother and Primary Caregiver) identifies him as the Social Father and designated Father Figure along with Jane’s soccer coach. The NCS children continue to maintain a secondary residence with the Father (Sam) but he is no longer a Legally Authorized Representative (LAR). To update the Participant Verification and Address Contact Information Verification grids, enable editing of two new rows by selecting the “REVISE/ADD ROW FLAG” and add participant information as appropriate for Social Father and Father-Figure, and enable editing in the row associated with the Father, Sam, and change the LAR to “N”. The Participant Verification Table grid and Address and Contact Information Verification grid have been modified to reflect these updates, with text changes in red font, and edited cells highlighted beige.

Participant Verification

REVISE / ADD ROW FLAG

Unique Person ID

First Name

Middle Name

Last Name

Nickname

Sex

DOB

Consent

Relationship to Child

Multi-Birth

Marital Status

CG Type

LAR

Secondary Residence CG

Father / Father Figure

Participant Association Active

HH Association Active

HH Residence Rank

11111

Jane

Ann

Smith

F

3/7/2011

Y

Self

Y

Yes

Yes

Primary

12222

Jill

Marie

Smith

F

3/7/2011

Y

Sibling

Y

Yes

Yes

Primary

13333

Susan

May

Smith

Sue

F

5/9/1986

Y

Biological Mother

M

P

Y

Yes

Yes

Primary

15555

James

Eugene

Smith

Jimmy

M

12/17/2008

Sibling

Yes

Yes

Primary

X

14444

Sam

Smith

M

8/22/1985

Y

Biological Father

S

N

Y

Yes

Yes

Secondary

X

41111

Mike

David

Jones

M

3/11/1976

Social Father

Y

Yes

Yes

Primary

X

42222

Lionel

Messi

M

1/1/1984

Y

Yes

Yes

Other

Address and Contact Information Verification

REVISE / ADD ROW FLAG

Unique Address ID

First Name

HH Rank

Address Type

Address 1 - Street/PO Box

Address (Line 2)

Apt / Unit Number

City / Town

State

Zip

Zip + four (if known)

Home Phone

Cell Phone

Business Phone

Email Address

Preferred Contact Method

Address Start Date

Address End Date

21111

Jane

Primary

Street

135 Bayview Lane

Jackson

GA

30233

3/7/2011

22222

Jill

Primary

Street

135 Bayview Lane

Jackson

GA

30233

3/7/2011

23333

Susan

Primary

Street

135 Bayview Lane

Jackson

GA

30233

111-111-1111

222-222-2222

[email protected]

Home

12/12/2010

26666

James

Primary

Street

135 Bayview Lane

Jackson

GA

30233

12/12/2010

31111

Sam

Secondary

Street

202 Longview Dr.

13

Jackson

GA

30233

555-555-5555

666-666-6666

[email protected]

Email

12/12/2010

31111

Sam

Secondary

Work

PO Box 415

Jackson

GA

30233

444-444-4444

12/12/2010

X

43333

Mike

Primary

Street

135 Bayview Lane

Jackson

GA

30233

777-777-777

[email protected]

Cell

5/9/2015

X

44444

Lionel

Other

Street

2 Oz Lane

Jackson

GA

30233

888-888-8888

Cell

Current date

Public reporting burden for this collection of information is estimated to average 7 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.