2016 Reinterview Questionnaire

Attachment 4f - Reinterview Questions

2016 NHIS Reinterview CATI-CAPI Instrument Screens
Quality Assurance & Measurment Error Staff
Demographic Statistical Methods Division
This document contains all scrrens in the 2016 NHIS Reinterview CATI-CAPI Instrument. Since this
instrument is based on the generic reinterview instrument, some screens are not applicable to NHIS (these
screens are marked by an asterisk (*)).

Front Section:
Screen: RIREASON
Reinterview Help Menu
♦

Press F8 to proceed to the reinterview.

 1. Why are you calling me again?
 2. Are you calling everyone or am I just lucky?
 3. Don’t you have anything better to do with my tax dollars?
I’m too busy to answer your questions again.
 4. Are you “checking up” on me? I told you the truth the first time you called.
 5. Do I have to answer your questions?
 6. How long will this reinterview take?
 7. I thought you only counted people.
 8. TOLL FREE (800) Telephone Number to Verify Reinterview
 9. Return to Reinterview

Screen: RIREF1
Why are you calling me again?
Like any business, we're interested in maintaining the quality of our product, so we reinterview a
few households who are in the survey to ensure we are efficiently and accurately collecting data.
 1. Continue
 2. Back to Reinterview Help Menu

Screen: RIREF2
Are you calling everyone or am I just lucky?
We are able to get a reliable measure of data quality by reinterviewing only a small percentage of
the total households interviewed in the survey.
 1. Continue
 2. Back to Reinterview Help Menu

2016 NHIS Reinterview Screens

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Screen: RIREF3
Don't you have anything better to do with my tax dollars?
I'm too busy to answer your questions again.
[Fill: RIREF3_DESCR]
 1. Continue
 2. Back to Reinterview Help Menu

Screen: RIREF4
Are you “checking up” on me?
I told you the truth the first time you called.
The purpose of reinterview is not to check up on respondents. In order to ensure that we are efficiently
and accurately collecting data, we reinterview a few households who are in the survey.
 1. Continue
 2. Back to Reinterview Help Menu
Screen: RIREF5
Do I have to answer your questions?
Your participation in this survey is voluntary. However, the information you provide will help us to
ensure the efficiency and accuracy of our data collection procedures. Like any business, we’re
interested in maintaining the quality of our product.
 1. Continue
 2. Back to Reinterview Help Menu

Screen: RIREF6
How long will this reinterview take?
We expect this reinterview to take about five to ten minutes. We have limited questions in this survey to
those essential to current policy initiatives.
 1. Continue
 2. Back to Reinterview Help Menu

2016 NHIS Reinterview Screens

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Screen: RIREF7
I thought you only counted people.
We also conduct surveys to collect information monthly, quarterly, and yearly, on labor force, retail and
wholesale trade, household expenses, household items, and education, to name a few examples.
 1. Continue
 2. Back to Reinterview Help Menu

Screen: RIREF8
TOLL FREE (800) Telephone Number to confirm
To verify that I am calling from the Census Bureau, you may call my regional office (PROVIDE
RESPONDENT WITH THE TELEPHONE NUMBER OF THE REGIONAL OFFICE).
When you call, please provide your name and the following identification number: 0000015.
♦READ IF NECESSARY:♦
To verify that the toll free number is legitimate, you may call Directory Assistance on
1-800-555-1212.
 1. Continue
 2. Back to Reinterview Help Menu

Screen: H_PURPOSE
Frequently Asked Questions for the National Health Interview Survey
♦

Press F8 to proceed with the reinterview.

 1. General Information
 2. How was I chosen for the National Health Interview Survey?
 3. Why not interview the house across the street? Why is my participation important?
 4. I’m not sick – why should I be included in a health survey?
 5. Will the data be held confidential?
 6. Why should I provide my social security number?
 7. How are the National Health Interview Survey data used?
 8. Address for Survey Comments
 9. Return to Reinterview

2016 NHIS Reinterview Screens

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Screen: H_PURPOSE1
General Information
The basic purpose of the National Health Interview Survey is to obtain national information about the
amount and distribution of illness, its effects in terms of disability and chronic impairments, and the kind
of health services people receive.
 1. Continue
 2. Back to original FAQ list

Screen: H_PURPOSE2
How was I chosen for the National Health Interview Survey?
Every week about 1,400 addresses are chosen by scientific sampling methods to serve as a cross section
of the entire United States. The people at those addresses are interviewed to obtain information used to
describe the health of all Americans.
 1. Continue
 2. Back to original FAQ list

Screen: H_PURPOSE3
Why not interview at the house across the street? Why is my participation important?
We cannot change another address for yours. Scientific sampling methods do not permit the substitution
of another address for those originally selected. It is important that the people living in the address
selected be a part of the survey in order to provide the most accurate picture of the country’s health.
 1. Continue
 2. Back to original FAQ list

Screen: H_PURPOSE4
I’m not sick – why should I be included in a health survey?
This is a survey of the nation’s health. Health is often described as people who are not sick. We want to
know how many people are sick and why they are sick, but it is also important to know how many people
are healthy and why they are healthy. These answers will help keep the nation healthy.
 1. Continue
 2. Back to original FAQ list

2016 NHIS Reinterview Screens

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Screen: H_PURPOSE5
Will the data be held confidential?
All information collected in this survey that would permit identification of any individual or any other
business will be held in strict confidence. This information is in accordance with Section 308(d) of the
Public Health Service Act (42 United States Code 242m (d)). We will not release information that could
identify you or your family without your consent. If any federal employee or contractor gives out
confidential information not authorized by law, he or she can be fired and fined and/or imprisoned.
 1. Continue
 2. Back to original FAQ list

Screen: H_PURPOSE6
Why should I provide my Social Security Number?
We would like to know your Social Security Number so we can obtain information that you have given to
other government agencies. The information will be used to conduct research on issues related to health.
This will help us avoid asking questions for which information is already available. It will also help
ensure the accuracy and completeness of survey results, and help us recontact you, if necessary. We will
protect any information we obtain about you from these agencies from unauthorized use just as the survey
responses are protected. Providing this information is voluntary, and is collected under the authority of
the Public Health Service Act. There will be no effect on your benefits if you do not provide it.
 1. Continue
 2. Back to original FAQ list

Screen:H_PURPOSE7
How are the National Health Interview Survey data used?
NCHS was authorized by Congress in Section 306 of the Public Health Service Act to conduct this
survey and to produce health information for the nation. Government agencies, universities, private
health planners, and researchers use the data to identify and work on significant health problems. The
data are also used to determine how best to use available dollars and personnel to solve these health
problems.
 1. Continue
 2. Back to original FAQ list

2016 NHIS Reinterview Screens

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Screen: H_PURPOSE8
Address for Survey Comments
If you have any comments about this survey, please send them to:
CDC/ATSDR Reports, Clearance Officer
Paperwork Reduction Project (0920 – 0214)
1600 Clifton Road, MS D-24
Atlanta, GA 30333
 1. Continue
 2. Back to original FAQ list
Front Section – CATI:

Screen: REACTOCAPI_RI_CT
This should not have been assigned to CATI because this case [fill: BADCASE].
This case needs to be recycled to field.
 1. Continue

Screen: Block:OMB_NOTICE_CT
OMB No. 0920-0214: Approval Expires 03/31/2017
National Health Interview Survey (NHIS) Reinterview
♦ Read the NOTICE statement to the respondent only if she/he has a serious grievance and would like
to make a complaint regarding the survey. Allow the respondent in this situation to copy the agency
titles and addresses listed in the NOTICE statement. Otherwise, continue with the reinterview.
NOTICE [n] – Information contained on this form which would permit identification of any individual
or establishment has been collected with a guarantee that it will be held in strict confidence, will be used
only for purposes stated for this study, and will not be disclosed or released to others without the
consent of the individual or establishment in accordance with Section 308(d) of the Public Health
Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act
(44 USC 3501 note). Public reporting burden of this collection of information is estimated to average
about five 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 CDC/ATSDR Reports, Clearance Officer; Paperwork Reduction
Project (0920-0214), 1600 Clifton Rd., MS D-24, Atlanta, GA 30333.
 1. Continue

2016 NHIS Reinterview Screens

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Screen: HELLO_TC_CT
Hello, This is ... from the U.S. Census Bureau.
May I please speak to [Fill: RESPNAME]?
Status: [Fill: ]

Cutoff Date: [Fill: ]

 1. This is correct person, or correct person called to the phone.
 2. Person not available now. Call back later.
 3. Person cannot be reached. Speak with another household member.
 4. Person unknown at this number.
 5. Person no longer lives there.
 6. Person deceased.
 7. Person can be reached at another number.
 8. Other outcome OR problem interviewing household

Screen: HELLO_TCX_CT
Hello. This is ... from the U.S. Census Bureau.
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted your household.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s
work?
Status: [Fill: ]

Cutoff Date: [Fill: ]

 1. Yes
 2. No
 3. Inconvenient time. Try again later.

Screen: HELLO_TN_CT
Hello, This is ... from the U.S. Census Bureau.
May I please speak to [Fill: NAME]?
Status: [Fill: ]

Cutoff Date: [Fill: ]

 1. This is correct person, or correct person called to the phone.
 2. Person not available now.
 3. Person unknown at this number.
 4. Person no longer lives there.
 5. Person deceased.
 6. Person can be reached at another number.
 7. Other outcome OR problem interviewing household

2016 NHIS Reinterview Screens

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Screen: HELLO_TNX_CT
Hello. I'm ... from the U.S. Census Bureau.
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted your location to
verify the status of:
[Fill:

ADDRESS1]

We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or someone else answer a few questions to help us evaluate the interviewer’s work?
Status: [Fill: ]

Cutoff Date: [Fill: ]

 1. Yes
 2. No
 3. Inconvenient time. Try again later.
Screen: INTRO_TC_CT
Thank you for helping us recently with the [Fill: SURVEY_NAME].
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Is your address: [Fill:

ADDRESS1]?

 1. Yes
 2. No
 3. Refused to verify Address
Screen: INTRO_TN_CT
Thank you for recently helping us verify the status of:
[Fill:

ADDRESS1]

We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
♦
Enter 1 to continue.
 1. Continue

2016 NHIS Reinterview Screens

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Screen: INTROB_RI_CT
This call may be recorded for quality assurance purposes. Do I have permission to record this call?
♦

If the respondent does not wish to be recorded:
Click on the NICE stop recording button.
Read: I appreciate your concern. I am turning off the recording.

 1. Yes; continue with the interview.
 2. Inconvenient time; schedule an appointment to callback.
 3. No; recording is turned off. Continue interview.
Screen: VERTELE_CT
Excuse me. I need to verify your telephone number again.
Have I reached area code [Fill: (AREA) PREFIX-SUFFIX, ext. EXTN] /
[CPPHON, ext. CPEXT]?
 1. Yes
 2. No. Exit instrument and redial.
 3. Refused to verify
Screen: ADDVER_CT
I need to verify that the address there is:
[Fill:

ADDRESS1]

 1. Same Address.
 2. Not same Address.
 3. Refused to verify.
HHMEM_CT
Perhaps you can help me.
Are you a household member [Fill: “who is” MIN_AGE “years or older” / blank]?
 1. Yes
 2. No
Screen: HHMEM2_CT
Is there a household member present I may speak to [Fill: “who is” MIN_AGE “years or older” /
blank]?
 1. Yes
 2. No

2016 NHIS Reinterview Screens

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Screen: PROX_C_CT
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted your household.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s
work?
 1. Yes
 2. No
Screen: PROX_N_CT
Perhaps you can help me.
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted this location to
verify the status of :
[Fill: ADDRESS1].
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or someone else answer a few questions to help us evaluate the interviewer’s work?
 1. Yes
 2. No
Screen: PROX_UC_CT
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted your household.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s
work?
 1. Yes
 2. No
 3. Inconvenient time. Try again later.
Screen: LIVEHERE_CT
Were you living here on [Fill: INTDATE]?
 1. Yes
 2. No
 3. Inconvenient time. Try again later. Make an appointment.

2016 NHIS Reinterview Screens

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Screen: ADDVER_N_CT
Perhaps you can help me.
I’m trying to find out information about:
[Fill: ADDRESS1].
Can you or someone else help me?
 1. Yes
 2. Inconvenient time, call back later. Make an appointment.
 3. No, but I have the phone number of someone who can.
 4. No.
Screen: PROX_UN_CT
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted this location to
verify the status of:
[Fill: ADDRESS1].
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
 1. Continue
Screen: HELLO_PRB_RI_CT
Thank you for your cooperation. You’ve been very helpful.
♦

Problem reinterviewing household – Household not available or another problem
Make several attempts before selecting choice 8 or 9. Then contact your supervisor.

 1.
 2.
 3.
 4.
 5.
 6.
 7.
 8.
 9.

Hard refusal.
Respondent can’t remember.
Entire HH institutionalized or temporarily ineligible.
Entire HH under age [Fill: MIN_AGE].
Temporarily occupied by persons with Usual Residence Elsewhere (URE).
Entire household deceased.
Entire household moved.
No knowledgeable proxy available.
Other problems with reinterview

2016 NHIS Reinterview Screens

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Front Section – CAPI:
Screen: FIN
THIS CASE IS NOT COMPLETED
♦

Enter 1 to continue

 1. Continue
Screen: OMB_NOTICE
OMB No. 0920-0214: Approval Expires 03/31/2017
National Health Interview Survey (NHIS) Reinterview
♦ Read the NOTICE statement to the respondent only if she/he has a serious grievance and would like
to make a complaint regarding the survey. Allow the respondent in this situation to copy the agency
titles and addresses listed in the NOTICE statement. Otherwise, continue with the reinterview.
NOTICE [n] – Information contained on this form which would permit identification of any individual
or establishment has been collected with a guarantee that it will be held in strict confidence, will be used
only for purposes stated for this study, and will not be disclosed or released to others without the
consent of the individual or establishment in accordance with Section 308(d) of the Public Health
Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act
(44 USC 3501 note). Public reporting burden of this collection of information is estimated to average
about five 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 CDC/ATSDR Reports, Clearance Officer; Paperwork Reduction
Project (0920-0214), 1600 Clifton Rd., MS D-24, Atlanta, GA 30333.
 1. Continue

2016 NHIS Reinterview Screens

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Screen: START
[Fill: SURVEY_NAME]
CAPI QUALITY CONTROL REINTERVIEW
Date: [Fill: RIDATE]

Time: [Fill: TIME_C]

Reinterview Case Status:

[Fill: OUTCOME ] - [Fill: OUTCOME_DESCRIP]

Original Interview Date:

[Fill: INTDATE]

Original FR Code:
Original James Bond ID:
Original Name:

[Fill: ORIFR]
[Fill: ORIUSERID]
[Fill: FR_NAME]

Original Outcome:

[Fill: ORIOUT] “-” [Fill: ORIOUT_DESCRIP] “-”
[Fill; TYPEA_SP/TYPEB_SP/TYPEC_SP/Blank]

Original Respondent Name: [Fill: RESPNAME]
Sample Unit Phone:
([Fill: AREA) [Fill: PREFIX] “-” [Fill: SUFFIX] ,
ext.[Fill: EXTN] ([Fill: PHTYP’s description])
Fill: "Second Phone:" SPHONE (SPHTYP) / blank]
Sample Unit Address:
[Fill: ADDRESS1]
[Fill: “Best Time to Contact:” BESTTIME’s description / “Best Time to Contact:” BESTTIM2 / blank]
[Fill: “Or” BESTTIM2 / blank]
[Fill: “DO NOT call on Sunday” / blank]
[Fill: “Spanish speaking” / blank]
 1. Continue
 2. Quit – Attempt later
Screen: START_1A
CONTACT PERSON INFORMATION
Name:
Title:
Phone:
Address:

[Fill: CPNAME]
[Fill: CPTITL]
[Fill: CPPHON], ext. [Fill: CPEXT] ([Fill: CPPHT])
[Fill: CPADD1
CPADD2
CPPO, CPST, CPZP5-CPZP4

[Fill: “NO CONTACT PERSON INFORMATION IS AVAILABLE” / blank]
 1. Continue

2016 NHIS Reinterview Screens

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Screen: HHCOMP
Line No.

Name

Relations
hip

Age

Sex

HH_INF
O1

HH_INF
O2

HH_INF
O3

[Fill:
LNO]

[Fill:
ALIAS]

[Fill:
REL]

[Fill:
AGE]

[Fill:
SEX]

[Fill:
HH_FILL
1]

[Fill:
HH_FILL
2]

[Fill:
HH_FILL
3]

•
•

•
•

•
•

•
•

•
•

•
•

•
•

•
•

♦ Press Shift-F1 to access this screen at any time during the reinterview.
♦ Enter 1 to continue.
 1. Continue
Screen: BY_OBS
The interviewer determined the original outcome by observation. No contact person information was
collected.
♦

Enter 1 to continue.

 1. Continue
Screen: METHOD
♦ Choose one of the following options to continue:
 1. Telephone Reinterview
 2. Personal Visit Reinterview
 3. Quit - Attempt later
 4. Reinterview Noninterview
 5. RO/HQ Discretion – Type A (Contact Supervisor)

2016 NHIS Reinterview Screens

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Screen: DIAL
Respondent Name:
Respondent Address:
/
Contact Name:
Contact Address:

♦

[Fill: RESPNAME]
[Fill: ADDRESS1]
[Fill: CPNAME]
[Fill: CPADD1
CPADD2
CPPO, CPST, CPZP5-CPZP4]

Dial this number:
([Fill: AREA]) [Fill: PREFIX]-[Fill: SUFFIX], ext. [Fill: EXTN] ([Fill: PHTYP’s description]) /
[Fill: CPPHON], ext. [Fill: CPEXT] ([Fill: CPPHT’s description])

 1. Someone answers
 2. Enter new telephone number
 3. Reinterview noninterview
 4. Quit - Attempt later
Screen: _INTRO_
♦

Enter 1 to update the telephone number.

Enter a text of at most 1 characters
Screen: NEWNUMBER_A
♦

Record new number.

In Area Code: [Fill: AREA]
♦ Edit area code or press Enter for same.
New Number: [Fill: PREFIX]-[Fill: SUFFIX]
EXT: [Fill: EXTN]
Enter a text of at most 3 characters
Screen: NEWNUMBER_P
♦

Record new number.

In Area Code: [Fill: NEWNUMBER_A]
New Number: [Fill: PREFIX]-[Fill: SUFFIX]
EXT: [Fill: EXTN]

♦

Edit prefix or press Enter for same.

Enter a text of at most 3 characters

2016 NHIS Reinterview Screens

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Screen: NEWNUMBER_S
♦

Record new number.

In Area Code: [Fill: NEWNUMBER_A]
New Number: [Fill: NEWNUMBER_P]-[Fill: SUFFIX] ♦ Edit suffix or press Enter for same.
EXT: [Fill: EXTN]
Enter a text of at most 4 characters
Screen: NEWNUMBER_E
♦

Record new number.

In Area Code:
New Number:
EXT:

[Fill: NEWNUMBER_A]
[Fill: NEWNUMBER_P]-[Fill: NEWNUMBER_S]
[Fill: EXTN] ♦ Edit extension or press Enter for same.

Enter a text of at most 5 characters
Screen: NEWNUMBER_CP
♦

Record new number.
♦

New Number: [Fill: CPPHON]
EXT: [Fill: CPEXT]

Edit phone number or press Enter for same.

Enter the 10-digit phone number, using no hyphens (-).
Screen: NEWNUMBER_CE
♦

Record new number.

New Number: [Fill: NEWNUMBER_CP]
EXT: [Fill: CPEXT] ♦ Edit extension or press Enter for same.
Enter a text of at most 5 characters
Screen: _END_
♦

Enter 1 to go back to Dial screen.

♦

You may have to press Enter twice to update the phone number entries.

 1. Redial.

2016 NHIS Reinterview Screens

17

Screen: CKSUP
♦

Contact your supervisor for authorization before conducting a personal visit.

 1. Personal visit reinterview authorized
 2. Quit - Attempt later
Screen: HELLO_TC
Hello, I'm ... from the U.S. Census Bureau.
May I speak to [Fill: RESPNAME]?
 1. This is correct person, or correct person called to the phone.
 2. Person not available now. Call back later.
 3. Person cannot be reached. Speak with another household member.
 4. Person unknown at this number.
 5. Person no longer lives there.
 6. Person deceased.
 7. Person can be reached at another number.
 8. Reinterview Noninterview.
Screen: HELLO_TCX
Hello. This is ... from the U.S. Census Bureau.
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted your household.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s
work?
 1. Yes
 2. No
 3. Inconvenient time. Try again later.
Screen: VERTELE
Have I reached area code [Fill: (AREA) PREFIX-SUFFIX, ext. EXTN] /
[CPPHON, ext. CPEXT]?
 1. Yes
 2. No
 3. Refused to verify

2016 NHIS Reinterview Screens

18

Screen: INTRO_TC
Thank you for helping us recently with the [Fill: SURVEY_NAME].
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Is your address: [Fill:

ADDRESS1]?

 1. Yes
 2. No
 3. Refused to verify Address
Screen: WRNUM
I'm sorry. I must have dialed incorrectly.
I'll try again.
♦

Enter 1 to go back to Dial screen.

♦

You may have to press Enter twice to go back to Dial screen.

 1. Redial.
Screen: REFNUM
I'm sorry. I'll dial again to be sure I've dialed correctly.
 1. After several attempts, wrap up case.
 2. Redial
Screen: HELLO_TN
Hello, I’m... from the U.S. Census Bureau.
May I speak to [Fill: CPNAME]?
 1. This is correct person, or correct person called to the phone.
 2. Person not available now.
 3. Person unknown at this number.
 4. Person no longer lives there.
 5. Person deceased.
 6. Person can be reached at another number.
 7. Reinterview Noninterview

2016 NHIS Reinterview Screens

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Screen: VERTYPEA
This case was a Type A in the original interview.
♦

Please use any available resource to check that the original outcome was:

[Fill: ORIOUT’s description] [Fill: “-” TYPEA_SP / blank] on [Fill: INTDATE].
 1. Original outcome was correct.
 2. Original outcome was incorrect.
 3. Reinterview Noninterview.
 4. Quit - Attempt later.
Screen: HELLO_TNX
Hello. I'm ... from the U.S. Census Bureau.
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted your location to
verify the status of:
[Fill:

ADDRESS1]

We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or someone else answer a few questions to help us evaluate the interviewer’s work?
 1. Yes
 2. No
 3. Inconvenient time. Try again later.
Screen: INTRO_TN
Thank you for recently helping us verify the status of:
[Fill:

ADDRESS1]

We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
♦ Enter 1 to continue.
 1. Continue

2016 NHIS Reinterview Screens

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Screen: HELLO_PC
Hello. I’m ... from the U.S. Census Bureau.
Here is my identification card.
♦

Show ID card.

May I speak to [FILL: RESPNAME]?
 1. Correct person available.
 2. Person not available now.
 3. Person unknown at this address.
 4. Person no longer lives there.
 5. Person deceased.
 6. No one lives at this address.
 7. Reinterview Noninterview.
Screen: HELLO_PCX
Hello, I'm ... from the U.S. Census Bureau.
Here is my identification card.
♦

Show ID card.

Our records show that one of our interviewers, [Fill : FR_NAME], recently contacted your household.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s
work?
 1. Yes
 2. No
 3. Inconvenient time. Try again later.
 4. No one lives at this address.
Screen: INTRO_PC
Thank you for helping us recently with the [Fill: SURVEY_NAME].
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Is your address: [Fill:

ADDRESS1]?

 1. Yes
 2. No
 3. Refused to verify address

2016 NHIS Reinterview Screens

21

Screen: HELLO_PN
Hello. I’m... from the U.S. Census Bureau.
Here is my identification card.
♦

Show ID card.

May I speak to [Fill: CPNAME]?
 1. Correct person available.
 2. Person not available now.
 3. Person unknown at this address.

 4. Person no longer lives there.
 5. Person deceased.
 6. Reinterview Noninterview.

Screen: HELLO_PNX
Hello, I’m... from the U.S. Census Bureau.
Here is my identification card.
♦

Show ID card.

Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted this location to
verify the status of:
[Fill: ADDRESS1]
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or someone else answer a few questions to help us evaluate the interviewer’s work?
 1. Yes
 2. No
 3. Inconvenient time. Try again later.
Screen: ADDVER
I need to verify that the address [Fill: “here” / “there”] is:
[Fill: ADDRESS1]
 1. Same Address.
 2. Not same Address.
 3. Refused to verify.

2016 NHIS Reinterview Screens

22

Screen: INTRO_PN
Thank you for recently helping us verify the status of:
[Fill:

ADDRESS1]

We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
♦

Enter 1 to continue.

 1. Continue
Screen: VERBYOBS
The interviewer determined the original outcome by observation.
♦

Please use any available resource to check that:

[Fill:

ADDRESS1]

was [Fill: ORIOUT’s description] [Fill: “-” TYPEB_SP / “-” TYPEC_SP / blank]
on [Fill: INTDATE].
 1. Original outcome was correct.
 2. Original outcome was incorrect.

 3. Reinterview Noninterview.
 4. Quit - Attempt later.

Screen: HHMEM
Perhaps you can help me.
Are you a household member [Fill: “who is” MIN_AGE “years or older” / blank]?
 1. Yes
 2. No
Screen: HHMEM2
Is there a household member present I may speak to [Fill: “who is” MIN_AGE “years or older” / blank]?
 1. Yes
 2. No

2016 NHIS Reinterview Screens

23

Screen: PROX_C
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted your household.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s
work?
 1. Yes
 2. No
Screen: PROX_N
Perhaps you can help me.
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted this location to
verify the status of :
[Fill: ADDRESS1].
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or someone else answer a few questions to help us evaluate the interviewer’s work?
 1. Yes
 2. No
Screen: PROX_UC
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted your household.
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
Can you or another household member answer a few questions to help us evaluate the interviewer’s
work?
 1. Yes
 2. No
 3. Inconvenient time. Try again later.
Screen: LIVEHERE
Were you living here on [Fill: INTDATE]?
 1. Yes
 2. No
 3. Inconvenient time. Try again later (make an appointment).

2016 NHIS Reinterview Screens

24

Screen: ADDVER_N
Perhaps you can help me.
I’m trying to find out information about:
[Fill:

ADDRESS1]

Can you or someone else help me?
 1. Yes
 2. Inconvenient time, call back later.
 3. No, but I have the phone number of someone who can.
 4. No.
Screen: PROX_UN
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted someone [Fill:
NUM_HERE] to verify the status of:
[Fill: ADDRESS1].
We’re doing a short quality control check to make sure that our interviewers are following correct
procedures.
 1. Continue

Middle Section:
Screen: RIRESP
Line No.

Name

Relations
hip

Age

Sex

HH_INF
O1

HH_INF
O2

HH_INF
O3

[Fill:
LNO]

[Fill:
ALIAS]

[Fill:
REL]

[Fill:
AGE]

[Fill:
SEX]

[Fill:
HH_FILL
1]

[Fill:
HH_FILL
2]

[Fill:
HH_FILL
3]

•
•

•
•

•
•

•
•

•
•

•
•

•
•

•
•

♦ Ask if necessary
♦ With whom am I speaking?
♦ Enter line of person you are speaking to ot (0) if person is not on roster.

2016 NHIS Reinterview Screens

25

Screen: RIRESPB_RI_CT
This call may be recorded for quality assurance. Do I have permission to record this call?
♦

If the respondent does not wish to be recorded:
- Click on the NICE stop recording button.
- Read: I appreciate your concern. I am turning off the recording.

 1. Continue
 2. Inconvenient time; schedule an appointment to callback.
 3. No; recording is turned off. Continue interview
Screen: CONTACT_C
Did an interviewer contact you or someone in your household on or about [Fill: INTDATE] and
[Fill: CONTACT_C_INFO1 CONTACT_C_INFO2]?
 1. Yes
 2. No
Screen: ORMODE
Did the interviewer conduct the interview in person or over the telephone?
 1. Personal visit only
 2. Telephone call only
 3. Both - Interviewer visited and called
Screen: PHONE_REQUEST*
Did you request the telephone interview?
 1. Yes
 2. No - Telephone interview requested by interviewer
Screen: POLITE
Was the interviewer polite and professional?
 1. Yes
 2. No
Screen: PO_NOTES
♦

Enter comments from the reinterview respondent here.

Screen: LENGTH_H
About how long did the interview last?
____ hours
♦

____ min.

If no hours, enter 0.

2016 NHIS Reinterview Screens

26

Screen: LENGTH_M
About how long did the interview last?
[Fill: LENGTH_H] hours

________________ minutes

Screen: LAPTOP
Did the interviewer use a laptop computer?
 1. Yes
 2. No
Screen: ROSTER_1
Line No.

Name

Relations
hip

Age

Sex

HH_INF
O1

HH_INF
O2

HH_INF
O3

[Fill:
LNO]

[Fill:
ALIAS]

[Fill:
REL]

[Fill:
AGE]

[Fill:
SEX]

[Fill:
HH_FILL
1]

[Fill:
HH_FILL
2]

[Fill:
HH_FILL
3]

•
•

•
•

•
•

•
•

•
•

•
•

•
•

•
•

Our records indicate that ♦Read above name(s) in blue ♦ was/were living or staying at
[Fill:

ADDRESS1]

on [Fill: INTDATE].
Is this correct?
 1. Yes
 2. No

2016 NHIS Reinterview Screens

27

Screen: ROSTER_2
Line No.

Name

Relations
hip

Age

Sex

HH_INF
O1

HH_INF
O2

HH_INF
O3

[Fill:
LNO]

[Fill:
ALIAS]

[Fill:
REL]

[Fill:
AGE]

[Fill:
SEX]

[Fill:
HH_FILL
1]

[Fill:
HH_FILL
2]

[Fill:
HH_FILL
3]

•
•

•
•

•
•

•
•

•
•

•
•

•
•

•
•

♦ Enter the line number of the household member(s) (above name(s) in blue) who wasn’t/weren’t
living or staying at the household on [Fill: INTDATE].
List of line numbers from household roster.
Screen: ROSTER_3
Line No.

Name

Relations
hip

Age

Sex

HH_INF
O1

HH_INF
O2

HH_INF
O3

[Fill:
LNO]

[Fill:
ALIAS]

[Fill:
REL]

[Fill:
AGE]

[Fill:
SEX]

[Fill:
HH_FILL
1]

[Fill:
HH_FILL
2]

[Fill:
HH_FILL
3]

•
•

•
•

•
•

•
•

•
•

•
•

•
•

•
•

Have I missed any household member who
[Fill: ROSTER_INFO1]
[Fill: ROSTER_INFO2]
[Fill: ROSTER_INFO3]
 1. Yes
 2. No

2016 NHIS Reinterview Screens

28

Screen: ROSTER_4
Line No.

Name

Relations
hip

Age

Sex

HH_INF
O1

HH_INF
O2

HH_INF
O3

[Fill:
LNO]

[Fill:
ALIAS]

[Fill:
REL]

[Fill:
AGE]

[Fill:
SEX]

[Fill:
HH_FILL
1]

[Fill:
HH_FILL
2]

[Fill:
HH_FILL
3]

•
•

•
•

•
•

•
•

•
•

•
•

•
•

•
•

♦

Enter the name of each Missing household member who

♦

[Fill: ROSTER_INFO1]
[Fill: ROSTER_INFO2]
[Fill: ROSTER_INFO3]

Press Enter after each name and again after last name to continue.

Screen: RI_MONTH
What is your date of birth?
♦

Click on or enter the number that corresponds to the month (1-12).

 1. January
 2. February
 3. March
 4. April
 5. May
 6. June
 7. July
 8. August
 9. September
 10. October
 11. November
 12. December
Screen: RI_DAY
What is your date of birth?
♦

Enter the number that corresponds to the day of the month (1-31).

Month: [FILL: RI_MONTH]

Day: ________

Year: ________

2016 NHIS Reinterview Screens

29

Screen: RI_YEAR
What is your date of birth?
♦

Enter the four digit year.

Month: [FILL: RI_MONTH]

Day: [FILL: RI_DAY]

Year: ______

Screen: CKANCEST
[Fill: ADD] consider [Fill: SELF ] to be Hispanic or Latino?
♦

Read if necessary.
Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican

Mexican American
Central or South American
Other Latin American
Other Hispanic/Latino/Spanish

(Where did your ancestors come from?)
 1. Yes
 1. No
Screen: CKRACE
[What [Fill: “is your race” / “race is [FNAME LNAME]”]?
♦ Read if necessary: White, Black, American Indian, Eskimo, Aleut, or Asian/ Pacific Islander
 1. Black of Asian
 1. Non-Black and Non-Asian

Screen: SURVEY
Now I am going to ask you a few questions about the content of the interview to verify whether
the interviewer asked you the correct questions.
◆ Press 1 to continue.
 1. Continue
Screen: HH1
Did the interviewer ask you questions about whether someone is your household has a cell
phone?
 1. Yes
 2. No

2016 NHIS Reinterview Screens

30

Screen: FAM1
Did the interviewer ask whether anyone in the family needs the help of other persons with
personal care needs, such as eating, bathing, dressing, or getting around inside this home?
 1. Yes
 2. No
Screen: FAM2
Did the interviewer ask you or someone in your household if anyone in the household was
covered by health insurance or some other kind of health care plan?
 1. Yes
 2. No
Screen: FAM3
Did the interviewer ask you about the amount of your total family income?
 1. Yes
 2. No
Screen: SADIBEV
These next questions are to make sure that the insterviewer recorded the correct responses:
Fill: SADIBEV_FILL] Have you ever been told by a doctor or health professional that you have
diabetes or sugar diabetes?
 1. Yes
 2. No
Screen: SAAVISION
Do you have trouble seeing, even when wearing glasses or contact lenses?
 1. Yes
 2. No
Screen: SAEXERCISE
Did the interviewer ask you how often you exercise?
 1. Yes
 2. No
Screen: SAFRUIT1
Did the interviewer ask whether you ate fruit in the last week?
 1. Yes
 2. No

1

SAFRUIT is not from any question in production. This question is used as a baseline to see how much people respond YES or NO
when they were never asked the question in NHIS.

2016 NHIS Reinterview Screens

31
Screen: SAAUSUAL
Did the interviewer ask you whether there is a place that you usually go to when you are sick or need
advice about your health?
 1. Yes
 2. No
Screen: SAORIENT
Did the interviewer ask whether you consider yourself to be gay, straight, bisexual, or something else?
 1. Yes
 2. No
Screen: SAACISAD
Did the interviewer ask whether you recently felt sad, nervous, or hopeless?
 1. Yes
 2. No

Screen: SABALEV
Did the interviewer ask whether you have ever had a problem with dizziness or feeling off-balance?
 1. Yes
 2. No

Screen: Sample Adult Social Security
Did the interviewer ask for the last four digits of your social security number?
 1. Yes
 2. No
Screen: PROX_PRESENT
Were you present during the original interview?
 1. Yes
 2. No
Screen: SOMEONE_ELSE
Could the interviewer have spoken to another person [Fill: AT_ABOUT]
[Fill:

ADDRESS1]

 1. Yes
 2. No
Screen: SPEAKTO
May I speak to her/him?
 1. Yes
 2. No

2016 NHIS Reinterview Screens

32
Screen: CONTACT_N
Did an interviewer visit or call regarding:
[Fill:

ADDRESS1]?

 1. Yes
 2. No
Screen: VACANT *
Was
[Fill:

ADDRESS1]

vacant on [Fill: INTDATE]?
 1. Yes
 2. No
Screen: STAT_VER*
Is there someone present I could speak with who could tell me the status of
[Fill:

ADDRESS1]

on or about [Fill: INTDATE]?
 1. Yes
 2. No
Screen: SPEAKTO2*
May I speak to her/him?
 1. Yes
 2. No

2016 NHIS Reinterview Screens

33
Screen: VACANT2*
Hello, I’m ... from the U.S. Census Bureau.
Our records show that one of our interviewers, [Fill: FR_NAME], recently contacted this location
to verify the status of: [Fill: ADDRESS1]
We’re doing a short quality control check to make sure that our interviewers are following
correct procedures.
Was
[Fill:

ADDRESS1]

vacant on [Fill: INTDATE]?
 1. Yes
 2. No
Screen: STATUS
Our records show that on [Fill: INTDATE],
[Fill:

ADDRESS1]

was [Fill: ORIOUT’s description].
Is this information correct?

 1. Yes
 2. No
Screen: STAT_PROBE
Original Outcome:

[Fill: ORIOUT] - [Fill: ORIOUT’s description] “-”
[Fill: TYPEB_SP / TYPEC_SP / blank]

Original Interview Date: [Fill: INTDATE]
What was the status of [Fill: ADDRESS1]
on or about [Fill: INTDATE]?
♦

Enter reported status.

♦

Explain any discrepancy between reported status and original outcome.

2016 NHIS Reinterview Screens

34
Screen: STAT_PROB2
Original Outcome:

[Fill: ORIOUT] - [Fill: ORIOUT’s description] “-”
[Fill: TYPEB_SP / TYPEC_SP / blank]

Original Interview Date: [Fill: INTDATE]
What was the status of
[Fill: ADDRESS1]
on or about [Fill: INDATE]?
♦

Enter reported status.

♦

Explain any discrepancy between reported status and original outcome.

Back Section:
Screen: THANK_SORRY
I'm sorry. I have the wrong address/telephone number. Thank you for your help.
♦ Attempt to contact the correct household now or at a later time.
 1. Continue
Screen: THANK_YOU
Thank you for your cooperation. You've been very helpful.
♦

Enter 1 to continue.

 1. Continue
Screen: THANK_REF
I’m sorry to have bothered you.
 1. Continue

2016 NHIS Reinterview Screens

35
Screen: THANK_NOHH
Thank you for your help, but I need to speak to a household member. I'll try back later.
♦

Enter 1 to continue.

 1. Continue
Screen: APPT
I'd like to schedule a date to complete/conduct the quality check. What Date and Time would be
best to call/visit?
Today is: [Fill: RIDATE].
♦
♦
♦

Enter Date and Time
Enter (0) if this is a break-off case.
Enter (1) if you don’t intend to follow up on this case.

Screen: APPT2
What Date and Time would be best to contact
[Fill: RESPNAME /CPNAME, CPTITL] in order to conduct the quality check?
Today is: [Fill: RIDATE]
♦

Enter Date and Time

♦

Enter (1) if you don't intend to follow up on this case.

Screen: APPT_CT
♦

Select (1) if this is a break-off case.

♦

Select (2) to access WebCATI and set a callback appointment. If necessary, ask respondent for
best callback date and time.

 1. Break-off Reinterview
 2. Set Callback Appointment

2016 NHIS Reinterview Screens

36
Screen: RI_BREAKOFF_CT
♦

What was the MAIN reason for breaking off the reinterview?

 1. Respondent was too busy.
 2. Respondent had to leave.
 3. Questions were too personal for respondent.
 4. Reinterview was too long for respondent.
 5. Respondent physically/mentally unable to participate.
 6. Dislike/mistrust of the government.
 7. Relative did not want respondent to participate.
 8. Language problem.
 9. Reinterviewer computer error.
10. Other.
Screen: CBTHANK
Thank you for your help.
We will call/visit again at the time suggested.
 1. Continue
Screen: STATUS_RI
This case is not completed.
♦

Make several attempts to contact respondent/contact person before selecting reinterview
noninterview.
 1. Quit - Complete later
 2. Reinterview Noninterview
Screen: RI_BREAKOFF
♦

What was the MAIN reason for breaking off the reinterview?

 1. Respondent was too busy.
 2. Respondent had to leave.
 3. Questions were too personal for respondent.
 4. Reinterview was too long for respondent.
 5. Respondent physically/mentally unable to participate.
 6. Dislike/mistrust of the government.
 7. Relative did not want respondent to participate.
 8. Language problem.
 9. Reinterviewer computer error.
10. Other.

2016 NHIS Reinterview Screens

37
Screen: RI_OUTCM
Original Outcome:
Original Interview Date:

[FILL: ORIOUT] - [FILL: ORIOUT’s description]“-”
[Fill: TYPEA_SP/TYPEB_SP/TYPEC_SP/blank]
[FILL: INTDATE].

♦ Was the original outcome correct?
 1. Yes
 2. No
 3. Reinterview Noninterview
Screen: RIOUT_NOTES
♦
♦

The reinterview respondent indicated the original outcome was not correct.
Enter the reason(s) here that lead you to determine that the original outcome was correct.

Screen: NONINT
♦

Which outcome describes this reinterview case?

 1. Type A Noninterview.
 2. Type B Noninterview.
 3. Type C Noninterview.
 4. Type D Noninterview - Household replaced by new household since the original interview.
Screen: TYPEA
♦ Which Type A outcome describes this reinterview case?
 1. Unable to complete, bad telephone number.
 2. Unable to locate.
 3. No one home.
 4. Temporarily absent.
 5. Refused.
 6. Language problem.
 7. Respondent can’t remember.
 8. Insufficient partial.
 9. Other Type A - Specify in the Reinterview Notes.

2016 NHIS Reinterview Screens

38
Screen: TYPEB*
♦

Which Type B outcome describes this reinterview case?

 1. Vacant, regular or seasonal.
 2. Vacant, storage of household furniture.
 3. Converted to temporary business or storage.
 4. Unoccupied tent or trailer site.
 5. Unfit, to be demolished.
 6. HH institutionalized or temporarily ineligible.
 7. Entire HH under age [Fill: MIN_AGE].
 8. Temporarily occupied by persons with Usual Residence Elsewhere (URE).
 9. Other Type B - Specify in the Reinterview Notes.
Screen: TYPEB_ALT*
♦

Which Type B outcome describes this reinterview case?

 1. Vacant, regular.
 2. Vacant, seasonal.
 3. Vacant, storage of household furniture.
 4. Converted to temporary business or storage.
 5. Unoccupied tent or trailer site.
 6. Unfit, to be demolished.
 7. HH institutionalized or temporarily ineligible.
 8. Entire HH under age [Fill: MIN_AGE].
 9. Temporarily occupied by persons with Usual Residence Elsewhere (URE), regular.
 10. Temporarily occupied by persons with Usual Residence Elsewhere (URE), seasonal.
 11. Other Type B - Specify in the Reinterview Notes.
Screen: TYPEC
♦

Which Type C outcome describes this reinterview case?

 1. Demolished.
 2. House or trailer moved.
 3. Converted to permanent business or storage.
 4. Condemned.
 5. Deceased.
 6. Moved.
 7. Other Type C - Specify in the Reinterview Notes.
Screen: MISC_B
♦

Which of the following options describes the misclassification of this original Type B case?

 1. Should have been an Interview or Type A.
 2. Should have been another Type B.
 3. Should have been a Type C.

2016 NHIS Reinterview Screens

39
Screen: MISC_C
♦

Which of the following options describes the misclassification of this original Type C case?

 1. Should have been an Interview or Type A (occupied at time of interview).
 2. Should have been a Type B.
 3. Should have been another Type C.
Screen: MISC_VINT*
♦ Which of the following options describes the misclassification of this original vacant interview
case?
 1. Should have been an Interview or Type A.
 2. Should have been a Type B or C.
Screen: MISC_BVINT*
♦

Which of the following options describes the misclassification of this original Type B case?

 1. Should have been an Interview or Type A.
 2. Should have been a vacant interview.
 3. Should have been another Type B.
 4. Should have been a Type C.
Screen: MISC_CVINT *
♦

Which of the following options describes the misclassification of this original Type C case?

 1. Should have been an Interview or Type A.
 2. Should have been a vacant interview.
 3. Should have been a Type B.
 4. Should have been another Type C.
Screen: FALSIF
[Fill:

“Your reinterview indicates the following discrepancies:”
code and description of each code listed in DISCREPANCY array /
“Your reinterview did not indicate any discrepancies.”]

♦

Do you suspect falsification?

 1. Yes
 2. No
 3. Unable to determine

2016 NHIS Reinterview Screens

40
Screen: FALSIF2
[Fill: “Your reinterview indicates the following discrepancies:”
code and description of each code listed in DISCREPANCY array]
♦

Falsification is suspected. Be sure to enter all proper notes explaining the situation.

 1. Continue
Screen: DISCREP_NOTES
[Fill: DISCREP_NTS]
Screen: NSF_RIDISP
Your reinterview detected multiple discrepancies.
♦ Enter the code of the detected discrepancy below which best describes this case.
 ** List of discrpenacies **
Screen: RO_DISC
♦ Caution: Obtain supervisor's permission before selecting an option below.
♦ Which of the following options describes this reinterview case?
 1. Hard to interview original case
 2. More than 50 miles from nearest reinterviewer and no phone number
 3. Observed during the original interview
 4. Personal visit needed, but not authorized
 5. Case management or ROSCO problems - Obtain HQ approval
 6. Sample adjustment - Obtain HQ approval
 7. Other RO discretion - Specify in the Reinterview Notes
Screen: NO_DISCREP
♦

Explain why you suspect falsification in the Reinterview Notes now.

♦

Press Ctrl-F7 to access Reinterview Notes.

♦

Enter 1 when done with your explanation in the Reinterview Notes

 1. Continue

2016 NHIS Reinterview Screens

41
Screen: SF_RIDISP
Your reinterview detected multiple discrepancies.
♦

Enter the code of the discrepancy below which best describes the primary reason you suspect
falsification.

 ** List of discrpenacies **
Screen: READYWRAP
This case is complete and ready to be transmitted. [fill: READY]
 1. Continue
Screen: WRAP_UP
OUTCOME: [fill: OUTCOME]
RI_DISP: [fill: RI_DISP]
 1. Continue
Screen: SHOW_CTRL
Wc_case_status.Outcome = [fill: OUTCOME]
Wc_case_status.Outcome_subtype = [fill: OUTCOME_SUBTYPE]
Wc_case_status.Mark =
Wc_case_status.Marktwo =
Wc_case_status.Supplement =
 1. Continue

2016 NHIS Reinterview Screens