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pdfKNINTRO
KNINTRO
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
KNINTR
Enable Functions:
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No
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No
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No
No
No
No
Grid Functions:
Add Line
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No
No
200
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If respondent is proxy, display "for (SP)".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Now I have some questions that ask how you get information about
the Medicare program [for (SP)]. Your answers will help Medicare
provide the information that people need.
Keep in mind that, generally, there are no right or wrong answers to
these questions. Your opinions and experiences are important to us.
Int. Instr II:
4:07:25 PM Tuesday, October 09, 2012
Page 1 of 149
KNINTRO
INPUT FIELDS / ROUTING
( KNQ1010 )
KNINTR
Field1:
Cheshire Name:
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN1 - KNOWMC ( KNQ1015 )
English text: CONTINUE
Attribute
Route
Empty
KN1 - KNOWMC ( KNQ1015 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
DISABLE PREVIOUS PAGE.
4:07:26 PM Tuesday, October 09, 2012
Page 2 of 149
KN1
KN1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNOWMC
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
300
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD KN1
Question Text:
Overall, how easy or difficult do you think the Medicare program is to
understand?
[PROBE IF NECESSARY: Would you say it is very easy to
understand, somewhat easy to understand, somewhat difficult to
understand, or very difficult to understand?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:27 PM Tuesday, October 09, 2012
Page 3 of 149
KN1
Field1:
KNOWMC
Cheshire Name:
( KNQ1015 )
KNOW.KNOWMC
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TKnowmc
1
No
No
Number Label
1 VeryEasy
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN2 - KCARKNOW ( KNQ1020 )
2
English text: VERY EASY
SomewhatEasy
KN2 - KCARKNOW ( KNQ1020 )
3
English text: SOMEWHAT EASY
SomewhatDifficult
KN2 - KCARKNOW ( KNQ1020 )
4
English text: SOMEWHAT DIFFICULT
VeryDifficult
KN2 - KCARKNOW ( KNQ1020 )
English text: VERY DIFFICULT
Attribute
Route
Don't know
KN2 - KCARKNOW ( KNQ1020 )
Refusal
KN2 - KCARKNOW ( KNQ1020 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:07:28 PM Tuesday, October 09, 2012
Page 4 of 149
KN2
KN2
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KCARKNOW
Enable Functions:
HELP
COMMENTS
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No
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No
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No
No
No
No
Grid Functions:
Add Line
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No
No
400
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD KN2
Question Text:
How much do you think you know about the Medicare program?
Do you know just about everything you need to know, most of what
you need to know, some of what you need to know, a little of what
you need to know or almost none of what you need to know about
the Medicare program?
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:29 PM Tuesday, October 09, 2012
Page 5 of 149
KN2
Field1:
KCARKNOW
Cheshire Name:
( KNQ1020 )
KNOW.KCARKNOW
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TMcarknow
1
No
No
Number Label
1 JustAboutEverythingYouNeedToKnow
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX KN1 - (KNQ1023 )
2
English text: JUST ABOUT EVERYTHING YOU NEED TO KNOW
MostOfWhatYouNeedToKnow
BOX KN1 - (KNQ1023 )
3
English text: MOST OF WHAT YOU NEED TO KNOW
SomeOfWhatYouNeedToKnow
BOX KN1 - (KNQ1023 )
4
English text: SOME OF WHAT YOU NEED TO KNOW
ALittleOfWhatYouNeedToKnow
BOX KN1 - (KNQ1023 )
5
English text: A LITTLE OF WHAT YOU NEED TO KNOW
AlmostNoneOfWhatYouNeedToKnow
BOX KN1 - (KNQ1023 )
English text: ALMOST NONE OF WHAT YOU NEED TO KNOW
Attribute
Route
Don't know
BOX KN1 - (KNQ1023 )
Refusal
BOX KN1 - (KNQ1023 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4:07:30 PM Tuesday, October 09, 2012
Page 6 of 149
KN2
DESIGN NOTES
4:07:30 PM Tuesday, October 09, 2012
Page 7 of 149
BOX KN1
BOX KN1
Page Order # :
450
BOX INSTRUCTIONS
( KNQ1023 )
IF THIS IS ROUND 65, GO TO KN25B1 - KNINFMCR ( KNQ1037 ).
ELSE GO TO KN24A - TOPICKN ( KNQ1025 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:07:30 PM Tuesday, October 09, 2012
Page 8 of 149
KN24A
KN24A
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
TOPICKN
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
500
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD KN4
Question Text:
This card lists different health care topics and programs. Please
look at this card and tell me the three topics that are important for
you to have more information about, starting with the most important.
[PROBE IF NECESSARY: Which of these topics would be the most
important for you to have more information about? Which would be
the next most important? Which would be the next most important?]
Int. Instr II:
4:07:31 PM Tuesday, October 09, 2012
CHECK THE TOP THREE SELECTED BY THE RESPONDENT,
STARTING WITH THE MOST IMPORTANT.
Page 9 of 149
KN24A
INPUT FIELDS / ROUTING
4:07:33 PM Tuesday, October 09, 2012
Page 10 of 149
KN24A
Field1:
TOPICKN
Cheshire Name:
Item Text display:
( KNQ1025 )
TEMP
If respondent is proxy, display "(SP)" in capital letters.
Else display "YOU".
Only allow 3 responses to be selected.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTOPICKN
3
No
No
Number Label
1 HowMuchForMedicalServices
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN25A - KNUPPICK ( KNQ1030 )
2
English text: HOW MUCH [YOU/(SP)] WOULD HAVE TO PAY FOR MEDICAL SERVICES
InfoAboutMedicareRxCoverage
KN25A - KNUPPICK ( KNQ1030 )
3
English text: INFORMATION ABOUT MEDICARE PRESCRIPTION DRUG COVERAGE
MedicareNewBenefits
KN25A - KNUPPICK ( KNQ1030 )
4
English text: MEDICARE'S NEW BENEFITS OR CHANGES
ServicesMedicareCovers
KN25A - KNUPPICK ( KNQ1030 )
5
English text: WHAT SERVICES MEDICARE DOES OR DOESN’T COVER
BenefitsOfMAPlans
KN25A - KNUPPICK ( KNQ1030 )
6
English text: THE BENEFITS OF MEDICARE ADVANTAGE PLANS
MedigapSuppInsurance
KN25A - KNUPPICK ( KNQ1030 )
7
English text: MEDIGAP OR SUPPLEMENTAL INSURANCE
Medicaid
KN25A - KNUPPICK ( KNQ1030 )
8
English text: MEDICAID
ChoosingADoctor
9
English text: CHOOSING OR FINDING A DOCTOR OR OTHER HEALTH CARE PROVIDER
StayingHealthy
KN25A - KNUPPICK ( KNQ1030 )
KN25A - KNUPPICK ( KNQ1030 )
10
English text: STAYING HEALTHY
QualityofCare
11
English text: QUALITY OF CARE FROM HEALTH CARE PROVIDERS
ChoosingNursingHome
KN25A - KNUPPICK ( KNQ1030 )
96
English text: CHOOSING A NURSING HOME
DoesntWantInfo
KN25A - KNUPPICK ( KNQ1030 )
KN25A - KNUPPICK ( KNQ1030 )
English text: DOESN’T WANT/NEED ANY OF THIS INFORMATION
4:07:37 PM Tuesday, October 09, 2012
Page 11 of 149
KN24A
Attribute
Don't know
Route
KN25A - KNUPPICK ( KNQ1030 )
Refusal
KN25A - KNUPPICK ( KNQ1030 )
BACKGROUND VARIABLE ASSIGNMENTS
Only 3 responses are allowed at KN24A. Each response will be stored in a separate field.
See additional instructions below.
TOPICKN1
If KN24A - TOPICKN = DK, set KNOW.TOPICKN1 =
DK.
Else if KN24A - TOPICKN = RF, set
KNOW.TOPICKN1 = RF.
Else if KN24A - TOPICKN = 96/DoesntWantInfo, set
KNOW.TOPICKN1 = 96/DoesntWantInfo.
Else set KNOW.TOPICKN1 = 1st response selected
at KN24A.
TOPICKN2
If 2nd response selected at KN24A, set
KNOW.TOPICKN2 = 2nd response selected.
TOPICKN3
If 3rd response selected at KN24A, set
KNOW.TOPICKN3 = 3rd response selected.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1:
If KN24A - TOPICKN includes 96/DoesntWantInfo, then KN24A
TOPICKN should not include any other response.
If not true, display message: "INVALID RESPONSE. PLEASE
INDICATE EITHER THE TYPES OF INFORMATION THE SP
CONSIDERS MOST IMPORTANT OR INDICATE THAT THE SP
DOESN’T WANT/NEED ANY OF THIS INFORMATION."
TECHNICAL NOTES
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
4:07:37 PM Tuesday, October 09, 2012
Page 12 of 149
KN25A
KN25A
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
KNUPPICK
Field 2:
KNUPOTOS
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
600
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD KN9
Question Text:
This card lists some people and places that could provide
information about the latest developments in Medicare. Please look
at this card and tell me all of the people and places you would prefer
to use to keep up with Medicare.
[PROBE: Any other source?]
Int. Instr II:
4:07:38 PM Tuesday, October 09, 2012
CHECK ALL THAT APPLY.
Page 13 of 149
KN25A
INPUT FIELDS / ROUTING
4:07:40 PM Tuesday, October 09, 2012
Page 14 of 149
KN25A
Field1:
KNUPPICK
Cheshire Name:
( KNQ1030 )
NONE
SQL FIELD = KNOW.KNUPPICK
REPLACES THE FOLLOWING CHECHIRE VARIABLES:
1/FriendsOrFamily=KNOW.KNUPFAML
2/MedicalProfessional=KNOW.KNUPPROF
3/Pharmacist=KNOW.KNUPPHAR
4/MedicareCMS=KNOW.KNUPMCRE
5/SocialSecurity=KNOW.KNUPSEC
6/StateMedicaidAgency=KNOW.KNUPSTMD
7/AnotherGovAgency=KNOW.KNUPGACY
8/InsuranceCompany=KNOW.KNUPINSR
9/EmployerOrUnion=KNOW.KNUPEMP
10/AARPOrSeniorOrgs=KNOW.KNUPAARP
11/Media=KNOW.KNUPMDIA
91/OtherPersonOrPlace=KNOW.KNUPOTR
96/DoesntWantInfo=KNUPNNE
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
Tknuppic
12
No
No
Number Label
1 FriendsOrFamily
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN25B1 - KNINFMCR ( KNQ1037 )
2
English text: FRIENDS OR FAMILY
MedicalProfessional
3
English text: MEDICAL PROFESSIONAL (DOCTOR, NURSE, CLINIC, ETC.)
Pharmacist
KN25B1 - KNINFMCR ( KNQ1037 )
4
English text: PHARMACIST
MedicareCMS
KN25B1 - KNINFMCR ( KNQ1037 )
5
English text: MEDICARE, CMS
SocialSecurity
KN25B1 - KNINFMCR ( KNQ1037 )
6
English text: SOCIAL SECURITY
StateMedicaidAgency
KN25B1 - KNINFMCR ( KNQ1037 )
7
English text: STATE MEDICAID AGENCY
AnotherGovAgency
KN25B1 - KNINFMCR ( KNQ1037 )
KN25B1 - KNINFMCR ( KNQ1037 )
English text: ANOTHER GOVERNMENT AGENCY
4:07:43 PM Tuesday, October 09, 2012
Page 15 of 149
KN25A
8
InsuranceCompany
KN25B1 - KNINFMCR ( KNQ1037 )
9
English text: INSURANCE COMPANY, INCLUDING MEDIGAP, MEDICARE ADVANTAGE,
MEDICARE PRESCRIPTION DRUG PLAN COMPANIES
EmployerOrUnion
KN25B1 - KNINFMCR ( KNQ1037 )
10
English text: CURRENT OR FORMER EMPLOYER OR UNION
AARPOrSeniorOrgs
KN25B1 - KNINFMCR ( KNQ1037 )
11
English text: AARP OR SENIOR ORGANIZATIONS
Media
KN25B1 - KNINFMCR ( KNQ1037 )
91
English text: MEDIA (NEWSPAPER, TV, RADIO, MAGAZINE)
Other
KN25A - KNUPOTOS ( KNQ1035 )
96
English text: ANY OTHER PERSON OR PLACE (SPECIFY)
DoesntWantInfo
KN26 - KNFOSATI ( KNQ1041 )
English text: DOESN'T WANT/NEED THIS INFORMATION
Attribute
Route
Don't know
KN25B1 - KNINFMCR ( KNQ1037 )
Refusal
KN25B1 - KNINFMCR ( KNQ1037 )
Field2:
Cheshire Name:
KNUPOTOS
( KNQ1035 )
KNOW.KNUPOTOS
Item Text display:
Display "(SPECIFY)" in same blue font used for interviewer
instructions.
Item Text:
ANY OTHER PERSON OR PLACE (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
KN25B1 - KNINFMCR ( KNQ1037 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
4:07:45 PM Tuesday, October 09, 2012
Page 16 of 149
KN25A
HARD EDIT CHECKS
Edit #1:
If KN25A - KNUPPICK includes 96/DoesntWantInfo, then KN25A
KNUPPICK should not include any other response.
If not true, display message: "INVALID RESPONSE. PLEASE
INDICATE EITHER THE SOURCES THE SP WOULD PREFER TO
USE TO KEEP UP WITH MEDICARE OR INDICATE THAT THE SP
DOESN’T WANT/NEED THIS INFORMATION."
TECHNICAL NOTES
DESIGN NOTES
4:07:45 PM Tuesday, October 09, 2012
Page 17 of 149
KN25B1
KN25B1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
KNINFMCR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
635
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If respondent is a Proxy, display "for (SP)".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
In the past year, have you tried to find any information [for (SP)]
about Medicare?
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:46 PM Tuesday, October 09, 2012
Page 18 of 149
KN25B1
Field1:
( KNQ1037 )
KNINFMCR
Cheshire Name:
KNOW.KNINFMCR
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN25C - KNINTMCR ( KNQ1039 )
English text: YES
No
KN25C - KNINTMCR ( KNQ1039 )
English text: NO
Attribute
Route
Don't know
KN25C - KNINTMCR ( KNQ1039 )
Refusal
KN25C - KNINTMCR ( KNQ1039 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
4:07:47 PM Tuesday, October 09, 2012
Page 19 of 149
KN25B1
DESIGN NOTES
4:07:47 PM Tuesday, October 09, 2012
Page 20 of 149
KN25C
KN25C
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNINTMCR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
660
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(more)" in parenthesis.
If respondent is a Proxy, display "for (SP)".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD KN13
Question Text:
How interested are you in getting (more) information [for (SP)] about
Medicare?
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:48 PM Tuesday, October 09, 2012
Page 21 of 149
KN25C
Field1:
( KNQ1039 )
KNINTMCR
Cheshire Name:
KNOW.KNINTMCR
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
Tinterest
1
No
No
Number Label
1 VeryInterested
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN26 - KNFOSATI ( KNQ1041 )
2
English text: VERY INTERESTED
SomewhatInterested
KN26 - KNFOSATI ( KNQ1041 )
3
English text: SOMEWHAT INTERESTED
NotVeryInterested
KN26 - KNFOSATI ( KNQ1041 )
4
English text: NOT VERY INTERESTED
NotAtAllInterested
KN26 - KNFOSATI ( KNQ1041 )
English text: NOT AT ALL INTERESTED
Attribute
Route
Don't know
KN26 - KNFOSATI ( KNQ1041 )
Refusal
KN26 - KNFOSATI ( KNQ1041 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
4:07:50 PM Tuesday, October 09, 2012
Page 22 of 149
KN25C
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
4:07:50 PM Tuesday, October 09, 2012
Page 23 of 149
KN26
KN26
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNFOSATI
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
700
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If respondent is proxy, display "for (SP)" .
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD KN6
Question Text:
How satisfied are you in general with the availability of information
about the Medicare program when you need it [for (SP)]?
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:50 PM Tuesday, October 09, 2012
Page 24 of 149
KN26
Field1:
( KNQ1041 )
KNFOSATI
Cheshire Name:
KNOW.KNFOSATI
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TSatisfy
1
No
No
Number Label
1 VerySatisfied
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN27INT - KN27IN ( KNQ1045 )
2
English text: VERY SATISFIED
Satisfied
KN27INT - KN27IN ( KNQ1045 )
3
English text: SATISFIED
Dissatisfied
KN27INT - KN27IN ( KNQ1045 )
4
English text: DISSATISFIED
VeryDissatisfied
KN27INT - KN27IN ( KNQ1045 )
5
English text: VERY DISSATISFIED
NotApplicable
KN27INT - KN27IN ( KNQ1045 )
English text: NOT APPLICABLE
Attribute
Route
Don't know
KN27INT - KN27IN ( KNQ1045 )
Refusal
KN27INT - KN27IN ( KNQ1045 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4
Respondent
4:07:52 PM Tuesday, October 09, 2012
On MRES where MRES.MRESRND = current round:
Page 25 of 149
KN26
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
4:07:52 PM Tuesday, October 09, 2012
Page 26 of 149
KN27INT
KN27INT
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
KN27IN
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
800
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If respondent is proxy, display "and (SP)" .
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Now I would like to ask you about publications that are available to
you [and (SP)] about the Medicare program.
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:53 PM Tuesday, October 09, 2012
Page 27 of 149
KN27INT
Field1:
( KNQ1045 )
KN27IN
Cheshire Name:
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN27 - KBOKRECD ( KNQ1050 )
English text: CONTINUE
Attribute
Route
Empty
KN27 - KBOKRECD ( KNQ1050 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
4:07:54 PM Tuesday, October 09, 2012
Page 28 of 149
KN27
KN27
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
KBOKRECD
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
900
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD KN7
Question Text:
Did [you/(SP)] receive a copy of this book, called "Medicare and You
2013", which gives an overview of the Medicare program? This
handbook is sent to Medicare beneficiaries every fall, and the cover
looks like this.
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:54 PM Tuesday, October 09, 2012
Page 29 of 149
KN27
Field1:
KBOKRECD
Cheshire Name:
( KNQ1050 )
KNOW.KBOKRECD
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN28 - KBOKREAD ( KNQ1055 )
English text: YES
No
BOX KN1A - (KNQ1062 )
English text: NO
Attribute
Route
Don't know
BOX KN1A - (KNQ1062 )
Refusal
BOX KN1A - (KNQ1062 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:07:55 PM Tuesday, October 09, 2012
Page 30 of 149
KN28
KN28
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KBOKREAD
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1000
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Would you say you have read this book thoroughly, that you have
read parts of it, or that you haven't read it at all?
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:56 PM Tuesday, October 09, 2012
Page 31 of 149
KN28
Field1:
KBOKREAD
( KNQ1055 )
KNOW.KBOKREAD
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TBookread
1
No
No
Number Label
1 ReadItThoroughly
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN29 - KBOKUNDR ( KNQ1060 )
2
English text: READ IT THOROUGHLY
ReadPartsOfIt
KN29 - KBOKUNDR ( KNQ1060 )
3
English text: READ PARTS OF IT
HaventReadItAtAll
BOX KN1A - (KNQ1062 )
English text: HAVEN'T READ IT AT ALL
Attribute
Don't know
Route
BOX KN1A - (KNQ1062 )
Refusal
BOX KN1A - (KNQ1062 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:07:57 PM Tuesday, October 09, 2012
Page 32 of 149
KN29
KN29
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KBOKUNDR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1200
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If KN28 - KBOKREAD = 2/ReadPartsOfIt, display "the parts you
read".
Else display "this book".
If KN28 - KBOKREAD = 2/ReadPartsOfIt, display "they were".
Else display "it was".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD KN1
Question Text:
How easy or difficult did you find (the parts you read/this book) to
understand?
[PROBE IF NECESSARY: Would you say (they were/it was) very
easy to understand, somewhat easy to understand, somewhat
difficult to understand, or very difficult to understand?]
4:07:58 PM Tuesday, October 09, 2012
Page 33 of 149
KN29
Int. Instr II:
INPUT FIELDS / ROUTING
KBOKUNDR
Field1:
Cheshire Name:
( KNQ1060 )
KNOW.KBOKUNDR
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TEasydiff
1
No
No
Number Label
1 VeryEasy
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX KN1A - (KNQ1062 )
2
English text: VERY EASY
SomewhatEasy
BOX KN1A - (KNQ1062 )
3
English text: SOMEWHAT EASY
SomewhatDifficult
BOX KN1A - (KNQ1062 )
4
English text: SOMEWHAT DIFFICULT
VeryDifficult
BOX KN1A - (KNQ1062 )
English text: VERY DIFFICULT
Attribute
Don't know
Route
BOX KN1A - (KNQ1062 )
Refusal
BOX KN1A - (KNQ1062 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4:07:59 PM Tuesday, October 09, 2012
Page 34 of 149
KN29
DESIGN NOTES
4:07:59 PM Tuesday, October 09, 2012
Page 35 of 149
BOX KN1A
BOX KN1A
Page Order # :
1225
BOX INSTRUCTIONS
( KNQ1062 )
IF THIS IS ROUND 65, GO TO KN50 - KNHAVCOM ( KNQ1233 ).
ELSEO GO TO KN34B1 - MDCOVMAM ( KNQ1065 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:07:59 PM Tuesday, October 09, 2012
Page 36 of 149
KN34B1
KN34B1
Page Order # :
Design Screen Type:
List
Fields:
Field 1:
MDCOVMAM
Field 2:
MDCOVPSA
Field 3:
MDCOVDNT
Field 4:
MDCOVFLU
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
1301
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If respondent is a Proxy, display "for (SP)".
Else do not display.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
4:08:00 PM Tuesday, October 09, 2012
We're interested in the knowledge that you may have gained when
getting information about the Medicare program [for (SP)]. I'm going
to read a list of health care services. For each item, please tell me
whether Medicare covers the service, or does not cover it.
Page 37 of 149
KN34B1
[READ IF NECESSARY: This is not a test. Your answers allow the
Medicare agency to know how well information about the program is
understood. At the end of the interview, I'll give you a fact sheet that
explains these issues.]
Does Medicare cover…
Int. Instr II:
INPUT FIELDS / ROUTING
MDCOVMAM
Field1:
Cheshire Name:
( KNQ1065 )
KNOW.MDCOVMAM
Item Text display:
Display "a." before question text.
Item Text:
an annual mammogram for women?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN34B1 - MDCOVPSA ( KNQ1070 )
English text: YES
No
KN34B1 - MDCOVPSA ( KNQ1070 )
English text: NO
Attribute
Don't know
Route
KN34B1 - MDCOVPSA ( KNQ1070 )
Refusal
KN34B1 - MDCOVPSA ( KNQ1070 )
4:08:03 PM Tuesday, October 09, 2012
Page 38 of 149
KN34B1
Field2:
MDCOVPSA
Cheshire Name:
( KNQ1070 )
KNOW.MDCOVPSA
Item Text display:
Display "b." before question text.
Item Text:
an annual PSA test for men (a blood test to detect prostate
cancer)?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN34B1 - MDCOVDNT ( KNQ1075 )
English text: YES
No
KN34B1 - MDCOVDNT ( KNQ1075 )
English text: NO
Attribute
Don't know
Route
KN34B1 - MDCOVDNT ( KNQ1075 )
Refusal
KN34B1 - MDCOVDNT ( KNQ1075 )
4:08:05 PM Tuesday, October 09, 2012
Page 39 of 149
KN34B1
Field3:
MDCOVDNT
Cheshire Name:
( KNQ1075 )
KNOW.MDCOVDNT
Item Text display:
Display "c." before question text.
Item Text:
a routine dental exam?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN34B1 - MDCOVFLU ( KNQ1080 )
English text: YES
No
KN34B1 - MDCOVFLU ( KNQ1080 )
English text: NO
Attribute
Route
Don't know
KN34B1 - MDCOVFLU ( KNQ1080 )
Refusal
KN34B1 - MDCOVFLU ( KNQ1080 )
4:08:08 PM Tuesday, October 09, 2012
Page 40 of 149
KN34B1
Field4:
( KNQ1080 )
MDCOVFLU
Cheshire Name:
KNOW.MDCOVFLU
Item Text display:
Display "d." before question text.
Item Text:
an annual flu shot?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN34B2 - MDCOVCOL ( KNQ1085 )
English text: YES
No
KN34B2 - MDCOVCOL ( KNQ1085 )
English text: NO
Attribute
Route
Don't know
KN34B2 - MDCOVCOL ( KNQ1085 )
Refusal
KN34B2 - MDCOVCOL ( KNQ1085 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
4:08:09 PM Tuesday, October 09, 2012
Page 41 of 149
KN34B1
4:08:09 PM Tuesday, October 09, 2012
Page 42 of 149
KN34B2
KN34B2
Page Order # :
Design Screen Type:
List
Fields:
Field 1:
MDCOVCOL
Field 2:
MDCOVCRD
Field 3:
MDCOVEYE
Field 4:
MDCOVDBT
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
1325
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Does Medicare cover…
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:10 PM Tuesday, October 09, 2012
Page 43 of 149
KN34B2
Field1:
MDCOVCOL
Cheshire Name:
( KNQ1085 )
KNOW.MDCOVCOL
Item Text display:
Display "e." before question text.
Item Text:
colon cancer screening tests, including a sigmoidoscopy or
colonoscopy?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN34B2 - MDCOVCRD ( KNQ1090 )
English text: YES
No
KN34B2 - MDCOVCRD ( KNQ1090 )
English text: NO
Attribute
Don't know
Route
KN34B2 - MDCOVCRD ( KNQ1090 )
Refusal
KN34B2 - MDCOVCRD ( KNQ1090 )
4:08:13 PM Tuesday, October 09, 2012
Page 44 of 149
KN34B2
Field2:
MDCOVCRD
Cheshire Name:
( KNQ1090 )
KNOW.MDCOVCRD
Item Text display:
Display "f." before question text.
Item Text:
cardiovascular screenings, including blood tests for
cholesterol levels?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN34B2 - MDCOVEYE ( KNQ1095 )
English text: YES
No
KN34B2 - MDCOVEYE ( KNQ1095 )
English text: NO
Attribute
Don't know
Route
KN34B2 - MDCOVEYE ( KNQ1095 )
Refusal
KN34B2 - MDCOVEYE ( KNQ1095 )
4:08:15 PM Tuesday, October 09, 2012
Page 45 of 149
KN34B2
Field3:
MDCOVEYE
Cheshire Name:
( KNQ1095 )
KNOW.MDCOVEYE
Item Text display:
Display "g." before question text.
Item Text:
a routine eye exam?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN34B2 - MDCOVDBT ( KNQ1100 )
English text: YES
No
KN34B2 - MDCOVDBT ( KNQ1100 )
English text: NO
Attribute
Route
Don't know
KN34B2 - MDCOVDBT ( KNQ1100 )
Refusal
KN34B2 - MDCOVDBT ( KNQ1100 )
4:08:18 PM Tuesday, October 09, 2012
Page 46 of 149
KN34B2
Field4:
MDCOVDBT
Cheshire Name:
( KNQ1100 )
KNOW.MDCOVDBT
Item Text display:
Display "h." before question text.
Item Text:
diabetes screening?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN34B3 - MDCOVHHS ( KNQ1105 )
English text: YES
No
KN34B3 - MDCOVHHS ( KNQ1105 )
English text: NO
Attribute
Route
Don't know
KN34B3 - MDCOVHHS ( KNQ1105 )
Refusal
KN34B3 - MDCOVHHS ( KNQ1105 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:19 PM Tuesday, October 09, 2012
Page 47 of 149
KN34B3
KN34B3
Page Order # :
Design Screen Type:
List
Fields:
Field 1:
MDCOVHHS
Field 2:
MDCOVNH
Field 3:
MDCOVER
Field 4:
MDPAPEX
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
1350
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Does Medicare cover…
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:20 PM Tuesday, October 09, 2012
Page 48 of 149
KN34B3
Field1:
MDCOVHHS
Cheshire Name:
( KNQ1105 )
KNOW.MDCOVHHS
Item Text display:
Display "i." before question text.
Item Text:
home health care services?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN34B3 - MDCOVNH ( KNQ1110 )
English text: YES
No
KN34B3 - MDCOVNH ( KNQ1110 )
English text: NO
Attribute
Route
Don't know
KN34B3 - MDCOVNH ( KNQ1110 )
Refusal
KN34B3 - MDCOVNH ( KNQ1110 )
4:08:22 PM Tuesday, October 09, 2012
Page 49 of 149
KN34B3
Field2:
MDCOVNH
Cheshire Name:
( KNQ1110 )
KNOW.MDCOVNH
Item Text display:
Display "j." before question text.
Item Text:
medical care in a nursing home?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN34B3 - MDCOVER ( KNQ1112 )
English text: YES
No
KN34B3 - MDCOVER ( KNQ1112 )
English text: NO
Attribute
Route
Don't know
KN34B3 - MDCOVER ( KNQ1112 )
Refusal
KN34B3 - MDCOVER ( KNQ1112 )
4:08:25 PM Tuesday, October 09, 2012
Page 50 of 149
KN34B3
Field3:
MDCOVER
Cheshire Name:
( KNQ1112 )
KNOW.MDCOVER
Item Text display:
Display "k." before question text.
Item Text:
a visit to a hospital emergency room for a life-threatening
situation?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN34B3 - MDPAPEX ( KNQ1114 )
English text: YES
No
KN34B3 - MDPAPEX ( KNQ1114 )
English text: NO
Attribute
Don't know
Route
KN34B3 - MDPAPEX ( KNQ1114 )
Refusal
KN34B3 - MDPAPEX ( KNQ1114 )
4:08:27 PM Tuesday, October 09, 2012
Page 51 of 149
KN34B3
Field4:
MDPAPEX
Cheshire Name:
( KNQ1114 )
KNOW.MDPAPEX
Item Text display:
Display "l." before question text.
Item Text:
a Pap test and pelvic exam for women?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN34B4 - MDPHYS ( KNQ1116 )
English text: YES
No
KN34B4 - MDPHYS ( KNQ1116 )
English text: NO
Attribute
Route
Don't know
KN34B4 - MDPHYS ( KNQ1116 )
Refusal
KN34B4 - MDPHYS ( KNQ1116 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:28 PM Tuesday, October 09, 2012
Page 52 of 149
KN34B4
KN34B4
Page Order # :
Design Screen Type:
List
Fields:
Field 1:
MDPHYS
Field 2:
MDSTPSMO
Field 3:
MDWEIGHT
Field 4:
MDPNEU
Field 5:
MDWELL
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
1375
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Does Medicare cover…
Int. Instr II:
4:08:29 PM Tuesday, October 09, 2012
Page 53 of 149
KN34B4
INPUT FIELDS / ROUTING
MDPHYS
Field1:
Cheshire Name:
( KNQ1116 )
KNOW.MDPHYS
Item Text display:
Display "m." before question text.
Item Text:
a "Welcome to Medicare" physical exam for new
beneficiaries?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN34B4 - MDSTPSMO ( KNQ1118 )
English text: YES
No
KN34B4 - MDSTPSMO ( KNQ1118 )
English text: NO
Attribute
Don't know
Route
KN34B4 - MDSTPSMO ( KNQ1118 )
Refusal
KN34B4 - MDSTPSMO ( KNQ1118 )
4:08:32 PM Tuesday, October 09, 2012
Page 54 of 149
KN34B4
Field2:
MDSTPSMO
Cheshire Name:
( KNQ1118 )
KNOW.MDSTPSMO
Item Text display:
Display "n." before question text.
Item Text:
counseling to stop smoking?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN34B4 - MDWEIGHT ( KNQ1120 )
English text: YES
No
KN34B4 - MDWEIGHT ( KNQ1120 )
English text: NO
Attribute
Route
Don't know
KN34B4 - MDWEIGHT ( KNQ1120 )
Refusal
KN34B4 - MDWEIGHT ( KNQ1120 )
4:08:34 PM Tuesday, October 09, 2012
Page 55 of 149
KN34B4
Field3:
MDWEIGHT
Cheshire Name:
( KNQ1120 )
KNOW.MDWEIGHT
Item Text display:
Display "o." before question text.
Item Text:
weight-loss counseling?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN34B4 - MDPNEU ( KNQ1122 )
English text: YES
No
KN34B4 - MDPNEU ( KNQ1122 )
English text: NO
Attribute
Route
Don't know
KN34B4 - MDPNEU ( KNQ1122 )
Refusal
KN34B4 - MDPNEU ( KNQ1122 )
4:08:37 PM Tuesday, October 09, 2012
Page 56 of 149
KN34B4
Field4:
MDPNEU
Cheshire Name:
( KNQ1122 )
KNOW.MDPNEU
Item Text display:
Display "p." before question text.
Item Text:
a pneumonia shot?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN34B4 - MDWELL ( KNQ1124 )
English text: YES
No
KN34B4 - MDWELL ( KNQ1124 )
English text: NO
Attribute
Route
Don't know
KN34B4 - MDWELL ( KNQ1124 )
Refusal
KN34B4 - MDWELL ( KNQ1124 )
4:08:39 PM Tuesday, October 09, 2012
Page 57 of 149
KN34B4
Field5:
MDWELL
Cheshire Name:
( KNQ1124 )
KNOW.MDWELL
Item Text display:
Display "q." before question text.
Item Text:
a yearly “Wellness” visit once every twelve months?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KNTFINT1 - KNTFIN1 ( KNQ1126 )
English text: YES
No
KNTFINT1 - KNTFIN1 ( KNQ1126 )
English text: NO
Attribute
Route
Don't know
KNTFINT1 - KNTFIN1 ( KNQ1126 )
Refusal
KNTFINT1 - KNTFIN1 ( KNQ1126 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:40 PM Tuesday, October 09, 2012
Page 58 of 149
KNTFINT1
KNTFINT1
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
KNTFIN1
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1400
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Now, I'm going to read a series of statements about Medicare. For
each one, please tell me whether you think it is true or false, or
whether you aren't sure.
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:41 PM Tuesday, October 09, 2012
Page 59 of 149
KNTFINT1
Field1:
KNTFIN1
Cheshire Name:
( KNQ1126 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX KN2 - (KNQ1128 )
English text: CONTINUE
Attribute
Route
Empty
BOX KN2 - (KNQ1128 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:42 PM Tuesday, October 09, 2012
Page 60 of 149
BOX KN2
BOX KN2
Page Order # :
1450
BOX INSTRUCTIONS
( KNQ1128 )
IF THIS IS ROUND 62, GO TO KNTF5 - KNELIG ( KNQ1136 ).
ELSE GO TO KNTF4 - KNOUTUS ( KNQ1130 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:08:42 PM Tuesday, October 09, 2012
Page 61 of 149
KNTF4
KNTF4
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNOUTUS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1500
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Medicare usually covers non-emergency care received while a
beneficiary is traveling outside the United States.
[PROBE: Do you think this is true or false or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:42 PM Tuesday, October 09, 2012
Page 62 of 149
KNTF4
Field1:
KNOUTUS
Cheshire Name:
( KNQ1130 )
KNOW.KNOUTUS
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX KN3 - (KNQ1142 )
2
English text: TRUE
False
BOX KN3 - (KNQ1142 )
3
English text: FALSE
NotSure
BOX KN3 - (KNQ1142 )
English text: NOT SURE
Attribute
Refusal
Route
BOX KN3 - (KNQ1142 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:43 PM Tuesday, October 09, 2012
Page 63 of 149
KNTF5
KNTF5
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNELIG
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1600
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
People are eligible for Medicare because they have low or moderate
incomes.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:44 PM Tuesday, October 09, 2012
Page 64 of 149
KNTF5
Field1:
KNELIG
Cheshire Name:
( KNQ1136 )
KNOW.KNELIG
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
KNTF6A - KNCHOCOV ( KNQ1138 )
2
English text: TRUE
False
KNTF6A - KNCHOCOV ( KNQ1138 )
3
English text: FALSE
NotSure
KNTF6A - KNCHOCOV ( KNQ1138 )
English text: NOT SURE
Attribute
Refusal
Route
KNTF6A - KNCHOCOV ( KNQ1138 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:45 PM Tuesday, October 09, 2012
Page 65 of 149
KNTF6A
KNTF6A
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNCHOCOV
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1630
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Most people covered by Medicare have choices about how they get
their Medicare health and prescription drug coverage; for example,
they can choose between fee-for-service coverage and coverage
provided by a managed care plan.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:46 PM Tuesday, October 09, 2012
Page 66 of 149
KNTF6A
Field1:
KNCHOCOV
Cheshire Name:
( KNQ1138 )
KNOW.KNCHOCOV
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
KNTF7 - KNPREMI ( KNQ1140 )
2
English text: TRUE
False
KNTF7 - KNPREMI ( KNQ1140 )
3
English text: FALSE
NotSure
KNTF7 - KNPREMI ( KNQ1140 )
English text: NOT SURE
Attribute
Refusal
Route
KNTF7 - KNPREMI ( KNQ1140 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:47 PM Tuesday, October 09, 2012
Page 67 of 149
KNTF7
KNTF7
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNPREMI
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1660
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
The premium or monthly payment that Medicare beneficiaries have
to pay for Medicare Part B can change at any time during the year.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:47 PM Tuesday, October 09, 2012
Page 68 of 149
KNTF7
Field1:
KNPREMI
Cheshire Name:
( KNQ1140 )
KNOW.KNPREMI
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX KN3 - (KNQ1142 )
2
English text: TRUE
False
BOX KN3 - (KNQ1142 )
3
English text: FALSE
NotSure
BOX KN3 - (KNQ1142 )
English text: NOT SURE
Attribute
Refusal
Route
BOX KN3 - (KNQ1142 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:48 PM Tuesday, October 09, 2012
Page 69 of 149
BOX KN3
BOX KN3
Page Order # :
1690
BOX INSTRUCTIONS
( KNQ1142 )
IF THIS IS ROUND 62, GO TO KNTF13 - KNADVTG ( KNQ1146 ).
ELSE GO TO KNTF10 - KNSAVMSP ( KNQ1144 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:08:49 PM Tuesday, October 09, 2012
Page 70 of 149
KNTF10
KNTF10
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNSAVMSP
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1700
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
People with limited income and resources may save money on their
Medicare costs with the help of Medicare Savings Programs.
[PROBE: Do you think this is true or false or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:49 PM Tuesday, October 09, 2012
Page 71 of 149
KNTF10
Field1:
KNSAVMSP
Cheshire Name:
( KNQ1144 )
KNOW.KNSAVMSP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
KNTF13 - KNADVTG ( KNQ1146 )
2
English text: TRUE
False
KNTF13 - KNADVTG ( KNQ1146 )
3
English text: FALSE
NotSure
KNTF13 - KNADVTG ( KNQ1146 )
English text: NOT SURE
Attribute
Refusal
Route
KNTF13 - KNADVTG ( KNQ1146 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:51 PM Tuesday, October 09, 2012
Page 72 of 149
KNTF13
KNTF13
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNADVTG
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1800
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Medicare Advantage plans, such as HMOs and PPOs, often cover
more health services, like eye exams or hearing aids, than original
Medicare.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:51 PM Tuesday, October 09, 2012
Page 73 of 149
KNTF13
Field1:
KNADVTG
Cheshire Name:
( KNQ1146 )
KNOW.KNADVTG
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX KN4 - (KNQ1148 )
2
English text: TRUE
False
BOX KN4 - (KNQ1148 )
3
English text: FALSE
NotSure
BOX KN4 - (KNQ1148 )
English text: NOT SURE
Attribute
Refusal
Route
BOX KN4 - (KNQ1148 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:53 PM Tuesday, October 09, 2012
Page 74 of 149
BOX KN4
BOX KN4
Page Order # :
1840
BOX INSTRUCTIONS
( KNQ1148 )
IF THIS IS ROUND 62, GO TO KNTF16 - KNLIMCHC ( KNQ1162 ).
ELSE GO TO KNTF14 - KNADVCHG ( KNQ1155 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:08:53 PM Tuesday, October 09, 2012
Page 75 of 149
KNTF14
KNTF14
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNADVCHG
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1880
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Most people enrolled in a Medicare Advantage plan can change to
another plan any time during the year.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:53 PM Tuesday, October 09, 2012
Page 76 of 149
KNTF14
Field1:
KNADVCHG
Cheshire Name:
( KNQ1155 )
KNOW.KNADVCHG
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
KNTF18 - KNCOVORG ( KNQ1164 )
2
English text: TRUE
False
KNTF18 - KNCOVORG ( KNQ1164 )
3
English text: FALSE
NotSure
KNTF18 - KNCOVORG ( KNQ1164 )
English text: NOT SURE
Attribute
Refusal
Route
KNTF18 - KNCOVORG ( KNQ1164 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:55 PM Tuesday, October 09, 2012
Page 77 of 149
KNTF16
KNTF16
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNLIMCHC
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1900
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
If you are enrolled in a Medicare Advantage plan, your choice of
doctors or hospitals may be limited.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:56 PM Tuesday, October 09, 2012
Page 78 of 149
KNTF16
Field1:
KNLIMCHC
Cheshire Name:
( KNQ1162 )
KNOW.KNLIMCHC
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
KNTF18 - KNCOVORG ( KNQ1164 )
2
English text: TRUE
False
KNTF18 - KNCOVORG ( KNQ1164 )
3
English text: FALSE
NotSure
KNTF18 - KNCOVORG ( KNQ1164 )
English text: NOT SURE
Attribute
Refusal
Route
KNTF18 - KNCOVORG ( KNQ1164 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:57 PM Tuesday, October 09, 2012
Page 79 of 149
KNTF18
KNTF18
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNCOVORG
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2000
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
If your Medicare Advantage plan leaves the Medicare program and
you do not choose another one, you will be covered by the Original
Medicare plan.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:58 PM Tuesday, October 09, 2012
Page 80 of 149
KNTF18
Field1:
KNCOVORG
Cheshire Name:
( KNQ1164 )
KNOW.KNCOVORG
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
KNTF19 - KNRAISE ( KNQ1166 )
2
English text: TRUE
False
KNTF19 - KNRAISE ( KNQ1166 )
3
English text: FALSE
NotSure
KNTF19 - KNRAISE ( KNQ1166 )
English text: NOT SURE
Attribute
Refusal
Route
KNTF19 - KNRAISE ( KNQ1166 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:00 PM Tuesday, October 09, 2012
Page 81 of 149
KNTF19
KNTF19
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNRAISE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2100
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
A Medicare Advantage plan can raise its fees or change its benefits
each year.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:00 PM Tuesday, October 09, 2012
Page 82 of 149
KNTF19
Field1:
KNRAISE
Cheshire Name:
( KNQ1166 )
KNOW.KNRAISE
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
KNTF21 - KNCOMOPT ( KNQ1168 )
2
English text: TRUE
False
KNTF21 - KNCOMOPT ( KNQ1168 )
3
English text: FALSE
NotSure
KNTF21 - KNCOMOPT ( KNQ1168 )
English text: NOT SURE
Attribute
Refusal
Route
KNTF21 - KNCOMOPT ( KNQ1168 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:02 PM Tuesday, October 09, 2012
Page 83 of 149
KNTF21
KNTF21
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNCOMOPT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2200
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Medicare offers a free counseling service in your state that
beneficiaries can use to help them understand and compare health
insurance options.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:03 PM Tuesday, October 09, 2012
Page 84 of 149
KNTF21
Field1:
KNCOMOPT
Cheshire Name:
( KNQ1168 )
KNOW.KNCOMOPT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
KNTF25 - KNRPTHMO ( KNQ1175 )
2
English text: TRUE
False
KNTF25 - KNRPTHMO ( KNQ1175 )
3
English text: FALSE
NotSure
KNTF25 - KNRPTHMO ( KNQ1175 )
English text: NOT SURE
Attribute
Refusal
Route
KNTF25 - KNRPTHMO ( KNQ1175 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:04 PM Tuesday, October 09, 2012
Page 85 of 149
KNTF25
KNTF25
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNRPTHMO
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2500
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
People can report complaints to Medicare about their Medicare
Advantage plans or supplemental insurance policies if they are not
satisfied with them.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:05 PM Tuesday, October 09, 2012
Page 86 of 149
KNTF25
Field1:
KNRPTHMO
Cheshire Name:
( KNQ1175 )
KNOW.KNRPTHMO
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX KN6 - (KNQ1177 )
2
English text: TRUE
False
BOX KN6 - (KNQ1177 )
3
English text: FALSE
NotSure
BOX KN6 - (KNQ1177 )
English text: NOT SURE
Attribute
Refusal
Route
BOX KN6 - (KNQ1177 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:06 PM Tuesday, October 09, 2012
Page 87 of 149
BOX KN6
BOX KN6
Page Order # :
2550
BOX INSTRUCTIONS
( KNQ1177 )
IF THIS IS ROUND 62, GO TO KNTF28 - KNAPLDEC ( KNQ1180 ).
ELSE GO TO BOX KN6A - (KNQ1185 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:09:06 PM Tuesday, October 09, 2012
Page 88 of 149
KNTF28
KNTF28
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNAPLDEC
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2600
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
You have a right to file an appeal if you disagree with decisions that
are made by Medicare or your Medicare Advantage plan.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:07 PM Tuesday, October 09, 2012
Page 89 of 149
KNTF28
Field1:
KNAPLDEC
Cheshire Name:
( KNQ1180 )
KNOW.KNAPLDEC
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
KNTF29 - KNOUTPOC ( KNQ1183 )
2
English text: TRUE
False
KNTF29 - KNOUTPOC ( KNQ1183 )
3
English text: FALSE
NotSure
KNTF29 - KNOUTPOC ( KNQ1183 )
English text: NOT SURE
Attribute
Refusal
Route
KNTF29 - KNOUTPOC ( KNQ1183 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:08 PM Tuesday, October 09, 2012
Page 90 of 149
KNTF29
KNTF29
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNOUTPOC
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2640
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
No matter which Medicare health insurance option you choose, your
out-of-pocket costs will be the same.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:08 PM Tuesday, October 09, 2012
Page 91 of 149
KNTF29
Field1:
KNOUTPOC
Cheshire Name:
( KNQ1183 )
KNOUTPOC
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX KN6A - (KNQ1185 )
2
English text: TRUE
False
BOX KN6A - (KNQ1185 )
3
English text: FALSE
NotSure
BOX KN6A - (KNQ1185 )
English text: NOT SURE
Attribute
Refusal
Route
BOX KN6A - (KNQ1185 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:09 PM Tuesday, October 09, 2012
Page 92 of 149
BOX KN6A
BOX KN6A
Page Order # :
2670
BOX INSTRUCTIONS
( KNQ1185 )
IF (SP HAS A "CURRENT" MEDICARE PRESCRIPTION DRUG PLAN) OR
(SP HAS A "CURRENT" MEDICARE MANAGED CARE PLAN THAT HAS RX
COVERAGE) OR (SP HAS A "CURRENT" PRIVATE PLAN THAT HAS RX
COVERAGE), GO TO KNTFINT2 - KNTFIN2 ( KNQ1187 ).
ELSE GO TO KN50 - KNHAVCOM ( KNQ1233 ).
ASSIGNMENTS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
342
MPDPCurrent
SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
344
MHMOCurrWithRx
SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
354
PrivPlanCurrWithRx
SP has a "current" Private Plan with RX coverage =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRORND=current round & (COVTIME=1/WholeTime or
COVNOW=1/Yes) & PRVRXCOV=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
4:09:10 PM Tuesday, October 09, 2012
Page 93 of 149
KNTFINT2
KNTFINT2
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
KNTFIN2
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2700
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
The next series of statements are about Medicare prescription drug
coverage. Again, for each one, please tell me whether you think it is
true or false, or whether you aren't sure.
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:10 PM Tuesday, October 09, 2012
Page 94 of 149
KNTFINT2
Field1:
KNTFIN2
Cheshire Name:
( KNQ1187 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
KNTF30 - KNVOLMED ( KNQ1193 )
English text: CONTINUE
Attribute
Route
Empty
KNTF30 - KNVOLMED ( KNQ1193 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:11 PM Tuesday, October 09, 2012
Page 95 of 149
KNTF30
KNTF30
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNVOLMED
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2800
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Everyone with Medicare can choose to enroll in the voluntary
Medicare prescription drug coverage regardless of their income or
health.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:12 PM Tuesday, October 09, 2012
Page 96 of 149
KNTF30
Field1:
KNVOLMED
Cheshire Name:
( KNQ1193 )
KNOW.KNVOLMED
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
KNTF32 - KNRXLIST ( KNQ1200 )
2
English text: TRUE
False
KNTF32 - KNRXLIST ( KNQ1200 )
3
English text: FALSE
NotSure
KNTF32 - KNRXLIST ( KNQ1200 )
English text: NOT SURE
Attribute
Refusal
Route
KNTF32 - KNRXLIST ( KNQ1200 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:14 PM Tuesday, October 09, 2012
Page 97 of 149
KNTF32
KNTF32
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNRXLIST
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3200
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
All Medicare prescription drug plans cover the same list of
prescription drugs.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:14 PM Tuesday, October 09, 2012
Page 98 of 149
KNTF32
Field1:
KNRXLIST
Cheshire Name:
( KNQ1200 )
KNOW.KNRXLIST
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX KN6B - (KNQ1203 )
2
English text: TRUE
False
BOX KN6B - (KNQ1203 )
3
English text: FALSE
NotSure
BOX KN6B - (KNQ1203 )
English text: NOT SURE
Attribute
Refusal
Route
BOX KN6B - (KNQ1203 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:15 PM Tuesday, October 09, 2012
Page 99 of 149
BOX KN6B
BOX KN6B
Page Order # :
3240
BOX INSTRUCTIONS
( KNQ1203 )
IF THIS IS ROUND 62, GO TO KNTF33 - KNCHGCST ( KNQ1206 ).
ELSE GO TO KNTF35 - KNACCPLN ( KNQ1208 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:09:15 PM Tuesday, October 09, 2012
Page 100 of 149
KNTF33
KNTF33
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNCHGCST
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3280
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Medicare prescription drug plans can change the price of
prescription drugs only once per year.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:16 PM Tuesday, October 09, 2012
Page 101 of 149
KNTF33
Field1:
KNCHGCST
Cheshire Name:
( KNQ1206 )
KNOW.KNCHGCST
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
KNTF35 - KNACCPLN ( KNQ1208 )
2
English text: TRUE
False
KNTF35 - KNACCPLN ( KNQ1208 )
3
English text: FALSE
NotSure
KNTF35 - KNACCPLN ( KNQ1208 )
English text: NOT SURE
Attribute
Refusal
Route
KNTF35 - KNACCPLN ( KNQ1208 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:17 PM Tuesday, October 09, 2012
Page 102 of 149
KNTF35
KNTF35
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNACCPLN
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3300
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
If you join a Medicare prescription drug plan, your plan must be
accepted at all pharmacies in the U.S.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:18 PM Tuesday, October 09, 2012
Page 103 of 149
KNTF35
Field1:
KNACCPLN
Cheshire Name:
( KNQ1208 )
KNOW.KNACCPLN
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX KN6C - (KNQ1212 )
2
English text: TRUE
False
BOX KN6C - (KNQ1212 )
3
English text: FALSE
NotSure
BOX KN6C - (KNQ1212 )
English text: NOT SURE
Attribute
Refusal
Route
BOX KN6C - (KNQ1212 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:19 PM Tuesday, October 09, 2012
Page 104 of 149
BOX KN6C
BOX KN6C
Page Order # :
3340
BOX INSTRUCTIONS
( KNQ1212 )
IF THIS IS ROUND 62, GO TO KNTF37 - KNLIMINC ( KNQ1222 ).
ELSE GO TO KNTF36 - KNCHGLST ( KNQ1218 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:09:19 PM Tuesday, October 09, 2012
Page 105 of 149
KNTF36
KNTF36
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNCHGLST
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3360
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Medicare prescription drug plans can change the list of prescription
drugs that they cover at any time during the year.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:20 PM Tuesday, October 09, 2012
Page 106 of 149
KNTF36
Field1:
KNCHGLST
Cheshire Name:
( KNQ1218 )
KNOW.KNCHGLST
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
KNTF37 - KNLIMINC ( KNQ1222 )
2
English text: TRUE
False
KNTF37 - KNLIMINC ( KNQ1222 )
3
English text: FALSE
NotSure
KNTF37 - KNLIMINC ( KNQ1222 )
English text: NOT SURE
Attribute
Refusal
Route
KNTF37 - KNLIMINC ( KNQ1222 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:21 PM Tuesday, October 09, 2012
Page 107 of 149
KNTF37
KNTF37
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNLIMINC
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3400
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
If you have limited income and resources, you may get extra help to
cover prescription drugs for little or no cost to you.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:22 PM Tuesday, October 09, 2012
Page 108 of 149
KNTF37
Field1:
KNLIMINC
Cheshire Name:
( KNQ1222 )
KNOW.KNLIMINC
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX KN6D - (KNQ1223 )
2
English text: TRUE
False
BOX KN6D - (KNQ1223 )
3
English text: FALSE
NotSure
BOX KN6D - (KNQ1223 )
English text: NOT SURE
Attribute
Refusal
Route
BOX KN6D - (KNQ1223 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:23 PM Tuesday, October 09, 2012
Page 109 of 149
BOX KN6D
BOX KN6D
Page Order # :
3440
BOX INSTRUCTIONS
( KNQ1223 )
IF THIS IS ROUND 62, GO TO KNTF38 - KNONLCHG ( KNQ1226 ).
ELSE GO TO KNTF39 - KNOUTPKT ( KNQ1229 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:09:23 PM Tuesday, October 09, 2012
Page 110 of 149
KNTF38
KNTF38
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNONLCHG
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3480
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Generally, once you join a Medicare prescription drug plan, you can
only change to another plan during the "Annual Enrollment period"
each year.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:24 PM Tuesday, October 09, 2012
Page 111 of 149
KNTF38
Field1:
KNONLCHG
Cheshire Name:
( KNQ1226 )
KNOW.KNONLCHG
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
KNTF39 - KNOUTPKT ( KNQ1229 )
2
English text: TRUE
False
KNTF39 - KNOUTPKT ( KNQ1229 )
3
English text: FALSE
NotSure
KNTF39 - KNOUTPKT ( KNQ1229 )
English text: NOT SURE
Attribute
Refusal
Route
KNTF39 - KNOUTPKT ( KNQ1229 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:25 PM Tuesday, October 09, 2012
Page 112 of 149
KNTF39
KNTF39
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNOUTPKT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3500
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Your out-of-pocket costs are the same in all Medicare prescription
drug plans.
[PROBE: Do you think this is true or false, or are you not sure?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:26 PM Tuesday, October 09, 2012
Page 113 of 149
KNTF39
Field1:
KNOUTPKT
Cheshire Name:
( KNQ1229 )
KNOW.KNOUTPKT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTruefals
1
No
No
Number Label
1 True
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN50 - KNHAVCOM ( KNQ1233 )
2
English text: TRUE
False
KN50 - KNHAVCOM ( KNQ1233 )
3
English text: FALSE
NotSure
KN50 - KNHAVCOM ( KNQ1233 )
English text: NOT SURE
Attribute
Refusal
Route
KN50 - KNHAVCOM ( KNQ1233 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:27 PM Tuesday, October 09, 2012
Page 114 of 149
KN50
KN50
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
KNHAVCOM
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3800
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Next, I'd like to ask about [your/(SP's)] use of computers.
[Do you/Does (SP)] have a personal computer in (your/his/her)
home?
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:28 PM Tuesday, October 09, 2012
Page 115 of 149
KN50
Field1:
KNHAVCOM
Cheshire Name:
( KNQ1233 )
KNOW.KNHAVCOM
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN51INT - KN51IN ( KNQ1235 )
English text: YES
No
KN51INT - KN51IN ( KNQ1235 )
English text: NO
Attribute
Route
Don't know
KN51INT - KN51IN ( KNQ1235 )
Refusal
KN51INT - KN51IN ( KNQ1235 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:29 PM Tuesday, October 09, 2012
Page 116 of 149
KN51INT
KN51INT
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
KN51IN
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
3900
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Some people use the Internet to get different kinds of information.
The next questions ask about the Internet.
[EXPLAIN IF NECESSARY: The Internet includes web sites, e-mail,
newsgroups, and other forums.]
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:30 PM Tuesday, October 09, 2012
Page 117 of 149
KN51INT
Field1:
KN51IN
Cheshire Name:
( KNQ1235 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN51A - KNETPERS ( KNQ1240 )
English text: CONTINUE
Attribute
Route
Empty
KN51A - KNETPERS ( KNQ1240 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:31 PM Tuesday, October 09, 2012
Page 118 of 149
KN51A
KN51A
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNETPERS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
4000
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Do you/Does (SP)] personally ever use the Internet to get
information of any kind?
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:31 PM Tuesday, October 09, 2012
Page 119 of 149
KN51A
Field1:
KNETPERS
Cheshire Name:
( KNQ1240 )
KNOW.KNETPERS
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesnonet
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN51C - KNETOFTN ( KNQ1246 )
2
English text: YES
No
KN51B - KNETFRND ( KNQ1242 )
3
English text: NO
NeverHeardOfTheInternet
BOX KN8 - (KNQ2266 )
English text: NEVER HEARD OF THE INTERNET
Attribute
Don't know
Route
BOX KN8 - (KNQ2266 )
Refusal
BOX KN8 - (KNQ2266 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:33 PM Tuesday, October 09, 2012
Page 120 of 149
KN51B
KN51B
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
KNETFRND
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
4100
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Do you/Does(SP)] have someone else, such as a friend, relative, or
anyone else, get information for (you/him/her) on the Internet?
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:33 PM Tuesday, October 09, 2012
Page 121 of 149
KN51B
Field1:
KNETFRND
Cheshire Name:
( KNQ1242 )
KNOW.KNETFRND
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN51C - KNETOFTN ( KNQ1246 )
English text: YES
No
BOX KN8 - (KNQ2266 )
English text: NO
Attribute
Route
Don't know
BOX KN8 - (KNQ2266 )
Refusal
BOX KN8 - (KNQ2266 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:35 PM Tuesday, October 09, 2012
Page 122 of 149
KN51C
KN51C
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KNETOFTN
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
4200
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
How often [do you/does (SP)] access the Internet to seek
information, either on (your/his/her) own or with someone else's
help?
Please do not include any time spent reading or sending e-mail.
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:35 PM Tuesday, October 09, 2012
Page 123 of 149
KN51C
Field1:
KNETOFTN
Cheshire Name:
( KNQ1246 )
KNOW.KNETOFTN
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
Toften
1
No
No
Number Label
1 EveryDay
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX KN7 - (KNQ1248 )
2
English text: EVERY DAY
TimesAWeek
BOX KN7 - (KNQ1248 )
3
English text: A FEW TIMES A WEEK
TimesPerMonth
BOX KN7 - (KNQ1248 )
4
English text: A FEW TIMES PER MONTH
TimesPerYear
BOX KN7 - (KNQ1248 )
English text: A FEW TIMES PER YEAR OR LESS
Attribute
Route
Don't know
BOX KN7 - (KNQ1248 )
Refusal
BOX KN7 - (KNQ1248 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:37 PM Tuesday, October 09, 2012
Page 124 of 149
BOX KN7
BOX KN7
Page Order # :
4300
BOX INSTRUCTIONS
( KNQ1248 )
IF SP DID NOT REPORT VISITING OR ACCESSING THE OFFICAL
WEBSITE FOR MEDICARE INFORMATION IN ANY PREVIOUS ROUND GO
TO KN53 - KVSITWEB ( KNQ1250 ).
ELSE GO TO BOX KN7A - (KNQ2000 ).
ASSIGNMENTS
TECHNICAL NOTES
420
KNSPNotCheckWebsite
SP did not report visiting or accessing the official website
for Medicare in any previous round =
There is no KNOW where KNOW.KNOWRND < current
round and KNOW.KVSITWEB = 1/Yes.
DESIGN NOTES
4:09:37 PM Tuesday, October 09, 2012
Page 125 of 149
KN53
KN53
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
KVSITWEB
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
4400
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If KN51B - KNETFRND = 1/YES, display "Has anyone" .
Else display "[Have you/Has (SP)]".
If KN51B - KNETFRND = 1/YES, display "- for [you/(SP)]".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
(Has anyone/[Have you/Has (SP)]) ever visited or ever accessed the
official website for Medicare information - www.medicare.gov (- for
[you/(SP)])?
Int. Instr II:
4:09:37 PM Tuesday, October 09, 2012
Page 126 of 149
KN53
INPUT FIELDS / ROUTING
KVSITWEB
Field1:
Cheshire Name:
( KNQ1250 )
KNOW.KVSITWEB
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX KN7A - (KNQ2000 )
English text: YES
No
BOX KN7A - (KNQ2000 )
English text: NO
Attribute
Don't know
Route
BOX KN7A - (KNQ2000 )
Refusal
BOX KN7A - (KNQ2000 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:38 PM Tuesday, October 09, 2012
Page 127 of 149
BOX KN7A
BOX KN7A
Page Order # :
4415
BOX INSTRUCTIONS
( KNQ2000 )
IF THIS IS ROUND 65, GO TO KN53D - KNDOCREC ( KNQ2262 ).
ELSE GO TO KN53A - KNHOSCOM ( KNQ2252 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:09:39 PM Tuesday, October 09, 2012
Page 128 of 149
KN53A
KN53A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
KNHOSCOM
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
4416
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If KN51B-KNETFRND = 1/Yes, display "has anyone".
Else display "[have you/has (SP)]".
If KN51B-KNETFRND = 1/Yes, display "for [you/(SP)]".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
"Hospital Compare" is a tool on the Medicare website that helps
beneficiaries compare the quality of care and patient experiences at
hospitals in their area. In the past year, (has anyone/[have you/has
(SP)]) visited the Medicare website to use "Hospital Compare" (for
[you/(SP)])?
Int. Instr II:
4:09:39 PM Tuesday, October 09, 2012
Page 129 of 149
KN53A
INPUT FIELDS / ROUTING
KNHOSCOM
Field1:
Cheshire Name:
( KNQ2252 )
KNOW.KNHOSCOM
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN53B - KNDPLFND ( KNQ2254 )
English text: YES
No
KN53B - KNDPLFND ( KNQ2254 )
English text: NO
Attribute
Don't know
Route
KN53B - KNDPLFND ( KNQ2254 )
Refusal
KN53B - KNDPLFND ( KNQ2254 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:40 PM Tuesday, October 09, 2012
Page 130 of 149
KN53B
KN53B
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
KNDPLFND
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
4432
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If KN51B-KNETFRND = 1/Yes, display "has anyone".
Else display "[have you/has (SP)]".
If KN51B-KNETFRND = 1/Yes, display "for [you/(SP)]".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
4:09:41 PM Tuesday, October 09, 2012
The "Medicare Prescription Drug Plan Finder" is a tool on the
Medicare website that helps beneficiaries compare Medicare
prescription drug plans in their area. In the past year, (has
anyone/[have you/has (SP)]) visited the Medicare website to
compare the quality and performance of Medicare prescription drug
plans (for [you/(SP)])?
Page 131 of 149
KN53B
Int. Instr II:
INPUT FIELDS / ROUTING
KNDPLFND
Field1:
Cheshire Name:
( KNQ2254 )
KNOW.KNDPLFND
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN53D - KNDOCREC ( KNQ2262 )
English text: YES
No
KN53D - KNDOCREC ( KNQ2262 )
English text: NO
Attribute
Route
Don't know
KN53D - KNDOCREC ( KNQ2262 )
Refusal
KN53D - KNDOCREC ( KNQ2262 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:42 PM Tuesday, October 09, 2012
Page 132 of 149
KN53D
KN53D
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
KNDOCREC
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
4475
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If respondent is a Proxy, display "visits".
Else display "visit".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Many health care providers are beginning to use electronic or
computer-based medical records instead of using paper-based
records.
When [you/(SP)] (visit/visits) (your/his/her) usual doctor, does the
doctor generally enter [your/(SP's)] health information into a
computer while (you are/he is/she is) present?
[EXPLAIN IF NECESSARY: "Health Information" includes
information such as symptoms, vital signs, test results, or prescribed
4:09:42 PM Tuesday, October 09, 2012
Page 133 of 149
KN53D
medicines.]
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
KNDOCREC
Cheshire Name:
( KNQ2262 )
KNOW.KNDOCREC
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX KN8 - (KNQ2266 )
English text: YES
No
BOX KN8 - (KNQ2266 )
English text: NO
Attribute
Route
Don't know
BOX KN8 - (KNQ2266 )
Refusal
BOX KN8 - (KNQ2266 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:43 PM Tuesday, October 09, 2012
Page 134 of 149
BOX KN8
BOX KN8
Page Order # :
4500
BOX INSTRUCTIONS
( KNQ2266 )
IF PROXY IS RESPONDENT, GO TO BOX KN9 - (KNQ2270 ).
ELSE GO TO KN54 - KCHIHELP ( KNQ2268 ).
ASSIGNMENTS
TECHNICAL NOTES
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
4:09:43 PM Tuesday, October 09, 2012
Page 135 of 149
KN54
KN54
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KCHIHELP
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
4600
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Most of the time, do you make decisions about Medicare health
insurance on your own, do you get help from someone in making
these decisions, or do you rely on someone else to make decisions
about health insurance for you?
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:44 PM Tuesday, October 09, 2012
Page 136 of 149
KN54
Field1:
KCHIHELP
Cheshire Name:
( KNQ2268 )
KNOW.KCHIHELP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TMchihelp
1
No
No
Number Label
1 MakesDecisionsOnOwn
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX KN9 - (KNQ2270 )
2
English text: MAKES DECISIONS ON OWN
GetsHelpOnDecisions
BOX KN9 - (KNQ2270 )
3
English text: GETS HELP ON DECISIONS
SomeoneElseMakesDecisions
BOX KN9 - (KNQ2270 )
English text: SOMEONE ELSE MAKES DECISIONS
Attribute
Don't know
Route
BOX KN9 - (KNQ2270 )
Refusal
BOX KN9 - (KNQ2270 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:45 PM Tuesday, October 09, 2012
Page 137 of 149
BOX KN9
BOX KN9
Page Order # :
4700
BOX INSTRUCTIONS
( KNQ2270 )
IF IT IS UNKNOWN WHETHER OR NOT THIS SP IS AWARE OF THE 1-800
MEDICARE LINE, GO TO KN56 - KREELINE ( KNQ2272 ).
ELSE GO TO BOX KN10 - (KNQ2274 ).
ASSIGNMENTS
TECHNICAL NOTES
421
KNSPNotAware800Line
Whether or not SP is aware of the 1-800-MEDICARE line
is unknown =
There is no KNOW where KNOW.KNOWRND < current
round and KNOW.KREELINE ^= EMPTY.
DESIGN NOTES
4:09:45 PM Tuesday, October 09, 2012
Page 138 of 149
KN56
KN56
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
KREELINE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
4800
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Before today, were you aware of the 1-800-MEDICARE toll-free line?
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:46 PM Tuesday, October 09, 2012
Page 139 of 149
KN56
Field1:
KREELINE
Cheshire Name:
( KNQ2272 )
KNOW.KREELINE
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN57 - KCPHINFO ( KNQ2275 )
English text: YES
No
KN58 - KCSUGGST ( KNQ2280 )
English text: NO
Attribute
Route
Don't know
KN58 - KCSUGGST ( KNQ2280 )
Refusal
KN58 - KCSUGGST ( KNQ2280 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:47 PM Tuesday, October 09, 2012
Page 140 of 149
BOX KN10
BOX KN10
Page Order # :
4900
BOX INSTRUCTIONS
( KNQ2274 )
IF SP DID NOT REPORT CALLING 1-800-MEDICARE TO GET
INFORMATION ABOUT MEDICARE IN ANY PREVIOUS ROUND GO TO
KN57 - KCPHINFO ( KNQ2275 ).
ELSE GO TO KN58 - KCSUGGST ( KNQ2280 ).
ASSIGNMENTS
TECHNICAL NOTES
422
KNSPNotCall800Line
SP did not report calling 1-800-MEDICARE to get
information about Medicare in any previous round =
There is no KNOW where KNOW.KNOWRND < current
round and KNOW.KCPHINFO = 1/Yes.
DESIGN NOTES
4:09:47 PM Tuesday, October 09, 2012
Page 141 of 149
KN57
KN57
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
KCPHINFO
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
5000
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Have you ever called 1-800-MEDICARE to get information about
Medicare?
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:48 PM Tuesday, October 09, 2012
Page 142 of 149
KN57
Field1:
KCPHINFO
Cheshire Name:
( KNQ2275 )
KNOW.KCPHINFO
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
KN58 - KCSUGGST ( KNQ2280 )
English text: YES
No
KN58 - KCSUGGST ( KNQ2280 )
English text: NO
Attribute
Route
Don't know
KN58 - KCSUGGST ( KNQ2280 )
Refusal
KN58 - KCSUGGST ( KNQ2280 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:49 PM Tuesday, October 09, 2012
Page 143 of 149
KN58
KN58
Page Order # :
Design Screen Type:
Verbatim Text
Fields:
Field 1:
KCSUGGST
Field 2:
KCSUGGVB
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
5100
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
As you know, this survey is sponsored by the Centers for Medicare
and Medicaid Services, which is the government agency that runs
Medicare. What are your suggestions or concerns about Medicare?
Int. Instr II:
RECORD VERBATIM.
INPUT FIELDS / ROUTING
4:09:50 PM Tuesday, October 09, 2012
Page 144 of 149
KN58
Field1:
KCSUGGST
Cheshire Name:
( KNQ2280 )
KNOW.KCSUGGST
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TMcsuggst
1
No
No
Number Label
1 RDoesNotHaveSuggestionsOrConcerns
91
FieldSize:
Min Value:
Max Value:
Mask:
Route
KNEND - KNENDSCR ( KNQ2290 )
English text: R DOES NOT HAVE SUGGESTIONS OR CONCERNS
RecordAllOtherResponsesVerbatim
KN58 - KCSUGGVB ( KNQ2285 )
English text: RECORD ALL OTHER RESPONSES VERBATIM
Attribute
Route
Don't know
KNEND - KNENDSCR ( KNQ2290 )
Refusal
KNEND - KNENDSCR ( KNQ2290 )
4:09:52 PM Tuesday, October 09, 2012
Page 145 of 149
KN58
Field2:
Cheshire Name:
KCSUGGVB
( KNQ2285 )
NONE
SQL FIELD = KNOW.KCSUGGVB
REPLACES CHESHIRE VARIABLES:
INVB.INVBTEXT on multiple INVB records:
INVB.INVBRNDC = current round
INVB.INVBRESP = 01
INVB.INFOQUES = KN58
INVB.INVBNUM = sequentinal #
DATA EDITING CODING VARIABLES:
KNOW.KSUGVC1
KNOW.KSUGVC2
KNOW.KSUGVC3
KNOW.KSUGVC4
KNOW.KSUGVC5
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Open
TOpen360
1
No
No
Number Label
1
FieldSize:
Min Value:
Max Value:
Mask:
360
Route
KNEND - KNENDSCR ( KNQ2290 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:53 PM Tuesday, October 09, 2012
Page 146 of 149
KNEND
KNEND
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
KNENDSCR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
5200
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "DO NOT" in bold.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
THERE IS NOT A "MEDICARE INFORMATION" SHEET FOR THIS
ROUND.
DO NOT SHOW ANY PREVIOUS ROUND VERSION OF THE
"MEDICARE INFORMATION" SHEET TO THE RESPONDENT.
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:53 PM Tuesday, October 09, 2012
Page 147 of 149
KNEND
Field1:
KNENDSCR
Cheshire Name:
( KNQ2290 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX KNEND - (KNQ2295 )
English text: CONTINUE
Attribute
Route
Empty
BOX KNEND - (KNQ2295 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:55 PM Tuesday, October 09, 2012
Page 148 of 149
BOX KNEND
BOX KNEND
Page Order # :
5301
BOX INSTRUCTIONS
( KNQ2295 )
GO TO NEXT SECTION .
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:09:55 PM Tuesday, October 09, 2012
Page 149 of 149
| File Type | application/pdf |
| File Title | KN_05.01.0002.pdf |
| Subject | KN_05.01.0002.pdf |
| Author | CMS |
| File Modified | 2013-07-01 |
| File Created | 2012-10-09 |