Attachment 1

NCVS New Demographic Items

Veteran status

• Ask of all persons age 18 or older.

• Ask once at first interview. If blank or no, ask or verify at subsequent interviews.

• Questions:
  From the American Community Survey (slightly modified to be asked directly of R) –
  Have you ever served on active duty in the U.S. Armed Forces, Reserves, or National Guard? [Mark one box.]

• Never served in the military

• Only on active duty for training in the Reserves or National Guard

• Now on active duty [Verify if person already said yes to Q20 on control card]

• On active duty in the past, but not now

When did you serve on active duty in the U.S. Armed Forces? [Mark a box for each period in which the person served, even if just for part of the period.]

• September 2001 or later

• August 1990 to August 2001 (including Persian Gulf War)

• May 1975 to July 1990

• Vietnam era (August 1964 to April 1975)

• February 1955 to July 1967

• Korean War (July 1950 to January 1955)

• January 1947 to June 1950

• World War II (December 1941 to December 1946)

• November 1941 or earlier

Citizenship

• Ask of all persons age 12 or older.

• Ask once. If blank or no, ask or verify at subsequent interviews.

• Question:

From the American Community Survey (slightly modified to be asked directly of R) –
Are you a citizen of the United States? That is, were you a born in the United States, born in a U.S. territory, born of U.S. citizen parent(s), or become a citizen of the U.S. through naturalization?

• Yes, born in the United States

• Yes, born in Puerto Rico, Guam, the U.S. Virgin Islands, or Northern Marianas

• Yes, born abroad of U.S. citizen parent or parents

• Yes, U.S. citizen by naturalization

• No, not a U.S. citizen

Disability

• Ask of all persons age 12 or older.

• Ask at 1^st, 3^rd, 5^th, and 7^th interview, or if never asked before.

• Questions:
  From the NCVS-2 –
  Are you deaf or do you have serious difficulty hearing?

• Yes

• No

Are you blind or do you have serious difficulty seeing even when wearing glasses?

• Yes

• No

Because of a physical, mental, or emotional condition, do you have serious difficulty…

a. Concentrating, remembering or making decisions?

• Yes

• No

b. Walking or climbing stairs?

• Yes

• No

c. Dressing or bathing?

• Yes

• No

Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor's office or shopping?

[NOTE: This question would be asked only of persons age 15 or older.]

• Yes

• No

NOTE: Disability items from the NCVS-2 will be dropped (168-173e).

Sexual orientation

• Ask of all persons age 16 or older.

• Ask at 1^st, 3^rd, 5^th, and 7^th interview, or if never asked before.

Questions:
From the National Health Interview Survey –
(NOTE: question numbers from cognitive testing are included for reference to skip patterns, but the actual question numbers will change)

Q24a. Which of the following best represents how you think of yourself?

[If NCVS control card sex question = Male]

• Gay [skip to Q27]

• Straight, that is, not gay [skip to Q27]

• Bisexual [skip to Q27]

• Something else [skip to Q25]

• I don’t know the answer [skip to Q26]

• Refused [skip to Q27]

Q24b. Which of the following best represents how you think of yourself?

[If NCVS control card sex question = Female]

• Lesbian or gay [skip to Q27]

• Straight, that is, not lesbian or gay [skip to Q27]

• Bisexual [skip to Q27]

• Something else [ask Q25]

• I don’t know the answer [skip to Q26]

• Refused [skip to Q27]

Q25. What do you mean by something else?

• You are not straight, but identify with another label such as queer, trisexual, omnisexual or pansexual [skip to Q27]

• You are transgender, transsexual or gender variant [skip to Q27]

• You have not figured out or are in the process of figuring out your sexuality
  [skip to Q27]

• You do not think of yourself as having sexuality [skip to Q27]

• You do not use labels to identify yourself [skip to Q27]

• You mean something else [skip to Q27]

• Refused [skip to Q27]

• Don't know [skip to Q27]

 

Q26. What do you mean by don't know?

• You don’t understand the words

• You understand the words, but you have not figured out or are in the process of figuring out your sexuality

• You mean something else

• Refused

• Don’t know

Gender identity

• Ask of all persons age 16 or older.

• Ask at 1^st, 3^rd, 5^th, and 7^th interview, or if never asked before.

Questions:
From the 2015 California Health Interview Survey –
(NOTE: question numbers from cognitive testing are included for reference to skip patterns, but the actual question numbers will change)

Q27. On your original birth certificate, was your sex assigned as male or female?

• Male

• Female

• Refused

• Don’t know

Q28a. Do you currently describe yourself as a man, woman, or transgender person?

• Man [if Q27 ne Male, then skip to Q28c; else, skip to next section]

• Woman [if Q27 ne Female, then skip to Q28c; else skip to next section]

• Transgender person [skip to next section]

• None of these [skip to Q28b]

Q28b. What is your current gender identity?

• Specify ________________________ [skip to next section]

• Refused [skip to next section]

• Don’t know [skip to next section]

ASK IF Q27 and Q28a DO NOT MATCH

Q28c. Just to confirm, you were assigned {INSERT RESPONSE FROM Q27} at birth and now describe yourself as a {Q28a}. Is that correct?

• Yes

• No

• Refused

• Don’t know
  
  

Household income

• Ask of household respondent.

• Ask at 1^st, 3^rd, 5^th, and 7^th interview. If blank, ask at 2^nd, 4^th, and 6^th interview.

• Current item:

Which category on this card represents the TOTAL combined income of all members of this HOUSEHOLD during the past 12 months? This includes money from jobs, net income from business, farm or rent, pensions, dividends, interest, Social Security payments, and any other money income received by members of this HOUSEHOLD who are 14 years of age or older.

• Less than $5,000

• $5,000 to $7,499

• $7,500 to $9,999

• $10,000 to $12,499

• $12,500 to $14,999

• $15,000 to $17,499

• $17,500 to $19,999

• $20,000 to $24,999

• $25,000 to $29,999

• $30,000 to $34,999

• $35,000 to $39,999

• $40,000 to $49,999

• $50,000 to $74,999

• $75,000 and over

• Refused

• Missing

• Revised item:

Which category on this card represents the TOTAL combined income of all members of this HOUSEHOLD during the past 12 months? This includes money from jobs, net income from business, farm or rent, pensions, dividends, interest, Social Security payments, and any other money income received by members of this HOUSEHOLD who are 14 years of age or older.

• Less than $5,000

• $5,000 to $7,499

• $7,500 to $9,999

• $10,000 to $12,499

• $12,500 to $14,999

• $15,000 to $17,499

• $17,500 to $19,999

• $20,000 to $24,999

• $25,000 to $29,999

• $30,000 to $34,999

• $35,000 to $39,999

• $40,000 to $49,999

• $50,000 to $74,999

• $75,000 to $99,999

• $100,000 to $149,999

• $150,000 to $199,999

• $200,000 or more

• Refused

• Missing