Recruitment Screener

2019 AHS Cognitive Testing – Telephone Screener

1. Is your home owned, rented, or occupied without payment of rent?

   1. Owned – Proceed to #2

   2. Rented – Skip to #4

   3. Occupied without payment of rent – Skip to #4

2. In the past two years, have you done any home improvement projects?

   1. Yes – Proceed to #3

   2. No – Skip to #4

3. What home improvement projects have you done?

(Allow entry for up to 3 projects)

Project 1: [ ]

Project 2: [ ]

Project 3: [ ]

4. What type of home do you live in?

   1. House or townhouse

   2. Apartment or condo

   3. Manufactured/mobile home

   4. Other residence: PLEASE EXPLAIN: [ ]

5. [Do you/Does anyone in your household] have any physical disabilities or other physical limitations? Do not include a temporary injury.

   1. Yes

   2. No

6. [Are you/Is anyone in your household] aged 16 to 19?

   1. Yes

   2. No

7. [Round 1 only] [Are you/Is anyone in your household] currently attending college or some other school beyond high school?

   1. Yes

   2. No

8. [Round 2 only] In March of this year, [were you/was anyone in your household] attending college or some other school beyond high school?

   1. Yes

   2. No

9. Does your home have any toilets that were ever out of order in the past 3 months?

   1. Yes

   2. No

10. Has your home had any problems with pest control in the past year?

    1. Yes

    2. No