Form CMS_P-0015A MCBS

Address Verification (AVQ)
Variable Name
MR Screen Name
BOX AVBEG

Question type
routing

Question text/description
GO TO AV1 - VERIFY.

Code list

Next, I would like to verify [your/(SP's)] home address. I have it listed as..[READ ADDRESS LISTED BELOW].

VERIFY

STADDR1

STADDR2

AV1

AV2

AV2

yes/no

addresses

addresses

CITY

AV2

addresses

STATE

AV2

addresses

ZIPCODE

AV2

addresses

SPMOVED

VERIFY

PHONAREA

AV3

yes/no

BOX AV3

routing

AV4

yes/no

AV5

phone

Is this correct?
[IF ANY INFORMATION IS MISSING (E.G., AN APARTMENT NUMBER), SELECT “NO” TO ENTER THE MISSING
DATA.]
NAME: (SP)
STREET ADDRESS 1: (STREET ADDRESS LINE 1)
STREET ADDRESS 2: (STREET ADDRESS LINE 2)
CITY: (CITY) STATE: (STATE) ZIPCODE: (ZIPCODE)
ENTER CORRECT ADDRESS.
What is [your/(SP's)] home address?
CLEAR ADDRESS LINE 2 IF NO LONGER APPLICABLE.
[PROBE FOR ANY MISSING INFORMATION.]
ENTER CORRECT ADDRESS.
What is [your/(SP's)] home address?
CLEAR ADDRESS LINE 2 IF NO LONGER APPLICABLE.
[PROBE FOR ANY MISSING INFORMATION.]
ENTER CORRECT ADDRESS.
What is [your/(SP's)] home address?
CLEAR ADDRESS LINE 2 IF NO LONGER APPLICABLE.
[PROBE FOR ANY MISSING INFORMATION.]
ENTER CORRECT ADDRESS.
What is [your/(SP's)] home address?
CLEAR ADDRESS LINE 2 IF NO LONGER APPLICABLE.
[PROBE FOR ANY MISSING INFORMATION.]
ENTER CORRECT ADDRESS.
What is [your/(SP's)] home address?
CLEAR ADDRESS LINE 2 IF NO LONGER APPLICABLE.
[PROBE FOR ANY MISSING INFORMATION.]
WAS CHANGE MADE TO SP'S ADDRESS BECAUSE SP MOVED?

(01) YES
(02) NO

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

IF A PRIMARY PHONE NUMBER HAS BEEN COLLECTED FOR THE SP, GO TO AV4 - VERIFY.
ELSE GO TO AV5 - PHONAREA.
Next, I would like to verify [your/(SP's)] phone [number/numbers]. I have [it/them] listed as …
[READ PHONE NUMBER(S) LISTED BELOW].
PHONE 1: (PRIMARY PHONE NUMBER)
PHONE 2: [(SECONDARY PHONE NUMBER)/NONE)
[IF ANY PART OF THE PHONE NUMBER(S) IS NOT CORRECT, SELECT “NO”. PROBE FOR A SECOND PHONE
NUMBER IF ONE IS NOT PRESENT. IF THERE IS A SECOND NUMBER TO ADD, SELECT “NO” TO ENTER THE
MISSING NUMBER.]
What is [your/(SP's)] phone number?

(01) YES
(02) NO

(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused

Address Verification (AVQ)
Variable Name
MR Screen Name

Question type

Question text/description

PHONEXCH

AV5

phone

What is [your/(SP's)] phone number?

PHONLOCL

AV5

phone

What is [your/(SP's)] phone number?

NOPHONE

AV5

phone

What is [your/(SP's)] phone number?

BOX AV5

routing

IF AV5 - NOPHONE = 1/NotHavePhone OR AV5 - PHONAREA = RF, GO TO BOX AV6.
ELSE GO TO AV6 - PHONAREA.
[Do you/Does (SP)] have a second phone number?

PHONAREA

AV6

phone
[PROBE: What is that number?]
[Do you/Does (SP)] have a second phone number?

PHONEXCH

AV6

phone
[PROBE: What is that number?]
[Do you/Does (SP)] have a second phone number?

PHONLOCL

AV6

phone
[PROBE: What is that number?]
[Do you/Does (SP)] have a second phone number?

NOPHONE

AV6

phone
[PROBE: What is that number?]

BOX AV6

routing

Code list
(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused
(01) PERSON DOES NOT HAVE PHONE
(-7) Empty

(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused
(01) PERSON DOES NOT HAVE PHONE
(-7) Empty

CHECK FOR SP'S PREVIOUS ROUND MAILING ADDRESS. IF SP'S MAILING ADDRESS WAS NOT COLLECTED IN
THE PREVIOUS ROUND, COPY SP'S CURRENT ROUND ADDRESS TO SP'S MAILING ADDRESS
GO TO AV7 - VERIFY.
I would also like to verify [your/(SP's)] mailing address. I have it listed as ... [READ ADDRESS LISTED BELOW.]
Is this the correct mailing address for [you/(SP)]?
NAME: (SP)

VERIFY

AV7

yes/no

MAILING ADDRESS 1: (MAILING ADDRESS LINE 1)
MAILING ADDRESS 2: (MAILING ADDRESS LINE 2)

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

CITY: (MAILING CITY) STATE: (MAILING STATE) ZIPCODE: (MAILING ZIPCODE)
[IF ANY INFORMATION IS MISSING (E.G., AN APARTMENT NUMBER), SELECT “NO” TO ENTER THE MISSING
DATA.]

STADDR1

AV8

address

ENTER CORRECT ADDRESS.
What is [your/(SP's)] mailing address?
CLEAR ADDRESS LINE 2 IF NO LONGER APPLICABLE.
[PROBE FOR ANY MISSING INFORMATION.]

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

Address Verification (AVQ)
Variable Name
MR Screen Name

Question type

STADDR2

address

AV8

CITY

AV8

address

STATE

AV8

address

ZIPCODE

AV8

address

BOX AVEND

routing

Question text/description
ENTER CORRECT ADDRESS.
What is [your/(SP's)] mailing address?
CLEAR ADDRESS LINE 2 IF NO LONGER APPLICABLE.
[PROBE FOR ANY MISSING INFORMATION.]
ENTER CORRECT ADDRESS.
What is [your/(SP's)] mailing address?
CLEAR ADDRESS LINE 2 IF NO LONGER APPLICABLE.
[PROBE FOR ANY MISSING INFORMATION.]
ENTER CORRECT ADDRESS.
What is [your/(SP's)] mailing address?
CLEAR ADDRESS LINE 2 IF NO LONGER APPLICABLE.
[PROBE FOR ANY MISSING INFORMATION.]
ENTER CORRECT ADDRESS.
What is [your/(SP's)] mailing address?
CLEAR ADDRESS LINE 2 IF NO LONGER APPLICABLE.
[PROBE FOR ANY MISSING INFORMATION.]
GO TO NEXT SECTION

Code list
(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused