Cms-p-0015a Mcbs

Demographics (DIQ)
Variable Name
DIINT
HISPORIG

MR Screen Name
DIINTROA
DI1A

Question type
no entry

Question text/description
The next few questions are about Hispanic origin and race.

Code list

yes/no

[Are you/Is (SP)] of Hispanic, (Latino/Latina), or Spanish origin?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) 1 MEXICAN/MEXICAN AMERICAN/CHICANO(A)
(02) PUERTO RICAN
(03) CUBAN
(91) OTHER HISPANIC, LATINO(A), OR SPANISH ORIGIN
(-8) Don't Know
(-9) Refused

HISPORDT

DI1B

code all

SHOW CARD DI1
Looking at this card, [are you/is SP] Mexican, Mexican American, or (Chicano/Chicana), Puerto Rican, Cuban,
or of another Hispanic, (Latino/Latina) or Spanish origin?
CHECK ALL THAT APPLY.

HISPDTOS

DI1B

verbatim text

OTHER ORIGIN (SPECIFY)

(01) continuous answer

SHOW CARD DI2
Looking at this card, what [is/was] [your/(SP's)] race?
[ASK IF NECESSARY: Are there any options from this card that you would like me to record?]

(01) AMERICAN INDIAN OR ALASKA NATIVE
(02) ASIAN
(03) BLACK OR AFRICAN AMERICAN
(04) NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER
(05) WHITE
(-8) Don't Know
(-9) Refused

RACECODE

DI2A

code all

RACEOS

DI2A

verbatim text

BOX DI2B

routing

RACEASDT

DI2B

code all

SOME OTHER RACE (SPECIFY)
IF DI2A-RACECODE INCLUDES 2/Asian, GO TO DI2B - RACEASDT.
ELSE GO TO BOX DI2C.
SHOW CARD DI3
Looking at this card, [are you/is (SP)] Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese or some
other Asian group?
You can choose more than one group.
CHECK ALL THAT APPLY.

RACEASOS

RACEPIDT

DI2B

verbatim text

BOX DI2C

routing

DI2C

code all

OTHER ASIAN GROUP (SPECIFY)
IF DI2A-RACECODE INCLUDES 4/NatHawOrOthPaclsl, GO TO DI2C - RACEPIDT.
ELSE GO TO ENGWELL - D12F
SHOW CARD DI4
Looking at this card, [are you/is (SP)] Native Hawaiian, Guamanian or Chamorro, Samoan, or some other
Pacific Islander group?

RACEPIOS

DI2C

verbatim text

You can choose more than one group.
CHECK ALL THAT APPLY.
OTHER PACIFIC ISLANDER GROUP (SPECIFY)

ENGWELL

DI2F

code one

How well [do you/does (SP)] speak English? Would you say…

ENGREAD

DI2FB

code one

How well [do you/does (SP)] read English? Would you say…

(01) continuous answer

(01) ASIAN INDIAN
(02) CHINESE
(03) FILIPINO
(04) JAPANESE
(05) KOREAN
(06) VIETNAMESE
(91) OTHER ASIAN GROUP
(-8) Don't Know
(-9) Refused
(01) continuous answer

(01) NATIVE HAWAIIAN
(02) GUAMANIAN OR CHAMORRO
(03) SAMOAN
(91) OTHER PACIFIC ISLANDER GROUP
(-8) Don't Know
(-9) Refused
(01) continuous answer
(01) Very well
(02) Well
(03) Not Well, or
(04) Not at all?
(01) Very well
(02) Well
(03) Not Well, or
(04) Not at all?

Demographics (DIQ)
Variable Name

MR Screen Name

Question type

Question text/description

OTHRLANG

DI2D

yes/no

[Do you/Does (SP)] speak a language other than English at home?

WHATLANG

DI2E

code one

What [is/was] this language?

WHTLNGOS
DIINT3

DI2E
DI3INTRO

verbatim text
no entry

SOME OTHER LANGUAGE (SPECIFY)
The next two questions are about education and income.

SPDEGRCV

DI3A

code one

DIINT4

DI4INTRO

no entry

SPINC25K

DI4

code one

SPINCLET

DI5A

code one

BOX DI3

routing

Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) SPANISH
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) continuous answer

(01) NO SCHOOLING COMPLETED
(02) NURSERY SCHOOL TO 8TH GRADE
(03) 9TH-12TH GRADE, NO DIPLOMA
(04) HIGH SCHOOL GRADUATE (HIGH SCHOOL
DIPLOMA OR THE EQUIVALENT)
SHOW CARD DI5
(05) VOCATIONAL/TECHNICAL/BUSINESS/TRADE
What is the highest degree or level of school [you have/(SP) has] completed?
SCHOOL CERTIFICATE OR DIPLOMA (BEYOND THE
[IF THE SAMPLE PERSON ATTENDED SCHOOL IN A FOREIGN COUNTRY, IN AN UNGRADED SCHOOL, HOME
HIGH SCHOOL LEVEL)
SCHOOLING, OR UNDER OTHER UNIQUE CIRCUMSTANCES, REFER THE RESPONDENT TO THE SHOWCARD AND (06) SOME COLLEGE, BUT NO DEGREE
ASK FOR THE NEAREST EQUIVALENT.]
(07) ASSOCIATE DEGREE
(08) BACHELOR'S DEGREE
(09) MASTER'S, PROFESSIONAL OR DOCTORATE
DEGREE
(-8) Don't Know
(-9) Refused
In studies like this, people are sometimes grouped together according to income.
Was [your and your spouse's/(SP's) and (his/her) spouse's/[your/(SP's)]] total income during the past 12
months less than $25,000 or $25,000 or more, before taxes? Include income from jobs, Social Security,
Railroad Retirement, other retirement income, Supplemental Security Income (SSI), pensions, interest, and
(01) LESS THAN $25,000/YEAR
any other sources.
(02) $25,000 OR MORE/YEAR
(03) LESS THAN $2080/MONTH
[PROBE IF NECESSARY: In estimating [your/(SP's)] total income, you can respond for all of the past 12
(04) $2080/MONTH OR MORE
months, or provide a one month estimate.]
(-8) Don't Know
(-9) Refused
[EXPLAIN IF NECESSARY: Income is important in analyzing the information we collect. For example, this
information helps us learn whether persons in one income group use certain types of medical care services or
have certain medical conditions more or less often than those in another group.]
(01) A. Less than $5,000
(02) B. $5,000 - less than $10,000
SHOW CARD DI6
(03) C. $10,000 - less than $15,000
Looking at this card, which letter best represents [your and your spouse's/(SP's) and (his/her)
(04) D. $15,000 - less than $20,000
spouse's/[your/(SP's)]] total income before taxes during the past 12 months? Include income from jobs,
(05) E. $20,000 - less than $25,000
Social Security, Railroad Retirement, other retirement income, and the other sources of income we just talked (06) F. $25,000 - less than $30,000
about.
(07) G. $30,000 - less than $40,000
(08) H. $40,000 - less than $50,000
[EXPLAIN IF NECESSARY: Income is important in analyzing the information we collect. For example, this
(09) I. $50,000 - less than $66,000
information helps us learn whether persons in one income group use certain types of medical care services or (10) J. $66,000 - less than $109,000
have certain medical conditions more or less often than those in another group.]
(11) K. $109,000 or more
(-8) Don't Know
(-9) Refused
GO TO NEXT SECTION.