CMS-P-0015A Comm2017R79ENS

2017 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

ENS-ENUMERATION SUMMARY

Question Text/Description

Code List

Routing

ENUMERATION SUMMARY SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C003, C004, C005, C006, C007, C008, C009, C010
SPALIVE=ALL
SEASON=ALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
If INTTYPE in(C001, C002, C003, C004, C005, C006, C007, C008, C009, C010), administer after INQ.
BOX ENSBEG

routing

GO TO ENSINTRO - ENSINT.

ENSINTRO

no entry

Now I’d like to [review with you who was living in the household/ask you a few questions about [your/(SP's)]
home and any other people who may live in the household.].

BOX ENS1

routing

IF AT LEAST ONE PERSON LIVED IN THE HOUSEHOLD WITH THE SP AT THE TIME OF THE PREVIOUS
ROUND INTERVIEW, GO TO ENS1 - HHSTILL.
ELSE GO TO ENS3 - HHNEW.

yes/no

From our last interview on (REFERENCE DATE), we have listed that [(READ NAME(S) LISTED BELOW)] lived
in the same household as [you/(SP)].
[As of (DATE OF DEATH/DATE OF INSTITUTIONALIZATION), did/Do/Does] [READ NAME(S) LISTED BELOW]
still live in the same household as [you/(SP)]?
[A SEPARATE QUESTION WILL ASK YOU IF ANYONE ELSE SHOULD BE ADDED. THIS QUESTION ONLY
REFERS TO THE LISTED PERSONS.]

HOUSEHOLD_NO
ENS2
T

roster

PROBE FOR AND SELECT THOSE PEOPLE WHO ARE NO LONGER IN THE HOUSEHOLD.

NAVIGATOR

instance navigator

ENSINT

HHSTILL

ENS1

ENS2_IN

BOX ENS1

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

ENS2_IN - NAVIGATOR
(01) ITEM SELECTED IN INSTANCE NAVIGATOR
(02) CONTINUE INTERVIEW SELECTED

NOTHHRSN

ENS2A

code 1

Why [is/was] (HOUSEHOLD MEMBER NAME) no longer in the household [as of (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]?

NOTHHROS

ENS2A

verbatim text

OTHER REASON (SPECIFY)

BOX ENS2

routing

GO TO ENS2_IN - NAVIGATOR.

(01) DECEASED
(02) INSTITUTIONALIZED, HEALTH CARE FACILITY
(03) INSTITUTIONALIZED, OTHER
(04) PERSON MOVED
(05) SP MOVED
(06) PERSON NOT IN HOUSEHOLD - PREVIOUS
ROUND ERROR
(91) OTHER REASON
(-8) Don't Know
(-9) Refused

ENS3

HOUSEHOLD_EN
ENS4
S

yes/no

roster

(01) YES
(02) NO
[Besides [you/(SP)], [is/was] there anyone else living or staying in the household [as of (DATE OF DEATH/DATE
(-8) Don't Know
OF INSTITUTIONALIZATION)]? Remember to include people who
(-9) Refused
[are/were] temporarily absent and any children who [may live/may
have lived] in the household.
Who else [is/was] living or staying in the household?
SELECT OR ADD ALL PERSONS LIVING IN THE HOUSEHOLD.

ENS4A

yes/no

(01) BOX ENS2
(02) BOX ENS2
(03) BOX ENS2
(04) BOX ENS2
(05) BOX ENS2
(06) BOX ENS2
(91) ENS2A - NOTHHROS
(-8) BOX ENS2
(-9) BOX ENS2

(01) ENS4 - HOUSEHOLD_ENS
(02) BOX ENS4
(-8) BOX ENS4
(-9) BOX ENS4

ENS4A - HHMISS

Now I want to make sure I have everyone who [lives/lived] in the household [as of (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]. I have listed (READ NAME(S) LISTED BELOW).
HHMISS

(01) ENS2A - NOTHHRSN
(02) ENS3 - HHNEW

BOX ENS2

[At the time of the last interview, [you were living by yourself/(SP)
was living by [himself/herself]]].
HHNEW

(01) ENS3 - HHNEW
(02) ENS2 - HOUSEHOLD_NOT
(-8) ENS3 - HHNEW
(-9) ENS3 - HHNEW

(01) YES
(02) NO
(-8) Don't Know
Have I missed any lodgers, boarders, or anyone else who usually [lives or stays/lived or stayed] in the household
(-9) Refused
but [is/was] away from home traveling or in the hospital?

(01) ENS4 - HOUSEHOLD_ENS
(02) ENS5 - HHPSEX
(-8) ENS5 - HHPSEX
(-9) ENS5 - HHPSEX

HHPSEX

ENS5

grid

Is (HOUSEHOLD MEMBER NAME) male or female?

(01) MALE
(02) FEMALE
(-8) Don't Know
(-9) Refused

EHHDOBMM

ENS5

grid

What is (HOUSEHOLD MEMBER NAME'S) date of birth?
[ENTER DATE.]

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

ENS5 - EHHDOBDD

EHHDOBDD

ENS5

grid

What is (HOUSEHOLD MEMBER NAME'S) date of birth?
[ENTER DATE.]

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

ENS5 - EHHDOBYY

ENS5 - EHHDOBMM

Page 1 of 3

2017 MCBS Community Questionnaire

ENS-ENUMERATION SUMMARY

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

EHHDOBYY

ENS5

grid

What is (HOUSEHOLD MEMBER NAME'S) date of birth?
[ENTER DATE.]

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

(01) BOX ENS4
(-8) ENS5 -HHPAGE
(-9) ENS5-HHPAGE

HHPAGE

ENS5

grid

How old is (HOUSEHOLD MEMBER NAME)?

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

BOX ENS4

routing

IF AT LEAST ONE PERSON LIVING IN THE HOUSEHOLD WITH THE SP IN THE CURRENT ROUND, WAS
ALSO LIVING IN THE HOUSEHOLD AT THE TIME OF THE PREVIOUS ROUND INTERVIEW AND (WAS
MISSING ANY PART OF THEIR DATE OF BIRTH IN THE PREVIOUS ROUND) AND (HAS NEVER BEEN
ASKED ENS10 IN ANY PREVIOUS ROUND), GO TO ENS10 - EHHDOBMM.
ELSE GO TO BOX ENS4A

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

ENS10 - EHHDOBDD

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

ENS10 - EHHDOBYY

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

ENS10 - HHPAGE

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

BOX ENS4A

BOX ENS4

ASK THE RESPONDENT TO PROVIDE INFORMATION FOR ALL "DK" AND "RF" ENTRIES LISTED BELOW.
DO NOT CHANGE THE ENTRIES IF THE RESPONDENT STILL DOES NOT KNOW THE INFORMATION.
EHHDOBMM

ENS10

grid
(HOUSEHOLD MEMBER NAME'S) DATE OF BIRTH.
[ENTER DATE.]
ASK THE RESPONDENT TO PROVIDE INFORMATION FOR ALL "DK" AND "RF" ENTRIES LISTED BELOW.
DO NOT CHANGE THE ENTRIES IF THE RESPONDENT STILL DOES NOT KNOW THE INFORMATION.

EHHDOBDD

ENS10

grid
(HOUSEHOLD MEMBER NAME'S) DATE OF BIRTH.
[ENTER DATE.]
ASK THE RESPONDENT TO PROVIDE INFORMATION FOR ALL "DK" AND "RF" ENTRIES LISTED BELOW.
DO NOT CHANGE THE ENTRIES IF THE RESPONDENT STILL DOES NOT KNOW THE INFORMATION.

EHHDOBYY

ENS10

grid
(HOUSEHOLD MEMBER NAME'S) DATE OF BIRTH.
[ENTER DATE.]

HHPAGE

ENS10

grid

ASK THE RESPONDENT TO PROVIDE INFORMATION FOR ALL "DK" AND "RF" ENTRIES LISTED BELOW.
DO NOT CHANGE THE ENTRIES IF THE RESPONDENT STILL DOES NOT KNOW THE INFORMATION.
(HOUSEHOLD MEMBER NAME'S) AGE.

HOUSEHOLD_O
WNS

BOX ENS4A

routing

IF (SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP'S PREVIOUS ROUND INTERVIEW WAS IN A
FACILITY), GO TO BOX ENS4B.
ELSE GO TO BOX ENS5

BOX ENS4B

routing

IF AT LEAST ONE PERSON LIVES IN THE HOUSEHOLD WITH THE SP, GO TO ENS10A HOUSEHOLD_OWNS.
ELSE SET SP AS PERSON WHO OWNS/RENTS HOME AND GO TO BOX ENS4C

ENS10A

roster

Who owns or rents [this/(SP’s)] home? (PROBE: Of the people living [here/there] now, who is the person who is
the head of the household?)
SELECT ONLY ONE.

BOX ENS4C

IF THE HOME IS JOINTLY OWNED BY THE RESPONDENT AND ANOTHER PERSON SELECT THE
RESPONDENT AS THE OWNER.
BOX ENS4C

ASKWORK

ENS10AA

BOX ENS5

JOBSTAT

ENS11

BOX ENS5A

routing

IF (SP IS IN THE SUPPLEMENTAL SAMPLE) AND (SP'S AGE IS 16 OR OLDER, OR AGE = DK OR RF), GO
TO ENS10AA - ASKWORK.
ELSE GO TO BOX ENS5.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

yes/no

Since (REFERENCE DATE), did [you/(SP)] work at any time at a job or business?

routing

IF (SP IS IN THE SUPPLEMENTAL SAMPLE AND ENS10AA - ASKWORK = 1/Yes) OR (IF SP IS NOT IN THE
SUPPLEMENTAL SAMPLE AND ((IT IS A FALL ROUND) AND (SP IS ALIVE AND NOT INSTITUTIONALIZED)
AND (SP'S AGE IS 16 OR OLDER, OR AGE = DK OR RF))), GO TO ENS11 - JOBSTAT.
ELSE GO TO BOX ENS5A.

routing

(01) YES
[Before I continue with the next set of questions, I need to collect information about [your/(SP’s)] job status.] [Are (02) NO
you/Is (SP)] currently working at a job or business?
(-8) Don't Know
(-9) Refused

BOX ENS5A

routing

IF AT LEAST ONE PERSON WHO LIVES IN THE HOUSEHOLD WITH THE SP IS AGE 16 OR OLDER, OR
AGE = DK OR RF AND ((THIS PERSON IS A NEW HOUSEHOLD MEMBER IN THE CURRENT ROUND) OR
(IT IS A FALL ROUND)), GO TO ENS11A_IN - NAVIGATOR.
ELSE GO TO BOX ENS7.

(01) ENS11A - HHJBSTAT
(02) BOX ENS7

(01) ITEM SELECTED IN INSTANCE NAVIGATOR
(02) CONTINUE INTERVIEW SELECTED

BOX ENS5

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2017 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

NAVIGATOR

ENS11A_IN

instance navigator

HHJBSTAT

ENS-ENUMERATION SUMMARY

Question Text/Description

Code List

Routing

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

BOX ENS6

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

(01) ENS13 - SPAFTIME
(02) ENS14 - SPNGEVER
(-8) ENS14 - SPNGEVER
(-9) ENS14 - SPNGEVER

(07) IRAQ OR AFGHANISTAN CONFLICT (2001present)
(06) PERSIAN GULF WAR/OPERATION DESERT
STORM (Aug 1990 - March 1991)
(01) VIETNAM ERA (Aug 1964 - May 1975)
(02) KOREAN CONFLICT (June 1950 - Jan 1955)
(03) WORLD WAR II (Sept 1940 - July 1947)
(05) PEACE TIME (ALL OTHER TIMES)
(-8) Don't Know
(-9) Refused

ENS14 - SPNGEVER

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

(01) ENS15 - SPNGALL
(02) BOX ENS14
(-8) BOX ENS14
(-9) BOX ENS14

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

ENS16 - SPNGDSBL

ENS11A

yes/no

[Before I continue with the next set of questions, I need to update information about [your/(HOUSEHOLD
MEMBER NAME'S)] job status.] [Are you/Is (HOUSEHOLD MEMBER NAME)] currently working at a job or
business?

BOX ENS6

routing

GO TO ENS11A_IN - NAVIGATOR.

BOX ENS7

routing

IF ((SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP IS NEW FROM THE FACILITY)) AND SP'S AGE IS 17
OR OLDER OR AGE = DK OR RF, GO TO ENS12 - SPAFEVER.
ELSE GO TO BOX ENSEND.
Now we have a few questions about military service.

SPAFEVER

ENS12

yes/no
Did [you/(SP)] ever serve in the Armed Forces of the United States?

SHOW CARD ENS1
SPAFTIME

ENS13

code all

Looking at this card, in which of these time periods did [you/(SP)] serve in the Armed Forces?
CHECK ALL THAT APPLY.

SPNGEVER

SPNGALL

SPNGDSBL

ENS14

yes/no

[Were you/Was (SP)] ever an active member of a National Guard or military reserve unit of the United States?

BOX ENS14

routing

IF ENS12 - SPAFEVER = 1/Yes, GO TO ENS16 - SPNGDSBL.
ELSE GO TO BOX ENSEND.

ENS15

ENS16

yes/no

Was all of [your/(SP’s)] active duty related to National Guard or military reserve training?

yes/no

(01) YES
[Do you/Does (SP)/Did (SP)] have a disability related to service in the Armed Forces of the United States?
(02) NO
[PROBE: ‘Have you received a V.A. disability rating?’ IF THE RESPONDENT HAS A V.A. DISABILITY RATING,
(-8) Don't Know
SELECT "YES"; IF HE OR SHE DOES NOT, SELECT "NO"]
(-9) Refused
What [is [your/(SP’s)]/was (SP's)] (current) V.A. disability rating?

SPVARATE

ENS17

BOX ENSEND

numeric

routing

THE VA DISABILITY RATING IS A PERCENTAGE IN MULTIPLES OF 10 (I.E., 10%, 20%, ETC.). ENTER THE
NUMBER AS A WHOLE NUMBER. YOU DO NOT NEED TO ENTER THE "%" SIGN.

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

(01) ENS17 - SPVARATE
(02) BOX ENSEND
(-8) BOX ENSEND
(-9) BOX ENSEND

BOX ENSEND

IF SEASON=FALL, GO TO HAQ.
IF (SEASON=WINTER OR SUMMER) AND INTTYPE in(C001, C002, C003, C004, C005, C006, C007, C008,
C010), GO TO HIQ.
IF (SEASON=SUMMER) AND INTTYPE in (C008) AND SP HAS ONGOING IP EVENT, GO TO IPQ.
IF (SEASON=SUMMER) AND INTTYPE in (C008) AND SO HAS NO ONGOING IP EVENTS, GO TO MBQ.

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