CMS-P-0015A Comm2017R79MBQ

2017 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

MBQ-Mobility of Beneficiaries

Question Text/Description

Code List

Routing

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

MB2 - MREDTRAV

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

MB3 - MASKRIDE

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

BOX MB1

MOBILITY OF BENEFICIARIES QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=ALL
SPALIVE=1
SEASON=ALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
If INTTYPE in(C001, C004, C005, C009), administer after CPS.
If INTTYPE in(C002, C006, C007, C010), administer after NSQ.
If INTTYPE in(C003), administer after HIQ.
If INTTYPE in(C008) and SP had ongoing IP event, administer after IPQ.
If INTTYPE in(C008) and SP did not have an ongoing IP event, administer after ENS.
BOX MBBEG

routing

GO TO MB1 - MTBLGTPL.
My next questions are about [your/(SP)’s] travel activities and [your/his/her] health.

MTBLGTPL

MB1

yes/no

Because of a health or physical problem, [have you/has (SP)]...
had trouble getting places, like the doctor’s office, a supermarket, or a friend’s house since (REFERENCE
DATE)]?
Because of a health or physical problem, [have you/has (SP)]…

MREDTRAV

MB2

yes/no
reduced [your/his/her] day-to-day travel since (REFERENCE DATE)]?

Because of a health or physical problem, [have you/has (SP)]...
MASKRIDE

MB3

yes/no
asked others for rides since (REFERENCE DATE)]?

BOX MB1

routing

If the respondent ever reported that they don't drive, have never driven, or gave up driving
(SAMPLE_PERSON.P_MGIVUPDR = 3, 4, or 5), go to MB6-MUSETRNS.
Else go to MB5-MGIVUPDR.
(01) YES
(02) NO
(03) DOESN'T DRIVE (DO NOT DISPLAY.)
given up driving altogether since (REFERENCE DATE)]?
(04) HAS NEVER DRIVEN
(05) GAVE UP DRIVING BEFORE (REFERENCE
[PROBE FOR PROPER RESPONSE IF R OFFERS MORE THAN A YES OR NO RESPONSE, USING PROBES
DATE)
SUCH AS “Was this because of a health or physical problem” and “I just want to check whether this was before
(-8) Don't Know
or after (REFERENCE DATE)”.]
(-9) Refused
Because of a health or physical problem, [have you/has (SP)]...

MGIVUPDR

MB5

yes/no

(01) MB6 - MUSETRNS
(02) MB4 - MLIMDRIV
(03) MB6 - MUSETRNS (DO NOT DISPLAY.)
(04) MB6 - MUSETRNS
(05) MB6 - MUSETRNS
(-8) MB4 - MLIMDRIV
(-9) MB4 - MLIMDRIV

Because of a health or physical problem, [have you/has (SP)]…
limited driving to daytime since (REFERENCE DATE)]?
MLIMDRIV

MB4

yes/no

(01) YES
(02) NO
[PROBE FOR PROPER RESPONSE IF R OFFERS MORE THAN A YES OR NO RESPONSE, USING PROBES (03) DOES NOT DRIVE (DO NOT DISPLAY.)
SUCH AS “Was this because of a health or physical problem” and “I just want to check whether this was before (-8) Don't Know
or after (REFERENCE DATE)”.]
(-9) Refused

MB6 - MUSETRNS

[IF THE R DOES NOT DRIVE, BACK UP AND CHANGE THE RESPONSE TO THE PREVIOUS QUESTION.]
Because of a health or physical problem, [have you/has (SP)]...
MUSETRNS

MB6

yes/no

used a taxi or special transportation service since (REFERENCE DATE)]?
[EXPLAIN IF NECESSARY: A special transportation service may include a van or shuttle service for seniors or
people with disabilities.]

BOX MBEND

routing

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

BOX MBEND

GO TO PVQ.

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