CMS-P-0015A Mobility of Beneficiaries

2018 MCBS Community Questionnaire

Variable Name

MR Screen Name

MBQ-MOBILITY OF BENEFICIARIES

Question Type

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

(01) YES
(02) NO
(03) DOESN'T DRIVE (DO NOT DISPLAY.)
(04) HAS NEVER DRIVEN
(05) GAVE UP DRIVING BEFORE (REFERENCE
DATE)
(-8) Don't Know
(-9) Refused

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

(01) YES
(02) NO
(03) DOES NOT DRIVE (DO NOT DISPLAY.)
(-8) Don't Know
(-9) Refused

MB6 - MUSETRNS

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), administer after CPS.
If INTTYPE in(C002, C006, C007, C010), administer after NSQ.
If INTTYPE in(C003), administer after HIQ.

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.
Because of a health or physical problem, [have you/has (SP)]...
given up driving altogether since (REFERENCE DATE)]?

MGIVUPDR

MB5

yes/no
[PROBE FOR PROPER RESPONSE IF R OFFERS MORE THAN A YES OR NO RESPONSE, USING
PROBES SUCH AS “Was this because of a health or physical problem” and “I just want to check whether this
was before or after (REFERENCE DATE)”.]

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

MB4

yes/no

[PROBE FOR PROPER RESPONSE IF R OFFERS MORE THAN A YES OR NO RESPONSE, USING
PROBES SUCH AS “Was this because of a health or physical problem” and “I just want to check whether this
was before or after (REFERENCE DATE)”.]
[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

BOX MBEND

routing

(01) YES
(02) NO
(-8) Don't Know
[EXPLAIN IF NECESSARY: A special transportation service may include a van or shuttle service for seniors or (-9) Refused
people with disabilities.]
used a taxi or special transportation service since (REFERENCE DATE)]?

BOX MBEND

GO TO PVQ.

Page 1 of 1