CMS-P-0015A Demographic Income

2018 MCBS Community Questionnaire

Variable Name

MR Screen Name

DIQ-DEMOGRAPHICS AND INCOME

Question Type

Question Text/Description

Code List

Routing

DEMOGRAPHICS AND INCOME QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C003
SPALIVE=ALL
SEASON=FALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after SCQ.
NOTES: USQ removed from Fall round in R79. Therefore, DIQ is now asked after SCQ.
DIINT

HISPORIG

DIINTROA

DI1A

no entry

The next few questions are about Hispanic origin and race.

DI1A - HISPORIG
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) DI1B - HISPORDT
(02) DI2A - RACECODE
(-8) DI2A - RACECODE
(-9) DI2A - RACECODE

yes/no

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

(01) DI2A - RACECODE
(02) DI2A - RACECODE
(03) DI2A - RACECODE
(91) DI1B - HISPDTOS
(-8) DI2A - RACECODE
(-9) DI2A - RACECODE

HISPORDT

DI1B

code all

(01) 1 MEXICAN/MEXICAN AMERICAN/CHICANO(A)
(02) PUERTO RICAN
SHOW CARD DI1
(03) CUBAN
Looking at this card, [are you/is (SP)] Mexican, Mexican American, or (Chicano/Chicana), Puerto Rican, Cuban,
(91) OTHER HISPANIC, LATINO(A), OR SPANISH
or of another Hispanic, (Latino/Latina) or Spanish origin?
ORIGIN
CHECK ALL THAT APPLY.
(-8) Don't Know
(-9) Refused

HISPDTOS

DI1B

verbatim text

OTHER ORIGIN (SPECIFY)

(01) continuous answer

DI2A - RACECODE

(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

(01) BOX DI2B
(02) BOX DI2B
(03) BOX DI2B
(04) BOX DI2B
(05) BOX DI2B
(-8) BOX DI2B
(-9) BOX DI2B

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

(01) BOX DI2C
(02) BOX DI2C
(03) BOX DI2C
(04) BOX DI2C
(05) BOX DI2C
(06) BOX DI2C
(91) DI2B - RACEASOS
(-8) BOX DI2C
(-9) BOX DI2C

(01) continuous answer

BOX DI2C

You can choose more than one group.
CHECK ALL THAT APPLY.

(01) NATIVE HAWAIIAN
(02) GUAMANIAN OR CHAMORRO
(03) SAMOAN
(91) OTHER PACIFIC ISLANDER GROUP
(-8) Don't Know
(-9) Refused

(01) ENGWELL - D12F
(02) ENGWELL - D12F
(03) ENGWELL - D12F
(91) DI2C - RACEPIOS
(-8) ENGWELL - D12F
(-9) ENGWELL - D12F

OTHER PACIFIC ISLANDER GROUP (SPECIFY)

(01) continuous answer

ENGWELL - D12F

RACECODE

RACEASDT

DI2A

code all

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?]

BOX DI2B

routing

IF DI2A-RACECODE INCLUDES 2/Asian, GO TO DI2B - RACEASDT.
ELSE GO TO BOX DI2C.

DI2B

code all

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

RACEPIOS

DI2B

verbatim text

OTHER ASIAN GROUP (SPECIFY)

BOX DI2C

routing

IF DI2A-RACECODE INCLUDES 4/NatHawOrOthPaclsl, GO TO DI2C - RACEPIDT.
ELSE GO TO ENGWELL - D12F

DI2C

DI2C

code all

verbatim text

SHOW CARD DI4
Looking at this card, [are you/is (SP)] Native Hawaiian, Guamanian or Chamorro, Samoan, or some other
Pacific Islander group?

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2018 MCBS Community Questionnaire

Variable Name

ENGWELL

ENGREAD

OTHRLANG

MR Screen Name

DI2F

DI2FB

DI2D

DIQ-DEMOGRAPHICS AND INCOME

Question Type

code one

code one

yes/no

Question Text/Description

Code List

Routing

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

(01) Very well
(02) Well
(03) Not Well, or
(04) Not at all?
(-8) Don't Know
(-9) Refused

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

(01) Very well
(02) Well
(03) Not Well, or
(04) Not at all?
(-8) Don't Know
(-9) Refused

OTHRLANG - D12D

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

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

(01) DI2E - WHATLANG
(02) DI3INTRO - DIINT3
(-8) DI3INTRO - DIINT3
(-9) DI3INTRO - DINT3
(01) DI3INTRO - DIINT3
(02) DI3INTRO - DIINT3
(03) DI3INTRO - DIINT3
(91) DI2E - WHTLNGOS
(-8) D13INTRO - D13
(-9) D13INTRO - D13
D13INTRO - DINT3

DI2FB - ENGREAD

WHATLANG

DI2E

code one

What [is/was] this language?

(01) SPANISH
(02) FRENCH
(03) GERMAN
(91) OTHER
(-8) Don't Know
(-9) Refused

WHTLNGOS

DI2E

verbatim text

SOME OTHER LANGUAGE (SPECIFY)

(01) continuous answer

DIINT3

DI3INTRO

no entry

The next questions are about education and income.

DI3A - SPDEGRCV

DI4INTRO - DIINT4

SPDEGRCV

DI3A

code one

(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)
(05) VOCATIONAL/TECHNICAL/BUSINESS/TRADE
SHOW CARD DI5
SCHOOL CERTIFICATE OR DIPLOMA (BEYOND
What is the highest degree or level of school [you have/(SP) has] completed?
[IF THE SAMPLE PERSON ATTENDED SCHOOL IN A FOREIGN COUNTRY, IN AN UNGRADED SCHOOL, THE HIGH SCHOOL LEVEL)
(06) SOME COLLEGE, BUT NO DEGREE
HOME SCHOOLING, OR UNDER OTHER UNIQUE CIRCUMSTANCES, REFER THE RESPONDENT TO
(07) ASSOCIATE DEGREE
THE SHOWCARD AND ASK FOR THE NEAREST EQUIVALENT.]
(08) BACHELOR'S DEGREE
(09) MASTER'S, PROFESSIONAL OR DOCTORATE
DEGREE
(-8) Don't Know
(-9) Refused

DIINT4

DI4INTRO

no entry

In studies like this, people are sometimes grouped together according to income.

DI4 - SPINC25K

code one

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 any other
(01) LESS THAN $25,000/YEAR
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) DI5A - SPINCLET
(02) DI5A - SPINCLET
(03) DI5A - SPINCLET
(04) DI5A - SPINCLET
(-8) BOX DI3
(-9) BOX DI3

SPINC25K

DI4

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2018 MCBS Community Questionnaire

Variable Name

SPINCLET

MR Screen Name

DIQ-DEMOGRAPHICS AND INCOME

Question Type

Question Text/Description

Code List

DI5A

code one

(01) A. Less than $5,000
(02) B. $5,000 - less than $10,000
(03) C. $10,000 - less than $15,000
SHOW CARD DI6
(04) D. $15,000 - less than $20,000
Looking at this card, which letter best represents [your and your spouse's/(SP's) and (his/her)
(05) E. $20,000 - less than $25,000
spouse's/[your/(SP's)]] total income before taxes during the past 12 months? Include income from jobs, Social
(06) F. $25,000 - less than $30,000
Security, Railroad Retirement, other retirement income, and the other sources of income we just talked 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

BOX DI3

routing

GO TO END SECTION.

Routing

BOX DI3

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