CMS-P-0015A Demographic Income

2020 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.
DIINT

DIINTROA

no entry

The next few questions are about Hispanic origin and race.

DI1A - HISPORIG

HISPORIG

DI1A

yes/no

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

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

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

(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

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

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

DI2A - RACECODE

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?]

(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

BOX DI2B

routing

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

(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

(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

RACECODE

RACEASDT

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

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

code all

SHOW CARD DI4
Looking at this card, [are you/is (SP)] Native Hawaiian, Guamanian or Chamorro, Samoan, or some other Pacific
Islander group?
You can choose more than one group.
CHECK ALL THAT APPLY.

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2020 MCBS Community Questionnaire

DIQ- DEMOGRAPHICS AND INCOME

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

RACEPIOS

DI2C

verbatim text

OTHER PACIFIC ISLANDER GROUP (SPECIFY)

(01) continuous answer

ENGWELL - D12F

ENGWELL

DI2F

code one

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

ENGREAD

DI2FB

code one

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

OTHRLANG

DI2D

yes/no

[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

(01) DI3INTRO - DIINT3
(02) DI3INTRO - DIINT3
(03) DI3INTRO - DIINT3
(04) DI3INTRO - DIINT3
(05) DI3INTRO - DIINT3
(06) DI3INTRO - DIINT3
(07) DI3INTRO - DIINT3
(08) DI3INTRO - DIINT3
(09) DI3INTRO - DIINT3
(10) DI3INTRO - DIINT3
(11) DI3INTRO - DIINT3
(12) DI3INTRO - DIINT3
(13) DI3INTRO - DIINT3
(14) DI3INTRO - DIINT3
(15) 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
(04) ITALIAN
(05) TAGALOG
(06) CHINESE (MANDARIN, CANTONESE, or OTHER)
(07) POLISH
(08) KOREAN
(09) RUSSIAN
(10) GREEK
(11) FILIPINO
(12) ARABIC
(13) JAPANESE
(14) VIETNAMESE
(15) HINDI
(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.

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)
SHOW CARD DI5
(05) VOCATIONAL/TECHNICAL/BUSINESS/TRADE SCHOOL
What is the highest degree or level of school [you have/(SP) has] completed?
CERTIFICATE OR DIPLOMA (BEYOND THE HIGH SCHOOL
[IF THE SAMPLE PERSON ATTENDED SCHOOL IN A FOREIGN COUNTRY, IN AN UNGRADED SCHOOL, HOME
DI4INTRO - DIINT4
LEVEL)
SCHOOLING, OR UNDER OTHER UNIQUE CIRCUMSTANCES, REFER THE RESPONDENT TO THE SHOWCARD
(06) SOME COLLEGE, BUT NO DEGREE
AND 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

SPDEGRCV

DI3A

DI3A - SPDEGRCV

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2020 MCBS Community Questionnaire

DIQ- DEMOGRAPHICS AND INCOME

Variable Name

MR Screen Name

Question Type

Question Text/Description

DIINT4

DI4INTRO

no entry

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 any other sources.
SPINC25K

DI4

code one

[PROBE IF NECESSARY: In estimating [your/(SP's)] total income, you can respond for all of the past 12 months, or
provide a one month estimate.]
[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.]

SPINCLET

DI5A

code one

SHOW CARD DI6
Looking at this card, which letter best represents [your and your spouse's/(SP's) and (his/her) spouse's/[your/(SP's)]]
total income before taxes during the past 12 months? Include income from jobs, Social Security, Railroad
Retirement, other retirement income, and the other sources of income we just talked about.
[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.]

BOX DI3

routing

Code List

Routing

DI4 - SPINC25K

(01) LESS THAN $25,000/YEAR
(02) $25,000 OR MORE/YEAR
(03) LESS THAN $2080/MONTH
(04) $2080/MONTH OR MORE
(-8) Don't Know
(-9) Refused

(01) DI5A - SPINCLET
(02) DI5A - SPINCLET
(03) DI5A - SPINCLET
(04) DI5A - SPINCLET
(-8) BOX DI3
(-9) BOX DI3

(01) A. Less than $5,000
(02) B. $5,000 - less than $10,000
(03) C. $10,000 - less than $15,000
(04) D. $15,000 - less than $20,000
(05) E. $20,000 - less than $25,000
(06) F. $25,000 - less than $30,000
(07) G. $30,000 - less than $40,000
(08) H. $40,000 - less than $50,000
(09) I. $50,000 - less than $66,000
(10) J. $66,000 - less than $109,000
(11) K. $109,000 or more
(-8) Don't Know
(-9) Refused

BOX DI3

GO TO END SECTION.

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