HH Interview HandCard

Att_3d_HH Interview HandCard_201129.docx

National Health and Nutrition Examination Survey

HH Interview HandCard

OMB: 0920-0950

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Attachment 3d


Household Interview Hand Cards



TABLE OF CONTENTS















Household Sample Person Questionnaires Hand Cards





Shape1

OSQ1





Hip replacement

Knee replacement

Plates or pins to fix a broken bone

Dental implants (posts)

Metal sutures or clips

Stents

Pacemakers

Shape2

AUQ1





Genetic/hereditary causes

Ear infections (including fluid in ears)

Ear diseases (otosclerosis, menieres, tumor)

Illness/infections (measles, meningitis, mumps)

Drugs/medications

Head or neck injury/trauma

Loud brief explosive noise sounds

Noise exposure, long-term (machinery, etc.)

Aging, getting older

SMQ1





Shape3

DMQ1


Never attended/kindergarten only

1st grade

2nd grade

3rd grade

4th grade

5th grade

6th grade

7th grade

8th grade

9th grade

10th grade

11th grade

12th grade, no diploma

High school graduate

GED or equivalent

Some college, no degree

Associate degree: Occupational, technical, or vocational program

Associate degree: Academic program

Bachelor’s degree (example: BA, AB, BS, BBA)

Master’s degree (example: MA, MS, MEng, MEd, MBA)

Professional school degree (example: MD, DDS, DVM, JD)

Doctoral degree (example: PhD, EdD)

Shape4

DMQ2



10. Mexican

11. Puerto Rican

12. Cuban

13. Dominican (Republic)

Central American:

14. Costa Rican

15. Guatemalan

16. Honduran

17. Nicaraguan

18. Panamanian

19. Salvadoran

20. Other Central American

South American:

21. Argentinean

22. Bolivian

23. Chilean

24. Colombian

25. Ecuadorian

26. Paraguayan

27. Peruvian

28. Uruguayan

29. Venezuelan

30. Other South American

Other Hispanic or Latino:

31. Filipino

32. Spaniard

33. Spanish

34. Spanish American

35. Hispano/Hispana

36. Hispanic/Latino

41. Chicana/Chicano

HIQ1



Private health insurance


Medicare


Medi-gap


Medicaid


Children’s Health Insurance Program (CHIP)


Military Related Health Care: Tricare

(CHAMPUS)/VA HEALTH CARE/Champ-VA


Indian Health Service


State-sponsored health plan


Other government program


No coverage of any type







Household Family Questionnaires Hand Cards





Shape5

DMQ1



Never attended/kindergarten only

1st grade

2nd grade

3rd grade

4th grade

5th grade

6th grade

7th grade

8th grade

9th grade

10th grade

11th grade

12th grade, no diploma

High school graduate

GED or equivalent

Some college, no degree

Associate degree: Occupational, technical, or vocational program

Associate degree: Academic program

Bachelor’s degree (example: BA, AB, BS, BBA)

Master’s degree (example: MA, MS, MEng, MEd, MBA)

Professional school degree (example: MD, DDS, DVM, JD)

Doctoral degree (example: PhD, EdD)

Shape6

CBQ1





EXAMPLES OF PLACES OTHER
THAN GROCERY STORES



Convenience Stores (7-11, Mini Mart)

Wholesale Stores (Costco, Sam’s Club, BJ’s)

Target/ Wal-Mart/ Kmart

Dollar Store

Bakeries

Meat Markets

Vegetable stands

Farmer’s Markets

Shape7

INQ1




U. $20,000 - $20,999

V. $21,000 - $21,999

W. $22,000 - $22,999

X. $23,000 - $23,999

Y. $24,000 - $24,999

Z. $25,000 - $25,999

AA. $26,000 - $26,999

BB. $27,000 - $27,999

CC. $28,000 - $28,999

DD. $29,000 - $29,999

EE. $30,000 - $30,999

FF. $31,000 - $31,999

GG. $32,000 - $32,999

HH. $33,000 - $33,999

II. $34,000 - $34,999

JJ. $35,000 - $39,999

KK. $40,000 - $44,999

LL. $45,000 - $49,999

MM. $50,000 - $54,999

NN. $55,000 - $59,999

OO. $60,000 - $64,999

PP. $65,000 - $69,999

QQ. $70,000 - $74,999

RR. $75,000 - $79,999

SS. $80,000 - $84,999

TT. $85,000 - $89,999

UU. $90,000 - $94,999

VV. $95,000 - $99,999

WW. $100,000 and over


Shape8

INQ2




A. Less than $1,000

B. $1,000 - $1,999

C. $2,000 - $2,999

D. $3,000 - $3,999

E. $4,000 - $4,999

F. $5,000 - $5,999

G. $6,000 - $6,999

H. $7,000 - $7,999

I. $8,000 - $8,999

J. $9,000 - $9,999

K. $10,000 - $10,999

L. $11,000 - $11,999

M. $12,000 - $12,999

N. $13,000 - $13,999

O. $14,000 - $14,999

P. $15,000 - $15,999

Q. $16,000 - $16,999

R. $17,000 - $17,999

S. $18,000 - $18,999

T. $19,000 - $19,999

INQ3





Cash

Checking account

Saving accounts

CDs (Certificates of deposit)

Retirement accounts (such as IRAs, 401K, etc.)

Stocks

Bonds

Mutual funds

INQ4



A: $0 - $3,000

B: $3,001 - $5,000

C: $5,001 - $10,000

D: $10,001 - $15,000

E: $15,001 - $20,000

________________________________________

Cash

Checking account

Saving accounts

CDs (Certificates of deposit)

Retirement accounts (such as IRAs, 401K, etc.)

Stocks

Bonds

Mutual funds


FSQ1




Often true


Sometimes true


Never true


3

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File TitleOL1
AuthorLori Houck
File Modified0000-00-00
File Created2021-01-22

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