HH Interview HandCard

Attachment 3d

Household Interview Hand Cards

TABLE OF CONTENTS

Household Sample Person Questionnaires Hand Cards 2

Household Family Questionnaires Hand Cards 9

Household Sample Person Questionnaires Hand Cards

OSQ1

Hip replacement

Knee replacement

Plates or pins to fix a broken bone

Dental implants (posts)

Metal sutures or clips

Stents

Pacemakers

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

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)

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

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)

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

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

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

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