Program for the International Assessment of Adult Competencies (PIAAC) Cycle II 2022 Operational Field Test

PIAAC Cycle II Field Test Screener

Appendix A-2 OMB # 1850-0870 v.10

Submitted by National Center for Education Statistics

U.S. Department of Education

September 2019

revised March 2021

Appendix A_2

PIAAC Cycle II Field Test Screener Instrument

SCQ1010 SCQAskNumberInHH

Item Type: Question

Item Integer

Item Including yourself, how many people live in this household and have no usual place of residence elsewhere?

Display

Incluyéndose usted mismo(a), ¿cuántas personas viven en este hogar y no tienen un lugar de residencia en otro sitio?

Notes Start enumeration timing here.

Lower Range: 1

CATA: NO Answers Allowed: 1 Upper Range: 25

Response Value Label Skip To

1 [Enter continuous answer.] SCQ1015

990 REFUSED SCQ1015

SCQ1015

Item Type: Route

Item Begin Loop

Item The following variables -- name, Screener respondent, gender, age, age range, and the misreported field (SCQ1020-SCQ1090) -- should appear as a grid. All enumeration information is entered in this grid.

Display Notes

Response Value Label Skip To

1 [Route executed.] SCQ1020

SCQ1020 SCQNameHHM

Item Type: Question Item String Item

1. What is the first name of the person, or one of the persons, who is living in the household who owns or rents this home?

2. Next, please tell me the names of all other members of this household (starting with your spouse, if applicable).

3. Please tell me the names of all other members of this household.

[HOUSEHOLD (HH) MEMBERS INCLUDE PEOPLE WHO THINK OF THIS HH AS THEIR PRIMARY PLACE OF RESIDENCE. IT INCLUDES PERSONS WHO USUALLY STAY IN THE HH BUT ARE TEMPORARILY AWAY ON BUSINESS, VACATION, IN A HOSPITAL, OR LIVING AT SCHOOL IN A DORM, FRATERNITY OR SORORITY.]

[PRESS THE DOWN ARROW KEY TO MOVE TO THE NEXT BLANK LINE. WHEN ALL NAMES ARE ENTERED, USE ARROW UP AND RIGHT KEYS TO GET TO NEXT QUESTION.]

1. ¿Cuál es el nombre de la persona, o de una de las personas, que está viviendo en el hogar que es dueño(a) o arrienda este hogar?

2. A continuación, por favor dígame los nombres de todos los otros miembros de este hogar (empezando por su esposo(a), si corresponde).

3. Por favor dígame los nombres de todos los otros miembros de este hogar.

[HOUSEHOLD (HH) MEMBERS INCLUDE PEOPLE WHO THINK OF THIS HH AS THEIR PRIMARY PLACE OF RESIDENCE. IT INCLUDES PERSONS WHO USUALLY STAY IN THE HH BUT ARE TEMPORARILY AWAY ON BUSINESS, VACATION, IN A HOSPITAL, OR LIVING AT SCHOOL IN A DORM, FRATERNITY OR SORORITY.]

[PRESS THE DOWN ARROW KEY TO MOVE TO THE NEXT BLANK LINE. WHEN ALL NAMES ARE ENTERED, USE ARROW UP AND RIGHT KEYS TO GET TO NEXT QUESTION.]

DisplayFor the first line on the grid, display text A. For the second line, display text B. For all subsequent lines, display text C.

For the first line on the grid, display text A. For the second line, display text B. For all subsequent lines, display text C.

Notes Allow 25 characters for names.

This variable should appear as the first column on the grid.

Lower Range:

CATA: NO Answers Allowed: Upper Range:

Response Value Label Skip To

1 [Enter continuous answer.] SCQ1025

SCQ1025 SCQWhoIsRespondent

Item Type: Question

Item Enumerated

Item [ENTER A '1' NEXT TO THE RESPONDENT.]

[IF NOT OBVIOUS, ASK: Thank you for telling me about all the people who live in this household. Now, I need to ask your name, so I know which household member you are.]

[ENTER A '1' NEXT TO THE RESPONDENT.]

Display

[IF NOT OBVIOUS, ASK: Gracias por decirme todas las personas que viven en este hogar. Ahora, necesito preguntarle su nombre, para saber qué miembro del hogar es usted.]

Notes Allow only one response to this question. This variable should appear as the second column in the grid.

CATA: NO Answers Allowed: 1

Response Value Label Skip To

1 RESPONDENT Respondent SCQ1030

SCQ1030

Item Type: Route

Item If Then

Item Allow open movement through grid. Do not require users to ask all items for each person before going to the next person.

Display Notes

Response Value Label Skip To

1 [Route executed.] SCQ1040

SCQ1040 SCQGender

Item Type: Question

Item Enumerated

Item [CODE GENDER. IF NOT OBVIOUS, ASK: Is {NAME} male or female?]

[CODE GENDER. IF NOT OBVIOUS, ASK: ¿Es {NAME} de sexo femenino o masculino?]

Display

Notes This variable should appear as the third column on the grid.

CATA: NO Answers Allowed: 1

Response	Value Label	Skip To
1 MALE	Male	SCQ1050
2 FEMALE	Female	SCQ1050

SCQ1050 SCQAge

Item Type: Question

Item Integer

Item How old {are you/is NAME}?

[IF UNDER 1 YEAR, ENTER AS "0"]

¿Qué edad tiene (usted/NAME}?

[IF UNDER 1 YEAR, ENTER AS "0"]

Display

Notes This variable should appear as the fourth column on the grid.

Lower Range: 0

CATA: NO Answers Allowed: 1 Upper Range: 130

1	Response [Enter continuous answer.]	Value Label	Skip To SCQ1055
980	DON'T KNOW		SCQ1060
990	REFUSED		SCQ1060

SCQ1055

Item Type: Check

Item Soft

Item If outside the range of 0 to 99, display the following: "I just need to check that

{your/NAME's} age is {SCQ1050}. Is this right?" Associated variable: SCQ1050

If outside the range of 1 to 99, display the following: "Necesito solamente verificar que la edad de {usted/NAME} es {SCQ1055}. ¿Es correcto ésto?"

Display Notes

Associated variable: SCQ1050

Response Value Label Skip To

1 [Check executed.] SCQ1090

SCQ1060	SCQAgeRange
Item Type: Item Item	Question Enumerated {Are you/Is NAME}...
	¿Tiene {usted/NAME} …
Display Notes CATA:	For Spanish, display the following response options: This variable should appear as the fifth column on the grid. NO Answers Allowed: 1 Response Value Label	Skip To
1	Under 16 years old? Under16YearsOld	SCQ1090
2	Menos de 16 años de edad? 16 to 25 years old? F16To25YearsOld	SCQ1090
3	de 16 a 25 años de edad? 26 to 35 years old? F26To35YearsOld	SCQ1090
4	de 26 a 35 años de edad? 36 to 45 years old? F36To45YearsOld	SCQ1090
5	de 36 a 45 años de edad? 46 to 55 years old? F46To55YearsOld	SCQ1090
6	de 46 a 55 años de edad? 56 to 65 years old? F56To65YearsOld	SCQ1090
7	de 56 a 65 años de edad? 66 to 74 years old? F66To74YearsOld	SCQ1090
8	de 66 a 74 años de edad? 75 years old or older? F75YearsOldOrOlder	SCQ1090
980	75 años de edad o más? DON'T KNOW	SCQ1061
990	DON'T KNOW REFUSED	SCQ1061
	REFUSED

SCQ1061	SCQBroadAgeRange
Item Type: Item Item	Question Enumerated {Are you/Is NAME}…
	¿Tiene {usted/NAME} …
Display Notes CATA:	For Spanish, display the following response options: This variable should appear as the sixth column on the grid. NO Answers Allowed: Response Value Label	Skip To
1	Under 16 years old? Under16YearsOld_	SCQ1090
2	Menos de 16 años de edad? 16 to 39 years old? _16To39YearsOld_	SCQ1090
3	de 16 a 39 años de edad? 40 to 65 years old? _40To65YearsOld	SCQ1090
4	de 40 a 65 años de edad? 66 to 74 years old? _66To74YearsOld	SCQ1090
4	de 66 a 74 años de edad? 75 years old or older? _75YearsOldOrOlder	SCQ1090
	75 años de edad o más?
SCQ1090	SCQMisreportedHHM
Item Type: Item Item	Instruction Enumerated

[LEAVE EMPTY UNLESS PERSON WAS MISREPORTED AND IS NOT A HOUSEHOLD MEMBER. IF MISREPORTED, ENTER "1".]

[LEAVE EMPTY UNLESS PERSON WAS MISREPORTED AND IS NOT A HOUSEHOLD MEMBER. IF MISREPORTED, ENTER "1".]

Display

Do not allow "MISREPORT" as an option on the first line of the grid, (reference person). If a person is marked as "MISREPORTED," all other fields on the grid associated with this person should be "show only."

Do not allow "MISREPORT" as an option on the first line of the grid, (reference person). If a person is marked as "MISREPORTED," all other fields on the grid associated with this person should be "show only."

Notes The default for this field is blank - it will only be filled if necessary.

This variable should appear as the seventh column on the grid.

Response Value Label Skip To

1 MISREPORTED Misreported SCQ1100

SCQ1100 SCQAllInfoEntered

Item Type: Question

Item Enumerated

Item [HAVE YOU ENTERED ALL NECESSARY INFORMATION ON THE GRID?]

[HAVE YOU ENTERED ALL NECESSARY INFORMATION ON THE GRID?]

Display

Notes This item should appear in the first column of the first empty row.

CATA: NO Answers Allowed: 1

Response	Value Label	Skip To
1 YES	Yes	SCQ1102
2 NO	No	SCQ1102

SCQ1102

Item Type: Route

Item If Then

Item Check enumeration grid to ensure that all necessary items have been answered. If any necessary fields are blank, return to grid. Else, go to SCQ1105.

Display Notes

Response Value Label Skip To

SCQ1105 SCQAnyoneElse

Item Type: Question

Item Enumerated

Item We have listed {NUMBER} household member{s}:

{NAME/GENDER/AGE}

Have we missed any other...

• members of this household who are related to {you/REFERENCE PERSON}?

• people living here who are not related to {you/REFERENCE PERSON}, including friends or boarders?

• household members who usually live here but are not here currently, such as someone away on vacation, business, in a hospital, or a student living in a dormitory?

Tenemos anotado {NUMBER} miembro(s) del hogar :

{NAME/GENDER/AGE}

¿Hemos olvidado ...

• algún otro miembro de este hogar que esté emparentado con {usted/REFERENCE PERSON}?

• alguna otra persona que viva aquí que no esté emparentada con {usted/REFERENCE PERSON}, incluyendo amigos o huéspedes?

• algún otro miembro del hogar que usualmente viva aquí pero que actualmente no esté aquí, tal como alguien que esté lejos de vacaciones, negocio, en un hospital, o un estudiante viviendo en una residencia para estudiantes?

Display Display the number of household members collected in the enumeration grid in {NUMBER}.

Display the name, gender and age of all household members collected in the grid in

{NAME/GENDER/AGE}.

Display the number of household members collected in the enumeration grid in {NUMBER}. Display the name, gender and age of all household members collected in the grid in

{NAME/GENDER/AGE}.

Notes The number of household members collected in the enumeration grid is the value that should be stored as household size.

End enumeration timing here when SCQ1105=2.

CATA: NO Answers Allowed: 1

Response Value Label Skip To

1. YES Yes SCQ1106

2. NO No SCQ1110 990 REFUSED SCQ1110

SCQ1106

Item Type: Check

Item Hard

Item PLEASE ADD ADDITIONAL INFORMATION TO THE TABLE.

Display Notes

PLEASE ADD ADDITIONAL INFORMATION TO THE TABLE.

Response Value Label Skip To

1 [Check executed.] SCQ1020

SCQ1110

Item Type: Route

Item If Then

Item Insert sampling messages here. Based on collected household characteristics, determine if there is at least one eligible person in the household.

If there is at least one eligible person, then go to SCQ1115. Else, go to SCQ1124.

Display

Notes Eligibility is determined at the time enumeration is completed. SCQ1105 is the final enumeration question that must be answered to determine eligibility.

Response Value Label Skip To

1 [Route executed.]

SCQ1115 SCQEligiblePersons

Item Type: Instruction

Item Enumerated

Item Based on the information you have provided, we have selected the following people to participate in the study: {PERSON(S)}

[PRESS 1 AND ENTER TO CONTINUE.]

Basados en la información que usted ha proporcionado, hemos seleccionado a la(s) siguiente(s) persona(s) para participar en el estudio: {PERSON(S)}

[PRESS 1 AND ENTER TO CONTINUE.]

Display

Notes Display name, age and gender of eligible SP(s) in "PERSON(S)".

Response Value Label Skip To

1 CONTINUE Continue SCQ1117

SCQ1116a SCQDOB

Item Type: Question

Item Class: Integer

Item Text: What is ^AuxNameYour birth date?

¿Cuál es fecha de cumpleaños de {NAME/usted}?

Display: Interviewer Instruction – Enter complete date, including date, month and year. If respondent does not know complete date enter DK. If respondent refuses to provide complete date, enter RF.

Notes: ^{ENTER AS DD/MM/YYYY.}

CAPI Instr: ^{Soft edit to compare SCQ1116a to Screener Age SCQXXXX.If difference is greater than} one year, display the edit: “Necesito verificar lo que anoté. Tengo que la fecha de nacimiento de {NAME/usted} es SCQ1116aDOB. ¿Es ésto correcto?”

1	Response [Enter Continuous answer]	Value Label Continue	Skip To SCQ1116d
9	DON’T KNOW		SCQ1116bMM
7	REFUSED		SCQ1116bMM

Item Type: Check

Item Class: Hard edit

Item Text: Date cannot be in future

Item Class: Soft edit

Item Text: Date cannot be before 1/1/1890

Derived age must be +/- 1 of enumeration age

SCQ1116bMM

Item Type: Question

Item Class: Integer

Item Text: Can you please tell me {NAME/usted} month of birth?”

Dígame por favor el mes en que nació {NAME/usted}.”

Notes: [^{ENTER AS MM]}

If DON”T KNOW OR REFUSED then current month used

Lower Range : 1 Upper Range : 12

1	Response [Enter Continuous answer]	Value Label Continue	Skip To SCQ1116cYY
9	DON’T KNOW		SCQ1116cYY
7	REFUSED		SCQ1116cYY

SCQ1116cYY

Item Type: Question

Item Class: Integer

Item Text: Can you please tell me ^AuxNameYour year of birth?” Dígame por favor el año en que nació {NAME/usted}.”

Notes: [^{ENTER AS YYYY]}

CAPI Instr: ^{Soft edit to compare SCQ1116cYYYY to Screener Age SCQXXXX. If difference is greater} than one year, display the edit: “I need to verify what I entered. I recorded that

^AuxNameYour year of birth is SCQ1116cYYYY. Is this correct?”

Soft edit to compare SCQ116cYYYY to Screener Age SCQXXXX. If difference is greater than one year, display the edit: “Necesito verificar lo que anoté. Tengo que el año en que

{NAME/usted} nació es SCQ1116cYYYY. ¿Es ésto correcto?”

If DON”T KNOW OR REFUSED then backward calculate year from enumeration age. Day set = 15(mid-month) for date calculations.

1	Response [Enter Continuous answer]	Value Label Continue	Skip To SCQ1116d
9	DON’T KNOW		SCQ1116d
7	REFUSED		SCQ1116d

Item Type: Check

Item Class: Hard edit

Item Text: Year cannot be in future

Item Class: Soft edit

Item Text: Year cannot be before 1890

Derived age must be +/- 1 of enumeration age

Note: When done, the following variables set or derived – SCQ1116Age (derived age); SCQ1116a (day of derived DOB); SCQ1116b (month of derived DOB); SCQ1116c (year of derived DOB).

SCQ1116d SCQHighestEdLevel

Item Type: Question

Item Class: Integer

Item Text: [SHOWCARD #1]

What is the highest level of education {you/NAME} [have/has] completed?” [SHOWCARD #1]

¿Cuál es el nivel de educación más alto que {usted/NAME} ha completado?

Notes:

Response	Value Label	Skip To
1 LESS THAN HIGH SCHOOL DIPLOMA	LessThanHSDiploma	SCQ1117
2 HIGH SCHOOL DIPLOMA/SOME COLLEGE
BUT NO DEGREE	HSDiploma/CollegeNoDegree	SCQ1117
3 COLLEGE DEGREE OR HIGHER	CollegeDegreeOrHigher	SCQ1117
(ASSOCIATE’S, BACHELOR’S,

DOCTORATE, ETC)

980 DON’T KNOW SCQ1117

990 REFUSED SCQ1117

SCQ1117 SCQSPEthnicity

Item Type: Question Item Enumerated Item

Do any of the following groups represent {your/NAME's} national origin or ancestry? Mexican/Mexican-American, Puerto Rican, Cuban, other Hispanic or Latino? You can select more than one answer.

[SELECT ALL THAT APPLY.]

¿Alguno de los siguientes grupos representa el origen nacional o ancestro {suyo/de NAME}; mexicano/mexicoamericano, puertorriqueño, cubano, otro hispano o latino? Puede seleccionar más de una respuesta.

[SELECT ALL THAT APPLY.]

Display Notes

CATA: YES Answers Allowed:

Response Value Label Skip To

1. MEXICAN/MEXICAN-AMERICAN Mexican_Mexican_American SCQ1118

2. PUERTO RICAN PuertoRican SCQ1118

3. CUBAN Cuban SCQ1118

4. OTHER HISPANIC OR LATINO OtherHispanicOrLatino SCQ1118

5. NOT HISPANIC NotHispanic SCQ1118

980 DON'T KNOW SCQ1119

990 REFUSED SCQ1119

SCQ1118

Item Type: Check

Item Hard

Item If SCQ1117=5 and another response, display: "I'm sorry, but NOT HISPANIC is not allowed with any other response."

Display Notes

If SCQ1117=5 and another response, display: "Lo lamento, pero NO HISPANO no se permite con ninguna otra respuesta."

Response Value Label Skip To

1 [Check executed.] SCQ1121

SCQ1119 SCQEthnicityObserve

Item Type: Question

Item Enumerated

Item [RECORD SP'S ETHNICITY BY OBSERVATION, IF POSSIBLE.]

[RECORD SP'S ETHNICITY BY OBSERVATION, IF POSSIBLE.]

Display Notes

CATA: NO Answers Allowed:

Response Value Label Skip To

1. MEXICAN/MEXICAN-AMERICAN Mexican_Mexican_American SCQ1121

2. PUERTO RICAN PuertoRican SCQ1121

3. CUBAN Cuban SCQ1121

4. OTHER HISPANIC OR LATINO OtherHispanicOrLatino SCQ1121

5. NOT HISPANIC NotHispanic SCQ1121

980 DON'T KNOW SCQ1121

SCQ1121 SCQSPRace

Item Type: Question Item Enumerated Item

What race do you consider {yourself/NAME} to be? White, Black or African American, Asian, Native Hawaiian or other Pacific Islander, or American Indian or Alaska Native? You can select more than one answer.

[SELECT ALL THAT APPLY.]

¿De qué raza considera que es {usted/NAME}: blanca, negra o afroamericana, asiática, native de Hawai o de otra isla del Pacífico, o india americana o nativa de Alaska? Puede seleccionar más de una respuesta.

[SELECT ALL THAT APPLY.]

Display Notes

CATA: YES Answers Allowed:

Response Value Label Skip To

1. WHITE White SCQ1123

2. BLACK/AFRICAN AMERICAN Black_AfricanAmerican SCQ1123

3. ASIAN Asian SCQ1123

4. NATIVE HAWAIIAN/PACIFIC NativeHawaiian_PacificIslande SCQ1123 ISLANDER r

5. AMERICAN INDIAN/ALASKA AmericanIndian_AlaskaNative SCQ1123 NATIVE

980 DON'T KNOW SCQ1122

990 REFUSED SCQ1122

SCQ1122 SCQRaceObserve

Item Type: Question

Item Enumerated

Item [RECORD SP'S RACE BY OBSERVATION, IF POSSIBLE.]

[RECORD SP'S RACE BY OBSERVATION, IF POSSIBLE.]

Display Notes

CATA: NO Answers Allowed:

Response Value Label Skip To

1. WHITE White SCQ1123

2. BLACK/AFRICAN AMERICAN Black_AfricanAmerican SCQ1123

3. ASIAN Asian SCQ1123

4. NATIVE HAWAIIAN/PACIFIC NativeHawaiian_PacificIslande SCQ1123 ISLANDER r

5. AMERICAN INDIAN/ALASKA AmericanIndian_AlaskaNative SCQ1123 NATIVE

980 DON'T KNOW SCQ1123

SCQ1123

Item Type: Route

Item If Then

Item If another SP, go to SCQ1117.

Else, go to SCQ1124.

Display Notes

Response Value Label Skip To

1 [Route executed.]

SCQ1124 SCQHomePhone

Item Type: Question

Item Enumerated

Item What is your home telephone number (in case my office wants to check my work)?

Display Notes

¿Cuál es el número de teléfono de su hogar (en caso de que alguien en mi oficina quiera verificar mi trabajo)?

CATA: NO Answers Allowed: 1

Response Value Label Skip To

1. ENTER PHONE NUMBER EnterPhoneNumber SCQ1125

2. NO HOME PHONE NoHomePhone SCQ1150 990 REFUSED SCQ1150

SCQ1125 SCQPhoneArea

Item Type: Question

Item Integer

Item [What is your home telephone number (in case my office wants to check my work)?] NUMBER: ()- ENTER THE AREA CODE

Display Notes

[¿Cuál es el número de teléfono de su hogar (en caso de que alguien en mi oficina quiera verificar mi trabajo)?]

NUMBER: ()- ENTER THE AREA CODE

Lower Range:

CATA: NO Answers Allowed: Upper Range:

Response Value Label Skip To

1 [Enter continuous answer.] SCQ1130

SCQ1130 SCQPhoneExchange

Item Type: Question

Item Integer

Item NUMBER: ({AREA})-ENTER THE EXCHANGE

Display Notes

NUMBER: ({AREA})-ENTER THE EXCHANGE

Lower Range:

CATA: NO Answers Allowed: 1 Upper Range:

Response Value Label Skip To

1 [Enter continuous answer.] SCQ1135

SCQ1135 SCQPhoneLocal

Item Type: Question

Item Integer

Item NUMBER: (AREA)-{EXCHANGE} ENTER THE LOCAL

Display Notes

NUMBER: (AREA)-{EXCHANGE} ENTER THE LOCAL

Lower Range:

CATA: NO Answers Allowed: 1 Upper Range:

Response Value Label Skip To

1 [Enter continuous answer.] SCQ1140

SCQ1140 SCQPhoneConfirm

Item Type: Question

Item Enumerated

Item CONFIRM TELEPHONE NUMBER: ({AREA}) {EXCHANGE}-{LOCAL}

Is this correct?

CONFIRM TELEPHONE NUMBER: ({AREA}) {EXCHANGE}-{LOCAL}

¿Es correcto ésto?

Display Notes

CATA: NO Answers Allowed: 1

Response	Value Label	Skip To
1 YES	Yes	SCQ1150
2 NO	No	SCQ1145

SCQ1145

Item Type: Check

Item Hard

Item SELECT FIELD TO RE-ENTER.

Display Notes

SELECT FIELD TO RE-ENTER.

Response Value Label Skip To

1 [Check executed.] SCQ1150

SCQ1150 SCQOtherNumber

Item Type: Question

Item Enumerated

Item Is there {a/another} phone number where you could be reached?

¿Hay {un/otro} número de teléfono donde nos podamos comunicar con usted?

Display If SCQ1124=1, display "another". Else, display "a".

If SCQ1124=1, display "otro". Else, display "un".

Notes

CATA: NO Answers Allowed:

	Response	Value Label	Skip To
1	YES	Yes	SCQ1155
2	NO OTHER PHONE	NoOtherPhone	SCQ2005
990	REFUSED		SCQ2005

SCQ1155 SCQOtherArea

Item Type: Question

Item Integer

Item [What is that phone number?]

NUMBER: ()- ENTER THE AREA CODE

Display Notes

[¿Cuál es ese número de teléfono?] NUMBER: ()- ENTER THE AREA CODE

Lower Range:

CATA: NO Answers Allowed: Upper Range:

Response Value Label Skip To

1 [Enter continuous answer.] SCQ1160

SCQ1160 SCQOtherExchange

Item Type: Question

Item Integer

Item NUMBER: ({AREA})-ENTER THE EXCHANGE

Display Notes

NUMBER: ({AREA})-ENTER THE EXCHANGE

Lower Range:

CATA: NO Answers Allowed: Upper Range:

Response Value Label Skip To

1 [Enter continuous answer.] SCQ1165

SCQ1165 SCQOtherLocal

Item Type: Question

Item Integer

Item NUMBER: (AREA)-{EXCHANGE} ENTER THE LOCAL

Display Notes

NUMBER: (AREA)-{EXCHANGE} ENTER THE LOCAL

Lower Range:

CATA: NO Answers Allowed: Upper Range:

Response Value Label Skip To

1 [Enter continuous answer.] SCQ1170

SCQ1170 SCQOtherConfirm

Item Type: Question

Item Enumerated

Item I have the phone number as: ({AREA}) {EXCHANGE}-{LOCAL} Is this correct?

CONFIRM TELEPHONE NUMBER: ({AREA}) {EXCHANGE}-{LOCAL}

¿Es correcto ésto?

Display Notes

CATA: NO Answers Allowed: 1

Response	Value Label	Skip To
1 YES	Yes	SCQ1180
2 NO	No	SCQ1175

SCQ1175

Item Type: Check

Item Hard

Item SELECT FIELD TO RE-ENTER.

Display Notes

SELECT FIELD TO RE-ENTER.

Response Value Label Skip To

1 [Check executed.] SCQ1180

SCQ1180 SCQOtherPhoneLocated

Item Type: Question

Item Enumerated

Item Where is this phone located? Is it in your home, in the home of a neighbor, at work, someplace else, or is it a cellular phone?

Display Notes

¿Dónde está localizado este teléfono? ¿Está éste en su hogar, en el hogar de un vecino, en el trabajo, en algún otro lugar o es un teléfono celular?

CATA: NO Answers Allowed:

	Response	Value Label	Skip To
1	OWN HOME	OwnHome	SCQ2005
2	HOME OF NEIGHBOR	HomeOfNeighbor	SCQ2005
3	WORK	Work	SCQ2005
4	CELLULAR PHONE	CellPhone	SCQ2005
910	OTHER, SPECIFY	OthSpecify	SCQ2005
980	DON'T KNOW		SCQ2005
990	REFUSED		SCQ2005

SCQ2005 SCQLanguage

Item Type: Question

Item Enumerated

Item [THIS SCREENER INTERVIEW WAS CONDUCTED IN:]

[THIS SCREENER INTERVIEW WAS CONDUCTED IN:]

Display Notes

CATA: NO Answers Allowed: 1

Response Value Label Skip To

1. ENGLISH English SCQ3010

2. SPANISH Spanish SCQ3010 910 OTHER, SPECIFY OthSpecify SCQ3010

SCQ3010

Item Type: Route

Item If Then

Item If hidden DU procedure is required, go to SCQ3012.

Display Notes

Else, go to SCQ3015.

Response Value Label Skip To

1 [Route executed.]

SCQ3012 SCQHiddenDU

Item Type: Instruction Item Enumerated Item

We want to be sure that every household in this area has been given a chance to participate

in this important study. Are there any other living quarters, like a basement or garage apartment that we may have missed?

IF NO > CODE 2

IF YES > DO THE DUs THAT R MENTIONED APPEAR ON THE LISTING SHEETS?

IF YES > CODE 2

IF NO > DO DUs MEET DEFINITION OF DU? [PERSONS LIVE/EAT SEPARATELY

AND HAVE ENTRANCE DIRECTLY FROM OUTSIDE OR THROUGH COMMON HALL]

IF YES > CODE 1

IF NO > CODE 2

Queremos asegurarnos de que cada hogar en esta área tiene la oportunidad de ser seleccionado para participar en este importante estudio. ¿Hay alguna otra unidad de vivienda tal como un apartamento en el sótano o en el garage que podamos haber olvidado?

Display Notes

Response Value Label Skip To

1 HIDDEN DU PROCEDURE REQUIRED

HiddenDuProcedureRequired SCQ3013 2 NO, HIDDEN DU PROCEDURE NOT

No_HiddenDuProcedureNotReq SCQ3013

REQUIRED uired

980 DON'T KNOW DK SCQ3013

SCQ3013

Item Type: Route

Item If Then

Item If SCQ3012 is YES then update tblCaseInfo.HiddenCasePendingYN to Y; If SCQ3012 is DK then update tblCaseInfo.HiddenCasePendingYN to Y; If SCQ3012 is NO then update tblCaseInfo.HiddenCasePendingYN to N.

Display Notes

Response Value Label Skip To

1 [Route executed.] SCQ3015

SCQ3015

Item Type: Route

Item If Then

Item If household contains SP(s), go to SCQ4005.

Display Notes

Else, go to SCQ4010.

Response Value Label Skip To

1 [Route executed.]

SCQ4005 SCQCompleteEligible

Item Type: Instruction

Item Enumerated

Item [END OF SCREENER. ATTEMPT TO ADMINISTER BQ WITH SP. IF NOT AVAILABLE, SET APPOINTMENT FOR BQ AND EXERCISE.]

[PRESS F10 AND ENTER TO CONTINUE.]

Display

Notes End instrument timing here.

COMPLETE SCREENER, 1-3 SAMPLE PERSONS SELECTED

Response Value Label Skip To

1 F10 F10 END

SCQ4010 SCQCompleteInelig

Item Type: Instruction

Item Enumerated

Item Thank you very much for your time today. Based on the information you have given us, no one in your household is eligible to participate in our study. Thank you.

[PRESS F10 AND ENTER TO CONTINUE.]

Muchas gracias por el tiempo que me ha dado hoy. Basado en la información que nos ha dado, nadie en su hogar cumple con los requisitos para participar en nuestro studio Muchas gracias.

[PRESS 1 AND ENTER TO CONTINUE.]

Display

Notes End instrument timing here.

COMPLETE SCREENER, NO ELIGIBLE SAMPLE PERSON(S)

Response Value Label Skip To

1 F10 F10 END