CMS-P-0015A Demographic Income

2023 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 CMQ

BOX DI1

routing

IF ROUND = FALL 2023 ROUND 97 AND INTTYPE ^= C003, GO TO SOGIINT,
ELSE GO TO DIINTROA-DIINT.

DIINT

DIINTROA

no entry

The next few questions are about Hispanic origin and race.

HISPORIG

DI1A

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

DI1A - HISPORIG

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

(01) DI1B - HISPORDT
(02) DI2A - RACECODE
(-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, or of
(91) OTHER HISPANIC, LATINO(A), OR SPANISH
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

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

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

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2023 MCBS Community Questionnaire

Variable Name

RACEPIDT

MR Screen Name

DI2C

DIQ-DEMOGRAPHICS AND INCOME

Question Type

code all

Question Text/Description

Code List

Routing

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.

(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

ENGWELL - D12F

RACEPIOS

DI2C

verbatim text

OTHER PACIFIC ISLANDER GROUP (SPECIFY)

(01) continuous answer

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

OTHRLANG - D12D

DI2FB - ENGREAD

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

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) D13INTRO - DINT3 SOGIINT
(-8) D13INTRO - DINT3 SOGIINT
(-9) D13INTRO - DINT3 SOGIINT

(01) D13INTRO - DINT3 SOGIINT
(02) D13INTRO - DINT3 SOGIINT
(03) DI3INTRO - DIINT3 SOGIINT
(04) DI3INTRO - DIINT3 SOGIINT
(05) DI3INTRO - DIINT3 SOGIINT
(06) DI3INTRO - DIINT3 SOGIINT
(07) DI3INTRO - DIINT3 SOGIINT
(08) DI3INTRO - DIINT3 SOGIINT
(09) DI3INTRO - DIINT3 SOGIINT
(10) DI3INTRO - DIINT3 SOGIINT
(11) DI3INTRO - DIINT3 SOGIINT
(12) DI3INTRO - DIINT3 SOGIINT
(13) DI3INTRO - DIINT3 SOGIINT
(14) DI3INTRO - DIINT3 SOGIINT
(15) DI3INTRO - DIINT3 SOGIINT
(91) DI2E - WHTLNGOS
(-8) D13INTRO - D13 SOGIINT
(-9) D13INTRO - D13 SOGIINT

D13INTRO - DINT3 SOGIINT

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) PORTUGUESE
(16) HINDI
(91) OTHER
(-8) Don't Know
(-9) Refused

WHTLNGOS

DI2E

verbatim text

SOME OTHER LANGUAGE (SPECIFY)

(01) continuous answer

SOGIINT

SEXORINT

SOGIINT

SEXORINT

no entry

code one

[Next we have some questions about your demographic characteristics, including sexual orientation, gender identity,
education, income, and religious preference. Like all your answers, these will be used to understand the health of
different groups in the population and will be kept confidential.]
/
[Next we have some questions about your demographic characteristics, including sexual
orientation, gender identity, and religious preference. Like all your answers, these will be used to understand the
health of different groups in the population and will be kept confidential.]

[(Do you think of yourself)/(Does (SP) think of themselves)] as (gay/lesbian); straight, that is, not (gay/lesbian);
bisexual; something else; or you don't know the answer?

SEXORINT

(01) (GAY/LESBIAN)
(02) STRAIGHT, THAT IS, NOT (GAY/LESBIAN)
(03) BISEXUAL
(04) SOMETHING ELSE
(05) I DON'T KNOW THE ANSWER
(-8 ) Don't Know
(-9) Refused

(01) SEXASGN
(02) SEXASGN
(03) SEXASGN
(04) SEXORIOS
(05) SEXASGN
(-8) SEXASGN
(-9) SEXASGN

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2023 MCBS Community Questionnaire

DIQ-DEMOGRAPHICS AND INCOME

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

SEXORIOS

SEXORIOS

verbatim text

What do you mean by something else?

(01) continuous answer

SEXASGN

SEXASGN

SEXASGN

code one

What sex [(were you)/(was (SP))] assigned at birth on [your/his/her] original birth certificate?

(01) MALE
(02) FEMALE
(-8 ) Don't Know
(-9) Refused

GENIDENT

GENIDENT

GENIDENT

code one

[(Do you)/(Does (SP))] currently describe [yourself/himself/herself] as male, female or transgender?

(01) MALE
(02) FEMALE
(03) TRANSGENDER
(04) NONE OF THESE
(-8 ) Don't Know
(-9) Refused

BOX DI2D

BOX DI2D

routing

IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) GO TO DI3INTRO-DIINT3.
ELSE GO TO RELGPREF.

DI3INTRO

no entry

The next questions are about education and income.

DIINT3

DI3A - SPDEGRCV

(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
SCHOOL CERTIFICATE OR DIPLOMA (BEYOND THE
HIGH SCHOOL LEVEL)
(06) SOME COLLEGE, BUT NO DEGREE
(07) ASSOCIATE DEGREE
(08) BACHELOR'S DEGREE
(09) MASTER'S, PROFESSIONAL OR DOCTORATE
DEGREE
(-8) Don't Know
(-9) Refused

SPDEGRCV

DI3A

code one

SHOW CARD DI5
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,
HOME SCHOOLING, OR UNDER OTHER UNIQUE CIRCUMSTANCES, REFER THE RESPONDENT TO THE
SHOWCARD AND ASK FOR THE NEAREST EQUIVALENT.]

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 sources.
(01) LESS THAN $25,000/YEAR
(02) $25,000 OR MORE/YEAR
[PROBE IF NECESSARY: In estimating [your/(SP's)] total income, you can respond for all of the past 12 months, or (03) LESS THAN $2080/MONTH
provide a one month estimate.]
(04) $2080/MONTH OR MORE
(-8) Don't Know
[EXPLAIN IF NECESSARY: Income is important in analyzing the information we collect. For example, this
(-9) Refused
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

DI4INTRO - DIINT4

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2023 MCBS Community Questionnaire

Variable Name

SPINCLET

MR Screen Name

DI5A

DIQ-DEMOGRAPHICS AND INCOME

Question Type

code one

Question Text/Description

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.]

What is [you/(SP)'s] religious preference?
RELGPREF

RELGPREF

code one
[IF NEEDED: This is the religion/religious preference with which you most closely identify]

RELGPROS

RELGPROS

verbatim text

What is [you/(SP)'s] religious preference?

BOX DI3

routing

IF ROUND = FALL 2023 ROUND 97 AND INTTYPE in(C001, C002, C004, C005, C006), GO TO DVH.
ELSE IF INTTYPE in(C003), GO TO END SECTION.

Code List

Routing

(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
RELGPREF

(01) PROTESTANT
(02) CATHOLIC
(03) EASTERN ORTHODOX, SUCH AS GREEK OR
RUSSIAN ORTHODOX
(04) JEWISH
(05) BUDDHIST
(06) HINDU
(07) MUSLIM, ISLAM, SUFI, SUNNI, OR SHIA
(08) SOME OTHER RELIGION
(09) NO RELIGION
(-8) DON'T KNOW
(-9) REFUSED

(01) BOX DI3
(02) BOX DI3
(03) BOX DI3
(04) BOX DI3
(05) BOX DI3
(06) BOX DI3
(07) BOX DI3
(08) RELGPROS
(09) BOX DI3
(-8) BOX DI3
(-9) BOX DI3

(01) continuous answer

BOX DI3

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