CMS-P-0015A Mobility of Beneficiaries

2021 MCBS Community Questionnaire

Variable Name

MR Screen Name

MBQ-MOBILITY OF BENEFICIARIES

Question Type

Question Text/Description

Code List

Routing

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

MB2 - MREDTRAV

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

MB3 - MASKRIDE

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

BOX MB1

MOBILITY OF BENEFICIARIES QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=ALL
SPALIVE=1
SEASON=FALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
If INTTYPE in (C001, C004, C005), administer after CPS.
If INTTYPE in (C002, C006), administer after NSQ.
If INTTYPE in (C003), administer after HIQ.

BOX MBBEG

routing

GO TO MB1 - MTBLGTPL.

My next questions are about [your/(SP)’s] travel activities and [your/his/her] health.
MTBLGTPL

MB1

yes/no

Because of a health or physical problem, [have you/has (SP)]...
had trouble getting places, like the doctor’s office, a supermarket, or a friend’s house since (TODAY'S DATE - 12
MONTHS, MONTH AND YEAR)?

MREDTRAV

MASKRIDE

MB2

MB3

BOX MB1

yes/no

yes/no

routing

Because of a health or physical problem, [have you/has (SP)]…
reduced [your/his/her] day-to-day travel since (TODAY'S DATE - 12 MONTHS, MONTH AND YEAR)?

Because of a health or physical problem, [have you/has (SP)]...
asked others for rides since (TODAY'S DATE - 12 MONTHS, MONTH AND YEAR)?

If the respondent ever reported that they don't drive, have never driven, or gave up driving
(SAMPLE_PERSON.P_MGIVUPDR =1, 3, 4, or 5), go to MB6-MUSETRNS.
Else go to MB5-MGIVUPDR.

(01) YES
(02) NO
(03) DOESN'T DRIVE (DO NOT DISPLAY.)
given up driving altogether since (TODAY'S DATE - 12 MONTHS, MONTH AND YEAR)?
(04) HAS NEVER DRIVEN
(05) GAVE UP DRIVING BEFORE (TODAY'S DATE - 12
[PROBE FOR PROPER RESPONSE IF R OFFERS MORE THAN A YES OR NO RESPONSE, USING PROBES
MONTHS, MONTH AND YEAR)
SUCH AS “Was this because of a health or physical problem” and “I just want to check whether this was before or
(-8) Don't Know
after (TODAY'S DATE - 12 MONTHS, MONTH AND YEAR)”.]
(-9) Refused
Because of a health or physical problem, [have you/has (SP)]...

MGIVUPDR

MB5

yes/no

(01) MB6 - MUSETRNS
(02) MB4 - MLIMDRIV
(03) MB6 - MUSETRNS (DO NOT DISPLAY.)
(04) MB6 - MUSETRNS
(05) MB6 - MUSETRNS
(-8) MB4 - MLIMDRIV
(-9) MB4 - MLIMDRIV

Page 1 of 2

2021 MCBS Community Questionnaire

Variable Name

MR Screen Name

MBQ-MOBILITY OF BENEFICIARIES

Question Type

Question Text/Description

Code List

Routing

Because of a health or physical problem, [have you/has (SP)]…
limited driving to daytime since (TODAY'S DATE - 12 MONTHS, MONTH AND YEAR)?
MLIMDRIV

MB4

yes/no

(01) YES
(02) NO
[PROBE FOR PROPER RESPONSE IF R OFFERS MORE THAN A YES OR NO RESPONSE, USING PROBES (03) DOES NOT DRIVE (DO NOT DISPLAY.)
SUCH AS “Was this because of a health or physical problem” and “I just want to check whether this was before or (-8) Don't Know
(-9) Refused
after (TODAY'S DATE - 12 MONTHS, MONTH AND YEAR)”.]

MB6 - MUSETRNS

[IF THE R DOES NOT DRIVE, BACK UP AND CHANGE THE RESPONSE TO THE PREVIOUS QUESTION.]

Because of a health or physical problem, [have you/has (SP)]...
MUSETRNS

MB6

yes/no

used a taxi or special transportation service since (TODAY'S DATE - 12 MONTHS, MONTH AND YEAR)?
[EXPLAIN IF NECESSARY: A special transportation service may include a van or shuttle service for seniors or
people with disabilities.]

BOX MBEND

routing

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

BOX MBEND

GO TO PVQ.

Page 2 of 2