CMS-P-0015A Demographic Income

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

DIQ-DEMOGRAPHICS AND INCOME

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

DIINT
HISPORIG

BOX DI1

routing

DIINTROA

no entry

DI1A

yes/no

HISPORDT

DI1B

code all

HISPDTOS

DI1B

verbatim text

RACECODE

DI2A

code all

BOX DI2B

routing

RACEASDT

DI2B

code all

RACEASOS

DI2B

verbatim text

BOX DI2C

routing

RACEPIDT

DI2C

code all

RACEPIOS

DI2C

verbatim text

ENGWELL

DI2F

code one

ENGREAD

DI2FB

code one

OTHRLANG

DI2D

yes/no

IF ROUND = FALL 2023 ROUND 97 AND INTTYPE ^= C003, GO TO SOGIINT,
ELSE GO TO DIINTROA-DIINT.
The next few questions are about Hispanic origin and race.
(01) YES
(02) NO
[Are you/Is (SP)] of Hispanic, (Latino/Latina), or Spanish origin?
(-8) Don't Know
(-9) Refused
(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 o
(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
OTHER ORIGIN (SPECIFY)
(01) continuous answer
(01) AMERICAN INDIAN OR ALASKA NATIVE
(02) ASIAN
(03) BLACK OR AFRICAN AMERICAN
SHOW CARD DI2
(04) NATIVE HAWAIIAN OR OTHER PACIFIC
Looking at this card, what [is/was] [your/(SP)'s] race?
ISLANDER
[ASK IF NECESSARY: Are there any options from this card that you would like me to record?]
(05) WHITE
(-8) Don't Know
(-9) Refused
IF DI2A-RACECODE INCLUDES 2/Asian, GO TO DI2B - RACEASDT.
ELSE GO TO BOX DI2C.
(01) ASIAN INDIAN
(02) CHINESE
SHOW CARD DI3
(03) FILIPINO
Looking at this card, [are you/is (SP)] Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese or some other
(04) JAPANESE
Asian group?
(05) KOREAN
(06) VIETNAMESE
You can choose more than one group.
(91) OTHER ASIAN GROUP
CHECK ALL THAT APPLY.
(-8) Don't Know
(-9) Refused
OTHER ASIAN GROUP (SPECIFY)
(01) continuous answer
IF DI2A-RACECODE INCLUDES 4/NatHawOrOthPaclsl, GO TO DI2C - RACEPIDT.
ELSE GO TO ENGWELL - D12F
SHOW CARD DI4
(01) NATIVE HAWAIIAN
Looking at this card, [are you/is (SP)] Native Hawaiian, Guamanian or Chamorro, Samoan, or some other Pacific
(02) GUAMANIAN OR CHAMORRO
Islander group?
(03) SAMOAN
(91) OTHER PACIFIC ISLANDER GROUP
You can choose more than one group.
(-8) Don't Know
CHECK ALL THAT APPLY.
(-9) Refused
OTHER PACIFIC ISLANDER GROUP (SPECIFY)
(01) continuous answer
(01) Very well
(02) Well
(03) Not Well, or
How well [do you/does (SP)/did (SP)] speak English? Would you say…
(04) Not at all?
(-8) Don't Know
(-9) Refused
(01) Very well
(02) Well
(03) Not Well, or
How well [do you/does (SP)/did (SP)] read English? Would you say…
(04) Not at all?
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
[Do you/Does (SP)] speak a language other than English at home?
(-8) Don't Know
(-9) Refused

DI1A - HISPORIG
(01) DI1B - HISPORDT
(02) DI2A - RACECODE
(-8) DI2A - RACECODE
(-9) DI2A - RACECODE
(01) DI2A - RACECODE
(02) DI2A - RACECODE
(03) DI2A - RACECODE
(91) DI1B - HISPDTOS
(-8) DI2A - RACECODE
(-9) DI2A - RACECODE
DI2A - RACECODE
(01) BOX DI2B
(02) BOX DI2B
(03) BOX DI2B
(04) BOX DI2B
(05) BOX DI2B
(-8) BOX DI2B
(-9) BOX DI2B

(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
BOX DI2C

(01) ENGWELL - D12F
(02) ENGWELL - D12F
(03) ENGWELL - D12F
(91) DI2C - RACEPIOS
(-8) ENGWELL - D12F
(-9) ENGWELL - D12F
ENGWELL - D12F

DI2FB - ENGREAD

OTHRLANG - D12D

(01) DI2E - WHATLANG
(02) SOGIINT
(-8) SOGIINT
(-9) SOGIINT

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2023 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

DIQ-DEMOGRAPHICS AND INCOME

Question Text/Description

Code List

Routing

(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

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

(01) continuous answer

SOGIINT

WHATLANG

DI2E

code one

What [is/was] this language?

WHTLNGOS

DI2E

verbatim text

SOGIINT

SOGIINT

no entry

SOME OTHER LANGUAGE (SPECIFY)
[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.]

BOX DI2CA

routing

SEXORINT

SEXORINT

code one

SEXORIOS

SEXORIOS

verbatim text

GENIDENT

GENIDENT

code one

SEXASGN

SEXASGN

code one

BOX DI2D

routing

DIINT3

DI3INTRO

no entry

SPDEGRCV

DI3A

code one

DIINT4

DI4INTRO

no entry

If the respondent is a proxy (SPPROXY=2), go to GENIDENT.
Else go to SEXORINT.
(01) LESBIAN OR GAY
(02) STRAIGHT, THAT IS, NOT LESBIAN OR GAY
(03) BISEXUAL
Do you think of yourself as lesbian or gay; straight, that is, not lesbian or gay; bisexual; something else; or you don't
(91) SOMETHING ELSE
know the answer?
(04) I DON'T KNOW THE ANSWER
(-8 ) Don't Know
(-9) Refused
What do you mean by something else?
(01) continuous answer
(01) MALE
(02) FEMALE
(03) TRANSGENDER
[(Do you)/(Does (SP))] currently describe [yourself/themselves] as male, female or transgender?
(04) NONE OF THESE
(-8 ) Don't Know
(-9) Refused
(01) MALE
(02) FEMALE
What sex [(were you)/(was (SP))] assigned at birth on [your/(SP)’s] original birth certificate?
(-8 ) Don't Know
(-9) Refused
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) GO TO DI3INTRO-DIINT3.
ELSE GO TO RELGPREF.
The next questions are about education and income.
(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)
SHOW CARD DI5
(05) VOCATIONAL/TECHNICAL/BUSINESS/TRADE
What is the highest degree or level of school [you have/(SP) has] completed?
SCHOOL CERTIFICATE OR DIPLOMA (BEYOND THE
[IF THE SAMPLE PERSON ATTENDED SCHOOL IN A FOREIGN COUNTRY, IN AN UNGRADED SCHOOL,
HIGH SCHOOL LEVEL)
HOME SCHOOLING, OR UNDER OTHER UNIQUE CIRCUMSTANCES, REFER THE RESPONDENT TO THE
(06) SOME COLLEGE, BUT NO DEGREE
SHOWCARD AND ASK FOR THE NEAREST EQUIVALENT.]
(07) ASSOCIATE DEGREE
(08) BACHELOR'S DEGREE
(09) MASTER'S, PROFESSIONAL OR DOCTORATE
DEGREE
(-8) Don't Know
(-9) Refused
In studies like this, people are sometimes grouped together according to income.

(01) GENIDENT
(02) GENIDENT
(03) GENIDENT
(91) SEXORIOS
(04) GENIDENT
(-8) GENIDENT
(-9) GENIDENT
GENIDENT

SEXASGN

BOX DI2D

DI3A - SPDEGRCV

DI4INTRO - DIINT4

DI4 - SPINC25K

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2023 MCBS Community Questionnaire

Variable Name

SPINC25K

SPINCLET

DIQ-DEMOGRAPHICS AND INCOME

MR Screen Name Question Type

Question Text/Description

DI4

Was [your and your spouse's/(SP's) and (SP)'s 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.]

DI5A

code one

code one

RELGPREF

RELGPREF

code one

RELGPROS

RELGPROS

verbatim text

BOX DI3

routing

Code List

(01) A. Less than $5,000
(02) B. $5,000 - less than $10,000
(03) C. $10,000 - less than $15,000
SHOW CARD DI6
(04) D. $15,000 - less than $20,000
Looking at this card, which letter best represents [your and your spouse's/(SP's) and (SP's) spouse's/[your/(SP's)]]
(05) E. $20,000 - less than $25,000
total income before taxes during the past 12 months? Include income from jobs, Social Security, Railroad
(06) F. $25,000 - less than $30,000
Retirement, other retirement income, and the other sources of income we just talked about.
(07) G. $30,000 - less than $40,000
(08) H. $40,000 - less than $50,000
[EXPLAIN IF NECESSARY: Income is important in analyzing the information we collect. For example, this
(09) I. $50,000 - less than $66,000
information helps us learn whether persons in one income group use certain types of medical care services or have
(10) J. $66,000 - less than $109,000
certain medical conditions more or less often than those in another group.]
(11) K. $109,000 or more
(-8) Don't Know
(-9) Refused
(01) PROTESTANT
(02) CATHOLIC
(03) EASTERN ORTHODOX, SUCH AS GREEK OR
RUSSIAN ORTHODOX
(04) JEWISH
What [is/was] [your/(SP)'s] religious preference?
(05) BUDDHIST
(06) HINDU
[IF NEEDED: This is the religion/religious preference with which [you/(SP)] most closely [identify/identifies/identified]]
(07) MUSLIM, ISLAM, SUFI, SUNNI, OR SHIA
(91) SOME OTHER RELIGION
(08) NO RELIGION
(-8) DON'T KNOW
(-9) REFUSED
What [is/was] [your/(SP)'s] religious preference?
(01) continuous answer
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.

Routing

(01) DI5A - SPINCLET
(02) DI5A - SPINCLET
(03) DI5A - SPINCLET
(04) DI5A - SPINCLET
(-8) RELGPREF
(-9) RELGPREF

RELGPREF

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

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