CMS-P-0015A Mobility of Beneficiaries

2022 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

MBQ-MOBILITY OF BENEFICIARIES

Question Text/Description

Code List

Routing

MOBILITY OF BENEFICIARIES QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=ALL
SPALIVE=1
SEASON=FALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
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

MREDTRAV

MASKRIDE

MB1

MB2

yes/no

yes/no

MB3

yes/no

BOX MB1

routing

(01) YES
(02) NO
(-8) Don't Know
had trouble getting places, like the doctor’s office, a supermarket, or a friend’s house since (TODAY'S DATE - 12 (-9) Refused
MONTHS, MONTH AND YEAR)?
Because of a health or physical problem, [have you/has (SP)]...

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)?

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

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.

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2022 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

MBQ-MOBILITY OF BENEFICIARIES

Question Text/Description

Code List

(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 [PROBE FOR PROPER RESPONSE IF R OFFERS MORE THAN A YES OR NO RESPONSE, USING PROBES
12 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
(-8) Don't Know
or 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

Routing

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

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 (-8) Don't Know
or after (TODAY'S DATE - 12 MONTHS, MONTH AND YEAR)”.]
(-9) Refused

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.

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