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pdf2025 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
IAQ-INCOME AND ASSETS
Question Text/Description
Code List
Routing
INCOME AND ASSETS QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C004, C005, C006, C010
SPALIVE=ALL
SEASON=SUMMER
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after CPQ.
Now I have some questions about income and other financial resources. We know that people aren't used to
talking about their assets, but we ask these questions to get an overall picture of people enrolled in Medicare NOT to find out about [you/(SP)] [and [your/(SP)'s] (spouse)] personally.
LFINTRO1
LFINTRO1
no entry
(01) CONTINUE
As with all information collected by the MCBS, the data are confidential and covered by the Privacy Act of 1974,
(-7) Empty
and [your/(SP)'s] Medicare benefits will not be affected in any way by answering these questions.
BOX LFINTRO1
GIVE BROCHURE TO RESPONDENT. ALLOW A FEW MINUTES FOR RESPONDENT TO REVIEW
BROCHURE IF NECESSARY.
BOX LFINTRO1
LFINTRO2
LFINTRO2
routing
no entry
If SPAISTATUS = 3 (Deceased in Community) or 4 (Deceased in institution), go to IAQ50 - TOTLCMB1.
Otherwise, go to LIFINTRO2 - LFINTRO2.
As the brochure explains, your responses to these questions can help us determine the impact of income on
[your/(SP)'s] use and access to health care. First, I will ask whether [you/(SP)/you and your (spouse)/(SP) and
(their) (spouse)] had particular types of income or other financial resources. Then, I will ask you to estimate
[your/(SP's)/their] total income. [Please answer all questions for [you and your (spouse)/(SP) and (their)
(spouse)].
(01) CONTINUE
(-7) Empty
LF3- WORKMNTH
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
(01) WEKLYHRS
(02) BOX LF13
(-8) BOX LF13
(-9) BOX LF13
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
MONTHLYP-MONTHLYP
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) BOX LF13
(-8) EARNSPRG
(-9) EARNSPRG
(01) LESS THAN $500
(02) $500 TO LESS THAN $1000
(03) $1000 TO LESS THAN $2000
(04) $2000 TO LESS THAN $3000
(05) $3000 TO LESS THAN $5000
(06) $5000 OR MORE
BOX LF13
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
(01) LF14-SPOUSERN
(02) HO1-OWNHOME
(-8) HO1-OWNHOME
(-9) HO1-OWNHOME
Please feel free to refer to any records or other persons who may be of assistance to you.
WORKMNTH
LF3
code one
Now think about last month, that is [CURRENT MONTH-1]. Did [you/(SP)] do any work for pay at any time in the
last month?
How many hours per week did [you/(SP)] usually work at [your/(SP)'s] job(s)?
WEKLYHRS
WEKLYHRS
quantity unit
ENTER NUMBER OF HOURS USUALLY WORKED.
IF NUMBER OF HOURS VARY EACH WEEK, ENTER 997
In [CURRENT MONTH -1], how much altogether did [you/(SP)] earn from any work [you/they] did in [CURRENT
MONTH -1], before taxes and before any other deductions?
[IF NEEDED: We don’t need an exact dollar amount. An approximate amount is fine.]
MONTHLYP
MONTHLYP
quantity unit
[IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.]
ENTER DOLLAR AMOUNT
$
EARNSPRG
SPOUSWRK
EARNSPRG
code one
BOX LF13
routing
LF13
code one
SHOW CARD IA1
Please look at this card and tell me which is closest.
If the SP has a spouse who is living in the household (ROSTREL=2, HHFLAG=1), go to LF13-SPOUSWRK.
Otherwise, go to HO1-OWNHOME.
Did [you/(your/(SP)’s) (spouse)] do any work for pay in the month of [CURRENT MONTH-1]?
Page 1 of 13
2025 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
IAQ-INCOME AND ASSETS
Question Text/Description
Code List
Routing
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) HO1-OWNHOME
(-8) SPOUSERG
(-9) SPOUSERG
(01) LESS THAN $500
(02) $500 TO LESS THAN $1000
(03) $1000 TO LESS THAN $2000
(04) $2000 TO LESS THAN $3000
(05) $3000 TO LESS THAN $5000
(06) $5000 OR MORE
HO1-OWNHOME
(01) OWN
(02) RENT (OR PAY MONTHLY AMOUNT)
(03) SOME OTHER ARRANGEMENT
(-8) DON’T KNOW
(-9) REFUSED
(01) HO2-MORTGAGE
(02) HO6-RENTAMT1
(03) HO5-PAYRENT
(-8) HO5-PAYRENT
(-9) HO5-PAYRENT
In [CURRENT MONTH -1], how much altogether did [you/your/(SP)’s] [spouse] earn before taxes and before any
other deductions?
IF NEEDED: We don’t need an exact dollar amount. An approximate amount is fine.
SPOUSERN
LF14
quantity unit
IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.
ENTER DOLLAR AMOUNT
$
SPOUSERG
OWNHOME
SPOUSERG
HO1
code one
code one
MORTGAGE
HO2
code one
MRTGAMT
HO3
quantity unit
SHOW CARD IA1
Please look at this card and tell me which is closest.
Next, I'd like to ask you some questions about the [home/apartment or condo] that is [your/(SP)’s] main
residence.
[Do you/Does (SP)] [or (SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] own the
[home/apartment or condo], rent it, or is there some other arrangement?
(01) PAID OFF
Is [your/(SP)’s] [or (SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] mortgage paid off or are
(02) STILL MAKE PAYMENTS
monthly mortgage payments still being made?
(03) REVERSE MORTGAGE
(-8) DON’T KNOW
IF NEEDED: Include any payments on a home equity loan or second mortgage.
(-9) REFUSED
(01) HO4-PRSNTVLU
(02) HO3-MRTGAMT
(03) MORREVER
(-8) HO4-PRSNTVLU
(-9) HO4-PRSNTVLU
How much altogether is that each month?
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) MORREVER
(-8) HO3A-MRTGAMRG
(-9) HO3A-MRTGAMRG
(01) LESS THAN $250
(02) $250 TO LESS THAN $500
(03) $500 TO LESS THAN $1,000
(04) $1,000 TO LESS THAN $3,000
(05) $3,000 TO LESS THAN $5,000
(06) $5,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
MORREVER
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) HO4-PRSNTVLU
(-8) MORTGOWE
(-9) MORTGOWE
(01) less than $50,000,
(02) $50,000 to less than $100,000, or
(03) $100,000 or more?
(-8) DON’T KNOW
(-9) REFUSED
HO4-PRSNTVLU
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) IAQINTRO1
(-8) HO4A-PRTVLURG
(-9) HO4A-PRTVLURG
ENTER DOLLAR AMOUNT
SHOW CARD IA2
MRTGAMRG
HO3A
code one
Please look at this card and tell me which is closest.
IF NEEDED: Include any payments on a home equity loan or second mortgage.
About how much [do you/does (SP)] [or (SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)]
still owe on the mortgage?
[IF NEEDED: The nearest $10,000 is fine.]
MORREVER
MORREVER
quantity unit
[IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.]
[IF NEEDED: Include the principal owed on a home equity loan or second mortgage.]
IF THE HOUSEHOLD HAS A REVERSE MORTGAGE OR A HOME EQUITY LOAN, THE PRINCIPAL OWED IS
THE TOTAL AMOUNT RECEIVED TO DATE.
ENTER DOLLAR AMOUNT
MORTGOWE
MORTGOWE
code one
Is the amount owed…
What is the present value of this [home/apartment or condo]? I mean, about what would it bring if it was sold
today, not counting any loans or outstanding mortgages?
PRSNTVLU
HO4
quantity unit
IF NEEDED: Your best guess or the nearest $10,000 is fine.
IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.
ENTER DOLLAR AMOUNT
Page 2 of 13
2025 MCBS Community Questionnaire
Variable Name
PRTVLURG
MR Screen Name
HO4A
Question Type
code one
PAYRENT
HO5
yes/no
RENTAMT1
HO6
quantity unit
RENTAMT2
HO6A
code one
IAQ-INCOME AND ASSETS
Question Text/Description
SHOW CARD IA3
Please look at this card and tell me which is closest.
[Do you/Does (SP)] [or (SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] pay rent to live
here?
How much is that each month?
ENTER DOLLAR AMOUNT
SHOW CARD IA4
Please look at this card and tell me which is closest.
Code List
Routing
(01) LESS THAN $50,000
(02) $50,000 TO LESS THAN $75,000
(03) $75,000 TO LESS THAN $100,000
(04) $100,000 TO LESS THAN $200,000
(05) $200,000 TO LESS THAN $300,000
(06) $300,000 TO LESS THAN $500,000
(07) $500,000 TO LESS THAN $750,000
(08) $750,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
IAQINTRO1
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
(01) HO6-RENTAMT1
(02) IAQINTRO1
(-8) IAQINTRO1
(-9) IAQINTRO1
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) IAQINTRO1
(-8) HO6A-RENTAMT2
(-9) HO6A-RENTAMT2
(01) LESS THAN $250
(02) $250 TO LESS THAN $500
(03) $500 TO LESS THAN $1,000
(04) $1,000 TO LESS THAN $3,000
(05) $3,000 TO LESS THAN $5,000
(06) $5,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
IAQINTRO1
The next few questions are about income and other resources. Your responses can help us understand how
people manage financially as they age.
IAQINTRO1
IAQINTRO1
no entry
SSRRLMTH
Please feel free to refer to any records or other persons that may be of assistance in answering these questions.
Many of these questions ask about “last month.” By last month, I mean in [CURRENT MONTH – 1].
SSRRLMTH
SSILMTH
IAQ1
IAQ4
code one
code one
Did [you/(SP)] [or (SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] receive Social Security
retirement and/or Railroad Retirement payments in the last month, that is in [CURRENT MONTH –1]?
(01) YES
(02) NO
(-8) DON’T KNOW
IF NEEDED: These checks are either automatically deposited in the bank or mailed to arrive on the 3rd of every
(-9) REFUSED
month. If mailed, they are often sent in gold or manila-colored envelopes.
Did [you/(SP)] [or (SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] receive Supplemental
Security Income, which is also called SSI, last month?
IF NEEDED: These are monthly government payments to lower-income people in need.
VALMTH
IAQ5
code one
Did [you/(SP)] [or (SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] receive any payments
from the Veteran’s Administration last month related to military service or veteran survivor’s benefits?
[IF NEEDED: The Veteran's Administration is also known as the U.S. Department of Veterans Affairs.]
IAQ4 -SSILMTH
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
IAQ5-VALMTH
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
IAQ6-PENSLMTH
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
IAQ7-401KLMNTH
People sometimes receive retirement income from other sources, such as pensions.
PENSLMTH
IAQ6
code one
[Did you/Did (SP)] [or (SP FIRSTNAME LASTNAME/SPOUSE FIRSTNAME LASTNAME] receive income from
any pension plans that were a job-related or union benefit last month?
IF NEEDED: These plans often require that a person work for a certain number of years before they qualify or
“are vested” in the pension plan.
Page 3 of 13
2025 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
IAQ-INCOME AND ASSETS
Question Text/Description
Code List
Routing
SHOW CARD IA5
These next questions ask about assets [you/(SP)] [or (SP FIRSTNAME LASTNAME/SPOUSE FIRSTNAME
LASTNAME] might own or contribute to, such as retirement plans, mutual funds, and bonds.
401KLMTH
IAQ7
code one
Please look at the types of retirement plans on this card. [Do you/Does (SP)] [or (SP FIRSTNAME
LASTNAME/SPOUSE FIRSTNAME LASTNAME] have any of these?
(01) YES
(02) NO
(-8) DON’T KNOW
IF NEEDED: 401Ks and 403Bs are plans where you contribute an amount each month from your paycheck, and (-9) REFUSED
your employer may match some of your contribution.
IAQ9-BONDS
IF NEEDED: IRAs, also known as Individual Retirement Accounts, are a type of plan you set up on your own.
IF NEEDED: A Keogh plan is a retirement plan for self-employed individuals or unincorporated small businesses.
BONDS
IAQ9
code one
Not including what we’ve already talked about, [do you/does (SP)] [or (SP FIRSTNAME
LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] own any bonds, such as Government Savings Bonds,
corporate, municipal, or other types of bonds?
The next questions ask about different kinds of bank or savings accounts people sometimes have or property
they own.
CHECKING
IAQ10
code one
Not counting what we’ve already talked about, [do you/does (SP)] [or (SP FIRSTNAME
LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] have...
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
IAQ10-CHECKING
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
IAQ11-SAVINGS
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
IAQ12-CERTDEPT
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
IAQ8-MULFUNDS
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
OTH_INVT
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
LUMP
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
NUMCAR
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
IAQINTRO2
A checking account?
SAVINGS
IAQ11
code one
[IF NEEDED: Not counting what we’ve already talked about, [do you/does (SP)] [or (SP FIRSTNAME
LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] have...]
A savings account or money market account?
CERTDEPT
IAQ12
code one
[IF NEEDED: Not counting what we’ve already talked about, [do you/does (SP)] [or (SP FIRSTNAME
LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] have...]
Certificates of deposit or CDs?
MULFUNDS
OTH_INVT
IAQ8
OTH_INVT
code one
code one
[(Not including the retirement accounts we have already talked about, {do you/does [SP]})/(Do you/Does {SP})]
[or (SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] own any mutual funds or stocks?
[Do you/Does (SP)] [or (SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] own any other
financial investments? Examples include a business, a farm, real estate [other than [your/(SP)’s] home,
motorcycles, boats, and RV's?
DO NOT INCLUDE BURIAL PLOTS.
People sometimes receive large amounts of money or property in the form of an inheritance, a trust fund, an
insurance settlement, and so on.
LUMP
IAQ52
code one
Now thinking about last year, that is, the calendar year ending in December [CURRENT YEAR - 1], [have
you/has (SP)] [or (SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] received money or
property in the form of an inheritance, a trust fund, an insurance settlement, a pension settlement, a gift, or a
lawsuit?
How many vehicles [do you/does (SP)] [or (SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)]
own?
NUMCAR
CO2
quantity unit
ENTER NUMBER OF VEHICLES
[IF NEEDED: Do not include leased cars.]
IAQINTRO2
IAQINTRO2
no entry
We now have a few questions about income which are important for understanding how
people manage financially as they age.
We want to be both as accurate and efficient as we can, so it would be very helpful if you could refer to any
records you might have.
BOX IAQ2
Page 4 of 13
2025 MCBS Community Questionnaire
Variable Name
IAQ-INCOME AND ASSETS
MR Screen Name
Question Type
Question Text/Description
BOX IAQ2
routing
If IAQ1-SSRRLMTH = 1/YES, go to SSRR_AMT.
Otherwise, go to BOX IAQ3.
First, what was the total amount of [your/(SP)’s] and [(SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME
LASTNAME)]’s most recent monthly Social Security or Railroad Retirement payment (for the month of
[CURRENT MONTH – 1])?
SSRR_AMT
SSRR_AMT
quantity unit
IF NEEDED: We don’t need an exact dollar amount.
Code List
Routing
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) BOX IAQ3
(-8) SSRR_SPA
(-9) SSRR_SPA
(01) LESS THAN $1,000
(02) $1,000 TO LESS THAN $1,500
(03) $1,500 TO LESS THAN $2,000
(04) $2,000 TO LESS THAN $3,000
(05) $3,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX IAQ3
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) BOX IAQ4
(-8) BOX SSIRANGE
(-9) BOX SSIRANGE
(01) LESS THAN $400
(02) $400 TO LESS THAN $800
(03) $800 TO LESS THAN $1,200
(04) $1,200 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX IAQ4
(01) LESS THAN $300
(02) $300 TO LESS THAN $600
(03) $600 TO LESS THAN $900
(04) $900 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX IAQ4
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) BOX IAQ5
(-8) BOX VARANGE
(-9) BOX VARANGE
IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.
SSRR_SPA
SSRR_SPA
code one
BOX IAQ3
routing
SHOW CARD IA6
Please look at this card and tell me which is closest.
If IAQ4-SSILMTH = 1/YES, go to SSI_AMT.
Otherwise, go to BOX IAQ4.
What was the total amount of [your/(SP)’s] and [(SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME
LASTNAME)]’s most recent monthly SSI payment (for the month of [CURRENT MONTH – 1])?
SSI_AMT
SSI_AMT
quantity unit
IF NEEDED: We don’t need an exact dollar amount.
IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.
BOX SSIRANGE
SSI_HHA
SSI_SPA
SSI_HHA
routing
code one
SSI_SPA
code one
BOX IAQ4
routing
IF SP HAS A SPOUSE WHO IS ALIVE AND LIVING IN THE HOUSEHOLD (ROSTREL=2, HHFLAG=1), GO TO
SSI_HHA,
ELSE GO TO SSI_SPA.
SHOW CARD IA7
Please look at this card and tell me which is closest.
SHOW CARD IA8
Please look at this card and tell me which is closest.
If IAQ5-VALMTH = 1/YES, go to VA_AMT.
Otherwise, go to BOX IAQ5.
What was the total amount of [your/(SP)’s] and [(SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME
LASTNAME)]’s most recent monthly Veteran’s Administration payment (for the month of [CURRENT MONTH –
1])?
VA_AMT
VA_AMT
quantity unit
IF NEEDED: We don’t need an exact dollar amount.
IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.
BOX VARANGE
routing
IF SP HAS A SPOUSE WHO IS ALIVE AND LIVING IN THE HOUSEHOLD (ROSTREL=2, HHFLAG=1), GO TO
VA_HHA,
ELSE GO TO VA_SPA.
Page 5 of 13
2025 MCBS Community Questionnaire
Variable Name
VA_HHA
VA_SPA
MR Screen Name
VA_HHA
Question Type
code one
VA_SPA
code one
BOX IAQ5
routing
IAQ-INCOME AND ASSETS
Question Text/Description
SHOW CARD IA9
Please look at this card and tell me which is closest.
SHOW CARD IA10
Please look at this card and tell me which is closest.
PEN_AMT
quantity unit
Routing
(01) LESS THAN $1,000
(02) $1,000 TO LESS THAN $2,000
(03) $2,000 TO LESS THAN $3,000
(04) $3,000 TO LESS THAN $4,000
(05) $4,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX IAQ5
(01) LESS THAN $500
(02) $500 TO LESS THAN $1,500
(03) $1,500 TO LESS THAN $2,500
(04) $2,500 TO LESS THAN $3,500
(05) $3,500 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX IAQ5
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) BOX IAQ6
(-8) PEN_SPA
(-9) PEN_SPA
(01) LESS THAN $500
(02) $500 TO LESS THAN $1,500
(03) $1,500 TO LESS THAN $2,500
(04) $2,500 TO LESS THAN $4,000
(05) $4,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX IAQ6
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) YREC_AMT
(-8) 401K_SPA
(-9) 401K_SPA
(01) LESS THAN $50,000
(02) $50,000 TO LESS THAN $200,000
(03) $200,000 TO LESS THAN $500,000
(04) $500,000 TO LESS THAN $1,000,000
(05) $1,000,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
YREC_AMT
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) BOX IAQ9C
(-8) YREC_SPA
(-9) YREC_SPA
If IAQ6-PENSLMTH = 1/YES, go to PEN_AMT.
Otherwise, go to BOX IAQ6.
You told me earlier that [you/(SP)] and [({SP FIRSTNAME LASTNAME}/{SPOUSE FIRSTNAME LASTNAME}]
have job-related pension plans. In total, how much was received from these pension plans in the last month,
before any federal or state taxes were taken out (for the month of [CURRENT MONTH – 1])?
PEN_AMT
Code List
IF NEEDED: We don’t need an exact dollar amount.
IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.
PEN_SPA
PEN_SPA
code one
BOX IAQ6
routing
SHOW CARD IA11
Please look at this card and tell me which is closest.
If IAQ7-401KLMTH = 1/YES, go to 401K_AMT.
Otherwise, go to BOX IAQ9C.
You mentioned that [you/(SP)] and [(SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] have
retirement accounts. In total, about how much is currently in all of these retirement accounts?
401K_AMT
401K_AMT
quantity unit
IF NEEDED: Retirement accounts include 401K, 403B, IRA, Keogh plans, and other retirement accounts.
IF NEEDED: We don’t need an exact dollar amount.
IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.
401K_SPA
401K_SPA
code one
SHOW CARD IA12
Please look at this card and tell me which is closest.
Now thinking about all of last year, that is calendar year [CURRENT YEAR – 1], in total, how much did [you/(SP)]
and [(SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] receive or withdraw from all of these
retirement accounts?
YREC_AMT
YREC_AMT
quantity unit
IF NEEDED: We don’t need an exact dollar amount.
IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.
Page 6 of 13
2025 MCBS Community Questionnaire
Variable Name
YREC_SPA
BNDS_AMT
MR Screen Name
Question Type
YREC_SPA
code one
BOX IAQ9C
routing
BNDS_AMT
IAQ-INCOME AND ASSETS
Question Text/Description
SHOW CARD IA13
Please look at this card and tell me which is closest.
Routing
(01) LESS THAN $5,000
(02) $5,000 TO LESS THAN $10,000
(03) $10,000 TO LESS THAN $20,000
(04) $20,000 TO LESS THAN $50,000
(05) $50,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX IAQ9C
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) BOX IAQ10
(-8) BNDS_SPA
(-9) BNDS_SPA
(01) LESS THAN $500
(02) $500 TO LESS THAN $2,500
(03) $2,500 TO LESS THAN $10,000
(04) $10,000 TO LESS THAN $50,000
(05) $50,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX IAQ10
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) BOX IAQ10A
(-8) CHCK_SPA
(-9) CHCK_SPA
(01) LESS THAN $1,000
(02) $1,000 TO LESS THAN $2,500
(03) $2,500 TO LESS THAN $5,000
(04) $5,000 TO LESS THAN $7,500
(05) $7,500 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX IAQ10A
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) BOX IAQ10B
(-8) SVGS_SPA
(-9) SVGS_SPA
(01) LESS THAN $2,000
(02) $2,000 TO LESS THAN $4,000
(03) $4,000 TO LESS THAN $7,500
(04) $7,500 TO LESS THAN $15,000
(05) $15,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX IAQ10B
If IAQ9-BONDS=1/YES, go to BNDS_AMT,
Otherwise, go to BOX IAQ10.
You told me earlier that [you/(SP)] and [(SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)]
own government, corporate, or other bonds that are not part of retirement accounts. In total, about how much are
these worth?
quantity unit
Code List
IF NEEDED: We don’t need an exact dollar amount.
IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.
BNDS_SPA
BNDS_SPA
code one
BOX IAQ10
routing
SHOW CARD IA14
Please look at this card and tell me which is closest.
If IAQ10-CHECKING = 1/YES, go to CHCK_AMT.
Otherwise, go to BOX IAQ10A.
You told me earlier that [you/(SP)] and [(SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)]
have a checking account.
CHCK_AMT
CHCK_AMT
quantity unit
In total, about how much is currently in your checking account(s)?
IF NEEDED: We don’t need an exact dollar amount.
IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.
CHCK_SPA
CHCK_SPA
code one
BOX IAQ10A
routing
SHOW CARD IA15
Please look at this card and tell me which is closest.
If IAQ11-SAVINGS=1/YES, go to SVGS_AMT.
Otherwise, go to BOX IAQ10B.
You told me earlier that [you/(SP)] and [(SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)]
have savings or money market accounts.
SVGS_AMT
SVGS_AMT
quantity unit
In total, about how much is currently in your savings or money market accounts?
IF NEEDED: We don’t need an exact dollar amount.
IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.
SVGS_SPA
SVGS_SPA
code one
BOX IAQ10B
routing
SHOW CARD IA16
Please look at this card and tell me which is closest.
If IAQ12-CERTDEPT = 1/YES, go to CD_AMT.
Otherwise, go to BOX IAQ10C.
Page 7 of 13
2025 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
IAQ-INCOME AND ASSETS
Question Text/Description
Code List
Routing
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) BOX IAQ10C
(-8) CD_SPA
(-9) CD_SPA
(01) LESS THAN $5,000
(02) $5,000 TO LESS THAN $15,000
(03) $15,000 TO LESS THAN $30,000
(04) $30,000 TO LESS THAN $50,000
(05) $50,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX IAQ10C
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) BOX IAQ11
(-8) MF_SPA
(-9) MF_SPA
(01) LESS THAN $10,000
(02) $10,000 TO LESS THAN $50,000
(03) $50,000 TO LESS THAN $150,000
(04) $150,000 TO LESS THAN $500,000
(05) $500,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX IAQ11
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) BOX IAQ12
(-8) INT_SPA
(-9) INT_SPA
(01) LESS THAN $25
(02) $25 TO LESS THAN $200
(03) $200 TO LESS THAN $2,000
(04) $2,000 TO LESS THAN $10,000
(05) $10,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX IAQ12
You told me earlier that [you/(SP)] and [(SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)]
have certificates of deposits or CDs.
CD_AMT
CD_AMT
quantity unit
In total, about how much are these certificates of deposits or CDs currently worth?
IF NEEDED: We don’t need an exact dollar amount.
IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.
CD_SPA
CD_SPA
code one
BOX IAQ10C
routing
SHOW CARD IA17
Please look at this card and tell me which is closest.
If IAQ8-MULFUNDS = 1/YES, go to MF_AMT.
Otherwise, go to BOX IAQ11.
You told me earlier that [you/(SP)] and [(SP FIRSTNAME LASTNAME)/(SPOUSE] own mutual funds or stocks
that are not part of retirement accounts. In total, about how much are these worth?
MF_AMT
MF_AMT
quantity unit
IF NEEDED: We don’t need an exact dollar amount.
IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.
MF_SPA
MF_SPA
BOX IAQ11
code one
routing
SHOW CARD IA18
Please look at this card and tell me which is closest.
If IAQ8-MULFUNDS = 1/YES or IAQ9-BONDS = 1/YES or IAQ10-CHECKING = 1/YES or IAQ11-SAVINGS =
1/YES or IAQ12-CERTDEPT = 1/YES, go to INT_AMT.
Otherwise, go to BOX IAQ12.
Now thinking about all of last year, that is calendar year [CURRENT YEAR – 1], in total, how much interest and
dividend income did [you/(SP)] and [(SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] have
from [mutual funds or stocks] [government, corporate, or other bonds] [bank accounts or CDs]?
INT_AMT
INT_AMT
quantity unit
IF NEEDED: We don’t need an exact dollar amount.
IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.
INT_SPA
OTH_VLU
INT_SPA
code one
BOX IAQ12
routing
OTH_VLU
quantity unit
SHOW CARD IA19
Please look at this card and tell me which is closest.
If OTH_INVT = 1/YES, go to OTH_VLU.
Otherwise, go to BOX IAQ13.
You told me earlier that [you/(SP)] and [(SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)]
have other financial investments, such as a business, a farm, real estate [other than [your/(SP)’s] home],
motorcycles, boats, and RV's. If these investments were sold today and any debts on them were paid off, in total,
(01) [continuous response]
about how much would they bring?
(-8) DON’T KNOW
(-9) REFUSED
IF NEEDED: We don’t need an exact dollar amount.
(01) BOX IAQ13
(-8) OTH_SPA
(-9) OTH_SPA
IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.
Page 8 of 13
2025 MCBS Community Questionnaire
Variable Name
OTH_SPA
MR Screen Name
Question Type
OTH_SPA
code one
BOX IAQ13
routing
IAQ-INCOME AND ASSETS
Question Text/Description
SHOW CARD IA20
Please look at this card and tell me which is closest.
Code List
Routing
(01) LESS THAN $50,000
(02) $50,000 TO LESS THAN $150,000
(03) $150,000 TO LESS THAN $300,000
(04) $300,000 TO LESS THAN $750,000
(05) $750,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX IAQ13
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) IAQ50
(-8) NCM_SPA
(-9) NCM_SPA
(01) LESS THAN $7,500
(02) $7,500 TO LESS THAN $15,000
(03) $15,000 TO LESS THAN $25,000
(04) $25,000 TO LESS THAN $75,000
(05) $75,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
IAQ50-TOTLCMB1
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) BOX IAQ15
(-8) TOTLCMRG
(-9) TOTLCMRG
(01)A. LESS THAN $10,000
(02)B. $10,000 TO LESS THAN $15,000
(03)C. $15,000 TO LESS THAN $20,000
(04)D. $20,000 TO LESS THAN $25,000
(05)E. $25,000 TO LESS THAN $35,000
(06)F. $35,000 TO LESS THAN $45,000
(07)G. $45,000 TO LESS THAN $55,000
(08)H. $55,000 TO LESS THAN $70,000
(09)I. $70,000 TO LESS THAN $100,000
(10)J. $100,000 TO LESS THAN $150,000
(11)K. $150,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX IAQ15
If OTH_INVT = 1/YES, go to INVT_NCM.
Otherwise, go to IAQ50.
Now thinking about all of last year, that is calendar year [CURRENT YEAR – 1], in total, how much income did
[you/(SP)] and [(SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] receive from these other
investments before any federal or state taxes were taken out?
INVT_NCM
INVT_NCM
quantity unit
IF NEEDED: We don’t need an exact dollar amount.
IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.
IF NO INCOME WAS RECEIVED FROM THESE OTHER INVESTMENTS, ENTER 0.
NCM_SPA
NCM_SPA
code one
SHOW CARD IA21
Please look at this card and tell me which is closest.
Now I want to ask about [your/(SP)’s] [and (SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)]
total income for last year, that is, for the calendar year ending in December [CURRENT YEAR - 1], before any
federal or state taxes were taken out.
Now think about that total income from:
[Social Security or Railroad Retirement] [Supplemental Security Income] [the Veteran’s Administration] [a
pension plan] [any retirement accounts] [mutual funds or stocks] [bonds] [bank accounts] [CDs] [business, farm
or real estate] [jobs] and from any other sources.
TOTLCMB1
IAQ50
quantity unit
How much was [your/(SP)’s] [and (SP FIRSTNAME LASTNAME)/(SPOUSE FIRSTNAME LASTNAME)] total
income before taxes for last year (this is, for the 12 months ending in December [CURRENT YEAR - 1])?
IF NEEDED: We don’t need an exact dollar amount – the nearest $1,000 is fine.
IF NEEDED: We know questions like these may be difficult to answer, but we need to know this to understand
how people manage financially as they age and what effect this might have on their health.
ENTER TOTAL INCOME FOR LAST YEAR.
TOTLCMRG
SPENDINC
SHOW CARD IA22
IAQ51B
code one
BOX IAQ15
routing
If SPAISTATUS = 3 (Deceased in Community) or 4 (Deceased in Institution), go to BOX ENDIAQ.
ELSE, go to SPENDINC.
code one
Over the past year, would you say that [your/[SP]'s] (family's) spending exceeded [your/[SP]'s] (family's) income,
that it was about the same as [your/[SP]'s] income, or that [you/[SP]] spent less than [your/[SP]'s] income?
(01) SPENDING EXCEEDED INCOME
(02) SPENDING SAME AS INCOME
[IF NEEDED: Spending should not include any investments [you have/(SP) has] made.)
(03) SPENDING WAS LESS THAN INCOME
(-8) DON’T KNOW
IF DEBTS ARE BEING REPAID ON NET, TREAT THIS AS SPENDING
(-9) REFUSED
LESS THAN INCOME.
SPENDINC
Please look at this card and tell me which is closest.
MEDIGRID-MEDIPROV
Page 9 of 13
2025 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
IAQ-INCOME AND ASSETS
Question Text/Description
Code List
Routing
The next few questions will now ask about any debt [you/(SP)] [or (SP FIRSTNAME LASTNAME)/(SPOUSE
FIRSTNAME LASTNAME)] may have.
MEDIPROV
MEDIGRID
grid
(01) YES
Please think about any money [you/(SP)] currently owe or debt you have due to medical or dental bills. This may
(02) NO
include bills for your own medical or dental care or someone else’s care, such as a child, spouse, or parent.
(-8) DON'T KNOW
(-9) REFUSED
[Do you/Does (SP)] currently have...
MEDIGRID-MEDICARD
Any medical or dental bills [you are/(SP) is] paying off over time directly to a provider?
MEDICARD
MEDILEND
MEDIFAM
MEDIOTH
PROV_AMT
PROV_SPA
CARD_AMT
CARD_SPA
LEND_AMT
MEDIGRID
MEDIGRID
MEDIGRID
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
MEDIGRID-MEDILEND
grid
Any debt [you owe/(SP) owes] to a bank, collection agency, or other lender that includes debt or loans used to
pay medical or dental bills?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
MEDIGRID-MEDIFAM
grid
Any debt [you owe/(SP) owes] to a family member or friend for money [you/(SP)] borrowed to pay medical or
dental bills?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
MEDIGRID-MEDIOTH
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX DEBT1
grid
Any medical or dental bills [you have/(SP) has] put on a credit card, and [you are/(SP) is] paying off over time?
[IF NEEDED: Please include consumer and medical credit cards.]
MEDIGRID
grid
Any other medical or dental bills that [you are/(SP) is] unable to pay?
BOX DEBT1
routing
IF MEDIPROV=1/YES, GO TO PROV_AMT,
ELSE GO TO BOX DEBT2.
PROV_AMT
quantity unit
(01) [continuous response]
You mentioned that [you have/(SP) has] medical or dental bills [you are/(SP) is] paying off over time directly to a
(-8) DON’T KNOW
provider. About how much [do you/does (SP)] currently owe?
(-9) REFUSED
SHOW CARD IA23
(01) LESS THAN $500
(02) $500 TO LESS THAN $2,500
(03) $2,500 TO LESS THAN $5,000
(04) $5,000 TO LESS THAN $25,000
(05) $25,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
PROV_SPA
code one
BOX DEBT2
routing
IF MEDICARD=1/YES, GO TO CARD_AMT,
ELSE GO TO BOX DEBT3.
quantity unit
You mentioned that [you have/(SP) has] medical or dental bills [you have/(SP) has] put on a credit card, and [you
(01) [continuous response]
are/(SP) is] paying off over time. About how much [do you/does (SP)] currently owe?
(-8) DON’T KNOW
(-9) REFUSED
Please include any interest and fees accrued in the total balance.
CARD_AMT
CARD_SPA
code one
BOX DEBT3
routing
LEND_AMT
quantity unit
Please look at this card and tell me which is closest.
SHOW CARD IA23
Please look at this card and tell me which is closest.
(01) BOX DEBT2
(-8) PROV_SPA
(-9) PROV_SPA
BOX DEBT2
(01) BOX DEBT3
(-8) CARD_SPA
(-9) CARD_SPA
(01) LESS THAN $500
(02) $500 TO LESS THAN $2,500
(03) $2,500 TO LESS THAN $5,000
(04) $5,000 TO LESS THAN $25,000
(05) $25,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX DEBT3
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) BOX DEBT4
(-8) LEND_SPA
(-9) LEND_SPA
IF MEDILEND=1/YES, GO TO LEND_AMT,
ELSE GO TO BOX DEBT4.
You mentioned that [you have/(SP) has] debt [you owe/(SP) owes] to a bank, collection agency, or other lender
that includes debt or loans used to pay medical or dental bills. About how much [do you/does (SP)] currently
owe?
Please do not include any debt held on a credit card.
Page 10 of 13
2025 MCBS Community Questionnaire
Variable Name
LEND_SPA
FAM_AMT
FAM_SPA
OTH_AMT
OTH_SPA
MEDIWHO
MR Screen Name
Question Type
IAQ-INCOME AND ASSETS
Question Text/Description
SHOW CARD IA23
LEND_SPA
code one
BOX DEBT4
routing
IF MEDIFAM=1/YES, GO TO FAM_AMT,
ELSE GO TO BOX_DEBT5.
FAM_AMT
quantity unit
You mentioned that [you have/(SP) has] debt [you owe/(SP) owes] to a family member or friend for money
borrowed to pay medical or dental bills. About how much [do you/does (SP)] currently owe?
Please look at this card and tell me which is closest.
SHOW CARD IA23
FAM_SPA
code one
BOX DEBT5
routing
IF MEDIOTH=1/YES, GO TO OTH_AMT,
ELSE GO TO MEDIWHO.
OTH_AMT
quantity unit
You mentioned that [you have/(SP) has] other medical or dental bills that [you/(SP)] are unable to pay. About
how much [do you/does (SP)] currently owe?
Please look at this card and tell me which is closest.
SHOW CARD IA23
MEDBILLS
Routing
(01) LESS THAN $500
(02) $500 TO LESS THAN $2,500
(03) $2,500 TO LESS THAN $5,000
(04) $5,000 TO LESS THAN $25,000
(05) $25,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX DEBT4
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) BOX DEBT5
(-8) FAM_SPA
(-9) FAM_SPA
(01) LESS THAN $500
(02) $500 TO LESS THAN $2,500
(03) $2,500 TO LESS THAN $5,000
(04) $5,000 TO LESS THAN $25,000
(05) $25,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX DEBT5
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) BOX DEBT6
(-8) OTH_SPA
(-9) OTH_SPA
(01) LESS THAN $500
(02) $500 TO LESS THAN $2,500
(03) $2,500 TO LESS THAN $5,000
(04) $5,000 TO LESS THAN $25,000
(05) $25,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
BOX DEBT6
OTH_SPA
code one
BOX DEBT6
routing
IF RESPONDENT HAS DEBT (MEDIPROV=1 or MEDICARD=1 or MEDILEND=1 or MEDIFAM=1 or
MEDIOTH=1), GO TO MEDIWHO.
ELSE GO TO CREDDEBT.
code one
(01) MY OWN CARE
(02) SOMEONE ELSE'S CARE
Thinking about the medical or dental bills that led to [your/(SP'S)] medical debt, were these bills for [your/(SP'S)]
(03) BOTH MY AND SOMEONE ELSE'S CARE
own care, someone else’s care, or both [your/(SP'S)] care and someone else’s care?
(-8) DON'T KNOW
(-9) REFUSED
MEDIWHO
Please look at this card and tell me which is closest.
Were any of the bills that caused [your/(SP's)] medical debt due to...
MEDISRCE
Code List
MEDISRCE
MEDBILLS
select all
code one
DOCTOR VISITS OR LAB FEES OR DIAGNOSTIC TESTS SUCH AS X-RAYS OR MRIS
EMERGENCY CARE OR AMBULANCE SERVICES
HOSPITALIZATION OR OUTPATIENT SURGERY
PRESCRIPTION DRUGS
LONG TERM CARE SERVICES OR SUPPORT, EITHER IN HOME OR IN A NURSING HOME OR
RESIDENTIAL FACILITY
MEDICAL EQUIPMENT
DENTAL CARE
OR SOME OTHER EVENT?
Which of the following comes closer to describing the bills that contributed to [your/(SP's)] medical debt?
MEDISRCE
(01) DOCTOR VISITS OR LAB FEES OR DIAGNOSTIC
TESTS SUCH AS X-RAYS OR MRIS
(02) EMERGENCY CARE OR AMBULANCE
SERVICES
(03) HOSPITALIZATION OR OUTPATIENT SURGERY
(04) PRESCRIPTION DRUGS
(05) LONG TERM CARE SERVICES OR SUPPORT,
MEDBILLS
EITHER IN HOME OR IN A NURSING HOME OR
RESIDENTIAL FACILITY
(06) MEDICAL EQUIPMENT
(07) DENTAL CARE
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED
(01) BILL FOR A ONE TIME OR SHORT-TERM
MEDICAL EXPENSE, SUCH AS A SINGLE HOSPITAL
STAY OR TREATMENT FOR AN ACCIDENT
(02) BILLS THAT BUILD UP OVER TIME, SUCH AS
TREATMENT FOR CHRONIC ILLNESS LIKE
DIABETES OR CANCER
(-8) DON'T KNOW
(-9) REFUSED
(01) MEDTIME
(02) MEDTIME
(-8) CREDDEBT
(-9) CREDDEBT
Page 11 of 13
2025 MCBS Community Questionnaire
Variable Name
MEDTIME
MR Screen Name
MEDTIME
Question Type
code one
IAQ-INCOME AND ASSETS
Question Text/Description
Code List
Routing
Approximately how long ago did [this incident occur/the treatment that led to [your/(SP's)] medical debt begin]?
(01) WITHIN THE LAST YEAR
(02) BETWEEN ONE AND TWO YEARS AGO
(03) BETWEEN THREE AND FOUR YEARS AGO
(04) FIVE YEARS AGO OR MORE
(-8) DON'T KNOW
(-9) REFUSED
CREDDEBT
Besides what you've already told me about, do [you/(SP)] [or (SP FIRSTNAME LASTNAME)/(SPOUSE
FIRSTNAME LASTNAME)] owe any money for credit card bills?
CREDDEBT
CREDDEBT
code one
EXCLUDE CREDIT CARD BILLS THAT WERE PAID IN FULL OR REIMBURSED. DO NOT INCLUDE ANY
AMOUNT CURRENTLY COUNTED TOWARDS MEDICAL DEBT BALANCE.
[IF NEEDED: This item is asking specifically about money owed for credit card bills that cannot be paid off by the
due date on the statement. If the bills were paid off by the statement due date, do not include those bills.]
What is the total amount of credit card debt [you/(SP)] [and (SP FIRSTNAME LASTNAME)/(SPOUSE
FIRSTNAME LASTNAME)] currently owe?
CRED_AMT
CRED_AMT
quantity unit
Please include any interest and fees accrued.
EXCLUDE CREDIT CARD DEBT FOR BUSINESS EXPENSES THAT WILL BE PAID OR REIMBURSED. DO
NOT INCLUDE ANY AMOUNT CURRENTLY COUNTED TOWARDS MEDICAL DEBT BALANCE.
CRED_SPA
CRED_SPA
code one
FSINTRO1
FSINTRO1
no entry
SHOW CARD IA24
Please look at this card and tell me which is closest.
FS1
(01) CRED_AMT
(02) FSINTRO1
(-8) FSINTRO1
(-9) FSINTRO1
(01) [continuous response]
(-8) DON’T KNOW
(-9) REFUSED
(01) FSINTRO1
(-8) CRED_SPA
(-9) CRED_SPA
(01) LESS THAN $1,000
(02) $1,000 TO LESS THAN $5,000
(03) $5,000 TO LESS THAN $10,000
(04) $10,000 TO LESS THAN $25,000
(05) $25,000 OR MORE
(-8) DON’T KNOW
(-9) REFUSED
FSINTRO1
These next questions are about the food eaten in [your/(SP)'s] household in the last 12 months, since [current
month] of last year and whether [you were/he was/she was/they were] able to afford the food [you need/he
needs/she needs/they need].
I’m going to read you some statements that people have made about their food situation. For these statements,
please tell me whether the statement was often true, sometimes true, or never true for [you/your
household/(SP)/(SP)'s household] in the last 12 months—that is, since last [current month].
FOODLAST
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
FS1
(01) OFTEN TRUE
(02) SOMETIMES TRUE
(03) NEVER TRUE
(-8) DON’T KNOW
(-9) REFUSED
FS2
(01) OFTEN TRUE
(02) SOMETIMES TRUE
(03) NEVER TRUE
(-8) DON’T KNOW
(-9) REFUSED
FS3
In the last 12 months, since last (name of current month), did [you/you or other adults in your
household/(SP)/((SP) or other adults in (SP)'s household] ever cut the size of [your/(SP's)/their] meals or skip
meals because there wasn't enough money for food?
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
(01) FS3A
(02) FS4
(-8) FS4
(-9) FS4
code one
How often did this happen—almost every month, some months but not every month, or in only 1 or 2 months?
(01) ALMOST EVERY MONTH
(02) SOME MONTHS BUT NOT EVERY MONTH
(03) IN ONLY 1 OR 2 MONTHS
(-8) DON’T KNOW
(-9) REFUSED
FS4
code one
In the last 12 months, did [you/(SP)] ever eat less than [you/he/she] felt [you/he/she] should because there
wasn't enough money for food?
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
FS5
code one
The first statement is, The food that [I/we/(SP)/(SP) or other adults in (SP)'s household] bought just didn’t last,
and [I/we/he/she/they] didn’t have money to get more.
Was that often, sometimes, or never true for [you/your household/(SP)/(SP)'s household] in the last 12 months?
The next statement is: [I/we/(SP)/(SP) or other adults in (SP)'s household] couldn’t afford to eat balanced meals.
FOODLAST_OFT
FS2
EN
SKIPMEAL
FS3
SKIPMEAL_OFTE
FS3A
N
EATLESS
FS4
code one
code one
Was that often, sometimes, or never true for [you/your household/(SP)/(SP)'s household] in the last 12 months?
[IF NEEDED: For these statements, please tell me whether the statement was often true, sometimes true, or
never true for [you/your household/(SP)/(SP)'s household] in the last 12 months—that is, since last [current
month].]
Page 12 of 13
2025 MCBS Community Questionnaire
Variable Name
HUNGRY
PGMINTRO
SNAPBNFT
SECTION8
ENRGYHLP
LISKNOW
MR Screen Name
FS5
PGMINTRO
Question Type
Question Text/Description
Code List
Routing
code one
In the last 12 months, [were you/was (SP)] ever hungry but didn't eat because there wasn't enough money for
food?
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
PGMINTRO
(01) CONTINUE
SNAPBNFT
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
BOX HO1
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
ENRGYHLP
no entry
SNAPBNFT
code one
BOX HO1
routing
HO7
ENRGYHLP
LISKNOW
IAQ-INCOME AND ASSETS
yes/no
yes/no
yes/no
We now have a few questions about programs that may be available to either [you or members of your
household/(SP) or members of (SP)'s household] to help pay for food, housing, or healthcare costs.
Some of these questions will ask you to consider [your and your household's/(SP) and their household's]
participation, while others will ask exclusively about [YOUR/(SP)'s] participation.
In the last 12 months, did [you/you or any member in the household/(SP)/((SP) or any member in (SP)'s
household] receive benefits from the Food Stamp Program or SNAP (the Supplemental Nutrition Assistance
Program) [,also called (STATE SNAP PROGRAM NAME)]?
DO NOT INCLUDE THE WOMEN, INFANTS, AND CHILDREN (WIC) SUPPLEMENTAL NUTRITION
PROGRAM, THE SCHOOL LUNCH PROGRAM, OR ANY ASSISTANCE FROM FOOD BANKS OR FOOD
PANTRIES.
If HO6>=$750 or HO6A=4 ($1,000 TO LESS THAN $3,000), 5 ($3,000 TO LESS THAN $5,000), OR 6 ($5,000
OR MORE) go to ENRGYHLP.
ELSE, go to HO7-SECTION8.
This next question asks about [your/(SP's)] home and affordable housing programs.
Is [your/(SP's)] home in Section 8 or public housing or housing for low-income seniors?
The government has an energy assistance program which helps pay heating and cooling costs. This assistance
can be received directly by the household or it can be paid directly to the electric company, gas company, or fuel (01) YES
dealer.
(02) NO
(-8) DON’T KNOW
In [CURRENT YEAR - 1], did [you/this household/(SP's) household] receive assistance of this type from the
(-9) REFUSED
federal, state, or local government?
As you may know, the government has programs that help beneficiaries pay for the costs associated with a
Medicare drug plan and the purchase of prescription drugs. The help provided is referred to as a "low-income
subsidy" or "extra help".
Before today, were you aware that Medicare offers a low-income subsidy or extra help with prescription drug
coverage?
PDRECLIS
MSPKNOW
RXPD18B
MSPKNOW
yes/no
yes/no
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
[Are you/Is (SP)] receiving this type of help to pay for [your/(SP's)] (CURRENT YEAR) Medicare prescription drug
coverage?
(01) YES
(02) NO
[EXPLAIN IF NECESSARY: Beneficiaries who qualify for these programs receive help paying for the Medicare (-8) DON’T KNOW
drug plan's monthly premium, help paying any yearly deductible, help paying coinsurance and copayments for
(-9) REFUSED
prescription drugs, and have no coverage gap.]
As you may know, the government has a set of programs, called Medicare Savings Programs (MSP), that help
beneficiaries pay for the costs associated with Medicare, such as Part A (Hospital Insurance) or Part B (Medical
(01) YES
Insurance) premiums, deductibles, coinsurance, and copayments. Unlike additional insurance plans that require
(02) NO
a monthly premium, Medicare Savings Programs provide financial help at no cost to eligible beneficiaries who
(-8) DON’T KNOW
have limited income and resources.
(-9) REFUSED
LISKNOW
(01) PDRECLIS
(02) MSPKNOW
(-8) MSPKNOW
(-9) MSPKNOW
MSPKNOW
(01) USEMSP
(02) BOX ENDIAQ
(-8) BOX ENDIAQ
(-9) BOX ENDIAQ
Before today, were you aware that Medicare offers these programs?
[Are you/Is (SP)] receiving any assistance from a Medicare Savings Program (MSP) to help pay for [your/(SP)'s]
(CURRENT YEAR) health care costs?
USEMSP
USEMSP
yes/no
BOX ENDIAQ
routing
(01) YES
[EXPLAIN IF NECESSARY: Medicare Savings Programs pay for remaining costs (premiums, deductibles,
(02) NO
coinsurance, and copayments) not covered by Medicare. These programs are different from additional insurance
(-8) Don't Know
plans, such as Medicare Supplement Insurance (Medigap) or private insurance plans, in that beneficiaries will
(-9) Refused
not pay for this extra financial help. Instead, beneficiaries must be eligible (i.e., have limited resources or
income) and some may need to apply to receive this financial assistance from an MSP.
BOX ENDIAQ
GO TO RXQ.
Page 13 of 13
| File Type | application/pdf |
| Author | NORC |
| File Modified | 2024-06-27 |
| File Created | 2024-06-27 |