Form In-Person Screenin In-Person Screenin In-Person Screening Questions

2025 National Household Survey of
Behavioral Health (NHSBH): Final InPerson Screening Specifications for
Programming

Substance Abuse and Mental Health Services Administration
Center for Behavioral Health Statistics and Quality
Rockville, Maryland
Last Revised: July 30, 2024

2025 National Household Survey of Behavioral Health
(NHSBH): Final In-Person Screening Specifications for
Programming
Acknowledgments
This report was prepared for the Substance Abuse and Mental Health Services Administration
(SAMHSA), U.S. Department of Health and Human Services (HHS), under Contract No.
75S20322C00001 with RTI International. Marlon Daniel served as the government project
officer and as the contracting officer representative.
Public Domain Notice
All material appearing in this report is in the public domain and may be reproduced or copied
without permission from SAMHSA. Citation of the source is appreciated. However, this
publication may not be reproduced or distributed for a fee without the specific, written
authorization of the Office of Communications, SAMHSA, HHS.
Electronic Access
This publication may be downloaded at https://www.samhsa.gov/data/.
Recommended Citation
Center for Behavioral Health Statistics and Quality. (2023). 2024 National Household Survey of
Behavioral Health (NHSBH): Final in-person screening specifications for programming.
Substance Abuse and Mental Health Services Administration.
Originating Office
Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health
Services Administration, 5600 Fishers Lane, Room 15-E09D, Rockville, MD 20857. For
questions about this report, please email [email protected].
Nondiscrimination Notice/Aviso de no discriminación
SAMHSA complies with applicable federal civil rights laws and does not discriminate on the
basis of race, color, national origin, age, disability, or sex. SAMHSA cumple con las leyes
federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad,
edad, discapacidad o sexo.
U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Behavioral Health Statistics and Quality
Populations Survey Branch
Last Revised: July 30, 2024

ii

2025 National Household Survey of Behavioral Health
Screening Application Updates
•

SR Race and Ethnicity questions have been updated per OMB directives.

•

Race and Ethnicity questions for all household members have been Updated per OMB
directives.

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iv

Table of Contents
Section

Page

Screening Application Updates...................................................................................................... iii
2023 NHSBH Screening Application Specifications ................................................................... vii
1.

HU Screening ................................................................................................................... 1-1

2.

GQU Screening ................................................................................................................ 2-1

3.

Select Case Screen Options ............................................................................................. 3-1

4.

Record of Calls ................................................................................................................ 4-1

5.

Screening and Interview Refusal ..................................................................................... 5-1

6.

Screening Verification ..................................................................................................... 6-1

7.

Interview Verification ...................................................................................................... 7-1

8.

FI Debriefing Questions ................................................................................................... 8-1

9.

Parental Introductory Script in English and Spanish ....................................................... 9-1

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vi

2025 NHSBH Screening Application Specifications
For all specification sections, the following format conventions apply:
•
•

•
•
•
•
•

Screen names are in bold uppercase letters.
English text to be read by FIs is shown in black font. Spanish screen text to be read
by FIs follows the English text. In the screening program, FIs can toggle between
English and Spanish text by pressing the SPAN/ENG button on the tablet.
FI instructions are provided in black uppercase text that is not in brackets. In the
screening program, FI instructions appear in red uppercase letters.
Text of any pop-up screens are provided in bracketed logic using uppercase text in
quotations.
Programming logic is designated by black uppercase text in brackets.
Fills are designated by parentheses and italics.
Response categories are underlined.

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viii

Section 1
HU Screening
The line number and address are located at the top of each screen. During the roster questions asking
about age through race, touch the address line to see the DU LINE box, an enlarged display of the
CaseID and address. If a case is an Added DU, the DU LINE box displays the link line number.

STUDY INTRODUCTION
Hello, my name is (FI NAME) with RTI International in North Carolina. We are conducting a
nationwide study sponsored by the U.S. Department of Health and Human Services.
(Buenas noches/Buenas tardes/Buenos días). Mi nombre es (FI NAME) y trabajo para RTI
International en Carolina del Norte. Estamos llevando a cabo un estudio nacional patrocinado por
el Departamento de Salud y Servicios Humanos de los Estados Unidos.
[IF NOT ADDED DU] You should have received a letter explaining the study.
Usted debe haber recibido una carta explicándole el estudio.
[IF NOT ADDED DU] HAND R COPY OF LETTER IF NEEDED
[IF ADDED DU] HAND R LEAD LETTER, ALLOW TIME TO READ
Next [IDENTIFY SR]

IDENTIFY SR [IF STUDY INTRODUCTION = NEXT]
First, just let me verify: do you live here?
Primero, déjeme verificar: ¿vive usted aquí?
IF NOT OBVIOUS:
And are you 18 or older?
Y ¿tiene 18 años o más de edad?
IF NO TO EITHER, ASK FOR AN ADULT RESIDENT, TOUCH “PREVIOUS”, AND BEGIN
AGAIN.
SR Available [ADDRESS VERIFICATION]
SR Not Available [EXIT SCREENING: “ARE YOU SURE YOU WANT TO EXIT
SCREENING?” IF Yes, RECORD OF CALLS. IF No, IDENTIFY SR.]

ADDRESS VERIFICATION [IF IDENTIFY SR = SR AVAILABLE]
I just need to verify -- is this
Solamente necesito confirmar que esta es

1-1

STREET: (NUMBER AND STREET)
CITY: (CITY)
STATE: (STATE)
ZIP: (ZIP)
Address Is Correct [INFORMED CONSENT]
Need to Edit Address [EDIT ADDRESS]
FI At Wrong Address [SELECT CASE]

EDIT ADDRESS [IF ADDRESS VERIFICATION = NEED TO EDIT ADDRESS]
TOUCH THE ITEM YOU NEED TO EDIT
STREET # (NUMBER)
STREET: (STREET)
APT.#: (APARTMENT NUMBER)
CITY: (CITY)
STATE: (STATE)
ZIP: (ZIP)
Update [SAVE UPDATED ADDRESS, THEN ADDRESS VERIFICATION]

INFORMED CONSENT [IF ADDRESS VERIFICATION = ADDRESS IS CORRECT]
GIVE PERSON STUDY DESCRIPTION AND SAY
Please read this statement. It describes the survey and the laws that ensure the confidentiality of
any information you provide. It also explains that your answers are used for statistical purposes
only and that your participation is voluntary. If anyone is selected for the full interview, each
person who completes the interview will receive $30.
Por favor lea esta declaración, la cual describe la encuesta y las leyes que aseguran la
confidencialidad de cualquier información que usted nos dé. También explica que sus respuestas
son usadas con propósitos estadísticos únicamente y que su participación es voluntaria. Si alguien
es seleccionado para participar en la entrevista en su totalidad, cada persona que complete la
entrevista recibirá $30.
Next [IF APT/CONDO=NO, MISSED DUs; IF APT/CONDO=YES, SR OCCUPANCY]

MISSED DUs [IF INFORMED CONSENT = NEXT AND APT/CONDO=NO]
Are there any other living quarters within this structure or on this property, such as a separate
apartment with a separate entrance?
¿Hay alguna otra vivienda dentro de esta casa o propiedad, tal como un apartamento separado con
entrada aparte?
Yes [MISSED DU ADDRESS]
[IF ADDED DU: CANNOT ADD UNIT
“YOU CANNOT ADD A MISSED DU

No [SR OCCUPANCY]

1-2

FROM A DU THAT HAS BEEN ADDED”
MISSED DUs]

MISSED DU ADDRESS [IF MISSED DUs = YES]
RECORD STREET ADDRESS OR DESCRIPTION OF UNIT
STREET #:
STREET:
APT.#: (APARTMENT NUMBER)
Update [Add Another DU: “DURING
THIS SESSION, YOU HAVE ADDED
1 UNIT. YOU STILL HAVE 4 UNUSED
ADDED LINES LEFT IN THIS SEGMENT.
DO YOU WANT TO ADD ANOTHER
MISSED DU?” IF Yes, MISSED DU
ADDRESS. IF No, SR OCCUPANCY.]

Cancel [CANCEL DU: “ARE YOU SURE
YOU WANT TO CANCEL ADDITION
OF THIS DU? IF Yes, SR OCCUPANCY.
IF No, MISSED DU ADDRESS.]

SR OCCUPANCY [IF MISSED DUs = NO OR APT/CONDO=YES OR MISSED DU ADDRESS =
UPDATE OR CANCEL MISSED DU = YES]
(Did/Will) you live here for most of the time during the months of (CURRENT QUARTER)?
(¿Vivió/¿Vivirá) usted aquí la mayor parte del tiempo durante los meses de (CURRENT
QUARTER)?
Yes [TOTAL SDU MEMBERS]
No [OCCUPANCY]

OCCUPANCY [IF SR OCCUPANCY = NO]
(Did/Will) anyone else in your household live here for most of the time during the months of
(CURRENT QUARTER)?
(¿Vivió /¿Vivirá) alguna otra persona en esta vivienda la mayor parte del tiempo durante los
meses de (CURRENT QUARTER)?
Yes [TOTAL SDU MEMBERS]

No [OCCUPANCY – CONFIRMATION: YOUR
‘NO’ RESPONSE WILL CONCLUDE THIS
SCREENING AND FINALIZE THIS CASE. DO YOU
WANT TO CHANGE YOUR ANSWER? (‘YES’ WILL
CONTINUE SCREENING. ‘NO’ WILL FINALIZE
THE CASE.) IF Yes, OCCUPANCY. IF No,
OCCUPANCY-CLOSE CASE: ARE YOU SURE
YOU WANT TO CLOSE OUT THIS CASE? IF Yes,
VERIFICATION. IF No, OCCUPANCY]

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TOTAL SDU MEMBERS [IF SR OCCUPANCY = YES OR OCCUPANCY= YES]
[IF SR OCCUPANCY = YES] Including yourself, how many people in this household (lived/will
live) here for most of the time during (CURRENT QUARTER)? (Do not include anyone who
(lived/will live) at school or somewhere else for most of the time during (CURRENT
QUARTER).)
Incluyéndose usted, ¿cuántas personas (vivieron/vivirán) en esta vivienda la mayor parte del
tiempo durante (CURRENT QUARTER)? (No incluya a nadie que (vivió/vivirá) en la escuela o en
otro lugar la mayor parte del tiempo durante (CURRENT QUARTER).)
[IF OCCUPANCY = YES] How many people in this household (lived/will live) here for most of
the time during (CURRENT QUARTER)? (Do not include anyone who (lived/will live) at school
or somewhere else for most of the time during (CURRENT QUARTER).)
¿Cuántas personas (vivieron/vivirán) en esta vivienda la mayor parte del tiempo durante
(CURRENT QUARTER)? (No incluya a nadie que (vivió/vivirá) en la escuela o en otro lugar la
mayor parte del tiempo durante (CURRENT QUARTER).)
ENTER NUMBER 1-20 [MEMBERS 12 OR OLDER]
[IF 1 TOTAL SDU MEMBERS = 1, ONLY HOUSEHOLD MEMBER: “CONFIRM
RESPONSE: IS THERE ONLY 1 PERSON IN THIS HOUSEHOLD?” IF No, TOTAL
SDU MEMBERS. IF Yes AND SR OCCUPANCY = NO AGE. IF Yes AND SR
OCCUPANCY = YES, SR AGE.]

MEMBERS 12 OR OLDER [IF TOTAL SDU MEMBERS NE BLANK AND >1]
Of these (TOTAL SDU MEMBERS) people, how many are now age 12 or older?
De estas (TOTAL SDU MEMBERS) personas, ¿cuántas tienen 12 años o más actualmente?
ENTER SUBSET OF TOTAL SDU MEMBERS
[IF SR OCCUPANCY = YES, SR AGE, ELSE IF SR OCCUPANCY = NO, AGE]
[IF MEMBERS 12 OR OLDER = 1, ONLY ELIGIBLE MEMBER: “CONFIRM
RESPONSE: IS THERE ONLY 1 PERSON AGE 12 OR OLDER IN THIS
HOUSEHOLD?” IF No, MEMBERS 12 OR OLDER. IF Yes AND SR OCCUPANCY
= NO, AGE. IF Yes, AND SR OCCUPANCY = YES SR AGE.]

SR AGE [IF SR OCCUPANCY = YES]
How old are you?
¿Cuántos años tiene usted?
ENTER AGE [SR SEX]
[IF SR AGE ≥ 99, ROSTER: PLEASE VERIFY: Let me confirm, are you (AGE) years old?
Permítame confirmar, ¿tiene usted (AGE) años de edad? IF Yes, SR SEX. IF No, SR AGE.]
[IF SR AGE = 17 OR UNDER: OLDER ELIGIBLE SR: “YOU HAVE IDENTIFIED AN SR
UNDER AGE 18. DOES AN ELIGIBLE SR 18 OR OLDER LIVE AT DU?”

1-4

IF Yes, CONTACT OLDER MEMBER: “CONDUCT SCREENING WITH SR AGED 18 OR
OLDER.” OK; CLEAR THE AGE ENTRY TO ALLOW FOR NEW SR.
If No, MINOR SR: “THIS SR IS 17 OR YOUNGER. STOP THE SCREENING AND CODE
AS AN 02.” OK [SCREENING CALL RECORD] ENTERING RESULT CODE 02 SR
UNAVAILABLE, AND COMMENT “SR age ineligible”.]

SR SEX [IF SR AGE NE BLANK]
What sex were you assigned at birth, on your original birth certificate?
¿Qué sexo le fue asignado al nacer, en su certificado de nacimiento original?
Male
Female
Unknown
Refused

Hombre
Mujer
No sabe
Se rehúsa

SR GENDER [IF SR SEX NE BLANK]
Do you describe yourself as male, female, transgender, or do you use a different term?
¿Se describe usted como hombre, mujer, transgénero o utiliza un término diferente?
Male
Female
Transgender
Use a different term
Unknown
Refused

Hombre
Mujer
Transgénero
Utiliza un término diferente
No sabe
Se rehúsa

(CHECK ALL THAT APPLY)
SR DIFTERM [IF SR GENDER = USE A DIFFERENT TERM]
What term do you use?
¿Qué término usa?
[ALLOW 50 CHARACTERS]
Unknown/REF
[IF AGE 17-65, MILITARY, OTHERWISE SR HISPANIC]

SR MILITARY [IF SR GENDER NE BLANK AND SR AGE = 17-65]
Are you currently on active duty in the United States military?
¿Está usted actualmente en servicio activo en las fuerzas armadas de los Estados Unidos?
Yes
No
Refused

Sí
No
Se rehúsa

1-5

[SR HISPANIC]

SR HISPANIC [IF SR MILITARY NE BLANK OR (SR GENDER NE BLANK AND SR AGE NE
17-65)]
Are you of Hispanic, Latino or Spanish origin?
¿Es usted de origen hispano, latino o español?
(That is, do any of these groups describe your national origin or ancestry – Puerto Rican, Cuban,
Cuban-American, Mexican, Mexican-American, Chicano, Central or South American, or origin
in some other Spanish-speaking country?)
(Es decir que su origen nacional o ascendencia se puede describir como puertorriqueño, cubano,
cubanoamericano, mexicano, mexicanoamericano, chicano, centro o sudamericano, o es nativo(a)
de otro país donde se habla español?)
Yes
No
Unknown
Refused

Sí
No
No sabe
Se rehúsa

[SR RACE]

SR RACE [IF SR HISPANIC NE BLANK]
Are you American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian
or other Pacific Islander, or White?
¿Es usted de raza indígena americana o nativa de Alaska, asiática, negra o afroamericana, nativa
de Hawái o de otra isla del Pacífico, o blanca?
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian/other Pacific Islander
White

Indígena americana o nativa de Alaska
Asiática
Negra o afroamericana
Nativa de Hawái o de otra isla del Pacífico
Blanca

(CHECK ALL THAT APPLY)
Unknown
Refused

No sabe
Se rehúsa

SR CONFIRM ROSTER [IF SR RACE NE BLANK]
[IF RACE, HISPANIC, AND/OR MILITARY IS ‘BLANK’ OMIT RESPECTIVE FILLS FROM
CONFIRM ROSTER SCREEN.]
CONFIRM:

1-6

I have listed you as a/an (AGE) year old respondent. You are (RACE), (HISPANIC), and (are/are
not) on active duty in the United States military.
Le he anotado a usted, una persona de (AGE) años de edad. Usted es de raza (RACE: indígena
americana o nativa de Alaska, asiática, negra o afroamericana, nativa de Hawái o de otra isla del
Pacífico, blanca), (HISPANIC: es una persona hispana) y (está/no está) en servicio activo en las
fuerzas armadas de los Estados Unidos.
Is this correct?
¿Es esto correcto?
Yes [OTHER MEMBERS] [IF ROSTER NE BLANK, THEN VERIFY ROSTER DATA]
No [SR AGE]

OTHER MEMBERS [IF SR CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER ≥ 2]
Now I need some general information about (the other person/all of the other people) in this
household who (is/are) 12 years old or older. [IF MEMBERS 12 OR OLDER >2] Let's start with
the oldest and work down to the youngest.
Ahora necesito información general sobre la otra persona en este hogar que tenga 12 años de edad
o más. [IF MEMBERS 12 OR OLDER >2] Empecemos con la persona mayor hasta llegar a la
persona menor.
Next [AGE]

NOT HOUSEHOLD MEMBER [IF SR OCCUPANCY = NO AND MEMBERS 12 OR OLDER ≥ 2]
Even though you (did/will) not live here for most of (CURRENT QUARTER), I need some
general information about (the other person/all of the other people) in this household who are 12
years old or older and (did/will) live here for most of those months. Let’s start with the oldest and
work down to the youngest.
Aunque usted no (vivió/vivirá) aquí la mayor parte de (CURRENT QUARTER), necesito alguna
información general acerca de (la otra persona/todas las otras personas) en este hogar que
tengan 12 años o más y (vivieron/vivirán) aquí la mayoría de esos meses. Empecemos con la
persona mayor hasta llegar a la persona menor.
Next [AGE]

AGE [IF (OTHER MEMBERS NE BLANK) OR (CONFIRM ROSTER = NO) OR SR NOT HH
MEMBER NE BLANK OR (TOTAL SDU MEMBERS = 1 AND ONLY ELIGIBLE HH MEMBER =
No) OR (MEMBERS 12 OR OLDER = 1 AND ONLY ELIGIBLE HH MEMBER = No)]
[IF MEMBERS 12 OR OLDER = 1 OR 2] How old is this person?
¿Cuántos años tiene esta persona?
[IF MEMBERS 12 OR OLDER > 2 HH MEMBERS] How old is the (oldest/next oldest) person?
¿Cuántos años tiene la (persona mayor/siguiente persona)?

1-7

ENTER AGE [ROSTER SCREEN 1]
[IF AGE ≥ 99, ROSTER: PLEASE VERIFY: Let me confirm, is this person (AGE) years old?
Permítame confirmar, ¿tiene esta persona (AGE) años de edad? IF Yes, ROSTER SCREEN 1.
IF No, AGE.]

ROSTER SCREEN 1 [IF AGE NE BLANK]
RELATION: [IF AGE NE BLANK]
How is this person related to you?
¿Cómo está relacionada esta persona con usted?
Spouse
Child (incl. step, foster, or adoptive)
Child-in-law
Sibling (incl. step, foster, or adoptive)

Sibling-in-law
Parent/Guardian (incl. step, foster, or
adoptive)
Parent-in-law
Uncle/Aunt
Nephew/Niece
Grandparent
Grandchild
Cousin
Ex-Spouse
Unmarried Partner
Housemate or Roommate
Tenant/Boarder/Exch Student
Other relative
Other Non-relative
Relationship Unspecified

Esposo(a)
Hijo(a) (incluye hijastro(a), hijo(a)
“foster” o hijo(a) adoptivo(a))
Yerno/Nuera
Hermano(a) (incluye medio(a)
hermano(a), hermanastro(a),
hermano(a) “foster” o hermano(a)
adoptivo(a))
Cuñado(a)
Padre/madre/Tutor(a) (incluye
padrastro/madrastra, padre/madre
“foster” o padre/madre adoptivo(a))
Suegro(a)
Tío(a)
Sobrino(a)
Abuelo(a)
Nieto(a)
Primo(a)
Ex-esposo(a)
Pareja (sin estar casados)
Compañero(a) de casa o de cuarto
Inquilino(a)/Pensionista/Intercambio
estudiantil
Otro pariente
Otra persona que no es pariente
No se especificó el parentesco

SEX: [IF RELATION NE BLANK]
What sex was this person assigned at birth, on their original birth certificate?
¿Qué sexo le fue asignado a esta persona al nacer, en su certificado de nacimiento original?
Male
Female
Unknown
Refused

Hombre
Mujer
No sabe
Se rehúsa

1-8

GENDER: [IF SEX NE BLANK]
Does this person describe themself as male, female, transgender, or do they use a different term?
¿Se describe esta persona como hombre, mujer, transgénero o utiliza un término diferente?
Male
Female
Transgender
Use a different term
Unknown
Refused

Hombre
Mujer
Transgénero
Utiliza un término diferente
No sabe
Se rehúsa

(CHECK ALL THAT APPLY)

ROSTER SCREEN 2
DIFTERM

[IF GENDER = USE A DIFFERENT TERM]

What term do they use?
¿Qué término usa?
Unknown/REF
[ALLOW 50 CHARACTERS]

ROSTER SCREEN 3
MILITARY [QUESTION/RESPONSE ACTIVE ONLY IF AGE 17-65]
Is this person currently on active duty in the United States military?
¿Está esta persona actualmente en servicio activo en las fuerzas armadas de los Estados Unidos?
Yes
No
Unknown
Refused

Sí
No
No sabe
Se rehúsa

[IF MORE THAN ONE SPOUSE, Multiple Spouses: YOU HAVE ALREADY ENTERED A
RECORD FOR SPOUSE. DOES THIS RESPONDENT HAVE MULTIPLE SPOUSES? IF Yes,
ROSTER SCREEN 2. If No, ROSTER SCREEN 1.]

Next [ROSTER SCREEN 3]

1-9

HISPANIC:
(Is he/Is she/Is this person) of Hispanic, Latino or Spanish origin?
¿Es (él/ella/esta persona) de origen hispano, latino o español?
(That is, do any of these groups describe (his/her/their) national origin or ancestry – Puerto
Rican, Cuban, Cuban-American, Mexican, Mexican-American, Chicano, Central or South
American, or origin in some other Spanish-speaking country?)
(¿Es decir que su origen nacional o ascendencia se puede describir como puertorriqueño, cubano,
cubanoamericano, mexicano, mexicanoamericano, chicano, centro o sudamericano, o es nativo(a)
de otro país donde se habla español?)
Yes
No
Unknown
Refused

Sí
No
No sabe
Se rehúsa

RACE
(Is he/Is she/Is this person) American Indian or Alaska Native, Asian, Black or African
American, Native Hawaiian or other Pacific Islander, or White?
¿Es (él/ella/esta persona) de raza indígena americana o nativa de Alaska, asiática, negra o afroamericana,
nativa de Hawái o de otra isla del Pacífico, o blanca?
American Indian or Alaska Native
Indígena americana o nativa de Alaska
Asian
Asiática
Black or African American
Negra o afroamericana
Native Hawaiian/other Pacific Islander Nativa de Hawái o de otra isla del Pacífico
White
Blanca
(CHECK ALL THAT APPLY)

Unknown
Refused

No sabe
Se rehúsa

Next [CONFIRM ROSTER]

CONFIRM ROSTER
[IF RACE, HISPANIC, AND/OR MILITARY IS ‘BLANK,’ ‘U’, OR ‘REF’ OMIT
RESPECTIVE FILLS FROM CONFIRM ROSTER SCREEN.]
CONFIRM:
I have listed your (AGE) year old (RELATIONSHIP). They are (RACE), (HISPANIC) [IF AGE
17-65] and (are/are not) on active duty the United States military.

1-10

He anotado a su (RELATIONSHIP) de (AGE) años. Esta persona es de raza (RACE), es hispana
[IF AGE 17-65] y (está/no está) en servicio activo en las fuerzas armadas de los Estados Unidos.
Is this correct?
¿Es esto correcto?
Yes
No

Sí [AGE FOR NEXT ROSTER MEMBER, OTHERWISE VERIFY ROSTER DATA]
No [AGE]

VERIFY ROSTER DATA [IF CONFIRM ROSTER = YES]
[IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER=1]
DO NOT READ TO RESPONDENT. WHEN READY, TOUCH NEXT TO MAKE
SELECTION.
TO MAKE CORRECTIONS: TOUCH AND HOLD THE ROSTER LINE THAT YOU WANT
TO EDIT, THEN TOUCH 'EDIT' FROM THE POP-UP MENU.
[IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER>=2]
I need to make sure this list is accurate. I have listed...
Necesito asegurarme que la lista está correcta. He anotado...
[READ AGES AND RELATIONSHIPS ROSTERED]
TO MAKE CORRECTIONS: TOUCH AND HOLD THE ROSTER LINE THAT YOU WANT
TO EDIT, THEN TOUCH ‘EDIT’ FROM THE POP-UP MENU.
Relation (Relationship)
AGE (Age)
SR (Y for Screening Respondent)
PROGRAMMER NOTE: INCLUDE SR DESIGNATION BUT DO NOT ALLOW EDITING
[TOUCH AND HOLD ANY ROSTER LINE, Choose an Action: IF Show Details]
Relation: Relationship
Age: Age
Sex: M, F, U, R
Gender: M, F, T, D, U, R
Hispanic: Y, N, U, R
Race: I, A, B, P, W
Military: Y, N, U, R
Eligible: E, I
[TOUCH AND HOLD ANY ROSTER LINE, Choose an Action: IF Edit. EDIT ROSTER RECORD:
DO YOU WANT TO EDIT THE ROSTER INFORMATION FOR THE (AGE) YEAR OLD
(RELATION)? IF Yes, EDIT ROSTER MEMBER. IF No, VERIFY ROSTER DATA.]

1-11

[+MEMBER OR FUNCTIONS TO ADD ROSTER MEMBERS]
Next [START SELECTION]

EDIT ROSTER MEMBER [EDIT ROSTER RECORD = YES]
SR Roster (or first person listed, if SR not rostered) version:
AGE: Age
SEX: M F U R
GENDER: (CHECK ALL THAT APPLY) M F T D U R (with appropriate boxes checked)
RELATION: Relationship
HISPANIC: Y N U R (with appropriate circle filled)
RACE: (CHECK ALL THAT APPLY) (with appropriate boxes checked)
Am. Indian
Asian Black
Hawaiian/PI
White
Unknown
Refused
MILITARY: Y N R (with appropriate circle filled)
ELIGIBLE: (box checked as appropriate)
SR: (box checked as appropriate) NOTE: this field cannot be edited
Roster #2 or after version: (includes unknown and refusal options)
AGE: Age
SEX: M F U R (with appropriate circle filled)
GENDER: (CHECK ALL THAT APPLY) M F T D U R (with appropriate boxes checked)
RELATION: Relationship
HISPANIC: Y N U R (with appropriate circle filled)
RACE: (CHECK ALL THAT APPLY) (with appropriate boxes checked)
Am. Indian
Asian Black
Hawaiian/PI
White
Unknown
Refused
MILITARY: Y N U R (with appropriate circle filled)
ELIGIBLE: (box checked, as appropriate)
SR: NOTE: this field cannot be edited

START SELECTION
THE PROGRAM WILL START THE SELECTION PROCESS. ARE YOU SURE YOU ARE
READY TO MAKE THE SELECTIONS?
Yes [RESPONDENT SELECTION]
No [VERIFY ROSTER DATA]
[IF INTERVIEW A = BLANK, NO SELECTION: NO ONE WAS SELECTED FOR AN
INTERVIEW AT THIS HOUSEHOLD. PLEASE COLLECT VERIFICATION
INFORMATION.]

RESPONDENT SELECTION [START SELECTION = YES AND INTERVIEW A NE BLANK]

1-12

Interview A
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Relation: (Relationship to SR, BLANK)
Age: (AGE, BLANK)
Race: (I, A, B, P, W, BLANK)

Gender: (M, F, T, DT, BLANK)
Hispanic: (Y, N, BLANK)

Interview B
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Relation: (Relationship to SR, BLANK)
Age: (AGE, BLANK)
Race: (I, A, B, P, W, BLANK)

Gender: (M, F, T, DT, BLANK)
Hispanic: (Y, N, BLANK)

WHEN FI SELECTS DONE ON RESPONDENT SELECTION SCREEN AND A
YOUTH IS SELECTED, DISPLAY POP-UP:
READ THE FOLLOWING INTRODUCTORY SCRIPT TO THE PARENT. YOU
MAY NOT USE A TRANSLATOR.
IF NO PARENT IS ON THE ROSTER AND PARENT IS UNAVAILABLE TO MEET INPERSON, READ TO GUARDIAN.
ALL INELIGIBLE [START SELECTION = YES AND ALL ROSTER MEMBERS MILITARY OR
INELIGIBLE]
ALL MEMBER(S) WERE INDICATED AS MILITARY OR INELIGIBLE. NO ONE IS
ELIGIBLE FOR SELECTION.
OK [VERIFICATION]

1-13

This page intentionally left blank.

1-14

Section 2
GQU Screening
STUDY INTRODUCTION
Hello, my name is (FI NAME) with RTI International in North Carolina. We are conducting a
nationwide study sponsored by the U.S. Department of Health and Human Services.
(Buenas noches/Buenas tardes/Buenos días). Mi nombre es (FI NAME) y trabajo para RTI
International en Carolina del Norte. Estamos llevando a cabo un estudio nacional patrocinado por
el Departamento de Salud y Servicios Humanos de los Estados Unidos.
You should have received a letter explaining the study.
Usted debe haber recibido una carta explicándole el estudio.
HAND R COPY OF LETTER IF NEEDED
Next [IDENTIFY SR]

IDENTIFY SR [IF STUDY INTRODUCTION = NEXT]
First, just let me verify: do you live here?
Primero, déjeme verificar: ¿vive usted aquí?
IF NOT OBVIOUS:
And are you 18 or older?
Y ¿tiene 18 años o más de edad?
IF NO TO EITHER, ASK FOR AN ADULT RESIDENT, TOUCH “PREVIOUS”, AND BEGIN
AGAIN.
SR Available [ADDRESS VERIFICATION]
SR Not Available [EXIT SCREENING: “ARE YOU SURE YOU WANT TO EXIT
SCREENING?” IF Yes, RECORD OF CALLS. IF No,
IDENTIFY SR.]

ADDRESS VERIFICATION [IF IDENTIFY SR = SR AVAILABLE]
I just need to verify -- is this
Solamente necesito confirmar que esta es
STREET: (NUMBER AND STREET)
CITY: (CITY)
STATE: (STATE)
ZIP: (ZIP)

2-1

Address Is Correct [INFORMED CONSENT]
Need to Edit Address [EDIT ADDRESS]
FI At Wrong Address [SELECT CASE]

EDIT ADDRESS [IF ADDRESS VERIFICATION = NEED TO EDIT ADDRESS]
TOUCH THE ITEM YOU NEED TO EDIT
STREET #: (NUMBER)
STREET: (STREET)
APT.#: (APARTMENT NUMBER)
CITY: (CITY)
STATE: (STATE)
ZIP: (ZIP)
Update [SAVE UPDATED ADDRESS, THEN ADDRESS VERIFICATION]

INFORMED CONSENT [IF ADDRESS VERIFICATION = ADDRESS IS CORRECT]
GIVE PERSON STUDY DESCRIPTION AND SAY
Please read this statement. It describes the survey and the laws that ensure the confidentiality of
any information you provide. It also explains that your answers are used for statistical purposes
only and that your participation is voluntary. If anyone is selected for the full interview, each
person who completes the interview will receive $30 in cash.
Por favor lea esta declaración, la cual describe la encuesta y las leyes que aseguran la
confidencialidad de cualquier información que usted nos dé. También explica que sus respuestas
son usadas con propósitos estadísticos únicamente y que su participación es voluntaria. Si alguien
es seleccionado para participar en la entrevista en su totalidad, cada persona que complete la
entrevista recibirá $30 dólares en efectivo.
Next [TRANSIENT]

TRANSIENT [IF INFORMED CONSENT = NEXT]
INTERVIEWER: IS THIS GQU A TRANSIENT SHELTER?
Yes [UNIT TYPE]
No [SR OCCUPANCY]

UNIT TYPE [IF TRANSIENT = YES]
ARE THE LISTED UNITS…
ROOMS [TOTAL GQU MEMBERS]

2-2

BEDS, OR [ROSTER #1 AGE]
PERSONS [ROSTER #1 AGE]

SR OCCUPANCY [IF TRANSIENT = NO]
(Did/Will) you live here for most of the time during the months of (CURRENT QUARTER)?
(¿Vivió /¿Vivirá) usted aquí la mayor parte del tiempo durante los meses de (CURRENT
QUARTER)?
Yes [TOTAL GQU MEMBERS]
No [OCCUPANCY]

OCCUPANCY [IF SR OCCUPANCY = NO]
(Did/Will) anyone else in this room live here for most of the time during the months of
(CURRENT QUARTER)?
(¿Vivió /¿Vivirá) alguna otra persona aquí la mayor parte del tiempo durante los meses de
(CURRENT QUARTER)?
Yes [TOTAL GQU MEMBERS]
No [OCCUPANCY – CONFIRMATION:
YOUR ‘NO’ RESPONSE WILL
CONCLUDE THIS SCREENING
AND FINALIZE THIS CASE. DO
YOU WANT TO CHANGE YOUR
ANSWER? (‘YES’ WILL CONTINUE
SCREENING. ‘NO’ WILL FINALIZE THE
CASE.) IF Yes, OCCUPANCY. IF No,
OCCUPANCY-CLOSE CASE: ARE YOU SURE
YOU WANT TO CLOSE OUT THIS CASE? IF
Yes, VERIFICATION. IF No, OCCUPANCY]

TOTAL GQU MEMBERS [IF SR OCCUPANCY = YES OR IF OCCUPANCY = YES OR IF UNIT
TYPE = ROOMS]
[IF TRANSIENT = YES AND UNIT TYPE = ROOMS] Including yourself, how many people
are staying in this room?
Incluyéndose usted, ¿cuántas personas se quedan en esta habitación?
[IF TRANSIENT = NO and SR OCCUPANCY = YES] Including yourself, how many people
(lived/will live) in this room for most of the time during (CURRENT QUARTER)?
Incluyéndose usted, ¿cuántas personas (vivieron/vivirán) en esta habitación la mayor parte del
tiempo durante (CURRENT QUARTER)?
[IF TRANSIENT = NO and OCCUPANCY = YES] How many people (lived/will live) in this
room for most of the time during (CURRENT QUARTER)?

2-3

¿Cuántas personas (vivieron/vivirán) en esta habitación la mayor parte del tiempo durante
(CURRENT QUARTER)?
ENTER NUMBER 1-20 [MEMBERS 12 OR OLDER]
[IF TOTAL GQU MEMBERS = 1, ONLY MEMBER: CONFIRM RESPONSE: IS
THERE ONLY 1 PERSON LIVING HERE? IF No, TOTAL GQU MEMBERS. IF Yes
AND SR OCCUPANCY = YES, ROSTER #1 AGE. IF Yes AND SR OCCUPANCY =
NO, NOT HOUSEHOLD MEMBER.

MEMBERS 12 OR OLDER [IF TOTAL GQU MEMBERS NE BLANK AND >1]
[IF TRANSIENT = YES] How many of these [TOTAL GQU MEMBERS] people are now age 12
or older?
¿Cuántas de estas [TOTAL GQU MEMBERS] personas tienen 12 años o más de edad
actualmente?
[IF TRANSIENT = NO] Of these [TOTAL GQU MEMBERS] people, how many are now age 12
or older?
De estas [TOTAL GQU MEMBERS] personas, ¿cuántas tienen 12 años o más actualmente?
ENTER SUBSET OF TOTAL GQU MEMBERS [ROSTER # AGE]
[IF MEMBERS 12 OR OLDER = 1, ONLY ELIGIBLE MEMBER: “CONFIRM
RESPONSE: IS THERE ONLY 1 PERSON AGE 12 OR OLDER IN THIS UNIT?” IF
No, MEMBERS 12 OR OLDER. IF Yes AND SR OCCUPANCY = YES ROSTER #
1 AGE. IF Yes AND SR OCCUPANCY = NO, NOT HOUSEHOLD MEMBER.]

NOT HOUSEHOLD MEMBER [IF SR OCCUPANCY = NO AND MEMBERS 12 OR OLDER ≥ 2]
Even though you (did/will) not live here for most of (CURRENT QUARTER), I need some
general information about (the other person/all of the other people) in this household who are 12
years old or older and (did/will) live here for most of those months. Let’s start with the oldest and
work down to the youngest.
Aunque usted no (vivió/vivirá) aquí la mayor parte de (CURRENT QUARTER), necesito alguna
información general acerca de (la otra persona/todas las otras personas) en este hogar que
tengan 12 años o más y (vivieron/vivirán) aquí la mayoría de esos meses. Empecemos con la
persona mayor hasta llegar a la persona menor.
Next [ROSTER #1 AGE]

ROSTER #1 AGE [IF MEMBERS 12 OR OLDER NE BLANK OR TOTAL GQU MEMBERS = 1
OR IF UNIT TYPE = BEDS OR PERSONS]
How old (are/is) (you/this person)?
¿Cuántos años tiene (usted/esta persona)?

2-4

ENTER AGE [ROSTER #1 NAME]
[IF SR AGE ≥ 99, ROSTER: PLEASE VERIFY: Let me confirm, are you (AGE) years old?
Permítame confirmar, ¿tiene usted (AGE) años de edad? IF Yes, SR SEX. IF No, SR AGE.]
[IF SR AGE = 17 OR UNDER: OLDER ELIGIBLE SR: “YOU HAVE IDENTIFIED AN SR
UNDER AGE 18. DOES AN ELIGIBLE SR 18 OR OLDER LIVE AT DU?”
IF Yes, CONTACT OLDER MEMBER: “CONDUCT SCREENING WITH SR AGED 18 OR
OLDER.” OK; CLEAR THE AGE ENTRY TO ALLOW FOR NEW SR.
If No, MINOR SR: “THIS SR IS 17 OR YOUNGER. STOP THE SCREENING AND CODE
AS AN 02.” OK [SCREENING CALL RECORD] ENTERING RESULT CODE 02 SR
UNAVAILABLE, AND COMMENT “SR age ineligible”.]

ROSTER #1 NAME [IF ROSTER #1 AGE NE BLANK]
What is (your/this person’s) first name?
¿Cuál es (su nombre/el nombre) (sin apellido) (de esta persona)?
ENTER FIRST NAME [ROSTER #1 SEX]

ROSTER #1 SEX [IF ROSTER #1 NAME NE BLANK]
What sex (were/was) (you/this person) assigned at birth, on (your/their) original birth certificate?
¿Qué sexo le fue asignado a (usted/esta persona) al nacer, en su certificado de nacimiento
original?
Male
Female
Unknown
Refused

Hombre
Mujer
No sabe
Se rehúsa

ROSTER #1 GENDER [IF ROSTER #1 SEX NE BLANK]
(Do you/Does this person) describe (yourself/themself) as male, female, transgender, or do
(you/they) use a different term?
¿Se describe (usted/esta persona) como hombre, mujer, transgénero o utiliza un término
diferente?
Male
Hombre
Female
Mujer
Transgender
Transgénero
Use a different term
Utiliza un término diferente
Unknown
No sabe
Refused
Se rehúsa
(CHECK ALL THAT APPLY)

2-5

ROSTER #1 DIFTERM [IF ROSTER #1 GENDER = USE A DIFFERENT TERM]
What term do (you/they) use?
¿Qué término usa?
[ALLOW 50 CHARACTERS]
Unknown/REF
[IF AGE 17-65, ROSTER #1 MILITARY, OTHERWISE ROSTER #1 HISPANIC]

ROSTER #1 MILITARY [IF ROSTER #1 GENDER NE BLANK AND ROSTER #1 AGE = 17-65]
(Are you /Are they) currently on active duty in the United States military?
¿Está esta persona actualmente en servicio activo en las fuerzas armadas de los Estados Unidos?
Yes
No
Refused

Sí
No
Se rehúsa

[ROSTER #1 HISPANIC]

ROSTER #1 HISPANIC [IF ROSTER #1 MILITARY NE BLANK OR (ROSTER #1 GENDER NE
BLANK AND AGE NE 17-65)]
(Are you/Are they) of Hispanic, Latino or Spanish origin?
¿Es esta persona de origen hispano, latino o español?
(That is, do any of these groups describe (your/his/her) national origin or ancestry – Puerto Rican,
Cuban, Cuban-American, Mexican, Mexican-American, Chicano, Central or South American, or
origin in some other Spanish-speaking country?)
(¿Es decir que su origen nacional o ascendencia se puede describir como puertorriqueño, cubano,
cubanoamericano, mexicano, mexicanoamericano, chicano, centro o sudamericano, o es nativo(a)
de otro país donde se habla español?)
Yes
Sí
No
No
Unknown
No sabe
Refused
Se rehúsa
[ROSTER #1 RACE]

ROSTER #1 RACE [IF ROSTER #1 HISPANIC NE BLANK]
(Are you/Are they) American Indian or Alaska Native, Asian, Black or African American, Native
Hawaiian or other Pacific Islander, or White?
¿Es esta persona de raza indígena americana o nativa de Alaska, asiática, negra o afroamericana,
nativa de Hawái o de otra isla del Pacífico, o blanca?

2-6

American Indian or Alaska Native
Indígena americana o nativa de Alaska
Asian
Asiática
Black or African American
Negra o afroamericana
Native Hawaiian/other Pacific Islander Nativa de Hawái o de otra isla del Pacífico
White
Blanca
Unknown
No sabe
Refused
Se rehúsa
(CHECK ALL THAT APPLY)
[CONFIRM ROSTER]

CONFIRM ROSTER [IF ROSTER #1 RACE NE BLANK]
[IF RACE, HISPANIC, AND/OR MILITARY IS ‘U’ OR ‘REF’ OMIT RESPECTIVE FILLS
FROM CONFIRM ROSTER SCREEN.]
CONFIRM:
I have listed (you as) a/an (AGE) year old resident. (You are/They are) (RACE), (HISPANIC) [IF
AGE =17-65] and (are/are not) on active duty in the United States military.
Le he anotado a usted, una persona de (AGE) años de edad. Usted es de raza (RACE: indígena
americana o nativa de Alaska, asiática, negra o afroamericana, nativa de Hawái o de otra isla
del Pacífico, blanca), (HISPANIC: es una persona hispana) y (está/no está) en servicio activo en
las fuerzas armadas de los Estados Unidos.
Is this correct?
¿Es esto correcto?
Yes [IF MEMBERS 12 OR OLDER ≥ 2 OTHER MEMBERS. IF UNIT TYPE = BEDS OR
PERSONS OR UNIT TYPE = ROOMS AND TOTAL GQU MEMBERS OR MEMBERS
12 OR OLDER =1 VERIFY ROSTER DATA]
No [ROSTER #1 AGE]
[IF MEMBERS 12 OR OLDER=1 AND SR=NO, NO SR: “INTERVIEWER: YOU HAVE NOT
IDENTIFIED A SCREENING RESPONDENT. IF THE SCREENING RESPONDENT IS A
MEMBER OF THE HOUSEHOLD, EDIT THEIR ROSTER RECORD AND MARK THE
APPROPRIATE ITEM.”]

OTHER MEMBERS [IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER ≥ 2]
READ TO RESPONDENT:
Now I need some general information about (the other person/all of the other people) who
(is/are) 12 years old or older. [IF MEMBERS 12 OR OLDER >2] Let's start with the oldest and
work down to the youngest.

2-7

Ahora necesito alguna información general sobre (la otra persona que tenga/todas las otras
personas que tengan) 12 años de edad o más. [IF MEMBERS 12 OR OLDER >2] Empecemos
con la persona mayor hasta llegar a la persona menor.
Next [AGE]

AGE [IF OTHER MEMBERS NE BLANK OR CONFIRM ROSTER = NO]
[IF MEMBERS 12 OR OLDER = 2] How old is this person?
¿Cuántos años tiene esta persona?
[IF MEMBERS 12 OR OLDER > 2 HH MEMBERS] How old is the (oldest/next oldest) person?
¿Cuántos años tiene la (persona mayor/siguiente persona)?
ENTER AGE [NAME]
[IF AGE ≥ 99, ROSTER: PLEASE VERIFY: Let me confirm, is this person (AGE) years old?
Permítame confirmar, ¿tiene esta persona (AGE) años de edad? IF Yes, NAME. IF No, AGE.]

NAME [IF AGE NE BLANK]
What is this person’s first name?
¿Cuál es el nombre (sin apellido) de esta persona?
ENTER FIRST NAME [SEX]

ROSTER SCREEN 1
SEX
What sex was this person assigned at birth, on their original birth certificate?
¿Qué sexo le fue asignado al nacer, en su certificado de nacimiento original?
Male
Female
Unknown
Refused

Hombre
Mujer
No sabe
Se rehúsa

GENDER [IF SEX NE BLANK]
Does this person describe themself as male, female, transgender, or do they use a different term?
¿Se describe esta persona como hombre, mujer, transgénero o utiliza un término diferente?
Male
Female
Transgender

Hombre
Mujer
Transgénero

2-8

Use a different term
Unknown
Refused

Utiliza un término diferente
No sabe
Se rehúsa

[IF AGE 17-65, MILITARY, OTHERWISE HISPANIC]
DIFTERM

[IF GENDER = USE A DIFFERENT TERM]

What term do they use?
¿Qué término usa?
Unknown/REF
[ALLOW 50 CHARACTERS]

MILITARY [IF GENDER NE BLANK AND AGE 17-65]
Is this person currently on active duty in the United States military?
¿Está esta persona actualmente en servicio activo en las fuerzas armadas de los Estados Unidos?
Yes
No
Unknown
Refused

Sí
No
No sabe
Se rehúsa

[HISPANIC]

ROSTER SCREEN 2
HISPANIC [IF MILITARY NE BLANK OR (GENDER NE BLANK AND AGE NE 17-65)]
(Is he/Is she/Is this person) of Hispanic, Latino or Spanish origin?
¿Es (él/ella/esta persona) de origen hispano, latino o español?
(That is, do any of these groups describe (his/her/their) national origin or ancestry – Puerto
Rican, Cuban, Cuban-American, Mexican, Mexican-American, Chicano, Central or South
American, or origin in some other Spanish-speaking country?)
(¿Es decir que su origen nacional o ascendencia se puede describir como puertorriqueño, cubano,
cubanoamericano, mexicano, mexicanoamericano, chicano, centro o sudamericano, o es nativo(a)
de otro país donde se habla español?)
Yes
No
Unknown
Refused

Sí
No
No sabe
Se rehúsa

[RACE]

RACE [IF HISPANIC NE BLANK]

2-9

(Is he/Is she/Is this person) American Indian or Alaska Native, Asian, Black or African
American, Native Hawaiian or other Pacific Islander, or White?
¿Es (él/ella/esta persona) de raza indígena americana o nativa de Alaska, asiática, negra o
afroamericana, nativa de Hawái o de otra isla del Pacífico, o blanca?
American Indian or Alaska Native
Indígena americana o nativa de Alaska
Asian
Asiática
Black or African American
Negra o afroamericana
Native Hawaiian/other Pacific Islander Nativa de Hawái o de otra isla del Pacífico
White
Blanca
(CHECK ALL THAT APPLY)
Unknown
Refused

No sabe
Se rehúsa

[CONFIRM ROSTER]

CONFIRM ROSTER [IF RACE NE BLANK]
[IF RACE, HISPANIC, AND/OR MILITARY IS ‘U’ OR ‘REF’ OMIT RESPECTIVE FILLS
FROM CONFIRM ROSTER SCREEN.]
CONFIRM:
I have listed a/an (AGE) year old resident. They are (RACE), (HISPANIC) [IF AGE 17-65] and
are /are not) on active duty in the United States military.
He anotado a una persona de (AGE) años de edad que vive aquí. Esta persona es de raza (RACE:
indígena americana o nativa de Alaska, asiática, negra o afroamericana, nativa de Hawái o de
otra isla del Pacífico, blanca), (HISPANIC: es / y es hispana / no es hispana) [IF AGE 17-65] (y
está en servicio activo en las fuerzas armadas de los Estados Unidos. / y no está en servicio
activo en las fuerzas armadas de los Estados Unidos).
Is this correct?
¿Es esto correcto?
Yes Sí [AGE FOR NEXT GQU MEMBER, OTHERWISE VERIFY ROSTER DATA]
No No [AGE]
[IF ALL MEMBERS ROSTERED AND NO SCREENING RESPONDENT, NO SR:
“INTERVIEWER: YOU HAVE NOT IDENTIFIED A SCREENING RESPONDENT. IF THE
SCREENING RESPONDENT IS A MEMBER OF THE HOUSEHOLD, EDIT THEIR ROSTER
RECORD AND MARK THE APPROPRIATE ITEM.”]

VERIFY ROSTER DATA [IF CONFIRM ROSTER = YES]
[IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER=1]

2-10

DO NOT READ TO RESPONDENT. WHEN READY, TOUCH NEXT TO MAKE
SELECTION.
TO MAKE CORRECTIONS: TOUCH AND HOLD THE ROSTER LINE THAT YOU WANT
TO EDIT, THEN TOUCH 'EDIT' FROM THE POP-UP MENU.
[IF CONFIRM ROSTER = YES AND MEMBERS 12 OR OLDER>=2]
I need to make sure this list is accurate. I have listed...
Necesito asegurarme que la lista está correcta. He anotado...
[READ LIST OF OCCUPANTS NAMES AND AGES]
TO MAKE CORRECTIONS: TOUCH AND HOLD THE ROSTER LINE THAT YOU WANT
TO EDIT, THEN TOUCH 'EDIT' FROM THE POP-UP MENU.
Name (First Name)
AGE (Age)
SR (Y for Screening Respondent)
[UPON TOUCHING ON ANY ROSTER LINE, Choose an Action: IF Show Details SELECT SHOW
DETAILS]
Name: First Name
Age: Age
Sex: M, F, U, R
Gender: M, F, T, D, U, R
Hispanic: Y, N, U, R
Race: I, A, B, P, W
Military: Y, N, U, R
Eligible: E, I
[TOUCH AND HOLD ANY ROSTER LINE, Choose an Action: IF Edit. EDIT ROSTER RECORD:
DO YOU WANT TO EDIT THE ROSTER INFORMATION FOR THE (AGE) YEAR OLD (NAME)? IF
Yes, EDIT ROSTER MEMBER. IF No, VERIFY ROSTER DATA.]
[+MEMBER OR FUNCTIONS TO ADD ROSTER MEMBERS]
Next [START SELECTION]

EDIT ROSTER MEMBER [EDIT ROSTER RECORD = YES]
SR Roster (or first person listed, if SR not rostered) version:
AGE: Age
SEX: M, F, U, R (with appropriate circle filled)
GENDER: (CHECK ALL THAT APPLY) M F T D U R (with appropriate boxes checked)
RELATION: Relationship
HISPANIC: Y N U R (with appropriate circle filled)
RACE: (CHECK ALL THAT APPLY) (with appropriate boxes checked)
Am. Indian
Asian Black

2-11

Hawaiian/PI
White
Unknown
Refused
MILIATRY: Y N R (with appropriate circle filled)
ELIGIBLE: (box checked as appropriate)
SR: (box checked as appropriate) NOTE: this field cannot be edited
Roster #2 or after version: (includes unknown and refusal options)
AGE: Age
SEX: M F U R (with appropriate circle filled)
GENDER: (CHECK ALL THAT APPLY) M F T D U R (with appropriate boxes checked)
RELATION: Relationship
HISPANIC: Y N U R (with appropriate circle filled)
RACE: (CHECK ALL THAT APPLY) (with appropriate boxes checked)
Am. Indian
Asian Black
Hawaiian/PI
White
Unknown
Refused
MILITARY: Y N U R (with appropriate circle filled)
ELIGIBLE: (box checked, as appropriate)
SR: NOTE: this field cannot be edited

START SELECTION
THE PROGRAM WILL START THE SELECTION PROCESS. ARE YOU SURE YOU ARE
READY TO MAKE THE SELECTIONS?
Yes [RESPONDENT SELECTION]
No [VERIFY ROSTER DATA]
[IF INTERVIEW A = BLANK, NO SELECTION: NO ONE WAS SELECTED FOR AN
INTERVIEW AT THIS GQU. PLEASE COLLECT VERIFICATION INFORMATION.]

RESPONDENT SELECTION [START SELECTION = YES AND INTERVIEW A NE BLANK]
Interview A
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Name: (First Name, BLANK)
Age: (AGE, BLANK)
Race: (I, A, B, P, W, BLANK)

Gender: (M, F, T, DT, BLANK)
Hispanic: (Y, N, BLANK)

Interview B
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Name: (First Name, BLANK)

2-12

Age: (AGE, BLANK)
Race: (I, A, B, P, W, BLANK)
Next

Gender: (M, F, T, DT, BLANK)
Hispanic: (Y, N, BLANK)

NEXT [IF INTEVIEW A = BLANK, THEN VERIFICATION]
[IF INTERVIEW A NE BLANK, THEN SELECTIONS]

WHEN FI SELECTS DONE ON RESPONDENT SELECTION SCREEN AND A YOUTH
IS SELECTED, DISPLAY POP-UP:
READ THE FOLLOWING INTRODUCTORY SCRIPT TO THE PARENT. YOU
MAY NOT USE A TRANSLATOR.
IF NO PARENT IS ON THE ROSTER AND PARENT IS UNAVAILABLE TO MEET
IN-PERSON, READ TO GUARDIAN.

2-13

Section 3
Select Case Screen Options
The Select Case screen contains the date, time, battery level, CaseID (list of cases), Address, Results for S
(Screening), A (Interview A), and B (Interview B) and menus detailed below.

ACTIONS MENU [TOUCH AND HOLD CASE UNTIL ACTIONS MENU APPEARS]
Items on the Actions Menu are case specific. First a case is selected on the screen, then the action from
the Actions Menu is selected.
Screen DU/Re-Open Case
Show DU on Map
Go To Record Of Calls
View Selections
View Roster
Edit Address
Add Missed DU
Place Case On Hold/Take Case Off Hold
View Verification Information
Add Appointment to Calendar
View Call Distribution

View Letters
View Participant Code

SCREEN DU [SELECT CASE, SCREEN DU]
[IF SCREENING COMPLETED, RE-OPEN CASE DISPLAYS ON ACTIONS
MENU. IF CODE 25, 26, 30-32, 70-79, RE-OPENING CONFIRMATION: “CASE
(CASEID) HAS ALREADY BEEN COMPLETED. DO YOU WISH TO RE-OPEN
THIS CASE? IF No, SELECT CASE. IF Yes, CASE RE-OPEN CODE: “ENTER
THE CODE TO RE-OPEN THIS CASE, THEN TOUCH ‘OK’ TO CONTINUE.”
ENTER CORRECT CODE, OK, STUDY INTRODUCTION. IF CODE 10-23, 29,
CANNOT RE-OPEN CASE: “FINAL SCREENER CODES 10-23 AND 29 CANNOT
BE OPENED WITH THIS METHOD. PLEASE CONTACT YOUR FS.”]

GO TO RECORD OF CALLS [SELECT CASE, GO TO RECORD OF CALLS – FOR
DETAILS SEE SECTION 6]

VIEW SELECTIONS [SELECT CASE, VIEW SELECTIONS]
RESPONDENT SELECTION [IF CASE COMPLETED WITH FINAL
RESULT CODE = 31, 32
Interview A
Roster #: (Roster # of selected member, None

3-1

[QC FORM]

QuestID: (7-digit Questionnaire ID, BLANK)
Relation: (Relationship to SR, BLANK)
Age: (AGE, BLANK)
Race: (I, A, B, P, W, BLANK)

Gender: (M, F, T, DT, BLANK)
Hispanic: (Y, N, BLANK)

Interview B
Roster #: (Roster # of selected member, None)
QuestID: (7-digit Questionnaire ID, BLANK)
Relation: (Relationship to SR, BLANK)
Age: (AGE, BLANK)
Race: (I, A, B, P, W, BLANK)

[QC FORM]

Gender: (M, F, T, DT, BLANK)
Hispanic: (Y, N, BLANK)

Done [SELECT CASE]
Roster [VERIFY ROSTER DATA]
ROC [RECORD OF CALLS]

VIEW ROSTER [SELECT CASE, VIEW ROSTER]
[IF CASE COMPLETED WITH FINAL RESULT CODE = 30, 31, 32, VERIFY
ROSTER DATA]
[VERIFY ROSTER DATA – FOR DETAILS, SEE SECTIONS 1& 2]
Done [SELECT CASE]
Selections [RESPONDENT SELECTION]
ROC [RECORD OF CALLS]

EDIT ADDRESS [SELECT CASE, EDIT ADDRESS]
[EDIT ADDRESS – FOR DETAILS, SEE SECTIONS 1 & 2]

ADD MISSED DU [SELECT CASE, ADD MISSED DU]
[MISSED DU ADDRESS – FOR DETAILS, SEE SECTION 1]
[IF CASE SELECTED IS ADDED DU: CANNOT ADD UNIT: “YOU CANNOT ADD
A MISSED DU FROM A DU THAT HAS BEEN ADDED.” OK, SELECT CASE.]
[IF ATTEMPTING TO ADD A DU TO A GQU: MISSED GQU: “YOU CANNOT
ADD MISSED GROUP QUARTERS UNITS (GQUS). YOU CAN ONLY ADD A
MISSED HOUSING UNIT THAT IS ASSOCIATED WITH A SELECTED LINE IN A
GROUP QUARTERS STRUCTURE. ARE YOU CERTAIN THE UNIT YOU WANT
TO ADD IS A HOUSING UNIT AND NOT A GROUP QUARTERS UNIT?”]
Yes [READY TO ADD: “DO YOU WANT TO ADD AN HU LINKED TO CASE
(CASEID)?” IF Yes, MISSED DU ADDRESS. IF No, SELECT CASE]

3-2

No [CALL FS: “IF THERE ARE MISSED GROUP QUARTERS UNITS IN THE
STRUCTURE, OBTAIN INFORMATION ABOUT ALL MISSED UNITS THEN
CALL YOUR FS.” OK, SELECT CASE.]

PLACE CASE ON HOLD [SELECT CASE, PLACE CASE ON HOLD]
This menu option toggles between “Place Case On Hold” and “Take Case Off Hold,”
depending on the on-hold status of the case. When a case is on hold, data for that case are
transmitted, but are not pulled into the control system—the data is maintained in a separate
location to be accessed, as necessary. This allows putting a case ‘On Hold’ for
troubleshooting.
[IF CASE NOT ON HOLD, PLACE CASE ON HOLD: “ARE YOU SURE YOU
WANT TO PUT CASE (CASEID) ON HOLD?” IF No, SELECT CASE WITH CASE
NOT ON HOLD. IF Yes, SELECT CASE WITH ‘On Hold’ NEXT TO CASEID.]
[IF CASE ON HOLD, TAKE CASE OFF HOLD: “ARE YOU SURE YOU WANT TO
TAKE CASE (CASEID) OFF HOLD?” IF No, SELECT CASE WITH CASE ON
HOLD. IF Yes, SELECT CASE WITH ‘On Hold” REMOVED AND CASE NOT ON
HOLD.]

VIEW VERIFICATION INFORMATION [SELECT CASE, VIEW VERIFICATION
INFORMATION]
[IF VERIFICATION INFORMATION AVAILABLE, VERIFICATION.]
[IF NO VERIFICATION INFORMATION AVAILABLE: “No Verification data found”
OK, SELECT CASE]

ADD APPOINTMENT TO CALENDAR [SELECT CASE, ADD APPOINTMENT TO
CALENDAR]
This optional calendar can be used to post work and personal appointments to help with time
management and scheduling of interview appointments.

NEW APPOINTMENT
SHOW CALENDAR WHEN DONE? (check box)
CASE: (Case ID)
FROM: (current date with link to calendar to select a beginning date) (time of day)
[IF SELECT A DIFFERENT DATE, Set CHANGES DATE,
Cancel MAINTAINS CURRENT DATE]
IF SELECT A DIFFERENT TIME, Set CHANGES TIME,
Cancel MAINTAINS CURRENT TIME]
TO: (current date with link to calendar to select an ending date) (time of day)
[IF SELECT A DIFFERENT DATE, Set CHANGES DATE,
Cancel MAINTAINS CURRENT DATE]
IF SELECT A DIFFERENT TIME, Set CHANGES TIME,

3-3

Cancel MAINTAINS CURRENT TIME]
ALL DAY? (check box)
REMINDER: (Drop-down box with incremental time choices)
TYPE: (Drop-down box with: Select Type, Screening, Interview A, Interview B, S/I
Other, Other)
DESCRIPTION: (text entry with comments describing appointment)
Done [Detail View containing appointment information, then side arrow to display
CALENDAR.] This calendar is an interactive stock tablet tool that allows calendar
viewing by day, week, month and list. Touching the day on the calendar will show any
entered appointments. New appointments can be added, and appointments for the current
day display at the bottom of the screen.
Back Arrow [SELECT CASE]

VIEW CALL DISTRIBUTION [SELECT CASE, VIEW CALL DISTRIBUTION]
This optional case management feature can be used to view past work patterns based on ROC
data and to determine the times/days when contact has not been attempted at SDUs.
CALL DISTRIBUTION
Link: (line number and address of link line case)

SELECT A CASE OR SEGMENT (Drop-down list of cases and segments
that have associated ROC data entered. FI chooses desired selection
criteria.) [IF SELECT ALL CASES ROC INFORMATION ON ALL
CASES IS DISPLAYED. IF SELECT AN INDIVIDUAL CASE, ONLY
ROC DATA FROM THAT CASE DISPLAYED. IF SELECT AN
INDIVIDUAL SEGMENT, ROC DATA FROM CASES WITHIN THAT
SEGMENT ONLY IS DISPLAYED.]
ALL ROC TYPE RECORDS (Drop-down list of selection criteria to
customize ROC data displayed.) [IF SELECT ALL ROC TYPE
RECORDS, ALL ROCS ENTERED DISPLAY. IF SELECT
SCREENING RECORDS ONLY, ONLY SCREENING RECORDS
DISPLAY. IF SELECT INTERVIEW RECORDS ONLY, ONLY
INTERVIEW ROCS DISPLAY.]
SELECT A STATUS (Drop-down list of selection criteria as shown
below. FI chooses desired selection criteria.)
All (includes all cases)
Not at Home (includes Screening codes: 01, 02, 03 and Interview
codes: 51, 52)
Pending (includes Screening codes: 01-09 and Interview codes:
50-59)
Completed (includes Screening codes: 30, 31, 32 and Interview
code: 70)
Finalized (includes Screening codes: 10 – 32 and Interview codes:
70 – 79)

3-4

Refusals (includes Screening codes: 07 and Interview codes: 57,
58)
Choose ROC code(s) (A DROP DOWN LIST OF ALL ROC
CODES APPEARS TO CHOOSE FROM)
DATE RANGE (INCLUSIVE)
BEGIN DATE: [SELECT A DATE] Date appears allowing beginning
date selection to narrow down the ROC results SET chooses the date
entered [CALL DISTRIBUTION], CANCEL, [CALL
DISTRIBUTION]
END DATE: [SELECT A DATE] Date appears allowing beginning date
selection to narrow down the ROC results SET chooses the date entered
[CALL DISTRIBUTION], CANCEL, [CALL DISTRIBUTION]

Su
M
Tu
W
Th
F
Sa
All

6A-10A 10A-12P 12P-4P 4P-6P 6P-10P 10P-6A All
- - - - - - - - -

Done [SELECT CASE]
Refresh (Refreshes displayed data based on most recent selection criteria
entered.) [IF NO CASE SELECTED, “PLEASE SELECT A CASE OR
SEGMENT FROM THE LIST THEN TOUCH “REFRESH”]
OK [CALL DISTRIBUTION]
ROC [IF CASE SELECTED, RECORD OF CALLS]
VIEW LETTERS [SELECT CASE, VIEW LETTERS]
[IF LETTER SENT, LETTERS. IF NO LETTER SENT, “NO LETTERS
FOUND” OK, SELECT CASE]
LETTERS [IF REFUSAL LETTER HAS BEEN SENT
AND IF RECORD OF CALLS = CALL RECORD SELECTED,
FUNCTIONS, VIEW LETTERS]
(Date letter requested – letter code – result code – FS that submitted
request)

3-5

ADMINISTRATIVE TOOLS MENU [SELECT CASE, FUNCTIONS, ADMINISTRATIVE
TOOLS]

Items on Administrative Tools Menu are administrative.
Set Name and Id
Reconcile Missed DUs
Reload Training Cases
Erase Training Cases

SET NAME AND ID [SELECT CASE, FUNCTIONS, ADMINISTRATIVE TOOLS, SET
NAME AND ID]

NHSBH SYSTEM IDENTIFICATION [SELECT CASE, ADMINISTRATIVE
TOOLS, SET NAME AND ID]
Government ID: (Government ID issued to iPAQ)
FIID: (RTI FI ID Number)
First Name: (FI First Name to be used on Study Introduction screen)
Last Name: (FI Last Name to be used on Study Introduction screen)
Save [SELECT CASE]
Cancel [SELECT CASE]

RECONCILE MISSED DUS [SELECT CASE, FUNCTIONS, ADMINISTRATIVE
TOOLS, RECONCILE MISSED DUS]
[IF NO MISSED DUs TO BE RECONCILED, NO MISSED DUs: “THERE ARE NO
MISSED DUs TO RECONCILE.” OK, SELECT CASE.]
[IF MISSED DUs TO BE RECONCILED, SEGMENTS AND MISSED DUs]

SEGMENTS AND MISSED DUs [SELECT CASE, FUNCTIONS,
ADMINISTRATIVE TOOLS, RECONCILE MISSED DUs]
SEGMENT (SEGID)
STREET ADDRESS (MISSED DU STREET ADDRESS)
TO RECONCILE A SEGMENT: TOUCH AND HOLD ON THE LINE, THEN
TOUCH ‘RECONCILE’ FROM THE POP-UP MENU.
Reconcile [RECONCILATION CONFIRMATION: “YOU WILL
BE REQUIRED TO RECONCILE ALL DUs WITHIN THE
SELECTED SEGMENTS. ARE YOU READY TO PROCEED?” IF No,
SEGMENTS AND MISSED DUs. IF Yes, MDU-SEGMENT KIT
CHECK.]
Exit [SELECT CASE]

3-6

MDU-SEGMENT KIT CHECK [SEGMENTS AND MISSED DUs =
RECONCILE AND RECONCILATION CONFIRMATION = YES]
Link: (line number and address of link line case)
INTERVIEWER: CONSULT YOUR SEGMENT MATERIALS AND
ANSWER THE FOLLOWING QUESTION(S):
IS THE UNIT THAT YOU ARE ATTEMPTING TO ADD
(Missed DU Street Address)
ALREADY ON THE LIST OF DWELLING UNITS?

Yes (UNIT NOT ADDED) [IF ANOTHER MISSED DU, NEXT
MISSED DU: “PLEASE ANSWER THE FOLLOWING QUESTIONS
TO RECONCILE THE NEXT MISSED DU.” OK, MDU-SEGMENT
KIT CHECK FOR NEXT MISSED DU.]
[IF NO OTHER MISSED DU, SELECT CASE]
No [MDU SDU CHECK]
Exit [SELECT CASE]

MDU SDU CHECK [MDU-SEGMENT KIT CHECK = NO]
Link: (line number and address of link line case)
IS THE MISSED UNIT LOCATED WITHIN THE SDU OR ON THE SDU
PROPERTY, AS WELL AS LOCATED WITHIN THE SEGMENT
BOUNDARIES?
REFER TO YOUR FI MANUAL AND YOUR SEGMENT MAPS OR CALL
YOUR FS IF YOU ARE UNSURE WHETHER THIS UNIT SHOULD BE
ADDED. IF YOU CANNOT DO THAT RIGHT NOW, TOUCH THE Exit
BUTTON TO EXIT THIS SCREEN. YOU CAN RECONCILE THIS DU
LATER.
Yes (UNIT ADDED) [MDU-ADDRESS VERIFICATION]
No (UNIT NOT ADDED) [IF ANOTHER MISSED DU, NEXT
MISSED DU: “PLEASE ANSWER THE FOLLOWING QUESTIONS
TO RECONCILE THE NEXT MISSED DU.” OK, MDU-SEGMENT
KIT CHECK FOR NEXT MISSED DU.]
[IF NO OTHER MISSED DU, SELECT CASE]
Exit [SELECT CASE]

3-7

MDU-ADDRESS VERIFICATION
Link: (line number and address of link line case)
THIS UNIT WILL BE ADDED TO THE SAMPLE. PLEASE VERIFY THE
INFORMATION BELOW. TOUCH ANY LINE TO EDIT IT.
STREET #: (street number)
STREET: (street name)
APT.#: (APARTMENT NUMBER)
CITY: (city)
STATE: (state)
ZIP: (zip code)
CASE #: (CaseID assigned to Added DU)
Update [IF ADDITIONAL MISSED DUs TO RECONCILE,
RECONCILE NEXT: “THE ADDED DU HAS BEEN
SUCCESFULLY RECONCILED. PLEASE ANSWER THE
FOLLOWING
QUESTIONS TO RECONCILE THE NEXT MISSED DU.” OK, MDUSEGMENT KIT CHECK FOR NEXT MISSED DU]
[IF NO ADDITIONAL MISSED DUs TO RECONCILE, SELECT
CASE]
Exit [SELECT CASE, WITH RECONCILIATION PENDING]

RELOAD TRAINING CASES [SELECT CASE, FUNCTIONS, ADMINISTRATIVE
TOOLS, RELOAD TRAINING CASES]
RELOAD TRAINING CASES: “ARE YOU SURE YOU WANT TO REMOVE AND
RELOAD ALL TRAINING CASES?” IF No, SELECT CASE. IF Yes, SELECT
CASE WITH TRAINING CASES REMOVED AND RELOADED.

ERASE TRAINING CASES [SELECT CASE, FUNCTIONS, ADMINISTRATIVE TOOLS,
ERASE TRAINING CASES]
ERASE TRAINING CASES: “ARE YOU SURE YOU WANT TO ERASE ALL
TRAINING CASES?” IF No, SELECT CASE. IF Yes, SELECT CASE WITH
TRAINING CASES REMOVED.

VIEW/SORT MENU [SELECT CASE, FUNCTIONS, VIEW/SORT]
View/Sort is a case management feature that allows an FI to view and sort cases in their assignment by
subgroups and varying orders on the Select Case screen. The View and Sort options can be used in a
variety of combinations.

VIEW/SORT PREFERENCES
The current VIEW, SEGMENT and SORT selections are shown in quotes below.

3-8

To change, touch VIEW, SEGMENT or SORT, then select an option from the list.
When finished, touch Done.
View – “CURRENT VIEW” [VIEW]
Segment – “CURRENT SEGMENT” [SEGMENT]
Sort – “CURRENT SORT” [SORT]
Done [SELECT CASE]

VIEW
All Cases (All Cases)
Pending Cases (All Screening and Interview cases with Result Codes 00-09, 50-59)
Pending Screenings (All Screening cases with Result Codes 00-09)
Pending Interviews (All Interview cases with Result Codes 50-59)
Pending Youth Interviews (All Interview cases with Result Codes 50-59 and 12-17 year old
respondent)
Pending Cases with Refusal (All Screening and Interview cases with Result Codes 00-09, 50-59
and at least one Result Code 07 or 57)
Cases not visited, 2 weeks (All Screening and Interview cases with no new ROC in the previous
two weeks)
Unactivated Cases (All Screening and Interview cases without at least one ROC)
Group Quarters Units (All GQU cases)
Final Screenings (Screening cases with Result Codes 10-32)
Final Interviews (Interview cases with Result Codes 70-79)
Added DUs (All added DUs)
On Hold Cases (All cases on hold)
Cancel [VIEW/SORT PREFERENCES]

SEGMENT
All Segments (All cases)

DISPLAY LIST OF SEGMENTS (Cases by segment)
Cancel [VIEW/SORT PREFERENCES]

SORT
By Case ID (Alphanumerical order by CaseID)
By Street (Alphanumerical order by street name within segment and number)
By Screening Code (Numerical order by Screening Result Code)
By ROC Date, Ascending (Ascending date order using most recent Record of Calls entry)
By ROC Date, Descending (Descending date order using most recent Record of Calls entry)
Cancel [VIEW/SORT PREFERENCES]

CALL DISTRIBUTION [SELECT CASE, FUNCTIONS, CALL DISTRIBUTION] (See Call
Distribution explanation under Actions Menu above)

ADD APPOINTMENT TO CALENDAR [SELECT CASE, FUNCTIONS, ADD APPOINTMENT
TO CALENDAR] (See Add Appointment explanation under Actions Menu above)

3-9

CALENDAR [SELECT CASE, FUNCTIONS, CALENDAR] (See Calendar explanation within the Add
Appointment to Calendar portion under Actions Menu above)
TRANSMIT [SELECT CASE, FUNCTIONS, TRANSMIT]
TRANSMISSION LOG
Done [SELECT CASE]
Transmit [BEGINS DATA TRANSMISSION]

3-10

Section 4
Record of Calls
RECORD OF CALLS [SELECT CASE, GO TO RECORD OF CALLS
OR ON ANY SUBSEQUENT SCREEN EXIT OR VERIFICATION, DONE OR
RESPONDENT SELECTION, DONE]
Type (Data Type: S, A, B)
Result (Result Code)
Date/time (Date, time, and day of the week ROC entered)
Done [IF ADDED DU, Reconcile Missed DUs: “There are missed DUs, would you like to
reconcile now?” IF Yes, Segments and Missed DUs. IF No, SELECT CASE. IF NO ADDED
DUs, SELECT CASE]
Add [IF CODE = PENDING SCREENING CODE, SCREENING CALL RECORD. FOR
PENDING INTERVIEW CODES, IF CODE 31 OR IF CODE 32 AND ONE
INTERVIEW CASE FINAL, INTERVIEW [fill with A or B] CALL RECORD, IF
CODE = 32 AND BOTH INTERVIEW CASES NOT FINAL, CHOOSE ROC TYPE]
CD [IF CALL RECORD ENTERED, CALL DISTRIBUTION FOR DETAILS SEE
SECTION 5]
Roster [IF CODE = 22, 25, 26, 30, 31, OR 32, VERIFY ROSTER DATA FOR DETAILS
SEE SECTION 1]
Selections [If CODE = 31 or 32, RESPONDENT SELECTION]

ACTIONS MENU [RECORD OF CALLS, TOUCH AND HOLD ROC EVENT UNTIL
ACTIONS MENU APPEARS]
Edit [IF UNTRANSMITTED ROC EVENT SELECTED, SCREENING CALL
RECORD or INTERVIEW CALL RECORD]
Delete [IF UNTRANSMITTED, NON-SYSTEM-GENERATED ROC EVENT (NE 26,
30, 31, 32), DELETES EVENT, RECORD OF CALLS]
View Refusal [IF CODE 07, 17, 57, 58, 77, 78, REFUSAL REPORT -FOR DETAILS
SEE SECTION 7]
View Comment [IF COMMENTS ENTERED, COMMENT]
View Other Specify [IF CODE 09, 23, 59, or 79, CODE [fill with 09, 23, 59, or 79]:
OTHER SPECIFY CATEGORIES]

FUNCTIONS MENU [RECORD OF CALLS, FUNCTIONS]
Add Appointment to Calendar [NEW APPOINTMENT]
Calendar [CALENDAR]
View Verification Information [IF CODE 10, 13, 18, 22, 25, 26, OR 30, VERIFICATION]
Help [HELP INFORMATION]

4-1

CHOOSE ROC TYPE [IF CODE = 32, AND BOTH INTERVIEW CASES NOT FINAL, RECORD
OF CALLS, ADD]
WHICH TYPE OF CALL RECORD DO YOU WANT TO ENTER?
Screening [Option listed but not available as screening is final]
Interview A [INTERVIEW A CALL RECORD]
Interview B [INTERVIEW B CALL RECORD]
Cancel [RECORD OF CALLS]

SCREENING CALL RECORD [IF AT COMPLETION OF SCREENING PROCESS
RESPONDENT SELECTION = DONE OR IF VERIFICATION = DONE AND CODE = 22, 25,
26 OR 30 OR IF RECORD OF CALLS = ADD]
RESULT (01-23, 26, 29)
01 No one at DU
02 SR Unavailable
03 Neighbor Indicates Occupancy
04 Pending Incapable
05 Pending Lang. Barrier (Spanish)
06 Pending Lang. Barrier (Other)
07 Pending Refusal
08 Unable to Locate SDU
09 Pending Other – Specify
10 Vacant
11 No one at DU - Repeated
12 SR Unavailable - Repeated
13 Not Primary Residence
14 Final Incapable
15 Final Lang. Barrier (Spanish)
16 Final Lang. Barrier (Other)
17 Final Refusal
18 Not a Dwelling Unit
19 GQU Listed as HU [IF DU IS NOT A GQU]
20 HU Listed as GQU [IF DU IS NOT AN HU]
21 Denied Access
22 All Military [CODED AUTOMATICALLY IF SCREENING COMPLETED AND ALL
ROSTER MEMBERS=MILITARY]
23 Final Other – Specify
26 R in DU Less Than ½ Quarter [CODED AUTOMATICALLY IF SCREENING
COMPLETED AND OCCUPANCY=NO]
29 Listing Error
RESULT (25, 30-32) [CANNOT BE SELECTED; CODED AUTOMATICALLY]
25 No Eligible Members [CODED AUTOMATICALLY IF SCREENING COMPLETED AND
ALL ROSTER MEMBERS=INELIGIBLE]
30 No one selected [CODED AUTOMATICALLY IF SCREENING COMPLETED AND NO
ONE SELECTED]

4-2

31 One person selected [CODED AUTOMATICALLY IF SCREENING COMPLETED AND
ONE PERSON SELECTED]
32 Two persons selected [CODED AUTOMATICALLY IF SCREENING COMPLETED AND
TWO PERSONS SELECTED]
COMMENTS: (text entry)
DO NOT CHANGE ROC DATE/TIME UNLESS INSTRUCTED BY TECH SUPPORT
OR FS.
DAY/DATE: (Day of week and Date ROC event entered)
TIME: HOUR (1-12) MINUTE (00-59) AM/PM (AM, PM)
Commit [IF CODE = 32, INTERVIEW EVENT: “REMEMBER TO ENTER CALL
RECORDS FOR INTERVIEWS A AND B.” OK, RECORD OF CALLS.]
[IF CODE = 31, INTERVIEW EVENT: “REMEMBER TO ENTER INTERVIEW
CALL RECORD FOR INTERVIEW A.” OK, RECORD OF CALLS]
[IF CODE = 10, 13, 18, 26, OR 30, VERIFICATION]
[IF 07 OR 17, REFUSAL REPORT -FOR DETAILS SEE SECTION 7]
[IF 09 OR 23, OTHER, SPECIFY]
[IF 6 OR 16, OTHER LANGUAGE]
[IF 04, 14, 54 OR 74, INCAPABLE, SPECIFY]
Cancel [ARE YOU SURE?: “ARE YOU SURE YOU WANT TO CANCEL THIS CALL
RECORD?” IF Yes, SELECT CASE. IF No, SCREENING CALL RECORD]

INTERVIEW CALL RECORD [RECORD OF CALLS, ADD, IF CODE 32 AND BOTH
INTERVIEW CASES NOT FINAL, CHOOSE ROC TYPE, A OR B]
RESULT (50-59, 70-79)
50 Appointment for Interview
51 No one at DU
52 R Unavailable
53 Pending Break-off (Partial Interview)
54 Pending Incapable
55 Pending Lang. Barrier (Spanish)
56 Pending Lang. Barrier (Other)
57 Pending Refusal
58 Pending Parental Refusal for age 12-17
59 Pending Other – Specify
70 Interview complete
71 No one at DU - Repeated
72 R Unavailable - Repeated
73 Final Break-off (Partial Interview)
74 Final Incapable
75 Final Lang. Barrier (Spanish)
76 Final Lang. Barrier (Other)
77 Final Refusal

4-3

78 Final Parental Refusal for age 12-17
79 Final Other - Specify
COMMENTS: (text entry)
DO NOT CHANGE ROC DATE/TIME UNLESS INSTRUCTED BY TECHNICAL SUPPORT
OR FS.
DAY/DATE: (Day of week and Date ROC event entered)
TIME: HOUR (1-12) MINUTE (00-59) AM/PM (AM, PM)
Relation (HU) or Name (GQU), Gender, Age, Race of selected respondent displays
Commit [SAVES DATA, RECORD OF CALLS]
[IF 57, 58, 77, 78, REFUSAL REPORT -FOR DETAILS SEE SECTION 7]
[IF 59 OR 79, OTHER, SPECIFY]
Cancel [ARE YOU SURE?: “ARE YOU SURE YOU WANT TO CANCEL THIS CALL
RECORD?” Yes, SELECT CASE, No, INT. CALL RECORD-A OR B]

CODE 09: OTHER SPECIFY CATEGORIES [SCREENING CALL RECORD =
RESULT CODE 09]
OTHER SPECIFY CATEGORIES
Screening breakoff
Selected wrong line number
Added in error
Safety issue
Controlled access
Possible vacant
Possible vacation/not primary residence
GQU is institution (ONLY ACTIVE FOR GQU CASES)
Other listing problem
Need to discuss with FS
Something else, Specify
Done [RECORD OF CALLS]

CODE 23: OTHER SPECIFY CATEGORIES [SCREENING CALL RECORD = FINAL
RESULT CODE 23]
OTHER SPECIFY CATEGORIES
Added in error
Safety issue
GQU is institution (ONLY ACTIVE FOR GQU CASES)
Something else, Specify
Done [RECORD OF CALLS]

CODE 59: OTHER SPECIFY CATEGORIES [INTERVIEW A CALL RECORD OR
INTERVIEW B CALL RECORD = RESULT CODE 59]

4-4

OTHER SPECIFY CATEGORIES
R moved
R under age 12
R in military
R rostered in error
R deceased
Interviewed wrong person
Screened wrong line
Safety issue
Controlled access
Need to discuss with FS
Something else, Specify
Done [RECORD OF CALLS]

CODE 79: OTHER SPECIFY CATEGORIES [INTERVIEW A CALL RECORD OR
INTERVIEW B CALL RECORD = RESULT CODE 79]
OTHER SPECIFY CATEGORIES
R moved
R under age 12
R in military
R rostered in error
R deceased
Interviewed wrong person
Screened wrong line
Safety issue
Controlled access
Something else, Specify
Done [RECORD OF CALLS]

OTHER LANGUAGE [SCREENING CALL RECORD = 06 OR 16, INTERVIEW A CALL
RECORD OR INTERVIEW B CALL RECORD = 56 OR 76]
LANGUAGE CATEGORIES
Arabic
Chinese
French
German
Italian
Korean
Polish
Portuguese
Russian
Tagalog

4-5

Vietnamese
Other, Specify
Specify other language or comments: (text entry)
Done [RECORD OF CALLS]
INCAPABLE, SPECIFY [SCREENING CALL RECORD = 04 OR 14, INTERVIEW A CALL
RECORD OR INTERVIEW B CALL RECORD = 54 OR 74]
CODE [fill with 04 or 14 or 54 or 74]: INCAPABLE CATEGORIES
Physically Incapable
Mentally Incapable
Done [RECORD OF CALLS]

4-6

Section 5
Screening and Interview Refusal
REFUSAL REPORT [IF SCREENING CALL RECORD = 07 P REFUSAL OR
IF SCREENING CALL RECORD = 17 F REFUSAL AND ALREADY HAS A PENDING
REFUSAL ENTERED OR IF INTERVIEW CALL RECORD = 57 P REFUSAL OR IF
INTERVIEW CALL RECORD = 58 P PARENTAL REFUSAL OR IF INTERVIEW CALL
RECORD = 77 F REFUSAL AND ALREADY HAS A PENDING REFUSAL ENTERED OR
IF INTERVIEW CALL RECORD = 78 F PARENTAL REFUSAL AND ALREADY HAS A
PENDING REFUSAL ENTERED]
[IF SCREENING CALL RECORD = 17 F REFUSAL AND DOES NOT ALREADY HAVE A
PENDING REFUSAL ENTERED: RESULT CODE ERROR: “TRY AT LEAST ONE
MORE TIME BEFORE ASSIGNING THIS FINAL CODE.” OK. SCREENING CALL
RECORD]
[IF INTERVIEW CALL RECORD = 77 F REFUSAL AND DOES NOT ALREADY HAVE A
PENDING REFUSAL ENTERED, OR IF INTERVIEW CALL RECORD = 78 F PARENTAL
REFUSAL AND DOES NOT ALREADY HAVE A PENDING REFUSAL ENTERED:
RESULT CODE ERROR: “TRY AT LEAST ONE MORE TIME BEFORE ASSIGNING
THIS FINAL CODE.” OK. INTERVIEW CALL RECORD]
Reason for refusal
Too busy / no time / did too many already
Surveys / Government invasive / teen exposure
Clarify confidentiality, legitimacy, selection
“Nothing in it for me” / Uncooperative
Gatekeeper / Parent/HH member disallow
Welfare / INS / ICE / USCIS concern
Too ill / house messy / not dressed
Requested web option
Health concerns
Need to discuss with FS
Comment: (text entry)
Done [SAVES REASON FOR REFUSALAND COMMENTS ENTERED, RECORD OF
CALLS]

5-1

Screening and Interview Refusal Functions on ROC
1. View refusal report or edit refusal report prior to transmission:
REFUSAL REPORT [IF RECORD OF CALLS = TOUCH AND HOLD CALL RECORD, ACTION
MENU, VIEW REFUSAL]
Reason for refusal
Too busy / no time / did too many already
Surveys / Government invasive / teen exposure
Clarify confidentiality, legitimacy, selection
“Nothing in it for me” / Uncooperative
Gatekeeper / Parent/HH member disallow
Welfare / INS / ICE / USCIS concern
Too ill / house messy / not dressed
Requested web option
Health concerns
Need to discuss with FS
Comment: (text entry)
Done [IF EDITED (BEFORE TRANSMISSION) SAVES REASON FOR REFUSAL AND
COMMENTS ENTERED, THEN RECORD OF CALLS]

5-2

Section 6
Screening Verification
VERIFICATION [IF SCREENING RESULT CODE = 10, 13, 18, 22, 26 OR IF RESPONDENT
SELECTION = ‘NONE’ FOR BOTH A AND B INTERVIEW OR IF OCCUPANCY =
‘NO’ OR IF ALL ROSTER MEMBERS = INELIGIBLE]
So that my supervisor may check the quality of my work, may I please have your first name
and telephone number?
Para que mi supervisor pueda revisar la calidad de mi trabajo, ¿me podría dar su primer
nombre y su número de teléfono?
FIRST NAME: (Screening Respondent’s first name)
Not Avail.
Ref.
PHONE: (Area code and phone number)
Home
Cell
Work
Not Avail.
Ref.
CONFIRM NUMBER WITH R.
NOTES TO VERIFICATION CALLER: (Text field for notes about best
times to call screening respondent or other needed clarification.)
Done [CHECKS FOR COMPLETE DATA ENTRY, RECORD OF CALLS]
Clear [VERIFICATION WITH ENTRY CLEARED]

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6-2

Section 7
Interview Verification
Following the commitment of a Screening Call Record with a final result of One Selected (Code 31) or
Two Selected (Code 32), the QC Form button appears on the Respondent Selection screen for each
respondent. When the QC Form button is touched, this Interview Verification module occurs.
QC PHONE
May I please have your phone number?
¿Me puede dar su número de teléfono por favor?
Phone (10 DIGIT NUMBER ENTRY FIELD)
Not available
Refused
CONFIRM NUMBER WITH R
Next [IF PHONE NUMBER ENTERED, OR NOT AVAILABLE, OR REFUSED, QC ADDRESS
VERIFICATION. IF NO PHONE NUMBER ENTERED, OR NOT AVAILABLE OR REFUSED
NOT SELECTED, QC PHONE]
QC PHONE FIX
YOU MUST ENTER A 10 DIGIT PHONE NUMBER OR REFUSED OR NOT AVAILABLE
OK [QC PHONE]

QC ADDRESS VERIFICATION
May I please confirm your current address?
¿Me puede confirmar su dirección actual por favor?
STREET: (NUMBER AND STREET)
CITY: (CITY)
STATE: (STATE)
ZIP: (ZIP)
Address Is Correct [IF R’s AGE GREATER THAN 17, RETURN TO RESPONDENT
SELECTION. IF R’s AGE 12-17, GO TO QC PARENTAL PERMISSION]
Need to Edit Address [QC EDIT ADDRESS]

QC EDIT ADDRESS [IF QC ADDRESS VERIFICATION = NEED TO EDIT ADDRESS]
TOUCH THE ITEM YOU NEED TO EDIT
STREET # (NUMBER)
STREET: (STREET)
APT.#: (APARTMENT NUMBER)
CITY: (CITY)
STATE: (STATE)
ZIP: (ZIP)

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Update [SAVE UPDATED ADDRESS, THEN QC ADDRESS VERIFICATION]

QC PARENTAL PERMISSION [IF R’s AGE = 12-17]
INDICATE WHO PROVIDED PERMISSION FOR YOUTH TO COMPLETE THE
INTERVIEW
Parent
Guardian
Other, specify [DISPLAY ENTRY FIELD BELOW]
Next [RESPONDENT SELECTION]

7-2

Section 8
FI Debriefing Questions
These questions appear following the commitment of an Interview Call Record with a final result of
Interview Complete (Code 70).
INTERVIEW DEBRIEFING QUESTIONS:
THESE QUESTIONS ARE FOR YOU TO ANSWER. DO NOT READ TO THE R.
FIDBF1
Did you conduct this interview at the respondent’s home, either inside or outside?
YES
NO
Next [IF FIDBF1=YES, GO TO FIDBF3]
FIDBF2 [IF FIDBF1=NO]
Where did you conduct this interview?
1. AT THE RESPONDENT’S WORKPLACE
2. AT THE HOME OF THE RESPONDENT’S RELATIVE OR FRIEND
3. IN SOME TYPE OF CONFERENCE ROOM IN A RESIDENCE HALL, SCHOOL OR
APARTMENT COMPLEX
4. AT A LIBRARY
5. IN SOME TYPE OF COMMON AREA, SUCH AS A LOBBY, HALLWAY, STAIRWELL, OR
LAUNDRY ROOM
6. SOME OTHER PLACE
Next [IF FIDBF2=6, GO TO FIDBF2a]
FIDBF2a [IF FIDBF2=6]
Where did the interview take place?
ALLOW 140 CHARACTERS
Next [FIDBF3]
FIDBF3
Please estimate for how much of the ACASI interview the respondent had their headphones on.
1.
2.
3.
4.
5.

NONE/R TOOK HEADPHONES OFF IMMEDIATELY
LESS THAN HALF OF THE ACASI INTERVIEW
ABOUT HALF OF THE ACASI INTERVIEW
MORE THAN HALF OF THE ACASI INTERVIEW
ALL OF THE ACASI INTERVIEW

8-1

Next [FIDBF4]
FIDBF4
How cooperative was the respondent?
1.
2.
3.
4.

VERY COOPERATIVE
FAIRLY COOPERATIVE
NOT VERY COOPERATIVE
OPENLY HOSTILE

Next [FIDBF5]
FIDBF5
Please indicate how private the interview was. Do not count yourself or a project observer as another
person in the room.
1. COMPLETELY PRIVATE – NO ONE WAS IN THE ROOM OR COULD OVERHEAR ANY
PART OF THE INTERVIEW
2. MINOR DISTRACTIONS – PERSON(S) IN THE ROOM OR LISTENING LESS THAN 1/3 OF
THE TIME
3. PERSON(S) IN THE ROOM OR LISTENING ABOUT 1/3 OF THE TIME
4. SERIOUS INTERRUPTIONS OF PRIVACY MORE THAN HALF THE TIME
5. CONSTANT PRESENCE OF OTHER PERSON(S)
Next [IF FIDBF5=1, GO TO FIDBF8; IF FIDBF5 NE1, GO TO FIDBF6]
FIDBF6 [IF FIDBF5 NE1]
Not including yourself or project observers, who were the other people present or listening to the
interview?
Check all that apply
1.
2.
3.
4.
5.
6.
7.

PARENT(S)
SPOUSE
LIVE-IN PARTNER/BOYFRIEND/GIRLFRIEND
OTHER ADULT RELATIVE(S)
OTHER ADULT(S)
CHILD(REN) UNDER 18
OTHER

Next [IF FIDBF6=1, 2, 3, 4, 5, OR 6, GO TO FIDBF8]
FIDBF7 [IF FIDBF6=7]
Please enter a description of the other person(s) present or listening to the interview. This description may
be relationship to the respondent if you have this information, or simply the gender and estimated age.
ALLOW 140 CHARACTERS

8-2

Next [FIDBF8]
FIDBF8 [IF FIDBF5=1; OR IF FIDBF6=1, 2, 3, 4, 5, OR 6; OR IF FIDBF7 NE BLANK]
Did the respondent make any comments about the interview being too long?
YES
NO
Next [FIDBF9]
FIDBF9
Did the respondent have trouble understanding any questions asked during the interview?
YES
NO
Next [IF FIDBF9=NO, GO TO FIDBF10]
FIDBF9a [IF FIDBF9=YES]
Enter the screen name and a brief description of what the respondent found confusing. If you do not know
the screen name, please provide as much information as possible.
ALLOW 140 CHARACTERS
Next [FIDBF10]
FIDBF10
How often did this respondent let you know what their answers were as they completed the ACASI
portion of the interview?
1.
2.
3.
4.
5.

NONE OF THE TIME – I DO NOT KNOW WHAT ANY OF THE ANSWERS ARE
A LITTLE OF THE TIME – I KNOW WHAT A FEW OF THE ANSWERS ARE
SOME OF THE TIME – I KNOW WHAT SOME OF THE ANSWERS ARE
A LOT OF THE TIME – I KNOW WHAT A LOT OF THE ANSWERS ARE
ALL OF THE TIME – I KNOW WHAT ALL OF THE ANSWERS ARE

Next [FIDBF11]
FIDBF11
Please note anything else you think would be helpful for the interpretation and understanding of this
interview.
ALLOW 250 CHARACTERS
Next [RECORD OF CALLS]

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8-4

Section 9
Parental Introductory Script in English and Spanish
Document Format:
• Screen/menu names are in bold uppercase letters.
• FI instructions are provided in black uppercase text that is not in brackets. In the
screening program, FI instructions appear in red uppercase letters.
• Fills are designated by parentheses and italics.

INTRODUCE YOURSELF/STUDY AS NECESSARY:
Hello, I’m ________with RTI International. We are conducting a nationwide study sponsored by
the U.S. Department of Health and Human Services. You should have received a letter about this
study. (SHOW LEAD LETTER, IF NECESSARY.)
(Buenos/as días/tardes/noches), mi nombre es _____ y trabajo para RTI International. Estamos
realizando un estudio a nivel nacional patrocinado por el Departamento de Salud y Servicios
Humanos de los Estados Unidos. Usted debe haber recibido una carta acerca de este estudio.
(SHOW LEAD LETTER, IF NECESSARY.)
ONE YOUTH IS SELECTED:
Your (AGE) year-old child has been selected for an interview. I would like to talk with them to
see if they are interested in participating in this study which asks about tobacco, alcohol, and
drug use and non-use and other health related issues.
If your child is interested, I will give both of you more information and ask for permission to
complete the interview. (Are they available?)
Se seleccionó a su hijo o hija de (AGE) para una entrevista. Me gustaría hablar con él o ella
para ver si tiene interés en participar en este estudio que hace preguntas sobre el uso y no uso
de tabaco, alcohol y drogas, así como otros temas sobre la salud.
Si su hijo o hija tiene interés, les daré a ustedes dos más información y les pediré permiso para
completar la entrevista. (¿Está disponible su hijo o hija?)
TWO YOUTHS ARE SELECTED:
Your (AGE) year-old and (AGE) year-old children have been selected for an interview. I would
like to talk with them to see if they are interested in participating in this study which asks
about tobacco, alcohol, and drug use and non-use and other health related issues.
If they are interested, I will give all of you more information and ask for permission to complete
the interview. (Are they available?)
9-1

Se seleccionaron a su hijo o hija de (AGE) años y a su hijo o hija de (AGE) años para una
entrevista. Me gustaría hablar con ellos para ver si tienen interés en participar en este estudio
que hace preguntas sobre el uso y no uso de tabaco, alcohol y drogas, así como otros temas
sobre la salud.
Si ellos están interesados, les daré a todos ustedes más información y les pediré permiso para
completar la entrevista. (¿Están ellos disponibles?)

9-2