Form 0920-0950 Household Screener Questionnaire

Attachment 6a

Household Screener Questionnaire

Attachment 6a: Household Screener Questionnaire

Form Approved

OMB No. 0920-0950

Exp. Date XX/XX/20XX

Notice – CDC estimates the average public reporting burden for this collection of information as 7 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road, MS H21-8, Atlanta, GA 30333; ATTN: PRA (0920-0950).

Assurance of Confidentiality – We take your privacy very seriously.  All information that relates to or describes identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes.  NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C. 242m(d)) and the Confidential Information Protection and Statistical Efficiency Act or CIPSEA (44 U.S.C. 3561-3583).  In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you. In addition to the above cited laws, NCHS complies with the Federal Cybersecurity Enhancement Act of 2015 (6 U.S.C. §§ 151 and 151 note) which protects Federal information systems from cybersecurity risks by screening their networks.

 

Preloads Needed

From IDstat Block:

• ADDRESS

  • {Address1}

  • {Address2}

  • {City}

  • {State}

  • {Zipcode}

• INTMODE:

  • 1=IN-PERSON 2=PHONE

Screener Interview Instrument

SCQINTR
ASK	All respondents
Hello, I’m {NAME} and we are conducting a survey for the National Center for Health Statistics, part of the Centers for Disease Control and Prevention, or CDC. <TEXT FILL 1> We recently sent a letter to your household about our study called the National Health and Nutrition Examination Survey. Do you remember receiving that letter? IF RESIDENT DOES NOT REMEMBER LETTER, <TEXT FILL 2> YES NO 9 DON’T KNOW 7 REFUSED
SPANISH	Buenos días/Buenas tardes, mi nombre es {NAME} y estamos realizando una encuesta para el Centro Nacional de Estadísticas de Salud, que es parte de los Centros para el Control y la Prevención de Enfermedades o CDC, por sus siglas en inglés. <TEXT FILL 1> Hace poco enviamos una carta a su hogar sobre nuestro estudio llamado la Encuesta Nacional de Examen de la Salud y la Nutrición. ¿Recuerda haber recibido esa carta? IF RESIDENT DOES NOT REMEMBER LETTER, <TEXT FILL 2> YES NO 9 DON’T KNOW 7 REFUSED
QUESTION TYPE	Radio buttons
FILLS	TEXT FILL 1: IF INTMODE = 1, DISPLAY “SHOW ID CARD.” TEXT FILL 2: IF INTMODE = 1, DISPLAY “HAND THEM A NEW COPY” ELSE, DISPLAY “REFER THEM TO THE WEBSITE FOR A COPY.”
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	SCQ.INTR
NEXT	SCQVER

SCQVER
ASK	All respondents
Before we begin, I would like to verify a few things. ASK IF PERSON APPEARS UNDER 30 YEARS OF AGE: (Are you 18 years or older?) YES NO
SPANISH	Antes de empezar, quisiera verificar algunos datos. ASK IF PERSON APPEARS UNDER 30 YEARS OF AGE: (¿Tiene usted 18 años o más?) YES NO
QUESTION TYPE	Radio button
FILLS
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	SCQ.011
NEXT	IF SCQVER in (1): SCQRES ELSE: SCQADAVAIL

SCQRES
ASK	IF SCQVER in (1)
(And) Do you currently live here? Yes No
SPANISH	(Y) ¿Vive actualmente aquí? Sí No
QUESTION TYPE	Radio button
FILLS
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	SCQ.016
NEXT	IF SCQRES in (1): SCQADDR ELSE: SCQADAVAIL

SCQADDR
ASK	IF SCQRES in (1)
I want to be sure I have your correct address – What is your full address? COMPARE TO THE ADDRESS DISPLAYED AND MAKE CHANGES AS NEEDED {Address1} {Address2} {City} {State} {Zipcode} NO CORRECTIONS NEEDED MINOR CORRECTIONS NEEDED MAJOR CORRECTIONS NEEDED (DESCRIPTIVE ADDRESS ONLY) NO (WRONG ADDRESS)
SPANISH	Quiero asegurarme de tener su dirección correcta. ¿Cuál es su dirección completa? COMPARE TO THE ADDRESS DISPLAYED AND MAKE CHANGES AS NEEDED {Address1} {Address2} {City} {State} {Zipcode} NO CORRECTIONS NEEDED MINOR CORRECTIONS NEEDED MAJOR CORRECTIONS NEEDED (DESCRIPTIVE ADDRESS ONLY) NO (WRONG ADDRESS)
QUESTION TYPE	Radio button
FILLS
NOTES	DISPLAY FULL ADDRESS FROM STATID BLOCK
HARD CHECK	IF DUTYPE = “GROUP QUARTERS” AND DROPPTFLAG = “N” AND SCQADDR = 3 DISPLAY, “THE DWELLING UNIT TYPE IS A GROUP QUARTER. ONLY MINOR CORRECTIONS ARE ALLOWED. PLEASE VERIFY THAT YOU ARE AT THE CORRECT ADDRESS.” IF DUTYPE = “GROUP QUARTERS” AND DROPPTFLAG = “Y” AND SCQADDR = 3 DISPLAY, “THE DWELLING UNIT TYPE IS A GROUP QUARTERS DROP POINT. ONLY MINOR CORRECTIONS ARE ALLOWED. PLEASE VERIFY THAT YOU ARE AT THE CORRECT ADDRESS.” IF DUTYPE = “HOUSING UNIT” AND DROPPTFLAG = “Y” AND SCQADDR = 3 DISPLAY, “THE DWELLING UNIT TYPE IS A DROP POINT. ONLY MINOR CORRECTIONS ARE ALLOWED. PLEASE VERIFY THAT YOU ARE AT THE CORRECT ADDRESS.”
SOFT CHECK
VERSION NOTES	SCQ.070a
NEXT	IF SCQADDR in (1): SCQHBPS IF SCQADDR in (2): SCQEDADD ELSE: SCQWRADD

SCQEDADD
ASK	IF SCQADDR in (2)
(Which part of your address is not correct?) {Address1} {Address2} {City} {State} {Zipcode}
SPANISH	(¿Qué parte de su dirección no es correcta?) {Address1} {Address2} {City} {State} {Zipcode}
QUESTION TYPE	Edit Display Data
FILLS
NOTES	DISPLAY THE ADDRESS COLUMNS LISTED ABOVE FROM IDSTAT BLOCK AND ALLOW THE INTERVIEWER TO MAKE CORRECTIONS AS NEEDED. IF DROPPTFLAG = “Y” AND SCQADDR = 2, ONLY ALLOW FOR CHANGES IN ADDRESS2 AND ZIP CODE ELSE IF DUTYPE = 2 (“GROUP QUARTER”) AND SCQADDR = 2, ONLY ALLOW FOR CHANGES IN ZIP CODE ELSE IF DUTYPE = 1 (“HOUSING UNIT”) AND DROPPTFLAG = “N” AND SCQADDR = 2, ONLY ALLOW FOR CHANGES IN ZIP CODE AND ADDRESS2 ELSE IF DUTYPE = 1 (“HOUSING UNIT”) AND DROPPTFLAG = “N” AND SCQADDR = 3, ONLY ALLOW FOR CHANGES IN ADDRESS1 AND ADDRESS2 ONCE THE INTERVIEWER IS DONE, THEY WILL PRESS THE NEXT KEY TO CONTINUE. THE FIELD FOR CITY AND STATE MAY NOT BE UPDATED.
HARD CHECK	IF UNIT/APT/BLDG = PO BOX OR IF “PO BOX” OR “P.O. BOX” IS ENTERED IN EITHER THE ADDRESS1 OR ADDRESS2 LINE DISPLAY MESSAGE, “PLEASE ENTER THE PHYSICAL STREET ADDRESS. DO NOT ENTER P.O. BOX ON THIS SCREEN.” IF NONE OF THE ADDRESS FIELDS ARE MODIFIED, DISPLAY: “YOU DID NOT MAKE CORRECTIONS, PLEASE VERIFY. IF NO CORRECTIONS ARE NECESSARY RETURN TO THE PREVIOUS SCREEN AND SELECT "NO CORRECTIONS NEEDED“
SOFT CHECK
VERSION NOTES	SCQ.070b
NEXT	SCQHBPS

SCQHBPS
ASK	IF SCQADDR in (1 OR 2)
First, I have some general questions about your household’s health. Has a doctor or other health professional ever told anyone in this household that they had hypertension also called high blood pressure? IF HIGH BLOOD PRESSURE ONLY DURING PREGNANCY, CODE NO. IF RESPONDENT SAYS “HIGH NORMAL BLOOD PRESSURE”, “BORDERLINE HYPERTENSION” OR “PREHYPERTENSION” ONLY, CODE NO. YES NO 9 DON’T KNOW 7 REFUSED
SPANISH	Primero, tengo algunas preguntas generales sobre la salud de las personas en su hogar. ¿Le ha dicho alguna vez un doctor u otro profesional de la salud a alguien en su hogar que tenía hipertensión, también llamada “presión arterial alta”? IF HIGH BLOOD PRESSURE ONLY DURING PREGNANCY, CODE NO. IF RESPONDENT SAYS “PRESIÓN ARTERIAL NORMAL ALTA”, “CASI HIPERTENSIÓN” O “PREHIPERTENSIÓN” ONLY, CODE NO. YES NO 9 DON’T KNOW 7 REFUSED
QUESTION TYPE	Radio button
FILLS
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	NEW QUESTION
NEXT	SCQDBT

SCQDBT
ASK	IF SCQADDR in (1 OR 2)
Has a doctor or other health professional ever told anyone in this household that they had diabetes? IF DIABETES ONLY DURING PREGNANCY, CODE NO. YES NO BORDERLINE OR PREDIABETES 9 DON’T KNOW 7 REFUSED
SPANISH	¿Le ha dicho alguna vez un doctor u otro profesional de la salud a alguien en su hogar que tenía diabetes? IF DIABETES ONLY DURING PREGNANCY, CODE NO. YES NO BORDERLINE OR PREDIABETES 9 DON’T KNOW 7 REFUSED
QUESTION TYPE	Radio button
FILLS
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	NEW QUESTION
NEXT	SCQMEDS

SCQMEDS
ASK	IF SCQADDR in (1 OR 2)
Is anyone in this household now taking any medications prescribed by a health professional such as a doctor or dentist? YES NO 9 DON’T KNOW 7 REFUSED
SPANISH	¿Toma alguien en su hogar actualmente algún medicamento recetado por un profesional de la salud, como un doctor o un dentista? YES NO 9 DON’T KNOW 7 REFUSED
QUESTION TYPE	Radio button
FILLS
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	NEW QUESTION
NEXT	SCQHHTOT

SCQHHTOT
ASK	IF SCQADDR in (1 OR 2)
To continue, I need some information about this household to see if you or anyone else will be selected to participate in the study. All the information that you give us is voluntary and confidential. If anyone is selected for an interview, they will receive $25 when they complete it. How many people live here? Please do not include anyone who usually lives somewhere else. ________ NUMBER OF PEOPLE IN HOUSEHOLD
SPANISH	Para continuar, necesito alguna información sobre este hogar para saber si usted o alguien más será seleccionado para participar en el estudio. Toda la información que nos brinde es voluntaria y confidencial. Si alguien es seleccionado para una entrevista, recibirá $25 dólares cuando la complete. ¿Cuántas personas viven aquí? No incluya a nadie que viva normalmente en otro lugar. ________ NUMBER OF PEOPLE IN HOUSEHOLD
QUESTION TYPE	Dropdown
FILLS
NOTES	DISPLAY RESPONSES 1-25 AS A DROP DOWN. INCLUDE 77 = REFUSED AND 99 = DON’T KNOW.
HARD CHECK
SOFT CHECK
VERSION NOTES	SCQ.090
NEXT	SCQNAME

SCQNAME
ASK	IF SCQADDR in (1 OR 2)
Next I would like to get the names of all the persons living here. Let’s start with you. What is your first name? (If you do not want to provide names, we can enter initials or a nickname. We just need a way to refer to you and the others in your household.) AFTER RESPONDENT’S NAME IS REPORTED: And how about the other persons living here—what are their first names? Please remember not to include anyone who usually lives somewhere else. (PROBE: Any others?) NAME NO OTHERS DON’T KNOW 9 REFUSED 7
SPANISH	A continuación, quisiera obtener los nombres de todas las personas que viven aquí. Empecemos por usted. ¿Cuál es su primer nombre? (Si no quiere dar nombres, podemos ingresar sus iniciales o un apodo. Solo necesitamos una forma de referirnos a usted y a las demás personas en su hogar). AFTER RESPONDENT’S NAME IS REPORTED: ¿Cuál es el primer nombre de las demás personas que viven aquí? Recuerde no incluir a nadie que viva normalmente en otro lugar. (PROBE: ¿Alguien más?) NAME NO OTHERS DON’T KNOW 9 REFUSED 7
QUESTION TYPE	Textbox: NAME Radio button: RF, DK
FILLS
NOTES	ENSURE THAT EACH NAME IS UNIQUE WITHIN THE HOUSEHOLD. IF DATA ENTERED IN NAME: DO NOT ALLOW RF/DK DO NOT ALLOW “DON’T KNOW” OR “REFUSED” TO BE ENTERED IN THE NAME FIELD CHARACTER LIMIT FOR NAME: 20 SET IT UP SO THAT ALL OF THE NAMES ENTERED ARE IN THE SAME PAGE. EVEN THOUGH WE COLLECT THE NUMBER IN THE HOUSEHOLD, ALLOW FOR MORE PEOPLE IF NEEDED, COUNT THE NUMBER OF NAMES ENTERED IN THE VARIABLE SCQHHTOTNUM FOR EACH NAME IN SCQNAME ASK SCQGEND THROUGH SCQRACE NO OTHERS IS NOT CODED AS ANYTHING, IT IS JUST USED AS A “STOP” BUTTON TO STOP ASKING FOR MORE NAMES TO ADD TO THE ROSTER. DO NOT DISPLAY “NO OTHERS” IN LOOP 1
HARD CHECK	IF A DUPLICATE NAME IS ENTERED, DISPLAY THE FOLLOWING ERROR MESSAGE, “NAMES MUST BE UNIQUE. PERSONS # AND # HAVE IDENTICAL NAMES RECORDED. CORRECT THE ERROR TO CONTINUE.” IF REFUSED OR DON’T KNOW ARE ENTERED IN THE NAME FIELD, DISPLAY, “INTERVIEWER: PLEASE PROBE FOR FIRST NAME, INITIALS, OR NICKNAME. IF STILL REFUSED OR DON’T KNOW, SELECT REFUSED OR DON’T KNOW BELOW.”
SOFT CHECK	IF SCQNAME = 7 OR 9, DISPLAY “INTERVIEWER: PLEASE PROBE FOR FIRST NAME, INITIALS, OR NICKNAME. IF STILL REFUSED OR DON’T KNOW, PLEASE CLICK [SUPPRESS] AND THEN NEXT TO CONTINUE.” IF SCQHHTOT > SCQHHTOTNUM THEN PROMPT “You mentioned that there were [SCQHHTOT] people, but I have only [SCQHHTOTNUM] names. Who did I miss?”
SOFT CHECK (SPA)	IF SCQNAME = 7 OR 9, DISPLAY “INTERVIEWER: PLEASE PROBE FOR FIRST NAME, INITIALS, OR NICKNAME. IF STILL REFUSED OR DON’T KNOW, PLEASE CLICK [SUPPRESS] AND THEN NEXT TO CONTINUE.” IF SCQHHTOT > SCQHHTOTNUM THEN PROMPT “Usted mencionó que habían [SCQHHTOT] personas, pero yo solo tengo [SCQHHTOTNUM] nombres. ¿Quién me faltó?”
VERSION NOTES	SCQ.130
NEXT	fSCQHHDEMO

fSCQHHDEMO SCQGEND / SCQAGE / SCQAGEUNIT SCQAGEEST / SCQAGEREF /SCQRACE
ASK	IF SCQNAME
[DISPLAY SCQNAME, DO NOT ALLOW UPDATES] What is <TEXT FILL 1> gender? [SCQGEND] MALE FEMALE ANOTHER GENDER 9 DON’T KNOW 7 REFUSED How old <TEXT FILL 2>? [SCQAGE] INTERVIEWER INSTRUCTION: ENTER NUMBER OF YEARS OR MONTHS COLLECT AGE IN MONTHS IF AGE IS LESS THAN ONE YEAR. IF AGE IS LESS THAN ONE MONTH OLD, ENTER ‘0 MONTHS.’ |___|___|___| DON’T KNOW 999 REFUSED 777 |___| ENTER UNIT [SCQAGEUNIT] YEARS 2 MONTHS 1 [ASK SCQAGEEST IF SCQAGE in (777) OR (999)] About how old <TEXT FILL 2>? <TEXT FILL 2>… [SCQAGEEST] Less than 5 years 5-11 years 12-17 years 18-44 years 45-64 years 65 years or older DON’T KNOW REFUSED [ASK SCQAGEREF IF LOOP IS NOT SCREENER RESPONDENT AND SCQAGEEST = 77 OR 99] Is <TEXT FILL 3> 18 years of age or older? [SCQAGEREF] YES NO 9 DON’T KNOW 7 REFUSED What is <TEXT FILL 1> race or ethnicity? You may choose more than one answer. Would you say <TEXT FILL 4>…[SCQRACE] CHECK ALL THAT APPLY. White Hispanic or Latino Black or African American Asian American Indian or Alaska Native Middle Eastern or North African Native Hawaiian or Pacific Islander DON’T KNOW REFUSED
SPANISH	[DISPLAY SCQNAME, DO NOT ALLOW UPDATES] ¿Cuál es <TEXT FILL 1>? [SCQGEND] MALE FEMALE ANOTHER GENDER 9 DON’T KNOW 7 REFUSED ¿Cuántos años tiene <TEXT FILL 2>? [SCQAGE] INTERVIEWER INSTRUCTION: ENTER NUMBER OF YEARS OR MONTHS COLLECT AGE IN MONTHS IF AGE IS LESS THAN ONE YEAR. IF AGE IS LESS THAN ONE MONTH OLD, ENTER ‘0 MONTHS.’ |___|___|___| DON’T KNOW 999 REFUSED 777 |___| ENTER UNIT [SCQAGEUNIT] YEARS 2 MONTHS 1 [ASK SCQAGEEST IF SCQAGE in (777) OR (999)] ¿Aproximadamente cuántos años tiene <TEXT FILL 2>? ¿Tiene <TEXT FILL 2>…? [SCQAGEEST] Menos de 5 años 5 a 11 años 12 a 17 años 18 a 44 años 45 a 64 años 65 años o más DON’T KNOW REFUSED [ASK SCQAGEREF IF LOOP IS NOT SCREENER RESPONDENT AND SCQAGEEST = 77 OR 99] ¿Tiene <TEXT FILL 3> 18 años o más? [SCQAGEREF] YES NO 9 DON’T KNOW 7 REFUSED ¿Cuál es <TEXT FILL 1>? Puede elegir más de una respuesta. ¿Diría que <TEXT FILL 4> es…[SCQRACE] CHECK ALL THAT APPLY. Blanco(a) Hispano(a) o latino(a) Negro(a) o afroamericano(a) Asiático(a) Indígena de las Américas o nativo(a) de Alaska De Medio Oriente o África del norte Nativo(a) de Hawái o de otras islas del Pacífico DON’T KNOW REFUSED
QUESTION TYPE	SCQGEND: Dropdown SCQAGE: Numeric SCQAGEUNIT: Dropdown SCQAGEEST: Dropdown SCQAGEREF: Dropdown SCQRACE: Select all that apply
FILLS	TEXT FILL 1: FILL “your” IF ONLY ONE PERSON ENTERED ON HH ROSTER OR IF INTERVIEWING FIRST RESPONDENT. ELSE FILL “{NAME}’s”. FILL “{NAME}” WITH {NAME} FROM SCQNAME TEXT FILL 2: FILL “are you” IF INTERVIEWING FIRST OR ONLY HH ELSE FILL “is [NAME]” TEXT FILL 3: FILL “{NAME} WITH {NAME} FROM SCQNAME TEXT FILL 4: FILL “you are” IF ONLY ONE PERSON ENTERED ON HH ROSTER OR IF INTERVIEWING FIRST RESPONDENT. ELSE FILL “{NAME} is”. FILL “{NAME}” WITH {NAME} FROM SCQNAME
FILLS (SPA)	TO PROGRAMMER: TEXT FILL 1 WILL VARY IN SPANISH DEPENDING ON THE CONTEXT. SEE BELOW. GENDER QUESTION [SCQGEND]: TEXT FILL 1: FILL “su género” IF ONLY ONE PERSON ENTERED ON HH ROSTER OR IF INTERVIEWING FIRST RESPONDENT. ELSE FILL “el género de {NAME}”. FILL “{NAME}” WITH {NAME} FROM SCQNAME RACE QUESTION [SCQRACE]: TEXT FILL 1: FILL “su raza u origen étnico” IF ONLY ONE PERSON ENTERED ON HH ROSTER OR IF INTERVIEWING FIRST RESPONDENT. ELSE FILL “la raza o el origen étnico de {NAME}”. FILL “{NAME}” WITH {NAME} FROM SCQNAME TEXT FILL 2: FILL “usted” IF INTERVIEWING FIRST OR ONLY HH ELSE FILL “{NAME}” TEXT FILL 3: FILL “{NAME} WITH {NAME} FROM SCQNAME TEXT FILL 4: FILL “usted” IF ONLY ONE PERSON ENTERED ON HH ROSTER OR IF INTERVIEWING FIRST RESPONDENT. ELSE FILL “{NAME}”. FILL “{NAME}” WITH {NAME} FROM SCQNAME
NOTES	LOOP THIS FORM FOR EACH HOUSEHOLD MEMBER IF LOOP 1 SCQAGE AND SCQAGEEST = 77 OR 99, PREFILL SCQAGEREF = 1 AND DO NOT DISPLAY SCQAGEREF.
HARD CHECK	SCQGEND: NONE SCQAGE: - IF SCQAGEUNIT = BLANK AND SCQAGE > 120, DISPLAY “YOUR ENTRY IS OUT OF RANGE. PLEASE ENTER A NUMBER BETWEEN 0-120.” - IF AGE IN YEARS = 0 DISPLAY, “IF AGE IS LESS THAN ONE YEAR, ASK RESPONDENT TO PROVIDE AGE IN MONTHS.” - IF AGE IN YEARS > 120 OR < 0 DISPLAY, “AGE IN YEARS MUST BE BETWEEN 1-120.” - IF AGE IN MONTHS > 23 OR < 0, DISPLAY: ‘AGE IN MONTHS MUST BE BETWEEN 0-23. IF THE PERSON IS 24 MONTHS OLD OR OLDER, PLEASE ENTER AGE IN YEARS.’ - IF AGE < 18 REPORTED FOR THE SCREENER RESPONDENT, DISPLAY “RESPONDENT AGE IS RECORDED LESS THAN 18. PLEASE CHECK YOUR ANSWER.”. - IF SCQAGE != BLANK AND SCQAGEUNIT = BLANK DISPLAY, “PLEASE SELECT MONTHS OR YEARS.” SCQAGEEST: - IF AGE IN 1, 2, OR 3 REPORTED FOR THE SCREENER RESPONDENT, DISPLAY “RESPONDENT AGE IS RECORDED LESS THAN 18. PLEASE CHECK YOUR ANSWER.”. SCQAGEREF: NONE SCQRACE: NONE
SOFT CHECK
VERSION NOTES	SCQ.131 / SCQ.235 / SCQ.310 / NEW / SCQ.NEW1
NEXT	AFTER LOOP HAS BEEN COMPLETED FOR ALL HH MEMBERS: SCQROSVER

SCQROSVER
ASK	IF SINGLE-HH OR IF fSCQHHDEMO COMPLETE WITH ALL HH MEMBERS
[FIRST NAME], DK, RF [GENDER: M, F, O], DK, RF [AGE: 0-120 {MONTH(S)/YEAR(S)} AND SCQAGEEST/SCQAGEREF], DK, RF [RACE/ETHNICITY: W, H, B, A, AI, MENA, NHPI], DK, RF I have {TOTAL # OF PERSONS ENUMERATED} {person/people} living here -- REVIEW HOUSEHOLD MEMBERS LISTED ABOVE. REFER TO THE LIST AS NEEDED. Is all of the information correct? Please let me know if I have missed anyone such as: babies or small children, lodgers, boarders, or anyone else who usually lives here but is now away from home?[SCQROSVER] IF YOU NEED TO ADD MORE HOUSEHOLD MEMBERS OR EDIT A HOUSEHOLD MEMBER’S NAME, CLICK HERE TO RETURN TO THE ROSTER NOTE: AFTER CHANGES ARE MADE TO THE ROSTER, USE "JUMP" KEY TO JUMP TO THIS SCREEN OR ANY NEWLY ADDED HH MEMBERS. YES, ALL INFORMATION IS CORRECT NO, NEED TO CORRECT ENTRIES
SPANISH	[FIRST NAME], DK, RF [GENDER: M, F, O], DK, RF [AGE: 0-120 {MONTH(S)/YEAR(S)} AND SCQAGEEST/SCQAGEREF], DK, RF [RACE/ETHNICITY: W, H, B, A, AI, MENA, NHPI], DK, RF Según mis registros, {TOTAL # OF PERSONS ENUMERATED} {persona/personas} vive(n) aquí -- REVIEW HOUSEHOLD MEMBERS LISTED ABOVE. REFER TO THE LIST AS NEEDED. ¿Es correcta toda la información? Dígame si me faltó contar a alguien como: bebés o niños pequeños, inquilinos, huéspedes, o ¿cualquier otra persona que viva normalmente aquí pero que ahora esté fuera del hogar?[SCQROSVER] IF YOU NEED TO ADD MORE HOUSEHOLD MEMBERS OR EDIT A HOUSEHOLD MEMBER’S NAME, CLICK HERE TO RETURN TO THE ROSTER NOTE: AFTER CHANGES ARE MADE TO THE ROSTER, USE "JUMP" KEY TO JUMP TO THIS SCREEN OR ANY NEWLY ADDED HH MEMBERS. YES, ALL INFORMATION IS CORRECT NO, NEED TO CORRECT ENTRIES
QUESTION TYPE	Radio Button
FILLS	{TOTAL # OF PERSONS ENUMERATED}: NUMBER OF PEOPLE LISTED IN SCQNAME IF {TOTAL # OF PERSONS ENUMERATED} = 1, DISPLAY “person" ELSE, DISPLAY = “people”
FILLS (SPA)	{TOTAL # OF PERSONS ENUMERATED}: NUMBER OF PEOPLE LISTED IN SCQNAME IF {TOTAL # OF PERSONS ENUMERATED} = 1, DISPLAY “persona" ELSE, DISPLAY = “personas”
NOTES	LIST EACH HOUSEHOLD MEMBER IN A TABLE WITH THE INFORMATION ABOVE. IF ANY OF THE VARIABLES IS DK/RF FOR A HH MEMBER, PLEASE DISPLAY DK/RF IN THAT VARIABLE’S CELL. IF SCQAGEEST = 77 OR 99, DISPLAY SCQAGEREF IN ‘Age Range’ FIELD COLUMN HEADERS SHOULD BE: Name/Initials, Gender, Age, Race DISPLAY ‘CLICK HERE’ AS A LINK FOR FIELD INTERVIEWERS TO CLICK ON TO RETURN TO THE ROSTER (SCQNAME) TO ENTER ADDITIONAL PEOPLE.
HARD CHECK
SOFT CHECK
VERSION NOTES	SCQ.145
NEXT	IF SCQROSVER = 2 GO TO SCQINTROInfoFix AND ALLOW INFORMATION TO BE EDITED/UPDATED ELSE: SCQMIL

SCQINTROInfoFix
ASK	IF SCQROSVER = 2
TO MAKE CHANGES TO LIST OF HOUSEHOLD MEMBERS, CLICK [EDIT] TO MOVE TO A HOUSEHOLD MEMBER TO EDIT. TO REMOVE HOUSEHOLD MEMBER, CLICK [DELETE]. YOU WILL BE PRESENTED WITH UPDATED LIST OF HOUSEHOLD MEMBERS. NOTE: AFTER CHANGES ARE MADE TO THE ROSTER, USE "JUMP" KEY TO RETURN TO THE ROSTER VERIFICATION SCREEN. <TEXT FILL 1>
SPANISH	NA
QUESTION TYPE	Radio button
FILLS	TEXT FILL 1: LIST HOUSEHOLD MEMBER NAMES IN A TABLE WITH “EDIT” AND “DELETE” OPTIONS NEXT TO EACH. “DELETE” REMOVES THE HH MEMBER
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES
NEXT	EDIT: ROUTES TO THE HH MEMBER Fscqhhdemo TO ALLOW FOR EDITING

SCQMIL
ASK	IF SCQROSVER = 1
Are {you/any of the persons in this household} now on full-time active duty with the Armed Forces of the United States? YES NO 9 DON’T KNOW 7 REFUSED
SPANISH	¿Está {usted/alguna de las personas en este hogar} actualmente en servicio activo a tiempo completo en las Fuerzas Armadas de los Estados Unidos? YES NO 9 DON’T KNOW 7 REFUSED
QUESTION TYPE	Radio button
FILLS	FILL ‘you’ IF ONLY ONE PERSON ENTERED ON HH ROSTER. ELSE FILL “any of the persons in this household.”
FILLS (SPA)	FILL ‘usted’ IF ONLY ONE PERSON ENTERED ON HH ROSTER. ELSE FILL “alguna de las personas en este hogar.”
NOTES
HARD CHECK
SOFT CHECK	IF SCQMIL = 1 AND SINGLE PERSON HOUSEHOLD AND RESPONDENT IS > 70, DISPLAY “ONLY HOUSEHOLD RESPONDENT IS GREATER THAN 70 YEARS OF AGE. PLEASE CHECK YOUR ANSWER.”
VERSION NOTES	SCQ.220
NEXT	IF SCQMIL in (1): AND THIS IS A SINGLE PERSON HOUSEHOLD, GO TO SCQSAMPALG THE SCREENER IS TERMINATED AFTER THE COLLECTION OF THE TELEPHONE NUMBER SCQCELL ELSE IF SCQMIL IN (1) AND MULTIPLE HH MEMBERS: SCQMILN ELSE: SCQLVAWY

SCQMILN
ASK	IF SCQMIL in (1)
(Who is that?) SELECT ACTIVE MILITARY MEMBERS. PROBE: Anyone else? <TEXT FILL 1>
SPANISH	(¿Quién es?) SELECT ACTIVE MILITARY MEMBERS. PROBE: ¿Alguien más? <TEXT FILL 1>
QUESTION TYPE	Selection from HH composition matrix
FILLS	TEXT FILL 1: DISPLAY NAMES OF ALL PERSONS > 16 YEARS OLD LISTED ON THE HOUSEHOLD COMPOSITION MATRIX AS CHECK ALL THAT APPLY.
NOTES	IF ALL HOUSEHOLD MEMBERS ARE SELECTED AS ACTIVE DUTY MILITARY, THE INSTRUMENT ROUTES TO SCQSAMPALG.THE SCREENER IS TERMINATED AFTER THE COLLECTION OF THE TELEPHONE NUMBER (SCQ.430/SFQ.230- SCQ.490). IF NOT ALL HOUSEHOLD MEMBERS ARE SELECTED, SCQAWYHOME SHOULD BE ASKED OF ALL MEMBERS SELECTED IN SCQMILN
HARD CHECK
SOFT CHECK	WHEN LEAVING THIS SCREEN, IF NONE OF THE “MILITARY” CELLS HAVE BEEN SET TO “YES”, DISPLAY, “YOU DID NOT SELECT ANY HH MEMBER ON ACTIVE DUTY. GO BACK AND SELECT A PERSON OR PRESS SUPPRESS IF NO ONE ON ACTIVE DUTY.” IF SUPPRESSED, AUTO-BACKCODE THE RESPONSE TO SCQMIL TO “NO” AND PROCEED TO SCQSAMPALG IF THE SELECTED PERSON IS 70 YEARS OR OLDER, DISPLAY “THE SELECTED HOUSEHOLD MEMBER IS GREATER THAN 70 YEARS OLD, PLEASE VERIFY THAT THE CORRECT HOUSEHOLD MEMBER WAS SELECTED FOR FULL-TIME ACTIVE DUTY WITH U.S. ARMED FORCES.”.
VERSION NOTES
NEXT	IF ALL HOUSEHOLD MEMBERS ARE SELECTED IN SCQMILN: SCQSAMPALG ELSE: SCQLVAWY

SCQLVAWY
ASK	IF SCQROSVER
Do {you/any of the persons in this household} have a home anywhere else? INTERVIEWER INSTRUCTION: STUDENTS AWAY AT SCHOOL WHO STILL LIVE SOMEWHERE ELSE FOR PART OF THE YEAR ARE CONSIDERED TO HAVE A HOME SOMEWHERE ELSE. YES NO 9 DON’T KNOW 7 REFUSED
SPANISH	¿Tiene {usted/alguna de las personas en este hogar} un hogar en algún otro lugar? INTERVIEWER INSTRUCTION: STUDENTS AWAY AT SCHOOL WHO STILL LIVE SOMEWHERE ELSE FOR PART OF THE YEAR ARE CONSIDERED TO HAVE A HOME SOMEWHERE ELSE. YES NO 9 DON’T KNOW 7 REFUSED
QUESTION TYPE	Radio button
FILLS	FILL ‘you’ IF ONLY ONE PERSON ENTERED IN HH ROSTER. ELSE FILL “any of the persons in this household”.
FILLS (SPA)	FILL ‘usted’ IF ONLY ONE PERSON ENTERED IN HH ROSTER. ELSE FILL “alguna de las personas en este hogar”.
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	SCQ.195
NEXT	IF SCQLVAWY in (1): SCQLVAWYN IF SCQMILTN IN (SELECTED): SCQLVAWYN ELSE: SCQSAMPALG

SCQLVAWYN
ASK	IF SCQLVAWY in (1)
(Who is that?) SELECT MEMBERS WITH HOME ELSEWHERE. <TEXT FILL 1> (PROBE: Anyone else?)
SPANISH	(¿Quién es?) SELECT MEMBERS WITH HOME ELSEWHERE. <TEXT FILL 1> (PROBE: ¿Alguien más?)
QUESTION TYPE	Selection from HH composition matrix
FILLS
NOTES	<TEXT FILL 1> DISPLAY NAMES OF ALL PERSONS LISTED ON THE HOUSEHOLD COMPOSITION MATRIX AS CHECK ALL THAT APPLY OPTIONS.
HARD CHECK
SOFT CHECK	IF NONE OF THE “OTHER HOME” CELLS HAVE BEEN SET TO “YES”, DISPLAY: “YOU DID NOT SELECT ANY HH MEMBER LIVING IN ANOTHER PLACE. GO BACK AND SELECT A PERSON OR PRESS SUPPRESS IF NO ONE LIVES SOMEWHERE ELSE.” IF SUPPRESSED, AUTO-BACKCODE THE RESPONSE TO SCQLVAWY TO “NO” AND PROCEED TO SCQMIL.
VERSION NOTES	SCQ.200
NEXT	SCQAWYHOME

SCQAWYHOME
ASK	IF SCQLVAWYN, ONLY FOR HOUSEHOLD MEMBERS SELECTED IN SCQLVAWYN AND FOR HOUSEHOLD MEMBERS SELECTED IN SCQMILN IF THE ENTIRE HOUSEHOLD IS NOT SELECTED AS ACTIVE DUTY MILITARY IN SCQMILN
Where {do you/does {NAME}} usually live and sleep-- here or somewhere else? INTERVIEWER INSTRUCTION: FOR STUDENTS, RECORD WHERE THEY LIVE FOR THE MAJORITY OF THE CALENDAR YEAR HERE SOMEWHERE ELSE 9 DON’T KNOW 7 REFUSED
SPANISH	¿Dónde {vive y duerme usted/vive y duerme {NAME}} normalmente? ¿Aquí o en otro lugar? INTERVIEWER INSTRUCTION: FOR STUDENTS, RECORD WHERE THEY LIVE FOR THE MAJORITY OF THE CALENDAR YEAR HERE SOMEWHERE ELSE 9 DON’T KNOW 7 REFUSED
QUESTION TYPE	Radio button for each ‘NAME’
FILLS	FILL “do you” FOR SCREENER RESPONDENT IF CHOSEN IN EITHER SCQLVAWYN OR SCQMILN ELSE FILL “does {NAME}”. FILL “{NAME}” FOR SELECTED PERSON(S) IN SCQLVAWYN OR SCQMILN
FILLS (SPA)	FILL “vive y duerme usted” FOR SCREENER RESPONDENT IF CHOSEN IN EITHER SCQLVAWYN OR SCQMILN ELSE FILL “vive y duerme {NAME}”. FILL “{NAME}” FOR SELECTED PERSON(S) IN SCQLVAWYN OR SCQMILN
NOTES	LOOP THIS QUESTION FOR EACH PERSON SELECTED IN SCQLVAWYN AND FOR HOUSEHOLD MEMBERS SELECTED IN SCQMILN IF THE ENTIRE HOUSEHOLD IS NOT SELECTED AS ACTIVE DUTY MILITARY IN SCQMILN IF “1”, “7”, OR “9” IS SELECTED, LEAVE THE PERSON ON THE HH COMPOSITION MATRIX; ELSE IF “2” IS SELECTED FOR AT LEAST ONE PERSON AND THE HOUSEHOLD IS MORE THAN A SINGLE PERSON HOUSEHOLD AND “2” HAS NOT BEEN SELECTED FOR ALL MEMBERS OF THE HH, SET A FLAG TO INDICATE THIS PERSON’S PERMANENT RESIDENCE WAS SOMEWHERE ELSE. THE FLAG IS AN INDICATION THAT ON ALL FUTURE DISPLAYS OF THE HH COMPOSITION MATRIX, THIS PERSON (AND ALL PERSON-LEVEL DATA) WILL NOT BE DISPLAYED.
HARD CHECK
SOFT CHECK
VERSION NOTES	SCQ.210
NEXT	SCQSAMPALG

SCQSAMPALG
ASK	IF SCQROSVER = 1 (YES)
{DISPLAY ROSTER} READ THROUGH ROSTER INFORMATION AND THEN ASK QUESTION BELOW. IF CHANGES ARE MADE TO THE ROSTER, USE "JUMP" KEY TO RETURN TO THIS PAGE. Do you have any changes that you would like to make to the information you have provided so far? IF CHANGES ARE NEEDED USE THE LINKS TO JUMP TO THE APPROPRIATE SECTION. UPDATE LIVES HERE UPDATE MILITARY UPDATE ROSTER LIST AFTER "NEXT" IS ENTERED, NO CHANGES CAN BE MADE TO PREVIOUS SCREENS. ALL INFORMATION IS CORRECT
SPANISH	{DISPLAY ROSTER} READ THROUGH ROSTER INFORMATION AND THEN ASK QUESTION BELOW. IF CHANGES ARE MADE TO THE ROSTER, USE "JUMP" KEY TO RETURN TO THIS PAGE. ¿Desea realizar algún cambio en la información que ha proporcionado hasta ahora? IF CHANGES ARE NEEDED USE THE LINKS TO JUMP TO THE APPROPRIATE SECTION. UPDATE LIVES HERE UPDATE MILITARY UPDATE ROSTER LIST AFTER "NEXT" IS ENTERED, NO CHANGES CAN BE MADE TO PREVIOUS SCREENS. ALL INFORMATION IS CORRECT
QUESTION TYPE	Radio button
FILLS
NOTES	DISPLAY ROSTER GRID INCLUDING NAME, GENDER, AGE, RACE, MILITARY STATUS, AND WHETHER THE PERSON LIVES HERE BASED ON INFORMATION THAT THE ALGORITHM USES. DISPLAY “UPDATE LIVES HERE”, “UPDATE MILITARY”, AND “UPDATE ROSTER LIST” AS LINKS TO THOSE SPECIFIC SECTIONS IF ALL HOUSEHOLD MEMBERS ARE ACTIVE MILITARY IN SCQMILN, DISPLAY “(ALL HOUSEHOLD MEMBERS ARE LISTED AS ACTIVE MILITARY, NO UPDATE ON "LIVES HERE" STATUS IS NEEDED)” AND DEACTIVATE THE “UPDATE LIVES HERE” LINK IF LINKS ARE SELECTED, PLEASE ALLOW FOR EDITING THE HH MEMBER OR ADDING ANOTHER HH MEMBER IF NEEDED. IF “ALL INFORMATION IS CORRECT” IS SELECTED AND NEXT IS CLICKED, APPLY SAMPLING ALGORITHM IF ALL HOUSEHOLD MEMBERS ARE ACTIVE MILITARY IN SCQMILN, THE HOUSEHOLD IS CODED AS “INELIGIBLE” IF ALL HOUSEHOLD MEMBERS (2) IN SCQAWYHOME, THE HOUSEHOLD IS CODED AS “INELIGIBLE”
HARD CHECK
SOFT CHECK
VERSION NOTES
NEXT	SCQSAMPALGC

SCQSAMPALGC
ASK	IF SCQSAMPALG = ‘ALL INFORMATION IS CORRECT’
SAMPLING ALGORITHM COMPLETE. PLEASE CLICK “NEXT” TO CONTINUE.
SPANISH	NA
QUESTION TYPE	TEXT
FILLS
NOTES	DO NOT DISPLAY BACK BUTTON.
HARD CHECK
SOFT CHECK
VERSION NOTES
NEXT	IF THE HOUSEHOLD IS CODED AS INELIGIBLE OR NO ONE SELECTED IN SAMPLING ALGORITHM, GO TO SCQINELG IF THERE ARE NO ELIGIBLE ADULTS TO BE AN HRP, GO TO SCQRPADSME AND CODE SCQHRP AS “NO ELIGIBLE HRP” ELSE, SCQHRP.

SCQINELG
ASK	IF SCQSAMPALG in (NOT SELECTED)
Thank you for your responses today. {No one in this household was/You were not} selected for participation in the study.
SPANISH	Gracias por sus respuestas de hoy. {Nadie fue seleccionado en este hogar/Usted no fue seleccionado(a)} para participar en el estudio.
QUESTION TYPE	N/A
FILLS	FILL “Nadie fue seleccionado en este hogar” IF MULTIPLE PEOPLE ENTERED ON HH ROSTER. ELSE DISPLAY “Usted no fue seleccionado(a)”.
FILLS (SPA)
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	SCQ.END1
NEXT	SCQVFQG

SCQHRP
ASK	IF SCQSAMPALG in (SELECTED) AND THERE IS AN ADULT ELIGIBLE TO BE AN HRP
Of these people, who owns or rents this home? [CODE ALL THAT APPLY] INTERVIEWER: IF NO SUCH PERSON, OR THE PERSON WHO OWNS OR RENTS THE HOME IS NOT LISTED, ASK: Who are the persons listed here who know the most about this household?
SPANISH	De estas personas, ¿quién es dueño(a) o alquila esta vivienda? [CODE ALL THAT APPLY] INTERVIEWER: IF NO SUCH PERSON, OR THE PERSON WHO OWNS OR RENTS THE HOME IS NOT LISTED, ASK: ¿Quiénes son las personas de esta lista que saben más sobre este hogar?
QUESTION TYPE	Selection from all HH members >= 18 CHECK ALL THAT APPLY.
FILLS
NOTES	DISPLAY ALL HOUSEHOLD MEMBERS WHO ARE >= 18 YEARS OLD IN SCQAGE OR SCQAGEEST OR SCQAGEREF AND (SCQAWYHOME = 1 OR BLANK) . ALLOW MULTIPLE PERSONS TO BE SELECTED IF ONLY ONE PERSON IDENTIFIED AS 18+ YEARS AND LIVES HERE, THEN AUTOFILL THAT PERSON AS “SELECTED” IN SCQHRP AND GO TO SCQRPADSME.   IF ONLY PERSON SELECTED IN SCQHRP, THAT PERSON IS FLAGGED AS THE HOUSEHOLD REFERENCE PERSON. IF MULTIPLE PERSONS ARE SELECTED IN SCQHRP, AMONG THE SELECTED ONES, THE PERSON LISTED FIRST ON THE ROSTER IS FLAGGED AS THE HOUSEHOLD REFERENCE PERSON.
HARD CHECK
SOFT CHECK
VERSION NOTES	New
NEXT	SCQRPADSME

SCQRPADSME
ASK	IF SCQHRP IN (1) OR “NO ELIGIBLE HRP”
Is <TEXT FILL 1> mailing address the same as <TEXT FILL 2> street address? YES NO 9 DON’T KNOW 7 REFUSED
SPANISH	¿Es <TEXT FILL 1> la misma que <TEXT FILL 2>? YES NO 9 DON’T KNOW 7 REFUSED
QUESTION TYPE	Radio button
FILLS	TEXT FILL 1: FILL “your” IF THE SELECTED PERSON IN SCQHRP IS THE SCREENER RESPONDENT ELSE FILL “{HOUSEHOLD REFERENCE PERSON}’s” FOR SELECTED PERSON IN SCQHRP. ELSE FILL “this household’s” IF SCQHRP = “NO ELIGIBLE HRP” (THIS IS WHEN THERE IS NO ONE AGE 18+ YEARS WHO USUALLY LIVES IN THIS HOUSEHOLD). TEXT FILL 2: FILL “your” IF THE SELECTED PERSON IN SCQHRP IS THE SCREENER RESPONDENT ELSE FILL “his” IF MALE, “her” IF FEMALE, “{HOUSEHOLD REFERENCE PERSON}” (NAME) IF ANOTHER GENDER. ELSE FILL “this household’s” IF SCQHRP = “NO ELIGIBLE HRP”
FILLS (SPA)	TEXT FILL 1: FILL “su dirección de correo postal” IF THE SELECTED PERSON IN SCQHRP IS THE SCREENER RESPONDENT ELSE FILL “{HOUSEHOLD REFERENCE PERSON}’s” FOR SELECTED PERSON IN SCQHRP. ELSE FILL “la dirección de correo postal de este hogar” IF SCQHRP = “NO ELIGIBLE HRP” (THIS IS WHEN THERE IS NO ONE AGE 18+ YEARS WHO USUALLY LIVES IN THIS HOUSEHOLD). TEXT FILL 2: FILL “su domicilio” IF THE SELECTED PERSON IN SCQHRP IS THE SCREENER RESPONDENT ELSE FILL “el domicilio de él” IF MALE, “el domicilio de ella” IF FEMALE, “{HOUSEHOLD REFERENCE PERSON}” (NAME) IF ANOTHER GENDER. ELSE FILL “el domicilio de esta vivienda” IF SCQHRP = “NO ELIGIBLE HRP”
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	SCQ.420
NEXT	IF SCQRPADSME in (2): SCQHRPADD ELSE: SCQSCVFQ

SCQHRPADD
ASK	IF SCQRPADSME in (2)
Please tell me <TEXT FILL 1> complete mailing address. {Address1} {Address2} {City} {State} {Zipcode}
SPANISH	Por favor dígame <TEXT FILL 1>. {Address1} {Address2} {City} {State} {Zipcode}
QUESTION TYPE
FILLS	TEXT FILL 1: FILL “your” IF THE SELECTED PERSON IN SCQHRP IS THE SCREENER RESPONDENT. FILL “{REFERENCE PERSON’s}” FOR SELECTED PERSON IN SCQHRP. FILL “this household’s” IF SCQHRP = “NO ELIGIBLE HRP”
FILLS (SPA)	TEXT FILL 1: FILL “su dirección de correo postal completa” IF THE SELECTED PERSON IN SCQHRP IS THE SCREENER RESPONDENT. FILL “{REFERENCE PERSON’s}” FOR SELECTED PERSON IN SCQHRP. FILL “la dirección de correo postal completa de esta vivienda” IF SCQHRP = “NO ELIGIBLE HRP
NOTES	DISPLAY THE CITY STATE AND ZIP CODE OF THE HOUSEHOLD AS COLLECTED IN SCQADDR OR SCQEADD AND ALLOW UPDATES IN ALL FIELDS. IF UPDATES ARE MADE, STORE THIS ADDRESS AS THE MAILING ADDRESS. IF NO UPDATES ARE MADE, RESET SCQHRP TO “NO” AND CONTINUE TO SCQVFQ ALLOW FOR P.O. BOX TO BE ENTERED.
HARD CHECK	IF NO CHANGES MADE TO ADDRESS DISPLAY, “YOU DID NOT MAKE CORRECTIONS. PLEASE VERIFY. IF NO CORRECTIONS ARE NECESSARY RETURN TO THE PREVIOUS SCREEN AND SELECT "YES" “ COMPARE STRINGS TO ADDRESS COLLECTED IN SCQADDR OR SCQEADD. IF SCQHRPADD IS THE SAME AS EITHER SCQADDR OR SCQEADD DISPLAY “THIS ADDRESS MATCHES THE HOUSEHOLD’S STREET ADDRESS. PLEASE VERIFY. IF THE MAILING ADDRESS MATCHES THE STREET ADDRESS, RETURN TO THE PREVIOUS SCREEN AND SELECT “YES” “
SOFT CHECK	IF “PO BOX” OR “P.O. BOX” WAS ENTERED INTO THE “ADDRESS 2” FIELD, DISPLAY A MESSAGE: “DO NOT INCLUDE STREET ADDRESS INFORMATION WHEN PO BOX INFORMATION IS ENTERED AS THE MAILING ADDRESS”.
VERSION NOTES	SCQ.425
NEXT	SCQVFQ

SCQVFQ/G/a/b
ASK	IF SCQSAMPALG in (SELECTED) OR (NOT SELECTED)
Thank you. My office may want to check on the quality of my work. May I have the best telephone number to reach you? ENTER PHONE NUMBER NO TELEPHONE 9 DON’T KNOW 7 REFUSED (|__|__|__|) |__|__|__|- |__|__|__|__| ENTER 10 DIGIT PHONE NUMBER 9 DON’T KNOW 7 REFUSED |__|__|__|__| ENTER EXTENSION 9 DON’T KNOW 7 REFUSED
SPANISH	Gracias. Es posible que el personal de mi oficina quiera verificar la calidad de mi trabajo. ¿Me puede dar el mejor número de teléfono para llamarlo(a)? ENTER PHONE NUMBER NO TELEPHONE 9 DON’T KNOW 7 REFUSED (|__|__|__|) |__|__|__|- |__|__|__|__| ENTER 10 DIGIT PHONE NUMBER 9 DON’T KNOW 7 REFUSED |__|__|__|__| ENTER EXTENSION 9 DON’T KNOW 7 REFUSED
QUESTION TYPE	Radio button (SCQVFQG) Numeric (SCQVFQa, SCQVFQb)
FILLS
NOTES	THE FIELD FOR "EXTENSION" IS ALLOWED TO BE BLANK.
HARD CHECK	IF SCQVFQG=1, ONLY ALLOW 10 DIGIT PHONE NUMBER OR DK/RF FOR SCQVFQA. DISPLAY HARD RANGE CHECK MESSAGE IF NOT 10 DIGITS OR 10 DIGITS THAT ARE ALL THE SAME (E.G., 1111111111), “PLEASE ENTER A VALID PHONE NUMBER.”
SOFT CHECK
VERSION NOTES	SCQ.431
NEXT	IF SCQVFQG in (1): SCQCELL IF SCQVFQG NOT EQUAL 1 AND SCQSAMPALG in (NOT SELECTGED): SCQTHANK IF SCQVFQG NOT EQUAL 1 AND SCQSAMPALG in (SELECTED); SCQSELECT ELSE, SCQTHANK

SCQCELL
ASK	IF SCQVFQG in (1)
Is this number a cell phone or landline? CELL PHONE LANDLINE 9 DON’T KNOW 7 REFUSED
SPANISH	¿Este número es de un teléfono celular o fijo? CELL PHONE LANDLINE 9 DON’T KNOW 7 REFUSED
QUESTION TYPE	Radio button
FILLS
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	SCQ.450
NEXT	IF SCQSAMPALG IN (NOT SELECTGED): SCQTHANK IF SCQSAMPALG IN (SELECTED); SCQSELECT IF BREAKOFF, SCQTHANK

SCQSELECT
ASK	IF SCQSAMPALG in (SELECTED)
Thank you for your responses today. {NAME/You} {and NAME2/NAME2} {and NAME3} {has/have} been selected for the study. {UNIQUE NAME, GENDER, AGE OF EACH SURVEY PARTICIPANT} EXPLAIN PARTICIPATION IN STUDY TO RESPONDENT. ADDRESS QUESTIONS ABOUT PARTICIPATION IN THE STUDY.
SPANISH	Gracias por sus respuestas de hoy. {NAME/Usted} {y NAME2/NAME2} {y NAME3} {ha sido seleccionado(a)/han sido seleccionados(as)} para el estudio. {UNIQUE NAME, GENDER, AGE OF EACH SURVEY PARTICIPANT} EXPLAIN PARTICIPATION IN STUDY TO RESPONDENT. ADDRESS QUESTIONS ABOUT PARTICIPATION IN THE STUDY.
QUESTION TYPE	N/a
FILLS	IF 1 PERSON SELECTED: FILL “You” AND “have” IF SELECTED PERSON IS THE RESPONDENT. ELSE DISPLAY “{NAME}” and “has”. IF 2 PEOPLE SELECTED: FILL “You and NAME2” IF SELECTED PERSON IS THE RESPONDENT. ELSE DISPLAY “{NAME and NAME2. FILL” “have”. IF 3 PEOPLE SELECTED: FILL “You, NAME2 and NAME3” IF SELECTED PERSON IS THE RESPONDENT. ELSE DISPLAY “{NAME, NAME2 and NAME3”. FILL” “have”.
FILLS (SPA)	IF 1 PERSON SELECTED: FILL “Usted” AND “ha sido seleccionado(a)” IF SELECTED PERSON IS THE RESPONDENT. ELSE DISPLAY “{NAME}” and “ha sido seleccionado(a)”. IF 2 PEOPLE SELECTED: FILL “Usted y {NAME2}” IF SELECTED PERSON IS THE RESPONDENT. ELSE DISPLAY “{NAME} y {NAME2}”. FILL “han sido seleccionados(as)”. IF 3 PEOPLE SELECTED: FILL “Usted, {NAME2} y {NAME3}” IF SELECTED PERSON IS THE RESPONDENT. ELSE DISPLAY “{NAME}, {NAME2} y {NAME3}”. FILL “han sido seleccionados(as)”.
NOTES	DISPLAY THE UNIQUE NAME, GENDER, AGE OF SURVEY PARTICIPANT IF SCQAGE AND SCQAGEEST AND SCQAGEREF ALL = RF/DK, DISPLAY AGE = 18 (THEY ARE SAMPLED AS IF THEY ARE IN THE 18-64 AGE RANGE AND WE TREAT THEIR AGE AS THE LOWEST AGE IN THE CATEGORY, WHICH IS 18).
HARD CHECK
SOFT CHECK
VERSION NOTES	SCQ.END2
NEXT	IF ANY PERSONS SELECTED <18 (I.E., SCQAGE < 18 YEARS, OR SCQAGEEST=(1, 2, 3), OR SCQAGEREF=2), GO TO SCQMINORINS ELSE, GO TO SCQINTP

SCQMINORINS
ASK	IF ANY SELECTED PERSON < 18 (I.E., SCQAGE < 18 YEARS, OR SCQAGEEST=(1, 2, 3), OR SCQAGEREF=2)
You previously indicated that <TEXT FILL 1> so we need an adult to answer questions about <TEXT FILL 2> health. Which adult(s) living in this household know the most about <TEXT FILL 2> health? (IF NEEDED: Is there another adult in this household who knows the most about <TEXT FILL 2> health?) CHECK ALL THAT APPLY. {DISPLAY ALL HOUSEHOLD MEMBERS > 18 ALLOW CHECK ALL THAT APPLY}
SPANISH	Usted indicó anteriormente que <TEXT FILL 1>, por lo que necesitamos que un adulto responda las preguntas sobre <TEXT FILL 2> salud. ¿Qué adulto(a) que vive en este hogar sabe más sobre <TEXT FILL 2> salud? (IF NEEDED: ¿Hay algún otro adulto en este hogar que sepa más sobre <TEXT FILL 2> salud?) CHECK ALL THAT APPLY. {DISPLAY ALL HOUSEHOLD MEMBERS > 18 ALLOW CHECK ALL THAT APPLY}
QUESTION TYPE	CHECK ALL THAT APPLY
FILLS	TEXT FILL 1: IF 1 MINOR IS SELECTED fill “[SELECTED SP NAME < 18] is younger than 18 years old” IF > 1 MINOR IS SELECTED fill “[LIST SELECTED SP NAMES < 18] are younger than 18 years old TEXT FILL 2: IF 1 MINOR IS SELECTED fill “his” IF MALE, “her” IF FEMALE, OR “[SP NAME]’s” IF ANOTHER GENDER IF > 1 MINOR IS SELECTED fill “their”
FILLS (SPA)	TEXT FILL 1: IF 1 MINOR IS SELECTED fill “[SELECTED SP NAME < 18] tiene menos de 18 años” IF > 1 MINOR IS SELECTED fill “[LIST SELECTED SP NAMES < 18] tienen menos de 18 años TEXT FILL 2: IF 1 MINOR IS SELECTED fill “su” IF MALE, “su” IF FEMALE, OR “[SP NAME]’s” IF ANOTHER GENDER IF > 1 MINOR IS SELECTED fill “su”
NOTES	IF ONLY ONE PERSON IDENTIFIED AS 18+ YEARS, THEN AUTOFILL THAT PERSON AS “SELECTED” IN SCQMINORINS AND GO TO SCQINTP.
HARD CHECK
SOFT CHECK
VERSION NOTES
NEXT	SCQINTP

SCQTHANK
ASK	IF THIS IS A BREAK-OFF
Thank you.
SPANISH
QUESTION TYPE	N/a
FILLS
NOTES	AFTER EXITING FROM THIS SCREEN, PRESENT THE LIST OF DISPOSITIONS AND DO NOT ALLOW EXIT FROM THE APPLICATION WITHOUT ENTRY OF A DISPOSITION.
HARD CHECK
SOFT CHECK
VERSION NOTES	SCQ.END3
NEXT	SCQINTP

SCQWRADD
ASK	IF SCQADDR IN (3),
Thank you. LOCATE CORRECT ADDRESS AND CLICK HERE TO RESTART SCREENER WITH THE CORRECT ADDRESS.
SPANISH
QUESTION TYPE	N/a
FILLS
NOTES	INCLUDE A LINK IN “CLICK HERE” THAT ROUTES THE FI BACK TO SCQINTR
HARD CHECK
SOFT CHECK
VERSION NOTES	SCQ.END5
NEXT	END OF SECTION

SCQADAVAIL
ASK	IF SCQVER in (2) IF SCQRES in (2)
Thank you. Is there someone whom I could speak with who is 18 years or older and lives here? IDENTIFY HOUSEHOLD RESIDENT WHO IS 18 YEARS OR OLDER. IF NOT AVAILABLE, ASK WHEN WOULD BE A GOOD TIME TO COME BACK TO SPEAK TO AN ADULT. CLICK HERE TO RESTART SCREENER WITH AN AVAILABLE ADULT. YES NO
SPANISH	Gracias. ¿Hay alguien con quien pueda hablar que tenga 18 años o más y viva aquí? IDENTIFY HOUSEHOLD RESIDENT WHO IS 18 YEARS OR OLDER. IF NOT AVAILABLE, ASK WHEN WOULD BE A GOOD TIME TO COME BACK TO SPEAK TO AN ADULT. CLICK HERE TO RESTART SCREENER WITH AN AVAILABLE ADULT. YES NO
QUESTION TYPE	Radio button
FILLS
NOTES	“CLICK HERE” SHOULD BE A LINK THAT ROUTES BACK TO SCQINTR FOR FI TO RESTART SCREENER WITH AN AVAILABLE ADULT
HARD CHECK
SOFT CHECK	IF SCQADAVAIL = 1, DISPLAY “PLEASE SUPPRESS THIS MESSAGE AND CLICK “NEXT” TO RESTART WITH AN AVAILABLE ADULT. IF AN ADULT IS NOT AVAILABLE, CLICK “NO” AND LOG IN THE CASE NOTES.”
VERSION NOTES	SCQ_END6
NEXT	END OF SECTION

SCQINTP
ASK	ALL (INTERVIEWER QUESTION ONLY)
WAS AN INTERPRETER USED FOR SCREENER? YES NO
SPANISH	NO SPANISH TRANSLATION NEEDED
QUESTION TYPE	Radio button
FILLS
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.001
NEXT	IF SCQINTP in (1): SCQILANG ELSE: END OF SECTION

SCQILANG
ASK	IF SCQINTP in (1)
LANGUAGE USED FOR SCREENER AMERICAN SIGN LANGUAGE CHINESE (CANTONESE) CHINESE (MANDARIN) FRENCH GERMAN ITALIAN JAPANESE KOREAN RUSSIAN SPANISH (READER) VIETNAMESE 90. OTHER SPECIFY
SPANISH	NO SPANISH TRANSLATION NEEDED
QUESTION TYPE	Radio button
FILLS
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.003
NEXT	IF SCQILANG in (90): SCQIOTHLNG ELSE: SCQINGOT

SCQIOTHLNG
ASK	IF SCQILANG in (99)
ENTER LANGUAGE USED FOR SCREENER ___________________________
SPANISH	NO SPANISH TRANSLATION NEEDED
QUESTION TYPE	Text box
FILLS
NOTES	ALLOW FOR 50 CHARACTERS IN TEXTBOX
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.004
NEXT	SCQINGOT

SCQINGOT
ASK	IF SCQINTP in (1)
HOW WAS INTERPRETER OBTAINED? ARRANGED BY THE OFFICE RECRUITED DURING VISIT/APPOINTMENT
SPANISH	NO SPANISH TRANSLATION NEEDED
QUESTION TYPE	Radio button
FILLS
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.005
NEXT	IF SCQINGOT in (2): SCQIHHN ELSE: SCQINAME

SCQINAME
ASK	IF SCQINGOT in (1)
ENTER NAME OF INTERPRETER HERE AND IN RECORD OF CALLS WHEN SCREENING IS COMPLETED.
SPANISH	NO SPANISH TRANSLATION NEEDED
QUESTION TYPE	Text box (“FIRST AND LAST NAME”)
FILLS
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	New
NEXT	END OF SECTION.

SCQIHHN
ASK	IF SCQINGOT in (2)
SELECT NAME OF INTERPRETER FROM HOUSEHOLD ROSTER. {DISPLAY LIST FROM HH ROSTER OF ALL HOUSEHOLD ADULTS >18 EXCEPT THE INSTRUMENT RESPONDENT INCLUDE AN OPTION FOR “SOMEONE OUTSIDE THE HOUESEHOLD”} <TEXT FILL 1>
SPANISH	NO SPANISH TRANSLATION NEEDED
QUESTION TYPE	Dropdown
FILLS
NOTES	FOR THE “SOMEONE OUTSIDE THE HOUSEHOLD” OPTION, PROGRAM LIKE AN “OTHER, SPECIFY” OPTION AND INCLUDE A TEXTBOX THAT ALLOWS THE FIRST AND LAST NAME TO BE TYPED IN, DISPLAY TEXT FILL 1: “ENTER NAME OF INTERPRETER HERE AND IN RECORD OF CALLS WHEN SCREENING IS COMPLETED.” [SCQOINTN]
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.008
NEXT	END OF SECTION

END OF SECTION

6a-29