0920-0950 Household Questionnaire

Attachment 6c

Household Questionnaire

Attachment 6c: Household 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 15 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

• Household Reference Persons

  • [LIST OF HOUSEHOLD REFERENCE PERSONS]

  • From SCQHRP –

    • IF ONLY PERSON SELECTED, THAT PERSON IS FLAGGED AS THE HOUSEHOLD REFERENCE PERSON.

    • IF MULTIPLE PERSONS ARE SELECTED, AMONG THE SELECTED ONES, THE PERSON LISTED FIRST ON THE ROSTER IS FLAGGED AS THE HOUSEHOLD REFERENCE PERSON.

    • IF THERE ARE NO ELIGIBLE ADULTS, THE HOUSEHOLD ROSTER IS FLAGGED AS “NO ELIGIBLE HRP”.

• Interpreters from previous instruments:

  • DISPLAY INTERPRETER NAME FROM SCREENER

    • Screener: SCQINAME or SCQIHHN

  • NEED TO KNOW WHETHER SCREENER INTERPRETER WAS ARRANGED BY OFFICE OR RECRUITED IN HOUSEHOLD

    • SCQINGOT: ARRANGED BY OFFICE (1), RECRUITED DURING VISIT/APPOINTMENT (2)

• Household Roster:

  • [list of household roster from SCQSAMPALG]

• Number of people in the household

  • From SCQSAMPALG

• Each household member’s age

  • SCQAGE, SCQAGEEST, OR SCQAGEREF

• Each household member’s gender:

  • SCQGEND
    
    

• Each household member’s status of whether they’re an SP or not

  • SCQSAMPALG?
    
    

• If the household is flagged in SCQHRP as “NO ELIGIBLE HRP”

  • Need the name of the oldest SP

  • This will come from a combination of SCQSAMPALG + (SCQAGE, SCQAGEEST, OR SCQAGREF)
    
    

• State EBT Name:

  • Display the name of the State EBT card if a name is available

  • [STATE NAME FOR EBT CARD]
    
    

• Participant Help Desk

  • • 800-344-1386

Survey Defaults

Unless otherwise noted in the specs, all variables are required to be answered.

• The default hard check if an answer is left blank is, “INTERVIEWER: ANSWER REQUIRED. SELECT A RESPONSE OR SELECT "DON'T KNOW" OR "REFUSED" IF AVAILABLE.”

• All other hard and soft check messages are dependent on the variable and are listed in the hard and soft check rows of the respective variable spec tables.

Interview Instrument – HHQ

HHQNAME
ASK	IF HHQVERIFY = 2
SELECT RESPONDENT FOR THE HOUSEHOLD QUESTIONNAIRE [LIST OF HOUSEHOLD REFERENCE PERSONS]
SPANISH	NA
QUESTION TYPE	Selection from displayed list
FILLS
NOTES	DISPLAY ALL HOUSEHOLD MEMBERS > 18 IDENTIFIED AS POSSIBLE HOUSEHOLD REFERENCE PERSONS. ALSO DISPLAY AN OPTION FOR ‘ANOTHER ADULT IN THE HOUSEHOLD’ AND ‘SOMEONE OUTSIDE HOUSEHOLD.’ IF A NAME IS SELECTED FROM THE LISTED NAMES, ASSIGN PERSON SELECTED IN HHQNAME AS THE HOUSEHOLD REFERENCE PERSON.
HARD CHECK	IF ‘ANOTHER ADULT IN THE HOUSEHOLD’ SELECTED AND THERE ARE NO OTHER ADULTS IN THE HOUSEHOLD, DISPLAY: ‘THERE ARE NO OTHER ADULTS IN THE HOUSEHOLD THAT QUALIFY. PLEASE SELECT ‘SOMEONE OUTSIDE THE HOUSEHOLD’ OR PRESS EXIT TO BREAK OFF AND CONTACT YOUR SUPERVISOR.”
SOFT CHECK	IF ‘ANOTHER ADULT IN THE HOUSEHOLD’ SELECTED AND THERE ARE OTHER HRP’S IN THE HOUSEHOLD, DISPLAY: “INTERVIEWER INSTRUCTION: INTERVIEW SHOULD BE COMPLETED WITH A HOUSEHOLD REFERENCE PERSON IF ONE IS AVAILABLE.” IF ‘SOMEONE OUTSIDE THE HOUSEHOLD’ SELECTED, DISPLAY: “INTERVIEWER INSTRUCTION: INTERVIEW SHOULD BE COMPLETED WITH A HOUSEHOLD REFERENCE PERSON IF ONE IS AVAILABLE. IF A HOUSEHOLD REFERENCE PERSON IS NOT AVAILABLE, THE INTERVIEW SHOULD BE COMPLETED WITH ANOTHER ADULT IN THE HOUSEHOLD IF AVAILABLE.”
VERSION NOTES	RIQ.010
NEXT	IF HHQNAME IN ‘ANOTHER ADULT IN THE HOUSEHOLD’ AND THERE IS NO OTHER ADULT IN THE HOUSEHOLD, EXIT MODULE ELSE IF HHQNAME in ‘ANOTHER ADULT IN THE HOUSEHOLD’: HHQHHADULT IF HHQNAME IN ‘SOMEONE OUTSIDE THE HOUSEHOLD’: HHQROHH ELSE: HHQINTRO

HHQHHADULT
ASK	IF HHQNAME = ‘ANOTHER ADULT IN THE HOUSEHOLD’
SELECT ADULT RESPONDENT FROM THE HOUSEHOLD FOR THE HOUSEHOLD QUESTIONNAIRE. [LIST OF ADULTS > 18 FROM HOUSEHOLD ROSTER]
SPANISH	NA
QUESTION TYPE	Selection from displayed list
FILLS
NOTES	DISPLAY LIST OF HOUSEHOLD ADULTS FROM ROSTER, NOT INCLUDING THOSE LISTED IN HHQNAME IF A NAME IS SELECTED FROM THE LISTED NAMES, ASSIGN PERSON SELECTED IN HHQHHADULT AS THE RESPONDENT AND RETAIN HRP AS THE FIRST PERSON ON THE ROSTER FROM SCQHRP.
HARD CHECK
SOFT CHECK
VERSION NOTES
NEXT	HHQROHHA

HHQROHHA/ HHQROHHAO
ASK	IF HHQNAME in ‘ANOTHER ADULT IN THE HOUSEHOLD’
THE INTERVIEW SHOULD BE CONDUCTED WITH A HOUSEHOLD MEMBER 18 YEARS OR OLDER WHO KNOWS ABOUT HOUSEHOLD MATTERS. WHY IS THE INTERVIEW BEING CONDUCTED WITH ANOTHER ADULT IN THE HOUSEHOLD? NONE OF THE VALID HOUSEHOLD REFERENCE PERSONS WERE AVAILABLE AFTER MULTIPLE ATTEMPTS ALL VALID HOUSEHOLD REFERENCE PERSONS REFUSED SELECTED IN ERROR OTHER (SPECIFY)
SPANISH	NA
QUESTION TYPE	HHQROHH: Radio button HHQROHHO: Text box (“Other specify”)
FILLS
NOTES	IF HHQROHH IS 4, DISPLAY ON SCREEN HHQROHHO: “WHY IS THE INTERVIEW BEING CONDUCTED WITH ANOTHER ADULT?” CHARACTER LIMIT FOR OTHER SPECIFY: 150. IF HHQROHHA IN (1) (2) OR (4), FLAG FOR SUPERVISOR REVIEW
HELP SCREEN
HARD CHECK	IF “SELECTED IN ERROR” (CODE 3), DISPLAY THE FOLLOWING MESSAGE: "INCORRECT RESPONDENT SELECTED. BACK UP AND PICK THE CORRECT RESPONDENT." ALLOW RETURN TO HHQROHH.
SOFT CHECK
VERSION NOTES	RIQ.041
NEXT	IF HHQROHHA IN (1), (2), OR (4): HHQINTRO

HHQROHH/ HHQROHHO
ASK	IF HHQNAME in ‘SOMEONE OUTSIDE HOUSEHOLD’
THE INTERVIEW SHOULD BE CONDUCTED WITH A HOUSEHOLD MEMBER 18 YEARS OR OLDER WHO KNOWS ABOUT HOUSEHOLD MATTERS. WHY IS THE INTERVIEW BEING CONDUCTED WITH SOMEONE OUTSIDE THE HOUSEHOLD? 1. ONLY HOUSEHOLD MEMBER HAS COGNITIVE PROBLEMS 2. SELECTED IN ERROR 3. OTHER (SPECIFY)
SPANISH	NA
QUESTION TYPE	HHQROHH: Radio button HHQROHHO: Text box (“OTHER SPECIFY”)
FILLS
NOTES	IF HHQROHH IS 3, DISPLAY ON SCREEN HHQROHHO: “WHY IS THE INTERVIEW BEING CONDUCTED WITH SOMEONE OUTSIDE THE HOUSEHOLD?” CHARACTER LIMIT FOR OTHER SPECIFY: 150.
HELP SCREEN
HARD CHECK	IF “SELECTED IN ERROR” (CODE 2), DISPLAY THE FOLLOWING MESSAGE: "INCORRECT RESPONDENT SELECTED. BACK UP AND PICK THE CORRECT RESPONDENT." ALLOW RETURN TO HHQROHH.
SOFT CHECK
VERSION NOTES	RIQ.041
NEXT	HHQSUPERM

HHQSUPERM
ASK	IF HHQROHH in (1) OR (3) AND HHQNAME = “SOMEONE OUTSIDE THE HOUSEHOLD”
DO YOU HAVE SUPERVISOR PERMISSION TO CONDUCT THE INTERVIEW WITH SOMEONE OUTSIDE THE HOUSEHOLD? 1. YES 2. NO
SPANISH	NA
QUESTION TYPE	Radio button
FILLS
NOTES	IF 'NO' (CODE 2), DISPLAY THE FOLLOWING MESSAGE: "SUPERVISOR PERMISSION IS REQUIRED TO USE SOMEONE OUTSIDE THE HOUSEHOLD FOR THIS INTERVIEW." IF SUPPRESS IS SELECTED, DISPLAY “SUPPRESSING THIS CHECK A SECOND TIME WILL END THE INTERVIEW.” SUPPRESSING THE MESSAGE AND CONTINUING EXITS THIS MODULE. IF HHQSUPERM = 1, FLAG FOR SUPERVISOR REVIEW
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	RIQ.042
NEXT	IF HHQSUPERM = 2, EXIT MODULE ELSE IF HHQSUPERM = 1 AND HHQNAME in ‘SOMEONE OUTSIDE HOUSEHOLD’, HHQRNAME

HHQRFNAME / HHQRLNAME
ASK	IF HHQSUPERM in (1) AND HHQNAME in ‘SOMEONE OUTSIDE HOUSEHOLD’
ENTER RESPONDENT NAME. FIRST NAME [HHQRFNAME] LAST NAME [HHQRLNAME]
SPANISH	NA
QUESTION TYPE	Textbox
FILLS
NOTES	HHQRFNAME : ALLOW 50 CHARACTERS HHQRLNAME : ALLOW 50 CHARACTERS
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	RIQ.045a/b
NEXT	HHQRPHONE

HHQRPHONE
ASK	IF HHQSUPERM in (1) AND HHQNAME in ‘SOMEONE OUTSIDE HOUSEHOLD’
ENTER RESPONDENT'S PHONE NUMBER. ENTER '000' IN AREA CODE IF NO PHONE. |___|___|___| |___|___|___| - |___|___|___|___| AREA CODE ENTER PHONE NUMBER 999 DON’T KNOW 777 REFUSED
SPANISH	NA
QUESTION TYPE	Numeric
FILLS
NOTES
HELP SCREEN
HARD CHECK	ONLY ALLOW RESPONSE OF DON’T KNOW, REFUSED, "000", or 10-DIGIT PHONE NUMBER.” DISPLAY HARD RANGE CHECK MESSAGE IF NOT "000" or 10 DIGITS THAT ARE NOT ALL THE SAME (E.G., 1111111111): ‘PLEASE ENTER A VALID PHONE NUMBER’.
SOFT CHECK
VERSION NOTES	RIQ.047
NEXT	HHQRRELAHH

HHQRRELAHH
ASK	IF HHQSUPERM in (1) AND HHQNAME in ‘SOMEONE OUTSIDE HOUSEHOLD’
DESCRIBE RESPONDENT'S RELATIONSHIP TO HOUSEHOLD.
SPANISH	NA
QUESTION TYPE	Textbox
FILLS
NOTES	ALLOW 100 CHARACTERS.
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	RIQ.049
NEXT	HHQINTRO

HHQINTRO
ASK	All respondents
INTERVIEWER INSTRUCTION: READ TEXT IN PARENTHESES ONLY IF RESPONDENT HAS NOT ALREADY RESPONDED TO ANY SP QUESTIONNAIRE. (Welcome to the National Health and Nutrition Examination Survey, also known as NHANES. <TEXT FILL 1> been selected to be part of this study which includes an interview and a health exam. This study is sponsored by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. The information collected in this interview will help us understand the health of people in the United States.) In this interview, I will ask health-related questions about <TEXT FILL 2> household. PRESS NEXT TO CONTINUE.
SPANISH	INTERVIEWER INSTRUCTION: READ TEXT IN PARENTHESES ONLY IF RESPONDENT HAS NOT ALREADY RESPONDED TO ANY SP QUESTIONNAIRE. (Bienvenido(a) a la Encuesta Nacional de Examen de la Salud y Nutrición, también conocida como NHANES, por sus siglas en inglés. <TEXT FILL 1> ha sido seleccionado(a) para formar parte de este estudio que incluye una entrevista y un examen de salud. Este estudio está patrocinado por el Centro Nacional de Estadísticas de la Salud, parte de los Centros para el Control y la Prevención de Enfermedades. La información recopilada en esta entrevista nos ayudará a comprender la salud de las personas en los Estados Unidos). En esta entrevista, haré preguntas relacionadas con la salud sobre <TEXT FILL 2>. PRESS NEXT TO CONTINUE.
QUESTION TYPE	Text
FILLS (ENG)	TEXT FILL 1: FILL “You have” RESPONDENT IS IN HOUSEHOLD AND IS SP; FILL “Someone in your household has” IF RESPONDENT IS IN HOUSEHOLD AND IS NOT SP; FILL “[SP’s NAME] has” IF HHQNAME = SOMEONE OUTSIDE HOUSEHOLD AND IS A ONE-PERSON HOUSEHOLD FILL “Someone in [HOUSEHOLD RP NAME]’s household has” HHQNAME = SOMEONE OUTSIDE HOUSEHOLD AND IS MULTIPLE PERSON HOUSEHOLD TEXT FILL 2: FILL “your” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “[HOUSEHOLD RP NAME]’s”
FILLS (SPA)	TEXT FILL 1: FILL “Usted” RESPONDENT IS IN HOUSEHOLD AND IS SP; FILL “Alguien en su hogar” IF RESPONDENT IS IN HOUSEHOLD AND IS NOT SP; FILL “[SP's NAME]” IF HHQNAME = SOMEONE OUTSIDE HOUSEHOLD AND IS A ONE-PERSON HOUSEHOLD FILL “Alguien en el hogar de [HOUSEHOLD RP NAME]” HHQNAME = SOMEONE OUTSIDE HOUSEHOLD AND IS MULTIPLE PERSON HOUSEHOLD TEXT FILL 2: FILL “su hogar” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “el hogar de [HOUSEHOLD RP NAME]”
NOTES	BEGIN RECORDING SO THAT WHEN INTERVIEWER READS THIS QUESTION IT IS CAPTURED ON RECORDING.
HARD CHECK
SOFT CHECK
VERSION NOTES	DMQ.INTRO
NEXT	HHQRECORD.

HHQRECORD
ASK	ALL RESPONDENTS
We would like to record the interview for training and data quality. The computer is now recording our conversation. Do I have your permission to continue recording? 1. YES 2. NO
SPANISH	Nos gustaría grabar la entrevista para la capacitación y calidad de los datos. La computadora está grabando nuestra conversación ahora. ¿Tengo su permiso para seguir grabando? 1. YES 2. NO
QUESTION TYPE	Radio button
FILLS
NOTES
HELP SCREEN	How long will the recording be kept? The audio recording will be deleted after three years. You can call our toll free number 800-344-1386 at any time to have your audio recording deleted prior to that time. Who will have access to my recordings? Recordings are only used by persons authorized to work on NHANES for reviewing the quality of my work and tools and questionnaires used in the survey.
HELP SCREEN (SPA)	¿Cuánto tiempo se conservará la grabación? La grabación de audio se borrará después de tres años. Puede llamar a nuestra línea gratuita al 800-344-1386 en cualquier momento si quiere que la borremos antes. ¿Quién tendrá acceso a mis grabaciones? Las grabaciones solo son usadas por las personas autorizadas a trabajar en la Encuesta Nacional de Examen de la Salud y Nutrición, con fines de revisar la calidad de mi trabajo, así como las herramientas y cuestionarios que se usan en la encuesta.
HARD CHECK
SOFT CHECK
VERSION NOTES	RIQ.211
NEXT	IF HHQRECORD = 2: HHQRECORDN ELSE: HHQCONSENT

HHQRECORDN
ASK	IF HHQRECORD = 2
I will turn off the recording now.
SPANISH	Apagaré la grabación ahora.
QUESTION TYPE	Instruction
FILLS
NOTES
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES
NEXT	HHQCONSENT

HHQCONSENT
ASK	All respondents
ADULT RESPONDENT INTERVIEW CONSENT In this interview, we will ask health-related questions about <TEXT FILL 1> household. On average, the interview will take 15 minutes. Taking part in this interview is voluntary, which means it’s your choice to participate. If you decide to participate, you may choose to skip any question you don’t want to answer. You can also end the interview at any time.  All the information you provide is kept private. By Federal law, we must follow strict procedures to protect the information you share with us. We will keep your information confidential, which means your answers will not be connected to your name or anything else that can identify <TEXT FILL 1> household’s participation. If you have questions about your rights in being in the survey, you can make a toll-free call to the National Center for Health Statistics Ethics Review Board at 1-800-223-8118. ANSWER ANY QUESTIONS Do you agree to proceed with the interview? 1. YES 2. NO
SPANISH	ADULT RESPONDENT INTERVIEW CONSENT En esta entrevista, haré preguntas relacionadas con la salud <TEXT FILL 1>. En promedio, la entrevista tomará 15 minutos. Tomar parte en esta entrevista es voluntario, lo que significa que usted elige participar. Si decide participar, puede dejar de contestar cualquier pregunta que no desee responder. También puede detener la entrevista en cualquier momento.  Toda la información que usted proporciona se mantiene privada. Según la ley federal, debemos seguir procedimientos estrictos para proteger la información que comparte con nosotros. Mantendremos su información confidencial, lo que significa que sus respuestas no estarán asociadas con su nombre ni con cualquier otra cosa que pueda identificar la participación <TEXT FILL 1>. Si tiene preguntas sobre sus derechos al participar en la encuesta, puede llamar a la línea gratuita a la Junta de Revisión de Ética del Centro Nacional de Estadísticas de la Salud al 1-800-223-8118. ANSWER ANY QUESTIONS ¿Acepta continuar con la entrevista? 1. YES 2. NO
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: “your” IF RESPONDENT IS IN HOUSEHOLD “[HOUSEHOLD RP NAME]'s” IF HHQNAME = SOMEONE OUTSIDE HOUSEHOLD
FILLS (SPA)	TEXT FILL 1: “de su hogar” IF RESPONDENT IS IN HOUSEHOLD “del hogar de [HOUSEHOLD RP NAME]” IF HHQNAME = SOMEONE OUTSIDE PARAGRAPH 2: HOUSEHOLD
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	RIQ.510
NEXT	IF HHQCONSENT = 2: HHQEND ELSE: HHQINT

HHQINT
ASK	ALL RESPONDENTS
IS AN INTERPRETER BEING USED FOR THE COLLECTION? 1. YES 2. NO
SPANISH	NA
QUESTION TYPE	Radio button
FILLS
NOTES
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.001
NEXT	IF HHQINT in (1): HHQINTL IF HHQINT in (2): HOQROOMS

HHQINTL
ASK	IF HHQINT in (1)
LANGUAGE USED FOR THE COLLECTION 1. AMERICAN SIGN LANGUAGE 2. CHINESE (CANTONESE) 3. CHINESE (MANDARIN) 4. FRENCH 5. GERMAN 6. ITALIAN 7. JAPANESE 8. KOREAN 9. RUSSIAN 10. SPANISH (READER) 11. VIETNAMESE 90. OTHER SPECIFY
SPANISH	NA
QUESTION TYPE	Radio button
FILLS
NOTES
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.003
NEXT	IF HHQINTL in (90): HHQINTLO IF INTERPRETER WAS USED IN SCREENER: HHQINTOI ELSE: HHQINTOB

HHQINTLO
ASK	IF HHQINTL in (90)
ENTER LANGUAGE USED FOR THE COLLECTION.
SPANISH	NA
QUESTION TYPE	Textbox
FILLS
NOTES	ALLOW 50 CHARACTERS.
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.004
NEXT	IF INTERPRETER USED IN SCREENER: HHQINTOI ELSE: HHQINTOB

HHQINTOI
ASK	IF HHQINT in (1)
INTERPRETERS USED IN SCREENER: <TEXT FILL 1> SELECT SOURCE 1. SAME INTERPRETER USED IN SCREENER (<TEXT FILL 1>) 2. NEW INTERPRETER
SPANISH	NA
QUESTION TYPE	Radio button
FILLS	TEXT FILL 1: DISPLAY INTERPRETER NAMES FROM ALL PREVIOUS INTERVIEWS: SCREENER
NOTES
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.013
NEXT	IF HHQINTOI in (1): HHQINTNUM IF HHQINTOI in (2): HHQINTOB

HHQINTOB
ASK	IF HHQINTOI in (2)
HOW WAS INTERPRETER OBTAINED? 1. ARRANGED BY THE OFFICE 2. RECRUITED DURING VISIT OR APPOINTMENT
SPANISH	NA
QUESTION TYPE	Radio button
FILLS
NOTES
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.005
NEXT	IF HHQINTOB in (1): HHQINTNOFC IF HHQINTOB in (2): HHQINTOBS

HHQINTNOFC
ASK	IF HHQINTOB in (1)
ENTER FIRST AND LAST NAME OF INTERPRETER HERE.
SPANISH	NA
QUESTION TYPE	Text box (“FIRST AND LAST NAME”)
FILLS
NOTES	ALLOW 150 CHARACTERS.
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.006
NEXT	HHQINTNUM

HHQINTOBS
ASK	IF HHQINTOB in (2)
SELECT INTERPRETER SOURCE 1. RELATIVE LIVING IN HOUSEHOLD 2. NON-RELATIVE LIVING IN HOUSEHOLD 3. NEIGHBOR, RELATIVE OR FRIEND – NOT IN HOUSEHOLD
SPANISH	NA
QUESTION TYPE	Radio button
FILLS
NOTES
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.007
NEXT	IF HHQINTOBS in (3): HHQINTOBSN ELSE HHQINTOBSHHR

HHQINTOBSHHR/ HHQINTOBSHHRO
ASK	IF HHQINTOBS in (1) OR (2)
SELECT NAME OF INTERPRETER FROM HOUSEHOLD ROSTER. <TEXT FILL 1>
SPANISH	NA
QUESTION TYPE	Dropdown
FILLS	TEXT FILL 1: {DISPLAY LIST OF ADULTS FROM HH ROSTER NOT INCLUDING THE RESPONDENT} INCLUDE “OTHER: SPECIFY” OPTION HHQINTOBSHHRO THAT ASKS FOR “FIRST AND LAST NAME”
NOTES	ALLOW 150 CHARACTERS.
HELP SCREEN
HARD CHECK
SOFT CHECK	IF “OTHER: SPECIFY” IS CHOSEN, DISPLAY: “INTERVIEWER: THIS PERSON WAS NOT ROSTERED IN THE SCREENER. CONFIRM THIS PERSON IS AN ADULT LIVING IN THE HOUSEHOLD. IF NEEDED, BACK UP AND SELECT 'NEIGHBOR, RELATIVE OR FRIEND – NOT IN HOUSEHOLD’. IF CONFIRMED, PRESS ‘SUPPRESS’ THEN CONTINUE.”
VERSION NOTES	INT.008
NEXT	HHQINTNUM

HHQINTOBSN
ASK	IF HHQINTOBS in (3)
ENTER FIRST AND LAST NAME OF INTERPRETER.
SPANISH	NA
QUESTION TYPE	Textbox (“FIRST AND LAST NAME”)
FILLS
NOTES	ALLOW 150 CHARACTERS.
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.009
NEXT	HHQINTNUM

HHQINTNUM
ASK	IF HHQINT IN (1)
ENTER PHONE # OF INTERPRETER. ENTER '000' IN AREA CODE IF NO PHONE. |___|___|___| |___|___|___| - |___|___|___|___| AREA CODE ENTER PHONE NUMBER DON'T KNOW 99 REFUSED 77
SPANISH	NA
QUESTION TYPE	Numeric
FILLS
NOTES
HELP SCREEN
HARD CHECK	ONLY ALLOW "000" or 10 DIGIT PHONE NUMBER.” DISPLAY HARD RANGE CHECK MESSAGE IF NOT "000" or 10 DIGITS THAT ARE NOT ALL THE SAME (E.G., 1111111111): ‘PLEASE ENTER A VALID PHONE NUMBER’.
SOFT CHECK
VERSION NOTES	INT.010
NEXT	HOQROOMS

HOUSING CHARACTERISTICS – HOQ

Target Group: SP’s Household

HOQROOMS
ASK	All respondents
First, I would like to ask you a few questions about this home. How many rooms are in this home? Count the kitchen but do not count any bathrooms, or an unfinished basement. |___|___| ENTER NUMBER OF ROOMS DON'T KNOW 99 REFUSED 77
SPANISH	Primero, me gustaría hacerle algunas preguntas sobre esta vivienda. ¿Cuántas habitaciones hay en esta vivienda? Cuente la cocina, pero no los baños ni el sótano sin terminar. |___|___| ENTER NUMBER OF ROOMS DON'T KNOW 99 REFUSED 77
QUESTION TYPE	Numeric
FILLS
NOTES	HARD EDIT: 1-25
HELP SCREEN	Rooms must be separated by built-in archways or walls that extend out at least 6 inches and go from floor to ceiling. INCLUDE bedrooms, kitchens, etc. EXCLUDE bathrooms, porches, balconies, foyers, halls, or unfinished basements.
HELP SCREEN (SPA)	Las habitaciones deben estar separadas por arcos incorporados o paredes que se extiendan al menos 6 pulgadas y vayan desde el piso hasta el techo. INCLUYA dormitorios, cocinas, etc. EXCLUYA baños, porches, balcones, vestíbulos, pasillos o sótanos sin terminar.
HARD CHECK
SOFT CHECK
VERSION NOTES	HOQ.051
NEXT	HOQDURATN

HOQDURATN
ASK	All respondents
How long <TEXT FILL 1> lived at this address? 1. Less than a year 2. 1 to 2 years 3. 3 to 5 years 4. 6 to 10 years 5. More than 10 years 9. DON’T KNOW 7. REFUSED
SPANISH	¿Cuánto tiempo ha vivido <TEXT FILL 1> en esta dirección? 1. Menos de un año 2. Entre 1 y 2 años 3. Entre 3 y 5 años 4. Entre 6 y 10 años 5. Más de 10 años 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “have you” IF RESPONDENT IS IN THE HOUSEHOLD ELSE, FILL “has [HOUSEHOLD RP NAME]”
FILLS (SPA)	TEXT FILL 1: FILL “usted” IF RESPONDENT IS IN THE HOUSEHOLD ELSE, FILL “[HOUSEHOLD RP NAME]”
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	HOQ.060N
NEXT	HOQTAPWATR

HOQTAPWATR
ASK	All respondents
Please look at this card. What is the main source of tap water in this home? HAND CARD HOQ1 1. A CITY WATER SUPPLY (ALSO KNOWN AS A PUBLIC OR COMMUNITY WATER SYSTEM) THROUGH UNDERGROUND PIPES TO THIS HOME 2. AN INDIVIDUAL OR PRIVATE WELL 3. RAINWATER ROUTED INTO A TANK OR CISTERN ON THIS PROPERTY 4. A SPRING 5. SOMETHING ELSE 9. DON’T KNOW 7. REFUSED
SPANISH	Mire esta tarjeta. ¿Cuál es la principal fuente de agua potable en este hogar? HAND CARD HOQ1 1. UN SUMINISTRO DE AGUA DE LA CIUDAD (TAMBIÉN CONOCIDO COMO SISTEMA DE AGUA PÚBLICO O COMUNITARIO) A TRAVÉS DE TUBERÍAS SUBTERRÁNEAS HACIA ESTE HOGAR 2. UN POZO INDIVIDUAL O PRIVADO 3. AGUA DE LLUVIA DIRIGIDA A UN TANQUE O CISTERNA EN ESTA PROPIEDAD 4. UN MANANTIAL 5. OTRA COSA 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	HOQ.070
NEXT	HOQODOR

HOQODOR
ASK	All respondents
In the last 12 months, <TEXT FILL 1> had a mildew odor or musty smell? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	En los últimos 12 meses, ¿ha tenido <TEXT FILL 1> olor a moho o humedad? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “has this home” IF HOQDURATN = (3, 4, 5). ELSE, FILL “have any of the homes you lived in” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “have any of the homes [HOUSEHOLD RP NAME] lived in”
FILLS (SPA)	TEXT FILL 1: FILL “este hogar” IF HOQDURATN = (3, 4, 5). ELSE, FILL “alguno de los hogares en los que vivió” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “alguno de los hogares en los que [HOUSEHOLD RP NAME] vivió”
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	HOQ.230
NEXT	HOQROACHES

HOQROACHES
ASK	All respondents
In the last 12 months, have cockroaches been seen in <TEXT FILL 1>? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	En los últimos 12 meses, ¿se han visto cucarachas en <TEXT FILL 1>? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “this home” IF HOQDURATN = (3, 4, 5). ELSE, FILL “any of the homes you lived in” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “any of the homes [HOUSEHOLD RP NAME] lived in”
FILLS (SPA)	TEXT FILL 1: FILL “este hogar” IF HOQDURATN = (3, 4, 5). ELSE, FILL “alguno de los hogares en los que vivió” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “alguno de los hogares en los que [HOUSEHOLD RP NAME] vivió”
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	HOQ.240
NEXT	HOQANIMALS

HOQANIMALS
ASK	All respondents
In the last 12 months, did any dogs, cats, or other small furry animals, such as a rabbit, guinea pig or hamster, live or spend time inside <TEXT FILL 1>? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	En los últimos 12 meses, ¿algún perro, gato u otro animal pequeño y peludo, como un conejo, un cuy o un hámster, ha vivido o ha pasado tiempo dentro de <TEXT FILL 1>? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “this home” IF HOQDURATN = (3, 4, 5). ELSE, FILL “any of the homes you lived in” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “any of the homes [HOUSEHOLD RP NAME] lived in”
FILLS (SPA)	TEXT FILL 1: FILL “este hogar” IF HOQDURATN = (3, 4, 5). ELSE, FILL “alguno de los hogares en los que ha vivido” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “alguno de los hogares en los que [HOUSEHOLD RP NAME] ha vivido”
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	HOQ.270
NEXT	HOQPETS

HOQPETS
ASK	All respondents
<TEXT FILL 1> avoided bringing new pets to or removed pets from this home because <TEXT FILL 2> had allergies or asthma? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	¿Ha evitado <TEXT FILL 1> traer mascotas nuevas a este hogar o ha sacado mascotas de este hogar porque <TEXT FILL 2> tenía alergias o asma? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “Has anyone in this household” IF > 1 PERSON IN HOUSEHOLD ELSE FILL “Have you” IF SINGLE PERSON IN HOUSEHOLD AND THE RESPONDENT IS IN HOUSEHOLD ELSE FILL “Has [HOUSEHOLD RP NAME]” IF SINGLE PERSON IN HOUSEHOLD AND IF RESPONDENT IS NOT IN HOUSEHOLD TEXT FILL 2: FILL “someone living here” IF > 1 PERSON IN HOUSEHOLD ELSE FILL “you” IF SINGLE PERSON IN HOUSEHOLD AND THE RESPONDENT IS IN HOUSEHOLD ELSE FILL “[HOUSEHOLD RP NAME]” IF SINGLE PERSON IN HOUSEHOLD AND IF RESPONDENT IS NOT IN HOUSEHOLD
FILLS (SPA)	TEXT FILL 1: FILL “alguien en esta vivienda” IF > 1 PERSON IN HOUSEHOLD ELSE FILL “usted” IF SINGLE PERSON IN HOUSEHOLD AND THE RESPONDENT IS IN HOUSEHOLD ELSE FILL “[HOUSEHOLD RP NAME]” IF SINGLE PERSON IN HOUSEHOLD AND IF RESPONDENT IS NOT IN HOUSEHOLD TEXT FILL 2: FILL “alguien que vivía aquí” IF > 1 PERSON IN HOUSEHOLD ELSE FILL “usted” IF SINGLE PERSON IN HOUSEHOLD AND THE RESPONDENT IS IN HOUSEHOLD ELSE FILL “[HOUSEHOLD RP NAME]” IF SINGLE PERSON IN HOUSEHOLD AND IF RESPONDENT IS NOT IN HOUSEHOLD
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	None – new question
NEXT	SMQSMK

SMOKING – SMQ

Target Group: Household

SMQSMK
ASK	All respondents
Now I would like to ask you a few questions about smoking in this home. How many people who live here smoke cigarettes, cigars, cigarillos, pipes, water pipes, hookahs, or any other tobacco product? (Do not include smoking marijuana or vaping any tobacco product.) INTERVIEWER INSTRUCTION: IF RESPONSE IS NO ONE, ENTER 0 |___|___| ENTER NUMBER OF PERSONS DON'T KNOW 99 REFUSED 77
SPANISH	Ahora, me gustaría hacerle algunas preguntas sobre el fumar en este hogar. ¿Cuántas personas que viven aquí fuman cigarrillos, puros, puritos, pipas, pipas de agua, narguiles o “hookahs”, o cualquier otro producto de tabaco? (No incluya fumar marihuana o vapear algún producto de tabaco). INTERVIEWER INSTRUCTION: IF RESPONSE IS NO ONE, ENTER 0 |___|___| ENTER NUMBER OF PERSONS DON'T KNOW 99 REFUSED 77
QUESTION TYPE	Numeric
FILLS
NOTES	RANGE: 0 - # OF PEOPLE IN THE HOUSEHOLD.
HARD CHECK	NUMBER ENTERED IN HHQSMQ MUST BE EQUALTO OR LESS THAN # OF PEOPLE IN THE HOUSEHOLD. IF GREATER, DISPLAY ERROR MESSAGE; ‘THE NUMBER ENTERED MUST BE EQUAL TO OR LESS THAN [FILL # OF PEOPLE IN THE HOUSEHOLD].”
SOFT CHECK
VERSION NOTES	SMQ.460
NEXT	IF SMQSMK = 0, 77 (RF) OR 99 (DK): SMQSMKALLI ELSE: SMQSMKINSD

SMQSMKINSD
ASK	IF 0 < SMQSMK < 77
Not counting decks, porches, or detached garages, how many people who live here smoke cigarettes, cigars, cigarillos, pipes, water pipes, hookahs, or any other tobacco product inside the home? (Do not include smoking marijuana or vaping any tobacco product.) |___|___| ENTER NUMBER OF PERSONS DON'T KNOW 99 REFUSED 77
SPANISH	Sin contar terrazas o “decks”, porches o garajes que no están pegados a la casa, ¿cuántas de las personas que viven aquí fuman cigarrillos, puros, puritos, pipas, pipas de agua, narguiles o “hookahs”, o cualquier otro producto de tabaco dentro del hogar? (No incluya fumar marihuana o vapear algún producto de tabaco). |___|___| ENTER NUMBER OF PERSONS DON'T KNOW 99 REFUSED 77
QUESTION TYPE	Numeric
FILLS
NOTES	RANGE: 0 – # IN SMQSMK.
HARD CHECK	NUMBER ENTERED IN HHQSMQINSD MUST BE EQUALTO OR LESS THAN SMQSMK. IF GREATER, DISPLAY ERROR MESSAGE; ‘THE NUMBER ENTERED MUST BE EQUAL TO OR LESS THAN [FILL # IN SMQSMK].”
SOFT CHECK
VERSION NOTES	SMQ.470
NEXT	SMQSMKALLI

SMQSMKALLI
ASK	ALL RESPONDENTS
Is smoking inside this home… INTERVIEWER INSTRUCTION: DO NOT COUNT DECKS, PORCHES, OR DETACHED GARAGES 1. Always allowed, 2. Allowed only at some times or in some areas, or 3. Never allowed? 9. DON’T KNOW 7. REFUSED
SPANISH	¿El fumar dentro de este hogar... INTERVIEWER INSTRUCTION: DO NOT COUNT DECKS, PORCHES, OR DETACHED GARAGES 1. Está siempre permitido? 2. Está permitido solo en algunas ocasiones o en algunas áreas? o 3. Nunca es permitido? 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	SMQ.New1
NEXT	SMQSMKALLV

SMQSMKALLV
ASK	All respondents
Now, thinking about the vehicles that <TEXT FILL 1> , is smoking inside these vehicles… INTERVIEWER INSTRUCTION: DO NOT COUNT MOTORCYCLES 1. Always allowed, 2. Sometimes allowed in at least one vehicle, or 3. Never allowed in any vehicle? 4. RESPONDENT’S HOUSEHOLD DOES NOT OWN OR LEASE A VEHICLE 9. DON’T KNOW 7. REFUSED
SPANISH	Ahora, piense en los vehículos que <TEXT FILL 1>. ¿El fumar dentro de estos vehículos… INTERVIEWER INSTRUCTION: DO NOT COUNT MOTORCYCLES 1. Está siempre permitido? 2. A veces está permitido en al menos un vehículo? o 3. Nunca está permitido en ningún vehículo? 4. RESPONDENT’S HOUSEHOLD DOES NOT OWN OR LEASE A VEHICLE 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “you own or lease” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “you or other household members own or lease” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME] owns or leases” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME] or [HOUSEHOLD RP NAME]’s other household members own or lease” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
FILLS (SPA)	TEXT FILL 1: FILL “usted es dueño(a) o alquila” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “que usted u otros miembros del hogar son dueños o alquilan” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME] es dueño(a) o alquila” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME] u otros miembros del hogar de [HOUSEHOLD RP NAME] son dueños o alquilan” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	None – new question
NEXT	CBQPREPARD

CONSUMER BEHAVIOR – CBQ

Target Group: Household

CBQPREPARD Q/U
ASK	All respondents
The next questions are about how much money <TEXT FILL 1> on food. Please do not include money spent on alcoholic beverages. In the last 30 days, how much money <TEXT FILL 2> spend on "ready to eat" or prepared meals, including eating out, fast food, and carry out or delivered meals, including those purchased online or through mobile apps? (You can tell me per week or per month.) INTERVIEWER INSTRUCTION: ENTER “0” IF RESPONDENT SAYS NO MONEY WAS SPENT. |___|___|___|___|___| ENTER AMOUNT DON'T KNOW 999999 REFUSED 777777 |___| ENTER UNIT WEEK 1 MONTH 2
SPANISH	Las siguientes preguntas se refieren a la cantidad de dinero que <TEXT FILL 1> en comida. No incluya el dinero que se gasta en bebidas alcohólicas. Durante los últimos 30 días, ¿cuánto dinero <TEXT FILL 2> en comidas “listas para comer” o comidas preparadas, incluso comer fuera de hogar, comida rápida y comidas para llevar o entrega a domicilio, incluidas las comidas compradas por Internet o a través de aplicaciones móviles? (Puede decirme por semana o por mes). INTERVIEWER INSTRUCTION: ENTER “0” IF RESPONDENT SAYS NO MONEY WAS SPENT. |___|___|___|___|___| ENTER AMOUNT DON'T KNOW 999999 REFUSED 777777 |___| ENTER UNIT WEEK 1 MONTH 2
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL “you spend” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “your household spends” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME] spends” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME]’s household spends” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 2: FILL “did you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “did your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “did [HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “did [HOUSEHOLD RP NAME]’s household” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
FILLS (SPA)	TEXT FILL 1: FILL “usted gasta” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “se gasta en su hogar” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “gasta [HOUSEHOD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “se gasta en el hogar de [HOUSEHOD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 2: FILL “gastó usted” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “se gastó su hogar” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “gastó [HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “se gastó el hogar de [HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
NOTES
HARD CHECK
SOFT CHECK	IF CBQPREPARDU = 1 AND CBQPREPARDQ < 6, DISPLAY: “UNUSUAL AMOUNT, PLEASE VERIFY YOUR ENTRY OF THE QUANTITY AND UNIT” IF CBQPREPARDU = 2 AND CBQPREPARDQ < 10, DISPLAY: “UNUSUAL AMOUNT, PLEASE VERIFY YOUR ENTRY OF THE QUANTITY AND UNIT” IF CBQPREPARDU = 1 AND CBQPREPARDQ >= 450, DISPLAY: “UNUSUAL AMOUNT, PLEASE VERIFY YOUR ENTRY OF THE QUANTITY AND UNIT” IF CBQPREPARDU = 2 AND CBQPREPARDQ >= 2000, DISPLAY: “UNUSUAL AMOUNT, PLEASE VERIFY YOUR ENTRY OF THE QUANTITY AND UNIT”
VERSION NOTES	CBQ.NEW1 Q/U
NEXT	CBQGROCERY

CBQGROCERY Q/U
ASK	All respondents
In the last 30 days, how much money <TEXT FILL 1> spend on food at supermarkets, grocery stores, and other stores where you buy food to prepare at home, including groceries purchased online or through mobile apps? Please include purchases made with food stamps. (Again, you can tell me per week or per month.) INTERVIEWER INSTRUCTION: ENTER “0” IF RESPONDENT SAYS NO MONEY WAS SPENT. |___|___|___|___|___| ENTER AMOUNT DON'T KNOW 999999 REFUSED 777777 |___| ENTER UNIT WEEK 1 MONTH 2
SPANISH	En los últimos 30 días, ¿cuánto dinero <TEXT FILL 1> en alimentos en supermercados, tiendas de comestibles y otras tiendas donde compra alimentos para preparar en casa, incluidos alimentos comprados por Internet o mediante aplicaciones móviles? Incluya las compras realizadas con cupones de alimentos. (Nuevamente, puede decirme por semana o por mes). INTERVIEWER INSTRUCTION: ENTER “0” IF RESPONDENT SAYS NO MONEY WAS SPENT. |___|___|___|___|___| ENTER AMOUNT DON'T KNOW 999999 REFUSED 777777 |___| ENTER UNIT WEEK 1 MONTH 2
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL “did you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “did your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “did [HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “did [HOUSEHOLD RP NAME]’s household” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
FILLS (SPA)	TEXT FILL 1: FILL “gastó usted” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL se “gastó su hogar” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “gastó [HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “se gastó en el hogar de [HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
NOTES
HARD CHECK
SOFT CHECK	IF CBQGROCERYU = 1 AND CBQGROCERYQ < 6, DISPLAY: “UNUSUAL AMOUNT, PLEASE VERIFY YOUR ENTRY OF THE QUANTITY AND UNIT” IF CBQGROCERYU = 2 AND CBQGROCERYQ < 10, DISPLAY: “UNUSUAL AMOUNT, PLEASE VERIFY YOUR ENTRY OF THE QUANTITY AND UNIT” IF CBQGROCERYU = 1 AND CBQGROCERYQ >= 900, DISPLAY: “UNUSUAL AMOUNT, PLEASE VERIFY YOUR ENTRY OF THE QUANTITY AND UNIT” IF CBQGROCERYU = 2 AND CBQGROCERYQ >= 4000, DISPLAY: “UNUSUAL AMOUNT, PLEASE VERIFY YOUR ENTRY OF THE QUANTITY AND UNIT”
VERSION NOTES	CBQ.NEW2 Q/U
NEXT	IF THE HOUSEHOLD INCLUDES AT LEAST ONE SP AGED 1-17 YEARS OLD: CBQPLANNAM ELSE: FSQRUNOUT

CBQPLANNAM
ASK	IF HOUSEHOLD INCLUDES AT LEAST ONE SP AGED 1-17 YEARS OLD
Who does most of the planning or preparing of meals in <TEXT FILL 1> household? INTERVIEWER INSTRUCTION: SELECT NAME(S) FROM ROSTER. IF RESPONDENT SELECTED MORE THAN 4 HOUSEHOLD MEMBERS, ASK THE RESPONDENT TO PICK FOUR. 1. SELECT 2. NOT SELECT 9. DON’T KNOW 7. REFUSED
SPANISH	¿Quién es la persona que hace la mayor parte de la planificación o preparación de las comidas en <TEXT FILL 1>? INTERVIEWER INSTRUCTION: SELECT NAME(S) FROM ROSTER. IF RESPONDENT SELECTED MORE THAN 4 HOUSEHOLD MEMBERS, ASK THE RESPONDENT TO PICK FOUR. 1. SELECT 2. NOT SELECT 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Select name(s) from roster
FILLS (ENG)	TEXT FILL 1: FILL “your” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “[HOUSEHOLD RP NAME]’s”
FILLS (SPA)	TEXT FILL 1: FILL “su hogar” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “en el hogar de [HOUSEHOLD RP NAME]”
NOTES	DISPLAY NAMES, GENDERS, AND AGES OF ALL HOUSEHOLD MEMBERS 12 YEARS OR OLDER. DO NOT DISPLAY THOSE SCQAGEREF = 2 OR THOSE SCQAGE SCQAGEEST AND SCQAGEREF ALL = DK OR RF. SORT THE HOUSEHOLD MEMBERS BY AGE FROM OLDEST TO YOUNGEST. WHEN SORTING AGE, FOR CATEGORICAL AGE ASSUME LOWEST AGE IN CATEGORY. ONLY ALLOW UP TO 4 PERSONS TO BE SELECTED. AUTOFILL THOSE WHO WERE NOT SELECTED AS CODE “2”.
HARD CHECK
SOFT CHECK	IF THE SELECTED PERSON IS LESS THAN 18 YEARS OLD, DISPLAY THE FOLLOWING MESSAGE: “PLEASE VERIFY THAT THE PERSON SELECTED IS YOUNGER THAN 18 YEARS OLD.” IF CBQPLANNAM = 2 (NOT SELECT) OR 9 (DK) FOR EVERY HH MEMBER, DISPLAY THE FOLLOWING MESSAGE: “PLEASE VERIFY THAT NO ONE LISTED DOES MOST OF THE PLANNING AND PREPARING OF MEALS IN THE SP’S HOUSEHOLD.”
VERSION NOTES	CBQ.210N
NEXT	CBQSHOPNAM

CBQSHOPNAM
ASK	IF HOUSEHOLD INCLUDES AT LEAST ONE SP AGED 1-17 YEARS OLD
Who does most of the food shopping in <TEXT FILL 1> household? INTERVIEWER INSTRUCTION: SELECT NAME(S) FROM ROSTER. IF RESPONDENT SELECTED MORE THAN FOUR HOUSEHOLD MEMBERS ASK THEM TO PICK FOUR. 1. SELECT 2. NOT SELECT 9. DON’T KNOW 7. REFUSED
SPANISH	¿Quién hace la mayor parte de las compras de alimentos en <TEXT FILL 1>? INTERVIEWER INSTRUCTION: SELECT NAME(S) FROM ROSTER. IF RESPONDENT SELECTED MORE THAN FOUR HOUSEHOLD MEMBERS ASK THEM TO PICK FOUR. 1. SELECT 2. NOT SELECT 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Select name(s) from roster
FILLS (ENG)	TEXT FILL 1: FILL “your” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “[HOUSEHOLD RP NAME]’s”
FILLS (SPA)	TEXT FILL 1: FILL “su hogar” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “el hogar de [HOUSEHOLD RP NAME]”
NOTES	DISPLAY NAMES, GENDERS, AND AGES OF ALL HOUSEHOLD MEMBERS 12 YEARS OR OLDER.DO NOT DISPLAY THOSE SCQAGEREF = 2 OR THOSE SCQAGE SCQAGEEST AND SCQAGEREF ALL = DK OR RF. SORT THE HOUSEHOLD MEMBERS BY AGE FROM OLDEST TO YOUNGEST.WHEN SORTING AGE, FOR CATEGORICAL AGE ASSUME LOWEST AGE IN CATEGORY. ONLY ALLOW UP TO FOUR PERSONS TO BE SELECTED. AUTOFILL THOSE WHO WERE NOT SELECTED AS CODE “2”.
HARD CHECK
SOFT CHECK	IF THE SELECTED PERSON IS LESS THAN 18 YEARS OLD, DISPLAY THE FOLLOWING MESSAGE: “PLEASE VERIFY THAT THE PERSON SELECTED IS YOUNGER THAN 18 YEARS OLD.” IF CBQSHOPNAM = 9 (DK) DISPLAY THE FOLLOWING MESSAGE: “PLEASE VERIFY THAT NO ONE LISTED DOES MOST OF THE SHOPPING FOR FOOD IN THE SP’S HOUSEHOLD.”
VERSION NOTES	CBQ.240N
NEXT	FSQRUNOUT

FOOD SECURITY – FSQ

Target Group: Household

FSQFOODSECf FSQRUNOUT FSQNOTLAST FSQBALANCE
ASK	All respondents
HAND CARD FSQ1. Please look at this card. I am going to read you several statements that people have made about their food situation. For these statements, please tell me whether the statement was often true, sometimes true, or never true for <TEXT FILL 1> in the last 12 months, that is since <TEXT FILL 2>. <TEXT FILL 3> worried whether <TEXT FILL 4> food would run out before <TEXT FILL 5> got money to buy more. The food that <TEXT FILL 3> bought just didn’t last, and <TEXT FILL 5> didn’t have enough money to get more food. <TEXT FILL 3> couldn’t afford to eat balanced meals. (A balanced meal includes all the types of food that you think should be in a healthy meal. For example, a starch like potatoes or rice, vegetables or fruit and some protein like meat, fish, cheese, or eggs.) OFTEN TRUE 1 SOMETIMES TRUE 2 NEVER TRUE 3 DON’T KNOW 9 REFUSED 7
SPANISH	HAND CARD FSQ1. Mire esta tarjeta. Voy a leerle varias declaraciones que han hecho las personas sobre su alimentación. Dígame si estas declaraciones fueron con frecuencia ciertas, a veces ciertas o nunca fueron ciertas para <TEXT FILL 1> en los últimos 12 meses, es decir, desde <TEXT FILL 2>. <TEXT FILL 3> preocupaba que <TEXT FILL 4> comida se acabara antes de conseguir dinero para comprar más. La comida que <TEXT FILL 3> simplemente no alcanzaba, y <TEXT FILL 5> poco dinero para conseguir más comida. Entonces, <TEXT FILL 3> pocas oportunidades de comer comidas balanceadas. (Una comida balanceada incluye todos los tipos de alimentos que usted cree que deberían estar en una comida saludable. Por ejemplo, un almidón como papas o arroz, verduras o frutas y algunas proteínas como carne, pescado, queso o huevos). CON FRECUENCIA CIERTA 1 A VECES CIERTA 2 NUNCA CIERTA 3 DON’T KNOW 9 REFUSED 7
QUESTION TYPE	Dropdown menu
FILLS (ENG)	TEXT FILL 1: FILL “you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME]’s household” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 2: DISPLAY CURRENT MONTH AND LAST YEAR TEXT FILL 3: FILL “I” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “we” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME]’s household” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 4: FILL “my” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “our” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “his” IF HOUSEHOLD RP IS MALE AND RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “her” IF HOUSEHOLD RP IS FEMALE AND RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME]’s” IF HOUSEHOLD RP DOES NOT IDENTIFY AS MALE OR FEMALE AND RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “their” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 5: FILL “I” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “we” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “<TEXT FILL 6>” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “they” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 6: FILL “he” IF HOUSEHOLD RP IS MALE FILL “she” IF HOUSEHOLD RP IS FEMALE FILL “[HOUSEHOLD RP NAME]” IF HOUSEHOLD RP DOES NOT IDENTIFY AS MALE OR FEMALE
FILLS (SPA)	TEXT FILL 1: FILL “usted” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “su hogar” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “el hogar de [HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 2: DISPLAY CURRENT MONTH AND LAST YEAR [NOTE TO PROGRAMMER: FOR SPANISH, THE FORMAT SHOULD BE “MONTH de YEAR”. FOR EXAMPLE: mayo de 2023. THE MONTH NAME NEEDS TO BE IN LOWER CASE.] TEXT FILL 3: FILL “Me” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “Nos” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME] se” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “El hogar de [HOUSEHOLD RP NAME] se” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 4: FILL “mi” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “nuestra” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “su” IF HOUSEHOLD RP IS MALE AND RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “su” IF HOUSEHOLD RP IS FEMALE AND RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “su” IF HOUSEHOLD RP DOES NOT IDENTIFY AS MALE OR FEMALE AND RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “su” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 5: FILL “” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “<TEXT FILL 6>” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 6: FILL “” IF HOUSEHOLD RP IS MALE FILL “” IF HOUSEHOLD RP IS FEMALE FILL “[HOUSEHOLD RP NAME]” IF HOUSEHOLD RP DOES NOT IDENTIFY AS MALE OR FEMALE
NOTES	Please display the questions and responses as a grid with the questions on the left and the response options along the top.
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VERSION NOTES	FSQ.032a FSQ.032b FSQ.032c
NEXT	IF RESPONSE TO FSQRUNOUT, FSQNOTLAST, OR FSQBALANCE, IS CODE 1 (OFTEN TRUE) OR 2 (SOMETIMES TRUE), CONTINUE. OTHERWISE, GO TO FSQEMERGEN.

FSQCUTSIZ
ASK	IF RESPONSE TO FSQRUNOUT, FSQNOTLAST, OR FSQBALANCE, IS CODE 1 (OFTEN TRUE) OR 2 (SOMETIMES TRUE).
In the last 12 months, since last <TEXT FILL 1>, did <TEXT FILL 2> ever cut the size of <TEXT FILL 3> meals or skip meals because there wasn’t enough money for food? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	En los últimos 12 meses, desde el pasado <TEXT FILL 1>, ¿alguna vez <TEXT FILL 2> el tamaño de sus comidas o se saltó/saltaron comidas porque no había suficiente dinero para comprar alimentos? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: DISPLAY CURRENT MONTH AND LAST YEAR TEXT FILL 2: FILL “you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “you or other adults in your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “any adults in [HOUSEHOLD RP NAME]’s household” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 3: FILL “your” IF RESPONDENT IS IN HOUSEHOLD FILL “<TEXT FILL 4>” IF RESPONDENT NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “their” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 4: FILL “his” IF HOUSEHOLD RP IS MALE FILL “her” IF HOUSEHOLD RP IS FEMALE FILL “[HOUSEHOLD RP NAME]’s” IF HOUSEHOLD RP DOES NOT IDENTIFY AS MALE OR FEMALE
FILLS (SPA)	TEXT FILL 1: DISPLAY CURRENT MONTH AND LAST YEAR [NOTE TO PROGRAMMER: FOR SPANISH, THE FORMAT SHOULD BE “MONTH de YEAR”. FOR EXAMPLE: mayo de 2023. THE MONTH NAME NEEDS TO BE IN LOWER CASE.] TEXT FILL 2: FILL “redujo usted” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “redujeron usted u otros adultos en su hogar” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME] redujo” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “redujo cualquier adulto en el hogar de [HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 3: FILL “” IF RESPONDENT IS IN HOUSEHOLD FILL “<TEXT FILL 4>” IF RESPONDENT NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 4: FILL “” IF HOUSEHOLD RP IS MALE FILL “” IF HOUSEHOLD RP IS FEMALE FILL “[HOUSEHOLD RP NAME]’s” IF HOUSEHOLD RP DOES NOT IDENTIFY AS MALE OR FEMALE
NOTES
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VERSION NOTES	FSQ.041
NEXT	IF FSQCUTSIZ = 1: FSQCUTSIZF ELSE: FSQEATLESS

FSQCUTSIZF
ASK	IF FSQCUTSIZ = 1
How often did this happen? 1. Almost every month, 2. Some months by not every month, or 3. In only 1 or 2 months? 9. DON’T KNOW 7. REFUSED
SPANISH	¿Con qué frecuencia sucedió esto? 1. ¿Casi todos los meses? 2. ¿Algunos meses, pero no todos los meses?, o 3. ¿Solo 1 o 2 meses? 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS
NOTES
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VERSION NOTES	FSQ.052
NEXT	FSQEATLESS

FSQEATLESS
ASK	IF RESPONSE TO FSQRUNOUT, FSQNOTLAST, OR FSQBALANCE, IS CODE 1 (OFTEN TRUE) OR 2 (SOMETIMES TRUE).
In the last 12 months, did <TEXT FILL 1> ever eat less than <TEXT FILL 2> felt <TEXT FILL 2> should because there wasn’t enough money for food? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	En los últimos 12 meses, ¿alguna vez <TEXT FILL 1> menos que lo que <TEXT FILL 2> comer porque no había suficiente dinero para comer? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “you or other adults in your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “any adults in [HOUSEHOLD RP NAME]’s household” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 2: FILL “you” IF RESPONDENT IS IN HOUSEHOLD FILL “<TEXT FILL 3>” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “they” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 3: FILL “he” IF HOUSEHOLD RP IS MALE FILL “she” IF HOUSEHOLD RP IS FEMALE FILL “[HOUSEHOLD RP NAME]” IF HOUSEHOLD RP DOES NOT IDENTIFY AS MALE OR FEMALE
FILLS (SPA)	TEXT FILL 1: FILL “usted comió” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “usted u otros adultos en su hogar comieron” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME] comió” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “cualquier adulto en el hogar de [HOUSEHOLD RP NAME] comió” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 2: FILL “creía que debía” IF RESPONDENT IS IN HOUSEHOLD FILL “creían que debían” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “<TEXT FILL 3>” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “creía que debía” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 3: FILL “creía que debía” IF HOUSEHOLD RP IS MALE FILL “creía que debía” IF HOUSEHOLD RP IS FEMALE FILL “[HOUSEHOLD RP NAME] creía que debía” IF HOUSEHOLD RP DOES NOT IDENTIFY AS MALE OR FEMALE
NOTES
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VERSION NOTES	FSQ.061
NEXT	FSQNOTEAT

FSQNOTEAT
ASK	IF RESPONSE TO FSQRUNOUT, FSQNOTLAST, OR FSQBALANCE, IS CODE 1 (OFTEN TRUE) OR 2 (SOMETIMES TRUE).
In the last 12 months, <TEXT FILL 1> ever hungry but didn’t eat because there wasn’t enough money for food? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	En los últimos 12 meses, ¿alguna vez <TEXT FILL 1> porque no había suficiente dinero para comprar comida? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “were you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “were you or other adults in your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “was [HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “were any adults in [HOUSEHOLD RP NAME]’s household” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
FILLS (SPA)	TEXT FILL 1: FILL “usted tuvo hambre pero no comió” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “usted u otros adultos en su hogar tuvieron hambre pero no comieron” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME] tuvo hambre pero no comió” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “cualquier adulto en el hogar de [HOUSEHOLD RP NAME] tuvo hambre pero no comió” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
NOTES
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VERSION NOTES	FSQ.071
NEXT	FSQLOSEWGT

FSQLOSEWGT
ASK	IF RESPONSE TO FSQRUNOUT, FSQNOTLAST, OR FSQBALANCE, IS CODE 1 (OFTEN TRUE) OR 2 (SOMETIMES TRUE).
In the last 12 months, did <TEXT FILL 1> lose weight because there wasn’t enough money for food? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	En los últimos 12 meses, ¿<TEXT FILL 1> peso porque no había suficiente dinero para comprar comida? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “you or other adults in your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “any adults in [HOUSEHOLD RP NAME]’s household” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
FILLS (SPA)	TEXT FILL 1: FILL “usted perdió” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “usted u otros adultos en su hogar perdieron” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME] perdió” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “cualquier adulto en el hogar de [HOUSEHOLD RP NAME] perdió” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
NOTES
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VERSION NOTES	FSQ.081
NEXT	IF FSQCUTSIZ, FSQEATLESS, FSQNOTEAT, OR FSQLOSEWGT in {1}: FSQSKPDAY. ELSE: FSQEMERGEN.

FSQSKPDAY
ASK	IF FSQCUTSIZ, FSQEATLESS, FSQNOTEAT, OR FSQLOSEWGT in {1}
In the last 12 months, did <TEXT FILL 1> ever not eat for a whole day because there wasn’t enough money for food? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	En los últimos 12 meses, ¿<TEXT FILL 1> de comer en todo el día entero porque no había suficiente dinero para comprar comida? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “you or other adults in your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “any adults in [HOUSEHOLD RP NAME]’s household” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
FILLS (SPA)	TEXT FILL 1: FILL “usted dejó” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “usted u otros adultos en su hogar dejaron” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME] dejó” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “cualquier adulto en el hogar de [HOUSEHOLD RP NAME] dejó” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
NOTES
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VERSION NOTES	HHQ.092
NEXT	IF FSQSKPDAY = 1: FSQSKPDAYF ELSE: FSQEMERGEN

FSQSKPDAYF
ASK	IF FSQSKPDAY = 1
How often did this happen? 1. Almost every month, 2. Some months but not every month, or 3. In only 1 or 2 months? 9. DON’T KNOW 7. REFUSED
SPANISH	¿Con qué frecuencia sucedió esto? 1. ¿Casi todos los meses? 2. ¿Algunos meses pero no todos los meses? o 3. ¿Solo 1 o 2 meses? 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS
NOTES
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VERSION NOTES	FSQ.102
NEXT	FSQEMERGEN

FSQEMERGEN
ASK	All respondents
In the last 12 months, did <TEXT FILL 1> ever get emergency food from a church, a food pantry, or a food bank, or eat in a soup kitchen? (Do not include a place you went to for social reasons, such as, a senior center or a place you went to for shelter because of something like a hurricane or flood.) 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	En los últimos 12 meses, ¿alguna vez <TEXT FILL 1> comida de emergencia de una iglesia, cocina de auxilio o banco de comida, o comió/comieron en un comedor comunitario o de beneficencia? (No incluya un lugar al que fue por motivos sociales, como un centro para personas mayores o un lugar al que fue en busca de refugio debido a algo como un huracán o una inundación). 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “you or any member of your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “any member in [HOUSEHOLD RP NAME]’s household” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
FILLS (SPA)	TEXT FILL 1: FILL “usted recibió” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “usted o cualquier miembro de su hogar recibieron” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME] recibió” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “cualquier miembro del hogar de [HOUSEHOLD RP NAME] recibió” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
NOTES
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VERSION NOTES	FSQ.151
NEXT	IF THE HOUSEHOLD INCLUDES:A CHILD AGED 5 YEARS OR UNDER, OR IN AN AGE RANGE THAT INCLUDES AGE 5 AND UNDER OR A FEMALE OR OTHER GENDER BETWEEN AGES 12 AND 64, OR IN AN AGE RANGE THAT INCLUDES ANY AGES BETWEEN 12 AND 64: FSQWIC ELSE: FSQSNP.

FSQWIC
ASK	IF THE HOUSEHOLD INCLUDES: **A CHILD AGED 5 YEARS OR UNDER, OR IN AN AGE RANGE THAT INCLUDES AGE 5 AND UNDER OR ** A FEMALE OR OTHER GENDER BETWEEN AGES 12 AND 64, OR IN AN AGE RANGE THAT INCLUDES ANY AGES BETWEEN 12 AND 64
The next questions are about WIC, the Women, Infants and Children program. Did <TEXT FILL 1> receive WIC benefits in the last 30 days? <TEXT FILL 2> (WIC is short for the Special Supplemental Nutrition Program for Women, Infants, and Children. This program provides food assistance and nutritional screening to low-income pregnant and postpartum women and their infants, as well as to low-income children up to age 5.) 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	Las siguientes preguntas son acerca del programa WIC, es decir, del Programa para Mujeres, Infantes y Niños. ¿Recibió <TEXT FILL 1> beneficios de WIC en los últimos 30 días? <TEXT FILL 2> (WIC es la abreviatura del Programa Especial de Nutrición Suplementaria para Mujeres, Infantes y Niños. Este programa ofrece ayuda alimenticia y evaluaciones nutricionales a mujeres de bajos ingresos durante el embarazo y después del parto, también a sus bebés recién nacidos, así como a niños de bajos ingresos hasta los 5 años de edad). 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “anyone in your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “anyone in [HOUSEHOLD RP NAME]’s household” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 2: FILL “Children 5 years of age and younger and household members ages 12 to 64 who may be eligible for WIC are: DISPLAY NAMES IF MORE THAN ONE PERSON IN HOUSEHOLD ELSE, TEXT FILL 2 IS EMPTY
FILLS (SPA)	TEXT FILL 1: FILL “usted” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “alguna persona en su hogar” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “alguna persona en el hogar de [HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 2: FILL “Los niños de 5 años o menos y los miembros del hogar de 12 a 64 años que pueden ser cumplir los requisitos para recbir WIC son: DISPLAY NAMES IF MORE THAN ONE PERSON IN HOUSEHOLD ELSE, TEXT FILL 2 IS EMPTY
NOTES	IF MORE THAN ONE PERSON IN HOUSEHOLD, DISPLAY NAMES OF ALL CHILDREN AGES 5 AND UNDER, AND FEMALES AND OTHER GENDERS (INCLUDING GENDER UNKNOWN) AGES 12 TO 64 OR AGE UNKNOWN IN THE HOUSEHOLD.
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VERSION NOTES	FSQ.760
NEXT	IF FSQWIC in {1} AND ONLY ONE PERSON IN HOUSEHOLD, FLAG PERSON AS RECEIVING WIC IN FSQWICNAME: FSQSNP IF FSQWIC in {1} AND MULTIPLE PEOPLE IN HOUSEHOLD: FSQWICNAME ELSE: FSQWICYR

FSQWICNAME
ASK	IF FSQWIC = 1 AND MULTIPLE PEOPLE IN HOUSEHOLD
Who in the household has received WIC benefits in the last 30 days? (Anyone else?) INTERVIEWER INSTRUCTION: SELECT NAME(S) FROM ROSTER 1. SELECT 2. NOT SELECT 9. DON’T KNOW 7. REFUSED
SPANISH	¿Qué persona del hogar ha recibido beneficios de WIC en los últimos 30 días ? (¿Alguien más?). INTERVIEWER INSTRUCTION: SELECT NAME(S) FROM ROSTER 1. SELECT 2. NOT SELECT 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Select name from roster
FILLS
NOTES	DISPLAY NAMES OF ALL CHILDREN AGES 5 AND UNDER, AND FEMALES AND OTHER GENDERS (INCLUDING GENDER UNKNOWN) AGES 12 TO 64 OR AGE UNKNOWN IN THE HOUSEHOLD, ALL FIELDS SHOULD BE BLANK WHEN SCREEN FIRST LOADS. AUTOFILL THOSE WHO WERE NOT SELECTED AS CODE “2”.
HARD CHECK	IF CODE = 2 FOR ALL MEMBERS IN ROSTER, DISPLAY THE FOLLOWING MESSAGE TO VERIFY THE ANSWER TO FSQWICNAME: “You said that someone who lives here has received WIC in the last 30 days, is that correct?” IF YES, SELECT NAME(S) FROM ROSTER. IF NO, GO BACK TO PREVIOUS QUESTION AND ANSWER ‘NO’.
HARD CHECK (SPA)	IF CODE = 2 FOR ALL MEMBERS IN ROSTER, DISPLAY THE FOLLOWING MESSAGE TO VERIFY THE ANSWER TO FSQWICNAME: “Usted dijo que alguien que vive aquí recibió beneficios de WIC en los últimos 30 días, ¿es eso correcto?” IF YES, SELECT NAME(S) FROM ROSTER. IF NO, GO BACK TO PREVIOUS QUESTION AND ANSWER ‘NO’.
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VERSION NOTES	FSQ.770
NEXT	FSQSNP

FSQWICYR
ASK	IF FSQWIC = 2, 7, OR 9
In the last 12 months, did <TEXT FILL 1> receive benefits from the WIC program? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	En los últimos 12 meses, ¿recibió <TEXT FILL 1> beneficios del programa WIC? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “any member of your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “any member of [HOUSEHOLD RP NAME]’s household” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
FILLS (SPA)	TEXT FILL 1: FILL “usted” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “algún miembro de su hogar” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “algún miembro del hogar de [HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
NOTES
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VERSION NOTES	FSQ.162
NEXT	FSQSNP

FSQSNP
ASK	All respondents
The next questions are about SNAP, the Supplemental Nutrition Assistance Program, also known as the Food Stamp Program. SNAP benefits are provided on a food stamp benefit card <TEXT FILL 1>. <TEXT FILL 2> currently get SNAP or Food Stamps? This includes any SNAP benefits or Food Stamps, even if the amount is small and even if the benefits are received on behalf of children in the household. 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	Las siguientes preguntas son sobre SNAP, el Programa de Asistencia Nutricional Suplementaria, también conocido como programa de cupones o estampillas de alimentos (“food stamps”). Los beneficios de SNAP se entregan en una tarjeta de beneficios de cupones o estampillas de alimentos <TEXT FILL 1>. Actualmente, ¿<TEXT FILL 2> beneficios de SNAP o cupones o estampillas de alimentos? Esto incluye cualquier beneficio de SNAP o cupones o estampillas de alimentos, incluso si la cantidad es pequeña y si los beneficios se reciben en nombre de los niños del hogar. 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “called the [STATE NAME FOR EBT CARD] card in [STATE]” IF INTERVIEWING IN A STATE THAT HAS SPECIFIC NAME FOR THE EBT CARD ELSE, FILL “or EBT card” TEXT FILL 2: FILL “Do you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “Do you or anyone in your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “Does [HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “Does anyone in [HOUSEHOLD RP NAME]’s household” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
FILLS (SPA)	TEXT FILL 1: FILL “llamada la tarjeta [STATE NAME FOR EBT CARD]” en [STATE]” IF INTERVIEWING IN A STATE THAT HAS SPECIFIC NAME FOR THE EBT CARD. ELSE, FILL “o “tarjeta EBT”” . TEXT FILL 2: FILL “recibe usted” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “reciben usted o alguna persona en su hogar” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “recibe [HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “recibe alguna persona en el hogar de [HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	FSQ.755
NEXT	IF FSQSNP in {1} AND ONLY ONE PERSON IN HOUSEHOLD, FLAG PERSON AS RECEIVING SNAP IN FSQSNPNAM: FSQSNPMOS. IF FSQSNP in {1} AND MULTIPLE PEOPLE IN HOUSEHOLD: FSQSNPNAM ELSE: FSQYSNP

FSQSNPNAM
ASK	IF FSQSNP = 1 AND MULTIPLE PEOPLE IN HOUSEHOLD
Who in the household is currently on the <TEXT FILL 1> to get Food Stamps? (Is anyone else on the card?) INTERVIEWER INSTRUCTION: READ NAMES OF ALL HOUSEHOLD MEMBERS TO THE RESPONDENT SELECT NAME(S) FROM ROSTER 1. SELECT 2. NOT SELECT 9. DON’T KNOW 7. REFUSED
SPANISH	¿Qué personas del hogar están actualmente en la <TEXT FILL 1> para recibir estampillas o cupones de alimentos? (¿Hay alguna otra persona en la tarjeta?). INTERVIEWER INSTRUCTION: READ NAMES OF ALL HOUSEHOLD MEMBERS TO THE RESPONDENT SELECT NAME(S) FROM ROSTER 1. SELECT 2. NOT SELECT 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Select name from roster
FILLS (ENG)	TEXT FILL 1: FILL “[STATE NAME FOR EBT CARD] card” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR THE EBT CARD ELSE, FILL “EBT card”
FILLS (SPA)	TEXT FILL 1: FILL “tarjeta [STATE NAME FOR EBT CARD]” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR THE EBT CARD ELSE, FILL “tarjeta EBT”
NOTES	DISPLAY NAMES OF ALL HOUSEHOLD MEMBERS. ALL FIELDS SHOULD BE BLANK WHEN SCREEN FIRST LOADS. AUTOFILL THOSE WHO WERE NOT SELECTED AS CODE “2”.
HARD CHECK	IF NO ONE IN THE ROSTER WAS SELECTED (1), DISPLAY THE FOLLOWING MESSAGE TO VERIFY THE ANSWER TO FSQSNPNAM: You said someone who lives here is currently getting Food Stamps or SNAP benefits. Is that correct? IF YES, ASK: “Who was that?” AND MARK SELECTION ON THE ROSTER DISPLAYED. IF NO, GO BACK TO CODE FSQSNP AS ‘NO’.
HARD CHECK (SPA)	IF NO ONE IN THE ROSTER WAS SELECTED (1), DISPLAY THE FOLLOWING MESSAGE TO VERIFY THE ANSWER TO FSQSNPNAM: Usted dijo que alguien que vive aquí recibe actualmente cupones o estampillas de alimentos o beneficios de SNAP. ¿Es correcto? IF YES, ASK: “¿Qué persona es?” AND MARK SELECTION ON THE ROSTER DISPLAYED. IF NO, GO BACK TO CODE FSQSNP AS ‘NO’.
SOFT CHECK
VERSION NOTES	FSQ.790
NEXT	IF AT LEAST ONE PERSON SELECTED:FSQSNPMOS IF FSQSNPNAM IN (7) OR (9): FSQYSNP

FSQSNPMOS
ASK	IF FSQSNP = 1
In the last 12 months, for how many months did <TEXT FILL 1> get Food Stamps? INTERVIEWER INSTRUCTION: ENTER ‘1’ FOR LESS THAN ONE MONTH PARTICIPATION ENTER NUMBER OF MONTHS |___|___| DON'T KNOW 99 REFUSED 77
SPANISH	En los últimos 12 meses, ¿durante cuántos meses <TEXT FILL 1> cupones de alimentos? INTERVIEWER INSTRUCTION: ENTER ‘1’ FOR LESS THAN ONE MONTH PARTICIPATION ENTER NUMBER OF MONTHS |___|___| DON'T KNOW 99 REFUSED 77
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL “you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “you, [NAME(S) OF HH MEMBERS SELECTED IN FSQSNPNAM EXCLUDING RESPONDENT]” IF RESPONDENT IS IN HOUSEHOLD AND WAS SELECTED IN FSQSNPNAM AND MORE THAN ONE PERSON IN HOUSEHOLD WERE SELECTED IN FSQSNPNAM FILL “[NAME(S) OF HH MEMBERS SELECTED IN FSQSNPNAM]” IF RESPONDENT IS IN HOUSEHOLD BUT NOT SELECTED IN FSQSNPNAM OR RESPONDENT IS NOT IN HOUSEHOLD
FILLS (SPA)	TEXT FILL 1: FILL “recibió usted” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “recibieron usted y [NAME(S) OF HH MEMBERS SELECTED IN FSQSNPNAM EXCLUDING RESPONDENT]” IF RESPONDENT IS IN HOUSEHOLD AND WAS SELECTED IN FSQSNPNAM AND MORE THAN ONE PERSON IN HOUSEHOLD WERE SELECTED IN FSQSNPNAM FILL “recibió(eron) [NAME(S) OF HH MEMBERS SELECTED IN FSQSNPNAM]” IF RESPONDENT IS IN HOUSEHOLD BUT NOT SELECTED IN FSQSNPNAM OR RESPONDENT IS NOT IN HOUSEHOLD
NOTES	FOR EVERY HH MEMBER WITH “SELECT (CODE “1”)” IN FSQSNPNAM, ENABLE A FIELD FOR INTERVIEWER TO ENTER THE NUMBER OF MONTHS. FILL FOR EVERY HH MEMBER WITH “SELECT (CODE “1”) IN FSQSNPNAM.
HARD CHECK	INPUT INVALID. VALUE NOT IN RANGE 1-12.
SOFT CHECK
VERSION NOTES	FSQ.795
NEXT	IF ONLY ONE PERSON SELECTED IN FSQSNPNAM: FSQSNPMO / FSQSNPDY / FSQSNPYR ELSE: FSQSNPCRD

FSQSNPCRD
ASK	IF MULTIPLE PEOPLE WITH “SELECTED” IN FSQSNPNAM (BOX 7)
Are <TEXT FILL 1> getting Food Stamps on the same <TEXT FILL 2> card? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	¿<TEXT FILL 1> cupones o estampillas de alimentos en la misma tarjeta de <TEXT FILL 2>? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1:FILL “you, [NAME(S) OF HH MEMBERS SELECTED IN FSQSNPNAM EXCLUDING RESPONDENT]” IF RESPONDENT IS IN HOUSEHOLD AND SELECTED IN FSQSNPNAM AND MORE THAN ONE PERSON IN HOUSEHOLD SELECTED IN FSQSNPNAM FILL “[NAME(S) OF HH MEMBERS SELECTED IN FSQSNPNAM]” IF RESPONDENT NOT SELECTED IN FSQSNPNAM OR RESPONDENT IS NOT IN HOUSEHOLD TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN A STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT”
FILLS (SPA)	TEXT FILL 1:FILL “Recibe usted, [NAME(S) OF HH MEMBERS SELECTED IN FSQSNPNAM EXCLUDING RESPONDENT]” IF RESPONDENT IS IN HOUSEHOLD AND SELECTED IN FSQSNPNAM AND MORE THAN ONE PERSON IN HOUSEHOLD SELECTED IN FSQSNPNAM FILL “Recibe(n) [NAME(S) OF HH MEMBERS SELECTED IN FSQSNPNAM]” IF RESPONDENT NOT SELECTED IN FSQSNPNAM OR RESPONDENT IS NOT IN HOUSEHOLD TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN A STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT”
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	FSQ.805
NEXT	IF FSQSNPCRD = 2: FSQCRDNUM ELSE: FSQSNPMO / FSQSNPDY / FSQSNPYR

FSQSNPMO FSQSNPDY FSQSNPYR
ASK	IF ONLY ONE PERSON SELECTED IN FSQSNPNAM OR IF FSQSNPCRD = 1
On what date were food stamps last put on <TEXT FILL 1> <TEXT FILL 2> card? INTERVIEWER INSTRUCTIONS: PROBE FOR ANY MISSING PORTIONS OF DATE. |___|___| - |___|___| - |___|___|___|___| MONTH DAY YEAR DON'T KNOW 9 REFUSED 7
SPANISH	¿En qué fecha se agregaron los cupones o estampillas de alimentos por última vez en <TEXT FILL 1> <TEXT FILL 2>? INTERVIEWER INSTRUCTIONS: PROBE FOR ANY MISSING PORTIONS OF DATE. |___|___| - |___|___| - |___|___|___|___| MONTH DAY YEAR DON'T KNOW 9 REFUSED 7
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL “your” IF RESPONDENT IS IN HOUSEHOLD AND SELECTED IN FSQSNPNAM FILL “<TEXT FILL 3>” IF ONLY ONE HH MEMBER SELECTED IN FSQSNPNAM FILL “their” IF MORE THAN ONE HH MEMBER SELECTED IN FSQSNPNAM TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT” TEXT FILL 3: FILL “his” SELECTED HOUSEHOLD MEMBER IS MALE FILL “her” IF SELECTED HOUSEHOLD MEMBER IS FEMALE FILL “[SELECTED HH MEMBER NAME]’s” IF SELECTED HOUSEHOLD MEMBER DOES NOT IDENITFY AS MALE OR FEMALE
FILLS (SPA)	TEXT FILL 1: FILL “su tarjeta” IF RESPONDENT IS IN HOUSEHOLD AND SELECTED IN FSQSNPNAM FILL “<TEXT FILL 3>” IF ONLY ONE HH MEMBER SELECTED IN FSQSNPNAM FILL “su tarjeta” IF MORE THAN ONE HH MEMBER SELECTED IN FSQSNPNAM TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT” TEXT FILL 3: FILL “su tarjeta” SELECTED HOUSEHOLD MEMBER IS MALE FILL “su tarjeta” IF SELECTED HOUSEHOLD MEMBER IS FEMALE FILL “la tarjeta de [SELECTED HH MEMBER NAME]” IF SELECTED HOUSEHOLD MEMBER DOES NOT IDENITFY AS MALE OR FEMALE
NOTES	SEPARATE FIELDS FOR MONTH, DAY, AND YEAR, ALLOW ENTRY OF RF AND DK IN FIELDS.
HARD CHECK	DATE MUST BE WITHIN PAST 31 DAYS OF CURRENT DATE. IF DATE IS NOT WITHIN THE PAST 31 DAYS, DISPLAY “MONTH AND YEAR ENTERED MUST BE WITHIN PAST 1 MONTH OF CURRENT MONTH.” IF THE “DAY” FIELD IS DK/RF, THEN THE MONTH/YEAR ENTERED MUST BE WITHIN PAST 1 MONTH OF CURRENT MONTH. IF THE “MONTH” FIELD IS DK/RF AND THE CURRENT MONTH IS NOT JANUARY, THE YEAR ENTERED MUST BE THE CURRENT YEAR, IF THE “MONTH” FIELD IS DK/RF AND THE CURRENT MONTH IS JANUARY, THE YEAR MUST BE CURRENT YEAR OR THE PREVIOUS YEAR. IF THE DATE IS IN THE FUTURE, DISPLAY “DATE CANNOT BE GREATER THAN TODAY.”
SOFT CHECK
VERSION NOTES	FSQ.810 FSQ.811 FSQ.812
NEXT	FSQSNPAMT

FSQSNPAMT
ASK	IF FSQSNPCRD = 1
<TEXT FILL 1> what amount in food stamps was put on <TEXT FILL 2> <TEXT FILL 3> card? |___|___|___|___| ENTER DOLLAR AMOUNT DON’T KNOW 99999 REFUSED 77777
SPANISH	<TEXT FILL 1>, ¿qué cantidad se agregó en cupones o estampillas de alimentos a <TEXT FILL 2> <TEXT FILL 3>? |___|___|___|___| ENTER DOLLAR AMOUNT DON’T KNOW 99999 REFUSED 77777
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL “In {FSQSNPMO}” IF FSQSNPMO IS NOT MISSING, RF (7) OR DK (9) ELSE, FILL “The last time food stamps were put on it,” TEXT FILL 2: FILL “your” IF RESPONDENT IS IN HOUSEHOLD AND WAS SELECTED IN FSQSNPNAM FILL “<TEXT FILL 4>” IF ONLY ONE HH MEMBER SELECTED IN FSQSNPNAM FILL “their” IF MORE THAN ONE HH MEMBER SELECTED IN FSQSNPNAM TEXT FILL 3: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT” TEXT FILL 4: FILL “his” IF SELECTED HOUSEHOLD MEMBER IS MALE FILL “her” IF SELECTED HOUSEHOLD MEMBER IS FEMALE FILL “[SELECTED HH MEMBER NAME]’s” IF SELECTED HOUSEHOLD MEMBER DOES NOT IDENTIFY AS MALE OR FEMALE
FILLS (SPA)	TEXT FILL 1: FILL “En {FSQSNPMO}” IF FSQSNPMO IS NOT MISSING, RF (7) OR DK (9) ELSE, FILL “La última vez que se agregaron cupones o estampillas de alimentos,” TEXT FILL 2: FILL “su tarjeta” IF RESPONDENT IS IN HOUSEHOLD AND WAS SELECTED IN FSQSNPNAM FILL “<TEXT FILL 4>” IF ONLY ONE HH MEMBER SELECTED IN FSQSNPNAM FILL “su tarjeta” IF MORE THAN ONE HH MEMBER SELECTED IN FSQSNPNAM TEXT FILL 3: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT” TEXT FILL 4: FILL “su tarjeta” IF SELECTED HOUSEHOLD MEMBER IS MALE FILL “su tarjeta” IF SELECTED HOUSEHOLD MEMBER IS FEMALE FILL “la tarjeta de [SELECTED HH MEMBER NAME]” IF SELECTED HOUSEHOLD MEMBER DOES NOT IDENTIFY AS MALE OR FEMALE
NOTES
HARD CHECK	AMOUNT SHOULD BE GREATER THAN 0.
SOFT CHECK	IF ONE PERSON SELECTED IN FSQSNPNAM AND FSQSNPAMT >700, CONFIRM AMOUNT ENTERED; IF 2-6 PERSONS SELECTED IN FSQSNPNAM AND FSQSNPAMT >900 CONFIRM AMOUNT; IF =>7 PERSONS SELECTED IN FSQSNPNAM AND FSQSNPAMT >1300 CONFIRM AMOUNT.
VERSION NOTES	FSQ.815
NEXT	IF ALL HH MEMBERS ARE MARKED “SELECT” ON FSQSNPNAM: INQINCY ELSE: FSQYSNP

FSQCRDNUM
ASK	IF FSQSNPCRD = 2
Among <TEXT FILL 1>, how many <TEXT FILL 2> cards are there? |___|___| NUMBER OF CARDS DON’T KNOW 99 REFUSED 77
SPANISH	Entre <TEXT FILL 1>, ¿cuántas tarjetas <TEXT FILL 2> hay? |___|___| NUMBER OF CARDS DON’T KNOW 99 REFUSED 77
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL “you and [NAME(S) OF HH MEMBERS SELECTED IN FSQSNPNAM EXCLUDING RESPONDENT]” IF RESPONDENT IS IN HOUSEHOLD AND IS CHOSEN IN FSQSNPNAM ELSE: FILL “[NAME(S) OF HH MEMBERS SELECTED IN FSQSNPNAM]” TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT”
FILLS (SPA)	TEXT FILL 1: FILL “usted y [NAME(S) OF HH MEMBERS SELECTED IN FSQSNPNAM EXCLUDING RESPONDENT]” IF RESPONDENT IS IN HOUSEHOLD AND IS CHOSEN IN FSQSNPNAM ELSE: FILL “[NAME(S) OF HH MEMBERS SELECTED IN FSQSNPNAM]” TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT”
NOTES
HARD CHECK	RESPONSE CANNOT BE ZERO OR ONE, AND CANNOT BE MORE THAN THE NUMBER OF PEOPLE “SELECTED (CODE 1)” IN FSQSNPNAM. DISPLAY, “INVALID NUMBER OF CARDS. PLEASE CHECK ENTRY AND IF NEEDED, GO BACK AND CHANGE RESPONSE.”
SOFT CHECK	IF FSQSNPCRD= NO, AND COUNT OF PEOPLE REPORTED IN FSQSNPNAM > FSQCRDNUM, THEN DISPLAY: “INTERVIEWER: RESPONDENT REPORTED FEWER SNAP CARDS IN THE HOUSEHOLD THAN PEOPLE. PLEASE CONFIRM WHETHER MULTIPLE PEOPLE SHARE CARDS AND UPDATE RESPONSES IF NEEDED OR PRESS “SUPPRESS” AND “NEXT” TO CONTINUE.”
VERSION NOTES	FSQ.825
NEXT	IF FSQCRDNUM = 77 (RF) OR 99 (DK) OR THE NUMBER OF CARDS EQUALS THE NUMBER OF PERSONS LISTED “SELECT” (CODE=1) IN HHQSNPNAM, THEN ALLOCATE EACH PERSON WITH ONE CARD: FSQCRDMO. ELSE FSQCRDNAM.

FSQCRDNAM

ASK

IF FSQCRDNUM != 77 OR 99

IF NUMBER OF CARDS IN FSQCRDNUM != NUMBER OF PERSONS LISTED “SELECT” IN FSQSNPNAM

Please tell me who uses which card?

SPANISH

¿Quién usa cual tarjeta?

QUESTION TYPE

DROPDOWN, ‘SELECT’

FILLS

FILL #: FILL WITH CARD NUMBER

NOTES

DISPLAY A GRID SO INTERVIEWER CAN ALLOCATE EACH HH MEMBERS WITH “SELECT” IN FSQSNPNAM TO EACH OF THE CARDS. EACH CARD SHOULD ALLOW MULTIPLE PERSONS BE SELECTED INTO. ONLY ALLOW ONE CARD PER PERSON.

FOR EXAMPLE:

	EBT Card Number
John Doe	[dropdown menu]
Jane Doe	[dropdown menu]
Bobby Jones	[dropdown menu]

NOTES

(SPA)

DISPLAY A GRID SO INTERVIEWER CAN ALLOCATE EACH HH MEMBERS WITH “SELECT” IN FSQSNPNAM TO EACH OF THE CARDS. EACH CARD SHOULD ALLOW MULTIPLE PERSONS BE SELECTED INTO. ONLY ALLOW ONE CARD PER PERSON.

FOR EXAMPLE:

	Número de tarjeta EBT
John Doe	[dropdown menu]
Jane Doe	[dropdown menu]
Bobby Jones	[dropdown menu]

HARD CHECK

IF NO MEMBER BELONGS TO A CARD, DISPLAY “AT LEAST ONE CARD HAS NO HOUSEHOLD MEMBERS LISTED. PLEASE CHECK ENTRY AND IF NEEDED, GO BACK AND CORRECT THE NUMBER OF CARDS.”

SOFT CHECK

VERSION NOTES

FSQ.835

NEXT

LOOP 1: ASK FSQCRDMO - FSQCRDAMT FOR EACH CARD.

FSQCRDMO FSQCRDDY FSQCRDYR
ASK	IF FSQSNPCRD = 2
On what date were food stamps last put on <TEXT FILL 1> <TEXT FILL 2> card? INTERVIEWER INSTRUCTION: PROBE FOR ANY MISSING PORTIONS OF DATE. |___|___| - |___|___| - |___|___|___|___| MONTH DAY YEAR DON'T KNOW 9 REFUSED 7
SPANISH	¿En qué fecha se agregaron los cupones o estampillas de alimentos por última vez a <TEXT FILL 1> <TEXT FILL 2>? INTERVIEWER INSTRUCTION: PROBE FOR ANY MISSING PORTIONS OF DATE. |___|___| - |___|___| - |___|___|___|___| MONTH DAY YEAR DON'T KNOW 9 REFUSED 7
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL “your” IF RESPONDENT BELONGS TO CARD ELSE, FILL “[NAME(S) OF HH MEMBERS THAT BELONG TO CARD]’s” TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT”
FILLS (SPA)	TEXT FILL 1: FILL “su tarjeta” IF RESPONDENT BELONGS TO CARD ELSE, FILL “la tarjeta de [NAME(S) OF HH MEMBERS THAT BELONG TO CARD]” TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT”
NOTES	SEPARATE FIELDS FOR MONTH, DAY, AND YEAR, ALLOW ENTRY OF RF AND DK IN FIELDS.
HARD CHECK	DATE MUST BE WITHIN PAST 31 DAYS OF CURRENT DATE. IF DATE IS NOT WITHIN THE PAST 31 DAYS, DISPLAY “MONTH AND YEAR ENTERED MUST BE WITHIN PAST 1 MONTH OF CURRENT MONTH.” ALL FIELDS SHOULD BE ABLE TO BE ANY COMBINATION OF DK/RF IF THE “DAY” FIELD IS DK/RF AND THE MONTH/YEAR ARE FILLED, THEN THE MONTH/YEAR ENTERED MUST BE WITHIN PAST 1 MONTH OF CURRENT MONTH. IF THE “MONTH” FIELD IS DK/RF AND THE CURRENT MONTH IS NOT JANUARY AND THE YEAR IS FILLED, THE YEAR ENTERED MUST BE THE CURRENT YEAR. IF THE “MONTH” FIELD IS DK/RF AND THE CURRENT MONTH IS JANUARY AND THE YEAR IS FILLED, THE YEAR MUST BE CURRENT YEAR OR THE PREVIOUS YEAR. IF THE “YEAR” FIELD IS DK/RF AND THE MONTH IS FILLED, THEN THE MONTH ENTERED MUST BE CURRENT MONTH OR THE MONTH PRIOR TO THE CURRENT MONTH. IF THE DATE IS IN THE FUTURE, DISPLAY “DATE CANNOT BE GREATER THAN TODAY.”
SOFT CHECK
VERSION NOTES	FSQ.840 FSQ.841 FSQ.842
NEXT	FSQCRDAMT

FSQCRDAMT
ASK	IF FSQSNPCRD = 2
<TEXT FILL 1> what amount in food stamps was put on <TEXT FILL 2> <TEXT FILL 3> card? |___|___|___|___| ENTER DOLLAR AMOUNT DON’T KNOW 99999 REFUSED 77777
SPANISH	<TEXT FILL 1>, ¿qué cantidad en cupones o estampillas de alimentos se agregó a <TEXT FILL 2> <TEXT FILL 3>? |___|___|___|___| ENTER DOLLAR AMOUNT DON’T KNOW 99999 REFUSED 77777
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL “In {FSQCRDMO}” IF FSQCRDMO IS NOT MISSING, RF (7), OR DK (9) ELSE, FILL “The last time food stamps were put on it,” TEXT FILL 2: FILL “your” IF RESPONDENT BELONGS TO CARD AND WAS CHOSEN IN FSQSNPNAM FILL “<TEXT FILL 4>” IF RESPONDENT DOES NOT BELONG TO CARD AND ONLY ONE HH MEMBERS BELONGS TO CARD FILL “their” IF RESPONDENT DOES NOT BELONG TO CARD AND MORE THAN ONE HH MEMBER BELONGS TO CARD TEXT FILL 3: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN A STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT” TEXT FILL 4: FILL “his” IF SELECTED HH MEMBER IS MALE FILL “her” IF SELECTED HH MEMBER IS FEMALE FILL “[SELECTED HH MEMBER NAME]’s” IF SELECTED HH MEMBER DOES NOT IDENTIFY AS MALE OR FEMALE
FILLS (SPA)	TEXT FILL 1: FILL “En {FSQCRDMO}” IF FSQCRDMO IS NOT MISSING, RF (7), OR DK (9) ELSE, FILL “La última vez que se agregaron cupones o estampillas de alimentos,” TEXT FILL 2: FILL “su tarjeta” IF RESPONDENT BELONGS TO CARD AND WAS CHOSEN IN FSQSNPNAM FILL “<TEXT FILL 4>” IF RESPONDENT DOES NOT BELONG TO CARD AND ONLY ONE HH MEMBERS BELONGS TO CARD FILL “su tarjeta” IF RESPONDENT DOES NOT BELONG TO CARD AND MORE THAN ONE HH MEMBER BELONGS TO CARD TEXT FILL 3: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN A STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT” TEXT FILL 4: FILL “su tarjeta” IF SELECTED HH MEMBER IS MALE FILL “su tarjeta” IF SELECTED HH MEMBER IS FEMALE FILL “la tarjeta de [SELECTED HH MEMBER NAME]” IF SELECTED HH MEMBER DOES NOT IDENTIFY AS MALE OR FEMALE
NOTES
HARD CHECK	AMOUNT SHOULD BE GREATER THAN ZERO.
SOFT CHECK	IF ONE PERSON SELECTED IN FSQSNPNAM AND FSQCRDAMT >700, CONFIRM AMOUNT ENTERED; IF 2-6 PERSONS SELECTED IN FSQSNPNAM AND FSQCRDAMT >900 CONFIRM AMOUNT; IF =>7 PERSONS SELECTED IN FSQSNPNAM AND FSQCRDAMT >1300 CONFIRM AMOUNT.
VERSION NOTES	FSQ.845
NEXT	ASK FSQCRDMO - FSQCRDAMT FOR SECOND CARD. IF INFORMATION COLLECTED FOR ALL CARDS AND ALL HH MEMBERS ARE MARKED “SELECT” ON FSQSNPNAM: FSQINCY ELSE: FSQYSNP.

FSQYSNP
ASK	IF FSQSNP = 2, 7, OR 9 IF FSQSNPNAM = 7 OR 9 IF NOT ALL HH MEMBERS MARKED “SELECT” ON FSQSNPNAM
<TEXT FILL 1> 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	<TEXT FILL 1> 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: IF FSQSNP = NO (2), RF (7), OR DK (9), FILL “In the last 12 months, did <TEXT FILL 2> get Food Stamps, even if only for one month? <TEXT FILL 3>” ELSE, FILL: “In the last 12 months, did <TEXT FILL 4> get Food Stamps, even if only for one month? This includes any SNAP benefits or Food Stamps received in the past year, even if the amount was small or if they were received on behalf of children in the household. TEXT FILL 2: FILL “you” IF ONLY ONE PERSON IN HOUSEHOLD ELSE, FILL “you or anyone in your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD ELSE, FILL “[RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD ELSE, FILL "anyone in [HOUSEHOLD RP NAME]'s household." IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 3: FILL “(Here is the list of people who live here, let me read it to you)” IF MORE THAN ONE PERSON IN HOUSEHOLD. ELSE, TEXT FILL 3 IS EMPTY TEXT FILL 4: FILL “you” IF ONLY ONE PERSON IN HOUSEHOLD FILL “you or [NAME(S) OF ALL HH MEMBER(S) NOT SELECTED IN FSQSNPNAM]” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD AND THE RESPONDENT AND SOMEONE WHO IS NOT THE RESPONDENT IS NOT SELECTED IN FSQSNPNAM FILL “[NAME(S) OF ALL HH MEMBER(S) NOT SELECTED IN FSQSNPNAM]” IF RESPONDENT IS IN HOUSEHOLD AND SELECTED IN FSQSNPNAM AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “you” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD AND RESPONDENT IS THE ONLY PERSON NOT SELECTED IN FSQSNPNAM FILL “[HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “[NAME(S) OF ALL HH MEMBER(S) NOT SELECTED IN FSQSNPNAM]” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
FILLS (SPA)	TEXT FILL 1: IF FSQSNP = NO (2), RF (7), OR DK (9), FILL “En los últimos 12 meses, ¿<TEXT FILL 2> cupones o estampillas de alimentos, aunque fuera solo por un mes? <TEXT FILL 3>” ELSE, FILL: “En los últimos 12 meses, ¿<TEXT FILL 4> cupones de alimentos, aunque fuera solo por un mes? Esto incluye cualquier beneficio de SNAP o cupones o estampillas de alimentos recibidos en los últimos 12 meses, incluso si la cantidad fue pequeña o si se recibieron en nombre de los niños del hogar. TEXT FILL 2: FILL “recibió usted” IF ONLY ONE PERSON IN HOUSEHOLD ELSE, FILL “recibieron usted o alguna persona en su hogar” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD ELSE, FILL “recibió [RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD ELSE, FILL "recibió alguna persona en el hogar de [HOUSEHOLD RP NAME]" IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 3: FILL “(Esta es la lista de las personas que viven aquí, permítame que se la lea.)” IF MORE THAN ONE PERSON IN HOUSEHOLD. ELSE, TEXT FILL 3 IS EMPTY TEXT FILL 4: FILL “recibió usted” IF ONLY ONE PERSON IN HOUSEHOLD FILL “recibieron usted o [NAME(S) OF ALL HH MEMBER(S) NOT SELECTED IN FSQSNPNAM]” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD AND THE RESPONDENT AND SOMEONE WHO IS NOT THE RESPONDENT IS NOT SELECTED IN FSQSNPNAM FILL “recibieron [NAME(S) OF ALL HH MEMBER(S) NOT SELECTED IN FSQSNPNAM]” IF RESPONDENT IS IN HOUSEHOLD AND SELECTED IN FSQSNPNAM AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “recibió usted” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD AND RESPONDENT IS THE ONLY PERSON NOT SELECTED IN FSQSNPNAM FILL “recibió [HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “recibió(eron) [NAME(S) OF ALL HH MEMBER(S) NOT SELECTED IN FSQSNPNAM]” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD
NOTES	IF MORE THAN ONE PERSON IN HOUSEHOLD, DISPLAY HOUSEHOLD ROSTER WITH NAMES OF ALL HH MEMBERS ENCLOSED IN PARENTHESES.
HARD CHECK
SOFT CHECK
VERSION NOTES	FSQ.870
NEXT	IF FSQYSNP IN [2, 7, OR 9], FSQSNPEVER IF FSQYSNP = 1 AND ONLY ONE PERSON IN HOUSEHOLD OR ONE PERSON THAT’S “NOT SELECTED (CODE 2)” IN FSQSNPNAM, FLAG PERSON AS RECEIVING SNAP IN FSQYSNPNAM: FSQYSNPMOS. ELSE: FSQYSNPNAM

FSQYSNPNAM
ASK	IF FSQYSNP = 1 AND MULTIPLE PEOPLE IN HOUSEHOLD
<TEXT FILL 1> INTERVIEWER INSTRUCTION: SELECT NAME(S) FROM ROSTER 1. SELECT 2. NOT SELECT 9. DON’T KNOW 7. REFUSED
SPANISH	N/A [HOWEVER, FILLS WILL NEED TO BE TRANSLATED BELOW]
QUESTION TYPE	Select name from roster
FILLS (ENG)	TEXT FILL 1: IF FSQSNP = NO (2), RF (7), OR DK (9), FILL: “Who in the household was on the <TEXT FILL 2> card to get Food Stamps in the last 12 months? (Here is the list of people who live here, let me read it to you.) DISPLAY HOUSEHOLD ROSTER WITH NAMES OF ALL HH MEMBERS ENCLOSED IN PARENTHESES” ELSE, FILL: “Among <TEXT FILL 3>, who was on the <TEXT FILL 2> card to get Food Stamps in the last 12 months? DISPLAY NAMES OF ALL HOUSEHOLD MEMBERS NOT SELECTED IN FSQSNPNAM (Was anyone else on the card?)” TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN A STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT” TEXT FILL 3: FILL “you and [NAME(S) OF ALL HH MEMBER(S) NOT SELECTED IN FSQSNPNAM]” IF RESPONDENT IS IN HOUSEHOLD AND RESPONDENT WAS NOT SELECTED IN FSQSNPNAM ELSE, FILL “[NAME(S) OF ALL HH MEMBER(S) NOT SELECTED IN FSQSNPNAM]”
FILLS (SPA)	TEXT FILL 1: IF FSQSNP = NO (2), RF (7), OR DK (9), FILL: “¿Quién en el hogar estuvo en la tarjeta <TEXT FILL 2> para recibir cupones o estampillas de alimentos en los últimos 12 meses? (Esta la lista de las personas que viven aquí, permítame que se la lea). DISPLAY HOUSEHOLD ROSTER WITH NAMES OF ALL HH MEMBERS ENCLOSED IN PARENTHESES” ELSE, FILL: “Entre <TEXT FILL 3>, ¿quién estuvo en la tarjeta <TEXT FILL 2> para recibir cupones o estampillas de alimentos en los últimos 12 meses? DISPLAY NAMES OF ALL HOUSEHOLD MEMBERS NOT SELECTED IN FSQSNPNAM (¿Había alguien más en la tarjeta?).” TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN A STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT” TEXT FILL 3: FILL “usted y [NAME(S) OF ALL HH MEMBER(S) NOT SELECTED IN FSQSNPNAM]” IF RESPONDENT IS IN HOUSEHOLD AND RESPONDENT WAS NOT SELECTED IN FSQSNPNAM ELSE, FILL “[NAME(S) OF ALL HH MEMBER(S) NOT SELECTED IN FSQSNPNAM]”
NOTES	AUTOFILL THOSE WHO WERE NOT SELECTED AS CODE “2”.
HARD CHECK	IF CODE=2 FOR ALL MEMBERS IN ROSTER, DISPLAY THE FOLLOWING MESSAGE TO VERIFY THE ANSWER TO FSQYSNPNAM: You said someone who lives here got Food Stamps in the last 12 months. Is that correct? IF YES, ASK: “Who was that?” AND MARK SELECTION ON THE ROSTER DISPLAYED. IF NO, GO BACK TO CODE FSQYSNP AS ‘NO’.
HARD CHECK (SPA)	IF CODE=2 FOR ALL MEMBERS IN ROSTER, DISPLAY THE FOLLOWING MESSAGE TO VERIFY THE ANSWER TO FSQYSNPNAM: Usted dijo que alguien que vive aquí recibió cupones o estampillas de alimentos en los últimos 12 meses. ¿Es correcto? IF YES, ASK: “¿Quién era esa persona?” AND MARK SELECTION ON THE ROSTER DISPLAYED. IF NO, GO BACK TO CODE FSQYSNP AS ‘NO’.
SOFT CHECK
VERSION NOTES	FSQ.880
NEXT	IF FSQYSNPNAM = 7 OR 9: FSQSNPEVER ELSE: FSQYSNPMOS

FSQYSNPMOS
ASK	IF FSQYSNP = 1
In the last 12 months, for how many months did <TEXT FILL 1> get Food Stamps? INTERVIEWER INSTRUCTION: ENTER ‘1’ FOR LESS THAN ONE MONTH PARTICIPATION |___|___| ENTER NUMBER OF MONTHS DON'T KNOW 99 REFUSED 77
SPANISH	En los últimos 12 meses, ¿durante cuántos meses <TEXT FILL 1> cupones o estampillas de alimentos? INTERVIEWER INSTRUCTION: ENTER ‘1’ FOR LESS THAN ONE MONTH PARTICIPATION |___|___| ENTER NUMBER OF MONTHS DON'T KNOW 99 REFUSED 77
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL “you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD ELSE, FILL “[NAME(S) OF HH MEMBERS SELECTED IN FSQYSNPNAM]”
FILLS (SPA)	TEXT FILL 1: FILL “recibió usted” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD ELSE, FILL “recibió(eron) [NAME(S) OF HH MEMBERS SELECTED IN FSQYSNPNAM]”
NOTES	FOR EVERY HH MEMBER SELECTED IN FSQYSNPNAM, ENABLE A FIELD FOR INTERVIEWER TO ENTER THE NUMBER OF MONTHS
HARD CHECK	INPUT INVALID. VALUE NOT IN RANGE 1-12. IF MONTHS ENTERED IS GREATER THAN AGE OF HH MEMBER DISPLAY: RESPONSE CAN NOT BE GREATER THAN PERSON’S AGE.
SOFT CHECK
VERSION NOTES	FSQ.885
NEXT	IF ONLY ONE PERSON WITH “SELECTED” IN FSQYSNPNAM: FSQYSNPMO ELSE: FSQYSNPCRD

FSQYSNPCRD
ASK	IF MULTIPLE PEOPLE WITH “SELECTED” IN FSQYSNPNAM
Did <TEXT FILL 1> get Food Stamps on the same <TEXT FILL 2> card? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	¿<TEXT FILL 1> cupones o estampillas de alimentos en la misma tarjeta <TEXT FILL 2>? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “you and [NAMES OF HH MEMBER(S) SELECTED IN FSQYSNPNAM]” IF RESPONDENT IS IN HOUSEHOLD AND IS SELECTED IN FSQYSNPNAM ELSE, FILL “[NAMES OF HH MEMBER(S) SELECTED IN FSQYSNPNAM]” TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN A STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT”
FILLS (SPA)	TEXT FILL 1: FILL “Recibieron usted y [NAMES OF HH MEMBER(S) SELECTED IN FSQYSNPNAM]” IF RESPONDENT IS IN HOUSEHOLD AND IS SELECTED IN FSQYSNPNAM ELSE, FILL “Recibió(eron) [NAMES OF HH MEMBER(S) SELECTED IN FSQYSNPNAM]” TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN A STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT”
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	FSQ.895
NEXT	IF FSQYSNPCRD in {2}: FSQYCRDNUM ELSE: FSQYSNPMO / FSQYSNPDY / FSQYSNPYR

FSQYSNPMO FSQYSNPDY FSQYSNPYR
ASK	IF FSQYSNPCRD= 1
On what date were food stamps last put on <TEXT FILL 1> <TEXT FILL 2> card? INTERVIEWER INSTRUCTION: PROBE FOR ANY MISSING PORTIONS OF DATE. |___|___| - |___|___| - |___|___|___|___| MONTH DAY YEAR DON'T KNOW 9 REFUSED 7
SPANISH	¿En qué fecha se agregaron cupones o estampillas de alimentos por última vez en <TEXT FILL 1> <TEXT FILL 2>? INTERVIEWER INSTRUCTION: PROBE FOR ANY MISSING PORTIONS OF DATE. |___|___| - |___|___| - |___|___|___|___| MONTH DAY YEAR DON'T KNOW 9 REFUSED 7
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL “your” IF RESPONDENT IS IN HOUSEHOLD AND WAS SELECTED IN FSQYSNPNAM FILL “<TEXT FILL 3>” IF ONLY ONE PERSON IN HOUSEHOLD SELECTED IN FSQYSNPNAM FILL “their” IF MORE THAN ONE PERSON IN HOUSEHOLD SELECTED IN FSQYSNPNAM TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT” TEXT FILL 3: FILL “his” IF SELECTED HH MEMBER IS MALE FILL “her” IF SELECTED HH MEMBER IS FEMALE FILL “[SELECTED HH MEMBER NAME]’s” IF SELECTED HH MEMBER DOES NOT IDENTIFY AS MALE OR FEMALE
FILLS (SPA)	TEXT FILL 1: FILL “su tarjeta” IF RESPONDENT IS IN HOUSEHOLD AND WAS SELECTED IN FSQYSNPNAM FILL “<TEXT FILL 3>” IF ONLY ONE PERSON IN HOUSEHOLD SELECTED IN FSQYSNPNAM FILL “su tarjeta” IF MORE THAN ONE PERSON IN HOUSEHOLD SELECTED IN FSQYSNPNAM TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT” TEXT FILL 3: FILL “su tarjeta” IF SELECTED HH MEMBER IS MALE FILL “su tarjeta” IF SELECTED HH MEMBER IS FEMALE FILL “la tarjeta de [SELECTED HH MEMBER NAME]” IF SELECTED HH MEMBER DOES NOT IDENTIFY AS MALE OR FEMALE
NOTES	SEPARATE FIELDS FOR MONTH, DAY, AND YEAR, ALLOW ENTRY OF RF AND DK IN FIELDS.
HARD CHECK	DATE MUST BE WITHIN PAST 12 MONTHS OF CURRENT MONTH. IF DATE IS NOT WITHIN THE PAST 12 MONTHS, DISPLAY “DATE MUST BE WITHIN PAST 12 MONTHS OF CURRENT DATE.” ALL FIELDS SHOULD BE ABLE TO BE ANY COMBINATION OF DK/RF IF THE “DAY” FIELD IS DK/RF AND THE MONTH/YEAR ARE FILLED, THEN THE MONTH/YEAR ENTERED MUST BE WITHIN PAST 12 MONTHS OF CURRENT MONTH, ELSE DISPLAY “DATE MUST BE WITHIN PAST 12 MONTHS OF CURRENT MONTH.” IF THE “MONTH” FIELD IS DK/RF AND THE YEAR IS FILLED, THE YEAR ENTERED MUST BE THE CURRENT YEAR OR THE PAST YEAR, ELSE DISPLAY “DATE MUST BE WITHIN PAST 12 MONTHS OF CURRENT MONTH.” IF THE DATE IS IN THE FUTURE, DISPLAY “DATE CANNOT BE GREATER THAN TODAY.”
SOFT CHECK
VERSION NOTES	FSQ.900 FSQ.901 FSQ.902
NEXT	FSQYSNPAMT

FSQYSNPAMT
ASK	IF FSQYSNPCRD!= NO
<TEXT FILL 1> what amount in food stamps was put on <TEXT FILL 2> <TEXT FILL 3> card? |___|___|___|___| ENTER DOLLAR AMOUNT DON’T KNOW 99999 REFUSED 77777
SPANISH	<TEXT FILL 1>, ¿qué cantidad se agregó en cupones de estampillas o alimentos en <TEXT FILL 2> <TEXT FILL 3>? |___|___|___|___| ENTER DOLLAR AMOUNT DON’T KNOW 99999 REFUSED 77777
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL “In {FSQYSNPMO}” IF FSQYSNPMO IS NOT MISSING, RF (7) OR DK (9) ELSE, FILL “The last time that food stamps were put on it,” TEXT FILL 2: FILL “your” IF RESPONDENT IS IN HOUSEHOLD AND SELECTED IN FSQYSNPNAM ELSE FILL “<TEXT FILL 4>” IF ONLY ONE HH MEMBER SELECTED IN FSQYSNPNAM ELSE FILL “their” IF MORE THAN ONE HH MEMBER SELECTED IN FSQYSNPNAM TEXT FILL 3: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT” TEXT FILL 4: FILL “his” IF SELECTED HH MEMBER IS MALE FILL “her” IF SELECTED HH MEMBER IS FEMALE FILL “[SELECTED HH MEMBER NAME]’s” IF SELECTED HH MEMBER DOES NOT IDENTIFY AS MALE OR FEMALE
FILLS (SPA)	TEXT FILL 1: FILL “En {FSQYSNPMO}” IF FSQYSNPMO IS NOT MISSING, RF (7) OR DK (9) ELSE, FILL “La última vez que se agregaron cupones o estampillas de alimentos” TEXT FILL 2: FILL “su tarjeta” IF RESPONDENT IS IN HOUSEHOLD AND SELECTED IN FSQYSNPNAM ELSE FILL “<TEXT FILL 4>” IF ONLY ONE HH MEMBER SELECTED IN FSQYSNPNAM ELSE FILL “su tarjeta” IF MORE THAN ONE HH MEMBER SELECTED IN FSQYSNPNAM TEXT FILL 3: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT” TEXT FILL 4: FILL “su tarjeta” IF SELECTED HH MEMBER IS MALE FILL “su tarjeta” IF SELECTED HH MEMBER IS FEMALE FILL “la tarjeta de [SELECTED HH MEMBER NAME]” IF SELECTED HH MEMBER DOES NOT IDENTIFY AS MALE OR FEMALE
NOTES
HARD CHECK	AMOUNT SHOULD BE GREATER THAN ZERO.
SOFT CHECK	IF ONE PERSON SELECTED IN FSQYSNPNAM AND FSQYSNPAMT >700, DISPLAY “PLEASE CONFIRM THE AMOUNT ENTERED.”; IF 2-6 PERSONS SELECTED IN FSQYSNPNAM AND FSQYSNPAMT >900 CONFIRM AMOUNT; IF =>7 PERSONS SELECTED IN FSQYSNPNAM AND FSQYSNPAMT >1300 CONFIRM AMOUNT.
VERSION NOTES	FSQ.905
NEXT	IF ALL HH MEMBERS ARE MARKED “SELECTED” ON FSQSNPNAM OR FSQYSNPNAM: INQINCY ELSE: FSQSNPEVER.

FSQYCRDNUM
ASK	IF FSQYSNPCRD = 2
Among <TEXT FILL 1>, how many <TEXT FILL 2> cards are there? |___|___| NUMBER OF CARDS DON’T KNOW 99 REFUSED 77
SPANISH	Entre <TEXT FILL 1>, ¿cuántas tarjetas <TEXT FILL 2> hay? |___|___| NUMBER OF CARDS DON’T KNOW 99 REFUSED 77
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL “you and [NAME(S) OF HH MEMBER(S) SELECTED IN FSQYSNPNAM]” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “[NAME(S) OF HH MEMBER(S) SELECTED IN FSQYSNPNAM]” TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT”
FILLS (SPA)	TEXT FILL 1: FILL “usted y [NAME(S) OF HH MEMBER(S) SELECTED IN FSQYSNPNAM]” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “[NAME(S) OF HH MEMBER(S) SELECTED IN FSQYSNPNAM]” TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT”
NOTES
HARD CHECK	RESPONSE CANNOT BE ZERO OR ONE, AND CANNOT BE MORE THAN THE NUMBER OF PEOPLE “SELECTED (CODE 1)” IN FSQYSNPNAM. DISPLAY “INVALID NUMBER OF CARDS. PLEASE CHECK ENTRY AND IF NEEDED, GO BACK AND CHANGE RESPONSE.”
SOFT CHECK	IF FSQYSNPCRD= NO, AND COUNT OF PEOPLE REPORTED IN FSQYSNPNAM > FSQYCRDNUM, THEN DISPLAY: “INTERVIEWER: RESPONDENT REPORTED FEWER SNAP CARDS IN THE HOUSEHOLD THAN PEOPLE. PLEASE CONFIRM WHETHER MULTIPLE PEOPLE SHARE CARDS AND UPDATE RESPONSES IF NEEDED OR PRESS “SUPPRESS” AND “NEXT” TO CONTINUE.”
VERSION NOTES	FSQ.915
NEXT	IF FSQYCRDNUM = 77 (RF) OR 99 (DK OR IF THE NUMBER OF CARDS IN FSQYCRDNUM EQUALS THE NUMBER OF PERSONS LISTED “SELECT” IN FSQYSNPNAM, ALLOCATE EACH PERSON WITH ONE CARD): FSQYCRDMO. ELSE: FSQYCRDNAM.

FSQYCRDNAM

ASK

IF FSQYCRDNUM != 77 OR 99 OR

IF FSQYCRDNUM NUMBER OF CARDS != NUMBER OF PERSONS LISTED “SELECT” ON FSQYSNPNAM

Please tell me who is on card <FILL #>.

SPANISH

Dígame quién está en la tarjeta <FILL #>..

QUESTION TYPE

Select name(s) for each card

FILLS

FILL #: FILL WITH CARD NUMBER

NOTES

DISPLAY A GRID SO INTERVIEWER CAN ALLOCATE EACH HH MEMBERS WITH “SELECT” IN FSQYSNPNAM TO EACH OF THE CARDS. EACH CARD SHOULD ALLOW MULTIPLE PERSONS BE SELECTED INTO. ONLY ALLOW ONE CARD PER PERSON

FOR EXAMPLE:

	EBT Card Number
John Doe	[DROPDOWN MENU]
Jane Doe	[DROPDOWN MENU]
Bobby Jones	[DROPDOWN MENU]

NOTES

(SPA)

DISPLAY A GRID SO INTERVIEWER CAN ALLOCATE EACH HH MEMBERS WITH “SELECT” IN FSQYSNPNAM TO EACH OF THE CARDS. EACH CARD SHOULD ALLOW MULTIPLE PERSONS BE SELECTED INTO. ONLY ALLOW ONE CARD PER PERSON

FOR EXAMPLE:

	Número de tarjeta EBT
John Doe	[DROPDOWN MENU]
Jane Doe	[DROPDOWN MENU]
Bobby Jones	[DROPDOWN MENU]

HARD CHECK

IF NO MEMBER BELONGS TO A CARD, DISPLAY “AT LEAST ONE CARD HAS NO HOUSEHOLD MEMBER LISTED. PLEASE CHECK ENTRY AND IF NEEDED, GO BACK AND CORRECT THE NUMBER OF CARDS.”

SOFT CHECK

VERSION NOTES

FSQ.925

NEXT

ASK FSQYCRDMO - FSQYCRDAMT FOR EACH CARD.

FSQYCRDMO FSQYCRDDY FSQYCRDYR
ASK	IF FSQYSNPCRD = 2
On what date were food stamps last put on <TEXT FILL 1> <TEXT FILL 2> card? INTERVIEWER INSTRUCTION: PROBE FOR ANY MISSING PORTIONS OF DATE. |___|___| - |___|___| - |___|___|___|___| MONTH DAY YEAR DON'T KNOW 9 REFUSED 7
SPANISH	¿En qué fecha se agregaron los cupones o estampillas de alimentos por última vez en <TEXT FILL 1> <TEXT FILL 2> ? INTERVIEWER INSTRUCTION: PROBE FOR ANY MISSING PORTIONS OF DATE. |___|___| - |___|___| - |___|___|___|___| MONTH DAY YEAR DON'T KNOW 9 REFUSED 7
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL “your” IF RESPONDENT BELONGS TO CARD ELSE, FILL “[NAME(S) OF HH MEMBERS THAT BELONG TO CARD]’s” TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT”
FILLS (SPA)	TEXT FILL 1: FILL “su tarjeta” IF RESPONDENT BELONGS TO CARD ELSE, FILL “la tarjeta de [NAME(S) OF HH MEMBERS THAT BELONG TO CARD]” TEXT FILL 2: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT”
NOTES	SEPARATE FIELDS FOR MONTH, DAY, AND YEAR, ALLOW ENTRY OF RF AND DK IN FIELDS.
HARD CHECK	DATE MUST BE WITHIN PAST 12 MONTHS OF CURRENT MONTH.
SOFT CHECK
VERSION NOTES	FSQ.930 FSQ.931 FSQ.932
NEXT	FSQYCRDAMT

FSQYCRDAMT
ASK	IF FSQYSNPCRD = 2
<TEXT FILL 1>, what amount in food stamps was put on <TEXT FILL 2> <TEXT FILL 3> card? |___|___|___|___| ENTER DOLLAR AMOUNT DON’T KNOW 99999 REFUSED 77777
SPANISH	<TEXT FILL 1>, ¿qué cantidad se agregó en cupones o estampillas de alimentos en <TEXT FILL 2> <TEXT FILL 3> ? |___|___|___|___| ENTER DOLLAR AMOUNT DON’T KNOW 99999 REFUSED 77777
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL “In {FSQYCRDMO}” IF FSQCRDMO IS NOT MISSING, RF (7), OR DK (9) ELSE, FILL “The last time food stamps were put on it,” TEXT FILL 2: FILL “your” IF RESPONDENT BELONGS TO CARD FILL “<TEXT FILL 4>” IF RESPONDENT DOES NOT BELONG TO CARD AND ONLY ONE HH MEMBERS BELONGS TO CARD FILL “their” IF RESPONDENT DOES NOT BELONG TO CARD AND MORE THAN ONE HH MEMBER BELONGS TO CARD TEXT FILL 3: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN A STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT” TEXT FILL 4: FILL “his” IF SELECTED HH MEMBER IS MALE FILL “her” IF SELECTED HH MEMBER IS FEMALE FILL “[SELECTED HH MEMBER NAME]’s” SELECTED HH MEMBER DOES NOT IDENTIFY AS MALE OR FEMALE
FILLS (SPA)	TEXT FILL 1: FILL “En {FSQYCRDMO}” IF FSQCRDMO IS NOT MISSING, RF (7), OR DK (9) ELSE, FILL “La última vez que se agregaron cupones o estampillas de alimentos” TEXT FILL 2: FILL “su tarjeta” IF RESPONDENT BELONGS TO CARD FILL “<TEXT FILL 4>” IF RESPONDENT DOES NOT BELONG TO CARD AND ONLY ONE HH MEMBERS BELONGS TO CARD FILL “su tarjeta” IF RESPONDENT DOES NOT BELONG TO CARD AND MORE THAN ONE HH MEMBER BELONGS TO CARD TEXT FILL 3: FILL “[STATE NAME FOR EBT CARD]” IF INTERVIEWING IN A STATE THAT HAS SPECIFIC NAME FOR EBT CARD ELSE, FILL “EBT” TEXT FILL 4: FILL “su tarjeta” IF SELECTED HH MEMBER IS MALE FILL “su tarjeta” IF SELECTED HH MEMBER IS FEMALE FILL “la tarjeta de [SELECTED HH MEMBER NAME]” SELECTED HH MEMBER DOES NOT IDENTIFY AS MALE OR FEMALE
NOTES
HARD CHECK	AMOUNT SHOULD BE GREATER THAN ZERO.
SOFT CHECK	IF ONE PERSON SELECTED IN FSQYSNPNAM AND FSQYCRDAMT >700, CONFIRM AMOUNT ENTERED; IF 2-6 PERSONS SELECTED IN FSQYSNPNAM AND FSQYCRDAMT >900 CONFIRM AMOUNT; IF =>7 PERSONS SELECTED IN FSQYSNPNAM AND FSQYCRDAMT >1300 CONFIRM AMOUNT.
VERSION NOTES	FSQ.935
NEXT	ASK FSQYCRDMO - FSQYCRDAMT FOR SECOND CARD. IF INFORMATION COLLECTED FOR ALL CARDS, AND IF ALL HH MEMBERS ARE MARKED “SELECTED” ON FSQSNPNAM OR FSQYSNPNAM: INQINCY ELSE: FSQSNPEVER.

FSQSNPEVER
ASK	IF FSQYSNP = 2, 7, OR 9 OR IF NOT ALL HH MEMBERS MARKED “SELECT” ON FSQSNPNAM OR FSQYSNPNAM
<TEXT FILL 1> 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	<TEXT FILL 1> 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: IF FSQSNP AND FSQYSNP = 2 (NO), 7 (RF), OR 9 (DK), THEN DISPLAY QUESTION AS: “<TEXT FILL 2> ever gotten Food Stamps? <TEXT FILL 3>” ELSE, FILL: . “<TEXT FILL 4> ever gotten Food Stamps? TEXT FILL 2: FILL “Have you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “Have you or anyone in your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “Has [HOUSEHOLD RP NAME]” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “Has anyone in [HOUSEHOLD RP NAME]’s household” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 3: IF MORE THAN ONE PERSON IN HOUSEHOLD, FILL: “(Here is the list of people who live here, let me read it to you.) DISPLAY HOUSEHOLD ROSTER WITH NAMES OF ALL HH MEMBERS ENCLOSED IN PARENTHESES.” ELSE, TEXT FILL 3 IS EMPTY TEXT FILL 4: FILL “Have you” IF RESPONDENT IS THE ONLY HOUSEHOLD MEMBER THAT IS NOT SELECTED ON FSQSNPNAM OR FSQYSNPNAM FILL “Have you or [NAME(S) OF ALL HH MEMBERS NOT SELECTED IN FSQSNPNAM AND FSQYSNPNAM]” IF RESPONDENT AND AT LEAST ONE OTHER HH MEMBER ARE NOT SELECTED ON FSQSNPNAM OR FSQYSNPNAM FILL “Has [NAME OF HH MEMBERS NOT SELECTED IN FSQSNPNAM AND FSQYSNPNAM]” IF ONLY ONE HH MEMBER IS NOT SELECTED ON FSQSNPNAM OR FSQYSNPNAM FSQYSNPNAM AND THAT PERSON IS NOT THE RESPONDENT FILL “Have [NAME(S) OF ALL HH MEMBERS NOT SELECTED IN FSQSNPNAM AND FSQYSNPNAM]” IF MORE THAN ONE HH MEMBER IS NOT SELECTED ON FSQSNPNAM OR FSQYSNPNAM
FILLS (SPA)	TEXT FILL 1: IF FSQSNP AND FSQYSNP = 2 (NO), 7 (RF), OR 9 (DK), THEN DISPLAY QUESTION AS: ¿Alguna vez “<TEXT FILL 2> recibido cupones o estampillas de alimentos? <TEXT FILL 3>” ELSE, FILL: . ¿Alguna vez “<TEXT FILL 4> recibido cupones o estampillas de alimentos? TEXT FILL 2: FILL “usted ha” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “usted o alguna persona en su hogar han” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[HOUSEHOLD RP NAME] ha” IF RESPONDENT IS NOT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “alguna persona en el hogar de [HOUSEHOLD RP NAME] ha” IF RESPONDENT IS NOT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD TEXT FILL 3: IF MORE THAN ONE PERSON IN HOUSEHOLD, FILL: “(Esta es la lista de las personas que viven aquí, permítame que se la lea). DISPLAY HOUSEHOLD ROSTER WITH NAMES OF ALL HH MEMBERS ENCLOSED IN PARENTHESES.” ELSE, TEXT FILL 3 IS EMPTY TEXT FILL 4: FILL “usted ha” IF RESPONDENT IS THE ONLY HOUSEHOLD MEMBER THAT IS NOT SELECTED ON FSQSNPNAM OR FSQYSNPNAM FILL “usted o [NAME(S) OF ALL HH MEMBERS NOT SELECTED IN FSQSNPNAM AND FSQYSNPNAM] han” IF RESPONDENT AND AT LEAST ONE OTHER HH MEMBER ARE NOT SELECTED ON FSQSNPNAM OR FSQYSNPNAM FILL “[NAME OF HH MEMBERS NOT SELECTED IN FSQSNPNAM AND FSQYSNPNAM] ha” IF ONLY ONE HH MEMBER IS NOT SELECTED ON FSQSNPNAM OR FSQYSNPNAM FSQYSNPNAM AND THAT PERSON IS NOT THE RESPONDENT FILL “[NAME(S) OF ALL HH MEMBERS NOT SELECTED IN FSQSNPNAM AND FSQYSNPNAM] ha(n)” IF MORE THAN ONE HH MEMBER IS NOT SELECTED ON FSQSNPNAM OR FSQYSNPNAM
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	FSQ.945
NEXT	IF FSQSNPEVER = 2, 7, OR 9, INQINCY IF FSQSNPEVER = 1 AND ONLY ONE PERSON IN HOUSEHOLD OR ONE PERSON THAT’S “NOT SELECTED (CODE 2)” IN FSQSNPNAM AND FSQYSNPNAM, FLAG PERSON AS RECEIVING SNAP IN FSQSNPID: INQINCY ELSE: FSQSNPID.

FSQSNPID
ASK	IF FSQSNPEVER = 1 AND MULTIPLE PEOPLE MARKED “NOT SELECTED (CODE 2)” IN FSQSNPNAM AND FSQYSNPNAM
<TEXT FILL 1> (Anyone else?) INTERVIEWER INSTRUCTION: SELECT NAME(S) FROM ROSTER 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	<TEXT FILL 1> (¿Alguien más?). INTERVIEWER INSTRUCTION: SELECT NAME(S) FROM ROSTER 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Select all that apply
FILLS (ENG)	TEXT FILL 1: IF BOTH FSQSNP AND FSQYSNP = NO (2), RF (7), OR DK (9), FILL: “Who in the household has ever gotten Food Stamps? DISPLAY HOUSEHOLD ROSTER WITH NAMES OF ALL HH MEMBERS ENCLOSED IN PARENTHESES.” ELSE, FILL: “Among <TEXT FILL 2>, who has ever gotten Food Stamps? DISPLAY NAMES OF ALL HOUSEHOLD MEMBERS NOT SELECTED IN BOTH FSQSNPNAM AND FSQYSNPNAM” TEXT FILL 2: FILL “you and [NAME(S) OF ALL HH MEMBERS NOT SELECTED IN BOTH FSQSNPNAM AND FSQYSNPNAM]” IF RESPONDENT AND AT LEAST ONE OTHER HH MEMBER NOT SELECTED IN BOTH FSQSNPNAM AND FSQYSNPNAM ELSE, FILL “[NAME(S) OF ALL HH MEMBERS NOT SELECTED IN BOTH FSQSNPNAM AND FSQYSNPNAM]”
FILLS (SPA)	TEXT FILL 1: IF BOTH FSQSNP AND FSQYSNP = NO (2), RF (7), OR DK (9), FILL: “¿Quién ha recibido alguna vez cupones o estampillas de alimentos en el hogar? DISPLAY HOUSEHOLD ROSTER WITH NAMES OF ALL HH MEMBERS ENCLOSED IN PARENTHESES.” ELSE, FILL: “Entre <TEXT FILL 2>, ¿quién ha recibido alguna vez cupones o estampillas de alimentos? DISPLAY NAMES OF ALL HOUSEHOLD MEMBERS NOT SELECTED IN BOTH FSQSNPNAM AND FSQYSNPNAM” TEXT FILL 2: FILL “usted y [NAME(S) OF ALL HH MEMBERS NOT SELECTED IN BOTH FSQSNPNAM AND FSQYSNPNAM]” IF RESPONDENT AND AT LEAST ONE OTHER HH MEMBER NOT SELECTED IN BOTH FSQSNPNAM AND FSQYSNPNAM ELSE, FILL “[NAME(S) OF ALL HH MEMBERS NOT SELECTED IN BOTH FSQSNPNAM AND FSQYSNPNAM]”
NOTES	AUTOFILL THOSE WHO WERE NOT SELECTED AS CODE “2”.
HARD CHECK	IF CODE=2 FOR ALL MEMBERS IN ROSTER, DISPLAY THE FOLLOWING MESSAGE TO VERIFY THE ANSWER TO FSQSNPID: “You said someone who lives here has been on Food Stamps. Is that correct?” IF YES, GO BACK TO FSQSNPID AND ASK: “Who was that?” WITH ROSTER DISPLAYED. IF NO, GO BACK TO CODE FSQSNPEVER AS ‘NO’.
HARD CHECK (SPA)	IF CODE=2 FOR ALL MEMBERS IN ROSTER, DISPLAY THE FOLLOWING MESSAGE TO VERIFY THE ANSWER TO FSQSNPID: “Usted dijo que alguien que vive aquí ha recibido cupones o estampillas de alimentos. ¿Es correcto?” IF YES, GO BACK TO FSQSNPID AND ASK: “¿Quién era esa persona?” WITH ROSTER DISPLAYED. IF NO, GO BACK TO CODE FSQSNPEVER AS ‘NO’.
SOFT CHECK
VERSION NOTES	FSQ.955
NEXT	END OF SECTION

INCOME – INQ

Target Group: Household

INQINCY INQINCY2
ASK	All respondents
HAND CARD INQ. Now I would like to ask about the total <TEXT FILL 1> income for <TEXT FILL 2> for <TEXT FILL 3>, including income from all sources such as wages, salaries, Social Security, or retirement benefits, help from relatives and so forth. Can you tell me that amount before taxes? (Income is an important factor in the analysis of the health information we collect. Access to medical care depends in part on a person or family’s financial resources. This information helps us learn if people in one income group use certain types of medical services more or less than people in other income groups. We may also learn if one income group has certain medical conditions more than other income groups.) |___|___|___|___|___|___|___|___|___|___| ENTER AMOUNT So that I can make sure that I am entering the correct amount, please tell me the total <TEXT FILL 1> income for <TEXT FILL 2> for <TEXT FILL 3>,again, before taxes. |___|___|___|___|___|___|___|___|___|___| RE-ENTER AMOUNT DON’T KNOW 99999999999 REFUSED 77777777777
SPANISH	HAND CARD INQ. Ahora me gustaría preguntar acerca <TEXT FILL 1> de <TEXT FILL 2> en <TEXT FILL 3>, incluidos los ingresos de todas las fuentes, como sueldos, salarios, Seguro Social o beneficios de jubilación, ayuda de familiares, etc. ¿Puede decirme esa cantidad antes de impuestos? (Los ingresos son un factor importante en el análisis de la información de salud que recopilamos. El acceso a la atención médica depende en parte de los recursos financieros de una persona o familia. Esta información nos ayuda a saber si las personas de un grupo de ingresos utilizan ciertos tipos de servicios médicos más o menos que las personas de otros grupos de ingresos. También podemos saber si un grupo de ingresos tiene ciertas condiciones médicas más que otros grupos de ingresos). |___|___|___|___|___|___|___|___|___|___| ENTER AMOUNT Para asegurarme de que estoy ingresando el monto correcto, dígame el ingreso total del <TEXT FILL 1> para <TEXT FILL 2> para el año <TEXT FILL 3>, nuevamente, antes de impuestos. |___|___|___|___|___|___|___|___|___|___| RE-ENTER AMOUNT DON’T KNOW 99999999999 REFUSED 77777777777
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL “household” IF THERE IS MORE THAN ONE PERSON IN HOUSEHOLD ELSE, TEXT FILL 1 IS EMPTY TEXT FILL 2: FILL “you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “you and [NAME(S) OF HH MEMBER(S)]” IF RESPONDENT IS IN HOUSEHOLD AND THERE IS MORE THAN ONE PERSON IN HOUSEHOLD FILL “[NAME(S) OF HH MEMBER(S)]” IF RESPONDENT IS NOT IN HOUSEHOLD TEXT FILL 3: FILL LAST CALENDAR YEAR.
FILLS (SPA)	TEXT FILL 1: FILL “del ingreso total del hogar” IF THERE IS MORE THAN ONE PERSON IN HOUSEHOLD ELSE, TEXT FILL 1 IS EMPTY TEXT FILL 2: FILL “usted” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “usted y [NAME(S) OF HH MEMBER(S)]” IF RESPONDENT IS IN HOUSEHOLD AND THERE IS MORE THAN ONE PERSON IN HOUSEHOLD FILL “[NAME(S) OF HH MEMBER(S)]” IF RESPONDENT IS NOT IN HOUSEHOLD TEXT FILL 3: FILL LAST CALENDAR YEAR.
NOTES	REQUIRE DOUBLE ENTRY OF INCOME. (DOUBLE ENTRY QUESTION NUMBER: INQINCY2) IF ENTRIES DO NOT MATCH, DISPLAY BOTH ENTRIES WITH THE ERROR MESSAGE “THESE TWO ENTRIES DO NOT MATCH. PLEASE RE-ENTER. INTERVIEW SHOULD SELECT ENTRY TO CORRECT.
HARD CHECK
SOFT CHECK
VERSION NOTES	INQ.NEW1
NEXT	IF INQINCY = 77777777777 (RF) OR 99999999999 (DK): INQINCYRNG ELSE: INQINCM

INQINCYRNG
ASK	IF HHQINCRYRNG = 777777777 (RF) OR 999999999 (DK)
You may not be able to give us an exact figure for <TEXT FILL 1>, but can you tell me if this income for <TEXT FILL 2> was . . . (Income is important in using the health information we collect. For example, it helps us to learn whether persons in one income group use certain types of medical services or have certain health conditions more or less often than those in another income group.) 1. $20,000 or more, or 2. less than $20,000? 9. DON’T KNOW 7. REFUSED
SPANISH	Es posible que no pueda darnos una cantidad exacta <TEXT FILL 1>, pero ¿puede decirme si este ingreso en <TEXT FILL 2> fue...? (Los ingresos son importantes para analizar la información de salud que obtenemos. Por ejemplo, esta información nos ayuda a aprender qué tipos de servicios médicos usan las personas o si tienen ciertas condiciones de salud con mayor o menor frecuencia que las personas de otros grupos de ingresos). 1. $20,000 dólares o más 2. menos de $20,000 dólares 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[NAME(S) OF HOUSEHOLD MEMBER(S)]” IF RESPONDENT IS NOT IN HOUSEHOLD TEXT FILL 2: FILL LAST CALENDAR YEAR.
FILLS (SPA)	TEXT FILL 1: FILL “de su ingreso” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “del ingreso de su hogar” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “del ingreso de [NAME(S) OF HOUSEHOLD MEMBER(S)]” IF RESPONDENT IS NOT IN HOUSEHOLD TEXT FILL 2: FILL LAST CALENDAR YEAR.
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	INQ.NEW3
NEXT	IF INQINCYRNG = 7 (RF) AND SCQHRP = NO VALID HRP: TTQCONTACT ELSE IF INQINCYRNG = 7 (RF) AND HRP IS NOT AN SP: DMQEDUC ELSE IF INQINCYRNG = 7 (RF) AND HRP IS AN SP: DMQMARRY IF INQINCYRNG = 9 (DK): INQINCM ELSE: INQINCYGRP

INQINCYGRPa

INQINCYGRPb

ASK

IF INQINCYRNG = 1 OR 2

HAND CARD <HAND CARD FILL>

Please, look at card <HAND CARD FILL>. Of the income groups listed on this card, please tell me which letter best represents <TEXT FILL 1> income for <TEXT FILL 2>.

ENTER LETTER(S) CORRESPONDING TO TOTAL COMBINED HOUSEHOLD INCOME.

|___|___|

<LETTERS FILL>

DON'T KNOW 99

REFUSED 77

SPANISH

HAND CARD <HAND CARD FILL>

Mire la tarjeta <HAND CARD FILL>. De los grupos de ingresos en esta tarjeta, dígame qué letra representa mejor <TEXT FILL 1> para <TEXT FILL 2>.

ENTER LETTER(S) CORRESPONDING TO TOTAL COMBINED HOUSEHOLD INCOME.

|___|___|

<LETTERS FILL>

DON'T KNOW 99

REFUSED 77

QUESTION TYPE

Numeric

FILLS (ENG)

HAND CARD FILL: FILL “INQ1” IF TOTAL COMBINED HOUSEHOLD INCOME IS $20,000 OR MORE

ELSE, FILL “INQ2”

TEXT FILL 1: FILL “your” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD

FILL “your household’s” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD

FILL “[NAME(S) OF HH MEMBER(S)]’s” IF RESPONDENT IS NOT IN HOUSEHOLD

TEXT FILL 2: FILL LAST CALENDAR YEAR

LETTERS FILL: IF TOTAL COMBINED HOUSEHOLD INCOME IS $20,000 OR MORE, FILL:

“

U. $20,000 - $20,999	CC. $28,000 - $28,999	KK. $40,000 - $44,999	SS. $80,000 - $84,999
V. $21,000 - $21,999	DD. $29,000 - $29,999	LL. $45,000 - $49,999	TT. $85,000 - $89,999
W. $22,000 - $22,999	EE. $30,000 - $30,999	MM. $50,000 - $54,999	UU. $90,000 - $94,999
X. $23,000 - $23,999	FF. $31,000 - $31,999	NN. $55,000 - $59,999	VV. $95,000 - $99,999
Y. $24,000 - $24,999	GG. $32,000 - $32,999	OO. $60,000 - $64,999	WW. $100,000 and over
Z. $25,000 - $25,999	HH. $33,000 - $33,999	PP. $65,000 - $69,999
AA. $26,000 - $26,999	II. $34,000 - $34,999	QQ. $70,000 - $74,999
BB. $27,000 - $27,999	JJ. $35,000 - $39,999	RR. $75,000 - $79,999

“

ELSE, FILL:

“

A. Less than $1,000	I. $8,000 - $8,999	Q. $16,000 - $16,999
B. $1,000 - $1,999	J. $9,000 - $9,999	R. $17,000 - $17,999
C. $2,000 - $2,999	K. $10,000 - $10,999	S. $18,000 - $18,999
D. $3,000 - $3,999	L. $11,000 - $11,999	T. $19,000 - $19,999
E. $4,000 - $4,999	M. $12,000 - $12,999
F. $5,000 - $5,999	N. $13,000 - $13,999
G. $6,000 - $6,999	O. $14,000 - $14,999
H. $7,000 - $7,999	P. $15,000 - $15,999

“

FILLS

(SPA)

HAND CARD FILL: FILL “INQ1” IF TOTAL COMBINED HOUSEHOLD INCOME IS $20,000 OR MORE

ELSE, FILL “INQ2”

TEXT FILL 1: FILL “su ingreso” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD

FILL “el ingreso de su hogar” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD

FILL “el ingreso de [NAME(S) OF HH MEMBER(S)]” IF RESPONDENT IS NOT IN HOUSEHOLD

TEXT FILL 2: FILL LAST CALENDAR YEAR

LETTERS FILL: IF TOTAL COMBINED HOUSEHOLD INCOME IS $20,000 OR MORE, FILL:

“

U. Entre $20,000 y $20,999 dólares	CC. Entre $28,000 y $28,999 dólares	KK. Entre $40,000 y $44,999 dólares	SS. Entre $80,000 y $84,999 dólares
V. Entre $21,000 y $21,999 dólares	DD. Entre $29,000 y $29,999 dólares	LL. Entre $45,000 y $49,999 dólares	TT. Entre $85,000 y $89,999 dólares
W. Entre $22,000 y $22,999 dólares	EE. Entre $30,000 y $30,999 dólares	MM. Entre $50,000 y $54,999 dólares	UU. Entre $90,000 y $94,999 dólares
X. Entre $23,000 y $23,999 dólares	FF. Entre $31,000 y $31,999 dólares	NN. Entre $55,000 y $59,999 dólares	VV. Entre $95,000 y $99,999 dólares
Y. Entre $24,000 y $24,999 dólares	GG. Entre $32,000 y $32,999 dólares	OO. Entre $60,000 y $64,999 dólares	WW. $100,000 dólares o más
Z. Entre $25,000 y $25,999 dólares	HH. Entre $33,000 y $33,999 dólares	PP. Entre $65,000 y $69,999 dólares
AA. Entre $26,000 y $26,999 dólares	II. Entre $34,000 y $34,999 dólares	QQ. Entre $70,000 y $74,999 dólares
BB. Entre $27,000 y $27,999 dólares	JJ. Entre $35,000 y $39,999 dólares	RR. Entre $75,000 y $79,999 dólares

“

ELSE, FILL:

“

A. Menos de $1,000 dólares	I. Entre $8,000 y $8,999 dólares	Q. Entre $16,000 y $16,999 dólares
B. Entre $1,000 y $1,999 dólares	J. Entre $9,000 y $9,999 dólares	R. Entre $17,000 y $17,999 dólares
C. Entre $2,000 y $2,999 dólares	K. Entre $10,000 y $10,999 dólares	S. Entre $18,000 y $18,999 dólares
D. Entre $3,000 y $3,999 dólares	L. Entre $11,000 y $11,999 dólares	T. Entre $19,000 y $19,999 dólares
E. Entre $4,000 y $4,999 dólares	M. Entre $12,000 y $12,999 dólares
F. Entre $5,000 y $5,999 dólares	N. Entre $13,000 y $13,999 dólares
G. Entre $6,000 y $6,999 dólares	O. Entre $14,000 y $14,999 dólares
H. Entre $7,000 y $7,999 dólares	P. Entre $15,000 y $15,999 dólares

“

NOTES

HARD CHECK

IF INQINCYRNG = 1, ONLY ALLOW U THROUGH WW TO BE ACCEPTED, DISPLAY “INVALID RESPONSE, PLEASE SELECT A LETTER BETWEEN ‘U’ AND ‘WW’ OR GO BACK AND CORRECT INQINCYRNG”

IF INQINCYRNG = 2, ONLY ALLOW A THROUGH T TO BE ACCEPTED, “INVALID RESPONSE, PLEASE SELECT A LETTER BETWEEN ‘A’ AND ‘T’ OR GO BACK AND CORRECT INQINCYRNG”

SOFT CHECK

VERSION NOTES

INQ.NEW4a

INQ.NEW4b

NEXT

INQINCM

INQINCM INQINCM2
ASK	All respondents
What is the total income received last month, <TEXT FILL 1>, by <TEXT FILL 2> before taxes? [Please include income from all sources such as wages, salaries, Social Security, or retirement benefits, help from relatives and so forth.] INTERVIEWER INSTRUCTION: IF RESPONDENT DOES NOT KNOW INCOME OF OTHER HOUSEHOLD MEMBERS, ENTER DON’T KNOW. |___|___|___|___|___|___|___|___|___| ENTER AMOUNT Again, to make sure that I am entering the correct amount, please tell me the total income received last month, <TEXT FILL 1>, by <TEXT FILL 2> before taxes. |___|___|___|___|___|___|___|___|___| RE-ENTER AMOUNT DON'T KNOW 9999999999 REFUSED 7777777777
SPANISH	¿Cuál es el ingreso total recibido el mes pasado, <TEXT FILL 1>, por <TEXT FILL 2> antes de la deducción de impuestos? [Incluya ingresos de todas las fuentes, como sueldos, salarios, Seguro Social o beneficios de jubilación, ayuda de parientes, etc.]. INTERVIEWER INSTRUCTION: IF RESPONDENT DOES NOT KNOW INCOME OF OTHER HOUSEHOLD MEMBERS, ENTER DON’T KNOW. |___|___|___|___|___|___|___|___|___| ENTER AMOUNT Nuevamente, para asegurarme de que estoy ingresando la cantidad correcta, dígame el ingreso total recibido el mes pasado, <TEXT FILL 1>, por <TEXT FILL 2> antes de la deducción de impuestos. |___|___|___|___|___|___|___|___|___| RE-ENTER AMOUNT DON'T KNOW 9999999999 REFUSED 7777777777
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL LAST CALENDAR MONTH AND LAST CALENDAR YEAR IF MONTH IS JANUARY ELSE FILL LAST CALENDAR MONTH AND CURRENT CALENDAR YEAR TEXT FILL 2: FILL “you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “you and everyone who lives here” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[NAME(S) OF HH MEMBER(S)]” IF RESPONDENT IS NOT IN HOUSEHOLD
FILLS (SPA)	TEXT FILL 1: FILL LAST CALENDAR MONTH AND LAST CALENDAR YEAR IF MONTH IS JANUARY ELSE FILL LAST CALENDAR MONTH AND CURRENT CALENDAR YEAR TEXT FILL 2: FILL “usted” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “usted y todos los que viven aquí” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[NAME(S) OF HH MEMBER(S)]” IF RESPONDENT IS NOT IN HOUSEHOLD
NOTES	REQUIRE DOUBLE ENTRY OF INCOME (INQINCM2) IF ENTRIES DO NOT MATCH, DISPLAY BOTH ENTRIES. WITH THE ERROR MESSAGE “THESE TWO ENTRIES DO NOT MATCH. PLEASE RE-ENTER. INTERVIEWER SHOULD SELECT ENTRY TO CORRECT. IF INQINCM = DK/RF, DO NOT ALLOW INPUT IN INQINCM2 AND CODE INQINCM2 THE SAME IF INQINCY OR INQINCYGRPa OR INQINCYGRPa ARE VALID AND THE ENTRY IS GREATER THAN THE TOTAL ANNUAL INCOME FROM INQINCY OR INQINCYGRPa OR INQINCYGRPa, DISPLAY “INTERVIEWER, YOU HAVE RECORDED AN ANNUAL TOTAL INCOME OF [FILL INQINCY OR INQINCYGRPa OR INQINCYGRPa] AND LAST MONTH’S TOTAL INCOME WAS RECORDED AS [FILL INQINCM]. PLEASE CONFIRM THAT LAST MONTH’S INCOME OF [FILL INQINCM] IS CORRECT.” FOR THE CALENDAR FILL: IF CURRENT MONTH IS JANUARY THE PAST CALENDAR YEAR WILL BE SHOWN
HARD CHECK
SOFT CHECK	IF AMOUNT REPORTED IN INQINCM (MONTHLY INCOME) GREATER THAN OR EQUAL TO THE AMOUNT REPORTED IN INQINCY OR LOWER RANGE VALUE IN INQINCYGRPa/b (ANNUAL INCOME), DISPLAY SOFT EDIT MESSAGE: “INTERVIEWER, YOU HAVE RECORDED AN ANNUAL TOTAL INCOME OF {ANNUAL INCOME REPORTED IN INQINCM OR LOWER RANGE VALUE IN INQINCYGRPa/b} AND LAST MONTH’S TOTAL INCOME WAS RECORDED AS {TOTAL MONTHLY INCOME REPORTED IN INQINCM}. PLEASE CONFIRM THAT LAST MONTH’S INCOME OF {TOTAL MONTHLY INCOME REPORTED IN INQINCM} IS CORRECT.
VERSION NOTES	INQ.NEW5
NEXT	IF INQINCM = 7777777777 (RF) OR 9999999999 (DK): INQINCMRNG ELSE: INQSAVE

INQINCMRNG

ASK

IF INQINCM = 777777777 (RF) OR 999999999 (DK)

You may not be able to give us an exact figure, but can you tell me if the income for <TEXT FILL 1> in <TEXT FILL 2> was . . .

(That would be <PROBE FILL> per year.)

1. <RESPONSE FILL> or less, or

2. more than <RESPONSE FILL>

9. DON’T KNOW

7. REFUSED

SPANISH

Es posible que no pueda darnos una cantidad exacta del ingreso total, ¿pero puede decirme si <TEXT FILL 1> en <TEXT FILL 2> fue de...?

(Eso sería <PROBE FILL> por año).

1. <RESPONSE FILL> o menos

2. más de <RESPONSE FILL>

9. DON’T KNOW

7. REFUSED

QUESTION TYPE

Radio button

FILLS (ENG)

TEXT FILL 1: FILL “you” IF RESPONDENT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD

FILL “your household” IF RESPONDENT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD

FILL “[NAME(S) OF HH MEMBER(S)]” IF RESPONDENT NOT IN HOUSEHOLD

TEXT FILL 2: IF MONTH IS JANUARY, FILL LAST CALENDAR MONTH AND LAST CALENDAR YEAR

ELSE, FILL LAST CALENDAR MONTH AND CURRENT CALENDAR YEAR

PROBE FILL: FILL 185% OF THE ANNUAL POVERTY LEVEL BASED ON HOUSEHOLD SIZE:

• FOR HOUSEHOLD SIZES 1-8, USE THE NUMBERS IN THE 5TH COLUMN IN THE TABLE BELOW

• FOR HOUSEHOLD SIZE >8, WITH EACH ADDITIONAL MEMBER:

  • FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA, FILL {[$86,266+($8,732 * # OF ADDITIONAL PERSON PAST 8)] ROUND TO NEAREST 100S}.

RESPONSE FILL: FILL 185% OF THE MONTHLY POVERTY LEVEL BASED ON HOUSEHOLD SIZE:

• FOR HOUSEHOLD SIZES 1-8, USE THE NUMBERS IN THE 3RD COLUMN IN THE APPROPRIATE TABLE BELOW.

• FOR HOUSEHOLD SIZE > 8, WITH EACH ADDITIONAL HOUSEHOLD MEMBER:

  • FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA, FILL {[$7,189+($728* # OF ADDITIONAL PERSON PAST 8)] ROUND TO NEAREST 100S}.

FILLS

(SPA)

TEXT FILL 1: FILL “su ingreso” IF RESPONDENT IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD

FILL “el ingreso de su hogar” IF RESPONDENT IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD

FILL “el ingreso de [NAME(S) OF HH MEMBER(S)]” IF RESPONDENT NOT IN HOUSEHOLD

TEXT FILL 2: IF MONTH IS JANUARY, FILL LAST CALENDAR MONTH AND LAST CALENDAR YEAR

ELSE, FILL LAST CALENDAR MONTH AND CURRENT CALENDAR YEAR

PROBE FILL: FILL 185% OF THE ANNUAL POVERTY LEVEL BASED ON HOUSEHOLD SIZE:

• FOR HOUSEHOLD SIZES 1-8, USE THE NUMBERS IN THE 5TH COLUMN IN THE TABLE BELOW

• FOR HOUSEHOLD SIZE >8, WITH EACH ADDITIONAL MEMBER:

  • FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA, FILL {[$86,266+($8,732 * # OF ADDITIONAL PERSON PAST 8)] ROUND TO NEAREST 100S}.

RESPONSE FILL: FILL 185% OF THE MONTHLY POVERTY LEVEL BASED ON HOUSEHOLD SIZE:

• FOR HOUSEHOLD SIZES 1-8, USE THE NUMBERS IN THE 3RD COLUMN IN THE APPROPRIATE TABLE BELOW.

• FOR HOUSEHOLD SIZE > 8, WITH EACH ADDITIONAL HOUSEHOLD MEMBER:

FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA, FILL {[$7,189+($728* # OF ADDITIONAL PERSON PAST 8)] ROUND TO NEAREST 100S}.

NOTES

TABLE 1A. 185% POVERTY LEVELS FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA

Persons in Household	185% monthly poverty level		185% annual poverty level
	Raw Number1	Rounded to nearest 100s2	Raw Number3	Rounded to nearest 100s4
1	2,095	2,100	25,142	25,100
2	2,823	2,800	33,874	33,900
3	3,550	3,600	42,606	42,600
4	4,278	4,300	51,338	51,300
5	5,006	5,000	60,070	60,100
6	5,733	5,700	68,802	68,800
7	6,461	6,500	77,534	77,500
8	7,189	7,200	86,266	86,300

¹: For each additional person past 8, the value is $7,189 + ($728 * # of additional persons past 8)

²: These are the numbers to be used in the response category fills.

³: For each additional person past 8, the value is $86,266 + ($8,732 * # of additional persons past 8)

⁴: These are the numbers to be used in the probe fills.

HARD CHECK

SOFT CHECK

VERSION NOTES

INQ.NEW7

NEXT

IF INQINCMRNG = 2: INQSAVE

ELSE: INQINCMPOV

INQINCMPOV

ASK

IF INQINCMRNG = 1, 7, OR 9

Was it more or less than <RESPONSE FILL>?

(That would be <PROBE FILL> per year.)

1. <RESPONSE FILL> OR LESS, OR

2. MORE THAN <RESPONSE FILL>

9. DON’T KNOW

7 REFUSED

SPANISH

¿Fue más o menos del <RESPONSE FILL>?

(Eso sería <PROBE FILL> por año).

1. <RESPONSE FILL> OR LESS, OR

2. MORE THAN <RESPONSE FILL>

9. DON’T KNOW

7 REFUSED

QUESTION TYPE

Radio button

FILLS (ENG)

PROBE FILL: FILL 130% OF THE ANNUAL POVERTY LEVEL BASED ON HOUSEHOLD SIZE:

• FOR HOUSEHOLD SIZES 1-8, USE THE NUMBERS IN THE 5TH COLUMN IN THE APPROPRIATE TABLE BELOW.

• FOR HOUSEHOLD SIZE > 8, WITH EACH ADDITIONAL MEMBER:

  • FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA, FILL {[$60,600+($6,136* # OF ADDITIONAL PERSON PAST 8)] ROUND TO NEAREST 100S}

RESPONSE FILL: FILL 130% OF THE MONTHLY POVERTY LEVEL BASED ON HOUSEHOLD SIZE:

• FOR HOUSEHOLD SIZES 1-8, USE THE NUMBERS IN THE 3RD COLUMN IN THE APPROPRIATE TABLE BELOW.

• FOR HOUSEHOLD SIZE > 8, WITH EACH ADDITIONAL HOUSEHOLD MEMBER:

  • FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA, FILL {[$5,052+($511* # OF ADDITIONAL PERSON PAST 8)] ROUND TO NEAREST 100S}.

NOTES

TABLE 2A. 130% POVERTY LEVELS FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA

Persons in Household	130% monthly poverty level		130% annual poverty level
	Raw Number1	Rounded to nearest 100s2	Raw Number3	Rounded to nearest 100s4
1	1,472	1,500	17,667	17,700
2	1,984	2,000	23,803	23,800
3	2,495	2,500	29,939	29,900
4	3,006	3,000	36,075	36,100
5	3,518	3,500	42,211	42,200
6	4,029	4,000	48,347	48,300
7	4,540	4,500	54,483	54,500
8	5,052	5,100	60,619	60,600

¹: For each additional person past 8, the value is $5,052 + ($511 * # of additional persons past 8)

²: These are the numbers to be used in the text of question and response category fills.

³: For each additional person past 8, the value is $60,619 + ($6,136 * # of additional persons past 8)

⁴: These are the numbers to be used in the probe fills.

HARD CHECK

SOFT CHECK

VERSION NOTES

INQ.NEW8

NEXT

INQSAVE

INQSAVE
ASK	All respondents
HAND CARD INQ3. <TEXT FILL 1> have more than $20,000 in savings at this time? Please include money in all types of accounts <TEXT FILL 2> may have. There are some examples of the types of accounts on card INQ3. 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	HAND CARD INQ3. ¿<TEXT FILL 1> más de $20,000 dólares ahorrados en este momento? Incluya el dinero en todo tipo de cuentas que <TEXT FILL 2> pueda tener. Hay algunos ejemplos de los tipos de cuentas en la tarjeta INQ3. 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “Do you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “Does your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “Do [NAME(S) OF HH MEMBER(S)]” IF RESPONDENT IS NOT IN HOUSEHOLD AND HH HAS > 1 MEMBERS FILL “DOES [NAME OF HH MEMBER]” IF RESPONDENT IS NOT IN HOUSEHOLD AND HH HAS ONLY 1 MEMBER TEXT FILL 2: FILL “you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[NAME(S) OF HH MEMBER(S)]” IF RESPONDENT IS NOT IN HOUSEHOLD
FILLS (SPA)	TEXT FILL 1: FILL “Tiene usted” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “Tiene su hogar” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “Tiene(n) [NAME(S) OF HH MEMBER(S)]” IF RESPONDENT IS NOT IN HOUSEHOLD AND HH HAS > 1 MEMBERS FILL “Tiene [NAME OF HH MEMBER]” IF RESPONDENT IS NOT IN HOUSEHOLD AND HH HAS ONLY 1 MEMBER TEXT FILL 2: FILL “usted” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “su hogar” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[NAME(S) OF HH MEMBER(S)]” IF RESPONDENT IS NOT IN HOUSEHOLD
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	INQ.NEW9
NEXT	IF INQSAVE = 2: INQSAVERNG ELSE IF HRP = NO VALID HRP: TTQCONTACT ELSE IF HRP IS NOT SP: DMQEDUC ELSE IF HRP IS SP: DMQMARRY

INQSAVERNG
ASK	IF INQSAVE = 2
HAND CARD INQ4. Next, please look at this card. Which letter on this card best represents the total savings or cash assets at this time for <TEXT FILL 1>? A: $0 - $3,000 B: $3,001 - $5,000 C: $5,001 - $10,000 D: $10,001 - $15,000 E: $15,001 - $20,000 9. DON'T KNOW 7. REFUSED
SPANISH	HAND CARD INQ4. Ahora, mire esta tarjeta. ¿Qué letra en esta tarjeta representa mejor el total de los ahorros o bienes en efectivo que tiene <TEXT FILL 1> en este momento? A: $0 - $3,000 dólares B: $3,001 a $5,000 dólares C: $5,001 a $10,000 dólares D: $10,001 a $15,000 dólares E: $15,001 a $20,000 dólares 9. DON'T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “you” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “your household” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[NAME(S) OF HH MEMBER(S)]” IF RESPONDENT IS NOT IN HOUSEHOLD
FILLS (SPA)	TEXT FILL 1: FILL “usted” IF RESPONDENT IS IN HOUSEHOLD AND ONLY ONE PERSON IN HOUSEHOLD FILL “su hogar” IF RESPONDENT IS IN HOUSEHOLD AND MORE THAN ONE PERSON IN HOUSEHOLD FILL “[NAME(S) OF HH MEMBER(S)]” IF RESPONDENT IS NOT IN HOUSEHOLD
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	INQ.NEW10
NEXT	ELSE IF HRP = NO VALID HRP: TTQCONTACT ELSE IF HRP IS NOT SP: DMQEDUC ELSE IF HRP IS SP: DMQMARRY

DEMOGRAPHIC BACKGROUND – DMQ

Target Group: Household Reference Person

DMQEDUC
ASK	IF HOUSEHOLD REFERENCE PERSON IS NOT SP AND IF SCQHRP != ‘NO VALID HRP’
Now, I have a few questions about <TEXT FILL 1> HAND CARD DMQ1 Please look at card DMQ1. What is the highest grade or level of school <TEXT FILL 2> completed? READ CARD CATEGORIES IF NECESSARY 0. NEVER ATTENDED/KINDERGARTEN ONLY 1. GRADE 1-11 2. 12TH GRADE, NO DIPLOMA 3. HIGH SCHOOL GRADUATE 4. GED OR EQUIVALENT 5. SOME COLLEGE, NO DEGREE 6. ASSOCIATE’S DEGREE (EXAMPLE, AA, AS) 7. BACHELOR’S DEGREE (EXAMPLE: BA, AB, BS, BBA) 8. MASTER’S DEGREE (EXAMPLE: MA, MS, MEng, MEd, MBA) 9. PROFESSIONAL SCHOOL DEGREE (EXAMPLE: MD, DDS, DVM, JD) 10. DOCTORAL DEGREE (EXAMPLE: PhD, EdD) 99. DON’T KNOW 77. REFUSED
SPANISH	Ahora tengo algunas preguntas sobre <TEXT FILL 1>. HAND CARD DMQ1 Mire la tarjeta DMQ1. ¿Cuál es el grado o nivel escolar más alto que <TEXT FILL 2> ha completado? READ CARD CATEGORIES IF NECESSARY 0. NUNCA ASISTIÓ/SOLO KINDERGARTEN 1. DEL PRIMER GRADO AL 11º GRADO 2. 12º GRADO, SIN DIPLOMA 3. ESCUELA SECUNDARIA/PREPARATORIA/SUPERIOR O “HIGH SCHOOL” 4. “GED” O EQUIVALENTE 5. ALGO DE UNIVERSIDAD, SIN GRADUARSE 6. TÍTULO ASOCIADO UNIVERSITARIO (POR EJEMPLO, AA, AS) 7. LICENCIATURA UNIVERSITARIA (POR EJEMPLO, BA, AB, BS, BBA) 8. TÍTULO DE MAESTRÍA (POR EJEMPLO, MA, MS, MEng, MEd, MBA) 9. ESCUELA PROFESIONAL DE POSTGRADO (POR EJEMPLO, MD, DDS, DVM, JD) 10. TÍTULO DE DOCTORADO (POR EJEMPLO, PhD, EdD) 99. DON’T KNOW 77. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “you” IF RESPONDENT IS THE NON-SP HOUSEHOLD REFERENCE PERSON. ELSE, FILL: “[NON-SP HOUSEHOLD REFERENCE PERSON NAME] TEXT FILL 2: FILL “you have” IF RESPONDENT IS THE NON-SP HOUSEHOLD REFERENCE PERSON. ELSE, FILL: “[NON-SP HOUSEHOLD REFERENCE PERSON NAME] has”
FILLS (SPA)	TEXT FILL 1: FILL “usted” IF RESPONDENT IS THE NON-SP HOUSEHOLD REFERENCE PERSON. ELSE, FILL: “[NON-SP HOUSEHOLD REFERENCE PERSON NAME] TEXT FILL 2: FILL “usted” IF RESPONDENT IS THE NON-SP HOUSEHOLD REFERENCE PERSON. ELSE, FILL: “[NON-SP HOUSEHOLD REFERENCE PERSON NAME]”
NOTES
HELP SCREEN	School: An institution that advances a person toward an elementary or high school diploma, or a college or professional school degree. Do not count schooling in non-regular schools unless the credits are accepted by regular schools. Regular school includes graded public, private, and parochial schools, colleges, universities, graduate and professional schools, seminaries where a Bachelor's degree is offered, community colleges specializing in skill training or offering Associates degrees, colleges of education, and nursing schools where a Bachelor's degree is offered. If the person attended school outside of the “regular” school system, probe to determine if the schooling is applicable here. Use the following guidelines to determine if the schooling should be included: Training Programs - Count training received "on the job," in the Armed Forces, or through correspondence school only if it was credited toward a school diploma, high school equivalency (GED), or college degree. Vocational, Trade, or Business School - Do not include secretarial school, mechanical or computer training school, nursing school where a Bachelor's degree is not offered, and other vocational trade or business schools outside the regular school system. General Educational Development (GED) or High School Equivalency - An exam certified equivalent of a high school diploma. If the person has not actually completed all 4 years of high school, but has acquired his/her GED (high school equivalency based on passing the GED exam), count this and select “GED OR EQUIVALENT”. Adult Education - Adult education classes should not be included as regular school unless such schooling has been counted for credit in a regular school system. If a person has taken adult education classes not for credit, these classes should not be counted as regular school. Adult education courses given in a public school building are part of regular schooling only if their completion can advance a person toward an elementary school certificate, a high school diploma (or GED), or a college degree. Other School Systems - If the person attended school in another country, in an ungraded school, in a "normal school", under a tutor, or under other special circumstances, ask the respondent to give the nearest equivalent of years in regular U.S. schooling.
HELP SCREEN (SPA)	Escuela/Colegio: Institución que prepara a una persona para obtener un diploma de escuela secundaria/preparatoria/superior o “high school”, o un título universitario o de escuela profesional. No incluya instrucción en escuelas no regulares a menos que los créditos se acepten por escuelas regulares. Las escuelas regulares incluyen escuelas públicas, privadas y parroquiales, universidades, escuelas de graduados y profesionales, seminarios donde se ofrece el título de licenciatura, universidades intermedias (junior college) especializadas en la capacitación de destrezas/habilidades o títulos de dos años, facultades de ciencias de la educación y escuelas de enfermería donde se ofrecen títulos de licenciatura. Si la persona asistió a la escuela fuera del sistema escolar “regular”, verifique para determinar si la instrucción cumple con esos requisitos. Use las siguientes pautas para determinar si la instrucción debe ser incluida: Programas de capacitación: Incluya la capacitación recibida “en el trabajo”, en las Fuerzas Armadas o por correspondencia únicamente si se recibieron créditos para obtener de un diploma de escuela secundaria/preparatoria/superior o “high school” o el examen de equivalencia de escuela secundaria/preparatoria/superior o “high school” (GED) o un título universitario. Escuela vocacional de comercio o de negocios: No incluya la escuelas de secretariado, de mecánica o escuelas de capacitación en computadoras, escuelas de enfermería donde no se ofrece licenciatura y otras escuelas vocacionales de comercio o negocios fuera del sistema escolar regular. Desarrollo Educativo General (GED) o equivalencia a la escuela secundaria/preparatoria/superior o “high school”: Examen certificado equivalente a un diploma de escuela secundaria/preparatoria/superior o “high school”. Si la persona en realidad no ha completado los 4 años de escuela secundaria/preparatoria/superior o “high school”, pero obtuvo un GED (equivalente al diploma de la escuela secundaria/preparatoria/superior o “high school”, cuente eso y seleccione “GED” O EQUIVALENTE”. Educación para adultos: Las clases de educación para adultos no deben incluirse como escuela regular a menos que tal instrucción haya sido contada como créditos en un sistema escolar regular. Si una persona toma clases de educación para adultos que no es para obtener créditos, estas clases no se deben contar como escuela regular. Los cursos de educación para adultos que se ofrecen en un edificio de una escuela pública forman parte de la instrucción regular únicamente si al completarlos, la persona puede avanzar para obtener un certificado de escuela elemental/primaria, un diploma de escuela secundaria/preparatoria/superior o “high school” (o GED) o un título universitario. Otros sistemas escolares: Si la persona asistió a la escuela en otro país, a una escuela no calificada, a una “escuela normal” bajo un tutor o bajo otras circunstancias especiales, pida a la persona encuestada que indique el equivalente más cercano de años de instrucción regular en Estados Unidos.
HARD CHECK
SOFT CHECK
VERSION NOTES	DMQ.141N
NEXT	DMQBORN

DMQBORN
ASK	IF HOUSEHOLD REFERENCE PERSON IS NOT SP AND IF SCQHRP != ‘NO VALID HRP’
<TEXT FILL 1> born in the United States or a United States territory? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
SPANISH	¿Nació <TEXT FILL 1> en los Estados Unidos o en un territorio de los Estados Unidos? 1. YES 2. NO 9. DON’T KNOW 7. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “Were you” IF RESPONDENT IS THE NON-SP HOUSEHOLD REFERENCE PERSON. ELSE, FILL “Was [NON-SP HOUSEHOLD REFERENCE PERSON NAME]”
FILLS (SPA)	TEXT FILL 1: FILL “usted” IF RESPONDENT IS THE NON-SP HOUSEHOLD REFERENCE PERSON. ELSE, FILL “[NON-SP HOUSEHOLD REFERENCE PERSON NAME]”
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	DMQ.128
NEXT	DMQMARRY

DMQMARRY
ASK	IF SCQHRP != ‘NO VALID HRP’
<TEXT FILL 1> <TEXT FILL 3> now married, widowed, divorced, separated, never married, or living with a partner? 1. MARRIED 2. WIDOWED 3. DIVORCED 4. SEPARATED 5. NEVER MARRIED 6. LIVING WITH PARTNER 99. DON’T KNOW 77. REFUSED
SPANISH	<TEXT FILL 1> ¿<TEXT FILL 3> actualmente casado(a), viudo(a), divorciado(a), separado(a), nunca se ha casado o está viviendo en pareja? 1. MARRIED 2. WIDOWED 3. DIVORCED 4. SEPARATED 5. NEVER MARRIED 6. LIVING WITH PARTNER 99. DON’T KNOW 77. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	IF THE HOUSEHOLD REFERENCE PERSON IS A SP, TEXT FILL 1: FILL: “Now, I have a few questions about <TEXT FILL 2> INTERVIEWER INSTRUCTION: VERIFY AND REENTER IF RESPONSE PROVIDED PREVIOUSLY IN SP INTERVIEW.” ELSE, TEXT FILL 1 IS EMPTY TEXT FILL 2: FILL “you” IF RESPONDENT IS THE HOUSEHOLD REFERENCE PERSON ELSE, FILL “[HOUSEHOLD REFERENCE PERSON NAME]” TEXT FILL 3: FILL “Are you” IF RESPONDENT IS THE HOUSEHOLD REFERENCE PERSON ELSE, FILL “Is [HOUSEHOLD REFERENCE PERSON NAME]”
FILLS (SPA)	IF THE HOUSEHOLD REFERENCE PERSON IS A SP, TEXT FILL 1: FILL: “Ahora tengo algunas preguntas sobre <TEXT FILL 2>. INTERVIEWER INSTRUCTION: VERIFY AND REENTER IF RESPONSE PROVIDED PREVIOUSLY IN SP INTERVIEW.” ELSE, TEXT FILL 1 IS EMPTY TEXT FILL 2: FILL “usted” IF RESPONDENT IS THE HOUSEHOLD REFERENCE PERSON ELSE, FILL “[HOUSEHOLD REFERENCE PERSON NAME]” TEXT FILL 3: FILL “Está usted” IF RESPONDENT IS THE HOUSEHOLD REFERENCE PERSON ELSE, FILL “Está [HOUSEHOLD REFERENCE PERSON NAME]”
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	DMQ.380
NEXT	IF DMQMARRY = 1 OR 6: DMQEDUCSPS ELSE: TTQCONTACT

DMQEDUCSPS
ASK	IF DMQMARRY = 1 OR 6
[HAND CARD DMQ1] Please look at card DMQ1. What is the highest grade or level of school <TEXT FILL 1> <TEXT FILL 2> completed? READ CARD CATEGORIES IF NECESSARY 0. NEVER ATTENDED/KINDERINTGARTEN ONLY 1. GRADE 1-11 2. 12TH GRADE, NO DIPLOMA 3. HIGH SCHOOL GRADUATE 4. GED OR EQUIVALENT 5. SOME COLLEGE, NO DEGREE 6. ASSOCIATE’S DEGREE (EXAMPLE: AA, AS) 7. BACHELOR’S DEGREE (EXAMPLE: BA, AB, BS, BBA) 8. MASTER’S DEGREE (EXAMPLE: MA, MS, MEng, MEd, MBA) 9. PROFESSIONAL SCHOOL DEGREE (EXAMPLE: MD, DDS, DVM, JD) 10. DOCTORAL DEGREE (EXAMPLE: PhD, EdD) 99. DON’T KNOW 77. REFUSED
SPANISH	[HAND CARD DMQ1] Mire la tarjeta DMQ1. ¿Cuál es el grado o nivel escolar más alto que <TEXT FILL 1> <TEXT FILL 2> ha completado? READ CARD CATEGORIES IF NECESSARY 0. NUNCA ASISTIÓ/SOLO KINDERGARTEN 1. DEL PRIMER GRADO AL 11º GRADO 2. 12.º GRADO, SIN DIPLOMA 3. ESCUELA SECUNDARIA/PREPARATORIA/SUPERIOR O “HIGH SCHOOL” 4. “GED” O EQUIVALENTE 5. ALGO DE UNIVERSIDAD, SIN GRADUARSE 6. TÍTULO ASOCIADO UNIVERSITARIO (POR EJEMPLO, AA, AS) 7. LICENCIATURA UNIVERSITARIA (POR EJEMPLO, BA, AB, BS, BBA) 8. TÍTULO DE MAESTRÍA (POR EJEMPLO, MA, MS, MEng, MEd, MBA) 9. ESCUELA PROFESIONAL DE POSTGRADO (POR EJEMPLO, MD, DDS, DVM, JD) 10. TÍTULO DE DOCTORADO (POR EJEMPLO, PhD, EdD) 99. DON’T KNOW 77. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: FILL “your” IF RESPONDENT IS THE HOUSEHOLD REFERENCE PERSON. ELSE, FILL: “[HOUSEHOLD REFERENCE PERSON NAME]’s” TEXT FILL 2: FILL “spouse” IF DMQMARRY = 1 (FROM EITHER SP OR HOUSEHOLD QUESTIONNAIRE) ELSE, FILL “partner”
FILLS (SPA)	TEXT FILL 1: FILL “su” IF RESPONDENT IS THE HOUSEHOLD REFERENCE PERSON. ELSE, FILL: “de [HOUSEHOLD REFERENCE PERSON NAME]” TEXT FILL 2: FILL “su esposo(a)” IF DMQMARRY = 1 (FROM EITHER SP OR HOUSEHOLD QUESTIONNAIRE) ELSE, FILL “su pareja”
NOTES
HELP SCREEN	School: An institution that advances a person toward an elementary or high school diploma, or a college or professional school degree. Do not count schooling in non-regular schools unless the credits are accepted by regular schools. Regular school includes graded public, private, and parochial schools, colleges, universities, graduate and professional schools, seminaries where a Bachelor's degree is offered, community colleges specializing in skill training or offering Associates degrees, colleges of education, and nursing schools where a Bachelor's degree is offered. If the person attended school outside of the “regular” school system, probe to determine if the schooling is applicable here. Use the following guidelines to determine if the schooling should be included: Training Programs - Count training received "on the job," in the Armed Forces, or through correspondence school only if it was credited toward a school diploma, high school equivalency (GED), or college degree. Vocational, Trade, or Business School - Do not include secretarial school, mechanical or computer training school, nursing school where a Bachelor's degree is not offered, and other vocational trade or business schools outside the regular school system. General Educational Development (GED) or High School Equivalency - An exam certified equivalent of a high school diploma. If the person has not actually completed all 4 years of high school, but has acquired his/her GED (high school equivalency based on passing the GED exam), count this and select “GED OR EQUIVALENT”. Adult Education - Adult education classes should not be included as regular school unless such schooling has been counted for credit in a regular school system. If a person has taken adult education classes not for credit, these classes should not be counted as regular school. Adult education courses given in a public school building are part of regular schooling only if their completion can advance a person toward an elementary school certificate, a high school diploma (or GED), or a college degree. Other School Systems - If the person attended school in another country, in an ungraded school, in a "normal school", under a tutor, or under other special circumstances, ask the respondent to give the nearest equivalent of years in regular U.S. schooling.
HELP SCREEN (SPA)	Escuela/Colegio: Institución que prepara a una persona para obtener un diploma de escuela secundaria/preparatoria/superior o “high school”, o un título universitario o de escuela profesional. No incluya instrucción en escuelas no regulares a menos que los créditos se acepten por escuelas regulares. Las escuelas regulares incluyen escuelas públicas, privadas y parroquiales, universidades, escuelas de graduados y profesionales, seminarios donde se ofrece el título de licenciatura, universidades intermedias (junior college) especializadas en la capacitación de destrezas/habilidades o títulos de dos años, facultades de ciencias de la educación y escuelas de enfermería donde se ofrecen títulos de licenciatura. Si la persona asistió a la escuela fuera del sistema escolar “regular”, verifique para determinar si la instrucción cumple con esos requisitos. Use las siguientes pautas para determinar si la instrucción debe ser incluida: Programas de capacitación: Incluya la capacitación recibida “en el trabajo”, en las Fuerzas Armadas o por correspondencia únicamente si se recibieron créditos para obtener de un diploma de escuela secundaria/preparatoria/superior o “high school” o el examen de equivalencia de escuela secundaria/preparatoria/superior o “high school” (GED) o un título universitario. Escuela vocacional de comercio o de negocios: No incluya la escuelas de secretariado, de mecánica o escuelas de capacitación en computadoras, escuelas de enfermería donde no se ofrece licenciatura y otras escuelas vocacionales de comercio o negocios fuera del sistema escolar regular. Desarrollo Educativo General (GED) o equivalencia a la escuela secundaria/preparatoria/superior o “high school”: Examen certificado equivalente a un diploma de escuela secundaria/preparatoria/superior o “high school”. Si la persona en realidad no ha completado los 4 años de escuela secundaria/preparatoria/superior o “high school”, pero obtuvo un GED (equivalente al diploma de la escuela secundaria/preparatoria/superior o “high school”, cuente eso y seleccione “GED” O EQUIVALENTE”. Educación para adultos: Las clases de educación para adultos no deben incluirse como escuela regular a menos que tal instrucción haya sido contada como créditos en un sistema escolar regular. Si una persona toma clases de educación para adultos que no es para obtener créditos, estas clases no se deben contar como escuela regular. Los cursos de educación para adultos que se ofrecen en un edificio de una escuela pública forman parte de la instrucción regular únicamente si al completarlos, la persona puede avanzar para obtener un certificado de escuela elemental/primaria, un diploma de escuela secundaria/preparatoria/superior o “high school” (o GED) o un título universitario. Otros sistemas escolares: Si la persona asistió a la escuela en otro país, a una escuela no calificada, a una “escuela normal” bajo un tutor o bajo otras circunstancias especiales, pida a la persona encuestada que indique el equivalente más cercano de años de instrucción regular en Estados Unidos.
HARD CHECK
SOFT CHECK
VERSION NOTES	DMQ.142N
NEXT	TTQCONTACT

TRACKING AND TRACING – TTQ

Target Group: Household

TTQCONTACT
ASK	All respondents
The National Center for Health Statistics may wish to contact <TEXT FILL 1> again to obtain additional health related information. Please give me the names, addresses, and telephone numbers of 2 relatives or friends who would know where <TEXT FILL 1> could be reached in case we have trouble getting in touch with <TEXT FILL 1>. (Please give me the names of persons not currently living in the household.) SELECT REFUSED IF RESPONDENT REFUSES ALL CONTACT INFORMATION SELECT DON'T KNOW IF RESPONDENT DOESN'T KNOW ANY CONTACT INFORMATION SELECT CONTINUE AND PRESS NEXT TO ADD FIRST CONTACT INFORMATION CONTINUE 1 DON'T KNOW 999999 REFUSED 777777 Relative: All relationships that occur through blood (grandfather, daughter), marriage (wife, stepson), or adoption (adopted son or daughter). Include foster relationships and guardian/ward relationships.
SPANISH	El Centro Nacional de Estadísticas de la Salud posiblemente desee comunicarse con <TEXT FILL 1> nuevamente para obtener información adicional relacionada con la salud. Por favor, deme los nombres, direcciones y números de teléfono de 2 parientes o amigos que sepan cómo nos podríamos comunicar con <TEXT FILL 1> en caso de que tengamos problemas para contactarnos con <TEXT FILL 1>. (Por favor, deme los nombres de personas que no estén viviendo actualmente en su hogar). SELECT REFUSED IF RESPONDENT REFUSES ALL CONTACT INFORMATION SELECT DON'T KNOW IF RESPONDENT DOESN'T KNOW ANY CONTACT INFORMATION SELECT CONTINUE AND PRESS NEXT TO ADD FIRST CONTACT INFORMATION CONTINUE 1 DON'T KNOW 999999 REFUSED 777777 Pariente: Todas las relaciones comunes que ocurren por sangre (abuelo, hija), matrimonio (esposa, hijastro) o adopción (hijo(a) adoptivo(a)). Incluya parentescos de crianza “foster” y las relaciones de guardianes/tutores legales con las personas que están bajo su cuidado.
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL “you” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “[HOUSEHOLD RP NAME]”
FILLS (SPA)	TEXT FILL 1: FILL “usted” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “[HOUSEHOLD RP NAME]”
NOTES
HARD CHECK	RESPONSE ENTRY TEXT IS “DON’T KNOW,” “DONT KNOW,” “REFUSED,” “REFUSE,” “DK,” OR “RF.” HARD EDIT MESSAGE: “CLEAR TEXT AND PRESS F5 TO ENTER A RESPONSE OF DON’T KNOW AND F6 TO ENTER A RESPONSE OF REFUSAL.”
SOFT CHECK
VERSION NOTES	TTQ.005
NEXT	TTQCONTACT = 777777 OR 999999: HHQEND ELSE: ASK TTQNAME - TTQRELATN FOR 2 CONTACT PERSONS.

TTQNAMEa/c
ASK	IF TTQCONTACT != 777777 OR 999999
REFERRING TO PERSON <FILL #> VERIFY SPELLING. a. ENTER FIRST NAME DON'T KNOW 9----9 REFUSED 7----7 c. ENTER LAST NAME DON'T KNOW 9----9 REFUSED 7----7
SPANISH	NA
QUESTION TYPE	Text box
FILLS	FILL #: FILL “1” IF FIRST CONTACT NOT COLLECTED ELSE, FILL “2”
NOTES
HARD CHECK	RESPONSE ENTRY TEXT IS “DON’T KNOW,” “DONT KNOW,” “REFUSED,” “REFUSE,” “DK,” OR “RF.” HARD EDIT MESSAGE: “PLEASE SELECT EITHER DON’T KNOW OR REFUSED”
SOFT CHECK	IF LOOP 1 TTQNAMEa AND TTQNAMEc BOTH 77 OR 99, DISPLAY, “If no contact person is available, please go back and change TTQCONTACT.”
VERSION NOTES	TTQ.010
NEXT	IF EITHER TTQNAMEa OR TTQNAMEc = FILLED: TTQADDRESS IF LOOP 2 ‘NO SECOND CONTACT’, HHQEND

TTQADDRESSa/b/c/d/e
ASK	IF TTQCONTACT != 777777 OR 999999
REFERRING TO PERSON <FILL NAME> What is this person's address? [If there is more than one address, please give us the address they use most often.] ENCOURAGE RESPONDENT TO LOOK UP DOCUMENTATION IF AVAILABLE. ENTER ADDRESS LINE 1 [TTQADDRESSa] ENTER ADDRESS LINE 2 [TTQADDRESSb] ENTER CITY [TTQADDRESSc] ENTER STATE [TTQADDRESSd] ENTER ZIP (5 DIGIT) [TTQADDRESSE]
SPANISH	REFERRING TO PERSON <FILL NAME> ¿Cuál es la dirección de esta persona? [Si hay más de una dirección, díganos la dirección que utiliza con más frecuencia.] ENCOURAGE RESPONDENT TO LOOK UP DOCUMENTATION IF AVAILABLE. ENTER ADDRESS LINE 1 [TTQADDRESSa] ENTER ADDRESS LINE 2 [TTQADDRESSb] ENTER CITY [TTQADDRESSc] ENTER STATE [TTQADDRESSd] ENTER ZIP (5 DIGIT) [TTQADDRESSE]
QUESTION TYPE	Textbox: TTQADDRESSa/b/c Select from list: TTQADDRESSd Numeric: TTQADDRESSe
FILLS	<FILL NAME>: IF TTQNAMEa = DK/RF, FILL “PERSON # [LOOP NUMBER 1 OR 2]” ELSE FILL “TTQNAMEa” FOR FIRST CONTACT IF FIRST CONTACT NOT COLLECTED ELSE, FILL “TTQNAMEa” FOR SECOND CONTACT
NOTES	DISPLAY FIPS STATE LIST. INTERVIEWER SHOULD ONLY BE ABLE TO SELECT 1 STATE FROM THE LIST. DON'T KNOW AND REFUSED SHOULD BE VALID OPTIONS. THE STATE LOOKUP IN THE SP AND HOUSEHOLD QUESTIONNAIRES SHOULD WORK EXACTLY THE SAME. SAVE STATE LOOKUP NAME AS TTQADDRESSd AND STATE FIPS LOOKUP CODE AS TTQADDRESSf TTQADDRESSE SHOULD ONLY ALLOW 5 DIGIT ENTRIES
HARD CHECK
SOFT CHECK
VERSION NOTES	TTQ.020
NEXT	TTQPHONE
TTQPHONEa/b/c
ASK	IF TTQCONTACT != 777777 OR 999999
REFERRING TO PERSON <FILL NAME> What is this person's telephone number, beginning with the area code? REPEAT AREA CODE REPEAT PHONE NUMBER REPEAT EXTENSION |___|___|___| |___|___|___| - |___|___|___|___| |___|___|____|____| ENTER AREA CODE, CODE b. ENTER TELEPHONE NUMBER c. ENTER EXTENSION ‘000’ IF THERE IS NO PHONE WITH HYPHEN NO PHONE…………….000 DON'T KNOW……….9999999999 DON'T KNOW……….9999999 DON'T KNOW…….999999 REFUSED……………7777777777 REFUSED……………….7777 REFUSED………….777777
SPANISH	REFERRING TO PERSON <FILL NAME> ¿Cuál es el número de teléfono de esta persona, comenzando con el código de área? REPEAT AREA CODE REPEAT PHONE NUMBER REPEAT EXTENSION |___|___|___| |___|___|___| - |___|___|___|___| |___|___|____|____| ENTER AREA CODE, CODE b. ENTER TELEPHONE NUMBER c. ENTER EXTENSION ‘000’ IF THERE IS NO PHONE WITH HYPHEN NO PHONE…………….000 DON'T KNOW……….9999999999 DON'T KNOW……….9999999 DON'T KNOW…….999999 REFUSED……………7777777777 REFUSED……………….7777 REFUSED………….777777
QUESTION TYPE	Numeric
FILLS	<FILL NAME>: IF TTQNAMEa = DK/RF, FILL “PERSON # [LOOP NUMBER 1 OR 2]” ELSE FILL “TTQNAMEa” FOR FIRST CONTACT IF FIRST CONTACT NOT COLLECTED ELSE, FILL “TTQNAMEa” FOR SECOND CONTACT
NOTES	ALLOW TTQPHONEc (PHONE EXTENSION) TO BE BLANK. IF TTQPHONEa = ‘000’ OR RF OR DK: ALLOW TTQPHONEb (PHONE NUMBER) TO BE BLANK
HARD CHECK	ONLY ALLOW RESPONSE OF DON’T KNOW, REFUSED, "000" or 10 DIGIT PHONE NUMBER.  IF PHONE NUMBER PROVIDED, DISPLAY HARD RANGE CHECK MESSAGE IF PHONE NUMBER NOT "000" OR IS 10 DIGITS OF ALL THE SAME NUMBER (I.E., 1111111111): ‘PLEASE ENTER A VALID PHONE NUMBER OR ENTER 000 IF THERE IS NO PHONE.’.
SOFT CHECK	IF TTQADDRESS AND TTQPHONE ALL FIELDS ARE ALL MISSING (DK/RF), DISPLAY, “If no contact information is available, please go back and pick another contact person or change TTQCONTACT.”
VERSION NOTES	TTQ.030
NEXT	TTQRELATN

TTQRELATN
ASK	IF TTQCONTACT != 777777 OR 999999
REFERRING TO PERSON <FILL NAME> What is the relationship of this contact person to <TEXT FILL 1>? 1. SPOUSE/EX-SPOUSE NOT LIVING IN HH 2. UNMARRIED PARTNER NOT LIVING IN HH 3. CHILD 4. GRANDCHILD 5. PARENT (MOTHER OR FATHER) 6. BROTHER OR SISTER 7. GRANDPARENT 8. OTHER RELATIVE 9. LEGAL GUARDIAN 10. FRIEND 11. CO-WORKER 12. NEIGHBOR 13. OTHER 99. DON’T KNOW 77. REFUSED
SPANISH	REFERRING TO PERSON <FILL NAME> ¿Cuál es la relación o parentesco de esta persona de contacto con <TEXT FILL 1>? 1. ESPOSO(A)/EXESPOSO(A) QUE NO VIVE EN EL HOGAR 2. PAREJA (SIN ESTAR CASADOS) QUE NO VIVE EN EL HOGAR 3. HIJO(A) 4. NIETO(A) 5. MADRE O PADRE 6. HERMANO(A) 7. ABUELO(A) 8. OTRO PARIENTE 9. TUTOR/GUARDIÁN LEGAL 10. AMIGO(A) 11. COMPAÑERO(A) DE TRABAJO 12. VECINO(A) 13. OTRO 99. DON’T KNOW 77. REFUSED
QUESTION TYPE	Radio button
FILLS (ENG)	<FILL NAME>: IF TTQNAMEa = DK/RF, FILL “PERSON # [LOOP NUMBER 1 OR 2]” ELSE FILL “TTQNAMEa” FOR FIRST CONTACT IF FIRST CONTACT NOT COLLECTED ELSE, FILL “TTQNAMEa” FOR SECOND CONTACT TEXT FILL 1 FILL “you” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “[HOUSEHOLD RP NAME]”
FILLS (SPA)	<FILL NAME>: IF TTQNAMEa = DK/RF, FILL “PERSON # [LOOP NUMBER 1 OR 2]” ELSE FILL “TTQNAMEa” FOR FIRST CONTACT IF FIRST CONTACT NOT COLLECTED ELSE, FILL “TTQNAMEa” FOR SECOND CONTACT TEXT FILL 1 FILL “usted” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “[HOUSEHOLD RP NAME]”
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	TTQ.040
NEXT	IF SECOND CONTACT PERSON INFORMATION COLLECTED, GO TO HHQEND.

TTQNCONTACT
ASK	IF TTQCONTACT != 777777 OR 999999
We would now like to collect the contact information for a second person who would know where <TEXT FILL 1> could be reached in case we have trouble getting in touch with <TEXT FILL 1>. SELECT REFUSED IF RESPONDENT REFUSES ALL CONTACT INFORMATION SELECT DON'T KNOW IF RESPONDENT DOESN'T KNOW ANY CONTACT INFORMATION SELECT CONTINUE AND PRESS NEXT TO ADD SECOND CONTACT INFORMATION Relative: All relationships that occur through blood (grandfather, daughter), marriage (wife, stepson), or adoption (adopted son or daughter). Include foster relationships and guardian/ward relationships. CONTINUE 1 DON'T KNOW 999999 REFUSED 777777
SPANISH	Ahora nos gustaría recopilar la información de contacto de una segunda persona que sepa cómo nos podríamos comunicar con <TEXT FILL 1> en caso de que tengamos problemas para contactarnos con <TEXT FILL 1>. SELECT REFUSED IF RESPONDENT REFUSES ALL CONTACT INFORMATION SELECT DON'T KNOW IF RESPONDENT DOESN'T KNOW ANY CONTACT INFORMATION SELECT CONTINUE AND PRESS NEXT TO ADD SECOND CONTACT INFORMATION Pariente: Todas las relaciones que ocurren por sangre (abuelo, hija), matrimonio (esposa, hijastro) o adopción (hijo o hija adoptivo/a). Incluya relaciones de acogida y relaciones de tutores(as) con las personas que están bajo su tutela. CONTINUE 1 DON'T KNOW 999999 REFUSED 777777
QUESTION TYPE	Numeric
FILLS (ENG)	TEXT FILL 1: FILL “you” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “[HOUSEHOLD RP NAME]”
FILLS (SPA)	TEXT FILL 1: FILL “usted” IF RESPONDENT IS IN HOUSEHOLD ELSE, FILL “[HOUSEHOLD RP NAME]”
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	TTQ.005
NEXT	IF TTQCONTACT = 1, ASK TTQNAME - TTQRELATN FOR SECOND CONTACT PERSON IF TTQCONTACT = RF OR DK: HHQEND

HHQEND
ASK	All respondents
This is the end of the Interview. Thank you very much for your cooperation. INTERVIEWER: PRESS THE SUBMIT BUTTON BELOW TO FINALIZE CASE AND RETURN TO THE CASE MANAGEMENT SYSTEM.
SPANISH	Este es el final de la entrevista. Muchas gracias por su cooperación. INTERVIEWER: PRESS THE SUBMIT BUTTON BELOW TO FINALIZE CASE AND RETURN TO THE CASE MANAGEMENT SYSTEM.
QUESTION TYPE	None
FILLS
NOTES
HARD CHECK
SOFT CHECK
VERSION NOTES	TTQ.050
NEXT	END OF QUESTIONNAIRE

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