Download:
pdf |
pdf2025 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
DIQ-DEMOGRAPHICS AND INCOME
Question Text/Description
Code List
Routing
DEMOGRAPHICS AND INCOME QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C003
SPALIVE=ALL
SEASON=FALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after CMQ
DIINT
HISPORIG
DIINTROA
DI1A
no entry
yes/no
The next few questions are about Hispanic origin and race.
DI1A - HISPORIG
[Are you/Is (SP)] of Hispanic, (Latino/Latina), or Spanish origin?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) DI1B - HISPORDT
(02) DI2A - RACECODE
(-8) DI2A - RACECODE
(-9) DI2A - RACECODE
(01) 1 MEXICAN/MEXICAN AMERICAN/CHICANO(A)
(02) PUERTO RICAN
(03) CUBAN
(91) OTHER HISPANIC, LATINO(A), OR SPANISH
ORIGIN
(-8) Don't Know
(-9) Refused
(01) DI2A - RACECODE
(02) DI2A - RACECODE
(03) DI2A - RACECODE
(91) DI1B - HISPDTOS
(-8) DI2A - RACECODE
(-9) DI2A - RACECODE
HISPORDT
DI1B
code all
SHOW CARD DI1
Looking at this card, [are you/is (SP)] Mexican, Mexican American, or (Chicano/Chicana), Puerto Rican, Cuban,
or of another Hispanic, (Latino/Latina) or Spanish origin?
CHECK ALL THAT APPLY.
HISPDTOS
DI1B
verbatim text
OTHER ORIGIN (SPECIFY)
(01) continuous answer
DI2A - RACECODE
(01) AMERICAN INDIAN OR ALASKA NATIVE
(02) ASIAN
(03) BLACK OR AFRICAN AMERICAN
(04) NATIVE HAWAIIAN OR OTHER PACIFIC
ISLANDER
(05) WHITE
(-8) Don't Know
(-9) Refused
(01) BOX DI2B
(02) BOX DI2B
(03) BOX DI2B
(04) BOX DI2B
(05) BOX DI2B
(-8) BOX DI2B
(-9) BOX DI2B
(01) ASIAN INDIAN
(02) CHINESE
(03) FILIPINO
(04) JAPANESE
(05) KOREAN
(06) VIETNAMESE
(91) OTHER ASIAN GROUP
(-8) Don't Know
(-9) Refused
(01) BOX DI2C
(02) BOX DI2C
(03) BOX DI2C
(04) BOX DI2C
(05) BOX DI2C
(06) BOX DI2C
(91) DI2B - RACEASOS
(-8) BOX DI2C
(-9) BOX DI2C
(01) continuous answer
BOX DI2C
RACECODE
RACEASDT
DI2A
code all
SHOW CARD DI2
Looking at this card, what [is/was] [your/(SP)'s] race?
[ASK IF NECESSARY: Are there any options from this card that you would like me to record?]
BOX DI2B
routing
IF DI2A-RACECODE INCLUDES 2/Asian, GO TO DI2B - RACEASDT.
ELSE GO TO BOX DI2C.
DI2B
code all
SHOW CARD DI3
Looking at this card, [are you/is (SP)] Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese or some
other Asian group?
You can choose more than one group.
CHECK ALL THAT APPLY.
RACEASOS
DI2B
verbatim text
OTHER ASIAN GROUP (SPECIFY)
BOX DI2C
routing
IF DI2A-RACECODE INCLUDES 4/NatHawOrOthPaclsl, GO TO DI2C - RACEPIDT.
ELSE GO TO ENGWELL - D12F
(01) ENGWELL - D12F
(02) ENGWELL - D12F
(03) ENGWELL - D12F
(91) DI2C - RACEPIOS
(-8) ENGWELL - D12F
(-9) ENGWELL - D12F
ENGWELL - D12F
RACEPIDT
DI2C
code all
SHOW CARD DI4
(01) NATIVE HAWAIIAN
Looking at this card, [are you/is (SP)] Native Hawaiian, Guamanian or Chamorro, Samoan, or some other Pacific (02) GUAMANIAN OR CHAMORRO
Islander group?
(03) SAMOAN
(91) OTHER PACIFIC ISLANDER GROUP
You can choose more than one group.
(-8) Don't Know
CHECK ALL THAT APPLY.
(-9) Refused
RACEPIOS
DI2C
verbatim text
OTHER PACIFIC ISLANDER GROUP (SPECIFY)
(01) continuous answer
How well [do you/does (SP)/did (SP)] speak English? Would you say…
(01) Very well
(02) Well
(03) Not Well, or
(04) Not at all?
(-8) Don't Know
(-9) Refused
ENGWELL
DI2F
code one
DI2FB - ENGREAD
Page 1 of 3
2025 MCBS Community Questionnaire
Variable Name
ENGREAD
OTHRLANG
MR Screen Name
DI2FB
DI2D
Question Type
code one
yes/no
DIQ-DEMOGRAPHICS AND INCOME
Question Text/Description
Code List
Routing
How well [do you/does (SP)/did (SP)] read English? Would you say…
(01) Very well
(02) Well
(03) Not Well, or
(04) Not at all?
(-8) Don't Know
(-9) Refused
OTHRLANG - D12D
[Do you/Does (SP)] speak a language other than English at home?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) DI2E - WHATLANG
(02) SOGIINT
(-8) SOGIINT
(-9) SOGIINT
(01) SOGIINT
(02) SOGIINT
(03) SOGIINT
(04) SOGIINT
(05) SOGIINT
(06) SOGIINT
(07) SOGIINT
(08) SOGIINT
(09) SOGIINT
(10) SOGIINT
(11) SOGIINT
(12) SOGIINT
(13) SOGIINT
(14) SOGIINT
(15) SOGIINT
(91) DI2E - WHTLNGOS
(-8) SOGIINT
(-9) SOGIINT
SOGIINT
WHATLANG
DI2E
code one
What [is/was] this language?
(01) SPANISH
(02) FRENCH
(03) GERMAN
(04) ITALIAN
(05) TAGALOG
(06) CHINESE (MANDARIN, CANTONESE, or OTHER)
(07) POLISH
(08) KOREAN
(09) RUSSIAN
(10) GREEK
(11) FILIPINO
(12) ARABIC
(13) JAPANESE
(14) VIETNAMESE
(15) PORTUGUESE
(16) HINDI
(91) OTHER
(-8) Don't Know
(-9) Refused
WHTLNGOS
DI2E
verbatim text
SOME OTHER LANGUAGE (SPECIFY)
(01) continuous answer
SOGIINT
SOGIINT
no entry
[Next we have some questions about [your/(SP)'s] demographic characteristics, including [sexual orientation,]
gender identity, education, income, and religious preference. Like all your answers, these will be used to
understand the health of different groups in the population and will be kept confidential.]
BOX DI2CA
routing
If the respondent is a proxy (SPPROXY=2), go to GENIDENT DI3INTRO-DINNT3.
Else go to SEXORINT.
BOX DI2CA
DI3INTRO-DINNT3
(01) GENIDENT
(02) GENIDENT
(03) GENIDENT
(91) SEXORIOS
(04) GENIDENT
(-8) GENIDENT
(-9) GENIDENT
SEXORINT
SEXORINT
code one
Do you think of yourself as lesbian or gay; straight, that is, not lesbian or gay; bisexual; something else; or you
don't know the answer?
(01) LESBIAN OR GAY
(02) STRAIGHT, THAT IS, NOT LESBIAN OR GAY
(03) BISEXUAL
(91) SOMETHING ELSE
(04) I DON'T KNOW THE ANSWER
(-8 ) Don't Know
(-9) Refused
SEXORIOS
SEXORIOS
verbatim text
What do you mean by something else?
(01) continuous answer
GENIDENT
[(Do you)/(Does (SP)/(As of (DATE OF DEATH), did SP)] [currently] describe [yourself/themselves] as male,
female or transgender?
(01) MALE
(02) FEMALE
(03) TRANSGENDER
(04) NONE OF THESE
(-8 ) Don't Know
(-9) Refused
SEXASGN
(01) MALE
(02) FEMALE
(-8 ) Don't Know
(-9) Refused
DI3INTRO-DINNT3
GENIDENT
GENIDENT
code one
SEXASGN
SEXASGN
code one
What sex [(were you)/(was (SP))] assigned at birth on [your/(SP)’s] original birth certificate?
DIINT3
DI3INTRO
no entry
The next questions are about education and income.
DI3A - SPDEGRCV
Page 2 of 3
2025 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
DIQ-DEMOGRAPHICS AND INCOME
Question Text/Description
Code List
(01) NO SCHOOLING COMPLETED
(02) NURSERY SCHOOL TO 8TH GRADE
(03) 9TH-12TH GRADE, NO DIPLOMA
(04) HIGH SCHOOL GRADUATE (HIGH SCHOOL
DIPLOMA OR THE EQUIVALENT)
(05) VOCATIONAL/TECHNICAL/BUSINESS/TRADE
SCHOOL CERTIFICATE OR DIPLOMA (BEYOND THE
HIGH SCHOOL LEVEL)
DI4INTRO - DIINT4
(06) SOME COLLEGE, BUT NO DEGREE
(07) ASSOCIATE DEGREE
(08) BACHELOR'S DEGREE
(09) MASTER'S, PROFESSIONAL OR DOCTORATE
DEGREE
(-8) Don't Know
(-9) Refused
SPDEGRCV
DI3A
code one
SHOW CARD DI5
What is the highest degree or level of school [you have/(SP) has] completed?
[IF THE SAMPLE PERSON ATTENDED SCHOOL IN A FOREIGN COUNTRY, IN AN UNGRADED SCHOOL,
HOME SCHOOLING, OR UNDER OTHER UNIQUE CIRCUMSTANCES, REFER THE RESPONDENT TO THE
SHOWCARD AND ASK FOR THE NEAREST EQUIVALENT.]
DIINT4
DI4INTRO
no entry
In studies like this, people are sometimes grouped together according to income.
Was [your and your spouse's/(SP's) and (SP)'s spouse's/[your/(SP's)]] total income during the past 12 months
less than $25,000 or $25,000 or more, before taxes? Include income from jobs, Social Security, Railroad
Retirement, other retirement income, Supplemental Security Income (SSI), pensions, interest, and any other
sources.
SPINC25K
DI4
code one
[PROBE IF NECESSARY: In estimating [your/(SP's)] total income, you can respond for all of the past 12
months, or provide a one month estimate.]
[EXPLAIN IF NECESSARY: Income is important in analyzing the information we collect. For example, this
information helps us learn whether persons in one income group use certain types of medical care services or
have certain medical conditions more or less often than those in another group.]
SPINCLET
DI5A
code one
SHOW CARD DI6
Looking at this card, which letter best represents [your and your spouse's/(SP's) and (SP's)
spouse's/[your/(SP's)]] total income before taxes during the past 12 months? Include income from jobs, Social
Security, Railroad Retirement, other retirement income, and the other sources of income we just talked about.
[EXPLAIN IF NECESSARY: Income is important in analyzing the information we collect. For example, this
information helps us learn whether persons in one income group use certain types of medical care services or
have certain medical conditions more or less often than those in another group.]
What [is/was] [your/(SP)'s] religious preference?
RELGPREF
RELGPREF
code one
RELGPROS
RELGPROS
verbatim text
What [is/was] [your/(SP)'s] religious preference?
BOX DI3
routing
GO TO END SECTION.
[IF NEEDED: This is the religion/religious preference with which [you/(SP)] most closely
[identify/identifies/identified]]
Routing
DI4 - SPINC25K
(01) LESS THAN $25,000/YEAR
(02) $25,000 OR MORE/YEAR
(03) LESS THAN $2080/MONTH
(04) $2080/MONTH OR MORE
(-8) Don't Know
(-9) Refused
(01) DI5A - SPINCLET
(02) DI5A - SPINCLET
(03) DI5A - SPINCLET
(04) DI5A - SPINCLET
(-8) RELGPREF
(-9) RELGPREF
(01) A. Less than $5,000
(02) B. $5,000 - less than $10,000
(03) C. $10,000 - less than $15,000
(04) D. $15,000 - less than $20,000
(05) E. $20,000 - less than $25,000
(06) F. $25,000 - less than $30,000
(07) G. $30,000 - less than $40,000
(08) H. $40,000 - less than $50,000
(09) I. $50,000 - less than $66,000
(10) J. $66,000 - less than $109,000
(11) K. $109,000
(-8) Don't Know
(-9) Refused
RELGPREF
(01) PROTESTANT
(02) CATHOLIC
(03) EASTERN ORTHODOX, SUCH AS GREEK OR
RUSSIAN ORTHODOX
(04) JEWISH
(05) BUDDHIST
(06) HINDU
(07) MUSLIM, ISLAM, SUFI, SUNNI, OR SHIA
(91) SOME OTHER RELIGION
(08) NO RELIGION
(-8) DON'T KNOW
(-9) REFUSED
(01) BOX DI3
(02) BOX DI3
(03) BOX DI3
(04) BOX DI3
(05) BOX DI3
(06) BOX DI3
(07) BOX DI3
(91) RELGPROS
(08) BOX DI3
(-8) BOX DI3
(-9) BOX DI3
(01) continuous answer
BOX DI3
Page 3 of 3
2025 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
INQ-INTRODUCTION
Question Text/Description
Code List
Routing
INTRODUCTION QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=ALL
SPALIVE=ALL
SEASON=ALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
(Start of interview)
QUEXLANG
QUEXLANG
code one
PLEASE SELECT THE LANGUAGE IN WHICH YOU WOULD LIKE TO CONDUCT THE INTERVIEW.
(01) ENGLISH
(02) SPANISH
PHONINQ
PHONINQ
PHONINQ
code one
ARE YOU CURRENTLY CONDUCTING THIS INTERVIEW IN-PERSON OR ON THE PHONE?
(01) IN-PERSON
(02) PHONE
INV1- CARIVER
(01) RESPONDENT AGREES TO CONTINUE WITH
RECORDING
(02) RESPONDENT DOES NOT WANT TO BE
RECORDED
(01) IN1AA - ATDOOR
(02) INV2 - NOCARI
CARIVER
INV1
code one
NOCARI
INV2
no entry
ATDOOR
IN1AA
no entry
Some of this interview will be recorded for quality control purposes.
I'd like to continue now, unless you have any questions.
That's fine. The interview will not be recorded.
IN1AA - ATDOOR
REVIEW WITH THE RESPONDENT THE FOLLOWING IMPORTANT FACTS FROM THE "AT-THE-DOOR"
SHEET:
All survey information will be kept private to the extent permitted by law, as prescribed by the Privacy Act of
1974.
IN2 - VERIFYSP
Medicare benefits will not be affected in any way by survey responses or participation.
REFER TO THE "AT-THE-DOOR" SHEET IF THE RESPONDENT NEEDS ADDITIONAL REASSURANCE.
VERIFYSP
IN2
yes/no
ROSTFNAM
IN3
text
ROSTMINI
IN3
text
ROSTLNAM
IN3
text
VERIFY THE SP’S NAME. IS THE SP’S NAME CORRECT AND COMPLETE?
FIRST NAME: (SP'S FIRST NAME)
MIDDLE INITIAL: (SP'S MIDDLE INITIAL)
LAST NAME: (SP'S LAST NAME)
(01) YES
(02) NO
MAKE ALL NECESSARY CORRECTIONS TO THE SP'S NAME.
(01) INS1- SPAISTATUS
(02) IN3 - ROSTFNAM
IN3 - ROSTMINI
FIRST NAME:
MAKE ALL NECESSARY CORRECTIONS TO THE SP'S NAME.
IN3 - ROSTLNAM
MIDDLE INITIAL:
MAKE ALL NECESSARY CORRECTIONS TO THE SP'S NAME.
INS1- SPAISTATUS
LAST NAME:
PLEASE INDICATE THE RESPONDENT'S CURRENT STATUS. IF THE CASE IS A PROXY INTERVIEW AND
YOU HAVEN'T TALKED ABOUT THE RESPONDENT'S VITAL STATUS, PROBE AT THIS TIME ABOUT
WHETHER THE RESPONDENT IS ALIVE OR DECEASED AND WHERE THE RESPONDENT IS LOCATED.
SPAISTATUS
INS1
code one
WHEN WE REFER TO INSTITUTIONALIZED, WE ARE REFERRING TO THE MCBS DEFINITION OF A
FACILITY. FOR THE FULL MCBS DEFINITION OF A FACILITY, CLICK F1. PLEASE REMEMBER THAT
HOSPITALS AND HOSPICE CARE ARE NOT FACILITIES UNDER THE MCBS DEFINITION, SO
RESPONDENTS IN HOSPITALS AND HOSPICE CARE SHOULD NOT BE CONSIDERED TO BE
INSTITUTIONALIZED BELOW.
(01) ALIVE AND NOT INSTITUTIONALIZED
(02) ALIVE AND INSTITUTIONALIZED
(03) DECEASED - DIED IN COMMUNITY
(04) DECEASED - DIED IN INSTITUTION/FACILITY
(01) BOX INS1
(02) INS2 - SPINSTMM
(03) INS3 - SPDIEMM
(04) INS2 - SPINSTMM
IS THE RESPONDENT CURRENTLY:
What was the first date [(since [REFERENCE DATE] that [SP])/([that SP])] entered the facility?
SPINSTMM
INS2
date
(01) continuous answer
[EXPLAIN IF NECESSARY: By "facility" we mean a place that provides long term care. By "first date" we mean
(-8) Don't Know
the earliest date that the beneficiary enters any facility and does not enter a hospital or return home.]
(-9) Refused
IN2 - SPINSTDD
IF MORE THAN ONE DATE, ENTER THE EARLIEST.
Page 1 of 5
2025 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
INQ-INTRODUCTION
Question Text/Description
Code List
Routing
What was the first date [(since [REFERENCE DATE] that [SP])/([that SP])]entered the facility?
SPINSTDD
INS2
date
(01) continuous answer
[EXPLAIN IF NECESSARY: By "facility" we mean a place that provides long term care. By "first date" we mean
(-8) Don't Know
the earliest date that the beneficiary enters any facility and does not enter a hospital or return home.]
(-9) Refused
SPINSTYY
IF MORE THAN ONE DATE, ENTER THE EARLIEST.
What was the first date [(since [REFERENCE DATE] that [SP])/([that SP])] entered the facility?
SPINSTYY
INS2
date
[EXPLAIN IF NECESSARY: By "facility" we mean a place that provides long term care. By "first date" we mean
(01) continuous answer
the earliest date that the beneficiary enters any facility and does not enter a hospital or return home.]
BOX INSA
IF MORE THAN ONE DATE, ENTER THE EARLIEST.
BOX INSA
routing
IF (INS1 - SPAISTATUS = 4/DeceasedInInstitute) GO TO INS3 - SPDIEMM.
ELSE GO TO BOX INSA1.
SPDIEMM
INS3
date
On what date did (SP) die?
(01) continuous answer
(-8) Don't Know
(-9) Refused
(01) INS3 - SPDIEDD
(-8) INS3 - SPDIEDD
(-9) INS3 - SPDIEDD
SPDIEDD
INS3
date
On what date did (SP) die?
(01) continuous answer
(-8) Don't Know
(-9) Refused
(01) INS3 - SPDIEYY
(-8) INS3 - SPDIEYY
(-9) INS3 - SPDIEYY
date
On what date did (SP) die?
(01) continuous answer
(-8) Don't Know
(-9) Refused
(01) BOX INSA1
(-8) BOX INSA1
(-9) BOX INSA1
routing
IF (SPDIEMM or SPINSTMM IN(-8,-9) OR SPDIEYY or SPINSTYY IN(-8,-9) THEN GO TO INS3B-INTHANK.
ELSE IF (INS1 - SPAISTATUS = 3/Deceased) AND (INTTYPE in(3,7,10)) AND
(VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE=0) AND (SP'S DATE OF DEATH ENTERED AT INS3 IS
BEFORE JANUARY 1 OF THE CURRENT YEAR), GO TO INS3A - DEASDATE.
ELSE IF (INS1 - SPAISTATUS = 4/DeceasedInInstitute) AND (INTTYPE in(7,10)) AND (SP'S DATE OF
INSTITUTIONALIZATION ENTERED AT INS2 AND SP'S DATE OF DEATH ENTERED AT INS3 ARE BOTH
PRIOR TO JANUARY 1 OF CURRENT YEAR) AND (VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE=0),
GO TO INS3A - DEASDATE.
ELSE IF(INS1 - SPAISTATUS = 4/DeceasedInInstitute) AND (INTTYPE in(7,10)) AND (SP'S DATE OF
INSTITUTIONALIZATION ENTERED AT INS2 IS PRIOR TO JANUARY 1 OF CURRENT YEAR) AND (SP'S
DATE OF DEATH ENTERED AT INS3 IS ON OR AFTER JANUARY 1 OF CURRENT YEAR) AND
(VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE=0), GO TO INS3A1 - INSTDATE.
ELSE IF (INS1 - SPAISTATUS = 2/AliveAndInstitute) AND (INTTYPE in(7,10)) AND (SP'S DATE OF
INSTITUTIONALIZATION ENTERED AT INS2 IS BEFORE JANUARY 1 OF THE CURRENT YEAR) AND
(VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE=0), GO TO INS3A1 - INSTDATE.
ELSE IF(INS1-SPAISTATUS = 2/AliveAndInstitute) AND INTTYPE = 3, GO TO INS3B-INTHANK
ELSE IF (INS1-SPAISTATUS = 3/Deceased) AND INTTYPE = 3 AND SP'S DATE OF DEATH ENTERED AT
INS3 IS PRIOR TO JANUARY 1, GO TO INS3A-DEASDATE
ELSE IF (INS1-SPAISTATUS = 4/DeceasedInInstitute) AND INTTYPE = 3, GO TO INS3B-INTHANK
ELSE GO TO BOX INS1.
SPDIEYY
INS3
BOX INSA1
DEASDATE
INS3A
no entry
BOX INS1A
routing
YOU HAVE ENTERED THAT THE SP, (SP), DIED BEFORE JANUARY 1ST OF [CURRENT YEAR]. IF THIS IS
NOT CORRECT, GO TO THE PREVIOUS PAGE AND ENTER THE CORRECT DATE AT INS3.
IF THIS IS CORRECT, YOU WILL NOT BE CONDUCTING THE COMMUNITY INTERVIEW WITH THE
RESPONDENT. GO TO THE NEXT PAGE TO END THE INTERVIEW.
BOX INS1A
IF SP IS DECEASED (SPAISTATUS = 3 OR 4), SET RESPONDENT TO PROXY AND GO TO INS3B INTHANK
YOU HAVE ENTERED THAT THE SP, (SP), WAS INSTITUTIONALIZED BEFORE JANUARY 1ST OF
[CURRENT YEAR]. IF THIS IS NOT CORRECT, GO TO THE PREVIOUS PAGE AND ENTER THE CORRECT
DATE AT INS2.
INSTDATE
INS3A1
no entry
IF THIS IS CORRECT, YOU WILL NOT BE CONDUCTING THE COMMUNITY INTERVIEW WITH THE
RESPONDENT.
INS3B - INTHANK
AFTER CLICKING "NEXT PAGE", YOU WILL RETURN TO CM-FIELD. PLEASE FILL OUT A RECORD OF
CALL AND CODE THIS CASE AS A “NO COM PROXY- GO TO FAC” .
PLEASE COLLECT ANY KNOWN FACILITY CONTACT INFORMATION AND DISCUSS THE CASE WITH
YOUR FIELD MANAGER.
INTHANK
INS3B
no entry
I would like to thank you for your time and cooperation during this interview. We may be contacting you in the
future for further information.
BOX INSB1
Page 2 of 5
2025 MCBS Community Questionnaire
Variable Name
SPPROXY
INQ-INTRODUCTION
MR Screen Name
Question Type
Question Text/Description
BOX INS1
routing
IF SP IS DECEASED OR INSTITUTIONALIZED (SPALIVE = 2 OR 3), SET RESPONDENT TO PROXY AND GO
TO IN4A - PERSON_PROXY.
ELSE GO TO IN4 - SPPROXY.
IN4
code one
WILL THIS INTERVIEW BE CONDUCTED WITH THE SAMPLE PERSON OR WITH A PROXY?
Code List
Routing
(01) SAMPLE PERSON
(02) PROXY
(01) BOX INS5
(02) IN4A - PERSON_PROXY
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
(01-N) BOX INS2AA
…
(N+1) IN4A-ROSTFNAM
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
IF EXISTING PERSON SELECTED, GO TO BOX
INS2AA.
DISPLAY:
ELSE IF "ADD ANOTHER" SELECTED, GO TO IN4A1 First Name Display ROST.ROSTFNAM.
ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/OtherRelative or 92/OtherNonRelative, display ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
PERSON_PROXY IN4A
roster
SELECT OR ADD THE NAME/RELATIONSHIP OF THE PROXY TO THE SP FOR THIS INTERVIEW.
SELECT OR ADD ONLY ONE PERSON.
ROSTFNAM
IN4A
text
[What is the name of the person and relationship to (SP)?]
(01) continuous answer
IN4A-ROSTLNAM
ROSTLNAM
IN4A
text
[What is the name of the person and relationship to (SP)?]
(01) continuous answer
IN4A-ROSTREL
(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX INS2AA
(56) BOX INS2AA
(58) BOX INS2AA
(59) BOX INS2AA
(60) BOX INS2AA
(61) BOX INS2AA
(91) IN4AROSTREOS - ROSTREOS
(-8) BOX INS2AA
(-9) BOX INS2AA
ROSTREL
IN4A
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
IN4AROSTREOS
verbatim text
[What is the name of the person and relationship to (SP)?]
BOX INS2AA
routing
IF PERSON IS ADDED AT IN4A, GO TO BOX INS2A-1.
ELSE GO TO IN5 - VRFYPROX.
(01) continuous reponse
(-8) Don't Know
(-9) Refused
BOX INS2AA
(01) YES
(02) NO
(01) BOX INS2A-1
(02) IN6 - ROSTFNAM
I would like to verify your name and relationship to (SP). I have you listed as [READ NAME AND
RELATIONSHIP LISTED BELOW]. Is that correct?
VRFYPROX
IN5
yes/no
IF RELATIONSHIP IS MISSING, SELECT "NO" AND PROBE FOR RELATIONSHIP ON THE NEXT SCREEN.
FIRST NAME: (PROXY'S FIRST NAME)
LAST NAME: (PROXY'S LAST NAME)
RELATIONSHIP: (PROXY'S RELATIONSHIP TO SP)
ROSTFNAM
IN6
text
[What is your correct name and relationship to (SP)?]
(01) continuous answer
IN6 - ROSTLNAM
ROSTLNAM
IN6
text
[What is your correct name and relationship to (SP)?]
(01) continuous answer
IN6 - ROSTREL
(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX INS2A-1
(56) BOX INS2A-1
(58) BOX INS2A-1
(59) BOX INS2A-1
(60) BOX INS2A-1
(61) BOX INS2A-1
(91) IN6 - ROSTREOS
(-8) BOX INS2A-1
(-9) BOX INS2A-1
ROSTREL
IN6
code one
[What is your correct name and relationship to (SP)?]
ROSTREOS
IN6
verbatim text
What is your correct name and relationship to (SP)?
(01) continuous reponse
(-8) Don't Know
(-9) Refused
BOX INS2A-1
Page 3 of 5
2025 MCBS Community Questionnaire
Variable Name
MR Screen Name
BOX INS2A-1
INQ-INTRODUCTION
Question Type
Question Text/Description
routing
IF SP IS ALIVE AND INSTITUTIONALIZED (SPAISTATUS = 2), SET REASON WHY RESPONDENT IS PROXY
TO "SP IS INSTITUTIONALIZED" (WHYPROXY = 07) AND GO TO BOX INS3.
ELSE IF SP IS DECEASED (SPAISTATUS = 3 OR 4), SET REASON WHY RESPONDENT IS PROXY TO "SP
IS DECEASED" (WHYPROXY = 06) AND GO TO BOX INS3.
ELSE GO TO IN6A - WHYPROXY.
WHAT IS THE MAIN REASON THAT A PROXY RESPONDENT IS NECESSARY?
Code List
Routing
(01) SP NOT CAPABLE
PHYSICALLY/SICK/BLIND/CAN’T SPEAK/HEAR
(02) SP NOT CAPABLE MENTALLY/POOR
MEMORY/PSYCHIATRIC DISORDER
(03) SP UNABLE TO PROVIDE INFORMATION
REGARDING MEDICAL RECORDS
(04) SP IN HOSPITAL
(05) LANGUAGE PROBLEM
(06) SP IS DECEASED
(07) SP IS INSTITUTIONALIZED
(08) SP NOT AVAILABLE THIS ROUND
(09) AUTHORIZED PROXY MUST ANSWER
QUESTIONS FOR SP (CODE REASON WHY)
(91) OTHER
(01) BOX INS2B
(02) BOX INS2B
(03) BOX INS2B
(04) BOX INS2B
(05) BOX INS2B
(06) BOX INS2B
(07) BOX INS2B
(08) BOX INS2B
(09) BOX INS2B
(91) IN6A - PNSPOS
(01) continuous response
BOX INS3
WHYPROXY
IN6A
code one
PNSPOS
IN6A
verbatim text
OTHER (SPECIFY)
BOX INS2B
routing
IF RESPONSE TO IN6a - WHYPROXY ONLY INCLUDES 9/CodeReasonWhy, GO TO IN6B - PNSPVB.
ELSE GO TO BOX INS3.
IN6B
verbatim text
BRIEFLY EXPLAIN WHY PROXY MUST ANSWER QUESTIONS.
BOX INS3
routing
IF SP IS IN THE SUPPLEMENTAL SAMPLE AND IN6A - WHYPROXY = 6/SPIsDeceased, GO TO IN6B1 SUPPDIED.
ELSE IF SP IS IN THE SUPPLEMENTAL SAMPLE AND IN6A - WHYPROXY = 7/SPIsInstitute, GO TO IN6B2 SUPPINST.
ELSE GO TO BOX INS5.
SUPPDIED
IN6B1
no entry
YOU HAVE ENTERED THAT THE SP, (SP), IS DECEASED. IF THIS IS NOT CORRECT, GO TO THE
PREVIOUS PAGE AND CORRECT YOUR RESPONSE AT IN6A.
BOX IN6
SUPPINST
IN6B2
no entry
YOU HAVE ENTERED THAT THE SP, (SP), IS INSTITUTIONALIZED. IF THIS IS NOT CORRECT, GO TO THE
PREVIOUS PAGE AND CORRECT YOUR RESPONSE AT IN6A.
BOX IN6
BOX INS5
routing
IF (SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP IS NEW FROM FACILITY), GO TO IN8 - CHEKBRTH.
ELSE IF IT'S A FALL ROUND, GO TO BOX IN6.
ELSE GO TO BOX IN8.
PNSPVB
BOX INS3
(01) IN10 - CHECKAGE
(02) IN9 - HHDOBMM
(-8) BOX IN6 RESPDSEX
(-9) BOX IN6 RESPDSEX
CHEKBRTH
IN8
yes/no
I have [your/(SP’s)] date of birth listed as (CMS BIRTH DATE). Is that correct?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HHDOBMM
IN9
date
What is [your/(SP’s)] date of birth?
(01) continuous answer
(-8) Don't Know
(-9) Refused
IN9 - HHDOBDD
HHDOBDD
IN9
date
What is [your/(SP’s)] date of birth?
(01) continuous answer
(-8) Don't Know
(-9) Refused
IN9 - HHDOBYY
HHDOBYY
IN9
date
What is [your/(SP’s)] date of birth?
(01) continuous answer
(-8) Don't Know
(-9) Refused
BOX IN3A
BOX IN3A
routing
IF SP'S DATE OF BIRTH MONTH, DAY OR YEAR COLLECTED AT IN9 = DK OR RF, GO TO BOX IN6
RESPDSEX.
ELSE GO TO IN10 - CHECKAGE.
CHECKAGE
IN10
yes/no
That makes [you/(SP)] (AGE) today. Is that correct?
(01) YES
(02) NO
(01) BOX IN6 RESPDSEX
(02) IN9 - HHDOBMM
RESPDSEX
RESPDSEX
code one
What is [your/(SP)'s] sex?
(01) FEMALE
(02) MALE
BOX IN6
BOX IN6
routing
IF SP'S AGE IS > 16, DK OR RF, GO TO IN13 - SPMARSTA.
ELSE GO TO BOX IN8.
Page 4 of 5
2025 MCBS Community Questionnaire
Variable Name
SPMARSTA
SPCHNLNM
MR Screen Name
Question Type
INQ-INTRODUCTION
Question Text/Description
Code List
Routing
(01) MARRIED
(02) WIDOWED
(03) DIVORCED
(04) SEPARATED
(05) NEVER MARRIED
(-8) Don't Know
(-9) Refused
BOX IN7
(01) continuous answer
(-8) Don't Know
(-9) Refused
BOX IN8
IN13
code one
[Are you/Is (SP)/Was (SP)] married, widowed, divorced, separated, or never married?
BOX IN7
routing
IF (SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP IS NEW FROM FACILITY), GO TO IN14 - SPCHNLNM.
ELSE GO TO BOX IN8.
IN14
numeric
Including natural, adopted, and stepchildren, how many living children [did (SP)/does (SP)/do you] have?
BOX IN8
routing
IF INTTYPE in(C001, C002, C003, C004, C005, C006, C007, C010), GO TO ENS.
BOX INSB1
routing
GO TO END1 - INTLANG.
END1 - INTLANG.
Page 5 of 5
2025 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
SCQ-SATISFACTION WITH CARE
Question Text/Description
Code List
Routing
SATISFACTION WITH CARE QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C003, C004, C005, C006
SPALIVE=1
SEASON=FALL
SPPROXY=SP or PROXY until BOX PA1
Other: N/A
PLACEMENT
Administer after NAQ.
SHOW CARD SC1
MCQUALTY
SC1
code 1
(01) VERY SATISFIED
(02) SATISFIED
We’re interested in how you feel about the health care [you have/(SP) has] received [over the past year/since
(03) DISSATISFIED
(TODAY'S DATE - 12 MONTHS, MONTH AND YEAR)] from doctors and hospitals. Please tell me how satisfied
(04) VERY DISSATISFIED
or dissatisfied you have been with the following:
(05) NOT APPLICABLE
(-8) Don't Know
The overall quality of the health care [you have /(SP) has] received [over the past year/since (TODAY'S DATE (-9) Refused
12 MONTHS)]. Have you been very satisfied, satisfied, dissatisfied, or very dissatisfied?
SC2 - MCAVAIL
(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
SC3 - MCEASE
(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
SC4 - MCCOSTS
(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
SC5 - MCINFO
(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
SC7-MCCONCRN
(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
SC8 - MCSAMLOC
(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
SC8A - MCSPECAR
SHOW CARD SC1
MCAVAIL
SC2
code 1
[Please tell me how satisfied or dissatisfied you have been with . . .]
The availability of health care at night and on weekends.
SHOW CARD SC1
MCEASE
SC3
code 1
[Please tell me how satisfied or dissatisfied you have been with . . .]
The ease and convenience of getting to a doctor or other health professional from where [you/(SP)] [live/lives].
SHOW CARD SC1
MCCOSTS
SC4
code 1
[Please tell me how satisfied or dissatisfied you have been with . . .]
The out-of-pocket costs [you/(SP)] paid for health care.
SHOW CARD SC1
MCINFO
SC5
code 1
[Please tell me how satisfied or dissatisfied you have been with . . .]
The information given to [you/you or (SP)] about what was wrong with [you/(SP)].
SHOW CARD SC1
MCCONCRN
SC7
code 1
[Please tell me how satisfied or dissatisfied you have been with . . .]
The concern of doctors or other health professionals for [your/(SP’s)] overall health rather than just for an
isolated symptom or disease.
MCSAMLOC
SC8
code 1
SHOW CARD SC1
[Please tell me how satisfied or dissatisfied you have been with . . .]
Getting all [your/(SP’s)] health care needs taken care of at the same location.
Page 1 of 4
2025 MCBS Community Questionnaire
Variable Name
MCSPECAR
MR Screen Name
SC8A
Question Type
code 1
SCQ-SATISFACTION WITH CARE
Question Text/Description
Code List
Routing
(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
SC8B - MCTELANS
(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
SC9-MDISSFY
(01) RESPONDENT IS NOT DISSATISFIED WITH
ANYTHING
(91) RESPONDENT IS DISSATISFIED (RECORD
VERBATIM IN THE NEXT SCREEN)
(-8) Don't Know
(-9) Refused
(01) SC9A-RCEQTY MCWORRY
(91) SC9 - MCDISVB
(-8) SC9A-RCEQTY MCWORRY
(-9) SC9A-RCEQTY MCWORRY
(01) continuous answer
SC9A-RCEQTY MCWORRY
(01) YES
(02) NO
(03) N/A, No visit in the last 12 months
(-8) Don't Know
(-9) Refused
SC9A-LANGEQTY
Language or accent?
(01) YES
(02) NO
(03) N/A, No visit in the last 12 months
(-8) Don't Know
(-9) Refused
SC9A-GENDEQTY
Gender or gender identity?
(01) YES
(02) NO
(03) N/A, No visit in the last 12 months
(-8) Don't Know
(-9) Refused
SC9A-SEXEQTY
Sexual orientation?
(01) YES
(02) NO
(03) N/A, No visit in the last 12 months
(-8) Don't Know
(-9) Refused
SC9A-AGEEQTY
Age?
(01) YES
(02) NO
(03) N/A, No visit in the last 12 months
(-8) Don't Know
(-9) Refused
SC9A-CULTEQTY
Culture or religion?
(01) YES
(02) NO
(03) N/A, No visit in the last 12 months
(-8) Don't Know
(-9) Refused
SC9A-DISEQTY
Disability?
(01) YES
(02) NO
(03) N/A, No visit in the last 12 months
(-8) Don't Know
(-9) Refused
SC9A-HISTEQTY
Medical history?
(01) YES
(02) NO
(03) N/A, No visit in the last 12 months
(-8) Don't Know
(-9) Refused
SC10A-MCWORRY
SHOW CARD SC1
[Please tell me how satisfied or dissatisfied you have been with . . .]
The availability of care by specialists when [you/(SP)] [feel/feels] [you/(SP)] [need/needs] it.
SHOW CARD SC1
MCTELANS
SC8B
code 1
[Please tell me how satisfied or dissatisfied you have been with . . .]
The ease of obtaining answers to questions over the telephone about [your/(SP’s)] treatment or prescriptions.
MDISSFY
MDISSFY
verbatim text
Please think about all of the health care services [you/(SP)] [receive/receives], including services provided by
doctors or other health professionals, hospitals and pharmacies.
What things, if anything, about the health care services [you/(SP)] [receive/receives] are you dissatisfied with?
MCDISVB
MCDISVB
verbatim text
[Please think about all of the health care services [you/(SP)] [receive/receives], including services provided by
doctors or other health professionals, hospitals and pharmacies.
What things, if anything, about the health care services [you/(SP)] [receive/receives] are you dissatisfied with?]
Now I have a question about [your/(SP's)] health care experiences.
RCEQTY
SC9apg
grid
[Over the past year/Since (TODAY'S DATE - 12 MONTHS)], did anyone from a clinic, emergency room, or
doctor’s office where [you/(SP)] got care treat [you/(SP)] in an unfair or insensitive way because of any of the
following things about [you/(SP)]?
Race or ethnicity?
LANGEQTY
GENDEQTY
SEXEQTY
AGEEQTY
CULTEQTY
DISEQTY
HISTEQTY
SC9apg
SC9apg
SC9apg
SC9apg
SC9apg
SC9apg
SC9apg
grid
grid
grid
grid
grid
grid
grid
Page 2 of 4
2025 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
SCQ-SATISFACTION WITH CARE
Question Text/Description
Please tell me whether each of the following statements is true or false.
MCWORRY
SC10A
list
[You/(SP)] [worry/worries] about [your/(SP)'s] health more than other people [your/(SP)'s] age.
[Is this statement true or false?]
MCAVOID
MCSICK
SC10A
SC10A
list
list
[Please tell me whether each of the following statements is true or false.]
[You/(SP)] will do just about anything to avoid going to the doctor.
[Please tell me whether each of the following statements is true or false.]
When [you/(SP)] [are/is] sick, [you/(SP)] [try/tries] to keep it to [yourself/themselves].
[Please tell me whether each of the following statements is true or false.]
MCDRSOON
SC10A
list
BOX PA1
PAINTRO
PAINSTRC
PAMEDREC
PACHGDRS
PADISAGR
PAINTRO
PA3
PA4
PA5
PA6
Usually, [you/(SP)] [go/goes] to the doctor or other health professional as soon as [you/(SP)] [start/starts] to feel
bad.
Code List
Routing
(01) TRUE
(02) FALSE
(-8) Don't Know
(-9) Refused
SC10A - MCAVOID
(01) TRUE
(02) FALSE
(-8) Don't Know
(-9) Refused
SC10A - MCSICK
(01) TRUE
(02) FALSE
(-8) Don't Know
(-9) Refused
SC10A - MCDRSOON
(01) TRUE
(02) FALSE
(-8) Don't Know
(-9) Refused
BOX PA1
(01) CONTINUE
(-7) Empty
PA3 - PAINSTRC
IF IN4-SPPROXY=1/SP then go to PAINTRO- PAINTRO. ELSE GO TO BOX SCEND
no entry
Now I have some questions about how you make health care decisions. Answers to questions like these will
help Medicare better understand how people use medical services.
Please keep in mind that there are no right or wrong answers to these questions. Your opinions and experiences
are important to us.
code 1
(01) VERY CONFIDENT
SHOW CARD SC2
(02) CONFIDENT
Doctors often give instructions about how you should care for yourself at home, like changing a bandage, taking (03) SOMEWHAT CONFIDENT
medicines on schedule, or applying ice packs. How confident are you that you can follow instructions to care for (04) NOT AT ALL CONFIDENT
yourself at home?
(-8) Don't Know
(-9) Refused
PA4 - PAMEDREC
code 1
(01) VERY CONFIDENT
SHOW CARD SC2
(02) CONFIDENT
Doctors also often give instructions about changing your habits or lifestyle, such as changing your diet, stopping (03) SOMEWHAT CONFIDENT
smoking, or getting regular exercise. How confident are you that you can follow this kind of instruction, to
(04) NOT AT ALL CONFIDENT
change your habits or lifestyle?
(-8) Don't Know
(-9) Refused
PA5 - PACHGDRS
code 1
code 1
SHOW CARD SC3
Please use this card to respond to the following questions.
How likely are you to change doctors or other health professionals if you are dissatisfied with the way you and
your doctor or other health professional communicate?
SHOW CARD SC3
How likely are you to tell your doctor or other health professional when you disagree with him or her?
(01) VERY LIKELY
(02) LIKELY
(03) UNLIKELY
(04) VERY UNLIKELY
(-8) Don't Know
(-9) Refused
PA6-PADISAGR
(01) VERY LIKELY
(02) LIKELY
(03) UNLIKELY
(04) VERY UNLIKELY
(-8) Don't Know
(-9) Refused
PA10-PARXINFO
SHOW CARD SC4
PARXINFO
PADRQUEX
PAANSWR
PA10
PA11
PA12
code 1
code 1
code 1
(01) ALWAYS
(02) USUALLY
These next questions are about practices sometimes associated with receiving medical care. Please tell me if
(03) SOMETIMES
you always, usually, sometimes, or never do the following:
(04) NEVER
(-8) Don't Know
Do you always, usually, sometimes, or never read information about a new prescription, such as side effects and
(-9) Refused
precautions?
PA11-PADRQUEX
(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
Bring with you to your doctor or other health professional visits a list of questions or concerns you want to cover? (-8) Don't Know
(-9) Refused
PA12-PAANSWR
(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
(-8) Don't Know
(-9) Refused
PA13-PALISTRX
SHOW CARD SC4
Do you always, usually, sometimes, or never...
SHOW CARD SC4
[Do you always, usually, sometimes, or never...]
Leave your doctor or other health professional's office feeling that all of your concerns or questions have been
fully answered?
Page 3 of 4
2025 MCBS Community Questionnaire
Variable Name
PALISTRX
MR Screen Name
PA13
Question Type
code 1
SCQ-SATISFACTION WITH CARE
Question Text/Description
SHOW CARD SC4
[Do you always, usually, sometimes, or never...]
Take a list of all of your prescribed medicines to your doctor or other health professional visits?
PATRSLT
PAOPTION
PADVICE
PA14
PA15
PA21
code 1
code 1
code 1
SHOW CARD SC4
[Do you always, usually, sometimes, or never...]
Make sure you understand the results of any medical test or procedure such as an x-ray, blood test, or EKG for
heart conditions?
SHOW CARD SC4
[Do you always, usually, sometimes, or never...]
Talk with your doctor or other health professional about your options if you need tests, follow-up care, or a
referral for care by a medical specialist?
SHOW CARD SC4
[Do you always, usually, sometimes, or never...]
Contact your doctor or other health professional's office to get medical advice when you need it.
BOX SCEND
routing
Code List
Routing
(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
PA14-PATRSLT
(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
(-8) Don't Know
(-9) Refused
PA15-PAOPTION
(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
(-8) Don't Know
(-9) Refused
PA21-PADVICE
(01) ALWAYS
(02) USUALLY
(03) SOMETIMES
(04) NEVER
(-8) Don't Know
(-9) Refused
BOX SCEND
GO TO CMQ.
Page 4 of 4
| File Type | application/pdf |
| Author | NORC |
| File Modified | 2025-04-04 |
| File Created | 2025-04-04 |