Instrument _Web

Data Collection Instrument: Web Version

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Screen 15 (Note: the numerical of value of ‘8,’ shown below, is a piped-text entry based on the value input into Q5b)

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Screen 18: (Note: the numerical of value of ‘8,’ shown below, is a piped-text entry based on the value input into Q5c.1)

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Screen 19 continued

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Screen 21: (Note: the numerical of value of ‘8,’ shown below, is a piped-text entry based on the value input into Q5d.1)

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Screen 24: (Note: the numerical of value of ‘8,’ shown below, is a piped-text entry based on the value input into Q5e.1)

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Screen 25 continued (if ‘yes’ is selected for 5f)

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Screen 41 continued:

Screen 42: Note: the numerical of value of ‘8,’ shown below, is a piped-text entry based on the value input into Q8b.1. The rows displayed are equal to the items selected in 8b.2

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Screen 43 continued

Screen 43 continued:

Screen 44: Note: the numerical of value of ‘8,’ shown below, is a piped-text entry based on the value input into Q8c.1. The rows displayed are equal to the items selected in 8c.2

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Screen 46 continued

Screen 46 continued:

Screen 47: Note: the numerical of value of ‘8,’ shown below, is a piped-text entry based on the value input into Q8d.1. The rows displayed are equal to the items selected in 8d.2

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Screen 49 continued

Screen 49 continued:

Screen 50: Note: the numerical of value of ‘8,’ shown below, is a piped-text entry based on the value input into Q8e.1. The rows displayed are equal to the items selected in 8e.2

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