Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

2026 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

The next few questions are about Hispanic origin and race.

DI1A - HISPORIG
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) DI1B - HISPORDT
(02) DI2A - RACECODE
(-8) DI2A - RACECODE
(-9) DI2A - RACECODE

yes/no

[Are you/Is (SP)] of Hispanic, (Latino/Latina), or Spanish origin?

(01) DI2A - RACECODE
(02) DI2A - RACECODE
(03) DI2A - RACECODE
(91) DI1B - HISPDTOS
(-8) DI2A - RACECODE
(-9) DI2A - RACECODE

HISPORDT

DI1B

code all

(01) 1 MEXICAN/MEXICAN AMERICAN/CHICANO(A)
(02) PUERTO RICAN
SHOW CARD DI1
(03) CUBAN
Looking at this card, [are you/is (SP)] Mexican, Mexican American, or (Chicano/Chicana), Puerto Rican, Cuban, or
(91) OTHER HISPANIC, LATINO(A), OR SPANISH
of another Hispanic, (Latino/Latina) or Spanish origin?
ORIGIN
CHECK ALL THAT APPLY.
(-8) Don't Know
(-9) Refused

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

You can choose more than one group.
CHECK ALL THAT APPLY.

(01) NATIVE HAWAIIAN
(02) GUAMANIAN OR CHAMORRO
(03) SAMOAN
(91) OTHER PACIFIC ISLANDER GROUP
(-8) Don't Know
(-9) Refused

(01) ENGWELL - D12F
(02) ENGWELL - D12F
(03) ENGWELL - D12F
(91) DI2C - RACEPIOS
(-8) ENGWELL - D12F
(-9) ENGWELL - D12F

OTHER PACIFIC ISLANDER GROUP (SPECIFY)

(01) continuous answer

ENGWELL - D12F

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

RACEPIDT

RACEPIOS

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

DI2C

DI2C

code all

verbatim text

SHOW CARD DI4
Looking at this card, [are you/is (SP)] Native Hawaiian, Guamanian or Chamorro, Samoan, or some other Pacific
Islander group?

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2026 MCBS Community Questionnaire

Variable Name

ENGWELL

MR Screen Name

DI2F

Question Type

code one

DIQ-DEMOGRAPHICS AND INCOME

Question Text/Description

Code List

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

Routing

OTHRLANG - D12D

DI2FB - ENGREAD

ENGREAD

DI2FB

code one

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

DI2D

yes/no

[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,]
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 DI3INTRO-DINNT3.
Else go to SEXORINT.

SEXORINT

SEXORINT

code one

Do you think of yourself as lesbian or gay; straight, that is, not lesbian or gay; bisexual; or you don't know the
answer?

DIINT3

DI3INTRO

no entry

The next questions are about education and income.

BOX DI2CA

(01) LESBIAN OR GAY
(02) STRAIGHT, THAT IS, NOT LESBIAN OR GAY
(03) BISEXUAL
(04) I DON'T KNOW THE ANSWER
(-8 ) Don't Know
(-9) Refused

DI3INTRO-DINNT3

DI3A - SPDEGRCV

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2026 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

DIQ-DEMOGRAPHICS AND INCOME

Question Text/Description

Code List

Routing

(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)
(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

DI4INTRO - DIINT4

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.

DI4 - SPINC25K

code one

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,
(01) LESS THAN $25,000/YEAR
other retirement income, Supplemental Security Income (SSI), pensions, interest, and any other sources.
(02) $25,000 OR MORE/YEAR
[PROBE IF NECESSARY: In estimating [your/(SP's)] total income, you can respond for all of the past 12 months, (03) LESS THAN $2080/MONTH
(04) $2080/MONTH OR MORE
or provide a one month estimate.]
(-8) Don't Know
(-9) Refused
[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.]

(01) DI5A - SPINCLET
(02) DI5A - SPINCLET
(03) DI5A - SPINCLET
(04) DI5A - SPINCLET
(-8) RELGPREF
(-9) RELGPREF

code one

(01) A. Less than $10,000
(02) B. $10,000 to less than $15,000
(03) C. $15,000 to less than $20,000
SHOW CARD DI6
(04) D. $20,000 to less than $25,000
Looking at this card, which letter best represents [your and your spouse's/(SP's) and (SP's) spouse's/[your/(SP's)]]
(05) E. $25,000 to less than $35,000
total income before taxes during the past 12 months? Include income from jobs, Social Security, Railroad
(06) F. $35,000 to less than $45,000
Retirement, other retirement income, and the other sources of income we just talked about.
(07) G. $45,000 to less than $55,000
(08) H. $55,000 to less than $70,000
[EXPLAIN IF NECESSARY: Income is important in analyzing the information we collect. For example, this
(09) I. $70,000 to less than $100,000
information helps us learn whether persons in one income group use certain types of medical care services or
(10) J. $100,000 to less than $150,000
have certain medical conditions more or less often than those in another group.]
(11) K. $150,000 or more
(-8) Don't Know
(-9) Refused

RELGPREF

SPINC25K

SPINCLET

DI4

DI5A

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]]

(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

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