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

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

ENS-ENUMERATION SUMMARY

Question Type

Question Text/Description

Code List

Routing

ENUMERATION SUMMARY SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C003, C004, C005, C006, C007, C010
SPALIVE=ALL
SEASON=ALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
If INTTYPE in(C001, C002, C003, C004, C005, C006, C007, C010), administer after INQ.

ENSINT

BOX ENSBEG

routing

GO TO ENSINTRO - ENSINT.

ENSINTRO

no entry

Now I’d like to [review with you who was living in the household/ask you a few questions about [your/(SP's)] home
and any other people who may live in the household.].

BOX ENS1

routing

IF AT LEAST ONE PERSON LIVED IN THE HOUSEHOLD WITH THE SP AT THE TIME OF THE PREVIOUS
ROUND INTERVIEW, GO TO ENS1 - HHSTILL.
ELSE GO TO ENS3 - HHNEW.

HHSTILL

ENS1

yes/no

From our last interview on (REFERENCE DATE), we have listed that [(READ NAME(S) LISTED BELOW)] lived
in the same household as [you/(SP)].
[As of (DATE OF DEATH/DATE OF INSTITUTIONALIZATION), did/Do/Does] [READ NAME(S) LISTED BELOW]
still live in the same household as [you/(SP)]?
[A SEPARATE QUESTION WILL ASK YOU IF ANYONE ELSE SHOULD BE ADDED. THIS QUESTION ONLY
REFERS TO THE LISTED PERSONS.]

HOUSEHOLD_NOT

ENS2

roster

PROBE FOR AND SELECT THOSE PEOPLE WHO ARE NO LONGER IN THE HOUSEHOLD.

NOTHHRSN

ENS2A

code 1

Why [is/was] (HOUSEHOLD MEMBER NAME) no longer in the household [as of (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]?

NOTHHROS

ENS2A

verbatim text

OTHER REASON (SPECIFY)

BOX ENS2

routing

IF ANOTHER HH MEMBER IS SELECTED AT ENS2-HOUSEHOLD_NOT, GO TO ENS2A-NOTHHRSN.
ELSE GO TO ENS3-HHNEW.
[At the time of the last interview, [you were living by yourself/(SP)
was living by [himself/herself]]].

HHNEW

ENS3

yes/no

[Besides [you/(SP)], [is/was] there anyone else living or staying in the household [as of (DATE OF DEATH/DATE
OF INSTITUTIONALIZATION)]? Remember to include people who
[are/were] temporarily absent and any children who [may live/may
have lived] in the household.

BOX ENS1

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

(01) ENS3 - HHNEW
(02) ENS2 - HOUSEHOLD_NOT
(-8) ENS3 - HHNEW
(-9) ENS3 - HHNEW

ENS2A - NOTHHRSN

(01) DECEASED
(02) INSTITUTIONALIZED, HEALTH CARE FACILITY
(03) INSTITUTIONALIZED, OTHER
(04) PERSON MOVED
(05) SP MOVED
(06) PERSON NOT IN HOUSEHOLD - PREVIOUS
ROUND ERROR
(91) OTHER REASON
(-8) Don't Know
(-9) Refused

(01) BOX ENS2
(02) BOX ENS2
(03) BOX ENS2
(04) BOX ENS2
(05) BOX ENS2
(06) BOX ENS2
(91) ENS2A - NOTHHROS
(-8) BOX ENS2
(-9) BOX ENS2

BOX ENS2

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

(01) ENS4 - HOUSEHOLD_ENS
(02) BOX ENS4
(-8) BOX ENS4
(-9) BOX ENS4

Page 1 of 5

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

ENS-ENUMERATION SUMMARY

Question Type

Question Text/Description

Code List

Routing

HOUSEHOLD_ENS

ENS4

roster

Who else [is/was] living or staying in the household?
SELECT OR ADD ALL PERSONS LIVING IN THE HOUSEHOLD.

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
(01-N) BOX ENS4
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS (N+1) HH-ROSTFNAM
(N+1) ADD ANOTHER
IF EXISTING PERSON SELECTED, GO TO BOX
ENS4.
DISPLAY:
ELSE IF "ADD ANOTHER" SELECTED, GO TO HH1 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.

ROSTFNAM

HH

text

[What is the name of the person and relationship to (SP)?]

(01) continuous answer

HH-ROSTLNAM

ROSTLNAM

HH

text

[What is the name of the person and relationship to (SP)?]

(01) continuous answer

HH-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) HHADD-HHADD
(56) HHADD-HHADD
(58) HHADD-HHADD
(59) HHADD-HHADD
(60) HHADD-HHADD
(61) HHADD-HHADD
(91) HH - ROSTREOS
(-8) HHADD-HHADD
(-9) HHADD-HHADD

ROSTREL

HH

code one

[What is the name of the person and relationship to (SP)?]

ROSTREOS

HH

verbatim text

[What is the name of the person and relationship to (SP)?]

HHADD

HHADD

code one

HHMISS

ENS4A

yes/no

BOX ENS3

routing

IF ROSTSEX IS NOT MISSING, GO TO BOX ENS4A.
ELSE GO TO ENS5-HHPSEX.

HHPSEX

ENS5

grid

Is (HOUSEHOLD MEMBER NAME) male or female?

(01) MALE
(02) FEMALE
(-8) Don't Know
(-9) Refused

ENS5 - EHHDOBMM

EHHDOBMM

ENS5

grid

What is (HOUSEHOLD MEMBER NAME'S) [date/year] of birth?
[ENTER DATE.]

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

ENS5 - EHHDOBDD

EHHDOBDD

ENS5

grid

What is (HOUSEHOLD MEMBER NAME'S) [date/year] of birth?
[ENTER DATE.]

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

ENS5 - EHHDOBYY

(01) continuous reponse
(-8) Don't Know
(-9) Refused

ENS4A- HHMISS

(01) ADD ANOTHER
(02) ALL DONE

(01) ROSTFNAM- HH
(02) ENS4A- HHMISS

Now I want to make sure I have everyone who [lives/lived] in the household [as of (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]. I have listed (READ NAME(S) LISTED BELOW).

(01) YES
(02) NO
(-8) Don't Know
Have I missed any lodgers, boarders, or anyone else who usually [lives or stays/lived or stayed] in the household
(-9) Refused
but [is/was] away from home traveling or in the hospital?

(01) HH-ROSTFNAM
(02) BOX ENS3
(-8) BOX ENS3
(-9) BOX ENS3

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2024 MCBS Community Questionnaire

ENS-ENUMERATION SUMMARY

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

EHHDOBYY

ENS5

grid

What is (HOUSEHOLD MEMBER NAME'S) [date/year] of birth?
[ENTER DATE.]

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

(01) BOX ENS4
(-8) ENS5 -HHPAGE
(-9) ENS5-HHPAGE

HHPAGE

ENS5

grid

How old is (HOUSEHOLD MEMBER NAME)?

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

BOX ENS4

(01)[Continuous answer.]
(-8) Don't Know
(-9) Refused

ENS10 - EHHDOBDD

(01)[Continuous answer.]
(-8) Don't Know
(-9) Refused

ENS10 - EHHDOBYY

(01)[Continuous answer.]
(-8) Don't Know
(-9) Refused

ENS10 - HHPSEX

(01)[Continuous answer.]
(-8) Don't Know
(-9) Refused

ENS10 - ROSTREL

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

ENS10 - HHPAGE

(01)[Continuous answer.]
(-8) Don't Know
(-9) Refused

BOX ENS4A

BOX ENS4

routing

IF AT LEAST ONE PERSON LIVING IN THE HOUSEHOLD WITH THE SP IN THE CURRENT ROUND, WAS
ALSO LIVING IN THE HOUSEHOLD AT THE TIME OF THE PREVIOUS ROUND INTERVIEW AND [(ROSTREL
^=02/SPOUSE OR 56/PARTNER) AND (EHHDOBYY IS MISSING)] OR [(ROSTREL= 02/SPOUSE OR
56/PARTNER) AND (EHHDOBMM OR EHHDOBDD OR EHHDOBYY IS MISSING)] AND (ENS10 HAS NEVER
BEEN ASKED IN ANY PREVIOUS ROUND), GO TO ENS10 - EHHDOBMM.
ELSE, GO TO BOX ENS4A

EHHDOBMM

ENS10

grid

EHHDOBDD

ENS10

grid

EHHDOBYY

ENS10

grid

HHPSEX

ENS10

grid

ASK THE RESPONDENT TO PROVIDE INFORMATION FOR ALL "DK" AND "RF" ENTRIES LISTED BELOW.
DO NOT CHANGE THE ENTRIES IF THE RESPONDENT STILL DOES NOT KNOW THE INFORMATION.
(HOUSEHOLD MEMBER NAME'S) [DATE/YEAR] OF BIRTH.
[ENTER DATE.]
ASK THE RESPONDENT TO PROVIDE INFORMATION FOR ALL "DK" AND "RF" ENTRIES LISTED BELOW.
DO NOT CHANGE THE ENTRIES IF THE RESPONDENT STILL DOES NOT KNOW THE INFORMATION.
(HOUSEHOLD MEMBER NAME'S) [DATE/YEAR] OF BIRTH.
[ENTER DATE.]
ASK THE RESPONDENT TO PROVIDE INFORMATION FOR ALL "DK" AND "RF" ENTRIES LISTED BELOW.
DO NOT CHANGE THE ENTRIES IF THE RESPONDENT STILL DOES NOT KNOW THE INFORMATION.
(HOUSEHOLD MEMBER NAME'S) [DATE/YEAR] OF BIRTH.
[ENTER DATE.]

ASK THE RESPONDENT TO PROVIDE INFORMATION FOR ALL "DK" AND "RF" ENTRIES LISTED BELOW.
DO NOT CHANGE THE ENTRIES IF THE RESPONDENT STILL DOES NOT KNOW THE INFORMATION.
(HOUSEHOLD MEMBER NAME'S) SEX

ROSTREL

ENS10

grid

ASK THE RESPONDENT TO PROVIDE INFORMATION FOR ALL "DK" AND "RF" ENTRIES LISTED BELOW.
DO NOT CHANGE THE ENTRIES IF THE RESPONDENT STILL DOES NOT KNOW THE INFORMATION.
(HOUSEHOLD MEMBER NAME'S) RELATIONSHIP

HHPAGE

ENS10

grid

ASK THE RESPONDENT TO PROVIDE INFORMATION FOR ALL "DK" AND "RF" ENTRIES LISTED BELOW.
DO NOT CHANGE THE ENTRIES IF THE RESPONDENT STILL DOES NOT KNOW THE INFORMATION.
(HOUSEHOLD MEMBER NAME'S) AGE.

BOX ENS4A

routing

IF (SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP'S PREVIOUS ROUND INTERVIEW WAS IN A FACILITY),
GO TO BOX ENS4B.
ELSE GO TO BOX ENS5

BOX ENS4B

routing

IF AT LEAST ONE PERSON LIVES IN THE HOUSEHOLD WITH THE SP, GO TO ENS10A HOUSEHOLD_OWNS.
ELSE SET SP AS PERSON WHO OWNS/RENTS HOME AND GO TO BOX ENS4C

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2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HOUSEHOLD_OWNS ENS10A

ENS-ENUMERATION SUMMARY

Question Type

roster

Question Text/Description

Code List

Who owns or rents [this/(SP’s)] home? (PROBE: Of the people living [here/there] now, who is the person who is
the head of the household?)
SELECT ONLY ONE.

Routing

BOX ENS4C

IF THE HOME IS JOINTLY OWNED BY THE RESPONDENT AND ANOTHER PERSON SELECT THE
RESPONDENT AS THE OWNER.

ASKWORK

JOBSTAT

SPOUSJOB

SPAFEVER

BOX ENS4C

routing

IF (SP IS IN THE SUPPLEMENTAL SAMPLE) AND (SP'S AGE IS 16 OR OLDER, OR AGE = DK OR RF), GO
TO ENS10AA - ASKWORK.
ELSE GO TO BOX ENS5.

ENS10AA

yes/no

Since (REFERENCE DATE), did [you/(SP)] work at any time at a job or business?

BOX ENS5

routing

IF (SP IS IN THE SUPPLEMENTAL SAMPLE AND ENS10AA - ASKWORK = 1/Yes) OR (IF SP IS NOT IN THE
SUPPLEMENTAL SAMPLE AND ((IT IS A FALL ROUND) AND (SP IS ALIVE AND NOT INSTITUTIONALIZED)
AND (SP'S AGE IS 16 OR OLDER, OR AGE = DK OR RF))), GO TO ENS11 - JOBSTAT.
ELSE GO TO BOX ENS5A.

ENS11

routing

(01) YES
[Before I continue with the next set of questions, I need to collect information about [your/(SP’s)] job status.] [Are (02) NO
you/Is (SP)] currently working at a job or business?
(-8) Don't Know
(-9) Refused

BOX ENS5A

BOX ENS5A

routing

IF ANOTHER PERSON WHO LIVES IN THE HOUSEHOLD WITH THE SP IS 02/SPOUSE OR 56/PARTNER
AND ((THIS PERSON IS A NEW HOUSEHOLD MEMBER IN THE CURRENT ROUND) OR (IT IS A FALL
ROUND)), GO TO ENS11A-SPOUSJOB.
ELSE GO TO BOX ENS7.

(01) ITEM SELECTED IN INSTANCE NAVIGATOR
(02) CONTINUE INTERVIEW SELECTED

(01) ENS11A - HHJBSTAT
(02) BOX ENS7

ENS11A

yes/no

[Before I continue with the next set of questions, I need to update information about [your/(HOUSEHOLD
MEMBER NAME'S)] job status.] [Are you/Is (HOUSEHOLD MEMBER NAME)] currently working at a job or
business?

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

BOX ENS6

BOX ENS6

routing

IF ANOTHER PERSON WHO LIVES IN THE HOUSEHOLD WITH THE SP IS 02/SPOUSE OR 56/PARTNER
AND ((THIS PERSON IS A NEW HOUSEHOLD MEMBER IN THE CURRENT ROUND) OR (IT IS A FALL
ROUND)), GO TO ENS11A-SPOUSJOB.
ELSE GO TO BOX ENS7.

BOX ENS7

routing

IF ((SP IS IN THE SUPPLEMENTAL SAMPLE) OR (SP IS NEW FROM THE FACILITY)) AND SP'S AGE IS 17
OR OLDER OR AGE = DK OR RF, GO TO ENS12 - SPAFEVER.
ELSE GO TO BOX ENSEND.

ENS12

yes/no

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

(01) ENS13 - SPAFTIME
(02) ENS14 - SPNGEVER
(-8) ENS14 - SPNGEVER
(-9) ENS14 - SPNGEVER

(07) IRAQ OR AFGHANISTAN CONFLICT (2001present)
(06) PERSIAN GULF WAR/OPERATION DESERT
STORM (Aug 1990 - March 1991)
(01) VIETNAM ERA (Aug 1964 - May 1975)
(02) KOREAN CONFLICT (June 1950 - Jan 1955)
(03) WORLD WAR II (Sept 1940 - July 1947)
(05) PEACE TIME (ALL OTHER TIMES)
(-8) Don't Know
(-9) Refused

ENS14 - SPNGEVER

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

(01) ENS15 - SPNGALL
(02) BOX ENS14
(-8) BOX ENS14
(-9) BOX ENS14

Now we have a few questions about military service.
Did [you/(SP)] ever serve in the Armed Forces of the United States?

SHOW CARD ENS1
SPAFTIME

ENS13

code all

Looking at this card, in which of these time periods did [you/(SP)] serve in the Armed Forces?
CHECK ALL THAT APPLY.

SPNGEVER

ENS14

yes/no

[Were you/Was (SP)] ever an active member of a National Guard or military reserve unit of the United States?

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

BOX ENS5

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2024 MCBS Community Questionnaire

Variable Name

ENS-ENUMERATION SUMMARY

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

BOX ENS14

routing

IF ENS12 - SPAFEVER = 1/Yes, GO TO ENS16 - SPNGDSBL.
ELSE GO TO BOX ENSEND.

SPNGALL

ENS15

yes/no

Was all of [your/(SP’s)] active duty related to National Guard or military reserve training?

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

ENS16 - SPNGDSBL

SPNGDSBL

ENS16

yes/no

[Do you/Does (SP)/Did (SP)] have a disability related to service in the Armed Forces of the United States?
[PROBE: ‘Have you received a V.A. disability rating?’ IF THE RESPONDENT HAS A V.A. DISABILITY RATING,
SELECT "YES"; IF HE OR SHE DOES NOT, SELECT "NO"]

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

(01) ENS17 - SPVARATE
(02) BOX ENSEND
(-8) BOX ENSEND
(-9) BOX ENSEND

SPVARATE

ENS17

numeric

(01) continuous answer
(-8) Don't Know
(-9) Refused

BOX ENSEND

BOX ENSEND

routing

What [is [your/(SP’s)]/was (SP's)] (current) V.A. disability rating?
THE VA DISABILITY RATING IS A PERCENTAGE IN MULTIPLES OF 10 (I.E., 10%, 20%, ETC.). ENTER THE
NUMBER AS A WHOLE NUMBER. YOU DO NOT NEED TO ENTER THE "%" SIGN.
IF SEASON=FALL, GO TO HAQ.
IF (SEASON=WINTER OR SUMMER) AND INTTYPE in(C001, C002, C003, C004, C005, C006, C007, C010),
GO TO HIQ.

Page 5 of 5