CP,YP,YX

1999 NHIS Family Core

N1. As far as you know, would you say (NAME'S) health is excellent, very
good, good, fair, or poor?

> ¿Según lo que Ud. sabe, Diría que la salud de NAME es excelente, muy
>
> buena, buena, regular o pobre (mala)?
>
> EXCELLENT 01
>
> VERY GOOD 02
>
> GOOD 03
>
> FAIR 04
>
> POOR 05
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

FACCT2 /CSHCN

N2. These next questions are about any kind of health problems,
concerns, or conditions that may affect (NAME'S) behavior, learning,
growth, or physical development.

> Does (NAME) need or use more **medical care, mental health, or
> educational services** than is usual for most (FILL "CHILDREN" IF AGE
> \< 17; "YOUNG PEOPLE" IF AGE IS 17+) of the same age?
>
> Las próximas preguntas son acera de cualquier tipo de problemas,
> preocupaciones, o condiciones de salud (NAME) que tal vez afecten la
> conducta, el saber, el crecimiento, o el desarrollo físicode (NAME).
>
> ¿Necesita o usa (NAME) más **servicios médicos, de salud mental, o de
> educación** de lo que es normal para la mayoría de (FILL "LOS niños"
> IF AGE=\<17; "LA GENTE" IF AGE=17+) de su misma edad?
>
> PROBE: These questions refer to a **current** condition, not a
> condition in the past.
>
> PROBE : Estas preguntas se refieren a una condición **en la
> actualidad**, no en el pasado.
>
> YES 01
>
> ![](media/image1.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

FACCT/CSHCN

N3. Is (NAME'S) need for medical care, mental health or educational
services because of ANY medical, behavioral, or other health condition?

¿Necesita (NAME) **servicios médicos, de salud mental, o de educación**
por causa de cualquier condición médica, o de conducta, u otra condición
de salud ?

> ![](media/image2.wmf)YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

FACCT/CSHCN

N4. Is this a condition that has lasted or is expected to last 12 months
or longer?

> ¿Es esta una condición que ya ha durado, o que esperan que va a durar
> 12 meses o más?
>
> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

FACCT1/CSHCN

N5. Does (NAME) currently need or use **medicine prescribed by a
doctor**, other than vitamins?

> Actualmente, además de vitaminas, ¿necesita o usa (NAME) **medicina
> recetada por un doctor**?
>
> INTERVIEWER: THESE QUESTIONS REFER ONLY TO A CURRENT CONDITION. THE
> RESPONDENT SHOULD ANSWER "YES" ONLY IF THE CHILD CURRENTLY HAS A
> SPECIAL HEALTH CARE NEED

PROBE: Over-the-counter medication such as cold or headache medication
is not included.

PROBE: No se incluye medicación sin receta tal como para catarro o dolor
de cabeza.

> ![](media/image3.wmf)YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

FACCT/CSHCN

N6. Is (NAME'S) need for prescription medicine because of ANY medical,
behavioral, or other health condition?

¿Necesita (NAME) **medicina recetada** por causa de CUALQUIER condición
médica, o de conducta, u otra condición de salud ?

> ![](media/image4.wmf)YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

FACCT/CSHCN

N7. Is this a condition that has lasted or is expected to last 12 months
or longer?

> ¿Es esta una condición que ya ha durado, o que esperan que va a durar
> 12 meses o más?
>
> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

FACCT3/CSHCN

N8. Is (NAME) **limited or prevented** in any way in (HIS/HER) ability
to do the things (FILL "CHILDREN" IF AGE \< 17; "YOUNG PEOPLE" IF AGE IS
17+) of the same age can do?

> ¿Está (NAME) **limitado(a) o impedido(a)** en su habilidad de hacer
> las cosas que la mayoría de (FILL "los niños" IF \<17; " LoS JÓVENES"
> IF 17+) de su misma edad pueden hacer?
>
> PROBE: In other words, are there things (NAME) can't do as much or
> can't do at all that (FILL "CHILDREN" IF AGE \< 17; "YOUNG PEOPLE" IF
> AGE IS 17+) the same age can?
>
> PROBE: En otras palabras, ¿Hay cosas que (NAME) no puede hacer tanto,
> o no puede hacer de ninguna manera, que (FILL "los niños" IF \<17; "
> LoS JÓVENES" IF 17+) de su misma edad pueden hacer?
>
> ![](media/image5.wmf)YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

FACCT/CSHCN

N9. Is (NAME'S) limitation in abilities because of ANY medical,
behavioral, or other health condition?

> Es la limitación de habilidades de (NAME) por causa de CUALQUIER
> condición médica, o de conducta, u otra condición de salud ?
>
> YES 01
>
> ![](media/image6.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

FACCT/CSHCN

N10. Is this a condition that has lasted or is expected to last 12
months or longer?

¿Es esta una condición que ya ha durado, o que esperan que va a durar 12
meses o más?

> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

FACCT4/CSHCN

N11. Does (NAME) need or get **special therapy**, such as physical,
occupational, or speech therapy?

¿Necesita (NAME) conseguir terapia especial, tal como terapia física,
ocupacional o del habla (logopedia)?

![](media/image7.wmf) YES 01

> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

FACCT/CSHCN

N12. Is (NAME'S) need for special therapy because of ANY medical,
behavioral, or other health condition?

¿Necesita (NAME) terapia especial por causa de CUALQUIER condición
médica, o de conducta, u otra condición de salud ?

> ![](media/image8.wmf)YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

FACCT/CSHCN

N13. Is this a condition that has lasted or is expected to last 12
months or longer?

¿Es esta una condición que ya ha durado, o que esperan que va a durar 12
meses o más?

> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

FACCT5/CSHCN

N14. Does (NAME) need or get **treatment or counseling** for any kind of
emotional, developmental, or behavioral problem?

¿Necesita o recibe (NAME) conseguir tratamiento o consejo por cualquier
problema emocional, de desarrollo, o de conducta?

PROBE: Treatment or counseling includes remedies, therapy or guidance a
child

or young person may receive for his/her health condition.

**Emotional Problems** such as depression or schizophrenia.

**Developmental problems** such as stunted growth.

> **Behavioral problems** such as aggressive behavior or Attention
> Deficit Disorder, also know as A-D-D.

PROBE: Tratamiento o consejo incluye remedias, terapia o consejos que
pueda recibir un(a) niño(a) o jóven por su condición de salud.

**Problemas emocionales** tales como depresión o esquisofrenia.

**Problemas de desarrollo** tal como crecimiento enano.

> **Problemas de conducta** tales como conducta agresivo o Attention
> Deficit Disorder, que también se conoce como A-D-D.
>
> ![](media/image9.wmf)YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

FACCT/CSHCN

N15. Has (NAME'S) emotional, developmental or behavioral problem lasted
or is it expected to last 12 months or longer?

¿Ya ha durado, o esperan que va a durar 12 meses o más el problema
emocional, de desarrollo, o de conducta de (NAME) ?

YES 01

> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

FACCT/CSHCN

N16. FACCT SCREENER DECISION (modified): Is N2=1, or N5=1, or N8=1, or
N11=1, or N14=1, that is, does (NAME) have a health condition?

YES 01 *Go to N19*

NO 00 *Continue*

CP,YP,YX

Created

N17. Thinking back to (INSERT YEAR OF APPLICATION) when (FILL "YOUR" if
RTYPE=01; "NAME'S" if RTYPE=03) family applied for Supplemental Security
Income, or SSI, for (NAME), did (NAME) have a medical, behavioral, or
other health condition then?

Pensando en (INSERT YEAR OF APPLICATION) cuando (FILL "su familia" IF
RTYPE=01; "la familia de (NAME)" IF RTYPE=03) aplicó para Supplemental
Security Income (Seguridad de Ingreso Suplementario), o SSI, para
(NAME); ¿tenía (NAME) una condición médica, o de conducta, u otra
condición de salud, en ese entonces?

> YES 01
>
> ![](media/image10.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

Created

N18. What health condition or problem was that?

¿Qué condición o problema de salud era ?

INTERVIEWER : PROBE FOR SPECIFIC ANSWER. ANSWERS SUCH AS "HE'S SLOW,"
"DOESN'T TALK WELL," OR "IS A SPECIAL NEEDS CHILD" ARE NOT SPECIFIC
ENOUGH.

PROBE 1: By what name do doctors call (NAME'S) health condition?

PROBE 2: What causes this condition?

PROBE 1: ¿Cómo llaman los doctores la condición de salud de (NAME) ?

PROBE 2: ¿Cuál es la causa de esta condición ?

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

CP,YP,YX (with health condition)

CSHCN

N19. The next questions are about any physical, mental, learning, or
developmental conditions or problems that (NAME) has. As far as you
know, how often does (HIS/HER) health condition or problem affect
(HIS/HER) ability to do things other (FILL "CHILDREN" IF AGE \<17;
"YOUNG PEOPLE" IF AGE=17+) do? Would you say:

> Las próximas preguntas son acerca de cualquieres condiciones o
> problemas
>
> físicos, mentales, de saber, o de desarrollo que tiene (NAME). Según
> lo que Ud.
>
> Sabe ¿Cuántas veces ha influido su condición o problema de salud en su
> habilidad de hacer cosas que hacen otros (FILL "niños" IF AGE \<17;
> "jóvenes" IF AGE=17+)? Diría:

INTERVIEWER: IF THE CONDITION IS EPISODIC, FOR EXAMPLE, ASTHMA ATTACKS,
RESPONDENTS SHOULD CONSIDER THE ENTIRE 12 MONTHS OF EPISODES, NOT JUST
ONE SPECIFIC EPISODE.

*Read list, code one answer*

> Never 01
>
> Sometimes 02
>
> Usually, or 03
>
> Always 04
>
> Nunca 01
>
> A veces 02
>
> Generalmente, o 03

Siempre 04

DON'T KNOW d

> REFUSED r

CP,YP,YX (with health condition)

CSHCN

N20. Does (NAME'S) health condition or problem affect (HIS/HER) ability
to do things a great deal, some, or very little?

Influye la condición o el problema de salud de (NAME) en su habilidad de
hacer cosas mucho, algo, o muy poco?

> A GREAT DEAL 01
>
> SOME 02
>
> VERY LITTLE 03

DON'T KNOW d

REFUSED r

CP,YP,YX (with health condition)

CSHCN

N21. Overall, how would you rank (HIS/HER) health condition(s) or
problem(s). Please pick a number between zero and ten where zero is the
mildest and ten is the most severe.

> En general, ¿cómo clasificaría la(s)condición(condiciones)o el (los)
> problema(s)
>
> de salud de (NAME)? Por favor escoja un número entre cero (0) y diez
> (10), con
>
> cero siendo lo más leve, y diez lo más severo o grave.
>
> interviewer: If name has more than one condition, then the respondent
> should rate the most severe condition rather than trying to average
> severity across all of the conditions.

\|\_\_\|\_\_\| NUMBER BETWEEN ZERO AND TEN

(NAME) DOESN'T HAVE A HEALTH

CONDITION OR PROBLEM 11

DON'T KNOW d

REFUSED r

CP,YP,YX (with health condition)

CSHCN

N22. As far as you know, which of the following statements best
describes (NAME'S) health care needs?

> ¿Según lo que usted sabe,cuál de las siguientes frases mejor describe
> las
>
> necesidades de servicios de salud de (NAME)?

*Read list, code only one response*

(NAME'S) health care needs change

all the time 01

(NAME'S) health care needs change

only once in a while 02

(NAME'S) health care needs are

> usually stable 03
>
> None of these 04
>
> Las necesidades de servicios de salud de
>
> (NAME) se cambian todo el tiempo 01
>
> Las necesidades de servicios de salud de
>
> (NAME) sólo se cambian de vez en cuando 02
>
> Las necesidades de servicios de salud
>
> de (NAME) son, por lo general, estables 03

Ninguno de estos 04

DON'T KNOW d

REFUSED r

CP,YP,YX (with health condition)

1978 SSA Survey (modified)

N23. Considering everything you just told me about, what do you consider
(NAME'S) **main** health condition or problem to be?

Considerando todo lo que me acaba de contar, ¿cuál considera usted que
es la principal condición o el principal problema de salud de (NAME)?

INTERVIEWER: PROBE FOR SPECIFIC ANSWER. ANSWERS SUCH AS "HE'S SLOW,"
"DOESN'T TALK WELL," OR "IS A SPECIAL NEEDS CHILD" ARE NOT SPECIFIC
ENOUGH.

PROBE 1: By what name do doctors call (NAME'S) health condition?

PROBE 2: What causes this condition?

PROBE 1: ¿Cómo llaman los doctores la condición de salud de (NAME)?

PROBE 2: ¿Cuál es la causa de esta condición?

*Record verbatim*

CP,YP,YX (with health condition)

1999 NHIS Family Core

N24. How long has (NAME) had this health condition or impairment?

¿Cuánto tiempo hace que (NAME) tiene está condición o este problema de
salud?

[NUMBER]{.underline} [TIME PERIOD]{.underline}

![](media/image11.wmf) \|\_\_\_\|\_\_\_\| (01-94) DAYS 01

95 + 95 WEEKS 02

SINCE BIRTH 96 MONTHS 03

DON\'T KNOW d YEARS 04

REFUSED r DON\'T KNOW d

REFUSED r

CP,YP,YX (with health condition)

1978 SSA Survey

N25. Does (NAME) have any other health conditions or problems?

¿Tiene (NAME) cualesquier otras condiciones o otros problemas de salud?

> ![](media/image12.wmf)YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX (with health condition)

1978 SSA Survey

N26. What are these?

¿Cuáles son?

PROBE FOR SPECIFIC ANSWER. ANSWERS SUCH AS "HE'S SLOW," "DOESN'T TALK
WELL," OR "IS A SPECIAL NEEDS CHILD" ARE NOT SPECIFIC ENOUGH.

PROBE 1: By what name do doctors call (NAME'S) health condition?

PROBE 2: What causes this condition?

PROBE 1: ¿Cómo llaman los doctores la condición de salud de (NAME)?

PROBE 2: ¿Cuál es la causa de esta condición?

*Record verbatim*

CP,YP,YX

Created

N27. In what year did (NAME) last live with you?

¿En qué año vivió (NAME) por última vez con usted?

\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\| YEAR (1970-2002)

NEVER LIVED WITH RESPONDENT n *Go to N31*

DON'T KNOW d

REFUSED r

CP,YP,YX

1999 NHIS Family Core (modified)

N28. Thinking back to the last year (NAME) was living with you, did
(HE/SHE) need the help of other persons with personal care needs, such
as eating, bathing, dressing, or getting around inside the home?

Pensando en el último año en que (NAME) estaba viviendo con usted,
¿necesitaba (él/ella) la ayuda de otras personas con sus necesidades de
cuidado o atención personal, tales como: comer, bañarse, vestirse, o
moverse de un lugar a otro dentro del hogar?

> PROBE: I mean help beyond which most young people of the same age
> would need.

PROBE: Quiero decir más ayuda de lo que la mayoría de los jóvenes de la
misma edad necesitarían.

> YES 01
>
> ![](media/image13.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

NHIS-D (Adult Followback)

N29. Did (NAME) need the help or supervision of other persons with \....

¿Necesitaba (NAME) la ayuda o supervisión de otras personas para . . .

*Code one for each*

> [YES]{.underline} [NO]{.underline} [DK]{.underline} [RF]{.underline}
>
> A. Bathing or showering 01 00 d r
>
> B. Dressing 01 00 d r
>
> C. Eating 01 00 d r
>
> D. Getting in or out of bed or chairs 01 00 d r
>
> E. (IF AGE=17+) Walking 01 00 d r
>
> F. (IF AGE=17+) Getting outside 01 00 d r
>
> G. Using the toilet, including getting to the
>
> toilet 01 00 d r
>
> H. Getting around inside the home 01 00 d r
>
> A. Bañarse o ducharse 01 00 d r
>
> B. Vestirse 01 00 d r
>
> C. Comer 01 00 d r

D.  Acostarse, sentarse o levantarse de la cama

> o de sillas 01 00 d r
>
> E. Caminar 01 00 d r
>
> F. Salir afuera 01 00 d r

G. Ir al baño, incluyendo usar el lavabo o

> inodoro (toilet)) 01 00 d r

H.  Moverse de un lugar a otro dentro

de la casa 01 00 d r

CP,YP,YX

NSAF (scale modified)

N30. I'm going to read a list of items that sometimes describe young
people. For each item please tell me if it was almost always true,
sometimes true, not often true, or never true for (NAME) in the year
(HE/SHE) (FILL "LAST LIVED WITH YOU" if RTYPE=01; "WAS INCARCERATED" if
RTYPE=03).

Le voy a leer una lista de cosas que a veces describen a las personas
jóvenes. Para cada cosa, por favor dígame si esto casi siempre era
cierto, a veces era cierto, no era frecuentemente cierto, o nunca era
cierto, en relación a (NAME) en el último año que (él/ella) (FILL "vivió
con usted" IF RTYPE=01; "fue encarcelado(a)" IF RTYPE=03)

a\. (NAME) had trouble sleeping. Was that...

> (NAME) tenía dificultades en dormir. ¿Era eso . . .
>
> Almost always true 01
>
> Sometimes true 02
>
> Not often true 03
>
> Never true 04
>
> Casi siempre cierto 01
>
> A veces cierto 02
>
> No frecuentemente cierto 03
>
> Nunca cierto 04
>
> DON'T KNOW d
>
> REFUSED r

b.  (NAME) couldn't concentrate or pay attention for long. Was that...

    (NAME) no podía concentrarse o prestar atención por mucho tiempo.

¿Era eso . . .

> Almost always true 01
>
> Sometimes true 02
>
> Not often true 03
>
> Never true 04
>
> Casi siempre cierto 01
>
> A veces cierto 02
>
> No frecuentemente cierto 03
>
> Nunca cierto 04
>
> DON'T KNOW d
>
> REFUSED r

c.  (NAME) had trouble getting along with other people. Was that

> (NAME) tenía dificultades en llevarse bien con otra gente. ¿Era eso .
> . .
>
> Almost always true 01
>
> Sometimes true 02
>
> Not often true 03
>
> Never true 04
>
> Casi siempre cierto 01
>
> A veces cierto 02
>
> No frecuentemente cierto 03
>
> Nunca cierto 04
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

NSAF

N31. What is the last grade of school, that (NAME) completed?

¿Cuál es el último grado o año de escuela que (NAME) completó?

> PROBE: This includes schooling (HE/SHE) might have received
>
> while incarcerated.

PROBE: Before earning a GED, if (NAME) has one.

> PROBE: Esto incluye estudios que (él/ella) podía haber recibido
> mientras que fue encarcelado(a).
>
> PROBE: Antes de recibir un Diploma de equivalencia o GED, si (NAME)
> tiene uno.
>
> \|\_\_\|\_\_\| GRADE
>
> 14 NURSERY/PRESCHOOL/

PRE-KINDERGARTEN

> 15 KINDERGARTEN
>
> 16 ABOVE 12^th^ GRADE
>
> 17 SPECIAL EDUCATION
>
> 18 NOT ATTENDING
>
> 19 NAME WAS HOME SCHOOLED
>
> d DON'T KNOW
>
> r REFUSED

CP,YP,YX

Created

N31a. Does (NAME) have a high school diploma or GED, also known as a
graduate equivalency degree, or neither?

¿Tiene (NAME) un diploma de estudios secundarios (high school) o un GED,
también llamado: Diploma de Equivalencia, o ninguno de estos?

> YES, HIGH SCHOOL DIPLOMA 01
>
> YES, GED 02
>
> NEITHER 03
>
> DON'T KNOW d

REFUSED r

CP,YP,YX

Mary Wagner

N32. Now, I'd like to ask you about any job training or help that (NAME)
might have received. As far as you know, prior to being incarcerated,
did (NAME) receive any training in job skills, vocational education,
career counseling, or help in finding a job?

Ahora quiero hacerle unas preguntas acerca de cualquier entrenamiento o
ayuda que (NAME) quizás ha recibido. Según lo que sabe Ud.,¿**alguna
vez** recibió (NAME) cualquier entrenamiento de destrezas de empleo,
educación vocacional, consejo de carrera (career counseling), o ayuda en
encontrar un empleo?

PROBE: This excludes services or training (HE/SHE) might be receiving
while incarcerated.

> PROBE: Esto no incluye servicios o entrenamiento que (él/ella) quizás
> recibe
>
> mientras que esencarcelado(a).
>
> YES 01
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

Mary Wagner

N33. As far as you know, has (NAME) **ever** received any training in
how to do things like manage money, cook, or keep house, or any other
life skills training? Do not include instruction from family members or
friends.

Según lo que sabe Ud.,¿**alguna vez** recibió (NAME) algún entrenamiento
en como hacer cosas tales como manejar (su) dinero, cocinar o mantener
la casa, o algún otro entrenamiento de destrezas de vida cotidiana (life
skills training)? No incluya instrucción por parte de miembros de la
familia o de amistades.

YES 01

NO 00

DON'T KNOW d

REFUSED r

CP,YP,YX

Created

N34. Now I would like to ask you about any experience (NAME) and (FILL
"YOUR" if RTYPE=01; "NAME'S" if RTYPE=03) family might have had with the
Supplemental Security Income, or SSI program operated by the Social
Security Administration.

Has (FILL "YOUR" if RTYPE=01; "NAME'S" if RTYPE=03) household ever
received an SSI benefit for (NAME)?

> Ahora le quiero hacer unas preguntas acerca de cualquier experiencia
> que (NAME) y su familia quizás tuvieron con el programa de SSI
> (Supplemental Security Income, o Seguridad de Ingreso Suplementario),
> que es administrado por el Social Security Administration
> (Administración de Seguro Social).

¿Alguna vez ha recibido (FILL "SU FAMILIA" IF RTYPE=01; "LA FAMILIA DE
(NAME)" IF RTYPE=03) un beneficio de SSI para (NAME)?

> YES 01 *Continue*
>
> ![](media/image14.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

N35t. CHECK AGE: Is (NAME)'s age.....

> \<18 .......... 01  *Go to N42*
>
> 18+........ 02  *Continue*

YP

N35. Was (NAME) receiving SSI benefits at the time of (HIS/HER) 18^th^
birthday?

> ¿Estaba (NAME) recibiendo beneficios de SSI al cumplir los18 años?
>
> YES 01
>
> ![](media/image15.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

YP

Created

N36. Before (NAME) was incarcerated, was (HIS/HER) eligibility for SSI
redetermined by the Social Security Administration around the time of
(HIS/HER) 18^th^ birthday using the rules for adults?

Antes de que NAME fuese encarcelado(a)¿fue su elegibilidad para SSI
redeterminada por la Administración de Seguro Social (Social Security
Administration), usando las reglas para adultos?

> ![](media/image16.wmf)YES 01 *Continue*
>
> NO 00
>
> REDETERMINATION PENDING 02
>
> DON'T KNOW d
>
> REFUSED r

YP

Created

N37. Did SSA make a final decision about (NAME'S) redetermination before
(NAME) was incarcerated?

¿Tomó la SSA una decisión final acerca de la redeterminación antes de
que (NAME) fuese encarcelado(a)?

PROBE: By final decision, I mean did SSA notify you that (NAME'S)
benefits would either continue or stop, and you decided not to appeal or
completed all your appeals.

PROBE: Por decisión final, quiero decir si SSA le notificó que los
beneficios de (NAME) continuarían o serían paradas, y Ud. decidió no
apelar o terminó todas sus apelaciones.

> YES 01 *Continue*
>
> ![](media/image17.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

YP

Created

N38. What was the outcome of that redetermination? Did (NAME)...

¿Cuál fue el resultado de esa redeterminación? ¿(NAME)...

> Continue to receive SSI benefits, or 01 *Go to N47*
>
> Stop receiving SSI benefits 02 *Go to N41*
>
> Continuó recibiendo beneficios de SSI 01 *Go to N47*
>
> Paró de recibir beneficios de SSI 02 *Go to N41*
>
> DON'T KNOW d *Go to N47*
>
> REFUSED r *Go to N47*

YP

Created

N39. Was the final decision pending or was it under appeal?

¿Estaba la decisión final pendiente, o aún estaba siendo apelada?

PENDING 01 *Go to N47*

UNDER APPEAL 02 *Continue*

DON'T KOW d *Go to N47*

REFUSED r *Go to N47*

YP

Created

N40. As far as you know, why did SSA make the initial decision to stop
SSI benefits for (NAME)?

Según lo que Ud. sabe, ¿por qué tomó la SSA la decisión inicial de parar
los beneficios de SSI para (NAME)?

*Code all that apply*

> (NAME'S) INCOME TOO HIGH 01
>
> (NAME'S) ASSETS TOO HIGH 02
>
> DETERMINED MEDICALLY INELIGIBLE 03
>
> DETERMINED ABLE TO WORK/ENGAGE
>
> IN SUBSTANTIAL GAINFUL ACTIVITY 04
>
> DID NOT FOLLOW PROGRAM RULES 05
>
> (NAME) MARRIED/REMARRIED 06
>
> ![](media/image18.wmf)(NAME) NOT IN SCHOOL/JOB TRAINING 07
>
> OTHER (SPECIFY) 08

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d

REFUSED r

YP

Created

N41. As far as you know, why did (NAME) stop receiving SSI benefits at
that time.

> Según lo que Ud. sabe, ¿por qué paró (NAME) de recibir beneficios de
> SSI en aquel entonces?
>
> *Code all that apply*
>
> (NAME'S) INCOME TOO HIGH 01
>
> (NAME'S) ASSETS TOO HIGH 02
>
> DETERMINED MEDICALLY INELIGIBLE 03
>
> DETERMINED ABLE TO WORK/ENGAGE
>
> IN SUBSTANTIAL GAINFUL ACTIVITY 04
>
> DID NOT FOLLOW PROGRAM RULES 05
>
> (NAME) MARRIED/REMARRIED 06
>
> ![](media/image19.wmf)(NAME) NOT IN SCHOOL/JOB TRAINING 07
>
> OTHER (SPECIFY) 08

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d

REFUSED r

CP,YP,YX

Created

N42. Since January 1996 but before (NAME) was incarcerated, was there
any time when (NAME) or (FILL "YOUR" if RTYPE=01; "NAME'S" if RTYPE=03)
family stopped receiving SSI benefits for (HIM/HER) for more than one
month?

Desde enero de 1996, pero antes de que (NAME) fuese encarcelado(a),
¿hubo algún tiempo en el cual (NAME) o su familia pararon de recibir
beneficios de SSI para (él/ella), por más de un mes?

> YES 01 *Go to N45*
>
> NO 00
>
> DON'T KNOW d
>
> REFUSED r

N43. CHECK: Does answer to N42 agree with pre-loaded SSA information?

YES 01 *Go to N47*

NO 00 *Continue*

CP,YP,YX

N44. Our records show that (NAME) stopped receiving benefits in (INSERT
MONTH AND YEAR FROM PRELOADED INFORMATION), for at least a month or
more. As far as you know, is that correct?

Nuestros registros muestran que (NAME) paró de recibir beneficios en
(INSERT MONTH AND YEAR FROM PRELOADED INFORMATION), por un mes o más.
Según lo que Ud. sabe, ¿es eso correcto?

> YES 01 *Continue*
>
> ![](media/image20.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

Created

N45. Why did (NAME) lose SSI benefits (the last time this happened/ when
this happened)? *Code all that apply*

¿Por qué perdió (NAME) beneficios de SSI cuando ocurrió esto?

> PARENT'S INCOME TOO HIGH 01
>
> PARENT'S ASSETS TOO HIGH 02
>
> (NAME'S) INCOME TOO HIGH 03
>
> (NAME'S) ASSETS TOO HIGH 04
>
> (NAME) DETERMINED MEDICALLY
>
> INELIGIBLE 05
>
> DID NOT FOLLOW PROGRAM RULES 06
>
> MARRIED/REMARRIED 07
>
> ![](media/image21.wmf)MOVED IN WITH FAMILY/OTHER PERSON 08
>
> OTHER (SPECIFY) 09

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d

REFUSED r

CP,YP,YX

Created

N46. When (NAME) stopped receiving SSI benefits at that time, did
(HE/SHE) stop receiving Medicaid benefits or (INSERT MEDICAID STATE
NAME) benefits at the same time?

> Cuando (FILL "NAME" IF RTYPE=01,03; "UD." IF RTYPE=02) paró de recibir
> beneficios de SSI lo más recientemente, ¿paró (fill "él/ella" if
> rtype=01,03; "Ud.' if rtype=02) de recibir beneficios de Medicaid o
> beneficios de (INSERT MEDICAID STATE NAME) a la misma vez?

YES 01

NO 02

NAME NEVER HAD MEDICAID 03

DON'T KNOW d

REFUSED r

CP,YP,YX

Created

N47. These last questions are about (NAME). In what month and year was
(NAME) incarcerated?

Estas últimas preguntas son acerca de (NAME). ¿En qué mes y año fue
(NAME) encarcelado(a)?

PROBE: Your best estimate is fine.

PROBE: Adivine lo major que pueda

\|\_\_\_\|\_\_\_\| MONTH \|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\| YEAR
(1970-2002)

DON'T KNOW d

REFUSED r

CP,YP,YX

Created

N48. What charges is (NAME) incarcerated for?

¿Por cuáles cargos fue (NAME) encarcelado(a)?

MANDATORY PROBE: Is (NAME) incarcerated for any other charges?

MANDATORY PROBE: ¿Es (NAME) encarcelado(a) por cualquier otro cargo?

*Do not read list, code all that apply.*

AGGRAVATED ASSAULT 01

BURGLARY 02

USE OR POSSESSION OF DRUGS 03

SALE OR MANUFACTURE OF DRUGS 04

DRUNKENNESS, LIQUOR LAWS, OR

DRIVING UNDER THE INFLUENCE 05

FRAUD 06

LARCENY OR THEFT 07

MOTOR VEHICLE THEFT OR CAR-JACKING 08

MURDER OR MANSLAUGHTER 09

OFFENSES AGAINST FAMILY OR

CHILDREN 10

PAROLE OR PROBATION VIOLATION 11

RAPE 12

ROBBERY 13

SEX OFFENSES (INCLUDING PROSTITUTION

AND SOLICITATION) 14

SHOPLIFTING 15

SIMPLE ASSAULT 16

STOLEN PROPERTY (EITHER BUYING,

RECEIVING, OR POSSESSION OF 17

VANDALISM 18

![](media/image22.wmf) CARRYING OR POSSESSION OF WEAPONS 19

OTHER (SPECIFY) 20

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d

REFUSED r

CP,YP,YX

Created

N49. How much time is (NAME) expected to serve?

¿Cuánto tiempo tendrá que servir (NAME)?

PROBE: How long will (NAME) serve before (HE/SHE) is released?

PROBE: ¿Cuánto tiempo tendrá (NAME) que servir, antes de ser puesto(a)
en libertad?

> \|\_\_\_\|\_\_\_\| ENTER AMOUNT AND CODE TIME PERIOD BELOW (0-999)

WEEKS 01

MONTHS 02

YEARS 03

HAS NOT YET BEEN SENTENCED 04

DON'T KNOW d

REFUSED r

CP,YP,YX

Created

N50. Altogether, how many times has (NAME) been arrested or charged with
a crime or parole violation?

En total, ¿cuántas veces ha sido (NAME) arrestado(a) o acusado(a) por un
crimen o una violación de libertad condicional (parole)?

\|\_\_\_\|\_\_\_\| TIMES (1-99)

DON'T KNOW d

REFUSED r

CP,YP,YX

Created

N51. Has (NAME) **ever** worked at a job or business? This includes work
(NAME) may be doing while incarcerated.

¿**Alguna vez** ha trabajado (NAME) en un empleo o en algún negocio?
Esto incluye trabajo que (NAME) puede estar haciendo mientras que es
encarcelado(a).

> YES 01
>
> ![](media/image23.wmf)NO 00
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

MPR

N52. In what month and year did (NAME) last work at a job or business?

¿En qué mes y año trabajó (NAME) la última vez en un empleo o en un
negocio?

\|\_\_\|\_\_\| MONTH \|\_\_\|\_\_\| YEAR (1970-2002)

NOW WORKING n

DON'T KNOW d

REFUSED r

CP,YP,YX

MPR

N53. What is (NAME's) ethnic background? Is (HE/SHE):

> ¿Cuál es el origen étnico de (NAME)? ¿Es (él/ella):
>
> Hispanic or Latino, or 01
>
> Not Hispanic or Latino 02
>
> Hispano(a) o Latino(a)), o 01
>
> Ni Hispano(a) ni Latino(a) 02
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

MPR

N54. What is (NAME's) race? Is (HE/SHE)....

¿Cuál es la raza de (NAME)? ¿Es (él/ella):

*Read list, code all that apply*

> Alaska Native or American Indian 01
>
> Asian 02
>
> Black or African American 03
>
> Native Hawaiian or Other Pacific Islander 04
>
> White 05
>
> Nativo(a) de Alaska, o amerindio(a) indígena 01
>
> Asiático(a) 02
>
> Negro(a) o Africano(a)-Americano(a) 03
>
> Nativo(a) de Hawaii o de Islas del Pacífico 04
>
> Blanco(a) 05
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

MPR

N55. Was (HE/SHE) born in the United States or in another country?

> ¿Nació (él/ella) en los Estados Unidos, o en otro país?
>
> ![](media/image24.wmf) United States 01
>
> Other (SPECIFY) 02
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> DON'T KNOW d
>
> REFUSED r

CP,YP,YX

MPR

N56. Finally, what language is spoken most often in (FILL "YOUR" if
RTYPE=01; "NAME'S" if RTYPE=03) home?

> Finalmente ¿qué idioma se habla con la mayor frecuencia en (FILL "su
> hogar" IF RTYPE=02; "EL HOGAR DE (nAME)" IF RTYPE=03)?

English 01

![](media/image25.wmf) Spanish 02

Other (SPECIFY) 03

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d

REFUSED r