> APPENDIX a
>
> APPENDIX A\
> \
> NSV 2001 RDD HOUSEHOLD SCREENING QUESTIONNAIRE

# SCREENER MODULE

**SCRN.SHHQUEX1**

SINTRO_1.

> Hello, I'm calling for a study that is being conducted for the U.S.
> Department of Veterans Affairs. We're interested in talking to
> veterans about their program and benefit needs.
>
> Are you a member of this household and at least 18 years old?

######## YES 1

######## NO 2

######## PROBABLE BUSINESS 3

######## ANSWERING MACHINE AM

######## RETRY AUTODIALER RT

> NONWORKING,

########  DISCONNECTED, CHANGED NW

######## GO TO RESULT GT

**SCRN.SFONEUSE**

SINTRO_3.

> Is this phone number used for...
>
> Home use, 4 GO TO SC4
>
> Home and business use, or 5 GO TO SC4
>
> Business use only? 6 GO TO THANK01
>
> GO TO RESULT GT GO TO RESULT
>
> HOME USE EXCLUDES GROUP QUARTERS \[I.E., 10 OR MORE UNRELATED
> ADULTS\], VACATION HOMES, NURSING HOMES, DORMITORIES, FRATERNITIES,
> AND SORORITIES.
>
> \[HHM'S INCLUDE PEOPLE WHO THINK OF THIS HH AS THEIR PRIMARY PLACE OF
> RESIDENCE. IT INCLUDES PERSONS WHO USUALLY STAY IN THE HH BUT ARE
> TEMPORARILY AWAY ON BUSINESS, VACATION, IN A HOSPITAL, OR LIVING AT
> SCHOOL IN A DORM, FRATERNITY, OR SORORITY.\]

***We will determine that we have a household member who is at least 18
years old on the phone before continuing to SC4***

**PROGRAMMER NOTE:**

**DISPLAY SC4 IF = YES GO TO S6 (MATRIX), COLLECT FNAME/AGE/SEX/SCRESP
AND AUTOCODE VETERAN STATUS = 1 (DISPLAY "ARMED FORCES" IN MATRIX, ELSE
GO TO SC5.**

**DISPLAY SC5 IF = YES GO TO S6 (MATRIX), COLLECT FNAME/AGE/SEX/SCRESP
AND AUTOCODE VETERAN STATUS = 2 (DISPLAY "MERCHANT MARINE" IN MATRIX,
ELSE GO TO SC6.**

**DISPLAY SC6 IF = YES GO TO S6 (MATRIX), COLLECT FNAME/AGE/SEX/SCRESP
AND AUTOCODE VETERAN STATUS = 3 (DISPLAY "WOMEN'S SERVICES" IN MATRIX,
ELSE GO TO SC7.**

**DISPLAY SC7 IF = YES GO TO S6 (MATRIX), COLLECT FNAME/AGE/SEX/SCRESP
AND AUTOCODE VETERAN STATUS = 4 (DISPLAY "PUBLIC SERVICES" IN MATRIX,
ELSE GO TO SC11.**

**DISPLAY SC11 IF = YES GO TO S6 (MATRIX), COLLECT FNAME/AGE/SEX/SCRESP
AND AUTOCODE VETERAN STATUS = 5 (DISPLAY "RESERVES/NAT'L GUARD" IN
MATRIX, ELSE GO TO S6VER.**

**SCRN.ACTDUTY**

SC4. This study is being conducted for the Department of Veterans
Affairs to assess future program and benefit needs. Your participation
is voluntary. Your answers will be kept confidential and used only for
the purpose of this study. My name is (INTERVIEWER NAME) and I'll be
conducting the interview.

Including yourself, has anyone in your household ever served on [active
duty]{.underline} in the U. S. Armed Forces?

> **\[ARMY, NAVY, MARINES, AIR FORCE, COAST GUARD, NURSING CORPS,
> WOMEN'S ARMED FORCES BRANCHES\]**
>
> YES 1 GO TO S6
>
> NO 2
>
> REFUSED -7
>
> DON'T KNOW -8

**SCRN.MERCHMAR**

SC5. Has anyone in your household ever served in the U.S. Merchant
Marine on a ship under U.S. flag, between December 1941 and August 1945?

> YES 1 GO TO S6
>
> NO 2
>
> REFUSED -7
>
> DON'T KNOW -8

**SCRN.WOMSVC**

SC6. Has anyone in your household ever served in the nursing corps, air
transport corps, or any of the women's armed forces branches?

> YES 1 GO TO S6
>
> NO 2
>
> REFUSED -7
>
> DON'T KNOW -8

**SCRN.COMOFF**

SC7. Has anyone in your household ever served as a commissioned officer
in the Public Health Service, the Environmental Services Administration,
or the National Oceanic and Atmospheric Administration?

> YES 1 GO TO S6
>
> NO 2
>
> REFUSED -7
>
> DON'T KNOW -8

**SCRN.RESVNAT**

SC11. Not counting the {person/people} you've already mentioned, has
anyone in your household ever served in the Reserves or National Guard?

> YES 1 GO TO S6
>
> NO 2

**SCRN.VERLIST**

**S6VER.** I have recorded {N} {person/people}.

> Have we missed anyone else who usually lives in this household who has
> ever served in the U.S. Armed Forces, including the National Guard,
> Reserves, on a U.S. Merchant Marine Ship, in the women's armed forces,
> or as a commissioned officer in the Public Health Service, the
> Environmental Services Administration or the National Oceanic and
> Atmospheric Administration?
>
> YES, RETURN TO MATRIX 1 RETURN TO MATRIX
>
> NO, NUMBER OF HHMS IN MATRIX CORRECT 2

**PROGRAMMER NOTE:**

**AT THE TOP OF S6 DISPLAY THE QUESTION CURRENTLY BEING REFERRED TO
(SC4-SC11).**

**WHEN THE CURSOR IS IN THE CURRENT ACTIVE COLUMN REPLACE THE SC4-SC11
QUESTION AT THE TOP OF THE SCREEN WITH "Is {FNAME/AGE/SEX} CURRENTLY ON
ACTIVE DUTY?"**

**AFTER ALL ENTRIES HAVE BEEN MADE FOR EACH QUESTION INTERVIEWERS MUST
BE REQUIRED TO ESCAPE OUT OF THE MATRIX AND CATI SHOULD DISPLAY THE NEXT
QUESTION IN THE SERIES.**

**ALLOW INTERVIEWERS TO CHANGE ALL INFORMATION IN MATRIX.**

S6. {INSERT QUESTION SC4 -- SC11 AS APPROPRIATE.}

{Is {FNAME/AGE/SEX} CURRENTLY ON ACTIVE DUTY?}

Please give me the first name, age and sex of this person/these people.

> **ENUM. ENUM. ENUM. ENUM. ENUM. ENUM.**
>
> **FNAME AGE SEX SR VETERAN STATUS CURRENT ACTIVE**

1.  ARMED FORCES

2.  MERCHANT MARINES

3.  WOMEN'S SERVICES

4.  RESERVE/NAT'L GUARD

5.  PUBLIC SERVICES

**S6VERF1.** OVERLAY: 1. CONTINUE 2. RETURN TO MATRIX 3. GO TO RESULT

+-----------------------------------------------------------------------+
| > PROGRAMMER NOTE:                                                    |
|                                                                       |
| **WE WILL COME INTO THE MATRIX AS A RESULT OF AN ENTRY OF 1 (YES) ON  |
| SC4 -- SC11 OR 1 ON S6VER. THE CURSOR WILL BE IN AN EMPTY FIRST NAME  |
| FIELD AND THE VET STATUS FIELD WILL BE BLANK. WHEN A FIRST NAME IS    |
| ENTERED, THE VET STATUS WILL BE AUTOCODED AND THE COLUMN FILLED IN AS |
| FOLLOWS.**                                                            |
|                                                                       |
| **IF WE CAME TO THE MATRIX AS A RESULT OF:**                          |
|                                                                       |
| **SC4 = 1, AUTOCODE 1 AND SHOW "ARMED FORCES"**                       |
|                                                                       |
| **SC5 = 1, AUTOCODE 2 AND SHOW "MERCHANT MARINES"**                   |
|                                                                       |
| **SC6 = 1, AUTOCODE 3 AND SHOW "WOMEN'S SERVICES"**                   |
|                                                                       |
| **SC7 = 1, AUTOCODE 4 AND SHOW "PUBLIC SERVICES"**                    |
|                                                                       |
| **SC11 = 1, AUTOCODE 5 AND SHOW "RESERVE/NAT'L GUARD"**               |
|                                                                       |
| **ELSE, DO NOT AUTOCODE; ALLOW INTERVIEWER TO MAKE AN ENTRY.**        |
|                                                                       |
| **THE CURSOR WILL MOVE THROUGH EACH OF THE FIELDS A THROUGH F. WHEN   |
| THE CURSOR IS IN FIELDS A THROUGH D, THE QUESTION SHOWN IN DISPLAY i  |
| WILL BE HIGHLIGHTED. WHEN THE CURSOR IS IN FIELD E OR F, THE          |
| APPROPRIATE QUESTION AS SHOWN IN DISPLAY ii WILL BE HIGHLIGHTED.      |
| AFTER AN ENTRY IS MADE IN FIELD F, GO TO THE FIRST NAME FIELD OF THE  |
| NEXT EMPTY PERSON LINE. DISPLAY ii SHOULD NO LONGER APPEAR. AGAIN     |
| HIGHLIGHT THE QUESTION IN DISPLAY i.**                                |
|                                                                       |
| **FIELD D (SCRESP) DOES NOT REQUIRE AN ENTRY. ALLOW INTERVIEWER TO    |
| PRESS ENTER.**                                                        |
|                                                                       |
| **ESC/ESC WILL GO TO S6VERF1.**                                       |
|                                                                       |
| **IF ENUM.VETSTAT = 1, 2, 3, OR 4 AND ENUM.ACTVDUTY = 2 OR**          |
|                                                                       |
| > **ENUM.VETSTAT = 1, 2, 3, OR 4 AND ENUM.ACTVDUTY = -7, -8 AND       |
| > ENUM.SCRESP DOES NOT = X**                                          |
|                                                                       |
| **SELECT THAT PERSNUM FOR EXTENDED INTERVIEW.**                       |
|                                                                       |
| **ELSE IF ENUM.VETSTAT = 5 SELECT PERSNUM FOR EXTENDED INTERVIEW.**   |
|                                                                       |
| **OTHERWISE CODE ENUM.SELECTFG = 2 (PERSON IS INELIGIBLE).**          |
|                                                                       |
| **ASK SCD9, SCD10, SCD11 OF ALL SELECTED RESPONDENTS.**               |
+-----------------------------------------------------------------------+

**ENUM.ETHNIC**

SCD9. {Are you/Is NAME} Spanish, Hispanic, or Latino?

> YES 1
>
> NO 2
>
> REFUSED -7
>
> DON'T KNOW -8

**PROGRAMMER NOTE:**

**IN SCD10 ALLOW 8 RESPONSE FIELDS.**

**ENUM.RACE01-RACE08**

**ENUM.RACEOS**

**ENUM.RACEARRY \[1\]-\[8\]**

SCD10. I'm going to read a list of racial categories. Please select one
or more to describe {your/NAME'S} race. {Are you/Is NAME}...

**\[CODE UP TO 8 RESPONSES. CTRL/P TO EXIT.\]**

> White, 1
>
> Black or African American, 2
>
> American Indian or Alaska Native, 3
>
> Asian, 4
>
> Native Hawaiian, or 5
>
> Other Pacific Islander? 6
>
> HISPANIC/MEXICAN 7
>
> OTHER \[SPECIFY **RACEOS**\] 91
>
> REFUSED -7
>
> DON\'T KNOW -8

**ENUM.GRADE**

SCD11. What is the highest grade or year of school {you have/NAME has}
[ever]{.underline} completed?

> NO FORMAL SCHOOLING 0
>
> NURSERY SCHOOL TO 4th GRADE 1
>
> 5th, 6th, or 7th GRADE 2
>
> 8th GRADE 3
>
> 9th, 10th, or 11th GRADE 4
>
> 12th GRADE, NO DIPLOMA 5
>
> GED 6
>
> HIGH SCHOOL GRADUATE 7
>
> TRADE/TECHNICAL/VOCATIONAL AFTER HIGH SCHOOL 8
>
> SOME COLLEGE BUT NO DEGREE 9
>
> ASSOCIATE\'S DEGREE IN COLLEGE 10
>
> BACHELOR\'S DEGREE 11
>
> MASTER\'S DEGREE 12
>
> PROFESSIONAL SCHOOL DEGREE \[MD, DDS, DVM, LLB, JD\] 13
>
> DOCTORAL DEGREE \[PHD, EDD\] 14
>
> REFUSED -7
>
> DON\'T KNOW -8

**SCRN.SADDPHON**

SC1b. Are there any telephone numbers in your household in addition to
{TELEPHONE NUMBER}?

> YES 1
>
> NO 2

***[TERMINATIONS:]{.underline}***

READMSG **\[PLEASE READ THE FOLLOWING MESSAGE INTO THE ANSWERING
MACHINE\]**

> This is {INTERVIEWER'S NAME} calling for an important research study
> that is being conducted by the U.S. Department of Veterans Affairs.
> We're interested in talking to veterans about their program and
> benefit needs. Your participation is extremely important to the
> success of this study. We will try to reach you again in the next few
> days.

THANK01. Thank you very much, but we are only interested in interviewing
in private residences.