All

A1. CHECK PRE-LOADED AGE: Is NAME'S age...

18 or older 01 *Continue*

\<18 02 *Go to A3*

All (18+)

A2. INTERVIEWER ENTER: Who/Where are you calling?

(NAME'S) LAST KNOWN ADDRESS 01 *Continue*

PARENT/GUARDIAN OF (NAME) 02 *Continue*

(NAME) HIM/HERSELF 03 *Go to A57*

KNOWN PROXY FOR (NAME) 04 *Go to A57a*

IN

A3. Hello, my name is \_\_\_\_\_\_\_\_\_\_\_\_ and I'm calling from
Mathematica Policy Research on behalf of the Social Security
Administration. May I please speak to a parent or guardian of (FIRST AND
LAST NAME)?

ALTERNATE LANGAUGE FOR CALL IN: Please confirm that I am speaking with a
parent or guardian of (FIRSTAND LAST NAME).

Buen día. Mi nombre es \_\_\_\_\_\_\_\_\_\_\_\_\_, y estoy llamando de
Mathematica Policy Research de parte de la Social Security
Administration. Por favor, ¿ puedo hablar con la madre , el padre el
tutor de (FIRST AND LAST NAME)?

> CONTINUE, SPEAKING WITH PARENT OR
>
> GUARDIAN 01 *Go to A8*
>
> PARENT/GUARDIAN COMES TO PHONE 02 *Go to A7*
>
> PARENT/GUARDIAN DOESN\'T LIVE HERE 03 *Go to A5*
>
> LANGUAGE BARRIER 04 LANG
>
> NO SUCH PERSON AT THIS NUMBER 07 THAN
>
> SUPERVISOR REVIEW REQUIRED 08
>
> (NAME) REPORTED DECEASED 09 *Go to A14*
>
> HUNG UP DURING INTRODUCTION H *End Interview*
>
> CALLBACK C
>
> REFUSED R

IN

A4. Your family should have received a letter explaining that we are
calling for an important study on the health of (FILL "CHILDREN" IF AGE
\<17; "YOUNG PEOPLE" IF AGE 17+). When would be a good time to call back
to reach a parent or guardian of (NAME)?

Su familia debe de haber recibido una carta explicando que llamaríamos
acerca de un importante estudio sobre la salud de (FILL "niños" IF AGE
\<17; "ADULTOS jóvenes" IF AGE 17+). ¿ Cuándo sería conveniente volver a
llamar para hablar con la madre o el padre o tutor de (NAME)?

PROBE: When is (HE/SHE) usually at home?

PROBE: Generalmente, ¿cuándo está (ÉL/ELLA) en casa?

*Go to callback screen. End interview.*

IN

A5. Do you know where I might reach a parent or guardian of (NAME),
(FILL IF AGE = 18+, "OR (NAME) HIMSELF/HERSELF")?

¿Sabe Ud. dónde me puedo comunicar con uno de los padres o el tutor de
(NAME), (FILL IF AGE = 18+, "o con (NAME) mismo(a)")?

YES 01

NO 00 *Go to A6a*

DON'T KNOW d *Go to A6a*

REFUSED r *Go to A6a*

IN

A6. What are the name, address, and telephone number of (NAME's) parent
or guardian (FILL IF AGE = 18+, "or (NAME) (HIMSELF/HERSELF)")?

¿ Cuáles son el nombre, la dirección y el número de teléfono de la madre
o el padre o tutor de (NAME) (FILL IF AGE = 18+, "o de (NAME)mismo(a)")?

> NAME:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> STREET ADDRESS:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> CITY/STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ZIP
> CODE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> TELEPHONE NUMBER: (\|\_\_\_\|\_\_\_\|\_\_\_\|)
> \|\_\_\_\|\_\_\_\|\_\_\_\| - \|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|
>
> AREA CODE
>
> DON'T KNOW d
>
> REFUSED r
>
> INTERVIEWER, MARK ONE: IS THIS PERSON...
>
> (NAME) 01
>
> (NAME'S) PARENT OR GUARDIAN 02
>
> OTHER (SPECIFY) 03
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

IN

A6a. Do you know anyone else who might know how to reach a parent or
guardian of (NAME), (FILL IF AGE = 18+, "OR (NAME) (HIMSELF/HERSELF)")?

¿Conoce a alguien que sepa cómo comunicarse con uno de los padres o con
el tutor de (NAME), (FILL IF AGE = 18+, "o con (NAME) mismo(a)")?

YES 01

NO 00 *End Interview*

DON'T KNOW d *End Interview*

REFUSED r *End Interview*

IN

A6b. What are the name, address, and telephone number of this person?

¿ Cuáles son el nombre, la dirección y el número de teléfono de esta
persona?

> NAME:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> STREET ADDRESS:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> CITY/STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ZIP
> CODE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> TELEPHONE NUMBER: (\|\_\_\_\|\_\_\_\|\_\_\_\|)
> \|\_\_\_\|\_\_\_\|\_\_\_\| - \|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|
>
> AREA CODE
>
> DON'T KNOW d
>
> REFUSED r

IN

A6c. How is this person related to (NAME), if at all?

¿Cuál es el parentesco de esta persona con (NAME) si lo hay?

> GRANDPARENT 07
>
> BROTHER/SISTER (NATURAL/STEP)
>
> OF (NAME) 08
>
> AUNT/UNCLE OF (NAME) 09
>
> (NAME'S) SPOUSE 10
>
> HOUSEMATE/ROOMMATE/FRIEND 13
>
> OTHER RELATIVE OF (NAME)
>
> (SPECIFY IN QUESTION) 15

##### NOT RELATED 

##### (SPECIFY IN QUESTION) 16

> DON\'T KNOW d
>
> REFUSED r

CP, YP

A7. *(When respondent comes to phone)* Hello, my name is
\_\_\_\_\_\_\_\_\_\_\_\_ and I'm calling from Mathematica Policy
Research on behalf of the Social Security Administration. *Continue to
A8.*

> Hola, mi nombre es \_\_\_\_\_\_\_\_\_\_\_\_ , y estoy llamando de
> Mathematica Policy

Research de parte de la Social Security Administration. *Continue to
A8.*

CP, YP

A8. You may have received a letter explaining that we are conducting a
study about the health of (FILL "CHILDREN" IF AGE \<17; "YOUNG PEOPLE"
IF AGE 17+). The study includes (FILL "CHILDREN" IF AGE \<17; "YOUNG
PEOPLE" IF AGE 17+) who are receiving Supplemental Security Income, or
SSI, and (FILL "CHILDREN" IF AGE \<17; "YOUNG PEOPLE" IF AGE 17+) whose
families once applied for or received SSI on their behalf. We're calling
to follow up about (FIRST AND LAST NAME's) health and your family's
well-being. Does (NAME) still live at this address or is (NAME) living
somewhere else?

Ud. quizás recibió una carta explicando que estamos conduciendo un
estudio acerca de la salud de (FILL "niños" IF AGE \<17; "personas
jóvenes" IF AGE 17+). El estudio incluye (FILL "niños" IF AGE \<17;
"personas jóvenes" IF AGE 17+) que están recibiendo Seguridad de Ingreso
Suplementario, o SSI; y (FILL "niños" IF AGE \< 17; "personas jóvenes"
IF AGE 17+) cuyas familias alguna vez solicitaron o recibieron SSI en
nombre de ellos. Estamos llamando para sequir con la salud de (NAME), y
del bienestar de su familia. ¿Aún vive (NAME) aquí o vive (NAME) en otro
lugar?

> YES, (NAME) STILL LIVES HERE 01 *Go to A29*
>
> NO, (NAME) LIVES SOMEWHERE ELSE 00 *IF AGE \<18* *Go* *to* *A9;*
> *ELSE*

*A10*

(NAME) DIED 02 *Go to A14*

DON'T KNOW d *IF AGE \<18* *Go*

*to* *A*9; *ELSE* *A10*

REFUSED r *IF AGE \<18 Go*

*to* *A*9; *ELSE A10*

CP (age \<18)

A9. Where does (NAME) live? Would that be with...

¿Dónde vive (NAME)? ¿ Sería eso. . .

*Read list, code only one answer*

> A relative 01 *Go to A15*

A family friend 03 *Go to A15*

> In a residential facility (PROBE: Such as an
>
> assisted living facility, center for independent
>
> living, personal care home, or halfway house) 04 *Go to A21*

In a Medicaid institution 05 *Continue*

> At school 06 *Go to A21*
>
> In a foster home 07 *Go to A15*

(NAME) IS IN JAIL/PRISON/JUVENILE

CORRECTION FACILITY 09 *Set RTYPE=01;*

> *Go to Part N*

(NAME) IS DECEASED 10 *Go to A14*

(NAME) RAN AWAY/LEFT HOME 11 *Go to A11*

Somewhere else (SPECIFY) 12 *Go to A15*

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

> Con un pariente 01 *Go to A15*

Con un amigo de la familia 03 *Go to A15*

En una residencia (PROBE: Tal cómo una

residencia asistido (assisted living facility),

un centro de vida independiente,un hogar de

cuidado personal, o un "halfway house"). 04 *Go to A21*

> En una institución de Medicaid 05 *Continue*
>
> En la escuela 06 *Go to A21*
>
> E n un hogar de crianza (foster home) 07 *Go to A15*

(NAME) IS IN JAIL/PRISON/JUVENILE

CORRECTION FACILITY 09 *Set RTYPE=01;*

> *Go to Part N*

(NAME) IS DECEASED 10 *Go to A14*

![](media/image1.wmf) (NAME) RAN AWAY/LEFT HOME 11 *Go to A11*

En algún otro lugar (SPECIFY) 12 *Go to A15*
­­­­­\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d *Go to A11*

REFUSED r *End Interview*

CP (age \<18)

A9a. Just to confirm, does Medicaid pay for half or more of the cost of
(NAME'S) stay at this place?

Para confirmar, paga Medicaid la mitad, o más, del costo de la estadía
de (NAME) en este lugar?

YES 01 *End Interview*

NO 00 *Go to A21*

DON'T KNOW d *End Interview*

REFUSED r *End Interview*

YP (age 18+)

A10. Where does (NAME) live? Would that be in...

¿Dónde vive (NAME)? ¿Sería eso...

*Read list, code only one answer*

> With a relative, not including
>
> (his/her) spouse or own children 01 *Go to A18*

(HIS/HER) own home (PROBE: Either alone

or with friends, roommates, or (HIS/HER)

own family) 02 *Go to A16*

> A residential facility (PROBE: Such as an
>
> assisted living facility, center for independent
>
> living, personal care home, or halfway house) 04 *Go to A25*
>
> In a Medicaid institution 05 *Continue*

At school 06 *Go to A29*

A nursing or convalescent home 08 *Go to A25*

(NAME) IS IN JAIL/PRISON/JUVENILE

CORRECTION FACILITY 09 *Go to* *A34*

(NAME) IS DECEASED 10 *Go to A14*

(NAME) RAN AWAY/LEFT HOME 11 *Go to A11* Somewhere else (SPECIFY) 12 *Go
to A18*

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

> Con un pariente, no incluyendo a su esposo(a)

o a sus propios hIjos" 01 *Go to A18*

En su propia casa (Probe: sea sólo(a) o

con amistades, compañeros (roomates), o

con su propia familia) 02 *Go to A16*

En una residencial, (PROBE: Tal cómo una

residencia de alojamiento asistido (assisted

living facility), un centro de vida independiente,

un hogar de cuidado personal, o un "halfway

house"). 04 *Go to A25*

> En una institución de Medicaid 05 *Continue*
>
> En la escuela 06 *Go to A29*

En un hogar de convalescentes o "Nursing

home"? 08 *Go to A25*

(NAME) IS IN JAIL/PRISON/JUVENILE

CORRECTION FACILITY 09 *Go to* *A34*

(NAME) IS DECEASED 10 *Go to A14*

![](media/image1.wmf) (NAME) RAN AWAY/LEFT HOME 11 *Go to A11* En algún
otro lugar (SPECIFY) 12 *Go to A18*

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

DON'T KNOW d *Go to A11*

REFUSED r *End Interview*

YP (age 18+)

A10a. Just to confirm, does Medicaid pay for half or more of the cost of
(NAME'S) stay at this place?

Para confirmar, paga Medicaid la mitad, o más, del costo de la estadía
de (NAME) en este lugar?

YES 01 *End Interview*

NO 00 *Go to A25*

DON'T KNOW d *End Interview*

REFUSED r *End Interview*

CP, YP

A11. In what month and year did (NAME) last live with you?

¿ En qué mes y año vivió (NAME) con Ud. la última vez?

\|\_\_\_\|\_\_\_\| MONTH \|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\| YEAR
(1970-2001)

(NAME) NEVER LIVED WITH RESPONDENT 99 *Go to A12a*

DON'T KNOW d *Go to A13*

REFUSED r *Go to A13*

CP, YP

A12. CHECK: Is time in A11 more than 12 months ago?

YES 01 *Continue*

NO 00 *Go to A13*

CP, YP

A12a. Do you know anyone who might know how to reach (NAME) or the place
where (HE/SHE) is living?

¿Conoce a alguien que sepa cómo comunicarse con (NAME) o el lugar dónde
vive (EL/ELLA)?

YES 01

NO 00 *End Interview*

DON'T KNOW d *End Interview*

REFUSED d *End Interview*

CP,YP

A12b. What are the name, address, and telephone number of this person?

¿Cuáles son el nombre, la dirección y el número de teléfono de esta
persona?

> NAME:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> STREET ADDRESS:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> CITY/STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ZIP
> CODE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> TELEPHONE NUMBER: (\|\_\_\_\|\_\_\_\|\_\_\_\|)
> \|\_\_\_\|\_\_\_\|\_\_\_\| - \|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|
>
> AREA CODE
>
> DON'T KNOW d
>
> REFUSED r

CP, YP

A12c. How is this person related to (NAME), if at all?

¿Cuál es el parentesco de esta persona con (NAME), si hay parentesco ?

(NAME) HIMSELF/HERSELF 01

> MOTHER (BIOLOGICAL OR ADOPTIVE) 02
>
> FATHER (BIOLOGICAL OR ADOPTIVE) 03
>
> STEP-PARENT OF (NAME) 04
>
> FOSTER PARENT OF (NAME) 05
>
> GRANDPARENT 07
>
> BROTHER/SISTER (NATURAL/STEP)
>
> OF (NAME) 08
>
> AUNT/UNCLE OF (NAME) 09
>
> (NAME'S) SPOUSE 10
>
> HOUSEMATE/ROOMMATE/FRIEND 13

OTHER RELATIVE OF (NAME)

> (SPECIFY IN QUESTION) 15

##### NOT RELATED 

##### (SPECIFY IN QUESTION) 16

> DON\'T KNOW d
>
> REFUSED r

# 

CP, YP

A13. Even though you don't know (NAME'S) whereabouts, I'd like to
continue the interview with you anyway. The questions are easy. They ask
about (NAME'S) health and your family's day-to-day living. If you don't
know the answer to a question, please just say so.

Aunque Ud. no sabe dónde anda (NAME), en todo caso quiesiera continuar
la entrevista con usted. Las preguntas son fáciles. Son acerca de la
salud de (NAME), y de la vida diaria de su familia. Si no sabe la
respuesta a alguna pregunta, por favor di'gamelo.

CONTINUE INTERVIEW 01 *Go to A29*

CP, YP

A14. I am very sorry to hear that (HE/SHE) passed away. I am calling
about a study we are conducting for the Social Security Administration.
A letter explaining why we are calling was recently sent to you. When
did (NAME) pass away?

Me apena mucho oir que (ÉL/ELLA) fallecidó. Estoy llamando acerca de un
estudio que estamos conduciendo para Social Security Administration. Una
carta explicando por qué estamos llamando le fue enviada a
recientemente. ¿Cuándo falleció (NAME)?

\|\_\_\_\|\_\_\_\| / \|\_\_\_\|\_\_\_\| /
\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|

MONTH DAY YEAR

DON'T KNOW d

REFUSED r

Thank you. Please accept my condolences. *End Interview.*

Muchas gracias. Y acompañandole en el sudolor. *End Interview.*

CP

A15. What are the name and address of the person with whom (NAME) is
living?

¿Cuáles son el nombre y la dirección de la persona con quien (NAME)
vive?

PERSON
NAME:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> STREET
> ADDRESS:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> CITY/STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ZIP
> CODE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> TELEPHONE NUMBER: (\|\_\_\_\|\_\_\_\|\_\_\_\|)
> \|\_\_\_\|\_\_\_\|\_\_\_\| - \|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|
>
> AREA CODE
>
> DON'T KNOW d *End Interview*
>
> REFUSED r *End Interview*

CP, YP

A16. CHECK AGE: Is NAME'S age...

> \<18 01 *Go to A29*
>
> 18+ 02 *Continue*

YP

A17. Is (NAME) living with (HIS/HER) spouse or children, living with
friends or roommates, or living alone?

¿ Está viviendo (NAME) con su esposo(a) o sus hijos, está viviendo con
amistades o compañeros (roommates), o vive sólo(a)?

LIVING WITH OWN SPOUSE/CHILDREN 01

LIVING WITH FRIENDS/ROOMMATES 02

LIVING ALONE 03

DON'T KNOW d

REFUSED r

YP

A18. We'd like to contact (NAME) there. What is the address and
telephone number of the place where (NAME) is living?

Quisiéramos comunicarnos con (NAME) allí. ¿ Cuál es la dirección y el
número de teléfono del lugar donde (NAME) está viviendo

> STREET ADDRESS:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> CITY/STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ZIP
> CODE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> TELEPHONE NUMBER: (\|\_\_\_\|\_\_\_\|\_\_\_\|)
> \|\_\_\_\|\_\_\_\|\_\_\_\| - \|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|
>
> AREA CODE
>
> DON'T KNOW d *End Interview*
>
> REFUSED r *End Interview*

YP

A19. Is there a person there we should speak to about (NAME), or should
we ask for (NAME) (HIMSELF/HERSELF)?

¿Hay alguna persona allí con la cual debemos de hablar acerca de (NAME)?
o debemos preguntar por (NAME) mismo(a)?

![](media/image1.wmf)

YES (SPECIFY PERSON) 01

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

NO, SPEAK TO (NAME) 00 *Go to A24*

DON'T KNOW d

REFUSED r

YP

A20. How is this person related to (NAME), if at all?

¿Cómo está esta persona emparentada con (NAME), si hay algún parentesco?
[]{.mark}

> []{.mark}
>
> MOTHER (BIOLOGICAL OR ADOPTIVE) 02 ­ *Set RTYPE=01*
>
> FATHER (BIOLOGICAL OR ADOPTIVE) 03 *Set RTYPE=01*

STEP-PARENT OF (NAME) 04 *Set RTYPE=01*

> FOSTER PARENT OF (NAME) 05 *Set RTYPE=01*
>
> GRANDPARENT 07 *Set RTYPE=03*
>
> BROTHER/SISTER (NATURAL/STEP)
>
> OF (NAME) 08 *Set RTYPE=03*
>
> AUNT/UNCLE OF (NAME) 09 *Set RTYPE=03*
>
> (NAME'S) SPOUSE 10 *Set RTYPE=03*
>
> OTHER RELATIVE OF (NAME)
>
> (SPECIFY IN QUESTION) 15 *Set RTYPE=03*

##### NOT RELATED 

> (SPECIFY IN QUESTION) 16 *Set RTYPE=03*
>
> DON\'T KNOW d *Set RTYPE=03*
>
> REFUSED r *Set RTYPE=03*

CP

A21. How long has (NAME) been living there?

¿ Por cuánto tiempo ha estado (NAME) viviendo allí?

\|\_\_\_\|\_\_\_\| MONTHS *OR* \|\_\_\_\|\_\_\_\| YEARS (0-99)

DON'T KNOW d

REFUSED r

CP

A22. CHECK: Is (NAME) living in a residential facility, Medicaid
institution or school, i.e., is A9 = 04, 05, or 06?

YES 01 *Go to A29*

NO 00 *Continue*

CP (not living in residential facility or school)

A23. CHECK: Is time in A21 greater than 12 months or 1 year?

YES 01 *Continue*

NO 00 *Go to A29*

CP,YP

A24. Thank you for your time. We'll try to (FILL "CONTACT THAT PERSON"
IF AGE \<18; "CONTACT (NAME) AT THAT ADDRESS" IF AGE = 18+). Those are
all the questions I have.

Le agradezco el tiempo que nos brindó. Nos trataremos de comunicar con
(FILL "esa persona" IF AGE \<18; "(NAME) allí" IF AGE = 18+). Esas son
todas mis preguntas.

CP, YP

A25. CHECK AGE: Is NAME'S age...

\<18 01 *Go to A29*

18+ 02 *Continue*

YP

A26. We'd like to contact (NAME) there. What are the address and
telephone number of the place where (NAME) is living?

Quisiéramos comunicarnos con (NAME) allí. ¿ Cuáles son la dirección y el
número de teléfono del lugar donde (NAME) está viviendo?

> PLACE
> NAME\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> STREET ADDRESS:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> CITY/STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> ZIP CODE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> TELEPHONE NUMBER: (\|\_\_\_\|\_\_\_\|\_\_\_\|)
> \|\_\_\_\|\_\_\_\|\_\_\_\| - \|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|
>
> AREA CODE
>
> DON'T KNOW d
>
> REFUSED r

# 

> YP

A27. Is there a person there we should speak to about (NAME), or should
we ask for (NAME) (HIMSELF/HERSELF?)

¿Hay alguna persona allí con la cual debemos hablar acerca de (NAME) o
debemos preguntar por (NAME) mismo(a)?

![](media/image1.wmf)

YES (SPECIFY PERSON) 01

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

NO, SPEAK TO (NAME) 00

DON'T KNOW d

REFUSED r

YP

A28. Thank you for your time. We'll try to contact that place. Those are
all the questions I have.

Le agradezco el tiempo que nos brindó. Trataremos de comunicarnos con
aquel lugar. Esas son todas mis preguntas. END INTERVIEW

# 

CP, YP

A29. Let me begin with some information about this study. Your
participation is voluntary and will not affect any SSI benefits that
(NAME) may receive now or may apply for in the future. The answers you
provide are strictly confidential and will be used for research purposes
only.

> In appreciation of your time, we'll send you a (FILL "A CHECK FOR
> \$10.00" IF INCENTIVE TYPE =1; FILL "A \$10.00 DEBIT CARD" IF
> INCENTIVE TYPE=2; FILL "A \$10.00 PHONE CARD" IF INCENTIVE TYPE=3)
> once we finish the interview. I would like to begin the interview now.
> The questions are easy. They ask about (NAME'S) health and your
>
> family's day-to-day living.
>
> READ IF NECESSARY: We estimate this interview will take about 60
> minutes to complete.

Permítame empezar con un poco de información acerca de este estudio. Su

participación en este estudio es voluntaria, y no afectará ningún
beneficio de

SSI que (NAME) reciba ahora, o por la cual appliqué en el futuro. Las
respuestas que

Ud. me de son estrictamente confidenciales, y sólo serán usadas para

propósitos de estudio.

> Para agradecerle el tiempo que nos brindará, le enviaremos (FILL "un
> cheque por \$10.00" IF INCENTIVE TYPE =1; FILL " UNA TARJETA CON
> DÉBITO DE \$10.00 IF INCENTIVE TYPE=2; FILL "UNA TARJETA TELEFÓNICA DE
> \$10.00 IF INCENTIVE TYPE=3), después de terminar la entrevista.
> Quisiera empezar la entrevista ahora mismo.

Las preguntas son fáciles. Son acerca de la salud de (NAME), y de la
vida diaria de su familia.

> READ IF NECESSARY: Calculamos que tomará unos 60 minutos para
> completar esta entrevista.

BEGIN INTERVIEW 01 *Go to A33*

NOT A GOOD TIME (SCHEDULE

CALLBACK) 02 *Go to A32a*

DID NOT RECEIVE OR DOES NOT

RECALL LETTER 03 *Continue*

CP, YP

A30. The letter explained that you were selected from a list of families
who have either received SSI benefits for one of their children, or
applied for benefits sometime in the past. The letter explained that we
would be calling to interview you. I would like to begin the interview
now.

La carta explicaba que Ud. fue seleccionado(a) de una lista de familias
que han recibido beneficios de SSI para uno de sus hijos, o que
completaron una solicitud para recibir beneficios, en el pasado. La
carta explicaba que le ibamos a llamar para conducir una entrevista.
Quisiera empezar la entrevista ahora mismo.

BEGIN INTERVIEW 01 *Go to A33*

NOT A GOOD TIME (SCHEDULE

CALLBACK) 02 *Go to A32a*

WANTS ANOTHER LETTER 03 *Continue*

CP, YP

A31. To what address would you like the letter sent?

¿A qué dirección quiere que le enviemos la carta?

STREET
ADDRESS:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

CITY:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_STATE:\_\_\_\_\_\_\_\_\_\_ZIP:\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d *Go to A33*

REFUSED r *Go to A33*

CP, YP

A32. You will receive the letter in a few days. I could read it to you
now. May we begin?

Ud. recibirá la carta dentro de unos días. Se la puedo leer ahora.
¿Podemos empezar?

YES 01*Read letter,* *then go to A33*

NO 00 *Continue*

> INTERVIEWER- IF NO READ: We will call you back I about a week so you
> have a chance to receive the letter. Thank you for your time.

A32a. When would be a good time to callback?

¿Cuándo le sería conveniente vulver a llamar?

*Go to callback screen. End interview.*

CP, YP

A33. First, I would like to verify some information about (NAME). Is
(NAME) male or female?

Primero, quisiera verificar alguna información acerca de (NAME). ¿Es
(NAME) hombre o mujer?

MALE 01

FEMALE 02

DON'T KNOW d

REFUSED r

CP, YP

A34. What is (NAME'S) date of birth?

¿ Cuál es la fecha de nacimiento de (NAME)?

> \|\_\_\_\|\_\_\_\| / \|\_\_\|\_\_\| / \|\_\_\|\_\_\|\_\_\|\_\_\|
> (1970-2001)
>
> MONTH DAY YEAR

DON'T KNOW d

REFUSED r

CP, YP

A35. CHECK: Does date of birth in A34 match pre-loaded date of birth (2
OF 3 MATCH)?

YES 00 Go to A39a

ONE DIDN'T MATCH 01 *Go to* *A36*

TWO DIDN'T MATCH 02 *Go to A36*

THREE DIDN'T MATCH 03 *Go to A36*

*\
* CP, YP

A36. (FILL \"HAVE YOU OR ANYBODY IN YOUR FAMILY APPLIED\" IF
RTYPE=01,02; \"HAS NAME OR ANYBODY IN NAME\'S FAMILY\" IF RTYPE=03)
applied for Supplemental Security Income or SSI benefits for (FILL
"NAME\" IF RTYPE=01,03, \"YOU\" IF RTYPE=02) anytime between 1978 and
2001?

> ¿Ha solicitud (FILL "UD." IF RTYPE=01, 02; "NAME" IF RTYPE=03) o
> alguna persona en su familia Seguridad de Ingreso Suplementario, o
> beneficios de SSI; para
>
> (FILL "NAME\" IF RTYPE=01,03, "UD." IF RTYPE=02) entre 1978 y 2001?

YES 01 *Go to A39a*

NO 00 *Go to A38*

DON'T KNOW d *Go to A38*

REFUSED r *Go to A38*

CP, YP

A37. DELETED

CP, YP

A38. There is a problem with our records and I'm not sure we've reached
the right person.

I need to speak with my supervisor. Someone will call you back shortly.
Thank you.

Hay un problema con nuestros registros, y no estoy seguro(a) que nos
hemos comunicado con la persona correcta. Necesito hablar con mi
supervisor(a). Alguien le llamará dentro de poco. Gracias.

*End interview, record problem.*

CP, YP

A39a. In what city and state is (NAME) now living?

¿En qué ciudad y estado vive (NAME) ahora?

CITY\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_STATE\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d *Continue*

REFUSED r *Continue*

CP, YP

A39a1. CHECK: Is (NAME) living outside the contiguous 48 states (i.e.,
in Alaska, Hawaii, or

a U.S. trust territory)?

YES 01 *End Interview*

NO 00 *IF A9=09* *or A10=09 Go to Section N;* *else* *continue*

CP, YP

A39b. Has (NAME) been living with you since (HE/SHE) was born, or has
(NAME) also lived with other people or in other places?

> ¿ Ha estado (NAME) viviendo con Ud. desde que (él/ella) nació, o
> también ha vivido (NAME) con otras personas o en otros lugares?

LIVED WITH RESPONDENT SINCE BIRTH 01 *Go to A41*

LIVED WITH OTHER PEOPLE/PLACES 02

DON'T KNOW d

REFUSED r

CP, YP

A40. In what year did (NAME) come to live with you most recently?

¿ En qué año vino (NAME) a vivir con Ud., lo más recientemente?

\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\| YEAR (1970-2001)

DON'T KNOW d

REFUSED r

CP, YP

A41. Next, I'd like to ask you some questions about the people who live
in your household at the present time. This includes both children and
adults and may include individuals who are not related to you. How many
people altogether live in this household, including yourself?

> Ahora le quiero hacer unas preguntas acerca de las personas que viven
> en su hogar, actualmente. Esto incluye tanto a niños como adultos, y
> también puede incluir a personas que no tienen una relación de familia
> o parentesco con usted. ¿Cuántas personas, en total, viven en su
> hogar, incluyendose Ud. misma(o)?

PROBE: This includes everyone who usually lives there, even those who
may be temporarily away on business, vacation, in a hospital, or away at
school.

> PROBE: Esto incluye a todas las personas que generalmente viven allí,
> incluyendo a los que están temporalmente fuera del hogar, viajando por
> negocios, de vacaciones, internados en el hospital, o estudiando.

\|\_\_\_\|\_\_\_\| HOUSEHOLD MEMBERS (2-20) *Go to A42* DON'T KNOW d

REFUSED r

CP, YP

A41a. This is a very important piece of information....

Esto es un dato muy importante

\|\_\_\_\|\_\_\_\| HOUSEHOLD MEMBERS (2-20)

DON'T KNOW d *Go to A42*

REFUSED r *End Interview*

CP, YP

A42. For each individual, please tell me their first name, gender, age,
and their relationship to (NAME). I already know about (NAME). Let's
begin with you... Please do not include (NAME) in the list.

Para cada individuo, por favor dígame su primer nombre, sexo, edad, y la
relación de familia o parentesco que tienen con (NAME). Ya sé lo de
(NAME) empecemos con Ud. Por favor, no incluya a (NAME) en la lista.

PROBE: I need this information in order to know what questions to ask
you later in the interview. Because households are different, not all
the questions may apply to you.

PROBE: Necesito esta información para saber cuáles preguntas hacerle más
tarde en la entrevista. Porque todos los hogares y familias son
diferentes, quizás hay preguntas que no son aplicables a ustedes.

INTERVIEWER: DO NOT INCLUDE (NAME) IN THE LIST.

+--------------+--------------+---------------------+------------------+
| A.  What is  | B. *Confirm  | C.What is (HIS/HER/ | D. What is       |
|              | or ask:* Is  |                     | (HIS/HER/YOUR)   |
|    (HIS/HER/ | that person  | YOUR) age?          | relationship to  |
|              | male or      |                     | NAME?            |
| YOUR) first  | female?      | ¿Qué edad tiene?    |                  |
| name?        |              |                     | ¿Cuál es su      |
|              | ¿Es esa      |                     | relación o       |
| ¿Cuál es su  | persona      |                     | parentesco con   |
| nombre?      | hombre o     |                     | (NAME)?          |
|              | mujer?       |                     |                  |
|              |              |                     | *Use             |
|              |              |                     | Relationship     |
|              |              |                     | Code List*       |
+==============+==============+=====================+==================+
| 1\.          | Male 01      | \|\_\_\|\_\_\|      | \|\_\_\|\_\_\|   |
|              |              | YEARS OLD           |                  |
| \_           | Female 02    |                     |                  |
| \_\_\_\_\_\_ |              |                     |                  |
| \_\_\_\_\_\_ | DK d         |                     |                  |
|              |              |                     |                  |
|              | RF r         |                     |                  |
+--------------+--------------+---------------------+------------------+
| 2\.          | Male 01      | \|\_\_\|\_\_\|      | \|\_\_\|\_\_\|   |
|              |              | YEARS OLD           |                  |
| \_           | Female 02    |                     |                  |
| \_\_\_\_\_\_ |              |                     |                  |
| \_\_\_\_\_\_ | DK d         |                     |                  |
|              |              |                     |                  |
|              | RF r         |                     |                  |
+--------------+--------------+---------------------+------------------+
| 3\.          | Male 01      | \|\_\_\|\_\_\|      | \|\_\_\|\_\_\|   |
|              |              | YEARS OLD           |                  |
| \_           | Female 02    |                     |                  |
| \_\_\_\_\_\_ |              |                     |                  |
| \_\_\_\_\_\_ | DK d         |                     |                  |
|              |              |                     |                  |
|              | RF r         |                     |                  |
+--------------+--------------+---------------------+------------------+
| 4\.          | Male 01      | \|\_\_\|\_\_\|      | \|\_\_\|\_\_\|   |
|              |              | YEARS OLD           |                  |
| \_           | Female 02    |                     |                  |
| \_\_\_\_\_\_ |              |                     |                  |
| \_\_\_\_\_\_ | DK d         |                     |                  |
|              |              |                     |                  |
|              | RF r         |                     |                  |
+--------------+--------------+---------------------+------------------+
| 5\.          | Male 01      | \|\_\_\|\_\_\|      | \|\_\_\|\_\_\|   |
|              |              | YEARS OLD           |                  |
| \_           | Female 02    |                     |                  |
| \_\_\_\_\_\_ |              |                     |                  |
| \_\_\_\_\_\_ | DK d         |                     |                  |
|              |              |                     |                  |
|              | RF r         |                     |                  |
+--------------+--------------+---------------------+------------------+
| 6\.          | Male 01      | \|\_\_\|\_\_\|      | \|\_\_\|\_\_\|   |
|              |              | YEARS OLD           |                  |
| \_           | Female 02    |                     |                  |
| \_\_\_\_\_\_ |              |                     |                  |
| \_\_\_\_\_\_ | DK d         |                     |                  |
|              |              |                     |                  |
|              | RF r         |                     |                  |
+--------------+--------------+---------------------+------------------+
| 7\.          | Male 01      | \|\_\_\|\_\_\|      | \|\_\_\|\_\_\|   |
|              |              | YEARS OLD           |                  |
| \_           | Female 02    |                     |                  |
| \_\_\_\_\_\_ |              |                     |                  |
| \_\_\_\_\_\_ | DK d         |                     |                  |
|              |              |                     |                  |
|              | RF r         |                     |                  |
+--------------+--------------+---------------------+------------------+

**PROGRAMMER NOTE: Create space for 14 household members.**

  -----------------------------------------------------------------------
  **GO TO A43**

  -----------------------------------------------------------------------

## 

## 

##  

## Relationship Codes

## 

2.  MOTHER (BIOLOGICAL OR ADOPTIVE)

3.  FATHER (BIOLOGICAL OR ADOPTIVE)

4.  STEP-PARENT OF (NAME)

5.  FOSTER PARENT OF (NAME)

6.  UNMARRIED PARTNER OF PARENT

7.  GRANDPARENT

8.  BROTHER/SISTER OF (NAME)

9.  AUNT/UNCLE OF (NAME)

10. (NAME'S) SPOUSE

11. (NAME'S) CHILD

12. FOSTER CHILD LIVING WITH FAMILY

13. HOUSEMATE/ROOMMATE/FRIEND

14. ROOMER/BOARDER

15. OTHER RELATIVE OF (NAME) (SPECIFY IN QUESTION)

16. OTHER NOT RELATED (SPECIFY IN QUESTION)

INTERVIEWER INSTRUCTION: IF RESPONDENT ANSWERS "MOTHER" OR "FATHER"
FOLLOW-UP WITH: "(ARE YOU/IS THIS PERSON) THE BIOLOGICAL, STEP,
ADOPTIVE, OR FOSTER (MOTHER/FATHER) OF (NAME)?"

I would like to take a minute and make sure I recorded the information
about the people in your household correctly.

Quisiera tomar un momento para asegurar que ha registrado exactamente la
information sobre las personas en su hogar.

INTERVIEWER: CONFIRM INFORMATION IN HOUSEHOLD GRID.

CP, YP

A43. CHECK: Is (NAME) living with a foster parent, i.e., is A42D_1 --
A42D_14=05?

YES 01 *Continue*

NO, \<18 02 *Go to Part B*

> NO 03 *Go to A50*

CP, YP (in foster care)

A44. You mentioned that (NAME) is in foster care in your home. How long
has (NAME) lived with you?

¿Ud. mencionó que (NAME) es su hijo(a) de crianza (foster child). ¿Por
cuánto tiempo ha vivido (NAME) con usted?

PROBE IF MORE THAN ONE TIME: How much time in total has (NAME) lived
with you?

PROBE IF MORE THAN ONE TIME: ¿Por cuánto tiempo en total ha vivido
(NAME) con usted?

NOT IN FOSTER CARE 97 *If Age \<18 go to Part B;*

*else* *go to A50*

DON'T KNOW d

> REFUSED r

[NUMBER]{.underline}

\_\_\_\_\_\_ (01-94)

95 + 95

SINCE BIRTH 96 *Go to A47*

DON\'T KNOW d

REFUSED r

[TIME PERIOD]{.underline}

DAYS 01

WEEKS 02

MONTHS 03

YEARS 04

DON\'T KNOW d

REFUSED r

CP, YP (in foster care)

1978 Survey

A45. And before (NAME) lived here, where did (HE/SHE) live?

Y antés de venir a vivir aquí, ¿dónde vivía?

*Do not read list, code one answer*

GROUP HOME, FAMILY CARE HOME,

PERSONAL CARE HOME, FOSTER CARE

HOME 01

FOSTER FAMILY 02

SPECIAL SCHOOL FOR DISABLED

CHILDREN 03

REGULAR SCHOOL 04

WITH ONE OR BOTH NATURAL PARENTS 05

![](media/image1.wmf) WITH OTHER RELATIVE 06

![](media/image2.wmf) OTHER (SPECIFY) 07

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

DON'T KNOW d

REFUSED r

CP, YP (in foster care)

1978 Survey

A46. Altogether, how many different times has (NAME) been placed since
(HE/SHE) first lived away from (HIS/HER) natural parents?

En total, ¿cuántas veces diferentes ha sido (NAME) colocado(a) desde la
primera vez que (él/ella) fue llevado(a) a vivir sin sus padres
naturales?

\|\_\_\|\_\_\| TIMES PLACED (0-20)

DON'T KNOW d

REFUSED r

CP, YP (in foster care)

1978 Survey

A47. As far as you know, did (NAME's) parents **originally** place
(HIM/HER) voluntarily or was (HE/SHE) originally placed through a court
order?

Según lo que Ud. sabe, ¿fue (NAME) **originalmente** colocado(a) en
forma voluntaria por parte de sus padres, o fue originalmente
colocado(a) por orden de la corte?

VOLUNTARILY 01 *Continue*

COURT ORDER 02 *Go to A49*

> DON'T KNOW d*If Age \<18, go to* *Part* *B,* *else A50*
>
> REFUSED r *If Age* *\<18, go to* *Part B,* *else A50*

CP, YP (in foster care)

1978 Survey

A48. As far as you know, what was the main reason for this original
placement by the parents?

Según lo que Ud. sabe, ¿cuál fue la razón principal para esta colocación
original por parte de los padres?

*Do not read list, code one answer*

PARENT COULDN'T AFFORD CARE

FOR (NAME) 01

PARENT DID NOT WANT (NAME) 02

PARENT FELT INCAPABLE OF CARING

FOR (NAME) 03

PARENT ILL OR DISABLED, UNABLE TO

![](media/image1.wmf) CARE FOR (NAME) 04

OTHER (SPECIFY) 05

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

DON'T KNOW d

REFUSED r

+-----------------------------------------------------------------------+
| **IF AGE \<18 GO TO**                                                 |
|                                                                       |
| **PART B**                                                            |
+-----------------------------------------------------------------------+

CP, YP (in foster care)

1978 Survey

A49. As far as you know, what was the main reason for this original
placement?

Según lo que Ud. sabe, ¿cuál fue la razón principal para esta colocación
original?

*Do not read list, code one answer*

(NAME) NEGLECTED 01

(NAME) ABUSED 02

PARENT JUDGED INCAPABLE OF CARING

FOR NAME 03

PARENT ILL OR DISABLED, UNABLE TO

CARE FOR NAME 04

NO ONE AVAILABLE TO CARE FOR

![](media/image1.wmf) NAME 05

OTHER (SPECIFY) 06

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

DON'T KNOW d

REFUSED r

YP

A50. CHECK: Is (NAME) living with his/her own spouse or children in this
household, i.e., is A42D_1 -- A42D_14=10,11?

YES 01 *Go to A52*

NO 00 *Go to Part B*

YP

A51. DELETED

YP

A52. According to our study procedures, I need to continue the interview
with (NAME) himself/herself. Is (NAME) available now?

> Según nuestros procedimientos de estudio, necesito continuar la
> entrevista con (NAME) mismo(a). ¿Está (NAME) disponible ahora?

YES 01 *Go to A55,*

*set RTYPE=02*

NO 00 *Continue* *set RTYPE=02*

(NAME) PHYSICALLY OR MENTALLY UNABLE

TO RESPOND ON THE TELEPHONE 03 *Go to A54,*

*set RTYPE=01*

DON'T KNOW d *Continue*

*set RTYPE=02*

REFUSED r *Continue*

*set RTYPE=02*

YP

A53. When would be a good time to call back to reach (NAME)?

¿Cuándo sería conveniente volver a llamar para comunicarnos con (NAME)?

PROBE: When is (HE/SHE) usually at home?

PROBE: Generalmente, ¿ cuándo está (él/ella) en casa?

*Go to callback screen. End interview.*

YP

A54. In that case, our study procedures say that I should continue the
interview with you.

En ese caso, nuestros procedimientos de estudio dicen que debo continuar
la entrevista con usted.

CONTINUE INTERVIEW 01 *Go to Part B*

YA

> A55. WHEN (NAME) COMES TO THE PHONE: Hello, my name is
> \_\_\_\_\_\_\_\_\_\_\_\_ and I'm calling from Mathematica Policy
> Research on behalf of the Social Security Administration. We're
> conducting a study about the health of young people who are receiving
> Supplemental Security Income, or SSI, or whose families once applied
> for or received SSI on their behalf. I'd like to ask you a few
> questions about how you're doing. Is now a good time to conduct the
> interview?

Buen día. Mi nombre es \_\_\_\_\_\_\_\_\_\_\_\_ y estoy llamando de
parte de Social Security Administration. Estamos conduciendo un estudio
acerca de la salud de personas jóvenes que están recibiendo Seguridad de
Ingreso Suplementario, o SSI, o cuyas familias solicitaron o recibieron
SSI en nombre de ellos. Quisiera hacerle algunas preguntas acerca de
cómo le va. ¿Le conviene que conduzca la entrevista ahora?

YES 01 *Go to A56*

NO 00 *Continue*

DON'T KNOW d *Continue*

REFUSED r *Continue*

YA

A55a. When would be a good time to call back?

¿Cuándo sería conveniente volver a llamar?

PROBE: When are you usually at home?

PROBE: Generalmente, ¿cuándo está Ud. en casa?

*Go to callback screen. End interview.*

YA

A56. Let me begin with some information about this study. The questions
I'll be asking are about your health and how you get along day-to-day.
Your participation in this study is voluntary and will not affect any
SSI benefits that you receive now or may apply for in the future. The
answers you provide are strictly confidential and will be used for
research purposes only. In appreciation of your time, we'll send you a
(FILL "A CHECK FOR \$10.00" IF INCENTIVE TYPE=1; FILL "A \$10.00 DEBIT
CARD" IF INCENTIVE TYPE=2; FILL "A \$10.00 PHONE CARD" IF INCENTIVE
TYPE=3) once we finish the interview. I would like to begin the
interview now.

Permítame empezar con un poco de información acerca de este estudio. Las
preguntas que le estaré haciendo son acerca de la salud de Ud., y cómo
se las arregla de día en día. Su participación en este estudio es
voluntaria, y no afectará a ningún beneficio de SSI que Ud. reciba
ahora, o por la cual aplique en el futuro. Las respuestas que me dará
son estrictamente confidenciales, y sólo serán usadas para los
propósitos de estudio. Para agradecerle el tiempo que nos brindará, le
enviaremos (FILL "un cheque por \$10.00" IF INCENTIVE TYPE=1; FILL "una
tarjeta de débito de \$10.00" IF INCENTIVE TYPE=2; FILL "una tarjeta
telefónica de \$10.00" IF INCENTIVE TYPE=3) después de terminar la
entrevista.

READ IF NECESSARY: We estimate this interview will take about 60 minutes
to complete.

> READ IF NECESSARY: Calculamos que tomará unos 60 minutos para
> completar esta entrevista.

IN

A57. Hello, my name is \_\_\_\_\_\_\_\_\_\_\_\_ and I'm calling from
Mathematica Policy Research on behalf of the Social Security
Administration. May I please speak to (NAME)?

Buen día. Mi nombre es \_\_\_\_\_\_\_\_\_\_\_\_\_, y estoy llamando de
Mathematica Policy

Research de parte de Social Security Administration. Por favor, ¿puedo
hablar con

> (NAME)?

SPEAKING TO (NAME) 01 *Go to A77*

(NAME) COMES TO PHONE 02 *Go to A77*

PERSON WANTS MORE INFORMATION 03 *Go to A63*

(NAME) PHYSICALLY OR MENTALLY UNABLE

TO RESPOND ON THE TELEPHONE 05 *Go to A64*

(NAME) HAS A SPEECH OR

HEARING PROBLEM 06 *Go to A73*

(NAME) DECEASED 07 *Go to A62*

(NAME) DOESN'T LIVE HERE 08 *Go to A59*

(NAME) DOES NOT SPEAK

ENGLISH OR SPANISH 09 *Go to A64*

SUPERVISOR REVIEW REQUIRED s *Go to supervisor review*

(NAME) UNAVAILABLE c *Go to callback screen*

REFUSED r *End Interview*

IN

A57a. Hello, my name is \_\_\_\_\_\_\_\_\_\_\_\_ and I'm calling from
Mathematica Policy Research on behalf of the Social Security
Administration. May I please speak to (FILL PROXY NAME IF AVAILABLE;
ELSE FILL "SOMEONE WHO IS KNOWLEDGEABLE ABOUT (NAME'S) DAY TO DAY
LIVING")?

Buen día. Mi nombre es \_\_\_\_\_\_\_\_\_\_\_\_\_, y estoy llamando de
Mathematica Policy

> Research de parte de Social Security Administration. Por favor, ¿puedo
> hablar con
>
> (FILL PROXY NAME IF AVAILABLE; ELSE FILL "alguien que sepa algo de la
>
> vida diaria de (NAME)")?

SPEAKING TO PROXY 01 *Go to A77a*

PROXY COMES TO PHONE 02 *Go to A77a*

PROXY DECEASED 07 *Go to A62*

PROXY DOESN'T LIVE HERE 08 *Go to A59*

PROXY DOES NOT SPEAK

ENGLISH OR SPANISH 09 *Go to A64*

PROXY UNAVAILABLE c *End Interview*

SUPERVISOR REVIEW REQUIRED s *Go to supervisor review*

REFUSED r *End Interview*

IN

A58. When is a good time to call back to reach (FILL "NAME" IF A2=03;
"(INSERT PROXY NAME)" IF A2=04; ELSE "THIS PERSON")?

¿Cuándo sería conveniente volver a llamar para comunicarnos con (FILL
"NAME" IF A2=03; "(INSERT PROXY NAME)" IF A2=04; ELSE "ESA PERSONA")?

*Go to callback screen. End interview.*

IN

A59. Do you know where I might reach (FILL "NAME" IF A2=03; "(INSERT
PROXY NAME)" IF A2=04; ELSE "THIS PERSON")?

¿Sabe Ud. dónde nos podemos comunicarnos con (FILL "NAME" IF A2=03;
"(INSERT PROXY NAME)" IF A2=04, ELSE "ESA PERSONA")?

YES 01

NO 00 *End Interview*

DON'T KNOW d *End Interview*

REFUSED d *End Interview*

IN

A60. What is (FILL "NAME'S" IF A2=03; "(INSERT PROXY NAME'S)" IF A2=04;
ELSE "THIS PERSON")?) address and telephone number?

¿Cuál es la dirección y el número de teléfono de (FILL "NAME" IF A2=03;
"(INSERT PROXY NAME; ELSE "ESA PERSONA") IF A2=04)?

> STREET ADDRESS:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> CITY/STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ZIP
> CODE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> TELEPHONE NUMBER: (\|\_\_\_\|\_\_\_\|\_\_\_\|)
> \|\_\_\_\|\_\_\_\|\_\_\_\| - \|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|
>
> AREA CODE
>
> DON'T KNOW d
>
> REFUSED r
>
> INTERVIEWER MARK ONE: IS THIS INFORMATION FOR ...
>
> (NAME) 01
>
> PROXY FOR (NAME) r

IN

A60a. CHECK: Is A2 = 04, that is, are you speaking with a proxy
respondent?

> YES 01 *Go to A61a*

NO 00 *Continue*

IN

A61. Is this (NAME'S) parent's or guardian's address, or somewhere else?

¿Es esta la dirección de los padres o guardianes de (NAME), o algún otro
lugar?

PARENT'S/GUARDIAN'S ADDRESS 01

SOMEWHERE ELSE (SPECIFY) 02

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

DON'T KNOW d

REFUSED r

IN

A61a. Thank you, we'll try to contact (HIM/HER) there.

Gracias. Trataremos de comunicarnos con (ÉL/ELLA) allí.

IN

A62. I am very sorry to hear that (HE/SHE) passed away. I am calling
about a study we are conducting for the Social Security Administration.
A letter explaining why we are calling was recently sent to (FILL "NAME"
IF A2=03; "(INSERT PROXY NAME)" IF A2=04). When did (HE/SHE) pass away?

Me apena mucho oir que (ÉL/ELLA) falleció. Estoy llamando acerca de un
estudio que estamos conduciendo para Social Security Administration. Una
carta explicando por qué estamos llamando, le fue enviada recientemente
a (FILL "NAME" IF A2=03; "(INSERT PROXY NAME)" IF A2=04). ¿Cuándo
falleció (NAME)?

\|\_\_\_\|\_\_\_\| / \|\_\_\_\|\_\_\_\| /
\|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|

MONTH DAY YEAR

DON'T KNOW d

REFUSED r

Please accept my condolences.

Le acompaño en el sentimiento.

IN

A63. I am calling about an interview we would like to conduct with
(NAME) concerning the health of young adults. The study includes young
people who are receiving SSI benefits, and young people whose families
once applied for or received SSI on their behalf. Would (HE/SHE) be able
to answer questions (HIMSELF/HERSELF) or would someone need to answer on
(HIS/HER) behalf?

Estoy llamando acerca de una entrevista que quisieramos conducir con
(NAME), acerca de la salud de adultos jóvenes. El estudio incluye
personas jóvenes que reciben beneficios de SSI, y jóvenes cuyas familias
alguna vez solicitaron o recibieron SSI en su nombre. ¿Podría (ÉL/ELLA)
contestar preguntas por sí mismo(a), o alguien necesitaría contestar en
su nombre?

(NAME) COULD RESPOND 01 *Continue*

(NAME) COULD NOT RESPOND 02 *Go to A64*

DON'T KNOW d *Continue*

REFUSED r *Continue*

IN

A63a. May I please speak with (NAME)?

¿Puedo hablar con (NAME) por favor?

YES 01 *Go to A77*

NO 00 *Go to A66*

DON'T KNOW d *Go to A66*

REFUSED r *Go to A66*

IN

A64. I need to speak to someone who is knowledgeable about (NAME's)
health and day-to-day living. Is there someone there I can speak with
who would be able to answer these questions? This is for a study the
Social Security Administration is conducting to follow up with young
adults who are either receiving SSI benefits or whose parents or
guardians once applied for SSI benefits on their behalf.

Necesito hablar con alguien que tenga información sobre la salud de
(NAME) y de su vida diaria. ¿Hay alguien allí con quien puedo hablar, y
que podría contestar estas preguntas? Esto es para un estudio de
seguimiento que el Social Security Administration está conduciendo con
adultos jóvenes que están recibiendo beneficios de SSI, o cuyos padres o
guardianes alguna vez hicieron una solicitud para beneficios de SSI en
sus nombres.

SPEAKING TO PROXY 01 *Go to A71*

PROXY NOT AVAILABLE, NOT A GOOD

TIME 02 *Continue*

PROXY LIVES AT DIFFERENT ADDRESS 03 *Go to A67*

NO PROXY AVAILABLE 04 *End Interview*

DON'T KNOW d *End Interview*

REFUSED r *End Interview*

IN

A65. Deleted

IN

A66. When would be a good time to call back to reach (HIM/HER)?

¿Cuándo sería conveniente volver a llamar para comunicarnos con
(ÉL/ELLA)?

*Go to callback screen, end interview*

IN

A67. We'd like to contact (HIM/HER). May I please have (HIS/HER) name,
address and telephone number?

> Quisieramos comunicarnos con (ÉL/ELLA). ¿Me podría dar su dirección y
> número de teléfono?
>
> NAME:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> STREET ADDRESS:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> CITY/STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> ZIP CODE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> TELEPHONE NUMBER: (\|\_\_\_\|\_\_\_\|\_\_\_\|)
> \|\_\_\_\|\_\_\_\|\_\_\_\| - \|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|
>
> AREA CODE

DON'T KNOW d

REFUSED r

IN

A68. Deleted

IN

A69. Deleted

IN

A70. How is (HE/SHE) related to (NAME), if at all?

> ¿Cómo está (ÉL/ELLA) relacionado(a) con (NAME), si hay algún
> parentesco?
>
> MOTHER (BIOLOGICAL OR ADOPTIVE) 02
>
> FATHER (BIOLOGICAL OR ADOPTIVE) 03
>
> STEP-PARENT OF (NAME) 04
>
> FOSTER PARENT OF (NAME) 05
>
> GRANDPARENT 07
>
> BROTHER/SISTER (NATURAL/STEP) OF (NAME) 08
>
> AUNT/UNCLE OF (NAME) 09
>
> (NAME'S) SPOUSE 10
>
> OTHER RELATIVE OF (NAME)
>
> (SPECIFY IN QUESTION) 15
>
> NOT RELATED (SPECIFY IN QUESTION) 16

YX

A71. Can you tell me why (NAME) needs you to help (HIM/HER) complete
this interview?

> ¿Me puede decir por qué (NAME) necesita su ayuda para completar esta
> entrevista?

TOO ILL 01

NOT COGNITIVELY/MENTALLY ABLE 02

LANGUAGE PROBLEM 03

HEARING PROBLEM (CAN'T BE RESOLVED

![](media/image1.wmf) WITH AMPLIFIER PHONE OR TTY) 04

OTHER (SPECIFY) 05

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

DON'T KNOW d

REFUSED r

YX

A72. Is now a good time to conduct the interview?

> ¿Le conveniene que conduzca la entrevista ahora?

YES 01 *Go to A77i*

NO 00 *Go to A77h*

IN

A73. I can get on a phone that will amplify my voice or (NAME's) voice,
or we could use a TTY service. Would either of these help (NAME)
complete the interview?

Puedo usar un teléfono que amplifique mi voz, o la de (NAME); o podemos
usar un servicio de TTY. ¿Ayudaría uno de estos a (NAME) para completar
la entrevista?

YES, AMPLIFIER PHONE 01 *Go to A74*

YES, TTY 02 *Go to A76*

NO 00 *Continue*

DON'T KNOW d *Continue*

REFUSED r *Continue*

IN

A73a. In that case, I'll continue the interview with you. *Go to A78*

En ese caso, voy a continuar la entrevista con Ud. *Go to A78*

IN

A74. Is (NAME) available now?

¿Está (NAME) disponible ahora?

YES 01 *Go to A75*

NO 00 *Go to A77f*

DON'T KNOW d *Go to A77f*

REFUSED r *Go to A77f*

IN

A75. Please hold while I get the amplifier phone.

Por favor espere en la línea hasta que traiga el teléfono con
amplificación.

(NAME) comes to phone 00 *Go to A77*

IN

A76. Is (NAME) available now?

¿Está (NAME) disponible ahora?

YES 01 *Go to A76a*

NO 00 *Go to A77f*

DON'T KNOW d *Go to A77f*

REFUSED r *Go to A77f*

A76a. INTERVIEWER: IF (NAME) IS AVAILABLE, ARRANGE CALL WITH TTY
OPERATOR, THEN START WITH A77.

YA

A77. (WHEN NAME COMES TO PHONE: Hello, my name is
\_\_\_\_\_\_\_\_\_\_\_\_ and I'm calling from Mathematica Policy
Research on behalf of the Social Security Administration.) We're
conducting a study about the health of young people who are receiving
Supplemental Security Income, or SSI, or whose families once applied for
or received SSI on their behalf. I'd like to ask you a few questions
about how you're doing. Is now a good time to conduct the interview?

(WHEN NAME COMES TO THE PHONE: Buen día. Mi nombre es
\_\_\_\_\_\_\_\_\_\_\_\_ y estoy llamando de Mathematica Policy Research
de parte de Social Security Administration.) Estamos conduciendo un
estudio acerca de la salud de personas jóvenes que están recibiendo
Seguridad de Ingreso Suplementario, o SSI; o cuyas familias solicitaron
o recibieron SSI en nombre de ellos. Quisiera hacerle algunas preguntas
acerca de cómo le va. ¿Es ahora conveniente para hacerle la entrevista?

YES 01 *Set RTYPE=02;*

*Go to A80*

NO 00 *Go to A77h*

DON'T KNOW d *Go to A80*

REFUSED r *End Interview*

YX

A77a. Hello, my name is \_\_\_\_\_\_\_\_\_\_ and I'm calling from
Mathematica Policy Research on behalf of the Social Security
Administration. We're conducting a study about the health of young
people who are receiving Supplemental Security Income, or SSI. I'd like
to ask you a few questions about a person in our study, (INSERT FIRST
AND LAST NAME). Would you be able to answer questions on (HIS/HER)
behalf?

Buen día. Mi nombre es \_\_\_\_\_\_\_\_\_\_\_\_ y estoy llamando de
Mathematica Policy Research de parte de Social Security Administration.
Estamos conduciendo un estudio acerca de la salud de personas jóvenes
que están recibiendo Seguridad de Ingreso Suplementario, o SSI; o cuyas
familias solicitaron o recibieron SSI en nombre de ellos. Quisiera
hacerle algunas preguntas acerca de una persona en nuestro estudio,
(INSERT FIRST & LAST NAME). Podría usted contestar unas preguntas por
(ÉL/ELLA)?

YES 01 *Continue*

NO 00 *Go to A77h*

DON'T KNOW d *Continue*

REFUSED r *End Interview*

YX

A77b. Just to confirm, does (NAME) need you to answer for (HIM/HER), or
would

(NAME) be able to answer questions (HIMSELF/HERSELF)?

Para confirmar, ¿necesita (NAME) que usted conteste por (ÉL/ELLA) o
podría (NAME) mismo(a) contestar?

(NAME) CAN ANSWER 01 *Go to A77d*

(NAME) NEEDS PROXY 02 *Continue*

DON'T KNOW d *Continue*

REFUSED r *Continue*

YX

A77c. Can you tell me why (NAME) needs you to help (HIM/HER) complete
this interview?

> ¿Puede decirme por qué necesita (NAME) su ayuda para completar esta
> entrevista?

TOO ILL 01

NOT COGNITIVELY/MENTALLY ABLE 02

LANGUAGE PROBLEM 03

HEARING PROBLEM (CAN'T BE RESOLVED

![](media/image1.wmf) WITH AMPLIFIER PHONE OR TTY) 04

OTHER (SPECIFY) 05

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

DON'T KNOW d

REFUSED r

YX

A77d. In that case, I'd like to speak to (NAME). Is (HE/SHE) available
now?

En ese caso, quisiera hablar con (NAME). ¿Está (NAME) disponible ahora?

YES 01 *Set RTYPE=02;*

*Go to A77e*

NO 00 *Go to A77f*

DON'T KNOW d *Go to* *A77e*

REFUSED r *Go to A77e*

YX

A77e. May I please speak with (NAME)?

¿Puedo hablar con (NAME) ahora?

YES 01 *Set RTYPE=02;*

*Go to* *A77g*

> NO 00 *Go to A77f*

DON'T KNOW d *Go to A77f*

REFUSED r *Go to A77f*

YX

A77f. When would be a good time to call back to reach (HIM/HER)?

¿Cuándo sería conveniente volver a llamar para comunicarnos con
(ÉL/ELLA)?

*Set RTYPE=02. Go to callback screen. End interview*

YA

A77g. (WHEN NAME COMES TO PHONE: Hello, my name is
\_\_\_\_\_\_\_\_\_\_\_\_ and I'm calling from Mathematica Policy
Research on behalf of the Social Security Administration.) We're
conducting a study about the health of young people who are receiving
Supplemental Security Income, or SSI, or whose families once applied for
or received SSI on their behalf. I'd like to ask you a few questions
about how you're doing. Is now a good time to conduct the interview?

> (WHEN NAME COMES TO PHONE: Buen día. Mi nombre es
> \_\_\_\_\_\_\_\_\_\_\_\_ y estoy llamando de Mathematica Policy
> Research de parte de Social Security Administration.) Estamos
> conduciendo un estudio acerca de la salud de personas jóvenes que
> están recibiendo Seguridad de Ingreso Suplementario, o SSI; o cuyas
> familias alguna vez solicitaron o recibieron SSI en nombre de ellos.
> Quisiera hacerle algunas preguntas acerca de cómo le va. ¿Le conviene
> que conduzco la entrevista ahora?

YES 01 *Go to A80*

NO 00 *Go to A77h*

DON'T KNOW d *Go to A77h*

REFUSED r *Go to A77h*

YX

A77h. When would be a good time to call back?

¿Cuándo sería conveniente volver a llamar?

*Go to callback screen. End interview*

YX

A77i. How are you related to (NAME), if at all?

¿Cómo está Ud. relacionado(a) con (NAME), si hay algún parentesco?

> MOTHER (BIOLOGICAL OR ADOPTIVE) 02 *Set RTYPE=01*
>
> FATHER (BIOLOGICAL OR ADOPTIVE) 03 *Set RTYPE=01*
>
> STEP-PARENT OF (NAME) 04 *Set RTYPE=01*
>
> FOSTER PARENT OF (NAME) 05 *Set RTYPE=01*
>
> UNMARRIED PARTNER OF PARENT 06 *Set RTYPE=01*
>
> GRANDPARENT 07 *Set RTYPE=01*
>
> BROTHER/SISTER OF (NAME) 08 *Set RTYPE=03*
>
> AUNT/UNCLE OF (NAME) 09 *Set RTYPE=01*
>
> (NAME'S) SPOUSE 10 *Set RTYPE=03*
>
> HOUSEMATE/ROOMMATE/FRIEND 13 *Set RTYPE=03*
>
> ROOMER/BOARDER 14 *Set RTYPE=03*
>
> OTHER RELATIVE OF (NAME)
>
> (SPECIFY IN QUESTION) 15 *Set RTYPE=03*
>
> NOT RELATED (SPECIFY IN QUESTION) 16 *Set RTYPE=03*

A78. DELETE

A79. DELETE

YA, YX , YP

A80. Let me begin with some information about this study. The questions
I'll be asking are about (FILL "NAME'S" IF RTYPE=01,03; "YOUR" IF
RTYPE=02) health and how (FILL "HE/SHE" IF RTYPE=01,03; "YOU" IF
RTYPE=02) gets along day-to-day. Your participation in this study is
voluntary and will not affect any SSI benefits that (FILL "NAME" IF
RTYPE=01,03; "YOU" IF RTYPE = 02) receive now or may apply for in the
future. The answers you provide are strictly confidential and will be
used for research purposes only.

In appreciation of your time, we'll send you a (FILL "A CHECK FOR
\$10.00" IF INCENTIVE TYPE=1; FILL "A \$10.00 DEBIT CARD" IF INCENTIVE
TYPE=2; FILL "A \$10.00 PHONE CARD" IF INCENTIVE TYPE=3) once we finish
the interview. I would like to begin the interview now.

> READ IF NECESSARY: We estimate this interview will take about 50
> minutes to complete. *Continue*

Permítame empezar con un poco de información acerca de este estudio. Las
preguntas que le estaré haciendo son acerca de la salud de (FILL "NAME"
IF RTYPE=01,03; "UD." IF RTYPE=02) y de cómo se las arregla día a día.
Su participación en este estudio es voluntaria, y no afectará a ningún
beneficio de SSI que (FILL "NAME" IF RTYPE=01,03; "UD." IF RTYPE = 02)
reciba ahora, o solicite en el futuro. Las respuestas que me dará son
estrictamente confidenciales, y sólo serán usadas para los propósitos de
estudio. Para agradecerle el tiempo que nos brindará, le enviaremos
(FILL "un cheque por \$10.00" IF INCENTIVE TYPE=1; FILL " una tarjeta de
débito de \$10.00" IF INCENTIVE TYPE=2; FILL " una tarjeta telefónica de
\$10.00" IF INCENTIVE TYPE=3) después de terminar la entrevista.

> READ IF NECESSARY: Calculamos que tomará unos 50 minutos para
> completar esta entrevista. *Continue*

YA, YX, YP

A81. First, I would like to verify some information about (FILL "NAME"
IF RTYPE=01,03; "YOU" IF RTYPE = 02). (FILL "IS NAME" IF RTYPE = 03;
"ARE YOU" IF RTYPE = 02) male or female?

Primero, quisiera verificar alguna información acerca de (FILL "NAME" IF
RTYPE=01,03; "YOU" IF RTYPE = 02). ¿Es (FILL "NAME" IF RTYPE=01,03;
"UD." IF RTYPE=02) hombre o mujer?

MALE 01

FEMALE 02

DON'T KNOW d

REFUSED r

YA, YX , YP

A82. What is (FILL "NAME'S" IF RTYPE=01,03; "YOUR" IF RTYPE = 02) date
of birth?

> ¿Cuál es la fecha de nacimiento de (FILL "NAME" IF RTYPE=01,03; "UD."
> IF RTYPE=02)?
>
> \|\_\_\_\|\_\_\_\| / \|\_\_\|\_\_\| / 19\|\_\_\|\_\_\| (1970-2001)
>
> MONTH DAY YEAR

DON'T KNOW d

REFUSED r

YA, YX, YP

A83. CHECK: Does date of birth in A82 match the pre-loaded date of
birth? (2 OF 3 MATCH)

YES 00 Go to A39a

ONE DIDN'T MATCH 01 *Go to A36*

TWO DIDN'T MATCH 02 *Go to A36*

THREE DIDN'T MATCH 03 *Go to A36*

YA, YX, YP

A84. (FILL \"HAVE YOU OR ANYBODY IN YOUR FAMILY APPLIED\" IF
RTYPE=01,02; \"HAS NAME OR ANYBODY IN NAME\'S FAMILY\" IF RTYPE=03)
applied for Supplemental Security Income or SSI benefits for (FILL
"NAME\" IF RTYPE=01,03, \"YOU\" IF RTYPE=02) anytime between 1978 and
2001?

¿Ha solicitado (FILL "UD." IF RTYPE=01,02; "NAME" IF RTYPE=03) o alguna
persona en su familia Ingresos de Seguridad Suplementario, o beneficios
de SSI; para (FILL "NAME\" IF RTYPE=01, 03, "UD." IF RTYPE=02) alguna
vez entre 1978 y 2001?

YES 01 *Go to A87a*

NO 00 *Go to A86*

DON'T KNOW d *Go to A86*

REFUSED r *Go to A86*

YA, YX , YP

A85. DELETED

YA, YX , YP

A86. There is a problem with our records and I'm not sure we've reached
the right person. I need to speak with my supervisor. Someone will call
you back shortly. Thank you.

Hay un problema con nuestros registros, y no estoy seguro(a) que nos
hemos comunicado con la persona correcta. Necesito hablar con mi
supervisor(a). Alguien le llamará dentro de poco. Gracias.

*End interview, record problem*

YA, YX , YP

A87a. In what city and state is (NAME) now living?

¿En que ciudad o estado vive (NAME) ahora?

CITY\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
STATE\_\_\_\_\_\_\_\_\_\_\_

DON'T KNOW d

REFUSED r

YA,YX, YP

A87a1. CHECK: Is (NAME) living outside the contiguous 48 states (i.e.,
in Alaska, Hawaii, or a U.S. trust territory)?

YES 01 *End Interview*

NO 00 *Continue*

DON'T KNOW d *Continue*

REFUSED r *Continue*

YA, YX, YP

A87b. And just to confirm, which of the following best describes (FILL
"NAME'S" IF RTYPE=01,03; "YOUR" IF RTYPE=02) current living situation?
(FILL "IS NAME" IF RTYPE=01,03; "ARE YOU" IF RTYPE=02) living ...

> Para confirmar, ¿cuáles de las siguientes frases mejor describe la
> situación de vivienda que (FILL "NAME" IF RTYPE=01,03; "UD." IF
> RTYPE=02) tiene, actualmente? ¿Está (FILL "NAME" IF RTYPE=01,03; "UD."
> IF RTYPE=02) viviendo. . .

*Read list, code only one answer*

> With a relative (If 18+, PROBE: Not including
>
> (FILL "HIS/HER"=IF RTYPE=01,03; "YOUR"

IF RTYPE=02") spouse or own children) 01 *Go to A90*

(FILL "HIS/HER"=IF RTYPE=01,03; "YOUR"

> IF RTYPE=02) own home (PROBE: Either
>
> alone or with friends, roommates, or (FILL
>
> "HIS/HER" IF RTYPE=01,03; "YOUR" IF

RTYPE=02) own family) . 02 *IF RTYPE =01 change*

*to RTYPE=03;* *go to* *A89*

> A residential facility (PROBE: Such

as an assisted living facility, center for

independent living, personal care home,

or halfway house). 04 *IF RTYPE =01* *change*

*to RTYPE =03;* *go to*

#########  Part B 

######### 

A Medicaid institution 05*IF RTYPE =01* *change*

*to* *RTYPE=03;*

*C* *ontinue*

At school 06 *IF RTYPE=01; go to A90; if RTYPE=02 or 03 go to A88*

A nursing or convalescent home 08 *IF RTYPE=01 change* *to RTYPE=03; go
to* *Part B*

(NAME) IS IN JAIL/PRISON/JUVENILE

CORRECTION FACILITY 09*IF RTYPE=2 go* *to A88;* *else go to* *to Part N*

Somewhere else (SPECIFY) 12*IF RTYPE=01change*

­­­­­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*to* *RTYPE=03;* *go to* *Part B*

> Con un pariente (FILL If 18+: "No incluyendo a

su esposo(a) o a sus propios hijos") 01 *Go to* *A90*

En su propia casa (ProbePROBE: sea sólo(a) o

con amistades,compa (roommates),

o con su propia familia 02 *IF RTYPE =01* *change* *to RTYPE =03;* *go
to*

*A89*

######### 

En una residencia de grupo bajo supervisión,

(Probe: Tal cómo una de alojamiento asistido

(assisted living facility), un centro de

vida independiente, un hogar de cuidado

personal, o un "halfway house"). 04 *IF RTYPE=01* *change*

*to RTYPE =03;* *go to* *Part* *B*

En una institución de Medicaid 05 *IF RTYPE =01,change*

*to* *RTYPE =03,*

> *Continue*

En la escuela 06*IF RTYPE=01; go to* *A90; if RTYPE=02 or* *03* *go* *to
A88*

En un hogar de convalescentes o "Nursing

home"? 08 *IF RTYPE=01 change to RTYPE=03; go to* *Part B*

(NAME) IS IN JAIL/PRISON/JUVENILE

CORRECTION FACILITY 09*IF RTYPE=2 go* *to* *A88;* *else* *go to Part N*

Algún otro lugar (SPECIFY) 12*IF RTYPE=01* *change*

­­­­­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*to RTYPE=03;*

*go to Part B*

###### 

###### 

###### 

###### 

###### 

######  

DON'T KNOW d *IF RTYPE=01 change to* *RTYPE=03; go to Part B*

REFUSED r *IF RTYPE=01 change* *to* *RTYPE=03; go to Part B*

YA, YX

A87c. Just to confirm, does Medicaid pay for half or more of the cost of
(FILL "NAME'S" IF RTYPE=01,03; "YOUR" IF RTYPE=02) stay at this place?

Para confirmar, paga Medicaid la mitad, o más, del costo de la estadía
de (NAME) en este lugar?

YES 01 *Go* *to A87d*

NO 00 *Go to Part B*

DON'T KNOW d *Go* *to A87d*

REFUSED r *Go* *to* *A87d*

YA, YX

A87d. Thank you for explaining the situation to me. We are not
interviewing individuals in Medicaid institutions. Thank you for your
time. Goodbye.

> Gracias por haberme explicado la situación. No estamos entrevistando a
> personas en instituciones de Medicaid. Le agredezco su tiempo. Adiós.

YA, YX

A88. According to our interviewing procedures, I need to speak with one
of (FILL "NAME'S" IF RTYPE=01,03; "YOUR" IF RTYPE=02) parents or legal
guardians. What are the name, address, and telephone number of (FILL
"NAME'S" IF RTYPE=01,03; "YOUR" IF RTYPE=02) parent or guardian?

Según nuestros procedimientos de entrevista, necesito hablar con uno de
(FILL "los padres o tutores de "NAME" IF RTYPE=01,03; sus padres o
tutores " IF RTYPE=02). ¿Cuáles son el nombre, la dirección y el número
de teléfono de (FILL "los padres o tutores de (NAME)" IF RTYPE=01,03;
"sus padres o tutores" IF RTYPE=02)?

> NAME:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> STREET ADDRESS:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> CITY/STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ZIP
> CODE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> TELEPHONE NUMBER: (\|\_\_\_\|\_\_\_\|\_\_\_\|)
> \|\_\_\_\|\_\_\_\|\_\_\_\| - \|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|
>
> AREA CODE
>
> DON'T KNOW d
>
> REFUSED r

YA, YX

A89. (FILL "ARE YOU" IF RTYPE=02; "IS NAME" IF RTYPE=03) living with
(FILL "YOUR" IF RTYPE=02; "HIS/HER" IF RTYPE=03) own spouse or children,
living with friends or roommates, living alone, or something else?

¿Está viviendo (FILL "UD." IF RTYPE=02; "NAME" IF RTYPE=03) con su
propio(a) esposa(o) o sus propios hijos, está viviendo con amistades o
compañeros (roommates), vive sólo(a), o es otra cosa?

LIVING WITH OWN SPOUSE/CHILDREN 01 *Continue*

LIVING WITH FRIENDS/ROOMMATES 02*Set A90=01;* *Fill SM info in A91; Set
RTYPE=02;* *Go to* *Part B*

LIVING ALONE 03 *Set A90=01; Fill SM info in A91; Set RTYPE=02; Go to*
*Part B*

OTHER (SPECIFY) 04 *Continue*

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

DON'T KNOW d *Continue*

REFUSED r *Continue*

YA, YX (living in own home or with another relative)

> A90. Next, I'd like to ask you some questions about the people who
> live in (FILL "NAME'S" IF RTYPE=03; "YOUR" IF RTYPE=02) household at
> the present time. This includes both children and adults and may
> include individuals who are not related to (FILL "NAME" IF RTYPE=03;
> "YOU" IF RTYPE=02). How many people altogether live in (FILL "NAME'S"
> IF RTYPE=03; "YOUR" IF RTYPE=02) household, including (FILL "NAME" IF
> RTYPE=03; "YOURSELF" IF RTYPE=02)?
>
> Ahora le quiero hacerle unas preguntas acerca de las personas que
> viven en (FILL "su hogar" IF RTYPE=02; "el hogar de (NAME)" IF
> RTYPE=03), actualmente. Esto incluye tanto a niños como adultos, y
> también puede incluir a personas que no tienen una relación de familia
> o parentesco con (FILL "UD." IF RTYPE=02; "NAME" IF RTYPE=03).
> ¿Cuántas personas, en total, viven en (FILL "su hogar" IF RTYPE=02;
> "el hogar de (NAME)" IF RTYPE=03), incluyendo a (FILL "UD." IF
> RTYPE=02; "NAME" IF RTYPE=03)?

PROBE: This includes everyone who usually lives there, even those who
may be temporarily away on business, vacation, in a hospital, or away at
school.

PROBE: Esto incluye a todas las personas que generalmente viven allí,
incluyendo a los que están temporalmente fuera del hogar, viajando por
negocios, vacaciones, internados en el hospital, o estudiando.

\|\_\_\_\|\_\_\_\| HOUSEHOLD MEMBERS *Go to A91* (2-20)

DON'T KNOW d *Go to A90a*

REFUSED r *Go to A90a*

YA, YX

A90a. This is a very important piece of information....

Esto es un dato muy importante.

\|\_\_\_\|\_\_\_\| HOUSEHOLD MEMBERS (2-20)

DON'T KNOW d *Go to A91*

REFUSED r *End Interview*

YA, YX (living in own home or with another relative)

> A91. For each individual, please tell me their first name, gender,
> age, and their relationship to (FILL "YOU" IF RTYPE=02; "NAME" IF
> RTYPE=03). Don't include (FILL "YOURSELF" IF RTYPE= 02; "NAME" IF
> RTYPE=03) because I already know this information. Let's begin with
> the youngest person...

Para cada individuo, por favor dígame nombre, su sexo, edad, y la
relación de familia o parentesco que tienen con (FILL "UD." IF RTYPE=02;
"NAME" IF RTYPE=03). No incluya a (FILL "UD." IF RTYPE=02; "NAME" IF
RTYPE=03), porque ya tenemos esa información. Empecemos con la persona
más jóven . . .

PROBE: I need this information in order to know what questions to ask
you later in the interview. Because households are different, not all
the questions may apply to (FILL "NAME" IF RTYPE=01,03; FILL "YOU" IF
RTYPE=02).

PROBE: Please do not include yourself in the list.

PROBE: Necesito esta información para saber qué preguntas hacerle más
tarde en la entrevista. Porque todos los hogares y familias son
diferentes, quizás hay preguntas que no son aplicables a (FILL "UD." IF
RTYPE=02; "NAME" IF RTYPE=03).

PROBE: Por favor, no se incluya a sí mismo(a) en la lista.

INTERVIEWER: DO NOT INCLUDE (NAME) IN THE LIST.

+---------------+-------------+-----------------+--------------------+
| A. What is    | B. *Confirm | B.  What is     | D. What is         |
| (HIS/HER/     | or ask:* Is |                 | (HIS/HER/YOUR)     |
| YOUR) first   | that person | (HIS/HER/YOOR)  | relationship to    |
| name?         | male or     | age?            | NAME?              |
|               | female?     |                 |                    |
| ¿Cuál es su   |             | ¿Qué edad       | ¿Cuál es su        |
| nombre?       | ¿Es esa     | tiene?          | parentesco con     |
|               | persona     |                 | (NAME)?            |
| *Record       | hombre o    |                 |                    |
| youngest to   | mujer?      |                 | *Use Relationship  |
| oldest*       |             |                 | Code List*         |
+===============+=============+=================+====================+
| 1\.           | Male 01     | \|\_\_\|\_\_\|  | \|\_\_\|\_\_\|     |
|               |             | YEARS OLD       |                    |
| \_\_\_\_\_\_\ | Female 02   |                 |                    |
| _\_\_\_\_\_\_ |             |                 |                    |
|               | DK d        |                 |                    |
|               |             |                 |                    |
|               | RF r        |                 |                    |
+---------------+-------------+-----------------+--------------------+
| 2\.           | Male 01     | \|\_\_\|\_\_\|  | \|\_\_\|\_\_\|     |
|               |             | YEARS OLD       |                    |
| \_\_\_\_\_\_\ | Female 02   |                 |                    |
| _\_\_\_\_\_\_ |             |                 |                    |
|               | DK d        |                 |                    |
|               |             |                 |                    |
|               | RF r        |                 |                    |
+---------------+-------------+-----------------+--------------------+
| 3\.           | Male 01     | \|\_\_\|\_\_\|  | \|\_\_\|\_\_\|     |
|               |             | YEARS OLD       |                    |
| \_\_\_\_\_\_\ | Female 02   |                 |                    |
| _\_\_\_\_\_\_ |             |                 |                    |
|               | DK d        |                 |                    |
|               |             |                 |                    |
|               | RF r        |                 |                    |
+---------------+-------------+-----------------+--------------------+
| 4\.           | Male 01     | \|\_\_\|\_\_\|  | \|\_\_\|\_\_\|     |
|               |             | YEARS OLD       |                    |
| \_\_\_\_\_\_\ | Female 02   |                 |                    |
| _\_\_\_\_\_\_ |             |                 |                    |
|               | DK d        |                 |                    |
|               |             |                 |                    |
|               | RF r        |                 |                    |
+---------------+-------------+-----------------+--------------------+
| 5\.           | Male 01     | \|\_\_\|\_\_\|  | \|\_\_\|\_\_\|     |
|               |             | YEARS OLD       |                    |
| \_\_\_\_\_\_\ | Female 02   |                 |                    |
| _\_\_\_\_\_\_ |             |                 |                    |
|               | DK d        |                 |                    |
|               |             |                 |                    |
|               | RF r        |                 |                    |
+---------------+-------------+-----------------+--------------------+
| 6\.           | Male 01     | \|\_\_\|\_\_\|  | \|\_\_\|\_\_\|     |
|               |             | YEARS OLD       |                    |
| \_\_\_\_\_\_\ | Female 02   |                 |                    |
| _\_\_\_\_\_\_ |             |                 |                    |
|               | DK d        |                 |                    |
|               |             |                 |                    |
|               | RF r        |                 |                    |
+---------------+-------------+-----------------+--------------------+
| 7\.           | Male 01     | \|\_\_\|\_\_\|  | \|\_\_\|\_\_\|     |
|               |             | YEARS OLD       |                    |
| \_\_\_\_\_\_\ | Female 02   |                 |                    |
| _\_\_\_\_\_\_ |             |                 |                    |
|               | DK d        |                 |                    |
|               |             |                 |                    |
|               | RF r        |                 |                    |
+---------------+-------------+-----------------+--------------------+

**PROGRAMMER NOTE: Create space for 14 household members.**

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

### Relationship Codes

2.  MOTHER (BIOLOGICAL OR ADOPTIVE)

3.  FATHER (BIOLOGICAL OR ADOPTIVE)

4.  STEP-PARENT OF (NAME)

5.  FOSTER PARENT OF (NAME)

6.  UNMARRIED PARTNER OF PARENT

7.  GRANDPARENT

8.  BROTHER/SISTER OF (NAME)

9.  AUNT/UNCLE OF (NAME)

10. (NAME'S) SPOUSE

11. (NAME'S) CHILD

12. FOSTER CHILD LIVING WITH FAMILY

13. HOUSEMATE/ROOMMATE/FRIEND

14. ROOMER/BOARDER

15. OTHER RELATIVE OF (NAME) (SPECIFY IN QUESTION)

16. OTHER NOT RELATED (SPECIFY IN QUESTION)

INTERVIEWER INSTRUCTION: IF RESPONDENT ANSWERS "MOTHER" OR "FATHER"
FOLLOW-UP WITH: "(ARE YOU/IS THIS PERSON) THE BIOLOGICAL, STEP,
ADOPTIVE, OR FOSTER (MOTHER/FATHER) OF (NAME)?"

CHECK: IS THE NUMBER OF HOUSEHOLD MEMBERS REPORTED IN A91 EQUAL TO THE
NUMBER LISTED IN A90 MINUS ONE. IF NOT, REVIEW WITH RESPONDENT.

YA, YX (living in own home or with another relative)

A92. I would like to take a minute and make sure I recorded the
information about the people in your household correctly.

Quisiera tomar un momento para asegurar que ha registrado exactamente la
information sobre las personas en su hogar.

INTERVIEWER: CONFIRM INFORMATION IN HOUSEHOLD GRID.

A92b. CHECK: Does RTYPE=03?

YES 01 *Go to Part B*

NO 00 *Continue*

YA (living in own home or with another relative)

A93. CHECK: Is (NAME) living with his/her parent(s), that is, is A91D_1
-- A91D_14 = 02, 03, 04?

YES 01 *Continue*

NO 00 *Go to Part B*

YA (living with parents)

A94. CHECK: Is (NAME) living with his/her own spouse or children in this
household, that is, is A91D_1 -- A91D_14 =10, 11?

YES 01 *Change RTYPE to 2,* *Go to Part B*

NO 00 *Change RTYPE to 1,* *Continue*

IN (living with parents and without own spouse or children)

A95. According to our study procedures, I need to continue the interview
with your parent or guardian. Is she or he available now?

Según nuestros procedimientos de entrevista, necesito hablar con uno de
sus padres o guardianes legales. ¿Está ella o él disponible ahora?

YES 01 *Go to A97*

NO 00 *Continue*

DON'T KNOW d *Continue*

REFUSED r *Continue*

IN (living with parents and without own spouse or children)

A96. When would be a good time to call back to reach (HIM/HER)?

¿Cuándo sería conveniente volver a llamar para comunicarnos con
(él/ella)?

PROBE: When is (HE/SHE) usually at home?

PROBE: Generalmente, ¿ cuándo está (él/ella) en casa?

*Go to callback screen. End interview.*

YP (living with parents and without own spouse or children)

> A97. (WHEN PARENT/GUARDIAN COMES TO THE PHONE) Hello, my name is
> \_\_\_\_\_\_\_\_\_\_\_\_ and I'm calling from Mathematica Policy
> Research on behalf of the Social Security Administration. We're
> conducting a study of young people who are receiving Supplemental
> Security Income, or SSI, or whose families once applied for or
> received SSI on their behalf. We're calling to follow up about
> (NAME'S) health and your family's well-being. Is now a good time to
> conduct the interview?
>
> Hola, mi nombre es \_\_\_\_\_\_\_\_\_\_\_\_ , y estoy llamando de
> Mathematica Policy Research de parte de Social Security
> Administration. Estamos conduciendo un estudio acerca de personas
> jóvenes que están recibiendo Seguridad de Ingreso Suplementario, o
> SSI; o cuyas familias solicitaron o recibieron SSI en nombre de ellos.
> Estamos llamando como seguimiento a la salud de (NAME), y del
> bienestar de su familia. ¿Le conviene que conduzca la entrevista
> ahora?

YES 01 *Go to A98*

NO 00 *Continue*

DON'T KNOW d *Go to A98*

REFUSED r *End Interview*

YP (living with parents and without own spouse or children)

A97a. When would be a good time to call back?

¿Cuándo sería conveniente volver a llamar?

PROBE: When are you usually at home?

PROBE: En general, ¿ cuándo está en casa?

*Go to callback screen. End interview.*

YP (living with parents and without own spouse or children)

A98. Let me begin with some information about this study. The questions
I'll be asking are about (NAME'S) health and how (HE/SHE) gets along
day-to-day. Your participation in this study is voluntary and will not
affect any SSI benefits that (NAME) receives now or may apply for in the
future. The answers you provide are strictly confidential and will be
used for research purposes only. In appreciation of your time, we'll
send you a (FILL " A CHECK FOR \$10.00" IF INCENTIVE TYPE=1; FILL " A
\$10.00 DEBIT CARD" IF INCENTIVE TYPE=2; FILL "A \$10.00 PHONE CARD" IF
INCENTIVE TYPE=3) once we finish the interview. I would like to begin
the interview now.

Permítame empezar con un poco de información acerca de este estudio. Las
preguntas que le estaré haciendo son acerca de la salud de (NAME), y
cómo se las arregla día a día. Su participación en este estudio es
voluntaria, y no afectará a ningún beneficio de SSI que (NAME) recibe
ahora, o por la cual aplique en el futuro. Las respuestas que me dará
son estrictamente confidenciales, y sólo serán usadas para los
propósitos de estudio. Para agradecerle el tiempo que nos brindará, le
enviaremos (FILL "UNA TARJETA DE DÉBITO DE \$10.00"; IF INCENTIVE
TYPE=2; FILL "UNA TARJETA TELEFÓNICA DE \$10.00 IF INCENTIVE TYPE=3),
después de terminar la entrevista.

READ IF NECESSARY: We estimate this interview will take about 50 minutes
to complete.

> READ IF NECESSARY: Calculamos que tomará unos 50 minutos para
> completar esta entrevista.

PROGRAMMER: CHANGE RTYPE TO 01 THEN GO TO PART B

**ONE LAST CHECK**

> INTERVIEWER: WE HAVE THE RESPONDENT AS....
>
> DISPLAY RTYPE (Fill "PARENT/GUARDIAN" IF RTYPE=01; FILL" YOUNG ADULT-
> HIMSELF/HERSELF" IF RTYPE=02; FILL" PROXY"IF RTYPE=03")
>
> Is that correct?

THIS IS CORRECT 01 *Continue*

THIS IS WRONG 00 *Go back and review*

*answers*