Contract No.: 0600-00-60021

MPR Reference No.: 8761-980

![](media/image1.png){width="1.9902777777777778in" height="0.625in"}

> Estimating the Size and Characteristics of the SSI Child Population: A
> Comparison Between the NSCF and Three National Surveys
>
> ***Final Report***
>
> ***April 2004***
>
> ***Henry Ireys***
>
> ***Daniel Kasprzyk***
>
> ***Ama Takyi***
>
> ***Jennifer Gillcrist***

+-----------------------------------+----------------------------------+
| Submitted to:                     | Submitted by:                    |
|                                   |                                  |
| Office of Disability and Income   | Mathematica Policy Research,     |
|                                   | Inc.                             |
| Security Programs                 |                                  |
|                                   | 600 Maryland Ave., SW, Suite 550 |
| Social Security Administration    |                                  |
|                                   | Washington, DC 20024-2512        |
| 3532 Annex Building               |                                  |
|                                   | Telephone: (202) 484-9220        |
| 6401 Security Boulevard           |                                  |
|                                   | Facsimile: (202) 863-1763        |
| Baltimore, MD 21235-6401          |                                  |
|                                   | Project Director: Susan Mitchell |
| Project Officer: Michele Adler    |                                  |
+-----------------------------------+----------------------------------+

# Acknowledgements

This report benefited from the contributions of numerous SSA staff and
MPR colleagues. At SSA, Kalman Rupp and Paul Davies provided guidance
and support during the conceptualization of the report, and Michele
Adler managed report review. At MPR, Craig Thornton and Susan Mitchell
provided helpful comments on early drafts of the report. Frank Potter
and Esther Friedman worked together to plan and conduct the analyses.
John Czajka, Scott Cody, Bruce Schechter, Miki Satake, and Rebecca Nyman
all provided help in understanding the data sets of the three comparison
surveys. Sharon Clark formatted the manuscript with her usual competence
and good cheer. We thank all of them for their assistance.

#   {#section .unnumbered}

# CONTENTS

# Chapter Page

Executive Summary ix

I. Introduction 1

II\. Methodological Issues 5

A.  differences in purpose and methods affecting

Comparability of Data Across Surveys 5

B. Identifying Children Receiving SSI 9

C. Selecting Items for Comparison 11

D.  Determining Statistical Significance of

Differences Between Estimates from

Different Surveys 12

E. RATES OF MISSING DATA 14

III. Estimates of the Size and Demographic

> Characteristics of Children Receiving SSI 17

A.  Comparison of Demographic Data from the

NSCF and SSA Administrative Records 17

B. Total Population Size 19

B.  Demographic Characteristics of Child

SSI Recipients 20

IV. Disability and Impairment Status of SSI Child

> Recipients 25

A. comparisons of Responses to the FACCT Screener 25

B. Functional Status 28

# CONTENTS (*continued*)

# Chapter Page

V. ASSETS, INCOME, AND BENEFITS 31

A. Income Estimates 31

B. Monthly SSI Payments 33

B.  Comparison of NSCF Estimates of SSI Payments

with SSA Administrative Data 33

D. ENROLLMENT IN BENEFIT PROGRAMS 35

E.  Effect of child's health Condition on Parental

Employment 36

VI\. Health Care Insurance, Service Use, and Unmet Needs 39

A.  Enrollment in Medicaid, SCHIP, and Military

Health Plans 40

B. Physician Visits and Hospitalizations 41

C. Unmet Needs 42

VII\. Summary 43

A. OVERVIEW 43

B.  Summary of Findings from Cross-Survey

Comparisons 45

C.  summary of comparisons with ssa

administrative data 46

D. IMPLICATIONS FOR THE FUTURE 46

REFERENCES 51

APPENDIX: Items from Four Surveys

# TABLES

# Table Page

II.1 PURPOSE OF FOUR NATIONAL SURVEYS WITH

SAMPLES OF CHILD SSI RECIPIENTS 6

III.1 COMPARISON OF NSCF ESTIMATES WITH SSA

ADMINISTRATIVE DATA FROM DECEMBER 2000 18

III.2 WEIGHTED TOTALS, STANDARD ERRORS, RELATIVE

STANDARD ERRORS AND 95 PERCENT CONFIDENCE

INTERVALS FOR THE NSCF AND THREE COMPARISON

SURVEYS 20

III.3 COMPARISONS OF ESTIMATES OF DEMOGRAPHIC

CHARACTERISTICS OF CHILD SSI RECIPIENTS IN FOUR

NATIONAL SURVEYS 21

IV.1 ITEM SETS IN THE FACCT SCREENER 23

IV.2 COMPARISON OF NSCF AND CSHCN SURVEY

ESTIMATES OF THE PERCENT OF CHILD SSI

RECIPIENTS IDENTIFIED AS HAVING A SPECIAL

HEALTH CARE NEED BY ITEMS ON THE FACCT

SCREENER 28

IV.3 COMPARISON OF NSCF AND CSHCN SURVEY ESTIMATES

OF FUNCTIONAL IMPAIRMENT OF CHILD SSI RECIPEINTS 29

IV.4 COMPARISON OF NSCF AND NHIS ESTIMATES OF

THE EXTENT TO WHICH SSI CHILD RECIPIENTS NEED

EXTRA ASSISTANCE IN ACTIVITIES OF DAILY LIVING 30

V.1 COMPARISONS OF NSCF AND SIPP ESTIMATES OF

MONTHLY HOUSEHOLD INCOME OF FAMILIES OF

SSI CHILDREN 32

V.2 COMPARISONS OF NSCF AND SIPP ESTIMATES

OF MONTHLY SSI BENEFITS FOR CHILDREN 34

V.3 COMPARISON OF NSCF ESTIMATES OF SSI MONTHLY

PAYMENTS WITH SSA ADMINISTRATIVE DATA 35

# TABLES (*continued*)

# Table Page

V.4 COMPARISON OF NSCF, SIPP, AND NHIS ESTIMATES

OF PROGRAM PARTICIPATION 36

V.5 COMPARISON OF ESTIMATES OF THE IMPACT OF

THE CHILD'S CONDITION ON PARENTAL EMPLOYMENT 37

VI.1 ESTIMATES FROM FOUR NATIONAL SURVEYS OF

ENROLLMENT BY CHILD SSI RECIPIENTS IN SELECTED

HEALTH INSURANCE PROGRAMS 40

VI.2 COMPARISON OF NSCF, CSHCN, AND NHIS ESTIMATES

OF PHYSICIAN VISITS AND HOSPITALIZATIONS 41

VI.3 UNMET SERVICE NEEDS OF CHILD SSI RECIPIENTS

IN SELECTED SURVEYS 42

# Executive Summary

To monitor and evaluate programs for children receiving Supplemental
Security Income (SSI), policymakers need reliable information on the
children's health and health care. The Social Security Administration
(SSA) is responsible for providing information on child SSI recipients,
including information on their characteristics, experiences, and needs.
In addition to publishing routine reports on SSI recipients using SSI
administrative data, SSA occasionally develops a special survey of
children receiving SSI to permit more comprehensive and detailed
analyses of critical policy issues. The National Survey of SSI Children
and Families (NSCF), fielded between August 2001 and July 2002, is the
most recent SSA-sponsored survey to focus specifically on child SSI
recipients.

SSA researchers and researchers in other agencies and institutions have
substantial interest in using data from the NSCF to address policy
questions related to children who are receiving SSI payments. The
introduction of a new data set, however, usually raises questions about
the quality of its data relative to more well-known, established
sources. Therefore, SSA is providing researchers with information on the
characteristics and quality of the NSCF data set.

One method for assessing the quality of NSCF data is to compare
estimates based on these data with estimates based on data from other
sources. These comparisons provide insights into how estimates from the
NSCF align with estimates from other data sources and can assist in the
interpretation of results from analyses using NSCF data. Three recent
surveys include samples of SSI children and are good candidates for a
comparative analysis: the National Survey of Children with Special
Health Care Needs (CSHCN), the Survey of Income and Program
Participation (SIPP), and the National Health Interview Survey (NHIS).
The NSCF incorporated a number of questions that were included in one or
more of these surveys, and, consequently, it is possible to compare
results from the NSCF with results from these surveys. The Office of
Research, Evaluation, and Statistics in SSA asked Mathematica Policy
Research (MPR) to undertake these comparative analyses.[^1] In this
report, we present the results of our analyses.

Overall, results indicate that the NSCF provides comprehensive and
accurate data for examining policy issues affecting children receiving
SSI payments. The NSCF data are particularly useful because of the
following characteristics associated with the data set:

-   ***Coverage of the Target Population*.** The NSCF was designed
    specifically to sample the population of children and young adults
    who applied for and were receiving SSI payments. The sampling frame
    for the survey was the SSA administrative records list of SSI
    applicants and recipients. In many cases, it is difficult
    identifying SSI recipients through a survey questionnaire, largely
    because of measurement error and response error; however, using SSA
    administrative records ensures representation of all individuals
    having a tangible connection to the SSI program. As a consequence,
    the population for which data are required can be identified and
    represented in the sample. Other surveys had broader goals and did
    not focus specifically on the SSI population, resulting in less
    complete coverage of the SSI population.

-   ***Large Sample Size*.** The NSCF was designed to yield precise
    estimates of the characteristics of the national population of
    children receiving SSI payments. Interviews were completed with the
    parents or guardians of 3,203 children. This sample is slightly
    larger than the sample of child SSI recipients in the CSHCN survey
    (3,042) and substantially larger than the samples in the SIPP (293)
    and the NHIS (274). The NSCF's large sample size allows for better
    precision (smaller variance) in estimating population
    characteristics compared with the SIPP and NHIS and a capacity to
    conduct subgroup analyses.

-   ***High Response Rate*.** The NSCF weighted response rate for the
    group of children receiving SSI payments was about 85 percent.
    Although it is not possible to calculate response rates for the
    group of children receiving SSI payments in the other surveys, the
    NSCF response rate meets acceptable standards for national surveys.

```{=html}
<!-- -->
```
-   ***Breadth of Information*.** The NSCF includes questions on a broad
    array of topics, including extensive demographic characteristics,
    functional status, family income and assets, SSI payments,
    participation in government programs, insurance coverage, service
    use, education, and unmet needs. This breadth of data allows
    researchers to address a wide range of policy questions and to
    examine relationships among many critical variables. Compared with
    the NSCF, no other survey covers as broad a range of topics that
    pertain to child SSI recipients. For example, the NSCF provides more
    information on assets and income compared with the CSHCN survey and
    includes questions on functional status and the effect of the
    child's condition on parental employment, which the SIPP and the
    NHIS do not.

Our analyses indicate that NSCF data yield accurate but somewhat
different estimates of the characteristics of the child SSI population
when compared with estimates from other survey data. For example,
policymakers may wish to know whether all or most child SSI recipients
are covered by Medicaid. The NSCF data indicate that over 90 percent of
these children have Medicaid coverage. In contrast, estimates of
Medicaid coverage for these children are lower based on CSHCN, SIPP, and
NHIS data (which provide estimates of 74, 81, and 61 percent,
respectively). Further analysis suggested that specific factors (for
example, differences in sample design and size) contributed to these
differences.

Examples of other differences between the NSCF and the other surveys
include the following:

-   The NSCF data yield significantly higher estimates of the percentage
    of child SSI recipients who are black and who live in single parent
    households.

-   NSCF data indicate that about 10 percent of child SSI recipients are
    not identified in the CSHCN through the use of a set of screening
    items designed to identify children who have a special health care
    need, resulting in reduced coverage of the child SSI recipient
    population in the CSHCN.

-   Compared with SIPP data, the NSCF data suggest that (1) SSI payments
    are higher, (2) a greater percentage of families of child SSI
    recipients receive welfare, food stamps, and other SSA benefits,
    and (3) a greater percentage of child SSI recipients are enrolled in
    State Children's Health Insurance Programs (SCHIP).

```{=html}
<!-- -->
```
-   In general, compared with the SIPP or NHIS data, the NSCF data
    suggest that families of child SSI recipients are somewhat more
    dependent on government benefits.

#  {#section-1 .unnumbered}

# I. Introduction

The National Survey of SSI Children and Families (NSCF) collected data
on children with special health care needs and their families who
received or applied for Supplemental Security Income (SSI). The Social
Security Administration (SSA) awarded Mathematica Policy Research (MPR)
a contract to conduct this survey to (1) provide information on the
characteristics, experiences, and needs of SSI child applicants,
recipients, and their families, and (2) evaluate the effects of welfare
reform on children who received or applied for SSI. As the first
national survey of SSI children since 1978, the NSCF provides
information of substantial interest to SSA and policy analysts in other
agencies and research institutions.

Other sources of information on child SSI recipients are available, but
the NSCF was designed to provide more detailed and a substantially
greater breadth of information about this population. As a result, the
NSCF data offer valuable opportunities to study policy issues affecting
children receiving SSI payments. To provide researchers with insights
into NSCF survey data, we compare NSCF estimates with estimates from
other national surveys as well as SSA administrative data.

Three recent national surveys on health care, health insurance, and
employment include SSI children in their samples, although none of the
surveys were designed to focus specifically on this population. The
National Survey of Children with Special Health Care Needs (CSHCN), the
Survey of Income and Program Participation (SIPP), and the National
Health Interview Survey (NHIS) all contain items that allow researchers
to identify children receiving SSI payments. The NSCF and these surveys
also share similar questions on demographic characteristics, health
status, parental assets and income, and health insurance coverage.

Although conducted for different purposes and with different sampling
strategies, all four surveys provide national estimates of children
receiving SSI benefits; and because of the overlap in questionnaire
content, we can compare survey estimates across the four surveys.[^2]
Where possible, we also compare estimates obtained from the NSCF with
SSA program data as found in its December 2000 report on children
receiving SSI.[^3] Specifically, the goals of this report are to:

1.  Compare survey estimates based on NSCF data with estimates based on
    data from three other national surveys and SSA administrative data;
    and

2.  Identify the possible reasons for observed differences in survey
    estimates.

In this report, we present findings from our comparative analyses of
survey estimates. Chapter II compares the goals of the four surveys and
discusses several key methodological issues, including the specific
steps taken to develop the analysis groups for this study, data
comparability issues across the surveys, the content areas in which
survey estimates were compared, and the analytic methods used to compare
and assess differences between the NSCF estimates and estimates from the
other surveys.

Chapter III describes our findings on the estimates of the population
size and demographic characteristics of children receiving SSI payments,
based on data from the NSCF and the three other surveys. Chapters IV-VI
present comparisons in the following content areas:

-   Disability and impairment status (Chapter IV)

-   Assets, income, and benefits (Chapter V)

```{=html}
<!-- -->
```
-   Health insurance, service use, and unmet needs (Chapter VI)

In each chapter, we highlight key findings, identify statistical
differences between survey estimates, and discuss potential reasons for
these differences. Finally, Chapter VII summarizes our findings and
discusses their implications for interpreting national survey data on
children receiving SSI payments.

The Appendix includes the list of items from each survey used for the
comparative analyses. Further information on the NSCF database may be
found in Gillcrist et al. (2003).

#   {#section-2 .unnumbered}

# II. Methodological Issues

The primary goal of the NSCF was to gather accurate and comprehensive
information on children who applied for and received SSI payments. The
sampling frame and interviewing procedures, therefore, were designed
specifically to serve this purpose. NSCF data may yield somewhat
different results compared with the other national surveys because of
differing goals and sampling strategy. Design differences among the
surveys have implications for the nature and extent of possible
comparisons and for interpreting the results of our analyses.

In this chapter, we address key differences across the surveys and
suggest how these differences may affect our analyses. We then address
the following topics:

-   The items used to identify child SSI recipients in each survey

-   Procedures used to select specific items for comparison

-   The approach used to determine whether differences are statistically
    significant

```{=html}
<!-- -->
```
-   Rates of missing data

## A. differences in purpose and methods affecting Comparability of Data Across Surveys

Three critical differences are especially germane to comparisons between
the NSCF and the other three surveys. First, the surveys vary in their
purpose (Table II.1). Although national estimates of the size and
characteristics of the population of children receiving SSI payments can
be developed from the four surveys, national estimates from the NSCF
probably will be more accurate because the sample was designed to meet
the specific precision requirements for estimates of the SSI population
as specified by SSA. Specifically, the NSCF was developed to provide
information on the characteristics, experiences, and needs of SSI child
recipients and their families and to evaluate the effects of welfare
reform on SSI children. In contrast, the other surveys had broader
goals, more expansive definitions of the target population, and used
different sampling strategies.

TABLE II.1

PURPOSE OF FOUR NATIONAL SURVEYS WITH SAMPLES OF CHILD SSI RECIPIENTS

  -------- --------------------------------------------------------------
  Survey   Purpose

  NSCF     To provide information on the characteristics, experiences,
           and needs of a cross-section of SSI child recipients and their
           families and to evaluate the effects of welfare reform on SSI
           children

  CSHCN    To gather information on health status, access to care,
           insurance status, care coordination, and availability of a
           medical home for a sample of children with special health care
           needs (CSHCN) in each state, as identified through a special
           CSHCN screener

  SIPP     To provide accurate estimates of earned and unearned income,
           assets, government transfer programs, and health insurance of
           a nationally representative sample of the
           non-institutionalized U.S. civilian population

  NHIS     To gather information on health and health care from a
           nationally representative sample of the noninstitutionalized
           U.S. civilian population
  -------- --------------------------------------------------------------

Second, the surveys differ in sampling procedures. The NSCF sample was
drawn from a list of child SSI recipients and applicants provided by
SSA.[^4] The CSHCN sample was based on results from screening of
households contacted using random-digit-dialing (RDD) methods. SIPP and
NHIS use addresses sampled in selected geographic areas and enumerate
individuals at the sampled addresses. In general, the latter designs can
result in underestimates of the populations of interest because
individuals in the household must identify themselves or other
individuals in the household as program participants. The sampling
weights for these household surveys are post-stratified to population
counts for the general population and not specifically to the population
of SSI recipients and applicants.

Furthermore, the CSHCN survey gathered information on children with
special health care needs who were identified as SSI recipients through
a special set of screening questions. As we describe in Chapter IV, the
screening questions appear to have missed certain children receiving SSI
payments, and as a result, national estimates of the population size of
child SSI recipients will be biased downward. In addition, because the
CSHCN survey is an RDD telephone survey, it could be administered to
only persons with telephone access; persons in households without a
telephone (or who use a cell phone for all calls) could not be reached
and would be excluded from the survey.

For information on specific sampling strategies of each survey, see
Potter and Diaz-Tena (2003) for the NSCF; Blumberg, Olson, Frankel, et
al. (2003) for the CSHCN; U.S. Census Bureau (2001) for the SIPP; and
the National Center for Health Statistics (2000) for the NHIS.

The third important difference among surveys is the size of the sample
of child SSI recipients available for analysis. NSCF interviews were
completed with the parents or guardians of 3,203 child SSI recipients.
This sample is slightly larger than the sample of child SSI recipients
in the CSHCN survey (3,042) and substantially larger than the samples in
the SIPP (293) and the NHIS (274). The NSCF's sample size allows greater
precision in estimating characteristics of the child SSI recipient
population and facilitates analyses of subgroups of child SSI
recipients. As expected, our analyses show that standard errors of the
NSCF estimates are consistently smaller when compared with the standard
errors of the estimates based on SIPP and NHIS data.

These factors are important because they suggest that *a priori* the
NSCF data will be of higher quality and utility when compared with data
from the other surveys. The fact that the NSCF was designed specifically
to gather information from the child SSI recipient population, using
sufficiently large sample for highly precise estimates lends immediate
credibility to the NSCF data.

Several other factors are important to consider in the interpretation of
cross-survey comparisons. Estimates may differ across surveys because of
the following factors:

-   ***Differences in response rates***. The NSCF response rate for
    children receiving SSI payments was about 85 percent. Response rates
    for this specific group of children are not available for the other
    surveys. However, the CSHCN survey reported a national special-needs
    interview response rate of 61.0 percent and a completion rate (i.e.,
    the proportion of age-eligible households in which special-needs
    screening was completed) of 76.2 percent. For more information on
    response rates for each survey, see Potter and Diaz-Tena (2003) for
    the NSCF; Blumberg, Olson, Frankel, et al. (2003) for the CSHCN;
    U.S. Census Bureau (2001) for the SIPP; and the National Center for
    Health Statistics (2000) for the NHIS.

-   ***Differences in data collection time periods.*** The NSCF was
    fielded during a period of time (July 2001 to August 2002) that
    overlapped with but was not identical to the other surveys. The
    CSHCN survey was fielded earlier (October 2000 to April 2002). The
    NHIS and SIPP are ongoing surveys; and, for our purposes, we used
    calendar year 2001 data from both of these surveys.

-   ***Item differences***. The NSCF developed questionnaire items
    specifically to provide SSA with information on the characteristics,
    experiences, and needs of SSI child recipients. Although the NSCF
    used items from other surveys in their original form when practical,
    some modifications were made. Items can vary across surveys with
    respect to wording, reference period (e.g., currently, last month,
    over the last year), response categories, and placement in the
    questionnaire. The net effect of these differences across surveys is
    not known and may vary from item to item. In particular, questions
    on income vary across surveys on time period for which data are
    reported.

-   ***Differences in survey administration methods***. All four surveys
    used computer-assisted interviewing procedures, but the NSCF
    combined telephone interviews of parents or guardians with in-person
    interviewing of telephone nonrespondents. In contrast, the CSHCN
    survey used only telephone interviewing of parents or guardians; the
    SIPP used a combination of telephone and in-person interviewing of
    any household member 15 years or older; and the NHIS used only
    in-person interviewing of an adult in the selected household.

-   ***Respondent differences***. The NSCF, CSHCN survey, and NHIS
    require a designated respondent for all persons less than 18 years
    old; the SIPP attempts to interview everyone in a household who is
    15 years old or older and, as a result, there are multiple types of
    respondents for children. About 75 percent of the respondents to the
    NSCF, CSHCN survey, and NHIS were mothers of the SSI children. The
    father was the respondent 5.5 percent of the time on NSCF, 11.8
    percent of the time on the CSHCN survey, and 9.8 percent of the time
    on the NHIS. Grandparents and other guardians were other
    respondents. Different respondents may have more or less knowledge
    about the SSI child recipient.

```{=html}
<!-- -->
```
-   ***Imputation differences***. Each survey team approached the use of
    imputation methods somewhat differently; for example, the NSCF team
    used four methods of imputation (deductive, unweighted hot-deck,
    weighted hot-deck, and regression-based) to compensate for missing
    data in the process of constructing income-related variables. The
    other teams may have used somewhat different methods (or different
    combinations of these methods) not only for constructed
    income-related variables, but for other variables as well. These
    different imputation methods may contribute to cross-survey
    variation in survey estimates.

## B. Identifying Children Receiving SSI

Our comparative analyses depend on the accurate identification of all
child SSI recipients in each survey sample. Therefore, we first defined
children as individuals who were younger than 18 years old at the time
the survey was conducted. We then used the following items to identify
child SSI recipients:

-   ***NSCF***: Did you receive an SSI benefit for (CHILD) in (LAST
    MONTH)?

-   ***CSHCN***: Does (CHILD) receive SSI, that is Supplemental Security
    Income?

-   ***SIPP***: In \[REFERENCE MONTH\], did you receive any Supplemental
    Security Income (SSI) on behalf of (CHILD)?

```{=html}
<!-- -->
```
-   ***NHIS***: \[In the last year\] did (CHILD) receive Supplemental
    Security Income (SSI)?

Although these items ask for essentially the same information, they vary
in their use of a reference period. In the first three surveys, the
reference period is a single month (last month, current month, or some
specific recent month). In each of these surveys, the information
collected yields point-in-time estimates for the population of child SSI
recipients.

The NHIS item is somewhat different because it refers to receiving SSI
at any time during the past year. On the one hand, this item could lead
to a higher count than an item based on the current or past month
because more children are on SSI in a year than in a single month. On
the other hand, it is possible that some respondents could interpret
this item as asking whether the child was receiving SSI for the full
year, rather than at any time in the past year. If some respondents
interpreted the question in this way, then the NHIS may undercount the
SSI child population. Overall, differences in questions that tap SSI
program participation contribute to differences in the population
estimates derived from each survey.

For the SIPP, sample cases are interviewed more than one time;
consequently, we can calculate the number of children in the sample who
were SSI recipients at the first interview (the point-in-time estimate)
and then add to that estimate the number of children in the sample who
became SSI recipients during the course of the subsequent 12 months (a
yearly "ever-enrolled" estimate). For the analyses reported in this
study, we use data from the first interview of the 2001 SIPP sample (the
point-in-time estimate) because the time period covered by the first
interview of SIPP corresponds most closely to the point in time when the
NSCF sample was drawn. [^5]

## C. Selecting Items for Comparison 

For the purposes of this study, we selected only questionnaire items
that were the same or essentially similar in wording across the surveys.
For example, to develop comparative estimates of how many families of
child SSI recipients participated in the Food Stamp program, we used
items from the NSCF and SIPP that varied slightly in wording, but were
not fundamentally different. These items were:

-   ***NSCF***: Did anybody in your household receive any Food Stamps?

```{=html}
<!-- -->
```
-   ***SIPP***: Were you authorized to receive Food Stamps?

If the items addressed the same concept, but differed substantially in
their wording, we excluded them from our analyses. For example, the NSCF
and the CSHCN surveys both include items that assess the impact of the
child's condition on parental employment. One NSCF item asks whether
"anyone in the household ever changed work hours to a different time of
day" for reasons related to the child's condition; the most similar item
on the CSHCN survey asks the respondent whether "you or other family
members cut down on the hours you work" to care for the child. We judged
these items to be too different to compare, even though they both
address the effect of the child's condition on parental employment.

Some surveys we used for comparisons did not include items related to
topics of interest. For example, the SIPP does not include items on
disability and impairment status. Therefore, tables in the following
chapters occasionally present results from only two or three surveys,
rather than all four.

## D. Determining Statistical Significance of Differences Between Estimates from Different Surveys

After identifying child SSI recipients in the samples of the individual
surveys and selecting items for comparison purposes, we:

-   Developed weighted national estimates using procedures recommended
    in the documentation for each survey

-   Estimated standard errors using procedures recommended in the
    documentation for each survey

```{=html}
<!-- -->
```
-   Developed tables showing weighted population totals and percentages
    for selected items for each survey.

We then determined whether estimates derived from the NSCF were
statistically different from estimates derived from the other three
surveys. We did this by first generating overall weighted counts of SSI
recipients in the total population and in selected groups defined by the
variables of interest (for example, males and females, age groups, and
income levels). Because of the complex nature of the sample designs,
SAS-callable SUDAAN was used to generate frequencies and the
corresponding standard errors (RTI 2001). For the NSCF, CSHCN, and NHIS,
person-level weights, analysis strata, and primary sampling unit
information were used to generate estimates and standard errors using
the Taylor series linearization variance estimation procedure. For SIPP,
person-level weights and replicate weights were used to generate
estimates and standard errors using the balanced repeated replication
variance estimation procedure. (See Wolter 1985 for descriptions of
these variance estimation methods.)

Standard errors were calculated for the estimated population totals and
for each of the selected groups. We also calculated relative standard
errors (RSE, defined as the standard error divided by the estimate and
expressed as a percent) and eliminated from further comparisons all
estimates with an RSE of 30 percent or more because these estimates
would not have sufficient reliability. To determine whether NSCF
estimates of percentages of individuals in each of the selected groups
were different from the estimates based on the other surveys, we
computed chi-square statistics. The chi-square statistics were the
square of the z-score, and the z-score is the difference in the
percentages divided by the square root of the sum of the variances of
the two percentages. We then compared the value of these statistics with
the criterion value of the chi-square distribution for alpha = .05 with
one degree of freedom. If the calculated statistic exceeded the
criterion value, we considered the difference between the percentages to
be statistically significant (that is, the probability is less than .05
that the observed differences are due to chance.)[^6]

For the purposes of determining the number of statistical comparisons,
we counted only one of the comparisons when the variable had two levels
(e.g., yes/no, male/female). For example, we counted the comparison of
the percentage of males in the NSCF and SIPP, but did not count the
comparison of females because if one comparison is significant, the
other will be as well. Similarly, if the variable had three levels, we
counted two comparisons, etc. We also did not count a comparison if any
of the relative standard errors of the percentage estimates exceeded 30
percent because in these cases we considered the survey estimate and
comparisons to be unreliable.[^7]

Overall, we made 100 two-way statistical comparisons between NSCF
estimates and estimates from the three other surveys. By chance, we
expect that five percent of these comparisons would be significant. In
fact, we found that 45 of the comparisons were statistically
significant, suggesting that certain factors are systematically
affecting the estimates from the different surveys.

## E. RATES OF MISSING DATA

Missing data can result from several factors, including "don't know"
answers, refusals, interviewer error, and programming mistakes. Data not
available for analysis also can result from questions skipped
deliberately as part of the interview (that is, certain questions about
school are not asked for children who are home schooled). These data are
referred to as "legitimate missing" data.

Rates of missing data (excluding the legitimate missing) were under
one-half of one percent for all items used from all surveys, with two
exceptions. First, items that asked for recall of numbers of school days
missed or visits to the doctor had more "don't know" responses than
other items. For example, on the NSCF, 2.9 percent of respondents
indicated they did not know how many days of school the child missed in
the past 12 months. On the CSHCN survey, 2.7 percent of the respondents
responded "don't know." Second, some respondents appeared to have
difficulty answering questions about enrollment in health insurance
plans. For example, on the NSCF, 4.6 percent of the respondents said
that they did not know if the child was enrolled in SCHIP.

#   {#section-3 .unnumbered}

# III. Estimates of the Size and Demographic Characteristics of Children Receiving SSI

Our analyses indicate that NSCF data yield estimates of the size and
demographic characteristics of the population of child SSI recipients
that are quite consistent with SSA's program data but differ
systematically from estimates based on data from the other three
surveys. Specific findings include the following:

-   After making appropriate sample adjustments, analyses of NSCF data
    indicate that the total population of child SSI recipients was
    844,983 in December 2000, which is about two-tenths of one percent
    above the SSA-reported number of 843,000; demographic differences
    between the NSCF sample and SSA administrative data are minor and
    probably the result of survey administration procedures.

-   The total SSI child population estimate from the NSCF was
    statistically similar to the total population estimates derived from
    the CSHCN survey and SIPP, but not the NHIS.

```{=html}
<!-- -->
```
-   Compared with the other surveys, the NSCF yielded significantly
    higher estimates of the percentage of child SSI recipients who were
    black and significantly lower estimates of the percentage of child
    SSI recipients who lived in two parent households.

## A. Comparison of Demographic Data from the NSCF and SSA Administrative Records

Using NSCF data, we estimate that the total population of child SSI
recipients is 844,983. This estimate is obtained by adding the weighted
estimate of the population (813,711) to the weighted estimate of sampled
children who were not interviewed (31,272) because they were determined
to be ineligible for the survey. These children were not administered a
survey because, during the period of survey administration, they were
found to be deceased, living in Medicaid institutions or outside of the
continental United States, or wards of the state and therefore had no
identifiable adult who could be interviewed. The total adjusted estimate
of the child SSI population based on the NSCF data is essentially
similar to the SSA-reported figure of 843,000 children who received SSI
payments in December 2000 (Table III.1).

TABLE III.1

COMPARISON OF NSCF ESTIMATES WITH SSA

ADMINISTRATIVE DATA FROM DECEMBER 2000

+-------------------+----------------+----------------+----------------+
|                   | NSCF Weighted  |                | SSA            |
|                   | Estimates      |                |                |
|                   |                |                | Administrative |
|                   |                |                | Data           |
+-------------------+----------------+----------------+----------------+
|                   | Number or      | 95 Percent     |                |
|                   | Percent        | Confidence     |                |
|                   |                | Interval       |                |
+-------------------+----------------+----------------+----------------+
| Total Population  | 813,711^a^     | 793,803 -      | 843,000        |
| Size              |                | 833,619        |                |
+-------------------+----------------+----------------+----------------+
| Percent Male      | 63.3           | 62.3 - 64.3    | 63.8           |
+-------------------+----------------+----------------+----------------+
| Percent in Age    |                |                |                |
| Groups            |                |                |                |
+-------------------+----------------+----------------+----------------+
| 0 -- 4            | 12.6           | 12.0 - 13.2    | 15.5           |
+-------------------+----------------+----------------+----------------+
| 5 -- 12           | 48.4           | 47.3 - 49.5    | 50.2           |
+-------------------+----------------+----------------+----------------+
| 13 -- 17          | 39.0           | 38.0 - 40.0    | 34.2           |
+-------------------+----------------+----------------+----------------+
| Percent in        |                |                |                |
| Households with:  |                |                |                |
+-------------------+----------------+----------------+----------------+
| 0 Parents         | 11.0           | 10.2 - 11.8    | 13.4           |
+-------------------+----------------+----------------+----------------+
| 1 Parent          | 60.3           | 58.8 - 61.8    | 62.5           |
+-------------------+----------------+----------------+----------------+
| 2 Parents         | 27.8           | 26.4 - 29.2    | 24.1           |
+-------------------+----------------+----------------+----------------+

[Source: S]{.smallcaps}ocial Security Administration. "Children
Receiving SSI, December 2000," Tables 5, 7, and 12. Available at
www.ssa.gov/policy/programs/ssipub.html.

[Note]{.smallcaps}: According to SSA, the total population count is
derived from a 10-percent sample file, which represents recipients who
received federally administered SSI payments (including federally
administered state supplementation payments) in December 2000 (footnote
to Table 5 in source document). The NSCF percents for number of parents
in household does not sum to 100 because "don't know" and "other"
responses are not included.

^a^Excludes weighted estimate of 31,272 children ineligible for the
survey because at the time of the interview they were deceased, living
in Medicaid institutions or outside of the United States, or wards of
the state and therefore had no identifiable adult who could be
interviewed

Table III.1 also shows percentages of SSI children in gender, age, and
household groupings as estimated from the NSCF data and as reported by
SSA. The NSCF estimate of the percentage of males in the population of
children receiving SSI is not significantly different from the SSA data
(that is, the SSA figure is not outside of the 95 percent confidence
intervals for the NSCF estimates). The other NSCF estimates are
statistically different from the SSA percentage (that is, the SSA figure
lies outside of the 95 percent confidence intervals for the NSCF
estimates) but the differences are relatively minor and probably result
from survey administration procedures. For example, the older age of the
NSCF sample is likely a result of the 18-month period between the time
of sample selection (December 2000) and the time participants were
interviewed (July 2001 to August 2002), during which the sample would
have aged. Compared with the NSCF estimate, there are significantly more
children in the SSA database who are in households where no parent is
present (13.4 compared with 11.0 percent) but this finding may result
from the fact that children known to be in Medicaid institutions were
not included in the NSCF sample.

## B. Total Population Size

Table III.2 shows total population estimates from the four surveys. The
difference between the CSHCN survey estimate (771,325) and the NSCF
estimate (813,711) is not statistically significant. We note, however,
that the point estimate for the CSHCN survey may have been affected by
the CSHCN screener questionnaire that was intended to identify children
having a special health care need. As we show in Chapter IV, about 10
percent of child SSI recipients are not identified by this screener as
having a special health care need (and, therefore, would not be included
in the CSHCN survey sample). Because of these missing cases, the CSHCN
survey is likely to underestimate the number of child SSI recipients. In
addition, the CSHCN survey, as noted previously, is limited to persons
in households with access to a telephone. While statistical procedures
are used by NCHS to compensate for the undercoverage of persons in
households without telephones, the statistical adjustments may not fully
achieve coverage for the child SSI recipient population.

The SIPP estimate (804,262) is similar to the NSCF estimate (about one
percent lower than the NSCF estimate, and not significantly different).
Conversely, the NHIS estimate (640,692) is lower than the NSCF estimate
by more than 20 percent, and the confidence intervals of the two
estimates do not overlap. The reasons for this finding may involve
differences in item wording and field procedures, including the survey
respondent, reference periods, and sample design (as discussed in
Chapter II).

TABLE III.2

WEIGHTED TOTALS, STANDARD ERRORS, RELATIVE STANDARD

ERRORS AND 95 PERCENT CONFIDENCE INTERVALS FOR

THE NSCF AND THREE COMPARISON SURVEYS

  -------------------- ------------ ------------ ------------ ------------
                       NSCF         CSHCN        SIPP         NHIS

  Weighted Estimate of 813,711      771,325      804,262      640,692
  Total Population                                            
  Size                                                        

  Weighted Standard    19,908       24,470       59,036       54,756
  Error                                                       

  Relative Standard    2.4          3.2          7.3          8.6
  Error                                                       

  95% Confidence                                              
  Interval                                                    

  Upper limit          852,732      819,287      919,973      748,015

  Lower limit          774,691      723,364      688,552      533,369
  -------------------- ------------ ------------ ------------ ------------

## C. Demographic Characteristics of Child SSI Recipients

Table III.3 shows the estimates of child SSI recipients across gender,
age groups, racial and ethnic backgrounds, and selected household
variables for the four surveys. The table includes the estimated total
number of children in each selected group, the standard error of the
population estimate, the estimate of the percentage of the total
population for each group, and the standard error of the percentage
estimate. We also identify the NSCF estimates that are significantly
different from the other surveys and relative standard errors of the
percentage estimates that exceed 30 percent. As the table shows, the
surveys yield similar estimates for

TABLE III.3

COMPARISONS OF ESTIMATES OF DEMOGRAPHIC CHARACTERISTICS OF CHILD SSI
RECIPIENTS IN FOUR NATIONAL SURVEYS

<table style="width:100%;">
<colgroup>
<col style="width: 8%" />
<col style="width: 6%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 1%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 1%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 5%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="2">Item/Variable</td>
<td colspan="4">NSCF</td>
<td></td>
<td colspan="4">CSHCN</td>
<td></td>
<td colspan="4">SIPP</td>
<td></td>
<td colspan="4">NHIS</td>
</tr>
<tr class="even">
<td>Estimated Number</td>
<td>SE of Number</td>
<td>Percent</td>
<td>SE of Percent</td>
<td></td>
<td>Estimated Number</td>
<td>SE of Number</td>
<td>Percent</td>
<td>SE of Percent</td>
<td></td>
<td>Estimated Number</td>
<td>SE of Number</td>
<td>Percent</td>
<td>SE of Percent</td>
<td></td>
<td>Estimated Number</td>
<td>SE of Number</td>
<td>Percent</td>
<td>SE of Percent</td>
</tr>
<tr class="odd">
<td>Child’s gender</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr class="even">
<td>Female</td>
<td>298,339</td>
<td>12,647</td>
<td>36.7</td>
<td>1.0</td>
<td></td>
<td>312,701</td>
<td>16,403</td>
<td>40.5</td>
<td>1.6</td>
<td></td>
<td>303,279</td>
<td>32,284</td>
<td>37.7</td>
<td>2.8</td>
<td></td>
<td>231,208</td>
<td>31,116</td>
<td>36.1</td>
<td>3.5</td>
</tr>
<tr class="odd">
<td>Male</td>
<td>515,372</td>
<td>12,323</td>
<td>63.3</td>
<td>1.0</td>
<td></td>
<td>458,476</td>
<td>18,568</td>
<td>59.4</td>
<td>1.6</td>
<td></td>
<td>500,983</td>
<td>42,682</td>
<td>62.3</td>
<td>2.8</td>
<td></td>
<td>409,484</td>
<td>40,198</td>
<td>63.9</td>
<td>3.5</td>
</tr>
<tr class="even">
<td>Child’s age</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr class="odd">
<td>0-4</td>
<td>102,501</td>
<td>5,447</td>
<td>12.6</td>
<td>0.6</td>
<td></td>
<td>108,232</td>
<td>10,041</td>
<td>14.0</td>
<td>1.2</td>
<td></td>
<td>76,532</td>
<td>15,908</td>
<td>9.5</td>
<td>2.0</td>
<td></td>
<td>99,289</td>
<td>18,308</td>
<td>15.5</td>
<td>2.5</td>
</tr>
<tr class="even">
<td>5-12</td>
<td>393,978</td>
<td>12,879</td>
<td>48.4</td>
<td>1.1</td>
<td></td>
<td>393,849</td>
<td>17,832</td>
<td>51.1</td>
<td>1.6</td>
<td></td>
<td>396,353</td>
<td>39,818</td>
<td>49.3</td>
<td>3.1</td>
<td></td>
<td>323,571</td>
<td>32,760</td>
<td>50.5</td>
<td>3.6</td>
</tr>
<tr class="odd">
<td>13-17</td>
<td>317,231</td>
<td>11,128</td>
<td>39.0</td>
<td>1.0</td>
<td></td>
<td>268,611</td>
<td>14,093</td>
<td>34.9</td>
<td>1.5</td>
<td></td>
<td>331,377</td>
<td>36,947</td>
<td>41.2</td>
<td>3.3</td>
<td></td>
<td>217,832</td>
<td>31,136</td>
<td>34.0</td>
<td>3.5</td>
</tr>
<tr class="even">
<td>Child’s ethnicity</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr class="odd">
<td>Hispanic</td>
<td>131,081</td>
<td>18,393</td>
<td>16.1</td>
<td>2.1</td>
<td></td>
<td>114,651</td>
<td>10,685</td>
<td>14.9</td>
<td>1.3</td>
<td></td>
<td>147,162</td>
<td>28,852</td>
<td>18.3</td>
<td>3.2</td>
<td></td>
<td>108,578</td>
<td>15,536</td>
<td>16.9</td>
<td>2.5</td>
</tr>
<tr class="even">
<td>Non-Hispanic</td>
<td>682,631</td>
<td>19,050</td>
<td>83.9</td>
<td>2.1</td>
<td></td>
<td>652,618</td>
<td>22,146</td>
<td>84.7</td>
<td>1.3</td>
<td></td>
<td>657,101</td>
<td>52,308</td>
<td>81.7</td>
<td>3.2</td>
<td></td>
<td>532,114</td>
<td>53,022</td>
<td>83.1</td>
<td>2.5</td>
</tr>
<tr class="odd">
<td>Child’s race</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr class="even">
<td><p>Black/African</p>
<p>American</p></td>
<td>372,685</td>
<td>26,265</td>
<td>45.8<sup>a,c</sup></td>
<td>2.8</td>
<td></td>
<td>221,712</td>
<td>14,130</td>
<td>28.7</td>
<td>1.5</td>
<td></td>
<td>314,553</td>
<td>34,578</td>
<td>39.1</td>
<td>3.5</td>
<td></td>
<td>228,092</td>
<td>28,025</td>
<td>35.6</td>
<td>3.7</td>
</tr>
<tr class="odd">
<td>White</td>
<td>383,179</td>
<td>21,923</td>
<td>47.1<sup>a,b,c</sup></td>
<td>2.7</td>
<td></td>
<td>454,115</td>
<td>18,060</td>
<td>58.9</td>
<td>1.6</td>
<td></td>
<td>460,194</td>
<td>45,151</td>
<td>57.2</td>
<td>3.3</td>
<td></td>
<td>371,947</td>
<td>44,602</td>
<td>58.1</td>
<td>3.9</td>
</tr>
<tr class="even">
<td>Other</td>
<td>57,847</td>
<td>5,591</td>
<td>7.1<sup>a</sup></td>
<td>0.7</td>
<td></td>
<td>91,091</td>
<td>9,340</td>
<td>11.8</td>
<td>1.1</td>
<td></td>
<td>29,516</td>
<td>11,769</td>
<td>3.7</td>
<td>1.5 <sup>d</sup></td>
<td></td>
<td>40,653</td>
<td>10,428</td>
<td>6.3</td>
<td>1.6</td>
</tr>
<tr class="odd">
<td>Maternal Education</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>&lt; HS</td>
<td>238,679</td>
<td>10,681</td>
<td>35.2</td>
<td>1.1</td>
<td></td>
<td>225,441</td>
<td>15,233</td>
<td>31.6</td>
<td>1.7</td>
<td></td>
<td>254,749</td>
<td>34,213</td>
<td>38.5</td>
<td>3.9</td>
<td></td>
<td>190,722</td>
<td>23,895</td>
<td>33.6</td>
<td>3.9</td>
</tr>
<tr class="odd">
<td>HS</td>
<td>275,014</td>
<td>9,449</td>
<td>40.6 <sup>b,c</sup></td>
<td>1.2</td>
<td></td>
<td>242,606</td>
<td>12,117</td>
<td>34.0</td>
<td>1.5</td>
<td></td>
<td>171,391</td>
<td>26,521</td>
<td>25.9</td>
<td>3.7</td>
<td></td>
<td>185,318</td>
<td>26,848</td>
<td>32.6</td>
<td>3.8</td>
</tr>
<tr class="even">
<td>Some college</td>
<td>138,135</td>
<td>8,268</td>
<td>20.4 <sup>a</sup></td>
<td>1.1</td>
<td></td>
<td>175,417</td>
<td>12,378</td>
<td>24.6</td>
<td>1.5</td>
<td></td>
<td>173,465</td>
<td>28,019</td>
<td>26.2</td>
<td>3.8</td>
<td></td>
<td>146,165</td>
<td>29,700</td>
<td>25.7</td>
<td>4.2</td>
</tr>
<tr class="odd">
<td>College grad.</td>
<td>23,367</td>
<td>4,236</td>
<td>3.5 <sup>a,b</sup></td>
<td>0.6</td>
<td></td>
<td>70,816</td>
<td>5,346</td>
<td>9.9</td>
<td>0.8</td>
<td></td>
<td>62,305</td>
<td>17,452</td>
<td>9.4</td>
<td>2.4</td>
<td></td>
<td>30,893</td>
<td>10,229</td>
<td>5.4</td>
<td>1.8 <sup>d</sup></td>
</tr>
<tr class="even">
<td>People in household</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr class="odd">
<td>2</td>
<td>99,077</td>
<td>7,615</td>
<td>12.2 <sup>a,b,c</sup></td>
<td>0.8</td>
<td></td>
<td>59,240</td>
<td>4,723</td>
<td>7.7</td>
<td>0.6</td>
<td></td>
<td>67,167</td>
<td>16,438</td>
<td>8.4</td>
<td>2.0</td>
<td></td>
<td>53,351</td>
<td>13,445</td>
<td>8.3</td>
<td>2.1</td>
</tr>
<tr class="even">
<td>3-5</td>
<td>556,353</td>
<td>15,060</td>
<td>68.4</td>
<td>1.1</td>
<td></td>
<td>547,435</td>
<td>20,291</td>
<td>71.5</td>
<td>1.5</td>
<td></td>
<td>596,861</td>
<td>55,671</td>
<td>74.2</td>
<td>3.5</td>
<td></td>
<td>425,837</td>
<td>46,035</td>
<td>66.5</td>
<td>4.1</td>
</tr>
<tr class="odd">
<td>6-8</td>
<td>141,249</td>
<td>8,022</td>
<td>17.4</td>
<td>0.9</td>
<td></td>
<td>148,499</td>
<td>12,339</td>
<td>19.4</td>
<td>1.4</td>
<td></td>
<td>136,960</td>
<td>25,859</td>
<td>17.0</td>
<td>3.0</td>
<td></td>
<td>152,480</td>
<td>28,111</td>
<td>23.8</td>
<td>3.8</td>
</tr>
<tr class="even">
<td>9+</td>
<td>17,032</td>
<td>2,970</td>
<td>2.1</td>
<td>0.4</td>
<td></td>
<td>10,253</td>
<td>4,472</td>
<td>1.3</td>
<td>0.6<sup>d</sup></td>
<td></td>
<td>3,274</td>
<td>3,287</td>
<td>0.4</td>
<td>0.4<sup>d</sup></td>
<td></td>
<td>7,020</td>
<td>4,087</td>
<td>1.1</td>
<td>0.6 <sup>d</sup></td>
</tr>
<tr class="odd">
<td>Number of parents in household</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr class="even">
<td>None</td>
<td>89,730</td>
<td>7,247</td>
<td>11.0</td>
<td>0.8</td>
<td></td>
<td> </td>
<td> NA</td>
<td> </td>
<td> </td>
<td></td>
<td>110,300</td>
<td>23,293</td>
<td>13.7</td>
<td>2.7</td>
<td></td>
<td>49,332</td>
<td>12,515</td>
<td>7.7</td>
<td>1.9</td>
</tr>
<tr class="odd">
<td>One</td>
<td>491,031</td>
<td>18,954</td>
<td>60.3 <sup>b</sup></td>
<td>1.5</td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td>407,555</td>
<td>41,136</td>
<td>50.7</td>
<td>3.5</td>
<td></td>
<td>351,355</td>
<td>39,897</td>
<td>54.8</td>
<td>4.0</td>
</tr>
<tr class="even">
<td>Two</td>
<td>226,218</td>
<td>11,389</td>
<td>27.8<sup>b,c</sup></td>
<td>1.4</td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td>286,407</td>
<td>33,930</td>
<td>35.6</td>
<td>3.4</td>
<td></td>
<td>240,005</td>
<td>33,287</td>
<td>37.5</td>
<td>4.0</td>
</tr>
</tbody>
</table>

^a^Significantly different from CSHCN ^b^Significantly different from
SIPP ^c^Significantly different from NHIS ^d^Relative standard error
over 30 percent

Note: SE means standard error. Alpha level for the statistical tests is
.05. Shaded area signifies that the survey did not include any
comparable item; as a result, estimates are not available (NA).
Percentages for some group do not sum to 100 because "don't know" and
"other" responses are not included.

several population characteristics. Specifically, the NSCF estimates are
not significantly different from any of the other three surveys with
respect to gender, age, and ethnicity.

However, the NSCF data yield estimates of the race of SSI children that
are significantly different from the other three surveys. According to
NSCF data, 45.8 percent of children receiving SSI are black, whereas
estimates range from 28.7 to 39.1 percent in the other surveys. NSCF
data also indicate that a smaller proportion of SSI children have
"other" racial backgrounds (neither Black nor White), compared with the
CSHCN data (7.1 percent versus 11.8 percent).

Estimates of maternal education levels vary across surveys. The NSCF
data indicate that 3.5 percent of mothers of children receiving SSI
graduated from college, a significantly lower estimate compared with
CSHCN and SIPP (9.9 and 9.4 percent, respectively). Table III.3 also
shows that, compared with the other surveys, the NSCF yields higher
estimates of the proportion of children living in households with just
two people. The NSCF estimate is 12.2 percent, whereas the percentage
estimates from the other surveys range from 7.7 to 8.4. Another
difference is evident in the estimated percentage of SSI child
recipients who live in two-parent households. Based on NSCF data, we
estimate that 27.8 percent of SSI children live with two parents; the
percentage estimates from the other surveys are 35.6 (SIPP) and 37.5
(NHIS).

Taken together, the differences between the NSCF and the other surveys
suggest that, compared with the other surveys, the NSCF estimates a
larger proportion of black children and children living with one parent
or guardian who had low levels of educational attainment. Compared with
the SIPP and the NHIS, the NSCF sample size is much larger and,
therefore, will yield greater precision in the estimates of population
characteristics. With respect to differences in estimates between the
NSCF and the CSHCN survey, methodological and procedural differences may
play a role. The CSHCN used only telephone interviewing; therefore, the
survey may have missed a larger share of low-income and minority
families, who are represented disproportionately among households
without telephones. Wording differences in the questions about race are
relatively minor (see Appendix), and are not likely to explain the
differences observed between the NSCF estimate and the other survey
estimates.

#   {#section-4 .unnumbered}

# IV. Disability and Impairment Status of SSI Child Recipients

Analyses of data on disability and impairment status of SSI child
recipients reveal important differences between the NSCF and CSHCN
survey. Our findings include the following:

-   About 10 percent of child SSI recipients are missed through the use
    of a special set of screener items in the CSHCN to identify children
    with special health care needs.

-   Response patterns on the screener (that is, which items on the
    screener identified children as having a special health care need)
    differ markedly between the NSCF and the CSHCN survey.

```{=html}
<!-- -->
```
-   Compared to the NSCF data, CSHCN data indicate that family members
    are providing more hours of help to their SSI children.

Analyses of data from items related to children's functional status
reveal few differences between the NSCF and the NHIS.

In the first section of this chapter, we compare findings between the
NSCF and the CSHCN surveys using data from a screener developed by the
Foundation for Accountability (FACCT). The second section of this
chapter includes results of data analyses from the functional status
items used in the NSCF, the CSHCN survey, and the NHIS.

## A. comparisons of Responses to the FACCT Screener 

The FACCT screener was developed to provide researchers and managed care
organizations with a short survey instrument that identifies children
with special health care needs (Table IV.1). The screener questions
include five item sets, each of which has three questions that ask
whether, compared with children of a similar age, a child has increased
use of services, needs more medications, requires extra assistance, or
has limitations that result from an ongoing medical, behavioral, or
other health condition.

In order for a child to be identified as having a special health care
need (that is, to be screened in), all three questions in one of the
item sets must be answered in the affirmative. To use item set 1 in
Table IV.1, for example, the child must use more services than most
children of the same age; this heightened service use must result from a
medical, behavioral, or other health condition; and this condition must
have lasted or be expected to last at least 12 months. A child may be
screened in by one or more than one item set and children with more
complex conditions are likely to be screened in by multiple items. (For
further information on the FACCT screener, see Bethell et al. 2002.)

TABLE IV.1

ITEM SETS IN THE FACCT SCREENER

  -----------------------------------------------------------------------
  1\. Does child need or use more medial care, mental health or
  educational services than is usual for most children of the same age?

  If yes, is this need because of any medical, behavioral, or other
  health condition?

  If yes, is this a condition that has lasted/is expected to last 12
  months or longer?

  2\. Does child currently need or use medicine prescribed by a doctor,
  other than vitamins?

  If yes, is this need because of any medical, behavioral, or other
  health condition?

  If yes, is this a condition that has lasted/is expected to last 12
  months or longer?

  3\. Is child limited or prevented in any way in his/her ability to do
  the things most children of the same age can do?

  If yes, is this need because of any medical, behavioral, or other
  health condition?

  If yes, is this a condition that has lasted/is expected to last 12
  months or longer?

  4\. Does child need or get special therapy, such as physical,
  occupational, or speech therapy?

  If yes, is this need because of any medical, behavioral, or other
  health condition?

  If yes, is this a condition that has lasted/is expected to last 12
  months or longer?

  5\. Does child need or get treatment or counseling for any kind of
  emotional, developmental, or behavioral problem?

  If yes, has this lasted/is expected to last 12 months or longer?
  -----------------------------------------------------------------------

The FACCT screener was used in the CSHCN survey as part of the sample
selection process. Only those children identified as having a special
health care need were administered the CSHCN survey. The FACCT screener
was included in the NSCF to allow respondents who did not report that
their child had a health condition to skip certain questions, and to
permit comparisons between the NSCF and the CSHCN survey data.

In theory, all children receiving SSI payments should be identified by
the screener as having a special health care need; however, our analyses
indicate that 10.1 percent of child SSI recipients in the NSCF sample
are not identified as having a special health care need by the FACCT
screener. Even though the disability determination process qualified
these children for SSI payments, their parents or guardians did not
answer "yes" to all three items in *any* of the five item sets in the
FACCT screener.

To begin examining the characteristics of the NSCF children not
identified by the FACCT screener as having a special health care need,
we determined their diagnoses using SSA data. Of the children in the
NSCF sample who were missed by the FACCT screener, 52.5 percent had
mental retardation, 8.3 percent had speech disturbances, 3.7 percent had
other specific learning difficulties, 3.7 percent had ADD/ADHD, and the
remaining had a wide range of other physical, cognitive, or behavioral
conditions. This finding is consistent with other research (Bethell et
al. 2002) suggesting that the FACCT screener may not identify some
children with cognitive problems or mild learning disabilities because
(1) despite being diagnosed as having a cognitive disorder, these
children do not use services more frequently, do not need more
medication or require extra therapy, and have no activity limitations;
or (2) some respondents may not define a child with certain limitations
as qualitatively different from other children and therefore would not
answer the screening questions in the affirmative. It would be useful to
examine this issue further because of its implications for the process
of determining SSI eligibility.

Table IV.2 shows the percentage of children in the NSCF and CSHCN
surveys identified as having a special health care need by each item set
in the FACCT screener. The percent of child SSI recipients identified by
each item set is significantly different across the two surveys. For all
but one of the item sets, a greater percent of SSI child recipients are
identified using NSCF data than using CSHCN data. The one exception
involves the use of prescription medication; this item identifies a
larger percent of child SSI recipients as having a special need in the
CSHCN survey than in the NSCF. The reasons for these differences are not
entirely clear. Further analyses of the demographic characteristics and
diagnoses of the children identified by each item set in the two surveys
may help clarify these differences.

TABLE IV.2

COMPARISON OF NSCF AND CSHCN SURVEY ESTIMATES OF THE PERCENT

OF CHILD SSI RECIPIENTS IDENTIFIED AS HAVING A SPECIAL

HEALTH CARE NEED BY ITEMS ON THE FACCT SCREENER

  --------------------------- ------------ ---------- -- ------------ ----------
                              NSCF                       CSHCN        

  Item Set                    Percent      Standard      Percent      Standard
                              Identified   Error         Identified   Error

  1\. Child use more services 74.9^a^      1.3           66.4         1.5
  compared with children of                                           
  same age                                                            

  2\. Child needs or uses     55.1^a^      1.2           63.9         1.6
  medicine prescribed by a                                            
  doctor                                                              

  3\. Child limited in        64.4^a^      1.0           47.7         1.6
  ability to do things like                                           
  most children his/her age                                           

  4\. Child needs or gets     52.3^a^      1.6           44.3         1.6
  special therapy                                                     

  5\. Child needs or gets     48.3^a^      1.0           44.0         1.6
  mental health treatment or                                          
  counseling                                                          
  --------------------------- ------------ ---------- -- ------------ ----------

^a^NSCF estimate is significantly different from that based on the CSHCN
survey at the alpha =.05 level.

## B. Functional Status

The NSCF and the CSHCN survey include two similar items related to the
child's functional status. Table IV.3 shows the estimates derived from
these items. The first item involves days of school missed. In general,
estimates of the percent of child SSI recipients in the various
categories of school days missed are similar for the two surveys;
however, the NSCF estimate of the percent of children with 11 or more
school days missed is larger than the CSHCN survey estimate (27.1
compared with 23.1 percent).

TABLE IV.3

COMPARISON OF NSCF AND CSHCN SURVEY ESTIMATES

OF FUNCTIONAL IMPAIRMENT OF CHILD SSI RECIPEINTS

  ----------------------------- ---------- ---------- -- --------- ----------
                                NSCF                     CSHCN     

  Item/Variable                 Percent    Standard      Percent   Standard
                                           Error                   Error

  Days of school missed in past                                    
  12 months                                                        

  None                          19.9       0.9           22.0      1.5

  1-5                           32.5       1.4           34.1      1.6

  6-10                          17.0       0.8           15.2      1.3

  11+                           27.1 ^a^   1.2           23.1      1.5

  Other                         NA         NA            2.1       0.5

  Don't Know                    2.9        0.5           3.1       0.8

  Amount of health care                                            
  provided by family                                               

  1-10 hrs/wk                   75.3 ^a^   0.9           57.9      2.1

  11-20 hrs/wk                  4.0 ^a^    0.4           7.0       1.0

  20+ hrs/wk                    15.7 ^a^   0.8           31.3      2.0

  Family never provided care    56.7 ^a^   1.4           41.0      1.6
  ----------------------------- ---------- ---------- -- --------- ----------

[Note]{.smallcaps}: The "other" category in the CSHCN survey includes
children not in school or home-schooled. In the NSCF, children not in
school or home-schooled were not asked this question. Therefore, we
indicate that data are not available (NA). Some percentages do not sum
to 100 because "don't know" responses are excluded.

^a^The NSCF estimate is significantly different at the alpha =.05 level
from the CSHCN estimate.

The second item involves the extent of health care provided by family
members. On this index, estimates differ markedly for each of the
categories. According to the NSCF data, 19.7 percent of families of SSI
children report providing more than 11 hours of help per week (4.0 added
to 15.7 percent). According to the CSHCN survey data, 38.3 percent of
families report providing this amount of health care (7.0 added to 31.3
percent). The observed difference is not likely to result from item
differences because both surveys use exactly the same phrasing for this
item; however, context effects or the placement of the item within the
questionnaire may account in part for this difference. Further research
could provide insight into factors that affect reporting of family
care-giving.

The NSCF and the NHIS also share an index of child functional status.
This index describes the extent to which the child needs extra
assistance in activities of daily living. Table IV.4 shows the
distribution of responses to this item in both surveys. Differences in
estimates between the two surveys are not statistically different. The
NHIS estimates are all numerically larger, but because of the large
standard errors are not statistically significant.

TABLE IV.4

COMPARISON OF NSCF AND NHIS ESTIMATES OF THE EXTENT TO WHICH SSI

CHILD RECIPIENTS NEED EXTRA ASSISTANCE IN ACTIVITIES OF DAILY LIVING

  ------------------------ ------------ ------------ -- --------- -----------
                           NSCF                         NHIS      

  Item/Variable            Percent      Standard        Percent   Standard
                                        Error                     Error

                                                                  

  Child needs extra                                               
  assistance with:                                                

  Bathing                  84.3         1.2             87.2      6.5

  Dressing                 82.6         1.5             85.2      6.8

  Eating                   35.2         1.7             50.0      9.3

  Getting into/out of bed  24.8         1.5             27.5      8.0

  Getting around in house  22.3         1.3             30.2      8.3

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

[Note]{.smallcaps}: Chi-square tests found no significant differences at
the alpha=.05 level.

# V. ASSETS, INCOME, AND BENEFITS

Our analyses identify consistent differences between the NSCF and the
other surveys with respect to data on income and assets of families of
SSI children and their enrollment in various benefit programs. Also,
compared with SSA administrative data, respondents to the NSCF appear to
underreport SSI payments but the underreporting is even greater in the
SIPP. Other findings include:

-   For some household income categories, NSCF estimates are
    significantly different from SIPP estimates, but the general pattern
    of results is quite similar across these two surveys.

-   NSCF data indicate SSI payments are higher and that a larger
    percentage of families of child SSI recipients are receiving
    welfare, food stamps, and other SSA benefits when compared with SIPP
    data.

```{=html}
<!-- -->
```
-   The NSCF estimates proportionally fewer parents quitting work
    compared with the CSHCN survey.

In this chapter, we first compare estimates of income and monthly SSI
payments and then estimates of enrollment in other public programs. In
addition, we examine how the NSCF estimate of SSI payments compares to
SSA's administrative data.

## A. Income Estimates

NSCF estimates are significantly different from SIPP estimates for two
total household income categories (Table V.1). NSCF data indicate 73.2
percent of families of SSI children have a total monthly household
income above \$1,000; SIPP data indicate 84.5 percent. Observed
differences in estimates between the two surveys may be due to a number
of factors, including different question wording, timing of the data
collection, questionnaire context effects, and survey administration and
processing procedures, including imputation methods. Although
differences are statistically significant, the general pattern of
results is quite similar for both surveys. Unearned income estimates
from the two surveys are not significantly different from each
other.[^8]

TABLE V.1

COMPARISONS OF NSCF AND SIPP ESTIMATES OF MONTHLY

HOUSEHOLD INCOME OF FAMILIES OF SSI CHILDREN

  ----------------- ------------- ------------- -- ------------ ------------
                    NSCF                           SIPP         

  Item/Variable     Percent       Standard         Percent      Standard
                                  Error                         Error

  Total Monthly                                                 
  Income                                                        

  None              1.4           0.5              0.0          0.0

  \<\$200           1.8           0.6              0.0          0.0

  \$200-399         0.8           0.2              1.8          1.2^b^

  \$400-599         7.9           0.5              5.2          1.7^b^

  \$600-999         16.3^a^       0.8              8.5          2.0

  \$1,000+          73.2^a^       1.3              84.5         2.8

  Unearned Income                                               

  None              0.5           0.2              0.0          0.0

  \<\$200           3.8           0.5              5.4          1.5

  \$200-399         6.2           0.5              5.7          1.7

  \$400-599         22.6          0.9              23.3         2.5

  \$600-999         24.6          1.0              20.1         2.5

  \$1,000+          42.8          1.2              45.5         3.3
  ----------------- ------------- ------------- -- ------------ ------------

[Note]{.smallcaps}: As the table shows, using the NSCF data, one-half of
one percent of the children on SSI are estimated to have no unearned
income, which appears inconsistent with their status as SSI recipients.
For individuals who refused to answer this question or who did not know
their monthly income, payment information was obtained from SSA
administrative data. In some cases, the SSA data showed that a zero
amount was paid for the reference month. These individuals may have been
in suspended status or did not receive a payment in the reference month
for some other reason, even though they were still considered SSI
recipients. The sample explicitly included individuals in suspended pay
status. Some percentages do not sum to 100 because of rounding error.

^a^Significantly different from SIPP at the alpha =.05 level.

^b^Relative standard error exceeds 30 percent

## B. Monthly SSI Payments

Analyses of the NSCF and SIPP estimates of monthly payments for child
SSI beneficiaries indicate different distributions for the two surveys
(Table V.2). In general, data from the NSCF suggest that payments are
higher compared with data from the SIPP. For example, using NSCF data,
we estimate that 40.6 percent of children receive the maximum federal
payment (at the time of the survey) of \$531 per month; using data from
SIPP, we estimate that 22.9 percent do so. (In both surveys, some
respondents reported receiving more than the maximum payment. We have no
definitive explanation for this, except that misreporting of income
amounts is typical in sample surveys.) Some of the difference in the
proportions receiving the maximum federal payment may be explained by
differences in item wording. The SIPP asks about federal SSI payments
only while the NSCF asks about total SSI payments, which may include
non-federally administered state supplements.

It is not clear why there is a spike in the SIPP estimate of the number
of families reporting SSI payments between \$100 and \$199, when there
is no such spike in the NSCF data. Further examination of the data,
focusing on reference period, respondent, and imputation procedures, is
needed to identify potential reasons for these differences.

## C. Comparison of NSCF Estimates of SSI Payments with SSA Administrative Data

In contrast to the comparison with SIPP, respondents to the NSCF tend to
underreport monthly SSI payments compared with SSA administrative data
(Table V.3). For example, using the NSCF data, we estimate that 40.6
percent of the children receive the maximum federal payment of \$531 per
month, whereas SSA administrative data from December 2001 (the
approximate mid-point of data collection) indicate that 64.3 percent do
so.

TABLE V.2

COMPARISONS OF NSCF AND SIPP ESTIMATES

OF MONTHLY SSI BENEFITS FOR CHILDREN

  ---------------- ------------- ------------- -- ------------- -------------
                   NSCF                           SIPP          

  Item/Variable    Percent       Standard         Percent       Standard
                                 Error                          Error

  Monthly benefit                                               

  None             0.9           0.3              0.0           0.0

  \<\$50           2.1           0.5              1.9           0.9^b^

  \$50-99          1.5 ^a^       0.4              6.8           2.0

  \$100-199        3.6 ^a^       0.5              16.1          3.3

  \$200-299        5.2           0.6              8.1           2.0

  \$300-399        10.3          0.8              8.9           2.0

  \$400-499        17.0 ^a^      0.9              11.5          2.1

  \$500-530        18.6          0.9              23.7          3.3

  \$531+           40.6 ^a^      1.5              22.9          2.8
  ---------------- ------------- ------------- -- ------------- -------------

[Note]{.smallcaps}: As the table shows, slightly less than one percent
of the NSCF sample reported having no monthly SSI payment, which appears
inconsistent with their status as SSI recipients. For individuals who
refused to answer this question or who said they did not know their SSI
payment amount, relevant information was obtained from SSA
administrative data. In some cases, the SSA data showed that a zero
amount was paid for the reference month. These individuals may have been
in suspended status or did not receive a payment in the reference month
for some other reason, even though they were still considered SSI
recipients. The sample explicitly included individuals in suspended pay
status. Percentages do not sum to 100 due to rounding.

^a^Significantly different from SIPP at the alpha = .05 level.

^b^Relative standard error exceeds 30 percent

The underreporting is even more pronounced if state SSI supplemental
payments are considered. The SSA administrative data include only
federal SSI payments and federally administered state supplements; in
contrast, the NCSF data include total SSI payments reported by
respondents, which may include both state and federal dollars. If the
state portion of the total SSI payments was removed, the underreporting
would be even greater than indicated in Table V.3.

Comparisons of Tables V.2 and V.3 suggest that SIPP data show even
greater underreporting than NSCF data when compared with SSA
administrative data. For example, using the SIPP data we estimate that
only 22.9 percent of SSI children receive the maximum federal payment,
compared with 64.3 percent in the SSA administrative data. This
discrepancy is particularly noteworthy because, unlike NSCF, the SIPP
asks respondents to report only the amount of the federal SSI benefit,
which is also the amount reported in the SSA administrative data.
Furthermore, the administrative data show no spike in the amount of SSI
received at \$100-\$199, suggesting possible measurement and reporting
problems with the SIPP data.

TABLE V.3

COMPARISON OF NSCF ESTIMATES OF

SSI MONTHLY PAYMENTS WITH SSA ADMINISTRATIVE DATA

  ---------------- ---------------- ---------------- -- -------------------
                   NSCF Estimates                       SSA Administrative
                                                        Data

                   Percent          95 Percent          Percent
                                    Confidence          
                                    Interval            

  None             0.9              .6-.12              0.3

  \<\$50           2.1              2.6-2.6             2.5

  \$50-99          1.5              1.1-1.9             1.1

  \$100-199        3.6              3.1-4.1             3.1

  \$200-299        5.2              4.6-5.8             4.3

  \$300-399        10.3             9.5-11.1            9.8

  \$400-499        17.0             16.1-17.9           11.0

  \$500-530        18.6             17.7-19.5           3.6

  \$531            40.6             39.1-42.1           64.3
  ---------------- ---------------- ---------------- -- -------------------

[Source: S]{.smallcaps}ocial Security Administration. *Children
Receiving SSI, December 2001,* Table 6.
http://www.ssa.gov/policy/programs/ssipub.html

[Note]{.smallcaps}: SSA data include children receiving federal SSI
payments and federally administered state supplements. According to SSA,
the 0.3 percent of children who are reported to have no payments are
individuals who received only a state supplementation payment as of
December 1, 2001. The maximum payment possible during the survey period
was \$531. However, the 40.6 percent of the NSCF sample indicating that
they received the maximum includes some individuals who reported that
they received more than \$531. Percentages do not sum to 100 because of
rounding error.

## D. ENROLLMENT IN BENEFIT PROGRAMS

Comparisons of estimates of the percentage of SSI children and their
families who were receiving benefits through the welfare, food stamp,
and school lunch programs show that NSCF data indicate a higher
percentage of families of SSI children are receiving welfare, food
stamps, and other SSA benefits compared with SIPP estimates (Table V.4).
There are no differences between survey estimates for the percentage of
families participating in the school lunch program. The NSCF data also
indicate that proportionally more families of SSI child recipients
receive welfare and food stamps compared with the NHIS data.

TABLE V.4

COMPARISON OF NSCF, SIPP, AND NHIS ESTIMATES OF PROGRAM PARTICIPATION

  ------------- ----------- ---------- -- --------- ---------- -- --------- ----------
                NSCF                      SIPP                    NHIS      

                Percent     Standard      Percent   Standard      Percent   Standard
                            Error                   Error                   Error

  Welfare                                                                   
  Recipient                                                                 

  Yes           16.3^a^     1.1           7.4       2.3^c^        10.3      2.9

  No            83.7^b^     1.1           92.6      2.3           88.8      3.1

  Food Stamps                                                               

  Yes           35.0^a,b^   1.5           22.5      2.8           19.2      3.2

  No            65.0^a,b^   1.5           77.5      2.8           78.7      3.4

  School Lunch                                                              

  Yes           78.3        1.1           78.8      2.9           NA        

  No            20.1        1.0           21.2      2.9                     

  Other SSA                                                                 
  Benefits                                                                  

  Yes           16.6^b^     1.0           9.3       1.9                     

  No            83.4^b^     1.0           90.7      1.9                     
  ------------- ----------- ---------- -- --------- ---------- -- --------- ----------

[Note]{.smallcaps}: Shaded area signifies that the survey did not
include any comparable items; as a result, estimates are not available
(NA). Other SSA benefits include retirement benefits, survivor benefits,
or disability insurance. Some percentages do not sum to 100 because
"don't know" responses are excluded or due to rounding.

^a^Significantly different from NHIS at the alpha =.05 level.

^b^Significantly different from SIPP at the alpha= .05 level.

^c^Relative standard error exceeds 30 percent

Overall, compared with the SIPP or NHIS data, the NSCF data suggest that
families of child SSI recipients are somewhat more dependent on
government benefits.

## E. Effect of child's health Condition on Parental Employment

As Table V.5 shows, proportionally fewer parents are estimated by the
NSCF to have quit work because of the child's health condition compared
with the CSHCN survey (24.3 versus 29.4 percent). This finding may
result from either or both of two factors. First, as noted in Chapter
IV, more respondents in the NSCF sample may have children with
relatively mild conditions compared with respondents in the CSHCN survey
sample, and therefore may not need to stop working or may need only to
reduce their hours to care for their children. Second, as noted in Table
II.3, the NSCF sample may have fewer resources and therefore may not be
able to afford to quit working.

TABLE V.5

COMPARISON OF ESTIMATES OF THE IMPACT OF THE CHILD'S

CONDITION ON PARENTAL EMPLOYMENT

  ------------------------ ----------- ----------- -- ----------- -----------
                           NSCF                       CSHCN       

                           Percent     Standard       Percent     Standard
                                       Error                      Error

  Any family members quit                                         
  working because of                                              
  child's condition?                                              

  Yes                      24.3^a^     1.1            29.4        1.5

  No                       75.3 ^a^    1.1            70.2        1.5
  ------------------------ ----------- ----------- -- ----------- -----------

^a^Significantly different from CSHCN at the alpha =.05 level.
Percentages do not sum to 100 because "don't know" responses are not
included.

#   {#section-5 .unnumbered}

# VI. Health Care Insurance, Service Use, and Unmet Needs

Comparisons of estimates of health insurance coverage, service use, and
unmet needs of child SSI recipients reveal that NSCF estimates are
frequently different from the other surveys. Overall, compared with data
from the other surveys, the NSCF data indicate that proportionally more
child SSI recipients are on Medicaid and SCHIP, and are in greater need
of outpatient medical services. Specifically, major findings include the
following:

-   Compared with all three surveys, the NSCF finds a larger percentage
    of SSI children on Medicaid.

-   Compared with the CSHCN data, NSCF data indicate a larger percent of
    SSI children have no yearly physician visits.

-   Compared with the SIPP data, NSCF data indicate a greater percentage
    of children who are recipients of SSI are enrolled in SCHIP.

```{=html}
<!-- -->
```
-   Compared with the NHIS data, NSCF data indicate a greater percentage
    of SSI children are hospitalized during a year.

In this chapter, we compare estimates of health insurance coverage,
service use, and unmet needs of child SSI recipients, using data from
all four surveys. In the first section, we compare estimates of
enrollment in Medicaid, SCHIP, and military health insurance plans, as
well as estimates of the number of children who lacked coverage for some
portion of the year.[^9] The second section includes estimates of
physician visits and hospital admissions and the third provides
estimates of the percentages of child SSI recipients who did not receive
needed medical, dental, or pharmaceutical services.

## A. Enrollment in Medicaid, SCHIP, and Military Health Plans

Based on the NSCF data, we estimate that 90.6 percent of child SSI
recipients are enrolled in Medicaid (Table VI.1). This estimate is
significantly larger than the estimates from the other three surveys. We
found similar results for enrollment in SCHIP. Using NSCF data, we
estimate that 14.4 percent of SSI child recipients are enrolled in
SCHIP, significantly higher than the estimates from SIPP and NHIS (but
not significantly different from the CSHCN survey estimate).

TABLE VI.1

ESTIMATES FROM FOUR NATIONAL SURVEYS OF ENROLLMENT

BY CHILD SSI RECIPIENTS IN SELECTED HEALTH INSURANCE PROGRAMS

  ----------- ------------ ---------- -- --------- ---------- -- --------- ---------- -- --------- ----------
              NSCF                       CSHCN                   SIPP                    NHIS      

              Percent      Standard      Percent   Standard      Percent   Standard      Percent   Standard
                           Error                   Error                   Error                   Error

  Medicaid                                                                                         

  Yes         90.6 ^a,b,c^ 1.1           73.9      1.4           81.1      3.0           61.1      4.0

  No          8.6^a,b,c^   1.1           26.1      1.4           18.9      3.0           38.4      4.0

  SCHIP                                                                                            

  Yes         14.4^a^      1.5           12.9      1.2           4.9       2.1^d^        6.0       2.6^d^

  No          81.1 ^a,b,c^ 1.6           87.1      1.2           95.1      2.1           93.5      2.6

  Military                                                                                         
  Plan                                                                                             

  Yes         0.8          0.2           2.1       0.3^d^        4.2       2.0 ^d^       0.8       0.6 ^d^

  No          98.8^a^      0.3           97.9      0.3           95.8      2.0           99.2      0.6

  Ever Not                                                                                         
  Covered                                                                                          

  Yes         4.0 ^a^      0.6           8.2       0.8           NA                      4.6       1.6 ^d^

  No          95.4 ^a^     0.6           91.7      0.8                                   94.6      1.7
  ----------- ------------ ---------- -- --------- ---------- -- --------- ---------- -- --------- ----------

> [Note]{.smallcaps}: Shaded area signifies that the survey did not
> include any comparable items; as a result, estimates are not available
> (NA). Some percentages do not sum to 100 percent because "don't know"
> responses are excluded or because of rounding errors.

^a^Significantly different from CSHCN at the alpha =.05 level.

^b^Significantly different from SIPP at the alpha =.05 level.

^c^Significantly different from NHIS at the alpha =.05 level.

^d^Relative standard error exceeds 30 percent

In general, the four surveys estimated that a small percentage of SSI
children were enrolled in military plans. Relative standard errors of
the estimates for the percentage of child SSI recipients enrolled in
military plans were over 30 percent, and therefore we did conduct tests
of significance.

## B. Physician Visits and Hospitalizations

In comparison to the CSHCN survey data, the NSCF data suggest a greater
percentage of SSI children have no yearly physician visits (Table VI.2);
the CSHCN data indicate a slightly larger percentage of SSI children
have four or more physician visits. In comparison to NHIS data, the NSCF
data also suggest that a smaller percentage of SSI children have no
hospitalizations during a year.

TABLE VI.2

COMPARISON OF NSCF, CSHCN, AND NHIS ESTIMATES

OF PHYSICIAN VISITS AND HOSPITALIZATIONS

  -------------- --------- ---------- -- --------- ---------- -- --------- ----------
                 NSCF                    CSHCN                   NHIS      

                 Percent   Standard      Percent   Standard      Percent   Standard
                           Error                   Error                   Error

  Physician                                                                
  visits in last                                                           
  year                                                                     

  None           6.3^a^    0.6           4.6       0.6           NA        

  1-3            31.8 ^a^  1.1           25.7      1.4                     

  4-6            24.4 ^a^  0.8           27.9      1.5                     

  7-9            7.2       0.6           8.5       0.9                     

  10+            27.0 ^a^  1.1           30.9      1.5                     

  Hospital                                                                 
  admissions                                                               

  0              81.5^b^   0.9           NA                      85.4      2.6

  1-2            12.0      0.6                                   10.1      2.2

  3-4            2.6       0.3                                   1.9       1.0^c^

  5+             3.5       0.5                                   2.6       1.1^c^
  -------------- --------- ---------- -- --------- ---------- -- --------- ----------

> [Note]{.smallcaps}: Shaded area signifies that the survey did not
> include any comparable items; as a result, estimates are not available
> (NA). Some percentages do not sum to 100 because "don't know"
> responses are excluded or because of rounding errors.

^a^Significantly different from CSHCN at the alpha =.05 level.

^b^Significantly different from NHIS at the alpha =.05 level.

^c^Relative standard error exceeds 30 percent

## C. Unmet Needs

Both the NSCF and CSHCN survey data indicate that the majority of child
SSI recipients have not gone without needed medical care (Table VI.3).
Although the difference between the NSCF and CSHCN estimates is
statistically significant (93.6 versus 89.7 percent), the overall
magnitude of the difference is minor.

TABLE VI.3

UNMET SERVICE NEEDS OF CHILD SSI RECIPIENTS IN SELECTED SURVEYS

  --------------------- ------------ ------------ -- ----------- -----------
                        NSCF                         CSHCN       

  Item/Variable         Percent      Standard        Percent     Standard
                                     Error                       Error

  Gone without needed                                            
  health care?                                                   

  Yes                   6.3^a^       0.7             10.1        1.1

  No                    93.6^a^      0.7             89.7        1.1

  Received needed                                                
  dental care?                                                   

  Yes                   84.5         0.8             87.0        1.3

  No                    15.3         0.8             12.8        1.2

  Received needed                                                
  medications?                                                   

  Yes                   94.6^a^      0.5             98.0        0.7

  No                    5.2^a^       0.5             2.0         0.7
  --------------------- ------------ ------------ -- ----------- -----------

^a^ Significantly different from CSHCN at the alpha =.05 level. Some
percentages do not sum to 100 because of rounding errors.

In terms of unmet dental needs, estimates from the two surveys are not
significantly different at the alpha = .05 level; however, the
difference in the percent of children who do not obtain needed
medication is significantly different. Based on NSCF data, 5.2 percent
of children do not get needed medication; based on the CSHCN survey
data, 2.0 percent do not. Additional analyses are required to examine
the reasons for these differences.

# VII. Summary

## A. OVERVIEW

The NSCF was designed specifically to obtain comprehensive and accurate
data on child SSI recipients to address key policy questions.
Information on these children is available from a number of other
surveys, but our analyses indicate that data from these surveys may lead
researchers to somewhat different conclusions compared with results
based on NSCF data. For example, policymakers may wish to know whether
all or most child SSI recipients are covered by Medicaid. As seen in
Chapter VI (Table VI.1), the NSCF data indicate that over 90 percent of
these children have Medicaid coverage. Estimates of Medicaid coverage
for these children are significantly lower when based on CSHCN, SIPP,
and NHIS data (which provide estimates of 74, 81, and 61 percent,
respectively). This example illustrates how the NSCF tells a somewhat
different "story" than the other surveys and could lead researchers and
policymakers to different conclusions.

There are several reasons why researchers should use the NSCF data to
study the child SSI recipient population. First, the design of the NSCF
provides a strong foundation for accurate survey estimates. Compared
with the other surveys, the NSCF focused its sample and its content on
the target population of child SSI recipients. The NSCF used a list of
child SSI recipients as its sampling frame and devoted substantial
resources to obtaining responses from about 85 percent of the target
sample. Furthermore, our analyses suggest that because of the sampling
frame's representation of the target population and the survey's large
sample size, the NSCF sample provides enough cases to represent certain
subgroups of child SSI recipients who are not well-represented in the
CSHCN, SIPP, or NHIS samples. These subgroups may include some of the
most vulnerable families and children (for example, children in
single-parent families where the mother may have few educational or
financial resources.) Because NSCF's large targeted sample includes a
broad range of child SSI recipients compared with the samples of other
surveys, it is able to provide a more complete picture of the
characteristics and needs of this population and important subgroups.

Second, we found numerous differences between estimates based on NSCF
data and estimates based on data from other surveys, but these
differences were internally consistent and presented a coherent picture
when examined as a whole. For example, we found that children in the
NSCF sample were more likely to be enrolled in government programs
compared with child SSI recipients in the other survey samples. This
finding was consistent across comparisons with all three surveys and for
different government programs, such as Medicaid, SCHIP, and other
benefit programs. The internal consistency of our results suggests our
findings are not random, but instead result from systematic factors
probably related to sampling and procedural differences between NSCF and
the other surveys.

The NSCF data provide the most comprehensive and accurate information
available on child SSI recipients. Researchers can confidently use the
NSCF dataset to develop national estimates and conduct studies of
disability status, functional limitations, use of health services,
educational status, the impact of the disabling condition on the family,
employment status, and the SSI experience itself for child SSI
recipients. Although they will be useful for purposes of refining
current policies affecting SSI child recipients and applicants, the NSCF
data are limited for other uses. For example, they will be less useful
for developing estimates of employment among all adolescents with
disabilities or of program participation of children who are potential
SSI recipients but have never applied. The other surveys, which include
samples of these children, may be more useful for these purposes.

## b. Summary of Findings from Cross-Survey Comparisons

On many items we investigated, NSCF estimates differed systematically
from other survey estimates. Some of the most important differences
include the following:

-   Compared with data from the other three surveys, NSCF data yield
    higher estimates of the percentage of child SSI recipients who
    were (1) black, (2) living in single-parent households, and (3) on
    Medicaid.

-   NSCF data indicate about 10 percent of child SSI recipients are not
    identified by the FACCT screener as having a special health care
    need, suggesting undercoverage of the SSI target population when the
    screener is used.

-   Compared with CSHCN data, the NSCF data suggest (1) the average
    amount of care provided by family members is lower, (2)
    proportionally fewer parents are estimated by the NSCF to have quit
    work to care for their child, (3) a larger percentage of SSI
    children go without needed medical care, and (4) a larger percentage
    have no yearly physician visits.

-   Compared with SIPP data, the NSCF data suggest (1) SSI payments are
    higher, (2) a larger percentage of families of child SSI recipients
    receive welfare, food stamps, and other SSA benefits, and (3) a
    larger percentage of child SSI recipients are enrolled in SCHIP.

```{=html}
<!-- -->
```
-   Compared with NHIS data, the NSCF data suggest (1) a larger
    percentage of SSI children are enrolled in SCHIP and (2) a lower
    percentage have no hospitalizations during a year.

The surveys are quite different from each other in terms of survey
objectives, sampling frame, sample design, sample size, and procedural
and operational issues. The NSCF offers the distinct advantage of using
a sampling frame---the SSI program files---that offers excellent
representation of the survey's target population. In contrast, the CSHCN
relies on sets of screening items designed to identify children having a
special health care need and these screening items lead to undercoverage
of the SSI child population. Compared with the SIPP and the NHIS, the
NSCF offers a larger sample of the child SSI recipient population, which
permits detailed subgroup analysis with high levels of precision.

## c. summary of comparisons with ssa administrative data

The NSCF estimates compare favorably with SSA program data on several
variables. For example, we found that:

-   The NSCF estimate of the total population of child SSI recipients
    was very close to the number of SSI child recipients reported by
    SSA, after accounting for children not eligible for the survey.

-   The distribution of the NSCF estimates across selected demographic
    variables was consistent with distributions reported by SSA. The
    differences that exist are relatively minor and probably result from
    survey administration procedures.

```{=html}
<!-- -->
```
-   Respondents to the NSCF tended to underreport monthly SSI payments
    compared with SSA administrative data, but less underreporting is
    observed in the NSCF when compared with the SIPP.

The essential similarity between the NSCF estimates and the SSA
administrative data on key variables suggests that comparability between
the NSCF data and SSA administrative data was achieved, and that NSCF
estimates accurately represent the target population. Parents'
underreporting SSI payments when compared with administrative data is
consistent with the literature on self-reported income data. (See
Mathiowetz, Brown, and Bound (2002) for a discussion of measurement
error in surveys of low-income populations.)

## D. IMPLICATIONS FOR THE FUTURE

Sample surveys are designed and implemented for a number of reasons;
oftentimes the survey has multiple purposes resulting in a variety of
descriptive statistics of a target survey population, other times the
survey is designed exclusively to test a specific set of hypotheses.
Although the comparison of critical estimates across two or more data
sets is an established method for ascertaining the usefulness of a new
data set, the method itself can be difficult to implement and the
results difficult to interpret. Future survey programs must recognize
that despite the implementation of good survey practices, nonsampling
error will exist in survey estimates. Furthermore, a repeated survey has
the obligation to review the design and implementation of previously
conducted surveys to identify areas that could be improved and determine
whether the survey design is consistent with the current survey
objectives.

It is important that a critical review of survey methods and practices
be conducted of similar surveys as well as the most recently implemented
survey, and when appropriate, to consider how improved methods and
practices can be implemented in the current round of the survey. As part
of this review, identifying the major sources of nonsampling error in
the survey and taking steps to minimize the error is essential. Ideally,
this means survey resources must be allocated directly to areas where
nonsampling error may be especially problematic. This resource
allocation, for example, could mean that a selected number of
questionnaire items need to be reviewed, improved, and tested again, or
in an interviewer-conducted survey that the interviewer training program
be evaluated and revised if the goals of the training are not met.
Surveys of participants of transfer programs have the added advantage
that administrative data associated with the program are available and
can be used in editing, imputation, and weighting to reduce some
components of nonsampling error and, thereby, improve the survey
estimates. As a general practice, repeated surveys ought to develop
programs in which important components of nonsampling error can be
measured; for example, steps in this direction include the development
of reinterview programs to quantify the response bias or response
variance properties of questionnaire items and concepts or the analysis
of the potential bias in estimates as a result of unit nonresponse.
Finally, the comparative results suggest SSA should identify and "stay
in touch" with its microdata user community, following their analyses,
understanding the data limitations and idiosyncrasies, and communicating
such information within the NSCF data user community. Extensive
involvement and communication with users produces an informed user
community that analyzes data with a full understanding their
limitations, and an informed survey sponsor who can take steps to reduce
survey error in the future.

# REFERENCES

Bethell, C., Read, D., Stein, R. et al. "Identifying Children with
Special Health Care Needs: Development and Evaluation of a Short
Screening Instrument." *Ambulatory Pediatrics*, vol. 2, no 1, 2002, pp.
38-47.

Blumberg, S., Olson, L., Frankel, M., et al. "Design and Operation of
the National Survey of Children with Special Health Care Needs."
National Center for Health Statistics, *Vital and Health Statistics,*
41(1), 2003.

Gillcrist, J., Kasprzyk, D. and Mitchell, S. "Report on Data Quality in
the National Survey of SSI Children and Families Database" Washington,
DC: Mathematica Policy Research, 2004.

Mathiowetz, N., Brown, C., Bound, J. "Measurement Error in Surveys of
the Low-Income Population." In *Studies of Welfare Populations: Data
Collection and Research Issues* (eds. M. Ver Ploeg, R. Moffitt, and C.
Citro). Committee on National Statistics. Division of Behavioral and
Social Sciences and Education. Washington, DC: National Academy Press,
2002.

National Center for Health Statistics. "Design and Estimation for the
National Health Interview Survey, 1995--2004," *Vital and Health
Statistics*, U.S. Department of Health and Human Services, Centers for
Disease Control and Prevention, June 2000.

Potter, Frank. "Report on Revised Sampling Design: National Survey of
SSI Children and Families, Final Report." Washington DC: Mathematica
Policy Research, July 2000.

Potter, F. and Diaz-Tena, N. " Weighting, Nonresponse Adjustments and
Imputation: National Survey of SSI Children and Families." Washington,
DC: Mathematica Policy Research, Inc., July 2003.

Research Triangle Institute. *SUDAAN User's Manual, Release 8.0*.
Research Triangle Park, NC: Research Triangle Institute, 2001.

U.S. Bureau of the Census, *Survey of Income and Program Participation
Users' Guide, Third Edition*, U.S. Department of Commerce, Economics and
Statistics Administration, Washington, D.C., 2001.

Wolter, K.M. *Introduction to Variance Estimation*. New York:
Springer-Verlag, 1985.

# 

# 

**[Appendix]{.smallcaps}**

# APPENDIX

## Items from Four Surveys

Table 1: Demographic Items

Table 2: Functional Impairment Items

Table 3: Asset, Income, and Benefit Items

Table 4: Health Insurance, Service Use, and Unmet Need Items

[Notes]{.smallcaps}: NSCF: National Survey of Children and Families

CSHCN: Children with Special Health Care Needs Survey

SIPP: Survey of Income and Program Participation

NHIS: National Health Interview Survey

TABLE 1

DEMOGRAPHIC ITEMS

+------+---------------+---------------+---------------+---------------+
| **It | **NCSF**      | **CSHCN**     | **SIPP**      | **NHIS**      |
| em** |               |               |               |               |
+======+===============+===============+===============+===============+
| Chi  | First, I      | Is child male | Sex of this   | (Is/Are)      |
| ld's | would like to | or female     | person        | (Person) male |
| Ge   | verify some   |               |               | or female?    |
| nder | information   |               |               |               |
|      | about (NAME). |               |               |               |
|      | Is (NAME)     |               |               |               |
|      | male or       |               |               |               |
|      | female?       |               |               |               |
+------+---------------+---------------+---------------+---------------+
| Chi  | What is       | You have      | Age as of     | What is       |
| ld's | (NAME)\'s     | previously    | last birthday | (             |
| Age  | date of       | given the     |               | your/name)age |
|      | birth?        | name(s) and   |               | and date of   |
|      |               | birth date(s) |               | birth? Please |
|      |               | of \[READ     |               | give month,   |
|      |               | NAMES IN      |               | day, and year |
|      |               | GRID\]. Now   |               | for the date  |
|      |               | would you     |               | of birth.     |
|      |               | please tell   |               |               |
|      |               | me the        |               |               |
|      |               | date(s) of    |               |               |
|      |               | birth for     |               |               |
|      |               | your other    |               |               |
|      |               | (ch           |               |               |
|      |               | ild/children) |               |               |
|      |               | under the age |               |               |
|      |               | of 18?        |               |               |
+------+---------------+---------------+---------------+---------------+
| Chi  | Now I'd like  | First, is     | Which of the  | Do you        |
| ld's | to ask some   | (CHILD 1) of  | categories on | consider      |
| E    | background    | Spanish,      | this card     | (NAME) to be  |
| thni | questions     | Hispanic, or  | best          | Hispanic or   |
| city | about (NAME). | Latino        | describes     | Latino?       |
|      | What is       | origin, that  | your origin   |               |
|      | (NAME'S)      | is Mexican,   | or descent?   | (Where did    |
|      | ethnic        | Mexi          |               | (your/name's) |
|      | background?   | can-American, | Canadian;     | ancestors     |
|      | Is (HE/SHE):  | Central       | Scotch-Irish; | come from?)   |
|      | Hispanic or   | American,     | Dominican     | READ IF       |
|      | Latino or not | South         | Republic;     | NECESSARY:    |
|      | Hispanic or   | American,     | Dutch;        |               |
|      | Latino        | Chicano, or   | Scottish;     | Puerto Rican  |
|      |               | Puerto Rican, | Other         |               |
|      |               | Cuban, or     | Hispanic;     | Cuban/Cuban   |
|      |               | other         | English;      |               |
|      |               | Spani         | Slovak;       | American      |
|      |               | sh-Caribbean? | Afr           | Dominican     |
|      |               |               | ican-American | (Republic)    |
|      |               |               | or French;    |               |
|      |               |               | Welsh         | Mexican       |
|      |               |               | A             |               |
|      |               |               | fro-American; | Mexican       |
|      |               |               | Fre           | American      |
|      |               |               | nch-Canadian; | Central or    |
|      |               |               | Other         | South         |
|      |               |               | European;     | American      |
|      |               |               | American      |               |
|      |               |               | Indian;       | Other Latin   |
|      |               |               | German;       | A             |
|      |               |               | Mexican       | merican/Other |
|      |               |               | Eskimo or     |               |
|      |               |               | Aleut;        | Other         |
|      |               |               | Hungarian;    | Hi            |
|      |               |               | Mexi          | spanic/Latino |
|      |               |               | can-American; |               |
|      |               |               |               |               |
|      |               |               | Arab; Irish;  |               |
|      |               |               | Chicano;      |               |
|      |               |               | Asian;        |               |
|      |               |               | Italian;      |               |
|      |               |               | Puerto Rican; |               |
|      |               |               | Pacific       |               |
|      |               |               | Islander;     |               |
|      |               |               | Polish;       |               |
|      |               |               | Cuban; West   |               |
|      |               |               | Indian;       |               |
|      |               |               | Russian;      |               |
|      |               |               | Central       |               |
|      |               |               | American;     |               |
|      |               |               | Another group |               |
|      |               |               | not listed    |               |
|      |               |               | Scandinavian; |               |
|      |               |               | South         |               |
|      |               |               | American;     |               |
|      |               |               | American      |               |
+------+---------------+---------------+---------------+---------------+
| Chi  | What is       | Now, I\'m     | Which of the  | What race do  |
| ld's | \[NAME's\]    | going to read | categories on | you consider  |
| Race | race? Is      | a list of     | this card     | (NAME) to be? |
|      | NAME: (Read   | categories.   | best          | Please select |
|      | list, code    | Please choose | describes     | one or more   |
|      | all that      | one or more   | your race?    | of these      |
|      | apply)        | of the        |               | categories.   |
|      |               | following     | White         |               |
|      | Alaska Native | categories to |               | White;        |
|      | or American   | describe      | Black         | Black/African |
|      | Indian        | (CHILD 1)'s   |               | American;     |
|      |               | race. Is      | American      | Indian        |
|      | Asian         | (CHILD 1)     | Indian,       | (American);   |
|      |               | White, Black  | Aleut, or     | Alaska        |
|      | Black or      | or African    | Eskimo        | Native;       |
|      | African       | American,     |               | Native        |
|      | American      | American      | Asian or      | Hawaiian;     |
|      |               | Indian,       | Pacific       | Guamanian;    |
|      | Native        | Alaska        | Islander      | Samoan; Other |
|      | Hawaiian or   | Native,       |               | Pacific       |
|      | Other Pacific | Asian, or     | Other Race    | Islander;     |
|      | Islander      | Native        |               | Asian Indian; |
|      |               | Hawaiian or   |               | Chinese;      |
|      | White         | other Pacific |               | Filipino;     |
|      |               | Islander?     |               | Japanese;     |
|      | Don't know    | \[MARK ALL    |               | Korean;       |
|      |               | THAT APPLY    |               | Vietnamese;   |
|      | Refused       | WITH "X"\]    |               | Other Asian;  |
|      |               |               |               | Some other    |
|      |               |               |               | race          |
+------+---------------+---------------+---------------+---------------+
| Mate | Now I'd like  | What is the   | What is the   | What is the   |
| rnal | to ask some   | highest grade | highest level | HIGHEST level |
| E    | background    | or level of   | of school     | of school     |
| duca | questions     | school that   | \[NAME\] has  | (you/NAME)    |
| tion | about you and | you have      | completed or  | completed or  |
|      | your family.  | completed?    | the highest   | the highest   |
|      | What is the   |               | degree he/she | degree        |
|      | highest year  |               | has received? | (you/NAME)    |
|      | or grade      |               |               | received?     |
|      | (YOU/NAME'S   |               |               | Please tell   |
|      | MOTHER)       |               |               | me the number |
|      | finished in   |               |               | from the      |
|      | school?       |               |               | card.         |
+------+---------------+---------------+---------------+---------------+
| Pe   | Next, I\'d    | Now I have    | Total number  | Number of     |
| ople | like to ask   | some          | of persons in | persons in    |
| in   | you some      | questions     | household     | family        |
| H    | questions     | about your    | this month    |               |
| ouse | about the     | household.    |               | (Constructed  |
| hold | people who    | Please tell   | (Constructed  | Variable:     |
|      | live in your  | me how many   | Variable:     | FM_SIZE)      |
|      | household at  | people live   | EHHNUMPP)     |               |
|      | the present   | in this       |               |               |
|      | time. This    | household,    |               |               |
|      | includes both | including all |               |               |
|      | children and  | children and  |               |               |
|      | adults and    | anyone who    |               |               |
|      | may include   | normally      |               |               |
|      | individuals   | lives here    |               |               |
|      | who are not   | even if they  |               |               |
|      | related to    | are not here  |               |               |
|      | you. How many | now, like     |               |               |
|      | people all    | someone who   |               |               |
|      | together live | is away       |               |               |
|      | in this       | traveling or  |               |               |
|      | household,    | in a          |               |               |
|      | including     | hospital.     |               |               |
|      | yourself?     |               |               |               |
|      | 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.       |               |               |               |
+------+---------------+---------------+---------------+---------------+
| Nu   | (Constructed  |               | Kind of       | Parents       |
| mber | Variable:     |               | family (or    | present in    |
| of   | C_LIVING_     |               | p             | family        |
| Par  | ARRANGEMENTS) |               | seudo-family) |               |
| ents |               |               |               | (Constructed  |
| in   |               |               | (Constructed  | Variable:     |
| H    |               |               | Variable:     | PARENTS)      |
| ouse |               |               | ESFKIND)      |               |
| hold |               |               |               |               |
+------+---------------+---------------+---------------+---------------+

TABLE 2

FUNCTIONAL IMPAIRMENT ITEMS

+--------+-------------------+-------------------+-------------------+
| **Ite  | **NCSF**          | **CSHCN**         | **NHIS**          |
| m/Vari |                   |                   |                   |
| able** |                   |                   |                   |
+========+===================+===================+===================+
| School | During the past   | During the past   |                   |
| days   | 12 months, that   | 12 months, that   |                   |
| missed | is, since (FILL   | is since (1 YEAR  |                   |
|        | LAST MONTH, LAST  | AGO TODAY), about |                   |
|        | YEAR), about how  | how many days did |                   |
|        | many days did     | ("N" CHILD) miss  |                   |
|        | (NAME) miss work  | school because of |                   |
|        | or school because | illness or        |                   |
|        | of illness or     | injury?           |                   |
|        | injury?           |                   |                   |
+--------+-------------------+-------------------+-------------------+
| Amount | How many hours    | How many hours    |                   |
| of     | per week do       | per week do you   |                   |
| health | family members    | or other family   |                   |
| care   | spend providing   | members spend     |                   |
| pr     | this kind of      | providing this    |                   |
| ovided | health care for   | kind of care?     |                   |
| by     | (NAME) PROBE: By  |                   |                   |
| family | this kind of care |                   |                   |
|        | we mean: changing |                   |                   |
|        | bandages, taking  |                   |                   |
|        | care of medical   |                   |                   |
|        | equipment, giving |                   |                   |
|        | medications, and  |                   |                   |
|        | things like that. |                   |                   |
|        | Do not include    |                   |                   |
|        | routine care for  |                   |                   |
|        | (NAME).           |                   |                   |
+--------+-------------------+-------------------+-------------------+
| Extra  | Does (NAME) need  |                   | Does (NAME) name) |
| assi   | the help of other |                   | need the help of  |
| stance | persons with      |                   | other persons     |
| needed | personal care     |                   | with \....?       |
|        | needs, such as    |                   |                   |
|        | eating, bathing,  |                   | Bathing or        |
|        | dressing, getting |                   | showering?        |
|        | into our out of   |                   |                   |
|        | bed, or getting   |                   | Dressing?         |
|        | around inside the |                   |                   |
|        | home?             |                   | Eating?           |
|        |                   |                   |                   |
|        |                   |                   | Getting in or out |
|        |                   |                   | of bed or chairs? |
|        |                   |                   |                   |
|        |                   |                   | Getting around    |
|        |                   |                   | inside the home?  |
+--------+-------------------+-------------------+-------------------+

TABLE 3

ASSETS, INCOME AND BENEFIT ITEMS

+------+---------------+--------------+---+---------------+---+---------------+
| *    | **NCSF**      | **CSHCN**    |   | **SIPP**      |   | **NHIS**      |
| *Ite |               |              |   |               |   |               |
| m/Va |               |              |   |               |   |               |
| riab |               |              |   |               |   |               |
| le** |               |              |   |               |   |               |
+======+===============+==============+===+===============+===+===============+
| T    | For the       |              |   | Reaggregated  |   |               |
| otal | purpose of    |              |   | total         |   |               |
| Mon  | this survey,  |              |   | household     |   |               |
| thly | it is         |              |   | income for    |   |               |
| H    | important to  |              |   | relevant      |   |               |
| ouse | learn the     |              |   | month of the  |   |               |
| hold | total income  |              |   | reference     |   |               |
| In   | received by   |              |   | period        |   |               |
| come | all members   |              |   |               |   |               |
|      | of your       |              |   | (Constructed  |   |               |
|      | household in  |              |   | Variable:     |   |               |
|      | (LAST MONTH). |              |   | THTOTINC)     |   |               |
|      | This includes |              |   |               |   |               |
|      | money from    |              |   |               |   |               |
|      | jobs, and     |              |   |               |   |               |
|      | from the      |              |   |               |   |               |
|      | sources we    |              |   |               |   |               |
|      | just talked   |              |   |               |   |               |
|      | about. What   |              |   |               |   |               |
|      | was your      |              |   |               |   |               |
|      | household's   |              |   |               |   |               |
|      | total income  |              |   |               |   |               |
|      | last month    |              |   |               |   |               |
|      | before taxes  |              |   |               |   |               |
|      | and           |              |   |               |   |               |
|      | deductions?   |              |   |               |   |               |
|      | (IF K11 = 01, |              |   |               |   |               |
|      | RECEIVING     |              |   |               |   |               |
|      | FOOD STAMPS,  |              |   |               |   |               |
|      | FILL "DO NOT  |              |   |               |   |               |
|      | INCLUDE THE   |              |   |               |   |               |
|      | VALUE OF YOUR |              |   |               |   |               |
|      | FOOD          |              |   |               |   |               |
|      | STAMPS".)     |              |   |               |   |               |
|      | PROBE:        |              |   |               |   |               |
|      | Include money |              |   |               |   |               |
|      | from all      |              |   |               |   |               |
|      | sources and   |              |   |               |   |               |
|      | for all       |              |   |               |   |               |
|      | members of    |              |   |               |   |               |
|      | your          |              |   |               |   |               |
|      | household.    |              |   |               |   |               |
+------+---------------+--------------+---+---------------+---+---------------+
| Unea | (Constructed  |              |   | Total monthly |   |               |
| rned | Variable: SUM |              |   | income less   |   |               |
| In   | OF            |              |   | total monthly |   |               |
| come | C_UNEA        |              |   | earned income |   |               |
|      | RNED_INCOME_1 |              |   | (Constructed  |   |               |
|      | TO            |              |   | Variable:     |   |               |
|      | C_UNEARN      |              |   | THT           |   |               |
|      | ED_INCOME_15) |              |   | OTINC-THEARN) |   |               |
+------+---------------+--------------+---+---------------+---+---------------+
| Am   | What was the  |              |   | Amount        |   |               |
| ount | amount of the |              |   | received in   |   |               |
| of   | SSI benefit   |              |   | separate      |   |               |
| mon  | you received  |              |   | Federal SSI   |   |               |
| thly | for (NAME) in |              |   | payments for  |   |               |
| SSI  | (LAST MONTH,  |              |   | children in   |   |               |
| ben  | YEAR)?        |              |   | this month.   |   |               |
| efit |               |              |   |               |   |               |
|      |               |              |   | (Constructed  |   |               |
|      |               |              |   | Variable:     |   |               |
|      |               |              |   | T03AMTK)      |   |               |
+------+---------------+--------------+---+---------------+---+---------------+
| Wel  | In (LAST      |              | D |               | A |               |
| fare | MONTH) did    |              | i |               | t |               |
| r    | anybody in    |              | d |               | a |               |
| ecip | your          |              | y |               | n |               |
| ient | household     |              | o |               | y |               |
|      | receive any   |              | u |               | t |               |
|      | other kind of |              | r |               | i |               |
|      | welfare       |              | e |               | m |               |
|      | assistance,   |              | c |               | e |               |
|      | such as help  |              | e |               | d |               |
|      | with getting  |              | i |               | u |               |
|      | a job,        |              | v |               | r |               |
|      | placement in  |              | e |               | i |               |
|      | education or  |              | a |               | n |               |
|      | training      |              | n |               | g |               |
|      | programs, or  |              | y |               | ( |               |
|      | help with     |              | c |               | l |               |
|      | t             |              | a |               | a |               |
|      | ransportation |              | s |               | s |               |
|      | or child      |              | h |               | t |               |
|      | care? PROBE:  |              | o |               | y |               |
|      | Please        |              | r |               | e |               |
|      | include only  |              | o |               | a |               |
|      | assistance    |              | t |               | r |               |
|      | received      |              | h |               | ) |               |
|      | through       |              | e |               | , |               |
|      | welfare.      |              | r |               | e |               |
|      |               |              | a |               | v |               |
|      |               |              | s |               | e |               |
|      |               |              | s |               | n |               |
|      |               |              | i |               | f |               |
|      |               |              | s |               | o |               |
|      |               |              | t |               | r |               |
|      |               |              | a |               | o |               |
|      |               |              | n |               | n |               |
|      |               |              | c |               | e |               |
|      |               |              | e |               | m |               |
|      |               |              | f |               | o |               |
|      |               |              | r |               | n |               |
|      |               |              | o |               | t |               |
|      |               |              | m |               | h |               |
|      |               |              | a |               | , |               |
|      |               |              | s |               | d |               |
|      |               |              | t |               | i |               |
|      |               |              | a |               | d |               |
|      |               |              | t |               | ( |               |
|      |               |              | e |               | y |               |
|      |               |              | o |               | o |               |
|      |               |              | r |               | u |               |
|      |               |              | c |               | / |               |
|      |               |              | o |               | a |               |
|      |               |              | u |               | n |               |
|      |               |              | n |               | y |               |
|      |               |              | t |               | f |               |
|      |               |              | y |               | a |               |
|      |               |              | w |               | m |               |
|      |               |              | e |               | i |               |
|      |               |              | l |               | l |               |
|      |               |              | f |               | y |               |
|      |               |              | a |               | m |               |
|      |               |              | r |               | e |               |
|      |               |              | e |               | m |               |
|      |               |              | p |               | b |               |
|      |               |              | r |               | e |               |
|      |               |              | o |               | r |               |
|      |               |              | g |               | l |               |
|      |               |              | r |               | i |               |
|      |               |              | a |               | v |               |
|      |               |              | m |               | i |               |
|      |               |              | ? |               | n |               |
|      |               |              |   |               | g |               |
|      |               |              |   |               | h |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | ) |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | c |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | i |               |
|      |               |              |   |               | v |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | n |               |
|      |               |              |   |               | y |               |
|      |               |              |   |               | C |               |
|      |               |              |   |               | A |               |
|      |               |              |   |               | S |               |
|      |               |              |   |               | H |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | s |               |
|      |               |              |   |               | s |               |
|      |               |              |   |               | i |               |
|      |               |              |   |               | s |               |
|      |               |              |   |               | t |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | n |               |
|      |               |              |   |               | c |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | f |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | m |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | s |               |
|      |               |              |   |               | t |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | t |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | c |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | u |               |
|      |               |              |   |               | n |               |
|      |               |              |   |               | t |               |
|      |               |              |   |               | y |               |
|      |               |              |   |               | w |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | l |               |
|      |               |              |   |               | f |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | p |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | g |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | m |               |
|      |               |              |   |               | s |               |
|      |               |              |   |               | u |               |
|      |               |              |   |               | c |               |
|      |               |              |   |               | h |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | s |               |
|      |               |              |   |               | ( |               |
|      |               |              |   |               | s |               |
|      |               |              |   |               | p |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | c |               |
|      |               |              |   |               | i |               |
|      |               |              |   |               | f |               |
|      |               |              |   |               | i |               |
|      |               |              |   |               | c |               |
|      |               |              |   |               | p |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | g |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | m |               |
|      |               |              |   |               | n |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | m |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | ) |               |
|      |               |              |   |               | ? |               |
+------+---------------+--------------+---+---------------+---+---------------+
| Food | In (LAST      |              | W |               | ( |               |
| St   | MONTH) did    |              | e |               | W |               |
| amps | anybody in    |              | r |               | e |               |
|      | your          |              | e |               | r |               |
|      | household     |              | y |               | e |               |
|      | receive any   |              | o |               | / |               |
|      | Food Stamps?  |              | u |               | W |               |
|      |               |              | a |               | a |               |
|      |               |              | u |               | s |               |
|      |               |              | t |               | ) |               |
|      |               |              | h |               | ( |               |
|      |               |              | o |               | y |               |
|      |               |              | r |               | o |               |
|      |               |              | i |               | u |               |
|      |               |              | z |               | / |               |
|      |               |              | e |               | a |               |
|      |               |              | d |               | n |               |
|      |               |              | t |               | y |               |
|      |               |              | o |               | o |               |
|      |               |              | r |               | n |               |
|      |               |              | e |               | e |               |
|      |               |              | c |               | i |               |
|      |               |              | e |               | n |               |
|      |               |              | i |               | t |               |
|      |               |              | v |               | h |               |
|      |               |              | e |               | e |               |
|      |               |              | f |               | f |               |
|      |               |              | o |               | a |               |
|      |               |              | o |               | m |               |
|      |               |              | d |               | i |               |
|      |               |              | s |               | l |               |
|      |               |              | t |               | y |               |
|      |               |              | a |               | ) |               |
|      |               |              | m |               | a |               |
|      |               |              | p |               | u |               |
|      |               |              | s |               | t |               |
|      |               |              | ? |               | h |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | i |               |
|      |               |              |   |               | z |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | d |               |
|      |               |              |   |               | t |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | c |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | i |               |
|      |               |              |   |               | v |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | f |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | d |               |
|      |               |              |   |               | s |               |
|      |               |              |   |               | t |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | m |               |
|      |               |              |   |               | p |               |
|      |               |              |   |               | s |               |
|      |               |              |   |               | ( |               |
|      |               |              |   |               | w |               |
|      |               |              |   |               | h |               |
|      |               |              |   |               | i |               |
|      |               |              |   |               | c |               |
|      |               |              |   |               | h |               |
|      |               |              |   |               | i |               |
|      |               |              |   |               | n |               |
|      |               |              |   |               | c |               |
|      |               |              |   |               | l |               |
|      |               |              |   |               | u |               |
|      |               |              |   |               | d |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | s |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | f |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | d |               |
|      |               |              |   |               | s |               |
|      |               |              |   |               | t |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | m |               |
|      |               |              |   |               | p |               |
|      |               |              |   |               | c |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | d |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | v |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | u |               |
|      |               |              |   |               | c |               |
|      |               |              |   |               | h |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | , |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | c |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | s |               |
|      |               |              |   |               | h |               |
|      |               |              |   |               | g |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | n |               |
|      |               |              |   |               | t |               |
|      |               |              |   |               | s |               |
|      |               |              |   |               | f |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | m |               |
|      |               |              |   |               | t |               |
|      |               |              |   |               | h |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | s |               |
|      |               |              |   |               | t |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | t |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | f |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | f |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | o |               |
|      |               |              |   |               | d |               |
|      |               |              |   |               | ) |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | t |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | n |               |
|      |               |              |   |               | y |               |
|      |               |              |   |               | t |               |
|      |               |              |   |               | i |               |
|      |               |              |   |               | m |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | d |               |
|      |               |              |   |               | u |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | i |               |
|      |               |              |   |               | n |               |
|      |               |              |   |               | g |               |
|      |               |              |   |               | ( |               |
|      |               |              |   |               | l |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | s |               |
|      |               |              |   |               | t |               |
|      |               |              |   |               | y |               |
|      |               |              |   |               | e |               |
|      |               |              |   |               | a |               |
|      |               |              |   |               | r |               |
|      |               |              |   |               | ) |               |
|      |               |              |   |               | ? |               |
+------+---------------+--------------+---+---------------+---+---------------+
| Sc   | In the past   |              | F |               |   |               |
| hool | 12 months,    |              | r |               |   |               |
| L    | did any of    |              | o |               |   |               |
| unch | the children  |              | m |               |   |               |
|      | living with   |              | t |               |   |               |
|      | you receive   |              | h |               |   |               |
|      | free or       |              | e |               |   |               |
|      | reduced       |              | f |               |   |               |
|      |               |              | i |               |   |               |
|      | price school  |              | r |               |   |               |
|      | lunches       |              | s |               |   |               |
|      | because they  |              | t |               |   |               |
|      | qualified for |              | d |               |   |               |
|      | the Federal   |              | a |               |   |               |
|      | School Lunch  |              | y |               |   |               |
|      | Program?      |              | o |               |   |               |
|      |               |              | f |               |   |               |
|      |               |              | t |               |   |               |
|      |               |              | h |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | f |               |   |               |
|      |               |              | i |               |   |               |
|      |               |              | r |               |   |               |
|      |               |              | s |               |   |               |
|      |               |              | t |               |   |               |
|      |               |              | r |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | f |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | r |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | n |               |   |               |
|      |               |              | c |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | m |               |   |               |
|      |               |              | o |               |   |               |
|      |               |              | n |               |   |               |
|      |               |              | t |               |   |               |
|      |               |              | h |               |   |               |
|      |               |              | t |               |   |               |
|      |               |              | o |               |   |               |
|      |               |              | t |               |   |               |
|      |               |              | h |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | n |               |   |               |
|      |               |              | d |               |   |               |
|      |               |              | o |               |   |               |
|      |               |              | f |               |   |               |
|      |               |              | t |               |   |               |
|      |               |              | h |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | f |               |   |               |
|      |               |              | o |               |   |               |
|      |               |              | u |               |   |               |
|      |               |              | r |               |   |               |
|      |               |              | t |               |   |               |
|      |               |              | h |               |   |               |
|      |               |              | r |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | f |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | r |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | n |               |   |               |
|      |               |              | c |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | m |               |   |               |
|      |               |              | o |               |   |               |
|      |               |              | n |               |   |               |
|      |               |              | t |               |   |               |
|      |               |              | h |               |   |               |
|      |               |              | , |               |   |               |
|      |               |              | d |               |   |               |
|      |               |              | i |               |   |               |
|      |               |              | d |               |   |               |
|      |               |              | a |               |   |               |
|      |               |              | n |               |   |               |
|      |               |              | y |               |   |               |
|      |               |              | o |               |   |               |
|      |               |              | f |               |   |               |
|      |               |              | t |               |   |               |
|      |               |              | h |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | c |               |   |               |
|      |               |              | h |               |   |               |
|      |               |              | i |               |   |               |
|      |               |              | l |               |   |               |
|      |               |              | d |               |   |               |
|      |               |              | r |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | n |               |   |               |
|      |               |              | i |               |   |               |
|      |               |              | n |               |   |               |
|      |               |              | t |               |   |               |
|      |               |              | h |               |   |               |
|      |               |              | i |               |   |               |
|      |               |              | s |               |   |               |
|      |               |              | h |               |   |               |
|      |               |              | o |               |   |               |
|      |               |              | u |               |   |               |
|      |               |              | s |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | h |               |   |               |
|      |               |              | o |               |   |               |
|      |               |              | l |               |   |               |
|      |               |              | d |               |   |               |
|      |               |              | u |               |   |               |
|      |               |              | s |               |   |               |
|      |               |              | u |               |   |               |
|      |               |              | a |               |   |               |
|      |               |              | l |               |   |               |
|      |               |              | l |               |   |               |
|      |               |              | y |               |   |               |
|      |               |              | g |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | t |               |   |               |
|      |               |              | a |               |   |               |
|      |               |              | l |               |   |               |
|      |               |              | u |               |   |               |
|      |               |              | n |               |   |               |
|      |               |              | c |               |   |               |
|      |               |              | h |               |   |               |
|      |               |              | o |               |   |               |
|      |               |              | f |               |   |               |
|      |               |              | f |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | r |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | d |               |   |               |
|      |               |              | a |               |   |               |
|      |               |              | t |               |   |               |
|      |               |              | s |               |   |               |
|      |               |              | c |               |   |               |
|      |               |              | h |               |   |               |
|      |               |              | o |               |   |               |
|      |               |              | o |               |   |               |
|      |               |              | l |               |   |               |
|      |               |              | ? |               |   |               |
+------+---------------+--------------+---+---------------+---+---------------+
| O    | In last month |              | S |               |   |               |
| ther | did (ANYBODY  |              | o |               |   |               |
| SSA  | IN NAME'S     |              | c |               |   |               |
| Bene | HOUSEHOLD)    |              | i |               |   |               |
| fits | receive any   |              | a |               |   |               |
|      | other social  |              | l |               |   |               |
|      | security      |              | s |               |   |               |
|      | payments?     |              | e |               |   |               |
|      | These include |              | c |               |   |               |
|      | retirement    |              | u |               |   |               |
|      | benefits,     |              | r |               |   |               |
|      | survivor's    |              | i |               |   |               |
|      | benefits, or  |              | t |               |   |               |
|      | social        |              | y |               |   |               |
|      | security      |              | c |               |   |               |
|      | disability    |              | o |               |   |               |
|      | insurance,    |              | v |               |   |               |
|      | also known as |              | e |               |   |               |
|      | SSDI?         |              | r |               |   |               |
|      |               |              | a |               |   |               |
|      |               |              | g |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | ( |               |   |               |
|      |               |              | C |               |   |               |
|      |               |              | o |               |   |               |
|      |               |              | n |               |   |               |
|      |               |              | s |               |   |               |
|      |               |              | t |               |   |               |
|      |               |              | r |               |   |               |
|      |               |              | u |               |   |               |
|      |               |              | c |               |   |               |
|      |               |              | t |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | d |               |   |               |
|      |               |              | V |               |   |               |
|      |               |              | a |               |   |               |
|      |               |              | r |               |   |               |
|      |               |              | i |               |   |               |
|      |               |              | a |               |   |               |
|      |               |              | b |               |   |               |
|      |               |              | l |               |   |               |
|      |               |              | e |               |   |               |
|      |               |              | : |               |   |               |
|      |               |              | R |               |   |               |
|      |               |              | C |               |   |               |
|      |               |              | U |               |   |               |
|      |               |              | T |               |   |               |
|      |               |              | Y |               |   |               |
|      |               |              | P |               |   |               |
|      |               |              | O |               |   |               |
|      |               |              | 1 |               |   |               |
|      |               |              | ) |               |   |               |
+------+---------------+--------------+---+---------------+---+---------------+
| Quit | For reasons   | Have you or  |   |               |   |               |
| bec  | related to    | other family |   |               |   |               |
| ause | (NAME'S)      | members      |   |               |   |               |
| of   | health, has   | stopped      |   |               |   |               |
| chi  | anyone in the | working      |   |               |   |               |
| ld's | household     | because of   |   |               |   |               |
| co   | ever quit     | (CHILD)'s    |   |               |   |               |
| ndit | working       | health       |   |               |   |               |
| ion? |               | conditions?  |   |               |   |               |
|      | other than    |              |   |               |   |               |
|      | normal        |              |   |               |   |               |
|      | maternity     |              |   |               |   |               |
|      | leave?        |              |   |               |   |               |
+------+---------------+--------------+---+---------------+---+---------------+

TABLE 4

HEALTH INSURANCE, SERVICE USE, AND UNMET NEED ITEMS

+------+--------------+---------------+---------------+---------------+
| *    | **NCSF**     | **CSHCN**     | **SIPP**      | **NHIS**      |
| *Ite |              |               |               |               |
| m/Va |              |               |               |               |
| riab |              |               |               |               |
| le** |              |               |               |               |
+======+==============+===============+===============+===============+
| Has  | The next     | At this time, | Were NAME(S)  | FHI.070 What  |
| Medi | questions    | is (CHILD)    | covered by    | kind of       |
| caid | are about    | covered by    | Medicaid at   | health        |
|      | all types of | Medicaid, a   | any time      | insurance or  |
|      | health       | health        | between       | health care   |
|      | insurance    | insurance     | \[reference   | coverage      |
|      | and health   | program for   | month 1\] 1st | (do/does)     |
|      | care         | persons with  | and today?    | (you/subject  |
|      | coverage     | certain       |               | name) have?   |
|      | that (NAME)  | income levels |               | include those |
|      | may have.    | and persons   |               | that pay for  |
|      | (NAME)       | with          |               | only one type |
|      | covered by   | disabilities? |               | of service    |
|      | Medicaid, a  | \[INSERT IF   |               | (nursing home |
|      | health       | APPLICABLE:   |               | care,         |
|      | insurance    | In this       |               | accidents, or |
|      | program for  | state, the    |               | dental care), |
|      | persons with | program is    |               | exclude       |
|      | certain      | sometimes     |               | private plans |
|      | income       | called        |               | that only     |
|      | levels and   | \[STATE       |               | provide extra |
|      | persons with | MEDICAID      |               | cash while    |
|      | d            | NAME\]        |               | hospitalized. |
|      | isabilities? |               |               |               |
|      | In this      |               |               | Private       |
|      | state, the   |               |               | health        |
|      | program is   |               |               | insurance     |
|      | sometimes    |               |               | plan from     |
|      | called (FILL |               |               | employer;     |
|      | STATE        |               |               | Private       |
|      | MEDICAID     |               |               | health        |
|      | NAME).       |               |               | insurance     |
|      | PROBE:       |               |               | plan          |
|      | Medicaid is  |               |               | purchased     |
|      | a medical    |               |               | directly;     |
|      | assistance   |               |               | Private       |
|      | program. It  |               |               | health        |
|      | serves       |               |               | insurance     |
|      | low-income   |               |               | plan through  |
|      | people of    |               |               | a state or    |
|      | every age.   |               |               | local         |
|      | Medical      |               |               | government or |
|      | bills are    |               |               | community     |
|      | paid from    |               |               | program;      |
|      | federal,     |               |               | Medicare;     |
|      | state and    |               |               | Medi-Gap;     |
|      | local tax    |               |               | Medicaid;     |
|      | funds.       |               |               | SCHIP;        |
|      | Patients     |               |               | Military      |
|      | usually pay  |               |               | h             |
|      | no part of   |               |               | ealthcare/VA; |
|      | the costs    |               |               | TRICARE/CHAMP |
|      | for covered  |               |               | US/CHAMP-VA ; |
|      | medical      |               |               | Indian Health |
|      | expenses. It |               |               | Service;      |
|      | is run by    |               |               | St            |
|      | state and    |               |               | ate-Sponsored |
|      | local        |               |               | health plan;  |
|      | governments  |               |               | Other         |
|      | within       |               |               | government    |
|      | federal      |               |               | program;      |
|      | guidelines.  |               |               | Single        |
|      |              |               |               | service plan  |
|      |              |               |               | (e.g.,        |
|      |              |               |               | dental,       |
|      |              |               |               | vision,       |
|      |              |               |               | pr            |
|      |              |               |               | escriptions); |
|      |              |               |               | No coverage   |
|      |              |               |               | of any kind   |
+------+--------------+---------------+---------------+---------------+
| Has  | (NAME)       | At this time, | At any time   | See above     |
| S    | covered by   | is (CHILD)    | between       |               |
| CHIP | the State    | covered by    | (reference    |               |
|      | Children's   | the State     | month 1) 1st  |               |
|      | Health       | Children's    | and today     |               |
|      | Insurance    | Health        | were you      |               |
|      | Program, or  | Insurance     | covered by    |               |
|      | S-CHIP?      | Program or    | (state        |               |
|      | (FILL IF     | S-CHIP? In    | program       |               |
|      | S-CHIP NAME  | this state,   | name), the    |               |
|      | IS DIFFERENT | the program   | State         |               |
|      | THAN STATE   | is sometimes  | Children\'s   |               |
|      | MEDICAID     | called        | Health        |               |
|      | NAME) In     | \[INSERT      | Insurance     |               |
|      | this state,  | S-CHIP        | Program that  |               |
|      | the program  | NAME\].       | helps         |               |
|      | is sometimes |               | families get  |               |
|      | called (FILL |               | health        |               |
|      | S-CHIP       |               | insurance for |               |
|      | NAME).       |               | children?     |               |
|      | PROBE: The   |               |               |               |
|      | State        |               |               |               |
|      | Children's   |               |               |               |
|      | Health       |               |               |               |
|      | Insurance    |               |               |               |
|      | Program      |               |               |               |
|      | (S-CHIP)     |               |               |               |
|      | expands      |               |               |               |
|      | health       |               |               |               |
|      | coverage to  |               |               |               |
|      | uninsured    |               |               |               |
|      | children     |               |               |               |
|      | whose        |               |               |               |
|      | families     |               |               |               |
|      | earn too     |               |               |               |
|      | much for     |               |               |               |
|      | Medicaid but |               |               |               |
|      | too little   |               |               |               |
|      | to afford    |               |               |               |
|      | private      |               |               |               |
|      | health       |               |               |               |
|      | insurance.   |               |               |               |
+------+--------------+---------------+---------------+---------------+
| Has  | Is (NAME)    | At this time, | (Constructed  | See above     |
| mili | covered by   | is (CHILD)    | variable:     |               |
| tary | military     | covered by    | RPHRVH1       |               |
| i    | health care, | military      | (types of     |               |
| nsur | TRICARE,     | health care,  | health        |               |
| ance | CHAMPUS, OR  | TRICARE,      | insurance)    |               |
|      | CHAMP-VA?    | CHAMPUS, or   | and EHEMPLY   |               |
|      |              | CHAMP-VA?     | (source of    |               |
|      |              |               | health        |               |
|      |              |               | insurance)    |               |
+------+--------------+---------------+---------------+---------------+
| Ever | In the past  | In the past   |               | In the past   |
| time | 12 months,   | 12 months,    |               | 12 months,    |
| not  | that is      | was there any |               | was there any |
| cov  | since (FILL  | time when     |               | time when     |
| ered | THIS MONTH,  | (CHILD) was   |               | (NAME) did    |
| in   | LAST YEAR),  | not covered   |               | NOT have ANY  |
| past | was there    | by ANY health |               | health        |
| 12   | any time     | insurance?    |               | insurance or  |
| mon  | when (FILL   |               |               | coverage?     |
| ths? | NAME WAS IF  |               |               |               |
|      | RTYPE = 01,  |               |               |               |
|      | 03; YOU WERE |               |               |               |
|      | IF RTYPE =   |               |               |               |
|      | 02) not      |               |               |               |
|      | covered by   |               |               |               |
|      | any health   |               |               |               |
|      | insurance?   |               |               |               |
+------+--------------+---------------+---------------+---------------+
| T    | In the past  | In the past   |               | In the past   |
| imes | 12 months,   | 12 months,    |               | 12 months,    |
| seen | about how    | about how     |               | about how     |
| p    | many months  | many months   |               | many months   |
| hysi | was (NAME)   | was (CHILD)   |               | was (NAME)    |
| cian | without      | without any   |               | without       |
| in   | coverage?    | health        |               | coverage?     |
| last |              | insurance or  |               |               |
| 12   |              | coverage?     |               |               |
| mo   |              |               |               |               |
| nths |              |               |               |               |
+------+--------------+---------------+---------------+---------------+
| Hosp | During the   |               |               | How many      |
| ital | past 12      |               |               | different     |
| ad   | months, how  |               |               | times did     |
| miss | many         |               |               | (NAME) stay   |
| ions | different    |               |               | in any        |
|      | times, if    |               |               | hospital      |
|      | any, did     |               |               | overnight or  |
|      | (NAME) stay  |               |               | longer DURING |
|      | overnight or |               |               | THE PAST 12   |
|      | longer in a  |               |               | MONTHS?       |
|      | hospital? Do |               |               |               |
|      | not include  |               |               |               |
|      | an overnight |               |               |               |
|      | stay in the  |               |               |               |
|      | emergency    |               |               |               |
|      | room.        |               |               |               |
+------+--------------+---------------+---------------+---------------+
| Gone | People often | People often  |               |               |
| wit  | delay or do  | delay or do   |               |               |
| hout | not get      | not get       |               |               |
| ne   | needed       | needed health |               |               |
| eded | healthcare.  | care. By      |               |               |
| he   | In the past  | health care I |               |               |
| alth | 12 months,   | mean medical  |               |               |
| c    | have you     | care as well  |               |               |
| are? | delayed or   | as other      |               |               |
|      | gone without | kinds of care |               |               |
|      | health care  | like dental   |               |               |
|      | for (NAME)?  | care, mental  |               |               |
|      |              | health        |               |               |
|      |              | services,     |               |               |
|      |              | physical,     |               |               |
|      |              | occupational, |               |               |
|      |              | or speech     |               |               |
|      |              | therapies,    |               |               |
|      |              | and special   |               |               |
|      |              | education     |               |               |
|      |              | services. In  |               |               |
|      |              | the past 12   |               |               |
|      |              | months, have  |               |               |
|      |              | you delayed   |               |               |
|      |              | or gone       |               |               |
|      |              | without       |               |               |
|      |              | health care   |               |               |
|      |              | for (CHILD)?  |               |               |
+------+--------------+---------------+---------------+---------------+
| Rece | During the   | (During the   |               |               |
| ived | past 12      | past 12       |               |               |
| ne   | months, was  | months was    |               |               |
| eded | there any    | there any     |               |               |
| de   | time when    | time when     |               |               |
| ntal | (NAME)       | (CHILD)       |               |               |
| care | needed       | needed)       |               |               |
| in   | dental care, | dental care   |               |               |
| last | including    | including     |               |               |
| 12   | check-ups,   | check-ups?    |               |               |
| mon  | but didn't   |               |               |               |
| ths? | get it?      |               |               |               |
+------+--------------+---------------+---------------+---------------+
| Rece | During the   | (During the   |               |               |
| ived | past 12      | past 12       |               |               |
| ne   | months, was  | months, was   |               |               |
| eded | there any    | there any     |               |               |
| med  | time when    | time when     |               |               |
| icat | (NAME)       | (CHILD)       |               |               |
| ions | needed       | needed)       |               |               |
| in   | prescription | prescription  |               |               |
| last | medicines    | medications?  |               |               |
| 12   | but didn\'t  |               |               |               |
| mon  | get them?    |               |               |               |
| ths? |              |               |               |               |
+------+--------------+---------------+---------------+---------------+

[^1]: ^1^MPR developed and implemented the NSCF for SSA, and has
    prepared public use data files that are available from the SSA
    project officer, Ms. Michele Adler (michele.c.adler@ssa.gov or
    410-965-5519).

[^2]: In addition to including child SSI recipients, the NSCF sample
    also included children who (1) applied for but did not receive SSI,
    (2) had lost SSI benefits by the time of the survey, or (3) were
    young adults (aged 18-24). We did not use these groups in our
    comparative analyses because the other surveys either did not sample
    these populations or had data limitations that prevented us from
    accurately identifying the comparable populations.

[^3]: Pickett, Clark. "Children Receiving SSI, December 2000."
    Baltimore, MD: Social Security Administration, 2001. (Available at
    http://ssa.gov/policy/programs/ssipub.html) We are using data from
    this report because the NSCF sample was poststratified to December
    2000 administrative counts provided by SSA to MPR (Potter and
    Diaz-Tena 2003). The files used to produce the poststratification
    controls were used originally to develop the sample frame and sample
    for the survey (Potter 2000). We also used December 2000 data files
    for poststratification because they were the most complete files
    available to us. Further analyses using other SSA administrative
    data files would be needed to poststratify population estimates to a
    point in time closer to the actual survey administration (for
    example, to December 2001, the approximate mid-point of the survey
    period).

[^4]: The NSCF sample included only child SSI recipients and applicants
    because SSA wanted to focus specifically on this population.
    Consequently, the NSCF sample did not include children who were
    similar to SSI child recipients and applicants in terms of economic
    status or functional impairments who did not apply for SSI benefits.
    The other survey samples did include some of these children.

[^5]: SIPP's sample of 35,100 living quarters or households is divided
    into four subsamples called rotation groups. One rotation group is
    interviewed each month over the course of four months. Most of
    SIPP's survey items collect data on the four months preceding the
    interview month. Those four months are collectively called the
    survey reference months or reference period. A "wave" is one cycle
    of four interviews administered to the entire sample using the same
    questionnaire. For example, the first interview for wave 1, rotation
    group 1, was fielded in February 2001 and, therefore, the reference
    period for rotation group 1 was October 2000 through January 2001.
    The 2001 SIPP will have 12 waves.

    This report uses data collected from the wave 1 core questionnaire.
    Like all the other waves in SIPP, wave 1 was fielded in a four-month
    period. In one of these months, information was obtained on the four
    rotation groups for a "common month." The common month in wave 1 is
    January 2001. In order to obtain cross-sectional estimates of our
    population at a point in time (January 2001), we selected the
    respondents who were interviewed during that common month as our
    study sample. It is also possible to identify children in the SIPP
    sample who became SSI recipients during a 12- month period. This
    strategy increases the number of child SSI recipients in the sample,
    but the sample still remains small (384) compared with the number of
    individuals in the NSCF sample. Also, this strategy yields estimates
    of the number of children who *ever* received SSI payments in a
    year, a concept different from the point-in-time estimates provided
    by the other surveys. Hence, to be consistent with the other
    surveys, we only studied children identified as receiving SSI
    payments in the common month of wave 1. Future studies could address
    the question of whether SIPP data are useful in estimating the
    number and characteristics of children who ever received an SSI
    payment in a given 12-month period.

[^6]: We do not show other levels of significance (i.e., .01 or .001)
    because doing so would complicate the tables excessively.

[^7]: We examined an alternative approach to conducting statistical
    tests on each comparison. This alternative approach involved summing
    the chi-square statistics across multiple comparisons and comparing
    the resulting sum to the criterion value for the appropriate degrees
    of freedom (two or three, depending on whether the NSCF was being
    compared to two or three surveys). This approach indicates whether
    the NSCF estimate was significantly different from *any* of the
    other surveys used in the comparison. If we found a significant
    difference, we then examined the individual, two-way comparisons to
    determine *which* survey was different from the NSCF. The advantage
    of this two-step approach is that it reduces the probability of
    finding a significant difference by chance because fewer comparisons
    are made. However, both approaches yield essentially similar
    findings. We report findings only from two-way comparisons because
    they are easier to present and interpret.

[^8]: We did not examine differences in estimates of earned income
    because the NSCF data set does not include this variable.

[^9]: We do not present estimates of the amount of private insurance
    coverage for SSI children because the surveys differed substantially
    in the way this information was gathered or coded. In addition,
    there is evidence that some respondents confuse private health
    insurance with certain government programs; for example, some
    respondents indicate that they are enrolled in both Medicaid and
    SCHIP.