Document ID: EPA-HQ-ORD-2005-0010-0009
Agency: epa
Document Type: Supporting & Related Material
Title: 
Posted Date: 2005-09-28T04:00Z

Household
Rostering
Script
NCS
Herald
Cohort
Study
Instrument
#
1
Household
Rostering
Script
Eligibility:
All
contacted
households
Mode
of
Administration:
Interviewer,
home
visit
8/
4/
2005
Public
reporting
burden
for
this
collection
of
information
is
estimated
to
average
10
minutes
per
response,
including
the
time
for
reviewing
instructions,
searching
existing
data
sources,
gathering
and
maintaining
the
data
needed,
and
completing
and
reviewing
the
collection
of
information.
An
agency
may
not
conduct
or
sponsor,
and
a
person
is
not
required
to
respond
to,
a
collection
of
information
unless
it
displays
a
currently
valid
OMB
control
number.
Send
comments
regarding
this
burden
estimate
or
any
other
aspect
of
this
collection
of
information,
including
suggestions
for
reducing
this
burden,
to:
Dr.
Pauline
Mendola,
US
EPA,
MD­
58A,
Research
Triangle
Park,
NC
27711.
E­
mail:
mendola.
pauline@
epa.
gov.
Household
Rostering
Script
HOUSEHOLD
ROSTERING
SCRIPT
FOR
IPAQ
1.
Hello,
my
name
is
______
with
RTI
International
in
North
Carolina.
We
are
conducting
a
study
of
children's
health
sponsored
by
the
U.
S.
Environmental
Protection
Agency.
You
should
have
received
a
letter
explaining
the
study.
(
HAND
R
COPY
OF
LETTER
)

2.
First,
just
let
me
verify:
do
you
live
here?
IF
NOT
OBVIOUS:
And
are
you
18
or
older?
IF
NO
TO
EITHER,
ASK
FOR
AN
ADULT
RESIDENT
AND
BEGIN
AGAIN.

ADULT
RESPONDENT
AVAILABLE
(
CONTINUE)
ADULT
RESPONDENT
NOT
AVAILABLE
NOW
(
GO
TO
RECORD
OF
CALLS)

3.
I
just
need
to
verify
 
is
this
[
READ
COMPLETE
ADDRESS
INCLUDING
CITY,
STATE,
AND
ZIP]?

ADDRESS
IS
CORRECT
 
CONTINUE
TO
STATEMENT
BEFORE
Q4.
NEED
TO
EDIT
ADDRESS
THEN
CONTINUE
TO
STATEMENT
BEFORE
Q4.
FI
AT
WRONG
ADDRESS

I'm
sorry,
I
must
be
at
the
wrong
address.
I
was
looking
for
[
READ
ADDRESS].
Thank
you
for
your
end
[
END
ROSTERING]

GIVE
PERSON
STUDY
DESCRIPTION
AND
SAY:
Please
read
this
statement.
It
describes
the
survey
and
the
legislation
that
assures
the
confidentiality
of
any
information
that
you
provide,
and
it
states
that
your
participation
is
voluntary.

4.
[
FOR
REGULAR
HOUSING
UNITS
(
HUs)
SUCH
AS
INDIVIDUAL
HOUSES,
TOWNHOUSES,
DUPLEXES,
TRAILERS,
COTTAGES]:
Are
there
any
other
living
quarters
within
this
structure
or
on
this
property,
such
as
a
separate
apartment
with
a
separate
entrance?

YES
(
GO
TO
MISSED
DU
ADDRESS
SCREEN)
NO
(
CONTINUE)

[
FOR
APARTMENT/
CONDO
HUs:
DON'T
ASK,
JUST
TAP
"
APT/
CONDO"
TO
CONTINUE]

5.
(
Will/
Have)
you
or
anyone
else
in
this
household
(
live/
lived)
here
for
most
of
the
time
during
the
months
of
[
SCREENING
MONTHS]?

6.
(
Including
yourself),
how
many
people
in
this
household,
age
18
and
older
(
will
live/
lived)
here
for
most
of
the
time
during
the
months
of
[
SCREENING
MONTHS]?
(
Do
not
include
anyone
who
(
will
live/
lived)
at
school
or
somewhere
else
for
most
of
the
time
during
the
months
of
[
SCREENING
MONTHS])

IF
MORE
THAN
1
PERSON
IN
THE
HOUSEHOLD,
CONTINUE.
IF
ONLY
1
PERSON
IN
THE
HOUSEHOLD,
SKIP
TO
Q8.

7.
Next
I'll
ask
a
few
questions
about
the
people
who
live
here.
Let's
start
with
the
person
or
one
of
the
persons
living
here
who
owns
or
rents
this
home.
We'll
refer
to
this
person
as
the
householder.

IF
MORE
THAN
1
PERSON,
FI
WILL
RECORD:
IS
THIS
PERSON
THE
SCREENING
RESPONDENT?
TAP
YES
TO
CONTINUE.

8.
Please
tell
me
the
age
of
this
person
on
his
or
her
last
birthday.
IF
RESPONDENT
IS
HOUSEHOLDER:
Please
tell
me
your
age
on
your
last
birthday.
Household
Rostering
Script
9.
ASK
ONLY
IF
NOT
OBVIOUS:
Is
this
person
male
or
female?

10.
ASKED
ONLY
IF
PERSON
LISTED
IS
18
TO
65
YEARS
OLD:
(
Are
you/
Is
(
he/
she))
currently
on
active
duty
in
the
military?
[
iPAQ
AUTOMATICALLY
RECORDS
NO
FOR
ANYONE
66+]

[
IPAQ
SCRIPT
WILL
CONFIRM
ROSTER
INFORMATION]

11.
Now
I
need
some
general
information
about
(
the
other
person/
all
of
the
other
people)
in
this
household
who
(
is/
are)
18
years
old
or
older
and
who
(
will
live/
lived)
here
for
most
of
the
time
during
the
months
of
[
SCREENING
MONTHS].
IF
MORE
THAN
2
HOUSEHOLD
MEMBERS:
(
Let's
start
with
the
oldest
and
work
down
to
the
youngest
person
18
years
or
over.)
Please
give
me
their
full
name.

REPEAT
SERIES
OF
QUESTIONS
FOR
ALL
HOUSEHOLD
MEMBERS
AGE
18
AND
OLDER:

Please
tell
me
the
age
of
(
this/
the
oldest/
the
next
oldest)
person
on
his
or
her
last
birthday.

ASK
ONLY
IF
NOT
OBVIOUS:
Is
this
person
male
or
female?

12.
ASKED
ONLY
IF
PERSON
LISTED
IS
18
TO
65
YEARS
OLD:
Is
(
he/
she)
currently
on
active
duty
in
the
military?
[
iPAQ
AUTOMATICALLY
RECORDS
NO
FOR
ANYONE
66+]

[
IPAQ
SCRIPT
WILL
CONFIRM
ROSTER
INFORMATION]

13.
I
need
to
make
sure
this
list
is
accurate.
I
have
listed...
[
READ
AGES
AND
ROSTERED].
TAP
ANY
LINE
TO
MAKE
A
CORRECTION.
WHEN
ALL
CORRECT,
TAP
THE
`
CONTINUE
ARROW.'

14.
(
Have/
Will)
(
all/
both
of
these
people/
this
person)
(
lived/
live)
here
for
most
of
the
time
during
the
months
of
[
SCREENING
MONTHS]?
(
Please
let
me
know
if
I
have
included
anyone
who
(
will
live/
lived)
at
school
or
somewhere
else
for
most
of
the
time
during
[
SCREENING
MONTHS].)
FOR
EACH
INDIVIDUAL
NOT
ELIGIBLE
FOR
SELECTION,
TAP
THE
LINE
WITH
HIS/
HER
DATA
AND
CHANGE
THE
ELIGIBILITY
FIELD
TO
INELIGIBLE.

15.
Did
we
miss
anyone
who
is
18
or
older
and
who
(
will
live/
was
living)
here
for
most
of
the
time
during
the
months
of
[
SCREENING
MONTHS]?
(
Do
not
include
anyone
who
(
will
live/
lived)
at
school
or
somewhere
else
for
most
of
the
time
during
[
SCREENING
MONTHS].)
TAP
THE
`
YES'
BUTTON
TO
ADD
EACH
ELIGIBLE
MEMBER
NOT
PREVIOUSLY
LISTED.

TAP
THE
`
NO'
BUTTON
TO
GET
A
POP
UP
CONFIRMING
THAT
YOU
ARE
READY
TO
START
THE
SELECTION
PROCESS.
THE
IPAQ
WILL
SHOW
THE
RESPONDENT
SELECTION
SCREEN.

I
F
NO
ONE
IS
SELECTED,
IPAQ
GOES
TO
VERIFICATION
SCREEN.
Thank
you
for
your
time
but
no
on
in
this
household
is
eligible
to
participate
in
this
study.
So
that
my
supervisor
may
check
the
quality
of
my
work,
may
I
please
have
your
first
name
and
telephone
number?

IF
ANYONE
IS
SELECTED,
IT
WILL
SHOW
INFORMATION
ABOUT
HOUSEHOLD
MEMBERS
SELECTED
FOR
INTERVIEW(
S).
Household
Rostering
Script
Based
on
this
information,
(
RESPONDENT
NAME(
S)/
YOU)
maybe
eligible
to
participate
in
this
study.
Is/
are
(
RESPONDENT
NAME(
S/
YOU)
available
to
answer
a
few
questions?

IF
NO:
I
would
like
to
schedule
a
time
to
come
back
and
talk
with
(
RESPONDENT
NAMES(
s)),
let's
go
ahead
and
set
a
time
for
me
to
come
back.

FI
SET
APPT
Thank
you
for
your
help.