Closing (CL) Section

Subsection 1: MPC Authorization Forms (Round 1
through Round 5)

CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME

IF:
AT LEAST ONE PERSON-PROVIDER-PAIR ELIGIBLE (SEE
SAMPLING BOXES BELOW) FOR AUTHORIZATION FORM
COLLECTION FOR THE CURRENT ROUND,
OR
AT LEAST ONE PERSON-PROVIDER-PAIR ELIGIBLE FOR
AUTHORIZATION FORM COLLECTION DURING THE PREVIOUS
ROUND AND CL04 WAS CODED '3' (LEFT WITH R), ‘4’
(MAILED TO R), ‘5’ (REFUSED), ‘91’ (OTHER) OR ‘-1’
(ADDED BY COMMENT REVIEW) FOR THIS PERSON-
PROVIDER-PAIR IN PREVIOUS ROUND, CONTINUE WITH
CL01

OTHERWISE, GO TO BOX_02

NOTE: RECEIPT CONTROL WILL UPDATE CAPI INTER-
ROUND, USING THE CODE STRUCTURE AT CL04. UPDATES
CAN BE EITHER POSITIVE OR NEGATIVE. THIS MEANS
THAT INTER-ROUND AN AUTHORIZATION FORM’S STATUS
CAN EITHER GET UPDATED TO A HIGHER STATUS CODE
(FROM UNSIGNED TO SIGNED) OR TO A LOWER STATUS
CODE (FROM SIGNED TO UNSIGNED -- I.E., IT WAS NOT
SIGNED BY THE RIGHT PERSON). SEE MAPPING
SPECIFICATIONS FOR EXACT UPDATES TO STATUS CODES.

NOTE: DUE TO LEGISLATION THAT WENT INTO
EFFECT IN APRIL 2003, MEPS CHANGED TO NEW HIPAA-
COMPLIANT AUTHORIZATION FORMS.

SAMPLING BOX (FOR ROUND 1):
PERSON-PROVIDER-PAIRS ELIGIBLE FOR MPC
AUTHORIZATION FORM COLLECTION:

NOTE: PERSON IS A KEY, ELIGIBLE RU MEMBER (AT
TIME OF EVENT).

ROUND 1: PERSON-PROVIDER-PAIRS ELIGIBLE FOR
AUTHORIZATION FORM COLLECTION ARE THOSE
ASSOCIATED WITH A HOSPITAL-BASED EVENT (HS, ER,
AND OP EVENTS) AND CARE WAS PROVIDED TO PERSON
DURING THE CURRENT REFERENCE PERIOD.

ONE AUTHORIZATION FORM IS CREATED FOR EACH
PERSON-PROVIDER-PAIR IN WHICH THE PROVIDER IS
ASSOCIATED WITH AN HS, ER, OR OP EVENT DURING
THE EVENT ROSTER OR EVENT DRIVER SECTION.

NOTE: PERSON-PROVIDER-PAIRS WHERE THE PROVIDER
LOCATION IS IN A FOREIGN COUNTRY (I.E., ‘FC’ IS
ENTERED IN THE STATE FIELD OF PROVIDER’S ADDRESS
ARE NOT ELIGIBLE FOR MPC AUTHORIZATION FORM
COLLECTION).

SAMPLING BOX (FOR ROUNDS 2-5):

PERSON-PROVIDER-PAIRS ELIGIBLE FOR MPC
AUTHORIZATION FORM COLLECTION:

NOTE: PERSON IS A KEY, ELIGIBLE RU MEMBER (AT
TIME OF EVENT).

ROUNDS 2-5: PERSON-PROVIDER-PAIRS ELIGIBLE FOR
AUTHORIZATION FORM COLLECTION ARE THOSE
ASSOCIATED WITH A HOSPITAL-BASED EVENT (HS, ER,
AND OP EVENTS) DURING THE CURRENT REFERENCE
PERIOD.

ADDITIONAL PAIRS ELIGIBLE FOR AUTHORIZATION FORM
COLLECTION ARE THOSE ASSOCIATED WITH A HOME
HEALTH EVENT (HH EVENT), WHERE THE PROVIDER IS
FLAGGED AS AN ‘AGENCY’, AND CARE WAS PROVIDED
TO PERSON DURING THE ROUND 1, ROUND 2, ROUND 3,
ROUND 4, OR ROUND 5 REFERENCE PERIODS.

OTHER PAIRS ELIGIBLE FOR AUTHORIZATION FORM
COLLECTION ARE THOSE ASSOCIATED WITH A MEDICAL
PROVIDER VISIT EVENT (MV EVENT) WHERE CARE WAS
PROVIDED TO PERSON DURING THE ROUND 1, ROUND 2,
ROUND 3, ROUND 4, OR ROUND 5 REFERENCE
PERIODS, WHERE THE RU IS SELECTED FOR THE MPC
SAMPLE, AS DEFINED BELOW, AND EITHER:
- A MEDICAL DOCTOR WAS SEEN DURING THE VISIT
(MV03 = 1)
- MEDICAL DOCTORS WORK AT THE SAME LOCATION AS
THE PROVIDER SEEN (MV06 = 1)

FINAL PAIRS ELIGIBLE FOR AUTHORIZATION FORM
COLLECTION ARE THOSE ASSOCIATED WITH AN
INSTITUTIONAL CARE EVENT (IC EVENTS), WHERE CARE
WAS PROVIDED TO PERSON DURING THE ROUND 1, ROUND
2, ROUND 3, ROUND 4 OR ROUND 5 REFERENCE
PERIODS.

SAMPLING BOX (FOR ROUNDS 2-5) CONT’D:

WHEN DETERMINING IF THE MV EVENTS FOR AN RU
REQUIRE AUTHORIZATION FORMS, AN RU IS SELECTED
FOR THE MPC SAMPLE AT THE TIME OF THE ROUND 1
INTERVIEW USING THE FOLLOWING RATES:
- 100% OF RUs WITH AT LEAST ONE RU MEMBER
COVERED BY MEDICAID OR GOV’T HOSPITAL
(PHYSICIAN) INSURANCE AT ANY TIME DURING THE
REFERENCE PERIOD
- 100% OF THE REMAINING RUs (THAT IS, RUs WITH
NO RU MEMBER COVERED BY MEDICAID OR GOV’T-
HOSPITAL/PHYSICIAN INSURANCE AT ANY TIME
DURING THE REFERENCE PERIOD) WITH AT LEAST ONE
RU MEMBER WITH HMO COVERAGE AT ANY TIME DURING
THE REFERENCE PERIOD. HMO COVERAGE IS DEFINED
AS:
IF AT LEAST ONE PRIVATE INSURANCE PLAN IN RU
MEETS THE FOLLOWING CONDITIONS:
- FLAGGED AS ‘PROVIDING HOSPITAL/PHYSICIAN
BENEFITS’ (EXCLUDE INSURERS WHERE
HOSPITAL/PHYSICIAN BENEFITS ARE PROVIDED
SOLELY THROUGH MEDIGAP)
- ESTABLISHMENT OR INSURER IS FLAGGED AS
‘HMO’
OR
INSURER IS AN HMO (MC01 IS CODED ‘1’
(YES))
OR
INSURER REQUIRES PERSONS TO SIGN UP WITH
PRIMARY PHYSICIAN (MC02 IS CODED ‘1’ (YES)
- 100% OF THE REMAINING RUs (THAT IS, RUs WITH
NO RU MEMBER COVERED BY MEDICAID OR GOV’T-
HOSPITAL/PHYSICIAN INSURANCE AND HMO COVERAGE
AT ANY TIME DURING THE REFERENCE PERIOD).

NOTE: IF THE SAME PROVIDER IS ASSOCIATED MORE
THAN ONCE WITH A PARTICULAR PERSON, ONLY ONE
AUTHORIZATION FORM IS CREATED FOR THAT PAIR. IF
THE SAME PROVIDER IS ASSOCIATED WITH MORE THAN ONE
PERSON, AN AUTHORIZATION FORM IS CREATED FOR EACH
UNIQUE PERSON-PROVIDER-PAIR.

NOTE: IF THE PERSON-PROVIDER-PAIR IS OUTSTANDING
FROM A PREVIOUS ROUND AND THERE IS A NEW ELIGIBLE
EVENT FOR THIS PAIR IN THE CURRENT ROUND, THE PAIR
WILL NOT BE TREATED AS IF IT IS OUTSTANDING. THAT
IS, THE DISPLAYS FOR PREVIOUS ROUND STATUS WILL
NOT BE SHOWN, ETC.

NOTE: PERSON-PROVIDER-PAIRS WHERE THE PROVIDER
LOCATION IS IN A FOREIGN COUNTRY (I.E., ‘FC’ IS
ENTERED IN THE STATE FIELD OF PROVIDER’S ADDRESS)
ARE NOT ELIGIBLE FOR MPC AUTHORIZATION FORM
COLLECTION.

NOTE: IF THE PERSON-PROVIDER-PAIR IS OUTSTANDING
FROM A PREVIOUS ROUND AND THE PERSON IS OUT-OF-
SCOPE BECAUSE THE PERSON WAS INSTITUTIONALIZED IN
A NON-HEALTH CARE FACILITY (PRND.INSTTYPE=3) IN A
PREVIOUS ROUND AND THE PERSON IS NOT ELIGIBLE FOR
ANY PART OF THE CURRENT ROUND, PERSON-PROVIDER-
PAIR IS NOT ELIGIBLE FOR MPC AUTHORIZATION FORM
COLLECTION.

DISPLAY ‘[As I mentioned during the last
interview], we’ IF NOT ROUND 1 AND AT LEAST ONE
PERSON-PROVIDER-PAIR WAS ELIGIBLE FOR MPC
AUTHORIZATION FORM COLLECTION DURING THE PREVIOUS
ROUND. OTHERWISE, DISPLAY ‘We’.

DISPLAY EACH UNIQUE ELIGIBLE PERSON NAME ONLY
ONCE.

CONTINUE WITH LOOP_01

ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)

ROSTER DEFINITION:
DISPLAY THE RU_PERSON_ESTABLISHMENT_PAIRS_ROSTER
FOR DISPLAY OF RU MEMBERS ONLY.

ROSTER BEHAVIOR:
1. DISPLAY ONLY.

2. SELECT, ADD, DELETE DISALLOWED.

ROSTER FILTER:
DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING
CONDITION(S):
- PERSON IS ELIGIBLE FOR MPC AUTHORIZATION FORM
COLLECTION FOR THE CURRENT ROUND (SEE BOX_01
SAMPLING SPECIFICATIONS)
OR
- PERSON WAS ASSOCIATED WITH A PERSON-PROVIDER-
PAIR ELIGIBLE FOR AUTHORIZATION FORM COLLECTION
IN PREVIOUS ROUND, AND
- CL04 WAS CODED '3' (LEFT WITH R), ‘4’ (MAILED
TO R), ‘5’ (REFUSED), ‘91’ (OTHER) OR ‘-1’
(ADDED BY COMMENT REVIEW) FOR THIS PERSON-
PROVIDER-PAIR IN PREVIOUS ROUND

FOR EACH ELEMENT ON THE RU-PERSON-PROVIDER-PAIRS-
ROSTER, ASK CL03 - END_LP01

LOOP DEFINITION: LOOP_01 PRESENTS EACH UNIQUE
PERSON-PROVIDER-PAIR ELIGIBLE FOR AUTHORIZATION
FORM COLLECTION (THIS INCLUDES NEW AND OUTSTANDING
FORMS) FOR THE INTERVIEWER TO COMPLETE THE
AUTHORIZATION FORM. THIS LOOP CYCLES ON RU-
PERSON-PROVIDER-PAIRS WITH AN EVENT-PROVIDER-
PAIR THAT MEET THE FOLLOWING CONDITION(S):
- PAIR IS ELIGIBLE FOR AUTHORIZATION FORM
COLLECTION FOR THE CURRENT ROUND (SEE BOX_01
SAMPLING SPECIFICATIONS)
OR
- PAIR WAS ELIGIBLE FOR AUTHORIZATION FORM
COLLECTION IN PREVIOUS ROUND, AND
- CL04 WAS CODED '3' (LEFT WITH R), ‘4’ (MAILED
TO R), ‘5’ (REFUSED), ‘91’ (OTHER) OR ‘-1’
(ADDED BY COMMENT REVIEW) FOR THIS PAIR IN THE
PREVIOUS ROUND

NOTE: LOOP ONLY ONE TIME FOR EACH UNIQUE PERSON-
PROVIDER-PAIR.

DISPLAY ‘COMPLETE A NEW MPC AF FOR THIS PAIR.’ IF
ROUND 1. OTHERWISE, (I.E., ROUND 2-5) DISPLAY
‘CHECK...MPC AF.’

DISPLAY ‘AF STATUS ... -40}’ IF CURRENT PERSON-
PROVIDER-PAIR IS OUTSTANDING FROM THE PREVIOUS
ROUND AND NO ELIGIBLE EVENT WAS CREATED FOR THIS
PAIR IN THE CURRENT ROUND.

FOR ‘DISPLAY PREVIOUS...-40’, DISPLAY THE CATEGORY
ENTRY ASSOCIATED WITH THE PREVIOUS ROUND (OR
RECEIPT CONTROL UPDATED) CL04 OUTSTANDING STATUS.
THAT IS, IF CL04 WAS CODED ‘3’, DISPLAY ‘LEFT WITH
R’; IF CL04 WAS CODED ‘4’, DISPLAY ‘MAILED TO R’;
IF CL04 WAS CODED ‘5’, DISPLAY ‘REFUSED’; AND IF
CL04 WAS CODED ‘91’ OR ‘-1’, DISPLAY THE FIRST 40
CHARACTERS FROM THE OTHER SPECIFY ENTRY FIELD (OR
THE RECEIPT CONTROL UPDATE TEXT GENERATED FOR THE
‘91’ AND ‘-1’ CODES).

DISPLAY THE INTERVIEW DATE OF THE MOST RECENT
ROUND’S INTERVIEW FOR WHICH PAIR IS/WAS ELIGIBLE
FOR AUTHORIZATION FORM COLLECTION FOR
‘MM/DD/YYYY’.

CYCLE ON NEXT PAIR ON THE RU-PERSON-PROVIDER-
PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN
THE LOOP DEFINITION.

IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END
LOOP_01 AND CONTINUE WITH LOOP_02

FOR EACH ELEMENT ON THE RU-PERSON-PROVIDER-PAIRS-
ROSTER, ASK CL04 - END_LP02

LOOP DEFINITION: LOOP_02 COLLECTS THE STATUS OF
PERSON-PROVIDER AUTHORIZATION FORMS ELIGIBLE FOR
AUTHORIZATION FORM COLLECTION (THIS INCLUDES NEW
AND OUTSTANDING FORMS). THIS LOOP CYCLES ON
RU-PERSON-PROVIDER-PAIRS WITH AN EVENT-PROVIDER-
PAIR THAT MEET THE FOLLOWING CONDITION(S):
- PAIR IS ELIGIBLE FOR AUTHORIZATION FORM
COLLECTION FOR THE CURRENT ROUND (SEE BOX_01
SAMPLING SPECIFICATIONS)
OR
- PAIR WAS ELIGIBLE FOR AUTHORIZATION FORM
COLLECTION IN PREVIOUS ROUND, AND
- CL04 WAS CODED '3' (LEFT WITH R), ‘4’ (MAILED TO
R), ‘5’ (REFUSED), ‘91’ (OTHER) OR ‘-1’ (ADDED
BY COMMENT REVIEW) FOR THIS PAIR
IN THE PREVIOUS ROUND

NOTE: LOOP ONLY ONE TIME FOR EACH UNIQUE PERSON-
PROVIDER-PAIR.

FOR ‘MM/DD/YYYY’, DISPLAY THE RU END REFERENCE
DATE OF THE MOST RECENT ROUND’S INTERVIEW FOR
WHICH PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM
COLLECTION.

SOFT CHECK:
CODE ‘4’ (MAILED TO R) MUST BE VERIFIED (ENTERED
TWICE) IF RU IS NOT A STUDENT RU. IF CODE ‘4’
SELECTED AND RU IS NOT A STUDENT RU, DISPLAY THE
FOLLOWING MESSAGE: ‘UNLIKELY RESPONSE. VERIFY
AND RE-ENTER.’

FOR ‘MM/DD/YYYY’, DISPLAY THE RU END REFERENCE
DATE OF THE MOST RECENT ROUND’S INTERVIEW FOR
WHICH PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM
COLLECTION.

NOTE: EACH AUTHORIZATION FORM HAS A PRE-ASSIGNED
AUTHORIZATION FORM NUMBER.

HARD CHECK – PANEL 16 MPC AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND
SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG
AND MUST BEGIN WITH AN ALPHA CHARACTER AND END
WITH A NUMERIC. PANEL 16 MPC AUTHORIZATION FORMS
ARE PRINTED ON WHITE PAPER.

ORIGIN	LETTER	5-NUMBER SEQUENCE	CHECK DIGIT	ROUND IDENTIFIER
PRE-GENERATED	A-M	00001-29499	RANDOM	1,2,3,4,5
FIELD GENERATED	A-M	29500-44999	RANDOM	1,2,3,4,5
HOME OFFICE	T	45000-49999	RANDOM	1,2,3,4,5
TRAINING/QC	Y	96000-96399	RANDOM	1,2,3,4,5

HARD CHECK – PANEL 17 MPC AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND
SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG
AND MUST BEGIN AND END WITH AN ALPHA CHARACTER.
PANEL 17 MPC AUTHORIZATION FORMS ARE PRINTED ON
BLUE PAPER.

ORIGIN	LETTER	5-NUMBER SEQUENCE	CHECK DIGIT	ROUND IDENTIFIER
PRE-GENERATED	A-M	00001-29499	RANDOM	A,B,C,D,E
FIELD GENERATED	A-M	29500-44999	RANDOM	A,B,C,D,E
HOME OFFICE	T	45000-49999	RANDOM	A,B,C,D,E
TRAINING/QC	Y	96000-96399	RANDOM	A,B,C,D,E

HARD CHECK – PANEL 18 MPC AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND
SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG
AND MUST BEGIN AND END WITH AN ALPHA CHARACTER.
PANEL 18 MPC AUTHORIZATION FORMS ARE PRINTED ON
GREEN PAPER.

ORIGIN	LETTER	5-NUMBER SEQUENCE	CHECK DIGIT	ROUND IDENTIFIER
PRE-GENERATED	A-M	00001-29499	RANDOM	G,H,J,K,L
FIELD GENERATED	A-M	29500-44999	RANDOM	G,H,J,K,L
HOME OFFICE	T	45000-49999	RANDOM	G,H,J,K,L
TRAINING/QC	Y	96000-96399	RANDOM	G,H,J,K,L

SOME IMPORTANT POINTS TO REMEMBER ABOUT MPC
AUTHORIZATION FORMS:
- THE PREFIX LETTER CHANGES BASED ON THE TYPE OF
AUTHORIZATION FORM AND THE ORIGIN OF THE FORM.
THIS MEANS THAT A PRE-PRINTED OR FIELD
GENERATED MPC AUTHORIZATION FORM WILL DRAW FROM
THE SAME LETTER OR RANGE OF LETTERS IN EACH
PANEL.
- THE 5-NUMBER SEQUENCE REPEATS ITSELF FOR EACH
PANEL.
- THE CHECK-DIGIT ALWAYS REMAINS CONSTANT.
- THE ROUND IDENTIFIER IS DIFFERENT FOR EACH
PANEL. THE ROUND IDENTIFIER WILL REMAIN THE
SAME FOR ALL AUTHORIZATION FORMS COLLECTED
WITHIN A PANEL, BUT CHANGES BASED ON THE ROUND.
FOR EXAMPLE: AUTHORIZATION FORMS GENERATED FOR
PANEL 14, ROUND 1 WILL USE THE ROUND IDENTIFIER
"M"; "M" OR "N" FOR ROUND 2; "M", "N", OR "P"
FOR ROUND 3; "M", "N", "P" OR "Q" FOR ROUND 4;
AND "M", "N", "P", "Q" OR "R" FOR ROUND 5.

NOTE: INTERVIEWERS WILL BE INSTRUCTED TO COLLECT
SIGNED MPC AUTHORIZATION FORMS WITH DATES EARLIER
THAN THE ONE DISPLAYED, BUT WILL NOT ENTER THE
NUMBER IN CAPI SINCE THE CURRENT STATUS FOR THE
AUTHORIZATION FORM WITH THE CORRECT DATE MAY BE
SOMETHING ELSE. THE CAPI STATUS OF THE MPC
AUTHORIZATION FORM SHOULD REFLECT THE FORM WITH
THE MOST RECENT DATE.

HARD CHECK:
DATE ENTERED MUST BE ON OR AFTER THE INTERVIEW
DATE OF THE MOST RECENT ROUND’S INTERVIEW FOR
WHICH THE PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION
FORM COLLECTION, BUT CANNOT BE AFTER ‘TODAY’S’
DATE (THE CURRENT DATE SET ON THE LAPTOP. IF DATE
IS BEFORE CORRECT DATE, DISPLAY THE FOLLOWING
MESSAGE: ‘MPC AF MUST BE SIGNED ON OR AFTER ABOVE
DATE. VERIFY AND RE-ENTER DATE OR COMPLETE NEW
AF.’

CYCLE ON NEXT PAIR ON THE RU-PERSON-PROVIDER-
PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN
THE LOOP DEFINITION.

IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END
LOOP_02 AND CONTINUE WITH BOX_02

IF NOT ROUND 1 AND ANY KEY RU MEMBER HAD A
STATUS OF INSTITUTIONALIZED (IN A HEALTH CARE
INSTITUTION) AT THE PREVIOUS ROUND’S INTERVIEW
DATE, BUT HAS A DIFFERENT STATUS AS OF THE
CURRENT ROUND’S INTERVIEW DATE, CONTINUE WITH
LOOP_02A

OTHERWISE, GO TO BOX_03

FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK
NAV_CL02A - END_LP02A

LOOP DEFINITION: LOOP_02A INSTRUCTS THE
INTERVIEWER TO COLLECT THE HEALTH CARE INSTITUTION
HISTORY AND THE APPROPRIATE NUMBER OF MEDICAL
PROVIDER AUTHORIZATION FORMS FOR ALL RU MEMBERS
WHO HAD A STATUS OF INSTITUTIONALIZED (IN A HEALTH
CARE INSTITUTION) IN ANY PREVIOUS ROUND
BUT WHO REJOINED THE COMMUNITY (OR CHANGED STATUS)
DURING THE CURRENT ROUND. THIS LOOP CYCLES ON RU
MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS AN RU MEMBER
- PERSON IS KEY
- PERSON DOES NOT HAVE A STATUS OF
INSTITUTIONALIZED AS OF THE CURRENT ROUND’S
INTERVIEW DATE (RE19A = 1, 3, -7, -8 IN THE
CURRENT ROUND)
- PERSON HAD A STATUS OF INSTITUTIONALIZED IN ANY
PREVIOUS ROUND

NAVIGATOR DETAILS: LOOP_02A USES NAV_CL02A TO
CONTROL THE FLOW OF THE LOOP.

ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED

ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.

ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.

ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS
STATED AT THE LOOP_02A DEFINITION.

CONTINUE WITH CL06A FOR SELECTED RU MEMBER.

DISPLAY THE INTERVIEW DATE OF THE MOST RECENT
ROUND’S INTERVIEW FOR WHICH PAIR IS/WAS ELIGIBLE
FOR AUTHORIZATION FORM COLLECTION FOR
‘MM/DD/YYYY’.

DISPLAY ‘We request ... prepare the forms.]’ IF
CL01 WAS NOT ASKED FOR THE CURRENT ROUND.
OTHERWISE, USE A NULL DISPLAY.

CONTINUE WITH END_LP02A

CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER WHO
MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION

IF NO OTHER PERSONS MEET THE STATED CONDITIONS,
END LOOP_02A AND CONTINUE WITH BOX_03

Subsection 2: HIPS AUTHORIZATION FORMS (BEGINNING
WITH THE SECOND YEAR OF PANEL 2 AND THE FIRST YEAR
OF PANEL 3 (1998), SAMPLING CONTINUES BUT
AUTHORIZATION FORMS ARE NOT COLLECTED).

SAMPLING BOX FOR ROUNDS 2 AND 3: (TO BASE ON
ROUND 1 CRITERIA FOR COLLECTION OF AFs IN ROUND 2
AND ROUND 3):
RU-ESTABLISHMENT-PERSON-PAIRS ELIGIBLE FOR HIPS
AUTHORIZATION FORM COLLECTION:

- ALL PAIRS WHERE THE PERSON IS THE POLICYHOLDER
OF THIS INSURANCE ON THE DATE OF THE ROUND 1
INTERVIEW AND THE ESTABLISHMENT IS A PRIVATE
SOURCE OF INSURANCE (DEFINED LATER) HELD ON THE
DATE OF THE ROUND 1 INTERVIEW (DEFINED LATER)
WITH FOUR EXCEPTIONS:
1. ESTABLISHMENT IS FLAGGED AS ‘EMPLOYER’ AND
EMPLOYER IS THE FEDERAL GOVERNMENT (EM96=2
OR HP13=1)
2. ESTABLISHMENT IS FLAGGED AS ‘NOT SELF-
EMPLOYED’ WITH ONE EMPLOYEE (EM91=1) AND ONE
LOCATION (EM93=2)
3. PERSON IS THE POLICYHOLDER OF THIS INSURANCE
AND IS FLAGGED AS ‘POLICYHOLDER NOT LISTED
IN RU’
4. ESTABLISHMENT ONLY PROVIDES LONG TERM CARE
IN A NURSING HOME, EXTRA CASH FOR HOSPITAL
STAYS, SERIOUS DISEASE OR DREAD DISEASE,
DISABILITY, WORKER’S COMPENSATION, OR
ACCIDENT INSURANCE (HX48 IS CODED ONLY
COMBINATIONS OF CODES ‘6’, ‘7’, ‘8’, ‘9’,
‘10’, AND ‘11’).

SAMPLING BOX FOR ROUNDS 2 AND 3: (TO BASE ON
ROUND 1 CRITERIA FOR COLLECTION OF AFs IN ROUND 2
AND ROUND 3):
RU-ESTABLISHMENT-PERSON-PAIRS ELIGIBLE FOR HIPS
AUTHORIZATION FORM COLLECTION:

- ALL PAIRS WHERE THE ESTABLISHMENT IS FLAGGED AS
‘EMPLOYER’ AND THE JOB SUBTYPE OF THAT EMPLOYER
IS FLAGGED AS ‘CURRENT MAIN’ AND THE JOB IS NOT
FLAGGED AS ‘PROVIDES HEALTH INSURANCE’ (PERSON
IS THE JOBHOLDER OF THIS CURRENT MAIN JOB ON THE
DATE OF THE ROUND 1 INTERVIEW) AS OF THE ROUND 1
INTERVIEW DATE WITH THREE EXCEPTIONS:
1. ESTABLISHMENT IS THE FEDERAL GOVERNMENT
(EM96 = 2)
2. ESTABLISHMENT IS FLAGGED AS ‘SELF-EMPLOYED’
WITH A FIRM-SIZE=1
3. ESTABLISHMENT IS FLAGGED AS ‘NOT SELF-
EMPLOYED’ WITH ONE EMPLOYEE (EM91=1) AND ONE
LOCATION (EM93=2)

SAMPLING BOX FOR ROUNDS 4 AND 5:
RU-ESTABLISHMENT-PERSON-PAIRS ELIGIBLE FOR HIPS
AUTHORIZATION FORM COLLECTION:

- ALL PAIRS WHERE THE ESTABLISHMENT IS FLAGGED AS
‘EMPLOYER’ AND THE JOB SUBTYPE OF THAT EMPLOYER
IS FLAGGED AS ‘CURRENT MAIN’ AND THE JOB IS NOT
FLAGGED AS ‘PROVIDES HEALTH INSURANCE’ (PERSON
IS THE JOBHOLDER OF THIS CURRENT MAIN JOB ON THE
DATE OF THE ROUND 1 INTERVIEW) AS OF THE ROUND 1
INTERVIEW DATE WITH THREE EXCEPTIONS:
1. ESTABLISHMENT IS THE FEDERAL GOVERNMENT
(EM96 = 2)
2. ESTABLISHMENT IS FLAGGED AS ‘SELF-EMPLOYED’
WITH A FIRM-SIZE=1
3. ESTABLISHMENT IS FLAGGED AS ‘NOT SELF-
EMPLOYED’ WITH ONE EMPLOYEE (EM91=1) AND ONE
LOCATION (EM93=2)

NOTE: PRIVATE INSURANCE IS DEFINED AS:
- ESTABLISHMENTS FLAGGED AS ‘EMPLOYER’ AND
FLAGGED AS ‘PROVIDES HEALTH INSURANCE’
(ESTABLISHMENTS FLAGGED AS ‘SELF-EMPLOYED’ WITH
A FIRM-SIZE-1 ARE TREATED AS DIRECT PURCHASED,
SEE NOTE BELOW)
- DIRECT PURCHASED INSURANCE, THAT IS,
ESTABLISHMENTS CREATED FROM THE HX23 SERIES

NOTE: HELD ON THE DATE OF THE ROUND 1 INTERVIEW:
- FOR PRIVATE SOURCES -- POLICYHOLDER HELD
INSURANCE AT THE TIME OF THE ROUND 1 INTERVIEW
DATE (HQ01 IS CODED ‘1’ (WHOLE TIME) OR HQ02 IS
CODED ‘1’ (YES, COVERED NOW) FOR THE
POLICYHOLDER)
- FOR PRIVATE SOURCES WHERE POLICYHOLDER IS
DECEASED -- AT LEAST ONE DEPENDENT (SELECTED AT
HP16) IS COVERED BY THE INSURANCE AT THE TIME OF
THE ROUND 1 INTERVIEW DATE (HQ01 IS CODED ‘1’
(WHOLE TIME) OR HQ02 IS CODED ‘1’ (YES, COVERED
NOW) FOR THE COVERED PERSON)

NOTE: ESTABLISHMENTS WHICH ARE EMPLOYERS AND
PROVIDE HEALTH INSURANCE AND ARE FLAGGED AS ‘SELF-
EMPLOYED’ WITH A FIRM-SIZE=1 ARE TREATED AS DIRECT
PURCHASED INSURANCE, THAT IS, HIPS WILL CONTACT
THE ESTABLISHMENT PROVIDING THE INSURANCE, (I.E.,
CREATED FROM THE HX03 SERIES) NOT THE EMPLOYER.

NOTE: FOR ESTABLISHMENTS WHICH ARE CURRENT MAIN
EMPLOYERS (ON THE ROUND 1 INTERVIEW DATE) AND
PROVIDE HEALTH INSURANCE, WHERE THE HEALTH
INSURANCE IS ONLY FROM A UNION (EM117=2), A HIPS
AUTHORIZATION FORM IS REQUIRED FOR BOTH THE
EMPLOYER AND THE UNION. IN THESE CASES, BOTH
ESTABLISHMENT-PERSON-PAIRS ARE ELIGIBLE FOR HIPS
AUTHORIZATION FORM COLLECTION.

NOTE: IF A CURRENT MAIN JOB IS FLAGGED AS
‘PREVIOUS HEALTH INSURANCE’ BUT THAT INSURANCE IS
ONLY LONG TERM CARE IN A NURSING HOME, EXTRA CASH
FOR HOSPITAL STAYS, SERIOUS DISEASE OR DREAD
DISEASE, DISABILITY, WORKER’S COMPENSATION, AND/OR
ACCIDENT INSURANCE, THE JOB IS PROCESSED AS IF IT
DOES NOT PROVIDE HEALTH INSURANCE BUT IS ELIGIBLE
FOR HEALTH INSURANCE PROVIDER AUTHORIZATION FORM
COLLECTION (AS LONG AS OTHER REQUIREMENTS ARE
MET).

NOTE: A ‘-7’ (REFUSED) AND ‘-8’ (DON’T KNOW)
RESPONSE AT ANY QUESTION LISTED ABOVE DOES NOT
MEET THE CRITERIA.

NOTE: IN ROUND 4, A NEW HIPS FLAG WILL BE SET AND
NEW HIPS AUTHORIZATION FORMS WILL BE COLLECTED FOR
ALL ESTABLISHMENT-PERSON-PAIRS BASED ON THE ABOVE
SAMPLING CRITERIA, BUT USING ROUND 3 DATA.

SAMPLING BOX (TO BASE ON ROUND 3 CRITERIA, FOR
COLLECTION OF AFs IN ROUNDS 4 AND 5):
RU-ESTABLISHMENT-PERSON-PAIRS ELIGIBLE FOR HIPS
AUTHORIZATION FORM COLLECTION:

- ALL PAIRS WHERE THE PERSON IS THE POLICYHOLDER
OF THIS INSURANCE ON THE DATE OF THE ROUND 3
INTERVIEW AND THE ESTABLISHMENT IS A PRIVATE
SOURCE OF INSURANCE (DEFINED LATER) HELD ON THE
DATE OF THE ROUND 3 INTERVIEW (DEFINED LATER)
WITH FOUR EXCEPTIONS:
1. ESTABLISHMENT IS FLAGGED AS ‘EMPLOYER’ AND
EMPLOYER IS THE FEDERAL GOVERNMENT (EM96=2
OR HP13=1)
2. ESTABLISHMENT IS FLAGGED AS ‘NOT SELF-
EMPLOYED’ WITH ONE EMPLOYEE (EM91=1) AND ONE
LOCATION (EM93=2)
3. PERSON IS THE POLICYHOLDER OF THIS INSURANCE
AND IS FLAGGED AS ‘POLICYHOLDER NOT LISTED
IN DU’
4. ESTABLISHMENT PROVIDES ONLY LONG TERM CARE
IN A NURSING HOME, EXTRA CASH FOR HOSPITAL
STAYS, SERIOUS DISEASE OR DREAD DISEASE,
DISABILITY, WORKER’S COMPENSATION, OR
ACCIDENT INSURANCE (HX48, OE10, OE24, OR
OE37 IS CODED ONLY COMBINATIONS OF CODES
‘6’, ‘7’, ‘8’, ‘9’, ‘10’, AND ‘11’).

SAMPLING BOX FOR ROUNDS 4 AND 5: (TO BASE ON ROUND
3 CRITERIA, FOR COLLECTION OF AFs IN ROUNDS 4 AND
5):
RU-ESTABLISHMENT-PERSON-PAIRS ELIGIBLE FOR HIPS
AUTHORIZATION FORM COLLECTION:

- ALL PAIRS WHERE THE ESTABLISHMENT IS FLAGGED AS
‘EMPLOYER’ AND THE JOB SUBTYPE OF THAT EMPLOYER
IS FLAGGED AS ‘CURRENT MAIN’ AND THE JOB IS NOT
FLAGGED AS ‘PROVIDES HEALTH INSURANCE’ (PERSON
IS THE JOBHOLDER OF THIS CURRENT MAIN JOB ON THE
DATE OF THE ROUND 3 INTERVIEW) AS OF THE ROUND 3
INTERVIEW DATE WITH THREE EXCEPTIONS:
1. ESTABLISHMENT IS THE FEDERAL GOVERNMENT
(EM96 = 2)
2. ESTABLISHMENT IS FLAGGED AS ‘SELF-EMPLOYED’
WITH A FIRM-SIZE=1
3. ESTABLISHMENT IS FLAGGED AS ‘NOT SELF-
EMPLOYED’ WITH ONE EMPLOYEE (EM91=1) AND ONE
LOCATION (EM93=2)

NOTE: PRIVATE INSURANCE IS DEFINED AS:
- ESTABLISHMENTS FLAGGED AS ‘EMPLOYER’ AND
FLAGGED AS ‘PROVIDES HEALTH INSURANCE’
(ESTABLISHMENTS FLAGGED AS ‘SELF-EMPLOYED’ WITH
A FIRM-SIZE-1 ARE TREATED AS DIRECT PURCHASED,
SEE NOTE BELOW)
- DIRECT PURCHASED INSURANCE, THAT IS,
ESTABLISHMENTS CREATED FROM THE HX23 SERIES

NOTE: HELD ON THE DATE OF THE ROUND 3 INTERVIEW:
- FOR PRIVATE SOURCES -- POLICYHOLDER HELD
INSURANCE AT THE TIME OF THE ROUND 3 INTERVIEW
DATE [(HQ01 IS CODED ‘1’ (WHOLE TIME) OR HQ02 IS
CODED ‘1’ (YES, COVERED NOW) FOR THE
POLICYHOLDER) OR (OE01, OE12, OE26 IS CODED ‘1’
(YES) FOR THE POLICYHOLDER)
- FOR PRIVATE SOURCES WHERE POLICYHOLDER IS
DECEASED -- AT LEAST ONE DEPENDENT [(SELECTED AT
HP16 OR OE45) OR (CONFIRMED AS STILL COVERED AT
OE29 OR OE30)] IS COVERED BY THE INSURANCE AT
THE TIME OF THE ROUND 3 INTERVIEW DATE [(HQ01
IS CODED ‘1’ (WHOLE TIME) OR HQ02 IS CODED ‘1’
(YES, COVERED NOW) FOR THE COVERED PERSON) OR
(OE26 IS CODED ‘1’ (YES) FOR THE COVERED
PERSON)]

NOTE: ESTABLISHMENTS WHICH ARE EMPLOYERS AND
PROVIDE HEALTH INSURANCE AND ARE FLAGGED AS
‘SELF-EMPLOYED’ WITH A FIRM-SIZE=1 ARE TREATED AS
DIRECT PURCHASED INSURANCE, THAT IS, HIPS WILL
CONTACT THE ESTABLISHMENT PROVIDING THE INSURANCE,
(I.E., CREATED FROM THE HX03 SERIES) NOT THE
EMPLOYER.

NOTE: FOR ESTABLISHMENTS WHICH ARE CURRENT MAIN
EMPLOYERS (ON THE ROUND 3 INTERVIEW DATE) AND
PROVIDE HEALTH INSURANCE, WHERE THE HEALTH
INSURANCE IS ONLY FROM A UNION (EM117=2), A HIPS
AUTHORIZATION FORM IS REQUIRED FOR BOTH THE
EMPLOYER AND THE UNION. IN THESE CASES, BOTH
ESTABLISHMENT-PERSON-PAIRS ARE ELIGIBLE FOR HIPS
AUTHORIZATION FORM COLLECTION.

NOTE: IF A CURRENT MAIN JOB IS FLAGGED AS
‘PREVIOUS HEALTH INSURANCE’ BUT THAT INSURANCE IS
ONLY LONG TERM CARE IN A NURSING HOME, EXTRA CASH
FOR HOSPITAL STAYS, SERIOUS DISEASE OR DREAD
DISEASE, DISABILITY, WORKER’S COMPENSATION, AND/OR
ACCIDENT INSURANCE, THE JOB IS PROCESSED AS IF IT
DOES NOT PROVIDE HEALTH INSURANCE BUT IS ELIGIBLE
FOR HEALTH INSURANCE PROVIDER AUTHORIZATION FORM
COLLECTION (AS LONG AS OTHER REQUIREMENTS ARE
MET).

NOTE: A ‘-7’ (REFUSED) AND ‘-8’ (DON’T KNOW)
RESPONSE AT ANY QUESTION LISTED ABOVE DOES NOT
MEET THE CRITERIA.

GO TO BOX_10

Subsection 4: Pharmacy Requests and Authorization
Forms (Rounds 2-5)

AS A PHARMACY WAS ENTERED OR SELECTED DURING THE
PRESCRIBED MEDICINES SECTION, THE PERSON-PHARMACY-
PAIR WAS FLAGGED WITH THE CURRENT ROUND (I.E., THE
MOST RECENT ROUND IT WAS ENTERED/SELECTED). THIS
ROUND FLAG IS USED TO DETERMINE WHETHER THE
PHARMACY IS ELIGIBLE FOR PHARMACY AUTHORIZATION
FORM COLLECTION FOR THIS RU MEMBER.

IF ROUND 1, GO TO BOX_14

OTHERWISE (I.E., IF ROUNDS 2-5), CONTINUE
WITH BOX_11

NOTE: PANELS 1 THROUGH 12 INCLUDED PHARMACY AF
COLLECTION ONLY IN ROUNDS 3 AND 5. PANEL 13
INCLUDES PHARMACY AF COLLECTION IN ROUNDS 3, 4,
AND 5. BEGINNING IN PANEL 14, AND ALL SUBSEQUENT
PANELS, PHARMACY AF COLLECTION OCCURS IN ROUNDS
2-5.

IF AT LEAST ONE PERSON-PHARMACY-PAIR ELIGIBLE
(SEE SAMPLING BOX BELOW) FOR PHARMACY
AUTHORIZATION FORM COLLECTION FOR THE CURRENT
ROUND,
OR
AT LEAST ONE PERSON-PHARMACY-PAIR ELIGIBLE FOR
AUTHORIZATION FORM COLLECTION DURING THE PREVIOUS
ROUND AND CL32 WAS CODED '3' (LEFT WITH R), ‘4’
(MAILED TO R), ‘5’ (REFUSED), ‘91’ (OTHER), OR
‘-1’ (ADDED BY COMMENT REVIEW) FOR THIS PERSON-
PHARMACY-PAIR IN PREVIOUS ROUND, CONTINUE WITH
CL30

OTHERWISE, GO TO BOX_14

NOTE: RECEIPT CONTROL WILL UPDATE CAPI INTER-
ROUND, USING THE CODE STRUCTURE AT CL32. UPDATES
CAN BE EITHER POSITIVE OR NEGATIVE. THIS MEANS
THAT INTER-ROUND AN AUTHORIZATION FORM’S STATUS
CAN EITHER GET UPDATED TO A HIGHER STATUS CODE
(FROM UNSIGNED TO SIGNED) OR TO A LOWER STATUS
CODE (FROM SIGNED TO UNSIGNED -- I.E., IT WAS NOT
SIGNED BY THE RIGHT PERSON). SEE MPC MAPPING
SPECIFICATIONS FOR EXACT UPDATES TO STATUS CODES.

SAMPLING BOX:
PERSON-PHARMACY-PAIRS ELIGIBLE FOR PHARMACY
AUTHORIZATION FORM COLLECTION IN ROUNDS 2-5:

- PERSON IS A KEY, ELIGIBLE RU MEMBER (INCLUDING
DECEASED AND INSTITUTIONALIZED)
- PERSON ASSOCIATED WITH THE PHARMACY
- PHARMACY COLLECTED OR USED DURING THE ROUND 1,
2, 3, 4, OR 5 REFERENCE PERIOD

NOTE: FORMS ASSOCIATED WITH ELIGIBLE PERSON-
PHARMACY-PAIRS CREATED IN ROUND 1 WILL BE
REQUESTED IN ROUND 2.

NOTE: FORMS ASSOCIATED WITH DECEASED AND
INSTITUTIONALIZED PERSONS IN ROUND 1 WILL BE
REQUESTED IN ROUND 2.

NOTE: IF THE SAME PHARMACY IS ASSOCIATED MORE
THAN ONCE WITH A PARTICULAR PERSON, ONLY ONE
AUTHORIZATION FORM IS ASKED ABOUT FOR THAT PAIR.
IF THE SAME PHARMACY IS ASSOCIATED WITH MORE THAN
ONE PERSON, AN AUTHORIZATION FORM IS ASKED FOR
EACH UNIQUE PERSON-PHARMACY-PAIR.

NOTE: IF THE PERSON-PHARMACY-PAIR IS OUTSTANDING
FROM A PREVIOUS ROUND AND THE SAME PHARMACY
IS SELECTED FOR THAT PERSON IN THE CURRENT ROUND,
THE PAIR WILL NOT BE TREATED AS IF IT IS
OUTSTANDING. THAT IS, THE DISPLAYS FOR PREVIOUS
ROUND STATUS WILL NOT BE SHOWN, ETC.

NOTE: PERSON-PHARMACY-PAIRS WHERE THE PHARMACY IS
IN A FOREIGN COUNTRY (I.E., ‘FC’ IS ENTERED IN THE
STATE FIELD OF PHARMACY’S ADDRESS) ARE NOT
ELIGIBILE FOR PHARMACY AUTHORIZATION FORM
COLLECTION.

NOTE: IF THE PERSON-PHARMACY-PAIR IS OUTSTANDING
FROM A PREVIOUS ROUND AND THE PERSON IS OUT-OF-
SCOPE BECAUSE THE PERSON WAS INSTITUTIONALIZED IN
A NON-HEALTH CARE FACILITY (PRND.INSTTYPE=3) IN A
PREVIOUS ROUND AND THE PERSON IS NOT ELIGIBLE FOR
ANY PART OF THE CURRENT ROUND, PERSON-PROVIDER-
PAIR IS NOT ELIGIBLE FOR PHARMACY AUTHORIZATION
FORM COLLECTION.

ROSTER DETAILS:
TITLE: RU_PERS_PHAR_PAIR_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: PHARMACY
INSTRUCTIONS: DISPLAY PHARMACY NAME
(PHAR.PHARNAME)

ROSTER DEFINITION:
DISPLAY EACH UNIQUE PAIR ON THE RU-PERSON-
PHARMACY-PAIRS-ROSTER.

ROSTER BEHAVIOR:
1. DISPLAY ONLY.

2. SELECT, EDIT, ADD, AND DELETE DISALLOWED.

ROSTER FILTER:
DISPLAY ONLY THOSE PAIRS THAT MEET THE FOLLOWING
CONDITION(S):
- PAIR IS ELIGIBLE FOR PHARMACY AUTHORIZATION FORM
COLLECTION FOR THE CURRENT ROUND (SEE BOX_11
SAMPLING SPECIFICATIONS)
OR
- PAIR ELIGIBLE FOR PHARMACY AUTHORIZATION FORM
COLLECTION IN PREVIOUS ROUND,
AND
- CL32 WAS CODED '3' (LEFT WITH R), ‘4’ (MAILED
TO R), ‘5’ (REFUSED), ‘91’ (OTHER) OR ‘-1’
(ADDED BY COMMENT REVIEW) FOR THIS PERSON-
PHARMACY-PAIR IN PREVIOUS ROUND

NOTE: DISPLAY EACH UNIQUE ELIGIBLE PERSON-
PHARMACY-PAIR ONLY ONCE.

FOR EACH ELEMENT ON THE RU-PERSON-PHARMACY-PAIRS-
ROSTER, ASK CL31 - END_LP07

LOOP DEFINITION: LOOP_07 PRESENTS EACH UNIQUE
PERSON-PHARMACY-PAIR ELIGIBLE FOR PHARMACY
AUTHORIZATION FORM COLLECTION FOR THE INTERVIEWER
TO COMPLETE THE AUTHORIZATION FORM. THIS LOOP
CYCLES ON THE RU-PERSON-PHARMACY-PAIRS THAT MEET
THE FOLLOWING CONDITIONS:

- PAIR IS ELIGIBLE FOR PHARMACY AUTHORIZATION FORM
COLLECTION FOR THE CURRENT ROUND (SEE BOX_11
SAMPLING SPECIFICATIONS)
OR
- PAIR ELIGIBLE FOR PHARMACY AUTHORIZATION FORM
COLLECTION IN PREVIOUS ROUND,
AND
- CL32 WAS CODED '3' (LEFT WITH R), ‘4’ (MAILED
TO R), ‘5’ (REFUSED), ‘91’ (OTHER) OR ‘-1’
(ADDED BY COMMENT REVIEW) FOR THIS PERSON-
PHARMACY-PAIR IN PREVIOUS ROUND

NOTE: LOOP ONLY ONE TIME FOR EACH UNIQUE PERSON-
PHARMACY-PAIR.

DISPLAY ‘PHARMACY AF STATUS ... -40}’ IF CURRENT
PERSON-PHARMACY-PAIR IS OUTSTANDING FROM THE
PREVIOUS ROUND.

FOR ‘DISPLAY PREVIOUS ROUND STATUS-40’, DISPLAY
THE CATEGORY ENTRY ASSOCIATED WITH THE PREVIOUS
ROUND (OR RECEIPT CONTROL UPDATED) CL32
OUTSTANDING STATUS. THAT IS, IF CL32 WAS CODED
‘3’, DISPLAY ‘LEFT WITH R’; IF CL32 WAS CODED ‘4’,
DISPLAY ‘MAILED TO R’; IF CL32 WAS CODED ‘5’,
DISPLAY ‘REFUSED’; AND IF CL32 WAS CODED ‘91’ OR
‘-1’, DISPLAY THE FIRST 40 CHARACTERS FROM THE
OTHER SPECIFY ENTRY FIELD (OR THE RECEIPT CONTROL
UPDATE TEXT GENERATED FOR THE ‘91’ OR ‘-1’ CODES)

DISPLAY THE INTERVIEW DATE OF THE MOST RECENT
ROUND’S INTERVIEW FOR WHICH PAIR IS/WAS ELIGIBLE
FOR AUTHORIZATION FORM COLLECTION FOR
‘MM/DD/YYYY’.

CYCLE ON NEXT PAIR ON THE RU-PERSON-PHARMACY-
PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN
THE LOOP DEFINITION.

IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END
LOOP_07 AND CONTINUE WITH LOOP_08

FOR EACH ELEMENT ON THE RU-PERSON-PHARMACY-PAIRS-
ROSTER, ASK CL32 - END_LP08

LOOP DEFINITION: LOOP_08 PRESENTS EACH UNIQUE
PERSON-PHARMACY-PAIR ELIGIBLE FOR PHARMACY
AUTHORIZATION FORM COLLECTION FOR THE INTERVIEWER
TO RECORD THE STATUS OF THE AUTHORIZATION FORM.
THIS LOOP CYCLES ON THE RU-PERSON-PHARMACY-PAIRS
THAT MEET THE FOLLOWING CONDITIONS:

- PAIR IS ELIGIBLE FOR PHARMACY AUTHORIZATION FORM
COLLECTION FOR THE CURRENT ROUND (SEE BOX_11
SAMPLING SPECIFICATIONS)
OR
- PAIR ELIGIBLE FOR PHARMACY AUTHORIZATION FORM
COLLECTION IN PREVIOUS ROUND,
AND
- CL32 WAS CODED '3' (LEFT WITH R), ‘4’ (MAILED
TO R), ‘5’ (REFUSED), ‘91’ (OTHER) OR ‘-1’
(ADDED BY COMMENT REVIEW) FOR THIS PERSON-
PHARMACY-PAIR IN PREVIOUS ROUND

NOTE: LOOP ONLY ONE TIME FOR EACH UNIQUE PERSON-
PHARMACY-PAIR.

FOR ‘MM/DD/YYY’, DISPLAY THE RU END REFERENCE DATE
OF THE MOST RECENT ROUND’S INTERVIEW FOR WHICH PAIR
IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION

SOFT CHECK:
CODE ‘4’ (MAILED TO R) MUST BE VERIFIED (ENTERED
TWICE) IF RU IS NOT A STUDENT RU. IF CODE ‘4’
SELECTED AND RU IS NOT A STUDENT RU, DISPLAY THE
FOLLOWING MESSAGE: ‘UNLIKELY RESPONSE. VERIFY
AND RE-ENTER.’

FOR ‘MM/DD/YYYY’, DISPLAY THE RU END REFERENCE
DATE OF THE MOST RECENT ROUND’S INTERVIEW FOR
WHICH PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM
COLLECTION.

NOTE: EACH PHARMACY AUTHORIZATION FORM HAS A
PRE-ASSIGNED PHARMACY AUTHORIZATION FORM NUMBER.

HARD CHECK–PANEL 16 PHARMACY AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND
SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG
AND MUST BEGIN WITH AN ALPHA CHARACTER AND END
WITH A NUMERIC. PANEL 16 PHARMACY AUTHORIZATION
FORMS ARE PRINTED ON ORCHID PAPER.

ORIGIN	LETTER	5-NUMBER SEQUENCE	CHECK DIGIT	ROUND IDENTIFIER
PRE-GENERATED	Q,R,S	70000-79999	RANDOM	1,2,3,4,5
FIELD GENERATED	Q,R,S	80000-89999	RANDOM	1,2,3,4,5
HOME OFFICE	Z	90000-95999	RANDOM	1,2,3,4,5
TRAINING/QC	Y	96600-96799	RANDOM	1,2,3,4,5

HARD CHECK–PANEL 17 PHARMACY AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND
SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG
AND MUST BEGIN AND END WITH AN ALPHA CHARACTER.
PANEL 17 PHARMACY AUTHORIZATION FORMS ARE PRINTED
ON PINK PAPER.

ORIGIN	LETTER	5-NUMBER SEQUENCE	CHECK DIGIT	ROUND IDENTIFIER
PRE-GENERATED	Q,R,S	70000-79999	RANDOM	A,B,C,D,E
FIELD GENERATED	Q,R,S	80000-89999	RANDOM	A,B,C,D,E
HOME OFFICE	Z	90000-95999	RANDOM	A,B,C,D,E
TRAINING/QC	Y	96600-96799	RANDOM	A,B,C,D,E

HARD CHECK–PANEL 18 PHARMACY AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND
SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG
AND MUST BEGIN AND END WITH AN ALPHA CHARACTER.
PANEL 18 PHARMACY AUTHORIZATION FORMS ARE PRINTED
ON GRAY PAPER.

ORIGIN	LETTER	5-NUMBER SEQUENCE	CHECK DIGIT	ROUND IDENTIFIER
PRE-GENERATED	Q,R,S	70000-79999	RANDOM	G,H,J,K,L
FIELD GENERATED	Q,R,S	80000-89999	RANDOM	G,H,J,K,L
HOME OFFICE	Z	90000-95999	RANDOM	G,H,J,K,L
TRAINING/QC	Y	96600-96799	RANDOM	G,H,J,K,L

SOME IMPORTANT POINTS TO REMEMBER ABOUT PHARMACY
AUTHORIZATION FORMS:
- THE PREFIX LETTER CHANGES BASED ON THE TYPE OF
AUTHORIZATION FORM AND THE ORIGIN OF THE FORM.
THIS MEANS THAT A PRE-PRINTED OR FIELD
GENERATED AUTHORIZATION FORM WILL DRAW FROM
THE SAME LETTER OR RANGE OF LETTERS IN EACH
PANEL. THE EXCEPTION IS PANEL 14 PHARMACY
AUTHORIZATION FORMS WHICH WILL DRAW FROM AN
EXPANDED LIST OF PREFIX LETTERS TO ACCOMMODATE
A CHANGE IN COLLECTION PROCEDURES.
- THE 5-NUMBER SEQUENCE REPEATS ITSELF FOR EACH
PANEL.
- THE CHECK-DIGIT ALWAYS REMAINS CONSTANT.
- THE ROUND IDENTIFIER IS DIFFERENT FOR EACH
PANEL. THE ROUND IDENTIFIER WILL REMAIN THE
SAME FOR ALL AUTHORIZATION FORMS COLLECTED
WITHIN A PANEL, BUT CHANGES BASED ON THE ROUND.
FOR EXAMPLE: AUTHORIZATION FORMS GENERATED FOR
PANEL 14, ROUND 1 WILL USE THE ROUND IDENTIFIER
"M"; "M" OR "N" FOR ROUND 2; "M", "N", OR "P"
FOR ROUND 3; "M", "N", "P" OR "Q" FOR ROUND 4;
AND "M", "N", "P", "Q" OR "R" FOR ROUND 5.

NOTE: INTERVIEWERS WILL BE INSTRUCTED TO COLLECT
SIGNED PHARMACY AUTHORIZATION FORMS WITH DATES
EARLIER THAN THE ONE DISPLAYED, BUT WILL NOT ENTER
THE NUMBER IN CAPI SINCE THE CURRENT STATUS FOR
THE AUTHORIZATION FORM WITH THE CORRECT DATE MAY
BE SOMETHING ELSE. THE CAPI STATUS OF THE PHARMACY
AUTHORIZATION FORM SHOULD REFLECT THE FORM WITH
THE MOST RECENT DATE.

HARD CHECK:
DATE ENTERED MUST BE ON OR AFTER THE INTERVIEW
DATE OF THE MOST RECENT ROUND’S INTERVIEW FOR
WHICH THE PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION
FORM COLLECTION BUT CANNOT BE AFTER ‘TODAY’S DATE’
(THE CURRENT DATE SET ON THE LAPTOP). IF DATE IS
BEFORE CORRECT DATE, DISPLAY THE FOLLOWING
MESSAGE: ‘PHARMACY AF MUST BE SIGNED ON OR AFTER
ABOVE DATE. VERIFY AND RE-ENTER DATE OR COMPLETE
NEW AF.’

CYCLE ON NEXT PAIR ON THE RU-PERSON-PHARMACY-
PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN
THE LOOP DEFINITION.

IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END
LOOP_08 AND CONTINUE WITH BOX_14

SUBSECTION 5: SELF-ADMINISTERED QUESTIONNAIRE
(ROUNDS 2 THROUGH 5)

IF ROUND 2 OR 4, CONTINUE WITH BOX_15

IF ROUND 3 OR 5, GO TO BOX_16

OTHERWISE, GO TO BOX_16A

IF ROUND 2 OR 4 AND AT LEAST ONE KEY RU MEMBER
ELIGIBLE FOR SAQ (I.E., AT LEAST ONE CURRENT RU
MEMBER WHO IS KEY AND WHO IS NOT DECEASED OR
INSTITUTIONALIZED AND IS IN THE RU AT THE ROUND 2
OR 4 INTERVIEW DATE AND IS 18 YEARS OF AGE OR
OLDER (OR IN AGE CATEGORIES 4-9) ON JULY 1,
{YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF
THE PANEL, IF ROUND 2 OR ON JULY 1, {YEAR}, WHERE
‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL,
IF ROUND 4, OR HAS TURNED 18 BETWEEN JULY 1,
{YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR
OF THE PANEL, AND THE DATE OF THE INTERVIEW IF
ROUND 2, OR JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE
SECOND CALENDAR YEAR OF THE PANEL, AND THE DATE
OF THE INTERVIEW IF ROUND 4, CONTINUE WITH CL35

OTHERWISE, GO TO CL41

NOTE: DETERMINING WHICH ADULTS IN THE RU RECEIVE
AN SAQ AND WHICH ADULTS ARE FOLLOWED-UP IN ROUND
3 OR 5 WILL BE BASED ONLY ON ROUND 2 OR 4
INFORMATION. THAT IS, NO RU MEMBERS ADDED IN
ROUND 3 OR 5 WILL BE ASKED TO COMPLETE AN SAQ.

ROSTER DETAILS:
TITLE: RU-MEMBERS_7

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: PID
INSTRUCTIONS: DISPLAY RU MEMBERS’ 3-DIGIT ID
(PERS.PID)

ROSTER DEFINITION:
DISPLAY PERSONS ON THE RU-MEMBERS-ROSTER FOR
DISPLAY ONLY.

ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, EDIT, ADD, DELETE DISALLOWED.

ROSTER FILTER:
DISPLAY ALL PERSONS WHO MEET THE FOLLOWING
CONDITIONS:
- PERSON IS KEY
- PERSON DOES NOT HAVE A STATUS OF DECEASED OR
INSTITUTIONALIZED ON ROUND 2 OR 4 INTERVIEW DATE
- PERSON CURRENTLY IN RU ON ROUND 2 OR 4 INTERVIEW
DATE
- PERSON IS 18 YEARS OF AGE OR OLDER (OR IN AGE
CATEGORIES 4-9) ON JULY 1, {YEAR}, WHERE ‘YEAR’
IS THE FIRST CALENDAR YEAR OF THE PANEL, IF
ROUND 2, OR ON JULY 1, {YEAR}, WHERE ‘YEAR’ IS
THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND
4, OR HAS TURNED 18 BETWEEN JULY 1, {YEAR},
WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE
PANEL, AND THE DATE OF THE INTERVIEW IF ROUND 2
OR JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE SECOND
CALENDAR YEAR OF THE PANEL AND THE DATE OF THE
INTERVIEW IF ROUND 4.

FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK
NAV_CL09 – END_LP09

LOOP DEFINITION: LOOP_09 COLLECTS THE SAQ STATUS
FOR EACH PERSON ELIGIBLE TO COMPLETE THE SAQ.
THIS LOOP CYCLES ON EACH PERSON ON THE RU-MEMBERS-
ROSTER WHO MEETS THE FOLLOWING CONDITIONS:
- PERSON IS KEY
- PERSON DOES NOT HAVE A STATUS OF DECEASED OR
INSTITUTIONALIZED ON ROUND 2 OR 4 INTERVIEW DATE
- PERSON CURRENTLY IN RU ON ROUND 2 OR 4 INTERVIEW
DATE
- PERSON IS 18 YEARS OF AGE OR OLDER (OR IN AGE
CATEGORIES 4-9) ON JULY 1, {YEAR}, WHERE ‘YEAR’
IS THE FIRST CALENDAR YEAR OF THE PANEL, IF
ROUND 2, OR ON JULY 1, {YEAR}, WHERE ‘YEAR’ IS
THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND
4, OR HAS TURNED 18 BETWEEN JULY 1, {YEAR},
WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE
PANEL, AND THE DATE OF THE INTERVIEW IF ROUND 2
OR JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE SECOND
CALENDAR YEAR OF THE PANEL AND THE DATE OF THE
INTERVIEW IF ROUND 4.

NAVIGATOR DETAILS: LOOP_09 USES NAV_CL09 TO
CONTROL THE FLOW OF THE LOOP.

ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED

ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.

ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.

ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS
STATED AT THE LOOP_09 DEFINITION.

CONTINUE WITH CL36 FOR SELECTED RU MEMBER.

DISPLAY THE PERSON’S 3-DIGIT PID FOR ‘PID’.

SOFT CHECK:
CODE ‘4’ (MAILED TO SAQ RESPONDENT) MUST BE
VERIFIED (ENTERED TWICE) IF RU IS NOT A STUDENT
RU. IF CODE ‘4’ SELECTED AND RU IS NOT A STUDENT
RU, DISPLAY THE FOLLOWING MESSAGE: ‘UNLIKELY
RESPONSE. VERIFY AND RE-ENTER.’

CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER WHO
MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION

IF NO OTHER PERSONS MEET THE STATED CONDITIONS,
END LOOP_09 AND GO TO BOX_16A

IF AT LEAST ONE PERSON WITH AN SAQ DISPOSITION IN
THE PREVIOUS ROUND (SAQSTAT) OF ‘5’ (REFUSED TO
COMPLETE SAQ) OR [‘91’ (OTHER) AND UPDATED BY
RECEPIT CONTROL (RCFLG) to 0, 1, or 3] DURING
ROUND 2 OR 4 AND NOT UPDATED BY RECEIPT, CONTINUE
WITH CL38

OTHERWISE, GO TO BOX_16A

ROSTER DETAILS:
TITLE: RU-MEMBERS_7

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: PID
INSTRUCTIONS: DISPLAY RU MEMBERS’ 3-DIGIT ID
(PERS.PID)

ROSTER DEFINITION:
DISPLAY PERSONS ON THE RU-MEMBERS-ROSTER FOR
DISPLAY ONLY.

ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, EDIT, ADD, DELETE DISALLOWED.

ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO
MEET THE FOLLOWING CONDITIONS:
- PERSON IS KEY
- PERSON DID NOT HAVE A STATUS OF DECEASED OR
INSTITUTIONALIZED ON ROUND 2 OR 4 INTERVIEW DATE
- PERSON WAS CURRENTLY IN RU ON ROUND 2 OR 4
INTERVIEW DATE
- PERSON IS 18 YEARS OF AGE OR OLDER (OR IN AGE
CATEGORIES 4-9) ON JULY 1, {YEAR}, WHERE ‘YEAR’
IS THE FIRST CALENDAR YEAR OF THE PANEL, IF
ROUND 2, OR ON JULY 1, {YEAR}, WHERE ‘YEAR’ IS
THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND
4, OR HAS TURNED 18 BETWEEN JULY 1, {YEAR},
WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE
PANEL, AND THE DATE OF THE INTERVIEW IF ROUND 2
OR JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE SECOND
CALENDAR YEAR OF THE PANEL AND THE DATE OF THE
INTERVIEW IF ROUND 4.
- CL36 WAS CODED ‘1’ (COMPLETED AND GIVEN TO
INTERVIEWER), ‘2’ (NOT COMPLETED, WILL PICK UP
AT LATER DATE), ‘3’ (NOT COMPLETED, WILL MAIL
TO OFFICE),‘4’ (MAILED TO SAQ RESPONDENT), ‘5’
(REFUSED TO COMPLETE SAQ), OR ‘91’ (OTHER)
DURING ROUND 2 OR 4 FOR PERSON AND NOT UPDATED
BY RECEIPT CONTROL TO ‘1’ (COMPLETE), ‘2’
(PARTIAL COMPLETE), ‘4’ (PROBLEM), OR ‘6’ (WRONG
SAQ TYPE) ((I.E., RECEIPT CONTROL IS EQUAL TO
‘3’ (REFUSED) OR ‘5’ (NOT HERE/BLANK))

FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK
NAV_CL10 - END_LP10

LOOP DEFINITION: LOOP_10 COLLECTS THE SAQ STATUS
FOR EACH PERSON ELIGIBLE TO COMPLETE THE SAQ.
THIS LOOP CYCLES ON EACH PERSON ON THE RU-MEMBERS-
ROSTER WHO MEETS THE FOLLOWING CONDITIONS:
- PERSON IS KEY
- PERSON DID NOT HAVE A STATUS OF DECEASED OR
INSTITUTIONALIZED ON ROUND 2 OR 4 INTERVIEW DATE
- PERSON WAS CURRENTLY IN RU ON ROUND 2 OR 4
INTERVIEW DATE
- PERSON IS 18 YEARS OF AGE OR OLDER (OR IN AGE
CATEGORIES 4-9) ON JULY 1, {YEAR}, WHERE ‘YEAR’
IS THE FIRST CALENDAR YEAR OF THE PANEL, IF
ROUND 2, OR ON JULY 1, {YEAR}, WHERE ‘YEAR’ IS
THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND
4, OR HAS TURNED 18 BETWEEN JULY 1, {YEAR},
WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE
PANEL, AND THE DATE OF THE INTERVIEW IF ROUND 2
OR JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE SECOND
CALENDAR YEAR OF THE PANEL AND THE DATE OF THE
INTERVIEW IF ROUND 4.
- CL36 WAS CODED ‘1’ (COMPLETED AND GIVEN TO
INTERVIEWER), ‘2’ (NOT COMPLETED, WILL PICK UP
AT LATER DATE), ‘3’ (NOT COMPLETED, WILL MAIL
TO OFFICE),‘4’ (MAILED TO SAQ RESPONDENT), ‘5’
(REFUSED TO COMPLETE SAQ), OR ‘91’ (OTHER)
DURING ROUND 2 OR 4 FOR PERSON AND NOT UPDATED
BY RECEIPT CONTROL TO ‘1’ (COMPLETE), ‘2’
(PARTIAL COMPLETE), ‘4’ (PROBLEM), OR ‘6’
(WRONG SAQ TYPE) ((I.E., RECEIPT CONTROL IS
EQUAL TO ‘3’ (REFUSED) OR ‘5’ (NOT HERE/BLANK))

NAVIGATOR DETAILS: LOOP_10 USES NAV_CL10 TO
CONTROL THE FLOW OF THE LOOP.

ROSTER DETAILS:
COL # 1 HEADER: SAQ FORMS
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED

ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.

ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.

ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS
STATED AT THE LOOP_10 DEFINITION.

CONTINUE WITH CL39 FOR SELECTED RU MEMBER.

DISPLAY THE PERSON’S 3-DIGIT PID FOR ‘PID’.

DISPLAY ‘SAQ STATUS FROM PREVIOUS ROUND’ {PREVIOUS
ROUND STATUS -40}’. OTHERWISE, USE A NULL
DISPLAY.

FOR ‘PREVIOUS ROUND STATUS-40’, DISPLAY THE TEXT
ASSOCIATED WITH THE ROUND 2 OR 4 (OR RECEIPT
CONTROL UPDATED STATUS) STATUS ENTERED AT CL36.
OTHERWISE, USE A NULL DISPLAY.

CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER WHO
MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION

IF NO OTHER PERSONS MEET THE STATED CONDITIONS,
END LOOP_10 AND CONTINUE WITH BOX_16A

SUBSECTION 5A: DIABETES CARE SUPPLEMENT (DCS)
QUESTIONNAIRE (ROUNDS 3 AND 5 ONLY)

IF ROUND 3 OR 5, CONTINUE WITH BOX_16B

OTHERWISE, GO TO CL41

IF ROUND 3 OR 5 AND AT LEAST ONE RU MEMBER
ELIGIBLE FOR DIABETES CARE SUPPLEMENT (I.E., AT
LEAST ONE RU MEMBER WHO IS CONFIRMED AS HAVING
DIABETES AT PC02A), CONTINUE WITH CL40A

OTHERWISE, GO TO BOX_16C

DISPLAY THE ROW PERSON’S PID FOR ‘PID’.

DISPLAY THE TYPE OF DCS FOR THE PERSON FOR
‘SELF/PROXY’. IF PC03 FOR THE ROW PERSON IS CODED
‘1’ (SELF), DISPLAY ‘SELF.’ IF PC03 FOR THE ROW
PERSON IS CODED ‘2’ (PROXY), DISPLAY ‘PROXY.’

ROSTER DETAILS:
TITLE: RU-MEMBERS_9

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: PID
INSTRUCTIONS: DISPLAY RU MEMBERS’ 3-DIGIT ID
(PERS.PID)

ROSTER DEFINITION:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER FOR
DISPLAY ONLY.

ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, ADD, EDIT, DELETE DISALLOWED.

ROSTER FILTER:
DISPLAY ALL PERSONS WHO MEET THE FOLLOWING
CONDITION:

- PC02A IS CODED ‘1’ (CONTINUE) FOR THE PERSON

FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK
NAV-CL10A – END_LP10A

LOOP DEFINITION: LOOP_10A COLLECTS THE DCS STATUS
FOR EACH PERSON ELIGIBLE TO COMPLETE THE DCS.
THIS LOOP CYCLES ON EACH PERSON ON THE RU-
MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITION:

- PC02A IS CODED ‘1’ (CONTINUE) FOR THE PERSON

NAVIGATOR DETAILS: LOOP_10A USES NAV_CL10A TO
CONTROL THE FLOW OF THE LOOP.

ROSTER DETAILS:
COL # 1 HEADER: DCS FORMS
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED

ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.

ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.

ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS
STATED AT THE LOOP_10A DEFINITION.

CONTINUE WITH CL40B FOR SELECTED RU MEMBER.

DISPLAY THE PERSON’S 3-DIGIT PID FOR ‘PID’.

FOR ‘SELF/PROXY’, DISPLAY ‘SELF’ IF THE PERSON
BEING LOOPED ON IS CODED ‘1’ (SELF) AT PC03.
DISPLAY ‘PROXY’ IF THE PERSON BEING LOOPED ON
IS CODED ‘2’ (PROXY) AT PC03.

SOFT CHECK:
CODE ‘4’ (MAILED TO DCS RESPONDENT) MUST BE
VERIFIED (ENTERED TWICE) IF RU IS NOT A STUDENT
RU. IF CODE ‘4’ SELECTED AND RU IS NOT A STUDENT
RU, DISPLAY THE FOLLOWING MESSAGE: ‘UNLIKELY
RESPONSE. VERIFY AND RE-ENTER.’

CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER WHO
MEETS THE CONDITION STATED IN THE LOOP DEFINITION

IF NO OTHER PERSONS MEET THE STATED CONDITION,
END LOOP_10A AND CONTINUE WITH BOX_16C

SUBSECTION 5B: CANCER SAQ QUESTIONNAIRE (ROUNDS 3
AND 5 ONLY)

IF PANEL 16 ROUND 3 OR PANEL 15 ROUND 5, CONTINUE
WITH BOX_16D

OTHERWISE, GO TO CL41

NOTE: THE DISTRIBUTION AND COLLECTION OF THE
CANCER SAQ OCCURS ONLY DURING PANEL 16 ROUND 3 AND
PANEL 15 ROUND 5. AT THIS TIME, THERE ARE NO
PLANS TO COLLECT THE CANCER SAQ IN FUTURE ROUNDS.

IF PANEL 16 ROUND 3 OR PANEL 15 ROUND 5 AND AT
LEAST ONE RU MEMBER ELIGIBLE FOR CANCER SAQ
(I.E., AT LEAST ONE RU MEMBER WHO IS CONFIRMED AS
HAVING CANCER AT PC04), CONTINUE WITH CL40D

OTHERWISE, GO TO CL41

ROSTER DETAILS:
TITLE: RU-MEMBERS_9

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: PID
INSTRUCTIONS: DISPLAY RU MEMBERS’ 3-DIGIT ID
(PERS.PID)

ROSTER DEFINITION:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER FOR
DISPLAY ONLY.

ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, ADD, EDIT, DELETE DISALLOWED.

ROSTER FILTER:
DISPLAY ALL PERSONS WHO MEET THE FOLLOWING
CONDITION:

- PC04 IS CODED ‘1’ (CONTINUE) FOR THE PERSON

FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK
NAV-CL10B – END_LP10B

LOOP DEFINITION: LOOP_10B COLLECTS THE CANCER
SAQ STATUS FOR EACH PERSON ELIGIBLE TO COMPLETE
THE CANCER SAQ. THIS LOOP CYCLES ON EACH PERSON
ON THE RU-MEMBERS-ROSTER WHO MEETS THE FOLLOWING
CONDITION:

- PC04 IS CODED ‘1’ (CONTINUE) FOR THE PERSON

NAVIGATOR DETAILS: LOOP_10B USES NAV_CL10B TO
CONTROL THE FLOW OF THE LOOP.

ROSTER DETAILS:
COL # 1 HEADER: CANCER SAQ FORMS
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED

ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.

ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.

ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS
STATED AT THE LOOP_10B DEFINITION.

CONTINUE WITH CL40E FOR SELECTED RU MEMBER.

DISPLAY THE PERSON’S 3-DIGIT PID FOR ‘PID’.

SOFT CHECK:
CODE ‘4’ (MAILED TO CANCER SAQ RESPONDENT) MUST BE
VERIFIED (ENTERED TWICE) IF RU IS NOT A STUDENT
RU. IF CODE ‘4’ SELECTED AND RU IS NOT A STUDENT
RU, DISPLAY THE FOLLOWING MESSAGE: ‘UNLIKELY
RESPONSE. VERIFY AND RE-ENTER.’

CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER WHO
MEETS THE CONDITION STATED IN THE LOOP DEFINITION

IF NO OTHER PERSONS MEET THE STATED CONDITION,
END LOOP_10B AND GO TO CL41

CL41 BEGINS SUBSECTION 6: COLLECTING/UPDATING
LOCATING INFORMATION (ROUND 1 THROUGH ROUND 5)

DISPLAY ‘In the coming months, ... use and
expenses.’ IF ROUNDS 1, 2, 3, OR 4. OTHERWISE,
DISPLAY ‘We are nearing ... month or so.’

DISPLAY ‘Just ... move.’ IF ROUND 1. OTHERWISE,
DISPLAY ‘Let ... interview.’

IF NOT ROUND 5, CONTINUE WITH CL42

OTHERWISE (I.E., IF ROUND 5), GO TO BOX_17

NOTE: CL42OV1 IS ALWAYS DISPLAYED ON THE SCREEN
WITH CL42. IT IS NOT A TRUE ‘OVERLAY’.

IF NO CURRENT RU MEMBER PART OF THE RU ON THE
CURRENT INTERVIEW DATE (I.E., ALL RU MEMBERS
DECEASED, INSTITUTIONALIZED, OR OUT OF THE COUNTRY
ON CURRENT INTERVIEW DATE), GO TO BOX_18

OTHERWISE, CONTINUE WITH CL43

ASSUMPTION: THE QUESTIONS IN CLOSING IN WHICH
CONTACT AND LOCATING INFORMATION IS PRE-RECORDED
IN CAPI (CL43-CL64) ARE SPECIFIED WITH THE
FOLLOWING BASIC ASSUMPTIONS:
1. LOCATING AND CONTACTING INFORMATION WILL NOT BE
WRITTEN OVER FROM ROUND TO ROUND.
2. ONLY THE MOST CURRENT INFORMATION WILL APPEAR
IN THE TEXT OF THESE QUESTIONS AND NO HISTORY
OF CONTACT AND LOCATING INFORMATION WILL APPEAR
ON THE CAPI SCREEN FOR THE INTERVIEWER.
3. IF INFORMATION STAYS THE SAME, IT WILL BE
CARRIED FORWARD.
4. WHETHER OR NOT PREVIOUS ROUND’S INFORMATION OR
ANY CONTACT HISTORY WILL BE PRINTED ON THE FACE
SHEET FOR ANY OF THE CONTACTING AND LOCATING
QUESTIONS IS STILL NOT KNOWN.

HARD CHECK:
CODES ‘2’ (YES, SECOND PHONE ABOVE CORRECT) AND
‘3’ (YES, SECOND PHONE ABOVE NEEDS CORRECTION)
CANNOT BE SELECTED IF NO CURRENT SECOND PHONE
INFORMATION AVAILABLE. IF CODES ‘2’ OR ‘3’
SELECTED WHEN NO CURRENT SECOND PHONE, DISPLAY
THE FOLLOWING MESSAGE: ‘CODE NOT AVAILABLE. NO
CURRENT SECOND PHONE. VERIFY AND RE-ENTER.’

FLAG SECOND PHONE INFORMATION FOR THE RU WITH THE
NUMBER ENTERED OR CORRECTED AT CL44 FOR THE
CURRENT ROUND.

HARD CHECK:
DISALLOW LEADING ZEROES AS AN ENTRY.

AN ENTRY MUST BE MADE FOR EVERY FIELD (REF AND DK
ARE ALLOWED).

FLAG SECOND PHONE INFORMATION FOR THE RU WITH THE
NUMBER ENTERED OR CORRECTED AT CL44 FOR THE
CURRENT ROUND.

HARD CHECK:
DISALLOW LEADING ZEROS AS AN ENTRY.

ALLOW 2 LINES OF 45 CHARACTERS FOR DESCRIPTION.

HARD CHECK:
CODES ‘2’ (YES, MAILING ADDRESS ABOVE CORRECT)
AND ‘3’ (YES, MAILING ADDRESS ABOVE NEEDS
CORRECTION) CANNOT BE SELECTED IF NO CURRENT
MAILING ADDRESS INFORMATION AVAILABLE. IF CODES
‘2’ OR ‘3’ SELECTED WHEN NO CURRENT MAILING
ADDRESS, DISPLAY THE FOLLOWING MESSAGE: ‘CODE
NOT AVAILABLE. NO CURRENT MAILING ADDRESS.
VERIFY AND RE-ENTER.’

CONTINUE WITH BOX_17A

HARD CHECK:
AN ENTRY MUST BE MADE FOR EVERY FIELD EXCEPT
SECOND STREET ADDRESS (REF AND DK ARE ALLOWED).

IF NOT ROUND 5, CONTINUE WITH CL48

OTHERWISE (I.E., IF ROUND 5), GO TO BOX_18

HARD CHECK:
CODES ‘2’ (YES, SECOND HOME ADDRESS AND TELEPHONE
ABOVE CORRECT) AND ‘3’ (YES, SECOND HOME ADDRESS
OR TELEPHONE ABOVE NEEDS CORRECTION) CANNOT BE
SELECTED IF NO CURRENT SECOND HOME ADDRESS
INFORMATION AVAILABLE. IF CODES ‘2’ OR ‘3’
SELECTED WHEN NO CURRENT SECOND HOME ADDRESS,
DISPLAY THE FOLLOWING MESSAGE: ‘CODE NOT
AVAILABLE. NO CURRENT SECOND HOME ADDRESS.
VERIFY AND RE-ENTER.’

HARD CHECK:
AN ENTRY MUST BE MADE FOR EVERY FIELD EXCEPT
SECOND STREET ADDRESS (REF AND DK ARE ALLOWED).

HARD CHECK:
CODES ‘2’ (YES, CONTACT PERSON/ADDRESS ABOVE
CORRECT) AND ‘3’ (YES, CONTACT PERSON/ADDRESS
ABOVE NEEDS CORRECTION) CANNOT BE SELECTED IF NO
CURRENT CONTACT PERSON INFORMATION AVAILABLE. IF
CODES ‘2’ OR ‘3’ SELECTED WHEN NO CURRENT CONTACT
INFORMATION, DISPLAY THE FOLLOWING MESSAGE: ‘CODE
NOT AVAILABLE. NO CURRENT CONTACT INFORMATION.
VERIFY AND RE-ENTER.’

NOTE: BEGINNING IN PANEL 17 ROUND 1, PANEL 16
ROUND 3, AND PANEL 14 ROUND 5 AND FOR ALL FUTURE
ROUNDS MEPS NO LONGER COLLECTS OR DISPLAYS THE
CONTACT PERSON’S MIDDLE NAME (HOME.CONTMNAM) IN
CAPI OR IN THE IMS.

DISPLAY THE NAME OF THE REFERENCE PERSON FOR THE
RU FOR ‘NAME OF REFERENCE PERSON’.

GO TO CL53

HARD CHECK:
AN ENTRY MUST BE MADE FOR EVERY FIELD EXCEPT
SECOND STREET ADDRESS (REF AND DK ARE ALLOWED).

DISPLAY THE NAME OF THE REFERENCE PERSON FOR THE
RU FOR ‘NAME OF REFERENCE PERSON’.

CONTINUE WITH CL53

IF CURRENT ALTERNATE RESPONDENT IS A DU MEMBER,
DO NOT DISPLAY CURRENT ADDRESS AND PHONE
INFORMATION. ONLY DISPLAY CURRENT ADDRESS AND
PHONE INFORMATION IF CURRENT ALTERNATE RESPONDENT
IS OUTSIDE OF THE DU.

HARD CHECK:
CODES ‘2’ (ALTERNATE RESPONDENT INFORMATION
CORRECT) AND ‘3’ (ALTERNATE RESPONDENT INFORMATION
NEEDS CORRECTION) CANNOT BE SELECTED IF NO CURRENT
ALTERNATE RESPONDENT INFORMATION AVAILABLE. IF
CODES ‘2’ OR ‘3’ SELECTED WHEN NO CURRENT
ALTERNATE RESPONDENT INFORMATION, DISPLAY THE
FOLLOWING MESSAGE: ‘RESPONSE NOT AVAILABLE. NO
NO CURRENT ALTERNATE INFORMATION. VERIFY AND
RE-ENTER.’

IF ‘SOMEONE OUTSIDE DU’ SELECTED AND CL53 IS
‘ENTER NEW ALTERNATE RESPONDENT INFORMATION,
CONTINUE WITH CL55.
ELSE IF ‘SOMEONE OUTSIDE DU’ SELECTED AND CL53 IS
‘ALTERNATE RESPONDENT INFORMATION NEEDS
CORRECTION’, CONTINUE WITH CL55_2.

OTHERWISE, GO TO CL57

ROSTER DETAILS:
TITLE: DU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY DU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)

ROSTER DEFINITION:
DISPLAY PERSONS ON THE DU-MEMBERS-ROSTER FOR
SELECTION.

ROSTER BEHAVIOR:
1. SELECT ONE ALLOWED.
2. MULTIPLE SELECT, EDIT, ADD, DELETE DISALLOWED.
3. DISPLAY ‘SOMEONE OUTSIDE DU’ AS LAST ENTRY ON
ROSTER.

ROSTER FILTER:
DISPLAY THOSE DU MEMBERS WHO MEET THE FOLLOWING
CONDITIONS:
- PERSON IS NOT CURRENT RESPONDENT
- PERSON IS NOT DECEASED

IF THERE IS NO CURRENT ALTERNATE RELATIONSHIP,
PROCEED TO CL56.
OTHERWISE, PROCEED TO CL56_2.

HARD CHECK:
AN ENTRY MUST BE MADE FOR EVERY FIELD EXCEPT
SECOND STREET ADDRESS (REF AND DK ARE ALLOWED).

IF THERE IS NO CURRENT ALTERNATE RELATIONSHIP,
PROCEED TO CL56.
OTHERWISE, PROCEED TO CL56_2.

DISPLAY THE NAME ENTERED AT CL55 FOR ‘NAME OF
ALTERNATE RESPONDENT CL55’.

DISPLAY THE NAME OF THE REFERENCE PERSON FOR THE
RU FOR ‘NAME OF REFERENCE PERSON’.

HARD CHECK:
AN ENTRY MUST BE MADE (REF AND DK ARE ALLOWED).

DISPLAY THE NAME ENTERED AT CL55 FOR ‘NAME OF
ALTERNATE RESPONDENT CL55’.

DISPLAY THE NAME OF THE REFERENCE PERSON FOR THE
RU FOR ‘NAME OF REFERENCE PERSON’.

CONTINUE WITH LOOP_11

ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)

ROSTER DEFINITION:
DISPLAY THE RU-MEMBERS-ROSTER FOR SELECTION.

ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, EDIT, DELETE DISALLOWED.

ROSTER FILTER:
DISPLAY ALL PERSONS WHO ARE CURRENT RU MEMBERS
(I.E., A MEMBER OF THE RU ON THE INTERVIEW DATE)

FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK
CL59 - END_LP11

LOOP DEFINITION: LOOP_11 COLLECTS ADDRESS
INFORMATION FOR POTENTIAL FUTURE MOVERS. THIS
LOOP CYCLES ON PERSONS ON THE RU-MEMBERS-ROSTER
WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER (I.E., PERSON PART
OF THE RU ON INTERVIEW DATE)
- PERSON SELECTED AS A FUTURE MOVER (I.E.,
SELECTED AT CL58)
- PERSON NOT FLAGGED AS ‘PROCESSED FUTURE MOVER’
(I.E., PERSON HAS NOT YET BEEN PROCESSED THROUGH
THIS LOOP OR SELECTED AT CL61)

REFUSED AND DON’T KNOW ALLOWED FOR EACH FIELD.

FLAG PERSON AS ‘PROCESSED FUTURE MOVER’.

IF ALL PERSONS SELECTED AS FUTURE MOVERS (I.E.,
SELECTED AT CL58) ARE FLAGGED AS ‘PROCESSED FUTURE
MOVER’, GO TO END_LP11

OTHERWISE, CONTINUE WITH CL60

HARD CHECK: CAPI REQUIRES AN ENTRY IN ALL FIELDS
EXCEPT SECOND STREET ADDRESS.

FLAG ALL SELECTED PERSONS AS ‘PROCESSED FUTURE
MOVER’.

CONTINUE WITH END_LP11

ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)

ROSTER DEFINITION:
DISPLAY PERSONS ON THE RU-MEMBERS-ROSTER FOR
SELECTION.

ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, EDIT, DELETE DISALLOWED.

ROSTER FILTER:
DISPLAY ALL PERSONS IN THE RU-MEMBERS-ROSTER WHO
MEET THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER (I.E., PERSON PART
OF THE RU ON INTERVIEW DATE)
- PERSON SELECTED AS A FUTURE MOVER (I.E.,
SELECTED AT CL58)
- PERSON NOT FLAGGED AS ‘PROCESSED FUTURE MOVER’

CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER WHO
MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION

IF NO OTHER PERSONS MEET THE STATED CONDITIONS,
END LOOP_11 AND CONTINUE WITH BOX_18

IF CURRENT RESPONDENT IS A PROXY, CONTINUE WITH
CL61A

OTHERWISE, GO TO BOX_18A

HARD CHECK:
CODES ‘2’ (YES, PROXY ADDRESS AND TELEPHONE ABOVE
CORRECT) AND ‘3’ (YES, PROXY ADDRESS OR TELEPHONE
ABOVE NEEDS CORRECTION) CANNOT BE SELECTED IF NO
CURRENT PROXY ADDRESS INFORMATION AVAILABLE. IF
CODES ‘2’ OR ‘3’ SELECTED WHEN NO CURRENT PROXY
ADDRESS, DISPLAY THE FOLLOWING MESSAGE: ‘CODE
NOT AVAILABLE. NO CURRENT PROXY ADDRESS. VERIFY
AND RE-ENTER.’

FLAG PROXY ADDRESS INFORMATION FOR THE RU WITH THE
ADDRESS AND PHONE ENTERED OR CORRECTED AT CL61B
FOR THE CURRENT ROUND.

CONTINUE WITH BOX_18A

HARD CHECK:
AN ENTRY MUST BE MADE FOR EVERY FIELD EXCEPT
SECOND STREET ADDRESS (REF AND DK ARE ALLOWED).

FLAG PROXY ADDRESS INFORMATION FOR THE RU WITH THE
ADDRESS AND PHONE ENTERED OR CORRECTED AT CL61B
FOR THE CURRENT ROUND.

CONTINUE WITH BOX_18A

IF ROUND 1, GO TO CL65

OTHERWISE, CONTINUE WITH BOX_18B

IF AT LEAST ONE RU MEMBER COMPLETED THE SAQ [CL36
IS CODED ‘1’ (COMPLETED AND GIVEN TO INTERVIEWER)
FOR AT LEAST ONE RU MEMBER IF ROUNDS 2 OR 4 OR
CL39 IS CODED ‘1’ (COMPLETED AND GIVEN TO
INTERVIEWER) FOR AT LEAST ONE RU MEMBER IF ROUNDS
3 OR 5], CONTINUE WITH CL64A

OTHERWISE, GO TO CL65

ROSTER DETAILS:
TITLE: RU_MEMBERS

COL # 1 HEADER: PID
INSTRUCTIONS: DISPLAY RU MEMBERS’ 3-DIGIT ID
(PERS.PID)

COL # 2 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)

COL # 3 HEADER: PAYMENT TYPE
INSTRUCTIONS: SELECT PAYMENT TYPE

COL # 4 HEADER: CHECK NUMBER
INSTRUCTIONS: ENTER CHECK NUMBER

ROSTER DEFINITION:
DISPLAY PERSONS ON THE RU-MEMBERS-ROSTER FOR
DISPLAY ONLY.

ROSTER BEHAVIOR:
1. THE PID COLUMN IS PROTECTED; NO CHANGES ARE
ALLOWED.

2. THE NAME COLUMN IS PROTECTED; NO CHANGES ARE
ALLOWED.

3. THE PAYMENT TYPE COLUMN IS A DROP DOWN
SELECTION BOX WITH TWO CHOICES: CHECK AND CASH.

4. THE CHECK NUMBER COLUMN IS A 7 DIGIT NUMERIC
ENTRY FIELD.

5. THE CHECK NUMBER COLUMN SHOULD BE INACTIVE OR
"GRAYED OUT" UNTIL A SELECTION IS MADE IN THE
PAYMENT TYPE COLUMN. IF ‘CHECK’ IS SELECTED,
THE CURSOR MOVES TO THE CHECK NUMBER COLUMN FOR
COMPLETION. IF ‘CASH’ IS SELECTED THE CHECK
NUMBER COLUMN REMAINS INACTIVE AND THE CURSOR
MOVES TO THE PAYMENT TYPE COLUMN FOR THE NEXT
RU MEMBER ON THE ROSTER.

6. SELECT, ADD, AND DELETE DISALLOWED.

ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER THAT
HAVE COMPLETED AN SAQ FOR THIS ROUND. THAT IS,
DISPLAY ALL RU MEMBERS THAT MEET THE FOLLOWING
CONDITION:

- IF ROUNDS 2 OR 4: CL36 IS CODED ‘1’ (COMPLETED
AND GIVEN TO INTERVIEWER) FOR THIS PERSON
OR
- IF ROUNDS 3 OR 5: CL39 IS CODED ‘1’ (COMPLETED
AND GIVEN TO INTERVIEWER) FOR THIS PERSON

DISPLAY ‘The next interview will take place in
about six months.’ IF ROUNDS 1 OR 2 OR 3 OR 4.
IF ROUND 5, USE A NULL DISPLAY.

DISPLAY ‘ASK ... GIFT.’ IF ROUNDS 1 OR 2 OR 3 OR
4. DISPLAY ‘GIVE RESPONDENT ... Panel Survey.’ IF
ROUND 5.

CL65OV SHOULD ALWAYS BE DISPLAYED AT CL65 (NOT AN
OVERLAY), BUT IT SHOULD BE INACTIVE OR "GRAYED
OUT". IF CL65 IS CODED ‘1’ (CHECK), CL65OV SHOULD
BECOME ACTIVE. IF CL65 IS CODED ‘2’ (CASH),
CL65OV REMAINS INACTIVE.

IF CL67_13 IS CODED '1' (YES), CONTINUE WITH
CL67OV

OTHERWISE, GO TO BOX_20

END INTERVIEW.