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BOX_00
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, PRND.BEGREFMM,
PRND.BEGREFDD, PRND.BEGREFYY, PRND.ENDREFMM,
PRND.ENDREFDD, PRND.ENDREFYY
IF PRND DATES ARE MISSING USE RU DATES:
RUBEGMM, RUBEGDD, RUENDMM, RUENDDD
BOX_01
IF PERSON IS LESS THAN 3 YEARS OF AGE (OR AGE
CATEGORIES 1 OR 2), GO TO BOX_03
OTHERWISE, CONTINUE WITH DD01
DD01
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
{The next questions ask about time/Now think about}
when {you/{(PERSON}}
may have missed a half day or more from work or school
{since {START
DATE}/between {START DATE} and {END DATE}}. {In
answering these
questions, please include any time when this occurred
because of {your/
{PERSON}’s} physical illness or injury, or a mental or
emotional
problem such as stress or depression.}
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
DISPLAY ‘The next questions ask about time’ IF
FIRST CYCLE THROUGH THE DISABILITY DAYS SECTION
FOR THE CURRENT ROUND. OTHERWISE, DISPLAY ‘Now
think about’.
DISPLAY ‘since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘between {START DATE} and {END DATE}’ IF
ROUND 5.
DISPLAY ‘In answering ... or depression.’ IF FIRST
CYCLE THROUGH THE DISABILITY DAYS SECTION FOR THE
CURRENT ROUND. OTHERWISE, USE A NULL DISPLAY.
NOTE: THERE IS NO UPPER AGE LIMIT RESTRICTION FOR
PERSONS WHO ARE ASKED THE WORK-LOSS DISABILITY
DAYS QUESTION.
IF PERSON IS = OR > 3 YEARS OLD AND < OR = 15
YEARS OLD (OR AGE CATEGORY 3), GO TO DD05
IF PERSON IS = OR > 16 YEARS OLD (OR AGE
CATEGORIES 4-9), CONTINUE WITH DD02
DD02
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
{NUMBER OF DAYS IN HOSPITAL: {NUMBER OF DAYS}}
{NUMBER OF DAYS INSTITUTIONALIZED: {NUMBER OF DAYS}}
Let's talk about work. {Including the time
{you/{PERSON}} {were/was}
in {the hospital} {and} {the long-term care facility},
how/How}
many days did {you/{PERSON}} miss a half day or more
from work {since
{START DATE}/between {START DATE} and {END DATE}}?
Please do not
include work around the house.
PROBE: Include any time when a half day or more was
missed
because of a physical illness or injury, or a mental
or
emotional problem.
[Enter Number of Days] .................
NO DAYS MISSED FROM WORK ............... 995
DOES NOT WORK (OTHER THAN AROUND THE
HOUSE) ................................. 996
REF .................................... -7
DK ..................................... -8
HELP AVAILABLE FOR DEFINITION OF HALF DAY OR MORE.
DISPLAY ‘NUMBER OF DAYS IN HOSPITAL: { }’ IF
PERSON HAS AT LEAST ONE HOSPITAL STAY THAT ENDED
IN CURRENT ROUND (I.E., DISCHARGE DATE NOT
CODED ‘95’ (STILL IN HOSPITAL)). OTHERWISE, USE A
NULL DISPLAY.
FOR ‘NUMBER OF DAYS’, DISPLAY TOTAL NUMBER OF DAYS
PERSON WAS IN HOSPITAL FOR ALL HOSPITAL STAYS THAT
ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT
CODED ‘95’ (STILL IN HOSPITAL)). OTHERWISE, USE A
NULL DISPLAY.
DISPLAY ‘NUMBER OF DAYS INSTITUTIONALIZED: { }’
IF PERSON HAS AT LEAST ONE INSTITUTIONAL STAY
(IC EVENT) THAT ENDED IN CURRENT ROUND (I.E.,
DISCHARGE DATE NOT CODED ‘95’ (STILL IN
INSTITUTION)). OTHERWISE, USE A NULL DISPLAY.
NULL DISPLAY.
FOR ‘NUMBER OF DAYS’, DISPLAY TOTAL NUMBER OF DAYS
PERSON WAS IN AN INSTITUTION FOR ALL INSTITUTIONAL
STAYS THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE
DATE NOT CODED ‘95’ (STILL IN INSTITUTION)).
OTHERWISE, USE A NULL DISPLAY.
DISPLAY ‘Including the time {you/{PERSON}} {were/
was} in {the hospital} {and} {the long-term care
facility}, how’ IF PERSON HAS AT LEAST ONE
HOSPITAL STAY (HS) OR ONE INSTITUTIONAL STAY (IC)
EVENT THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE
DATE NOT CODED ‘95’ (STILL IN HOSPITAL/
INSTITUTION)). OTHERWISE, DISPLAY ‘How’.
DISPLAY ‘the hospital’ IF PERSON HAS AT LEAST ONE
HOSPITAL STAY (HS) EVENT THAT ENDED IN THE CURRENT
ROUND.
DISPLAY ‘the long-term care facility’ IF PERSON
HAS AT LEAST ONE INSTITUTIONAL CARE (IC) EVENT
THAT ENDED IN THE CURRENT ROUND.
DISPLAY ‘and’ IF PERSON HAS BOTH A HOSPITAL STAY
(HS) EVENT AND A INSTITUTIONAL STAY (IC) EVENT
THAT BOTH ENDED IN THE CURRENT ROUND.
DISPLAY ‘since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘between {START DATE} and {END DATE}’ IF
ROUND 5.
IF ‘0’ ENTERED, DISPLAY THE FOLLOWING ERROR
MESSAGE: "SELECT THE CODE ‘NO DAYS MISSED FROM
WORK’ TO RECORD ZERO."
IF NUMBER ENTERED > NUMBER OF DAYS IN REFERENCE
PERIOD, DISPLAY THE FOLLOWING ERROR MESSAGE:
‘NUMBER OF DAYS MUST BE EQUAL TO OR LESS THAN
NUMBER IN REFERENCE PERIOD.’
IF CODED '995' (NO DAYS MISSED FROM WORK), '996'
(DOES NOT WORK), '-7' (REFUSED), OR '-8' (DON'T
KNOW) AND PERSON IS 16 THROUGH 22 YEARS OF AGE
INCLUSIVE (OR AGE CATEGORY 4), GO TO DD05
IF CODED '995' (NO DAYS MISSED FROM WORK), '996'
(DOES NOT WORK), '-7' (REFUSED), OR '-8' (DON'T
KNOW) AND PERSON IS 23 YEARS OF AGE OR OLDER (OR
AGE CATEGORIES 5-9), GO TO BOX_02
OTHERWISE, CONTINUE WITH BOX_01A
HARD CHECK:
RANGE CHECK: 1 THROUGH NUMBER OF DAYS IN REFERENCE
PERIOD OR 996 FOR THIS PERSON.
BOX_01A
IF ROUND 3, CONTINUE WITH DD02A
OTHERWISE (I.E., IF NOT ROUND 3), GO TO BOX_01B
DD02A
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
NUMBER OF DAYS MISSED WORK: {NUMBER OF DAYS}
Of those days, how many were in {YEAR}?
[Enter Number of Days] ................. {BOX_01B}
REF ................................... -7 {BOX_01B}
DK .................................... -8 {BOX_01B}
FOR ‘NUMBER OF DAYS,’ DISPLAY THE NUMBER ENTERED
AT DD02
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES
AUTOMATICALLY): ‘YEAR’ IN QUESTION TEXT IS FIRST
CALENDAR YEAR OF PANEL.
HARD CHECK:
DAYS IN {YEAR} AT DD02A MUST BE < OR = DAYS MISSED
FROM WORK AT DD02.
DD03
OMITTED.
DD04
OMITTED.
BOX_01B
IF PERSON IS 16 THROUGH 22 YEARS OF AGE INCLUSIVE
(OR AGE CATEGORY 4), CONTINUE WITH DD05
OTHERWISE (I.E., PERSON IS 23 YEARS OF AGE OR
OLDER OR IN AGE CATEGORIES 5-9), GO TO BOX_02
DD04A
OMITTED.
DD05
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
{NUMBER OF DAYS IN HOSPITAL: {NUMBER OF DAYS}}
{NUMBER OF DAYS INSTITUTIONALIZED: {NUMBER OF DAYS}}
Let's talk about school (and day care). {Including the
time
{you/{PERSON}} {were/was} in {the hospital} {and} {the
long-term care
facility}, how/How} many days did {you/{PERSON}} miss
a half day or more
of school (or day care) {since {START DATE}/between
{START DATE} and
{END DATE}}?
PROBE: Include any time when a half day or more of
school (or
day care) was missed because of a physical illness or
injury, or
a mental or emotional problem.
[Enter Number of Days] ................. {BOX_01C}
NO DAYS MISSED FROM SCHOOL ............. 995 {BOX_02}
DOES NOT ATTEND SCHOOL ................. 996 {BOX_02}
REF .................................... -7 {BOX_02}
DK ..................................... -8 {BOX_02}
HELP AVAILABLE FOR DEFINITION OF HALF DAY OR MORE.
[Code One]
DISPLAY ‘NUMBER OF DAYS IN HOSPITAL: { }’ IF
PERSON HAS AT LEAST ONE HOSPITAL STAY THAT ENDED
IN CURRENT ROUND (I.E., DISCHARGE DATE NOT
CODED ‘95’ (STILL IN HOSPITAL)). OTHERWISE, USE A
NULL DISPLAY.
FOR ‘NUMBER OF DAYS’, DISPLAY TOTAL NUMBER OF DAYS
PERSON WAS IN HOSPITAL FOR ALL HOSPITAL STAYS THAT
ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT
CODED ‘95’ (STILL IN HOSPITAL)). OTHERWISE, USE A
NULL DISPLAY.
DISPLAY ‘NUMBER OF DAYS INSTITUTIONALIZED: { }’
IF PERSON HAS AT LEAST ONE INSTITUTIONAL STAY
(IC EVENT) THAT ENDED IN CURRENT ROUND (I.E.,
DISCHARGE DATE NOT CODED ‘95’ (STILL IN
INSTITUTION)). OTHERWISE, USE A NULL DISPLAY.
NULL DISPLAY.
FOR ‘NUMBER OF DAYS’, DISPLAY TOTAL NUMBER OF DAYS
PERSON WAS IN AN INSTITUTION FOR ALL INSTITUTIONAL
STAYS THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE
DATE NOT CODED ‘95’ (STILL IN INSTITUTION)).
OTHERWISE, USE A NULL DISPLAY.
DISPLAY ‘Including the time {you/{PERSON}} {were/
was} in {the hospital} {and} {the long-term care
facility}, how’ IF PERSON HAS AT LEAST ONE
HOSPITAL STAY (HS) OR ONE INSTITUTIONAL STAY (IC)
EVENT THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE
DATE NOT CODED ‘95’ (STILL IN HOSPITAL/
INSTITUTION)). OTHERWISE, DISPLAY ‘How’.
DISPLAY ‘the hospital’ IF PERSON HAS AT LEAST ONE
HOSPITAL STAY (HS) EVENT THAT ENDED IN THE CURRENT
ROUND.
DISPLAY ‘the long-term care facility’ IF PERSON
HAS AT LEAST ONE INSTITUTIONAL CARE (IC) EVENT
THAT ENDED IN THE CURRENT ROUND.
DISPLAY ‘and’ IF PERSON HAS BOTH A HOSPITAL STAY
(HS) EVENT AND A INSTITUTIONAL STAY (IC) EVENT
THAT BOTH ENDED IN THE CURRENT ROUND.
DISPLAY ‘since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘between {START DATE} and {END DATE}’ IF
ROUND 5.
IF ‘0’ ENTERED, DISPLAY THE FOLLOWING ERROR
MESSAGE: "SELECT THE CODE ‘NO DAYS MISSED FROM
SCHOOL’ TO RECORD ZERO."
IF NUMBER ENTERED > NUMBER OF DAYS IN REFERENCE
PERIOD, DISPLAY THE FOLLOWING ERROR MESSAGE:
‘NUMBER OF DAYS MUST BE EQUAL TO OR LESS THAN
NUMBER OF DAYS IN REFERENCE PERIOD.’
HARD CHECK:
RANGE CHECK: 1 THROUGH NUMBER OF DAYS IN REFERENCE
PERIOD FOR THIS PERSON.
BOX_01C
IF ROUND 3, CONTINUE WITH DD05A
OTHERWISE (I.E., IF NOT ROUND 3), GO TO BOX_02
DD05A
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
NUMBER OF DAYS MISSED SCHOOL: {NUMBER OF DAYS}
Of those days, how many were in {YEAR}?
[Enter Number of Days] ................. {BOX_02}
REF ................................... -7 {BOX_02}
DK .................................... -8 {BOX_02}
FOR ‘NUMBER OF DAYS,’ DISPLAY THE NUMBER ENTERED
AT DD05.
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES
AUTOMATICALLY): ‘YEAR’ IN QUESTION TEXT IS FIRST
CALENDAR YEAR OF PANEL.
HARD CHECK:
DAYS MISSED FROM SCHOOL IN {YEAR} AT DD05A MUST BE
< OR = DAYS MISSED FROM SCHOOL AT DD05.
DD06
OMITTED.
DD07
OMITTED.
BOX_01D
OMITTED.
DD07A
OMITTED.
DD08
OMITTED.
BOX_01E
OMITTED.
DD08A
OMITTED.
DD09
OMITTED.
BOX_02
CHECK AGE AND WORK STATUS:
IF LESS THAN 16 YEARS OF AGE (OR AGE CATEGORIES
1-3), GO TO BOX_03
IF 16 YEARS OF AGE OR OLDER (OR AGE CATEGORIES
4-9) AND DD02 IS NOT CODED '996' (DOES NOT WORK
OTHER THAN AROUND THE HOUSE), CONTINUE WITH DD10
IF 16 YEARS OF AGE OR OLDER (OR AGE CATEGORIES
4-9) AND DD02 IS CODED '996' (DOES NOT WORK
OTHER THAN AROUND THE HOUSE), GO TO BOX_03
DD10
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
{Besides the {NUMBER OF MISSED WORK DAYS} days
{you/{PERSON}} missed
a half day or more from work because of {your/his/her}
own illness
or injury, did/Did} {you/{PERSON}} miss more than a
half day from
work {between {START DATE} and {END DATE}} because of
someone
else's illness, injury, or health care needs, for
example, to
take care of a sick child or a relative?
YES .................................... 1 {DD11}
NO/DO NOT WORK ......................... 2 {BOX_03}
REF ................................... -7 {BOX_03}
DK .................................... -8 {BOX_03}
[Code One]
HELP AVAILABLE FOR DEFINITION OF HALF DAY OR MORE.
DISPLAY ‘Besides the ..., did’ IF ANY MISSED WORK
DAYS RECORDED FOR THIS PERSON IN DD02. DISPLAY
‘Did’ IF NO MISSED WORK DAYS RECORDED FOR THIS
PERSON IN DD02.
DISPLAY NUMBER RECORDED IN DD02 FOR ‘NUMBER OF
MISSED WORK DAYS’ IF DD02 DOES NOT = ‘-7’
(REFUSED) OR ‘-8’ (DON’T KNOW). IF DD02 = ‘-7’
(REFUSED) OR ‘-8’ (DON’T KNOW), USE A NULL
DISPLAY.
DISPLAY ‘between {START DATE} and {END DATE}’ IF
ROUND 5. OTHERWISE, USE A NULL DISPLAY.
DD11
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
How many days did {you/{PERSON}} miss a half day or
more from work
because of someone else's illness, injury, or health
care needs?
[Enter Number of Days] ................. {BOX_02A}
REF ................................... -7 {BOX_03}
DK .................................... -8 {BOX_03}
IF ‘0’ ENTERED, DISPLAY THE FOLLOWING ERROR
MESSAGE: ‘IF NO WORK DAYS MISSED, BACK UP AND
CORRECT PREVIOUS ANSWER.’
IF NUMBER ENTERED > NUMBER OF DAYS IN REFERENCE
PERIOD, DISPLAY THE FOLLOWING ERROR MESSAGE:
‘NUMBER OF DAYS MUST BE EQUAL TO OR LESS THAN
NUMBER IN REFERENCE PERIOD.’
HARD CHECK:
DAYS ENTERED AT DD11 MUST BE < OR = NUMBER OF DAYS
IN REFERENCE PERIOD FOR PERSON.
BOX_02A
IF ROUND 3, CONTINUE WITH DD11A
OTHERWISE (I.E., IF NOT ROUND 3), GO TO BOX_03
DD11A
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
NUMBER OF DAYS MISSED WORK DUE TO SOMEONE ELSE’S
HEALTH:
{NUMBER OF DAYS}
Of those days, how many were in {YEAR}?
[Enter Number of Days] ................. {BOX_03}
REF ................................... -7 {BOX_03}
DK .................................... -8 {BOX_03}
FOR ‘NUMBER OF DAYS,’ DISPLAY THE NUMBER ENTERED
AT DD11.
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES
AUTOMATICALLY): ‘YEAR’ IN QUESTION TEXT IS FIRST
CALENDAR YEAR OF PANEL.
HARD CHECK:
DAYS IN {YEAR} AT DD11A MUST BE < OR = DAYS MISSED
WORK DUE TO SOMEONE ELSE’S HEALTH AT DD11.
BOX_03
GO TO NEXT QUESTIONNAIRE SECTION
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