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NOTE: ALL INFORMATION IS SAVED BY ROUND. THE
INFORMATION USED FOR THE FACE SHEET WILL BE
THE ENTIRE HISTORY.
RS01
DID YOU COMPLETE THIS INTERVIEW IN-PERSON OR BY
TELEPHONE?
(YOU MUST HAVE SUPERVISOR APPROVAL PRIOR TO
INTERVIEWING
BY TELEPHONE.)
IN-PERSON .............................. 1 {RS01A}
BY TELEPHONE ........................... 2 {RS01A}
[Code One]
RS01A
WAS THIS INTERVIEW COMPLETED WHILE ON TRAVEL?
YES .................................... 1 {RS02}
NO ..................................... 2 {RS02}
RS02
WHAT LANGUAGE WAS THIS INTERVIEW COMPLETED IN?
ENGLISH ................................ 1 {RS03}
SPANISH ................................ 2 {RS03}
BOTH ENGLISH AND SPANISH ............... 3 {RS03}
OTHER LANGUAGE ........................ 91 {RS02OV}
[Code One]
RS02OV
ENTER OTHER LANGUAGE:
[Enter Other Specify-45] ............... {RS03}
RS03
WAS ANYONE OTHER THAN THE {RESPONDENT/PROXY}
PRESENT FOR ALL OR PART OF THE INTERVIEW?
NO ONE ELSE PRESENT .................... 1 {BOX_01}
SOMEONE ELSE PRESENT FOR ALL OF
INTERVIEW ........................... 2 {RS04}
SOMEONE ELSE PRESENT FOR PART OF
INTERVIEW ........................... 3 {RS04}
[Code One]
DISPLAY ‘RESPONDENT’ IF CURRENT RESPONDENT IS AN
RU MEMBER. DISPLAY ‘PROXY’ IF CURRENT RESPONDENT
IS A PROXY.
RS04
SELECT ALL OTHER PERSONS PRESENT DURING INTERVIEW.
[First Name, [Middle Name], Last Name-65]
[First Name, [Middle Name], Last Name-65]
[First Name, [Middle Name], Last Name-65]
DISPLAY ‘SOMEONE OUTSIDE DU’ AS AN OPTION ON THIS
SCREEN.
CONTINUE WITH BOX_01
ROSTER DETAILS:
TITLE: DU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
ROSTER DEFINITION:
DISPLAY PERSONS ON THE DU-MEMBERS-ROSTER FOR
SELECTION.
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, EDIT, DELETE DISALLOWED.
ROSTER FILTER:
DISPLAY PERSONS ON THE DU-MEMBERS-ROSTER WHO MEET
THE FOLLOWING CONDITION(S):
- PERSON IS ON THE DU ROSTER, BUT NOT THE RU
ROSTER
OR
- PERSON ON THE RU ROSTER AND WAS ELIGIBLE AT THE
END OF RE-ENUMERATION AND IS PHYSICALLY IN THE
RU ON THE INTERVIEW DATE
AND
- PERSON IS NOT IDENTIFIED AS CURRENT RESPONDENT
RS04AA
HOW CONFIDENT ARE YOU THAT THE RESPONDENT GAVE YOU ALL
HEALTH CARE FOR ALL RU MEMBERS?
NOT AT ALL CONFIDENT ................... 1 {RS04BB}
NOT VERY CONFIDENT ..................... 2 {RS04BB}
SOMEWHAT CONFIDENT ..................... 3 {RS04BB}
VERY CONFIDENT ......................... 4 {BOX_01}
RS04BB
ENTER COMMENTS OR DESCRIBE THE SITUATION THAT LED YOU
TO
BELIEVE THIS.
[Enter Text] ....................... {BOX_01}
ALLOW THE MAXIMUM NUMBER OF LINES AND CHARACTERS
PER LINE THAT THE SCREEN WILL PERMIT.
BOX_01
IF NOT ROUND 5, CONTINUE WITH RS04A
OTHERWISE (I.E., IF ROUND 5), GO TO RS09
RS04A
DO YOU HAVE ANY TIPS ABOUT THE RU OR THE RESPONDENT
THAT CAN HELP
WITH COLLECTING BETTER DATA IN THE NEXT ROUND? INCLUDE
NOTES ABOUT
ADDITIONAL HELPFUL RECORDS THAT YOU DIDN’T HAVE THIS
ROUND, THINGS YOU
DID OR SAID TO MOTIVATE THE RESPONDENT TO GET RECORDS,
ETC.
YES .................................... 1 {RS04B}
NO ..................................... 2 {RS05}
RS04B
ENTER RECORD KEEPING AND OTHER DATA QUALITY TIPS:
[Enter Text] ....................... {RS05}
ALLOW THE MAXIMUM NUMBER OF LINES AND CHARACTERS
PER LINE THAT THE SCREEN WILL PERMIT.
RS05
ARE THERE ANY {ADDITIONAL} SPECIAL INSTRUCTIONS THAT
SHOULD BE
CARRIED OVER TO THE NEXT ROUND THAT WOULD HELP WITH
THE COMPLETION
OF THE INTERVIEW? INCLUDE SUCH THINGS AS BEST TIME TO
CONTACT,
SPECIAL NEEDS OF THE RESPONDENT, OR OTHER
CONSIDERATIONS.
YES .................................... 1 {RS06}
NO ..................................... 2 {RS07}
IF ROUND > 1, DISPLAY THE WORD "ADDITIONAL".
IF ROUND 1, USE A NULL DISPLAY.
RS06
ENTER SPECIAL INSTRUCTIONS:
[Enter Text] ....................... {RS07}
ALLOW 270 CHARACTERS.
RS07
ARE THERE ANY {ADDITIONAL OR DIFFERENT} LOCATING
DIRECTIONS THAT SHOULD BE CARRIED OVER TO THE NEXT
ROUND
THAT WOULD HELP IN FINDING THE HOUSEHOLD? INCLUDE SUCH
THINGS AS LANDMARKS, MILEAGE, ROAD SIGNS AND SO FORTH.
YES .................................... 1 {RS08}
NO ..................................... 2 {RS09}
IF ROUND > 1, DISPLAY "ADDITIONAL OR DIFFERENT".
IF ROUND 1, USE A NULL DISPLAY.
RS08
ENTER DIRECTIONS THAT WILL HELP TO LOCATE THE
RU IN THE
NEXT ROUND.
[Enter Text] ........................ {RS09}
ALLOW THE MAXIMUM NUMBER OF LINES AND CHARACTERS
PER LINE THAT THE SCREEN WILL PERMIT.
RS09
OTHER THAN AUTHORIZATION FORM PROBLEMS REPORTED IN THE
CLOSING
SECTION, IN GENERAL, DID YOU HAVE ANY PROBLEMS WITH
THE
ADMINISTRATION OF THE QUESTIONNAIRE? IS THERE ANYTHING
IN THE
CASE RECORDS THAT NEEDS TO BE FIXED AT THE HOME OFFICE
BEFORE
THE NEXT ROUND?
YES .................................... 1 {RS10}
NO ..................................... 2 {RS11}
RS10
ENTER COMMENTS OR QUESTIONS OR DESCRIBE THE SITUATION:
[Enter Text] ............................ {RS11}
ALLOW THE MAXIMUM NUMBER OF LINES AND CHARACTERS
PER LINE THAT THE SCREEN WILL PERMIT.
NOTE THAT INFORMATION COLLECTED AT THIS ITEM WILL
NOT APPEAR ON THE FACE SHEET.
RS10A
OMITTED.
RS10B
OMITTED.
RS10C
OMITTED.
RS10D
OMITTED.
RS11
WAS THE INTERVIEW FOR THIS RU OBSERVED THIS ROUND?
YES .................................... 1
NO ..................................... 2
IF MESSAGE FROM DATA PREP, CONTINUE WITH RS12
OTHERWISE, GO TO RS14
RS12
MESSAGE FROM DATA PREP:
{MESSAGE TEXT}
THE MESSAGE TEXT WILL DISPLAY THE SPECIAL
INSTRUCTIONS (FROM DATA PREP).
ALLOW 225 CHARACTERS.
CONTINUE WITH RS13
RS13
PLEASE PROVIDE ENOUGH INFORMATION TO CLARIFY THE
SITUATION AND/OR
DESCRIBE THE ACTION TAKEN TO CORRECT THE SITUATION:
[Enter Text] ................. {RS14}
ALLOW 210 CHARACTERS.
RS14
HAS THIS RU MOVED TO A NEW CITY OR STATE SINCE THE
START OF THIS
ROUND?
YES .................................... 1 {RS15}
NO ..................................... 2 {RS16}
RS15
PLEASE INDICATE THE NEW CITY AND STATE FOR THIS RU:
CITY:
[Enter City-30] ................
STATE:
[Enter State-2] ................ {RS16}
RS16
WAS THIS RU CONVERTED FROM A REFUSAL?
YES .................................... 1 {RS17}
NO ..................................... 2 {BOX_02}
RS17
WHICH OF THE FOLLOWING STRATEGIES, IF ANY, HELPED YOU
CONVERT
THIS REFUSAL?
CODE ALL THAT APPLY.
ASKED A DIFFERENT RU
MEMBER TO
COMPLETE THE INTERVIEW
............... 1
EMPHASIZED THE
RESPONDENT INCENTIVE .... 2
PROVIDED REASSURANCE
ABOUT THE
CONFIDENTIALITY OF THE
DATA .......... 3
PROMOTED THE
IMPORTANCE OF MEPS DATA
AND STATISTICS FOR
HEALTHCARE POLICY
AND RESEARCH
......................... 4
MADE A PERSONAL LINK
BETWEEN THE RU
MEMBERS AND THE
PURPOSE OF MEPS
(E.G., COSTS AND
CONCERNS ABOUT CARING
FOR AN ELDERLY
HOUSEHOLD MEMBER) ..... 5
EMPHASIZED FLEXIBILITY
IN THE DAY,
TIME OR PLACE OF
INTERVIEW TO
ACCOMMODATE RESPONDENT
............... 6
RESPONDED DIRECTLY TO
"TAKES TOO MUCH
TIME" AS A BARRIER TO
PARTICIPATION .. 7
SET INTERVIEW UP AS
JUST AGREEING TO
THIS INTERVIEW, NOT
NECESSARILY THE
WHOLE PANEL; NOTED CAN
STOP
PARTICIPATING AT ANY
TIME ............ 8
SWITCHED LANGUAGE OF
INTERVIEW, OR USED
AN INTERPRETER
....................... 9
EMPHASIZED THAT THE RU
CANNOT BE
REPLACED IN THE SAMPLE
.............. 10
OFFERED TO CONDUCT THE
INTERVIEW BY
PHONE
............................... 11
APPROACHED RU MEMBER
AS IF UNAWARE OF
ANY PRIOR CONTACTS
.................. 12
USED ANOTHER STRATEGY
(SPECIFY) ....... 91
[Code All That Apply]
IF CODE ‘91’ (USED ANOTHER STRATEGY) ENTERED ALONE
OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE
WITH RS17OV
OTHERWISE, GO TO BOX_02
RS17OV
PLEASE DESCRIBE THE STRATEGY YOU USED TO CONVERT THIS
REFUSAL:
[Enter Other Specify].................. {BOX_02}
REF ................................... -7 {BOX_02}
DK .................................... -8 {BOX_02}
ALLOW 180 CHARACTERS.
BOX_02
END OF RU INFORMATION SCREEN (RS) SECTION.
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