Information Screen (RS) Section

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]

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]

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}

BOX_01

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}

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}

RS06

ENTER SPECIAL INSTRUCTIONS:

[Enter Text] ....................... {RS07}

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}

RS08

ENTER DIRECTIONS THAT WILL HELP TO LOCATE THE RU IN
THE NEXT ROUND.

[Enter Text] ........................ {RS09}

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}

RS10A

OMITTED.

RS10B

OMITTED.

RS10C

OMITTED.

RS10D

OMITTED.

RS11

WAS THE INTERVIEW FOR THIS RU OBSERVED THIS ROUND?

YES .................................... 1
NO ..................................... 2

RS12

MESSAGE FROM DATA PREP:

{MESSAGE TEXT}

RS13

PLEASE PROVIDE ENOUGH INFORMATION TO CLARIFY THE SITUATION AND/OR
DESCRIBE THE ACTION TAKEN TO CORRECT THE SITUATION:

[Enter Text] ................. {RS14}

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]

RS17OV

PLEASE DESCRIBE THE STRATEGY YOU USED TO CONVERT THIS REFUSAL:

[Enter Other Specify].................. {BOX_02}
REF ................................... -7 {BOX_02}
DK .................................... -8 {BOX_02}

BOX_02

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