Information Screen (RS) Section

NOTE: ALL INFORMATION IS SAVED BY ROUND. THE
INFORMATION USED FOR THE FACE SHEET WILL BE THE
ENTIRE HISTORY.

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]

WAS THIS INTERVIEW COMPLETED WHILE ON TRAVEL?

YES .................................... 1 {RS02}
NO ..................................... 2 {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]

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.

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

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}

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.

IF NOT ROUND 5, CONTINUE WITH RS04A

OTHERWISE (I.E., IF ROUND 5), GO TO RS09

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}

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.

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.

ALLOW 270 CHARACTERS.

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.

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.

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}

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.

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

THE MESSAGE TEXT WILL DISPLAY THE SPECIAL
INSTRUCTIONS (FROM DATA PREP).

ALLOW 225 CHARACTERS.

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

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

ALLOW 210 CHARACTERS.

HAS THIS RU MOVED TO A NEW CITY OR STATE SINCE THE START OF THIS
ROUND?

YES .................................... 1 {RS15}
NO ..................................... 2 {RS16}

PLEASE INDICATE THE NEW CITY AND STATE FOR THIS RU:

CITY:

[Enter City-30] ................

STATE:

[Enter State-2] ................ {RS16}

WAS THIS RU CONVERTED FROM A REFUSAL?

YES .................................... 1 {RS17}
NO ..................................... 2 {BOX_02}

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

PLEASE DESCRIBE THE STRATEGY YOU USED TO CONVERT THIS REFUSAL:

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