MEDICAL EXPENDITURE PANEL SURVEY
HOUSEHOLD COMPONENT MAIN STUDY
BLAISE SHOW CARDS
Panels 24, 23, and 22
January 2019
TABLE OF CONTENTS
ROUNDS 1-5
Card Number |
Topic |
Round(s) Used |
RE-1 |
Periods of Active Duty Service |
1, 2, 3, 4, 5 |
RE-2 |
Ethnic Background |
1, 2, 3, 4, 5 |
RE-3 |
Racial Background |
1, 2, 3, 4, 5 |
PE-1 |
Types of Cancer |
1, 2, 3, 4 |
PE-2 |
Frequency Scale |
1, 2, 3, 4 |
HE-1 |
Level of Difficulty Categories |
1, 3 |
PP-1 |
Types of Hospital Visits |
1, 2, 3, 4, 5 |
PP-2 |
Types of Emergency Room Services |
1, 2, 3, 4, 5 |
PP-3 |
Types of Outpatient Care |
1, 2, 3, 4, 5 |
PP-4 |
Types of Primary Care |
1, 2, 3, 4 ,5 |
PP-5 |
Types of Medical Specialists |
1, 2, 3, 4, 5 |
PP-6 |
Types of Dental Care Providers |
1, 2, 3, 4, 5 |
PP-7 |
Types of Mental Health Professionals |
1, 2, 3, 4, 5 |
PP-8 |
Types of Other Medical Professionals |
1, 2, 3, 4, 5 |
PP-9 |
Types of Clinics |
1, 2, 3, 4, 5 |
PP-10 |
Types of Laboratories |
1, 2, 3, 4, 5 |
PP-11 |
Types of Therapists |
1, 2, 3, 4, 5 |
PP-12 |
Types of Vision Care Providers |
1, 2, 3, 4, 5 |
PP-13 |
Types of Alternative Care |
1, 2, 3, 4, 5 |
PP-14 |
Types of Home Care Services |
1, 2, 3, 4, 5 |
PP-15 |
Types of Residential Care |
1, 2, 3, 4, 5 |
EV-1A |
Examples of Where Care Received (Event Typing) |
1, 2, 3, 4, 5 |
EV-1B |
Examples of Where Care Received (Event Typing) |
1, 2, 3, 4, 5 |
HS-1 |
Reasons for Entering the Hospital |
1, 2, 3, 4, 5 |
ER-1 |
Care Received During ER Visit |
1, 2, 3, 4, 5 |
ER-2 |
Services Received During ER Visit |
1, 2, 3, 4, 5 |
OP-1 |
Care Received During Outpatient Visit |
1, 2, 3, 4, 5 |
OP-2 |
Services Received During Outpatient Visit |
1, 2, 3, 4, 5 |
MV-1 |
Care Received During Medical Provider Visit |
1, 2, 3, 4, 5 |
MV-2 |
Services Received During Medical Provider Visit |
1, 2, 3, 4, 5 |
DN-1 |
Types of Dental Care Providers |
1, 2, 3, 4, 5 |
DN-2 |
Care Received During Dental Visit |
1, 2, 3, 4, 5 |
HH-1 |
Types of Home Health Care Workers |
1, 2, 3, 4, 5 |
HH-2 |
Types of Home Health Care Workers |
1, 2, 3, 4, 5 |
IC-1 |
Types of Residential Care Facilities |
1, 2, 3, 4, 5 |
OM-1 |
Types of Disposable Medical Supplies |
1, 2, 3, 4, 5 |
OM-2 |
Types of Other Medical Equipment |
1, 2, 3, 4, 5 |
CP-1 |
Reasons for Not Receiving Anything in Writing |
1, 2, 3, 4, 5 |
CP-2 |
Total Charges for Disposable Supplies |
1, 2, 3, 4, 5 |
CS-1 |
Scale for Child Health Supplement |
2, 4 |
CS-2 |
Scale for Child Health Supplement |
2, 4 |
CS-3 |
Number of Times Went to Doctor’s Office or Clinic |
2, 4 |
CS-4 |
Scale for Child Health Supplement |
2, 4 |
AC-1 |
Provider’s Race |
2, 4 |
AC-2 |
Difficulty Scale |
2, 4 |
AC-3 |
Frequency Scale |
2, 4 |
HX-1 |
Sample Medicare Card |
1, 2, 3, 4, 5 |
HX-2 |
Sample Medicaid Card (for STATE) |
1, 2, 3, 4, 5 |
HX-3 |
Source of Health Insurance (for STATE) |
1, 2, 3, 4, 5 |
HX-4 |
Types of Public Insurance |
1, 2, 3, 4, 5 |
HX-5 |
Medicare HMO Premium Ranges |
1, 3 |
HX-6 |
Medicare Part D Premium Ranges |
1, 3 |
HX-7 |
Types of Health Insurance Coverage |
1, 2, 3, 4, 5 |
HX-8 |
State Sources of Health Insurance for Self-Employed Jobs |
1, 2, 3, 4, 5 |
IN-1 |
Yearly Income Ranges |
3, 5 |
IN-2 |
Yearly Income Ranges |
3, 5 |
IN-3 |
Monthly Income Ranges |
3, 5 |
IN-4 |
Other Sources of Income Categories |
3, 5 |
AS-1 |
Asset Ranges |
5 |
AS-2 |
Asset Ranges |
5 |
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One or more categories may be selected.
- -- September 2001 or later
- -- August 1990 to August 2001, including the Persian Gulf War
- -- May 1975 to July 1990
- -- Vietnam era, August 1964 to April 1975
- -- February 1955 to July 1964
- -- Korean War, July 1950 to January 1955
- -- January 1947 to June 1950
- -- World War II, December 1941 to December 1946
- -- November 1941 or earlier
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One or more categories may be selected.
- -- Mexican
- -- Mexican-American/Chicano
- -- Puerto Rican
- -- Cuban/Cuban American
- -- Dominican
- -- Central or South American
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One or more categories may be selected.
- -- White
- -- Black or African American
- -- American Indian or Alaska Native
- -- Asian Indian
- -- Chinese
- -- Filipino
- -- Japanese
- -- Korean
- -- Vietnamese
- -- Other Asian
- -- Native Hawaiian
- -- Guamanian or Chamorro
- -- Samoan
- -- Other Pacific Islander
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- -- Bladder
- -- Blood
- -- Bone
- -- Brain
- -- Breast
- -- Cervical
- -- Colon
- -- Esophagus
- -- Gallbladder
- -- Kidney/Renal
- -- Larynx-Windpipe
- -- Leukemia
- -- Liver
- -- Lung
- -- Lymphoma (Non-Hodgkin’s)
- -- Mouth/Tongue/Lip
- -- Ovarian
- -- Pancreas
- -- Prostate
- -- Rectum
- -- Skin – Melanoma
- -- Skin – Non-Melanoma
- -- Skin (unknown type)
- -- Soft tissue muscle or fat
- -- Stomach
- -- Testicular
- -- Throat or Pharynx
- -- Thyroid
- -- Uterine
- -- Other
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- -- Within the last 7 days
- -- More than 7 days ago, but within last 30 days
- -- More than 30 days ago
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- -- No Difficulty
- -- Some Difficulty
- -- A Lot of Difficulty
- -- Completely Unable To Do It
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- -- Admitted to the hospital for one or more nights
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- -- Any type of care received in a hospital emergency room
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Same-day care received at a hospital outpatient department such as...
- -- Surgery Centers
- -- Cancer Treatment Centers
- -- Physical Therapy and Rehabilitation Centers
- -- Cardiology Centers
- -- Obesity Treatment Centers
- -- Radiology and Imaging Centers
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Primary care doctor such as...
- -- General Practitioner
- -- Internist
- -- Pediatrician
- -- Family Medicine Provider
- -- Medical Doctor
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Such as...
- -- Orthopedist
- -- Cardiologist
- -- Dermatologist
- -- Oncologist
- -- Neurologist
- -- Gynecologist
- -- Allergist
- -- Gastroenterologist
- -- Surgeon
- -- Kidney specialist (Nephrologist)
- -- Radiologist
- -- Ear, nose and throat specialist (Otorhinolaryngologist)
- -- Urologist
- -- Podiatrist
- -- Audiologist
- -- Any other type of medical specialist
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Such as...
- -- Dentists
- -- Oral Surgeons
- -- Orthodontists
- -- Dental Assistants
- -- Dental Hygienists
- -- Pediatric Dentists
- -- Endodontists
- -- Periodontists
- -- Dental Technicians
- -- Other Type of Dental Care Providers
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Such as...
- -- Psychiatrist
- -- Psychologist
- -- Licensed Clinical Social Worker
- -- Mental Health Therapist
- -- Counselor
- -- Psychiatric Social Worker
- -- Other Mental Health Professional
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Such as...
- -- Nurse (RN, LPN, PHN, BSN)
- -- Nurse practitioner
- -- Nurse’s aide
- -- Physician’s assistant (PA)
- -- Midwife
- -- Health aide
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Such as...
- -- Walk-in Urgent Care
- -- Retail Clinic – in a pharmacy
- -- Retail Clinic – in a grocery store
- -- Family Planning Center
- -- College or University Clinic
- -- Employer Clinic
- -- Free Clinic
- -- Infirmary
- -- Other type of Health Clinic
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Such as...
- -- Independent Medical Lab
- -- Testing Facility Lab
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Such as...
- -- Physical Therapists
- -- Occupational Therapist
- -- Speech Therapist
- -- Chiropractor
- -- Physiatrist
- -- Behavioral Therapist
- -- Other type of Therapist
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Such as...
- -- Optometrist
- -- Ophthalmologist
- -- Vision Technician
- -- Optician
- -- Orthoptist
- -- Other Eye Care Professional
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Such as...
- -- Acupuncture
- -- Homeopathic care
- -- Massage therapy
- -- Hypnosis
- -- Naturopathic care
- -- Herbalist
- -- Other alternative care professional
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Care received at home, such as...
- Skilled Medical Care from -
- -- a home care nurse,
- -- any type of therapist,
- -- a social worker,
- -- anyone else providing nursing or medical care
- Personal Care Services such as help with -
- -- bathing,
- -- dressing,
- -- taking medication
- Household Chore Services
- -- help with cooking
- -- help with cleaning
- Companionship Services such as -
- -- reading,
- -- talking,
- -- going for a walk or drive
- Any Other Type of Home Care
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Residential or long-term care received at places such as...
- -- Nursing Home for Rehabilitation Services
- -- Inpatient Rehabilitation Facility or Convalescent Home
- -- Hospice Care
- -- Respite Care
- -- Mental Health Treatment Center
- -- Drug and Alcohol Treatment Center
- -- Addiction Treatment Center
- -- Eating Disorder Treatment Center
- -- Other Treatment Center
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- -- Hospital – Inpatient Stay
- -- Hospital Emergency Room
- -- Hospital Outpatient Department
- -- Dental Office
- -- Medical Provider Office or Clinic
- -- Care Received at Home
- -- Residential or Long Term Care Facility
- e.g., Nursing Home, Rehabilitation Facility, Drug Treatment, Psychiatric Facility
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- -- Hospital – Inpatient Stay
- -- Hospital Emergency Room
- -- Hospital Outpatient Department
- -- Dental Office
- -- Medical Provider Office or Clinic
- -- Care Received at Home
- -- Residential or Long Term Care Facility
- e.g., Nursing Home, Rehabilitation Facility, Drug Treatment, Psychiatric Facility
- -- Glasses/Contact Lenses
- -- Other Medical Expenses
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- -- Operation or Surgical Procedure
- -- Treatment or Therapy, Not Including Surgery
- -- Diagnostic Tests Only
- -- Give Birth to a Baby - Normal or Caesarean Section (Mother)
- -- To Be Born (Baby)
- -- Pregnancy-Related Complications
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- -- Diagnosis or Treatment
- -- Emergency (e.g., Accident or Injury)
- -- Psychotherapy or Mental Health Counseling
- -- Follow-up or Post-Operative Visit
- -- Immunization or Shots
- -- Pregnancy-Related (Including Prenatal Care and Delivery)
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- -- Laboratory Tests
- -- Sonogram or Ultrasound
- -- X-Rays
- -- Mammogram
- -- MRI or CAT Scan
- -- EKG, ECG, or EEG
- -- Vaccination
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- -- General Checkup
- -- Diagnosis or Treatment
- -- Emergency (e.g., Accident or Injury)
- -- Psychotherapy or Mental Health Counseling
- -- Follow-up or Post-Operative Visit
- -- Immunizations or Shots
- -- Vision Exam
- -- Pregnancy-Related (Including Prenatal Care and Delivery)
- -- Well Child Exam
- -- Laser Eye Surgery
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- -- Laboratory Tests
- -- Sonogram or Ultrasound
- -- X-Rays
- -- Mammogram
- -- MRI or CAT Scan
- -- EKG, ECG, or EEG
- -- Vaccination
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- -- General Checkup
- -- Diagnosis or Treatment
- -- Emergency (e.g., Accident or Injury)
- -- Psychotherapy or Mental Health Counseling
- -- Follow-up or Post-Operative Visit
- -- Immunizations or Shots
- -- Vision Exam
- -- Pregnancy-Related (Including Prenatal Care and Delivery)
- -- Well Child Exam
- -- Laser Eye Surgery
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- -- Laboratory Tests
- -- Sonogram or Ultrasound
- -- X-Rays
- -- Mammogram
- -- MRI or CAT Scan
- -- EKG, ECG, or EEG
- -- Vaccination
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- -- General Dentist
- -- Pediatric Dentist
- -- Dental Specialist (e.g., Orthodontist, Endodontist, Periodontist)
- -- Dental Hygienist
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- Diagnostic or Preventive
- -- General Exam, Check-up or Consultation
- -- Cleaning, Prophylaxis, Polishing, or Periodontal Recall Visit (Periodic or Regular)
- -- X-Rays, Radiographs, or Bitewings
- -- Fluoride Treatment
- -- Sealant (Plastic Coatings on Back Teeth)
- Restorative or Endodontic
- -- Fillings, Inlays, Crowns or Caps
- -- Root Canal
- Periodontic (Gum Treatment)
- -- Periodontal Scaling, Root Planing, or Gum Surgery
- Oral Surgery
- -- Extraction, Tooth Pulled, or Other Oral Surgery
- -- Implants
- Prosthetics
- -- Fixed Bridges, Dentures or Removable Partial Dentures, Relining or Repair of Bridges or Dentures
- Orthodontics
- -- Orthodontia, Braces, or Retainers
- Additional Procedures
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- -- Certified Nursing Assistant (CNA)
- -- Dietitian/Nutritionist
- -- I.V. or Infusion Therapist
- -- Medical Doctor
- -- Nurse/Nurse Practitioner
- -- Occupational Therapist
- -- Physical Therapist
- -- Respiratory Therapist
- -- Social Worker
- -- Speech Therapist
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- -- Companion
- -- Homemaker or House Cleaner
- -- Home Health or Home Care Aide
- -- Hospice Worker
- -- Nurse’s Aide
- -- Personal Care Attendant
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- -- Inpatient Rehabilitation Facility or Convalescent Home
- -- Nursing Home
- -- Residential Mental Health Treatment Center
- -- Residential Eating Disorder Treatment Center
- -- Residential Drug and Alcohol or Addiction Treatment Center
- -- Residential Hospice Care
- -- Residential Respite Care
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Disposable Supplies such as...
- -- Ostomy supplies
- -- Bandages and dressings
- -- Tape
- -- Adult disposable diapers
- -- Catheters
- -- Syringes not prescribed by a physician
- -- IV supplies
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Medical Equipment such as...
- Mobility aids
- -- Walker
- -- Scooter
- -- Wheelchair
- -- Braces
- Equipment used in the home
- -- Hospital bed
- -- Monitor
- -- Bed pan
- -- Lift
- -- Special chair
- -- Adaptive feeding equipment
- Home and automobile modifications
- -- Ramp
- -- Elevator
- -- Handrails
- -- Automobile modification
- Hearing and speech assistance
- -- Hearing aid
- -- Amplifier for a telephone
- -- Adaptive speech equipment
- Other
- -- Blood pressure monitor
- -- Oxygen
- -- Vaporizer or nebulizer
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- -- Paid at Time of Visit
- -- Made a Co-payment
- -- Bill Sent Directly to Other Source
- -- Bill Has Not Arrived
- -- No Bill Sent:
- -- HMO Plan
- -- VA (Veterans Administration)/CHAMPVA
- -- Military Facility
- -- Public Assistance/Medicaid/SCHIP
- -- Indian Health Service (IHS)
- -- Worker’s Compensation
- -- Private Health Center/Clinic
- -- Public Clinic/Health Center or Private Charity
- -- Telephone Call – No Charge
- -- Free From Provider
- -- Government-Financed Research and Clinical Trials
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- -- 0
- -- 1 - 10
- -- 11 - 30
- -- 31 - 100
- -- 101 or More
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- 0 No Problem
- 1
- 2 Some Problem
- 3
- 4 A Very Big Problem
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- -- Never
- -- Sometimes
- -- Usually
- -- Always
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- None
- 1 time
- 2 times
- 3 times
- 4 times
- 5 to 9 times
- 10 or more times
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- 0 Worst Health Care Possible
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10 Best Health Care Possible
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- -- White
- -- Black/African American
- -- Asian
- -- Indian/Native American Alaska Native
- -- Other Pacific Islander
- -- Some Other Race
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- -- Very Difficult
- -- Somewhat Difficult
- -- Not Too Difficult
- -- Not At All Difficult
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- -- Never
- -- Sometimes
- -- Usually
- -- Always
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Retiring Medicare Card Sample
New Medicare Card Sample
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Sample Medicaid Card
[State Name Here]
(One for Each State)
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- -- From a Group or Association
- -- Directly Through a School
- -- Directly From an Insurance Agent
- -- Directly From Insurance Company
- -- Directly From an HMO
- -- From a Union
- -- From Anyone’s Previous Employer
- -- From Spouse’s/Deceased Spouse’s Previous Employer
- -- From Some Other Employer
- -- Under Plan of Someone Not Living Here
- -- Directly From the Health Insurance Marketplace
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- -- Medicare
- -- Medicaid
- -- SCHIP
- -- TRICARE
- -- CHAMPVA
- -- VA
- -- Other Government Program Providing Hospital and Physician Benefits
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- -- 1 - 50
- -- 51 - 100
- -- 101 - 200
- -- 201 - 300
- -- 301 or more
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- -- 1 - 30
- -- 31 - 60
- -- 61 - 90
- -- 91 - 120
- -- 121 or more
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- -- Hospital and Physician Benefits, Including Coverage Through an HMO
- -- Dental
- -- Prescription Drugs
- -- Vision
- -- Medicare Supplement/Medigap
- -- Long-Term Care in a Nursing Home
- -- Extra Cash for Hospital Stays
- -- Serious Disease or Dread Disease
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- -- From a Professional Association
- -- From a Small Business Group
- -- From a Union
- -- Directly From an Insurance Agent
- -- Directly From an Insurance Company
- -- Directly From an HMO
- -- From a Previous Employer
- -- Directly From the Health Insurance Marketplace
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- -- 1 - 5,000
- -- 5,001 - 10,000
- -- 10,001 - 15,000
- -- 15,001 - 25,000
- -- 25,001 - 50,000
- -- 50,001 - 100,000
- -- 100,001 or more
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- -- 1 - 100
- -- 101 - 500
- -- 501 - 1,000
- -- 1,001 - 5,000
- -- 5,001 - 15,000
- -- 15,001 or more
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- -- 1 - 250
- -- 251 - 500
- -- 501 - 750
- -- 751 - 1,000
- -- 1,001 or more
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- -- Wages and salary
- -- Farm income (or loss)
- -- Business income (or loss)
- -- Social Security/Railroad Retirement
- -- Private, military, or government pensions
- -- Interest
- -- Dividends
- -- Rental income (or loss)
- -- Other source
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- -- 0 - 10,000
- -- 10,001 - 25,000
- -- 25,001 - 50,000
- -- 50,001 - 100,000
- -- 100,001 - 250,000
- -- 250,001 - 500,000
- -- 500,001 - 1,000,000
- -- 1,000,001 or more
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- -- 0 - 1,000
- -- 1,001 - 5,000
- -- 5,001 - 10,000
- -- 10,001 - 25,000
- -- 25,001 - 50,000
- -- 50,001 - 100,000
- -- 100,001 - 250,000
- -- 250,001 - 500,000
- -- 500,001 or more
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