Questionnaire set 1                                             

Questionnaire set 2

Questionnaire set 3

Questionnaire set 4

Questionnaire set 5

Questionnaire set 6

Questionnaire set 7

Questionnaire set 8

Questionnaire set 9

Questionnaire set 10

Questionnaire set 11

Questionnaire set 12

------------------------------------------------

Questionnaire set 1

The first questions are about family routines.


1.    How many times a week do you usually eat dinner together as a family?
Never
Less than once a week
1 - 2 times a week
3 - 5 times a week
Everyday or almost everyday


2.    During the school year, how many times a week do you usually get your home work done on time?
Never
Less than once a week
1 - 2 times a week
3 - 5 times a week
Everyday or almost everyday
Does not apply -- not in school


3.    During the school year, how often are you usually late for school?
Never
Once a month
Once every two weeks
Once a week
Several times a week
Everyday


4.    During the school year, how often are you usually late for a class?
Never
Once a month
Once every two weeks
Once a week
Several times a week
Everyday

Next, I will read a list of jobs some people do at home. After I read a job, please tell me how often you do that job. 

5.    How often do you clean the house?
Never
Once a month
Once every two weeks
Once a week
Several times a week
Everyday


6.    How often do you wash the dishes or load and empty the dishwasher?
Never
Once a month
Once every two weeks
Once a week
Several times a week
Everyday

7.    How often do you fix family meals?
Never
Once a month
Once every two weeks
Once a week
Several times a week
Everyday

8.    How often do you do the laundry?
Never
Once a month
Once every two weeks
Once a week
Several times a week
Everyday

9.    How often do you take care of brothers or sisters?
Never
Once a month
Once every two weeks
Once a week
Several times a week
Everyday
Does not apply - do not have any brothers or sisters

Now, I will read a series of statements about how you feel about your responsibilities at home. Please tell me how strongly you disagree or agree with each statement. 

10.    I feel I have too many responsibilities at home for someone my age.
Strongly disagree
Disagree
I'm in the middle
Agree
Strongly agree

11.    I feel I do more than my share of chores in my family .
Strongly disagree
Disagree
I'm in the middle
Agree
Strongly agree

12.    I have not been doing well in school because of my responsibilities at home.
Strongly disagree
Disagree
I'm in the middle
Agree
Strongly agree

13.    Please tell me which category best describes the mother you live with. Is it:
Your biological mother (that is the mother you were born to) who lives with you
Your adoptive mother who lives with you
Your stepmother who lives with you
Another female in the household who is like a mother to you (please describe how she is related to you)
You don't live with a biological, adoptive, step, or other mother figure

Thinking about this woman, please indicate how strongly you disagree or agree with the following statements about her.

14.     I think highly of her.
Strongly disagree
Disagree
I'm in the middle
Agree
Strongly agree

15.    She is a person that I respect.
Strongly disagree
Disagree
I'm in the middle
Agree
Strongly agree

16.    I really enjoy spending time with her.
Strongly disagree
Disagree
I'm in the middle
Agree
Strongly agree

17.    I can count on her to keep her promises.
Strongly disagree
Disagree
I'm in the middle
Agree
Strongly agree

Thinking about the mother you live with, please tell me how often she did the following things during the past 12 months. 

18.    Help you with things that are important to you?
Never
Rarely
Sometimes
Usually
Always

19.    Blame you for her problems?
Never
Rarely
Sometimes
Usually
Always

20.    Spend time just talking with you?
Never
Rarely
Sometimes
Usually
Always

21.    Show that she really cares about you?
Never
Rarely
Sometimes
Usually
Always

22.    Please tell me which category best describes the father you live with. Is it:
Your biological father (that is, the father you were born to) who lives with you
Your adoptive father who lives with you
Your stepfather who lives with you
Another male in the household who is like a father to you (please describe how he is related to you)
You don't live with a biological, adoptive, step, or other father figure

Thinking about this man, please indicate how strongly you disagree or agree with the following statements about him. 

23.    I think highly of him.
Strongly disagree
Disagree
I'm in the middle
Agree
Strongly agree

24.    He is a person that I respect.
Strongly disagree
Disagree
I'm in the middle
Agree
Strongly agree

25.    I really enjoy spending time with him.
Strongly disagree
Disagree
I'm in the middle
Agree
Strongly agree

26.    I can count on him to keep his promises.
Strongly disagree
Disagree
I'm in the middle
Agree
Strongly agree

Thinking about the father you live with, please indicate how often he did the following things during the past 12 months. 

27.   Help you with things that are important to you?
Never
Rarely
Sometimes
Usually
Always

28.    Blame you for his problems?
Never
Rarely
Sometimes
Usually
Always

29.    Spend time just talking with you?
Never
Rarely
Sometimes
Usually
Always

30.    Show that he really cares about you?
Never
Rarely
Sometimes
Usually
Always

Now we have a few questions about your parents or parent that you live with. 

31.     How much do your parents/parent know about your close friends? Do they:
Know nothing
Know a little
Know some things
Know most things
Know everything

32.    How much do your parents or parent know about your close friends' parents?
Know nothing
Know a little
Know some things
Know most things
Know everything

33.    How much do your parents or parent know about WHERE you are when YOU are not home?
Know nothing
Know a little
Know some things
Know most things
Know everything

34.    How much do your parents or parent know about WHO you are with when YOU are not at home?
Know nothing
Know a little
Know some things
Know most things
Know everything

35.    How much do your parents or parent know about WHAT you are doing when THEY are not at home?
Know nothing
Know a little
Know some things
Know most things
Know everything

36.    During the school year, how much do your parents or parent know about who your teachers are?
Know nothing
Know a little
Know some things
Know most things
Know everything
Does not apply -- not in school

37.    During the school year, how much do your parents or parent know about what you are doing in school?
Know nothing
Know a little
Know some things
Know most things
Know everything

Now we are going to name some things parents often set limits about. 

38.     Thinking only about the parents or parent that you live with, who sets the limits on how late you stay out at night?
You decide
Parent or parents set limits
Parent or parents and you decide jointly
Does not apply -- don't go out at night
Does not apply -- don't have limits

39.    How often have you broken the limits about how late you stay out at night?
Never in the past month
One or two times in the past month
Once a week
Several times a week
Everyday or almost everyday in the past month
Does not apply - I set my own limits

40.    Who sets the limits on what kinds of TV shows and movies you watch?
You decide
Parent or parents set limits
Parent or parents and you decide jointly
Does not apply -- don't watch TV shows or movies
Does not apply -- don't have limits

41.    How often have you broken the limits about what kinds of TV shows and movies you watch?
Never in the past month
One or two times in the past month
Once a week
Several times a week
Everyday or almost everyday in the past month
Does not apply - I set my own limits

42.    Who sets the limits on who you can hang out with?
You decide
Parent or parents set limits
Parent or parents and you decide jointly
Does not apply -- don't hang out
Does not apply -- don't have limits

43.    How often have you broken the limits about who you can hang out with?
Never in the past month
One or two times in the past month
Once a week
Several times a week
Everyday or almost everyday in the past month
Does not apply - I set my own limits

Next, I will read some sentences about school. After I read a sentence please tell me whether the statement is not at all true, not very true, sort of true, or very true for you during the last school year. 

44.    "I work very hard on my school work." Is that:
Not at all true
Not very true
Sort of true
Very true
Does not apply -- not in school

45.    "I don't try very hard in school."
Not at all true
Not very true
Sort of true
Very true
Does not apply -- not in school

46.    "I pay attention in class."
Not at all true
Not very true
Sort of true
Very true
Does not apply -- not in school

47.    "I come to class unprepared."
Not at all true
Not very true
Sort of true
Very true
Does not apply -- not in school

48.    How important is it to you to do the best you can in school?
Not important at all
Somewhat important
Very important
Extremely important
Does not apply -- not in school

The next few questions are about things young people sometimes do. 

49.    In the past year, how many times did you run away from home for at least one night?
Never in the past year
1 time
2 - 3 times
4 - 5 times
6 or more times in the past year

50.    How many times in the past year have you purposely damaged or destroyed property that did not belong to you?
1 time
2 - 3 times
4 - 5 times
6 or more times in the past year

-----------------------------------------------------------------------------------------------------------------------

Questionnaire set 2

AID.040.    Is {sample adult name} Male or Female?
Male
Female
Refused
Don't know

AID.050.    How old is {sample adult name}?
years old
Refused
Don't know

AID.060.    What is {sample adult name} birthday?
January
February
March
April
May
June
July
August
September
October
November
December

Now I am going to ask you about certain medical conditions.

ACN.010.    Have you EVER been told by a doctor or other health professional that you had Hypertension, also called high blood pressure?
Yes
No
Refused
Don't know

ACN.020.    Were you told on two or more DIFFERENT visits that you had hypertension, also called high blood pressure?
Yes
No
Refused
Don't know

ACN.031.    Have you EVER been told by a doctor or other health professional that you had coronary heart disease? Angina, also called angina pectoris? A heart attack (also called myocardial infarction)? Any kind of heart condition or heart disease (other than the ones I just asked about)? A stroke? Emphysema?
Yes
No
Refused
Don't know

ACN.080.    Have you EVER been told by a doctor or other health professional that you had asthma?
Yes
No
Refused
Don't know

ACN.090.    During the PAST 12 MONTHS, have you had an episode of asthma or asthma attack?
Yes
No
Refused
Don't know

ACN.100.    During the PAST 12 MONTHS, have you had to visit an emergency room or urgent care center because of asthma?
Yes
No
Refused
Don't know

ACN.110.    Have you EVER been told by a doctor or other health professional that you had an ulcer? This could be a stomach, duodenal or peptic ulcer.
Yes
No
Refused
Don't know

ACN.120.    During the PAST 12 MONTHS have you had an ulcer?
Yes
No
Refused
Don't know

ACN.130.    Have you EVER been told by a doctor or other health professional that you had cancer or a malignancy of any kind?
Yes
No
Refused
Don't know

ACN.140.    What kind of cancer was it?
Bladder
Blood
Bone
Brain
Breast
Cervix
Colon
Esophagus
Gallbladder
Kidney
Larynx-windpipe
Leukemia
Liver
Lung
Lymphoma
Melanoma
Mouth/tongue/lip
Ovary
Pancreas
Prostate
Rectum
Skin (non-melanoma)
Skin (Don't know what kind)
Soft Tissue (muscle or fat)
Stomach
Testis
Throat - pharynx
Thyroid
Uterus
Other
More than 3 kinds
Refused
Don't know

ACN.150.    How old were you when cancer was first diagnosed?
Age in years

ACN.160.    Other than during pregnancy, have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?
Yes
No
Borderline
Refused
Don't know

ACN.170.    How old were you when a doctor FIRST told you that you had diabetes or sugar diabetes?
Age in years

ACN.180.    Are you NOW taking insulin?
Yes
No
Refused
Don't know

ACN.190.    Are you NOW taking diabetic pills to lower your blood sugar? These are sometimes called oral agents or oral hypoglycemic agents.
Yes
No
Refused
Don't know

ACN.201.    During the PAST 12 MONTHS, have you been told by a doctor or other health professional that you had hay fever? Sinusitis? Chronic bronchitis? Weak or failing kidneys? Do not include kidney stones, bladder infections or incontinence. Any kind of liver condition?
Yes
No
Refused
Don't know

ACN.250.    During the PAST 12 MONTHS, have you had pain, aching, stiffness or swelling in or around a joint?
Yes
No
Refused
Don't know

ACN.260.    Were these symptoms present on MOST DAYS FOR AT LEAST ONE MONTH?
Yes
No
Refused
Don't know

ACN.270.    Did these symptoms begin only because of an injury?
Yes
No
Refused
Don't know

ACN.290.    Which joints are affected?
Shoulder-right
Shoulder-left
Elbow-right
Elbow-left
Hip-right
Hip-left
Wrist-right
Wrist-left
Knee-right
Knee-left
Ankle-right
Ankle-left
Toes-right
Toes-left
Fingers/thumb-right
Fingers/thumb-left
Other joint not listed
Refused
Don't know

The following questions are about pain you may have experienced in the PAST THREE MONTHS. Please refer to pain that LASTED A WHOLE DAY OR MORE. Do not report aches and pains that are fleeting or minor.

ACN.300.    During the PAST THREE MONTHS, did you have neck pain?
Yes
No
Refused
Don't know

ACN.310.    During the PAST THREE MONTHS, did you have low back pain?
Yes
No
Refused
Don't know

ACN.320.    Did this pain spread down either leg to areas below the knees?
Yes
No
Refused
Don't know

ACN.331.    During the PAST THREE MONTHS, did you have facial ache or pain in the jaw muscles or the joint in front of the ear? Severe headache or migraine?
Yes
No
Refused
Don't know

These next questions are about your recent health during the TWO WEEKS outlined on that calendar.

ACN.350.    Did you have a head cold or chest cold that started during those TWO WEEKS?
Yes
No
Refused
Don't know

ACN.360.    Did you have a stomach or intestinal illness with vomiting or diarrhea that started during those TWO WEEKS?
Yes
No
Refused
Don't know

ACN.370A.    Are you currently pregnant?
Yes
No
Refused
Don't know


These next questions are about your hearing, vision, and teeth.

ACN.410.    Have you ever worn a hearing aid?
Yes
No
Refused
Don't know

ACN.420.    Which statement best describes your hearing (without a hearing aid: good, a little trouble, a lot of trouble, deaf)?
Good
Little trouble
Lot of trouble
Deaf
Refused
Don't know

ACN.430.    Do you have any trouble seeing, even when wearing glasses or contact lenses?
Yes
No
Refused
Don't know

ACN.440.    Are you blind or unable to see at all?
Yes
No
Refused
Don't know

ACN.451.    Have you lost all of your upper natural (permanent) teeth? Lower natural (permanent) teeth?
Yes
No
Refused
Don't know

Now I am going to ask you some questions about feelings you may have experienced over the PAST 30 DAYS.

ACN.471.    During the PAST 30 DAYS, how often did you feel so sad that nothing could cheer you up? Nervous? Restless or fidgety? Hopeless? That everything was an effort? Worthless?
ALL of the time
MOST of the time
SOME of the time
A LITTLE of the time
NONE of the time
REFUSED
Don't know

ACN.530.    We just talked about a number of feelings you had during the PAST 30 DAYS. Altogether, how MUCH did these feelings interfere with your life or activities: a lot, some, a little, or not at all?
A lot
Some
A little
Not at all
Refused
Don't know

AHS.010.    Earlier I recorded that you were working last week. Is that correct?
Yes
No
Refused
Don't know

AHS.020.    Earlier I recorded that you were not working last week. Is that correct?
Yes
No
Refused
Don't know

AHS.030.    Although you did not work last week, did you have a job or business at any time in the PAST 12 MONTHS?
Yes
No
Refused
Don't know

AHS.040.    During the PAST 12 MONTHS, that is, since {12-month ref. date}, ABOUT how many days did you miss work at a job or business because of illness or injury (do not include maternity leave)?
None
days
Refused
Don't know

AHS.050.    During the PAST 12 MONTHS, that is, since {12-month ref. date}, ABOUT how many days did illness or injury keep you in bed more than half of the day? (Include days while an overnight patient in a hospital).
None
days
Refused
Don't know

AHS.060.    Compared with 12 MONTHS AGO, would you say your health is better, worse, or about the same?
Better
Worse
About the same
Refused
Don't know

AHS.070.    Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?
Yes
No
Refused
Don't know

The next questions ask about difficulties you may have doing certain activities because of a HEALTH PROBLEM. By "health problem" we mean any physical, mental, or emotional problem or illness (not including pregnancy).

AHS.091.    By yourself, and without using any special equipment, how difficult is it for you to walk a quarter of a mile - about 3 city blocks? Walk up 10 steps without resting? Stand or be on your feet for about 2 hours? Sit for about 2 hours? Stoop, bend, or kneel? Reach up over your head?
NOT AT ALL difficult
ONLY A LITTLE difficult
SOMEWHAT difficult
VERY difficult
CAN'T DO at all
REFUSED

AHS.141.    By yourself, and without using any special equipment, how difficult is it for you to use your fingers to grasp or handle small objects? Lift or carry something as heavy as 10 pounds such as a full bag of groceries? Push or pull large objects like a living room chair?
NOT AT ALL difficult
ONLY A LITTLE difficult
SOMEWHAT difficult
VERY difficult
CAN'T DO at all
REFUSED

AHS.171.    By yourself, and without using any special equipment, how difficult is it for you to go out to things like shopping, movies, or sporting events? Participate in social activities such as visiting friends, attending clubs and meetings, going to parties? Do things to relax at home or for leisure (reading, watching TV, sewing, listening to music)?
NOT AT ALL difficult
ONLY A LITTLE difficult
SOMEWHAT difficult
VERY difficult
CAN'T DO at all
REFUSED

AHS.200.    What condition or health problem causes you to have difficulty with {names of up to 3 specified activities/these activities}?
Vision/problem seeing
Hearing problem
Arthritis/rheumatism
Back or neck problem
Fractures,bone/joint injury
Other injury
Heart problem
Stroke problem
Hypertension/high blood
Diabetes
Lung/breathing problem
Cancer
Birth defect
Mental retardation
Other developmental problem (as cerebral palsy)
Senility
Depression/anxiety/emotional problem
Weight problem pressure
Other impairment/problem
Other impairment/problem
Refused
Don't know

AHS.201.    First condition:
Second condition:


AHS.300.    How long have you had {name the first condition}?
Since birth
(Days
Weeks
Months
Years)
Refused
Don't know
-----------------------------------------------------------------------------------------------------------------------
Questionnaire set 3

These next questions are about cigarette smoking.

AHB.010.    Have you smoked at least 100 cigarettes in your ENTIRE LIFE?
Yes
No
Refused
Don't know

AHB.020.    How old were you when you FIRST started to smoke fairly regularly?
years of age
Never smoked regularly
Refused
Don't know

AHB.030.    Do you NOW smoke cigarettes every day, some days or not at all?
Every day
Some days
Not at all
Refused
Don't know

AHB.040.    How long has it been since you quit smoking cigarettes?
Days
Weeks
Months
Years
Refused
Don't know

AHB.045.    Have you quit smoking since {current month in word format} 19__?
Yes
No
Refused
Don't know

AHB.050.    On the average, how many cigarettes do you now smoke a day?
cigarettes
Refused
Don't know

AHB.060.    On how many of the PAST 30 DAYS did you smoke a cigarette?
None
Days
Don't know
Refused

AHB.070.    On the average, when you smoked during the PAST 30 DAYS, about how many cigarettes did you smoke a day?
cigarettes
Refused
Don't know

AHB.080.    During the PAST 12 MONTHS, have you stopped smoking for one day or longer BECAUSE YOU WERE TRYING TO QUIT SMOKING?
Yes
No
Refused
Don't know

The next questions are about physical activities (exercise, sports, physically active hobbies...) that you may do in your LEISURE time.

AHB.090.    How often do you do VIGOROUS activities for AT LEAST 10 MINUTES that cause HEAVY sweating or LARGE increases in breathing or heart rate?
NUMBER OF TIMES
Never
Unable to do this type activity
Refused
Don't know

TIME PERIOD
Day
Week
Month
Year
Unable to do this Activity
Refused
Don't know

AHB.100.    About how long do you do these vigorous activities each time?
NUMBER
Refused
Don't know

TIME PERIOD
Minutes
Hours
Refused
Don't know

AHB.110.    How often do you do LIGHT OR MODERATE activities for AT LEAST 10 MINUTES that cause ONLY LIGHT sweating or a SLIGHT to MODERATE increase in breathing or heart rate?
NUMBER OF TIMES
Never
Unable to do this
Refused
Don't know

TIME PERIOD
Day
Week
Month
Year
Unable to do this type activity
Refused
Don't know

AHB.120.    About how long do you do these light or moderate activities each time?
NUMBER
Refused
Don't know

TIMER PERIOD
Minutes
Hours
Refused
Don't know

AHB.130.    How often do you do physical activities specifically designed to STRENGTHEN your muscles such as lifting weights or doing calisthenics? (Include all such activities even if you have mentioned them before.)
NUMBER OF TIMES
Unable to do this
Refused
Don't know

TIMER PERIOD
Day
Week
Month
Year
Unable to do this type activity
Refused
Don't know

These next questions are about drinking alcoholic beverages. Included are liquor such as whiskey or gin, beer, wine, wine coolers, and any other type of alcoholic beverage.

AHB.140.    In ANY ONE YEAR, have you had at least 12 drinks of any type of alcoholic beverage?
Yes
No
Refused
Don't know

AHB.150.    In your ENTIRE LIFE, have you had at least 12 drinks of any type of alcoholic beverage?
Yes
No
Refused
Don't know

AHB.160.    In the PAST YEAR, how often did you drink any type of alcoholic beverage?
NUMBER OF TIMES
Never
Refused
days
Don't know

TIME PERIOD
Never/None
Week
Month
Year
Refused
Don't know

AHB.170.    In the PAST YEAR, on those days that you drank alcoholic beverages, on the average, how many drinks did you have?
drinks
Refused
Don't know

AHB.180.    In the PAST YEAR, on how many DAYS did you have 5 or more drinks of any alcoholic beverage?
NUMBER PER DAYS
Never/none
days
Refused
Don't know

TIME PERIOD
Never/None
Week
Month
Year
Refused
Don't know

AHB.190.    About how tall are you without shoes?
feet
Inches
Refused

AHB.200.    About how much do you weigh without shoes?
pounds
Refused
Don't know

The next questions are about health care.

AAU.020.    Is there a place that you USUALLY go to when you are sick or need advice about your health?
Yes
There is NO place
There is MORE THAN ONE place
Refused
Don't know

AAU.030.    What kind of place is it - a clinic, doctor's office, emergency room, or some other place?

What kind of place do you go to most often - a clinic, doctor's office, emergency room, or some other place?

Clinic or health center
Doctor's office or HMO
Hospital emergency room
Hospital outpatient department
Some other place
Refused
Don't know

AAU.035.    Is that {full name from AAU.030} the same place you USUALLY go when you need routine or preventive care, such as a physical examination or check up?
Yes
No
Refused
Don't know

AAU.037.    What kind of place do you go to when you need routine preventive care, such as a physical examination or check-up?
Doesn't get preventive care anywhere
Clinic or health center
Doctor's office or HMO
Hospital emergency room
Hospital outpatient department
Some other place
Refused
Don't know

AAU.040.    At any time in the PAST 12 MONTHS did you CHANGE the place(s) to which you USUALLY go for health care?
Yes
No
Refused
Don't know

AAU.050.    Was this change for a reason related to health insurance?
Yes
No
Refused
Don't know

AAU.061.    There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS? You couldn't get through on the telephone. You couldn't get an appointment soon enough. Once you get there, you have to wait too long to see the doctor. The clinic/doctor's office wasn't open when you could get there. You didn't have transportation.
Yes
No
Refused
Don't know

AAU.111.    During the PAST 12 MONTHS, was there any time when you needed any of the following but didn't get it because you couldn't afford it? Prescription medicines. Mental health care or counseling. Dental care (including check-ups).
Yes
No
Refused
Don't know

AAU.135.    About how long has it been since you last saw or talked to a dentist? Include all types of dentists, such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.
6 months or less
More than 6 months, but not more than 1 year ago
More than 1 year, but not more than 3 years ago
More than 3 years
Never
Refused
Don't know

AAU.141.    During the PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following health care providers about your own health? A mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker? An optometrist, optician, or eye doctor (someone who prescribes eyeglasses)? A foot doctor? A chiropractor? A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist? A nurse practitioner, physician assistant, or midwife?
Yes
No
Refused
Don't know

AAU.200.    During the PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following health care providers about your own health? A doctor who specializes in women's health (an obstetrician/gynecologist)?
Yes
No
Refused
Don't know

AAU.211.    During the PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following health care providers about your own health? A medical doctor who specializes in a particular medical disease or problem (other than obstetrician/gynecologist, psychiatrist,or ophthalmologist)? A general doctor who treats a variety of illnesses (a doctor in general practice, family medicine, or internal medicine)?
Yes
No
Refused
Don't know

AAU.230.    Does that doctor treat children and adults (a doctor in general practice or family medicine)?
Yes
No
Refused
Don't know

AAU.240.    During the PAST 12 MONTHS, HOW MANY TIMES have you gone to a HOSPITAL EMERGENCY ROOM about your own health? (This includes emergency room visits that resulted in a hospital admission.)
None
1
2-3
4-9
10-12
13 or more
Refused
Don't know

AAU.250.    During the PAST 12 MONTHS, did you receive care AT HOME from a nurse or other health care professional?
Yes
No
Refused
Don't know

AAU.260.    During how many of the PAST 12 MONTHS did you receive care AT HOME from a health care professional?
months
Refused
Don't know

AAU.270.    What was the total number of home visits received during {that month/those months}?
1
2-3
4-9
10-12
13 or more
Refused
Don't know

AAU.280.    During the PAST 12 MONTHS, HOW MANY TIMES have you seen a doctor or other health care professional about your own health at a DOCTOR'S OFFICE, A CLINIC, OR SOME OTHER PLACE? DO NOT INCLUDE TIMES YOU WERE HOSPITALIZED OVERNIGHT, VISITS TO HOSPITAL EMERGENCY ROOMS, HOME VISITS, OR TELEPHONE CALLS.
None
1
2-3
4-9
10-12
13 or more
Refused
Don't know

AAU.290.    During the PAST 12 MONTHS, have you had SURGERY or other surgical procedures either as an inpatient or outpatient?
Yes
No
Refused
Don't know

AAU.300.    Including any times you may have already told me about, HOW MANY DIFFERENT TIMES have you had surgery during the PAST 12 MONTHS?
times
Refused
Don't know

AAU.305.    About how long has it been since you last saw or talked to a doctor or other health care professional about your own health? Include doctors seen while a patient in a hospital.
6 months or less
More than 6 months but not more than 1 year ago
More than 1 year, but not more than 3 years ago
More than 3 years
Never
Refused
Don't know

AAU.310.    During the PAST 12 MONTHS, have you had a flu shot? A flu shot is usually given in the fall and protects against influenza for the flu season.
Yes
No
Refused
Don't know

AAU.320.    Have you EVER had a pneumonia vaccination? This shot is usually given only once in a person's lifetime and is different from the flu shot.
Yes
No
Refused
Don't know

ASD.050.    Earlier I recorded that in the last week you were {answer code description from FSD.050}. Is that correct?
Yes
No
Refused
Don't know

ASD.060.    What is your correct working status?
Working at a job or business
With a job or business but not at work
Looking for work
Not working at a job or business
Refused
Don't know

ASD.070.    For whom did you work at your MAIN job or business? (Name of company, business, organization or employer)
Job or Business
Refused
Don't know

ASD.080.    What kind of business or industry is this? (For example: TV and radio mgt., retail shoe store, State Department of Labor)
Kind of Business
Refused
Don't know

ASD.090.    What kind of work were you doing? (For example: farming, mail clerk, computer specialist.)
Kind of Work
Refused
Don't know

ASD.100.    What were your most important activities on this job or business? (For example: sells cars, keeps account books, operates printing press.)
Activities
Refused
Don't know
-----------------------------------------------------------------------------------------------------------------------

Questionnaire set 4

H1.    Which best describes this building? Include all apartments, flats, etc., even if vacant.
A mobile home or trailer
A one-family house detached from any other house
A one-family house attached to one or more houses
A building with 2 apartments
A building with 3 or 4 apartments
A building with 5 to 9 apartments
A building with 10 to 19 apartments
A building with 20 to 49 apartments
A building with 50 or more apartments
Boat, RV, van, etc.

H2.    About when was this building first built? If you do not know the exact year, give your best estimate.
(Year)

H3.    When did PERSON 1 move into this house or apartment?
(Year)

H4.    Do all persons staying in this house or apartment usually spend more than two consecutive months of the year at another residence?
Yes
No

    Where is that residence located?
U.S. State
foreign country

    How long does this household usually spend at that residence?
Months each year

H5.    Is this house or mobile home on:
Less than 1 acre?
1 to less than 10 acres?
10 or more acres?

H6.    IN THE PAST 12 MONTHS, were the sales of all agricultural products from this property $1,000 or more?
Yes
No

H7.    Is there a business such as a store or barber shop or a medical office on this property?
Yes
No

H8.    How many rooms are in this house or apartment? Do NOT count bathrooms, porches,
balconies, foyers, halls, half-rooms, or utility rooms.

Room(s)

H9.    How many bedrooms are in this house or apartment? Count the number of bedrooms that you would list if this house or apartment were for sale or for rent.
Bedroom(s)
None

H10.    Does this house or apartment have complete plumbing facilities; that is, 1) hot and cold piped water, 2) a flush toilet, and 3) a bathtub or shower?
Yes, has all three facilities
No

H11.    Does this house or apartment have complete kitchen facilities; that is, 1) a sink with piped water, 2) a stove or range, and 3) a refrigerator?
Yes, has all three facilities
No

H12.    Does this house or apartment building get water from:
A public system such as a city water department or private company?
An individual drilled well?
An individual dug well?
Some other source, such as a spring, creek, river, cistern, etc.?

H13.    Is this house or apartment building connected to a public sewer?
Yes, connected to a public sewer
No, connected to septic tank or cesspool
No, uses other means

H14.    Does this house or apartment have air conditioning?
Yes, a central air conditioning system
Yes, one or more individual room units
No

H15.    Does this house or apartment have a central heating system; that is, one system that heats all or most of the rooms?
Yes
No

H16.    Is there a telephone in this house or apartment?
Yes
No

H17.    How many automobiles, vans, and trucks of one-ton capacity or less are kept at home for use by members of this household?
Vehicle(s)
None

H18.    Which FUEL is used MOST for heating this house or apartment?
Gas: from underground pipes serving the neighborhood
Gas: bottled, tank, or LP
Electricity
Fuel oil, kerosene, etc.
Coal or coke
Wood
Solar energy
Other fuel
No fuel used

H19.    LAST MONTH, what was the cost of electricity for this house or apartment?
Dollars last month
Included in rent or in condominium fee
No charge or electricity not used

    LAST MONTH, what was the cost of gas for this house or apartment?
Dollars last month
Included in rent or in condominium fee
No charge or gas not used

    IN THE PAST 12 MONTHS, what was the cost of water and sewer for this house or
apartment? If you have lived here less than 12 months, estimate the cost.

Dollars past 12 months
Included in rent or in condominium fee
No charge

    IN THE PAST 12 MONTHS, what was the cost of fuel oil, wood, kerosene, coal, etc. for this house or apartment? If you have lived here less than 12 months, estimate the cost.
Dollars Past 12 months
Included in rent or in condominium fee
No charge or these fuels not used

H20.    At any time DURING THE PAST 12 MONTHS, were you or any member of this household
enrolled in or receiving benefits from:
free or reduced-price meals at school through the Federal School Lunch Program or the Federal School Breakfast Program?

Yes
No

    The Federal home heating and cooling assistance program?
Yes
No

H21.    At any time DURING THE PAST 12 MONTHS, did anyone in this household receive Food Stamps?
No
Yes

    What was the value of the food stamps?
Dollars 12-month amount

H22.    Is this house or apartment part of a condominium?
No
Yes

    What is the monthly condominium fee?
Dollars monthly
None

H23.    Is this house or apartment:
Owned by you or someone in this household with a mortgage or loan?
Owned by you or someone in this household free and clear (without a mortgage)?
Rented for cash rent?
Occupied without payment of cash rent?

H24.    What is the monthly rent for this house or apartment?
Dollars monthly

H25.    Does the monthly rent include any meals?
Yes
No

H26.    Is the rent on this house or apartment reduced because the Federal, state, or local government is paying part of the cost?
Yes
No

H27.    Is this house or apartment in a public housing project; that is, is it part of a government housing project for persons with low income?
Yes
No

H28.    What is the value of this property; that is, how much would this house or mobile home and lot, or condominium unit sell for if it were for sale?
Dollar value

H29.    What are the annual real estate taxes on this property?
Dollars annually
None

H30.    What is the annual payment for fire, hazard, and flood insurance on this property?
Dollars annually
None

H31.    Do you or any member of this household have a mortgage, deed of trust, contract to purchase, or similar debt on this property?
Yes, mortgage, deed of trust, or similar debt
Yes, contract to purchase
No

H32.    How much is the regular monthly mortgage payment on this property? Include payments only on FIRST mortgage or contract to purchase
Dollars monthly
No regular payment required

H33.    Does the regular monthly mortgage payment include payments for real estate taxes on this property?
Yes, taxes included in payment
No, taxes paid separately or taxes not required

H34.    Does the regular monthly mortgage payment include payments for fire, hazard, or flood insurance on this property?
Yes, insurance included in payment
No, insurance paid separately or no insurance

H35.    Do you or any member of this household have a second mortgage or a home equity loan on this property?
Yes, home equity loan
Yes, second mortgage
Yes, second mortgage and home equity loan
No

H36.    How much is the regular monthly payment on ALL second and third mortgages and home equity loans?
Dollars monthly
No regular payment required

H37.    What are the total annual costs for personal property taxes, site rent, registration fees, and license fees on this mobile home and its site? Do NOT include real estate taxes.
Dollars annually

7.    In what U.S. State, territory, commonwealth or foreign country was this person born?

8.    Is this person a CITIZEN of the United States?
Yes, born in the United States
Yes, born in Puerto Rico, Guam, the U.S. Virgin Islands, or the Northern Marianas
Yes, born abroad of American parent(s)
Yes, U.S. citizen by naturalization
No, not a citizen of the United States

9.    When did this person come to live in the United States?
Year

10.    At any time IN THE PAST 3 MONTHS, was this person attending a school or college? Include nursery or preschool, kindergarten, elementary school, and schooling that leads to a high school diploma, college degree, or vocational certificate.
Yes, public school or public college
Yes, private school or private college
Yes, vocational, technical, or business school
No, has not attended in the last 3 months

11.    What is the highest degree or level of school this person has COMPLETED?
None, no schooling completed
Nursery or preschool
Kindergarten
Grade
12th grade, NO DIPLOMA
HIGH SCHOOL GRADUATE - high school DIPLOMA or the equivalent (GED)
Some college but no degree
Vocational, technical, or business school degree
Associate degree in college
Bachelor's degree (BA, AB, BS)
Master's degree (MA, MS, MEng, MEd, MSW, MBA)
Professional school degree (MD, DDS, DVM, LLB, JD)
Doctorate degree (PhD, EdD)

12.    What is this person's ancestry? For example: Italian, African Am., Cape Verdean, Ecuadorian, Haitian, Irish, Jamaican, Korean, Lebanese, Mexican, Nigerian, Polish, Taiwanese, Ukrainian, or any other ancestry.

13a.    Did this person live in this house or apartment 5 years ago?
Yes
No

13b.    Where did this person live 5 years ago?
Name of U.S. State, territory, commonwealth or foreign country
Name of city or town
Name of county
ZIP Code

13c.    Did this person live inside the city or town limits?
Yes
No, lived outside city/town limits

14a.    Does this person speak a language other than English at home?
Yes
No, only English

14b.    What is this language? For example: Korean, Italian, Spanish, Vietnamese

14c.    How well does this person speak English?
Very well
Well
Not well
Not at all

15.    If this person has difficulty seeing, hearing, or walking, mark the appropriate boxes. If this person has no difficulty with these activities, mark "None of the above."
Difficulty seeing (even with glasses)
Difficulty hearing (even with a hearing aid)
Difficulty walking, or
None of the above

    Does this person have a long-lasting physical or mental condition that:

16a.    Makes it difficult to go outside the home alone, for example, to shop or visit a doctor's office?
Yes
No
-----------------------------------------------------------------------------------------------------------------------

Questionnaire set 5

1
Please print the names of all the people living or staying here on April 18, 1998, as shown in this example:
Last Name
First Name
MI

BE SURE TO INCLUDE anyone who is:
a foster child, roomer, or housemate
staying here on April 18, 1998 and has no other permanent place to stay
staying here most of the time while working even if he or she has another place to live

DO NOT INCLUDE anyone who:
is living away while attending college
was in a correctional facility, nursing home, or mental hospital on April 18, 1998
is in the Armed Forces and living somewhere else
lives or stays at another place most of the time

Start with the person, or one of the people living here in whose name this house or apartment is owned, being bought, or rented. If there is no such person, start with any adult living or staying here.

Person 1 - Last Name
First Name
MI
Person 2 - Last Name
First Name
MI
Person 3 - Last Name
First Name
MI
Person 4 - Last Name
First Name
MI
Person 5 - Last Name
First Name
MI
Person 6 - Last Name
First Name
MI
Person 7 - Last Name
First Name
MI
Person 8 - Last Name
First Name
MI
Person 9 - Last Name
First Name
MI
Person 10 - Last Name
First Name
MI
Person 11 - Last Name
First Name
MI
Person 12 - Last Name
First Name
MI

1
What is this person's name? Print the name of Person 1 from page 2.
Last Name
First Name
MI

2
What is this person's telephone number? We may contact this person if we don't understand an answer.
Area Code
Number

3
What is this person's sex? Mark ONE box.
Male
Female

4
What is this person's age and what is this person's date of birth? Print numbers in boxes. Age on April 18, 1998

Month Day Year of birth

5
Is this person Spanish/Hispanic/Latino? Mark the "No" box if not Spanish/Hispanic/Latino.
No, not Spanish/Hispanic/Latino
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, other Spanish/Hispanic/Latino - Print group.

6
What is this person's race? Mark one or more races to indicate what this person considers himself/herself to be.
White
Black, African Am., or Negro
American Indian or Alaska Native - Print name of enrolled or principal tribe.
Asian Indian
Native Hawaiian
Chinese
Guamanian or Chamorro
Filipino
Japanese
Samoan
Korean
Vietnamese
Other Pacific Islander - Print race.
Other Asian - Print race.
Some other race - Print race.

7
What is this person's marital status?
Now married
Widowed
Divorced
Separated
Never married

8a
At any time since February 1, 1998, has this person attended regular school or college? Include only nursery school or preschool, kindergarten, elementary school, and schooling which leads to a high school diploma or a college degree.
No, has not attended since February 1
Yes, public school, public college
Yes, private school, private college

8b
What grade or level was this person attending? Mark ONE box.
Nursery school, preschool
Kindergarten
Grade 1 to grade 4
Grade 5 to grade 8
Grade 9 to grade 12
College undergraduate years (freshman to senior)
Graduate or professional school (for example: medical, dental, or law school)

9
What is the highest degree or level of school this person has COMPLETED? Mark ONE box. If currently enrolled, mark the previous grade or highest degree received.
No schooling completed
Nursery school to 4th grade
5th grade or 6th grade
7th grade or 8th grade
9th grade
10th grade
11th grade
12th grade, NO DIPLOMA
HIGH SCHOOL GRADUATE - high school DIPLOMA or the equivalent (for example: GED)
Some college credit, but less than 1 year
1 or more years of college, no degree Associate degree (for example: AA, AS)
Bachelor's degree (for example: BA, AB, BS)
Master's degree (for example: MA, MS, MEng, MEd, MSW, MBA)
Professional degree(for example: MD, DDS, DVM, LLB, JD)
Doctorate degree (for example: PhD, EdD)

10
What is this person's ancestry or ethnic origin? (For example: Italian, Jamaican, African Am., Cambodian, Cape Verdean, Norwegian, Dominican, French Canadian, Haitian, Korean, Lebanese, Polish, Nigerian, Mexican, Taiwanese, Ukrainian, and so on.)

11a
Does this person speak a language other than English at home?
Yes
No

11b
What is this language? (For example: Korean, Italian, Spanish, Vietnamese)

11c How well does this person speak English?
Very well
Well
Not well
Not at all

12
Where was this person born? In the United States - Print name of state.
Outside the United States - Print name of foreign country, or Puerto Rico, Guam, etc.

13
Is this person a CITIZEN of the United States?
Yes, born in the United States
Yes, born in Puerto Rico, Guam, the U.S. Virgin Islands, or Northern Marianas
Yes, born abroad of American parent or parents
Yes, U.S. citizen by naturalization
No, not a citizen of the United States

14
When did this person come to live in the United States? Print numbers in boxes.
Year

15a
Did this person live in this house or apartment 5 years ago (on April 18, 1993)?
Person is under 5 years old
Yes, this house
No, outside the United States - Print name of foreign country, or Puerto Rico, Guam, etc., below
No, different house in the United States

15b
Where did this person live 5 years ago?
Name of city, town, or post office

Did this person live inside the limits of the city or town?
Yes
No, outside the city/town limits
Name of county
Name of state
ZIP Code

16
Does this person have any of the following long-lasting conditions:
Blindness, deafness, or a severe vision or hearing impairment?
A condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifting, or carrying?
Yes
No

17
Because of a physical, mental, or emotional condition lasting 6 months or more, does this person have any difficulty in doing any of the following activities:
Learning, remembering, or concentrating?
Dressing, bathing, or getting around inside the home?
(Answer if this person is 16 YEARS OLD OR OVER.) Going outside the home alone to shop or visit a doctor's office?
(Answer if this person is 16 YEARS OLD OR OVER.) Working at a job or business? Yes
No

18
Was this person under 15 years of age on April 18, 1998?
Yes
No

19a
Does this person have any of his/her own grandchildren under the age of 18 living in this house or apartment?
Yes
No

19b
Is this grandparent currently responsible for most of the basic needs of any grandchild(ren) under the age of 18 who live(s) in this house or apartment?
Yes
No

19c
How long has this grandparent been responsible for the(se) grandchild(ren)? If the grandparent is financially responsible for more than one grandchild, answer the question for the grandchild for whom the grandparent has been responsible for the longest period of time.
Less than 1 month
1 to 6 months
7 to 12 months
More than 12 months
Don't know

20a
Has this person ever served on active duty in the U.S. Armed Forces, military Reserves, or National Guard? Active duty does not include training for the Reserves or National Guard, but DOES include activation, for example, for the Persian Gulf War.
Yes, now on active duty
Yes, on active duty in past, but not now
No, training for Reserves or National Guard only
No, never served in the military

20b
When did this person serve on active duty in the U.S. Armed Forces? Mark
a box for EACH period in which this person served.
April 1995 or later
August 1990 to March 1995 (including Persian Gulf War)
September 1980 to July 1990
May 1975 to August 1980
Vietnam era (August 1964-April 1975)
February 1955 to July 1964
Korean conflict (June 1950-January 1955)
World War II (September 1940-July 1947)
Some other time

20c
In total, how many years of active-duty military service has this person had?
Less than 2 years
2 years or more

21
LAST WEEK, did this person do ANY work for either pay or profit? Mark the "Yes" box even if the person worked only 1 hour, or helped without pay in a family business or farm for 15 hours or more, or was on active duty in the Armed Forces.
Yes
No

22
At what location did this person work LAST WEEK? If this person worked at more than one location, print where he or she worked most last week.
Address (Number and street name)
(If the exact address is not known, give a description of the location such as the building name or the nearest street or intersection.)
Name of city, town, or post office
Is the work location inside the limits of that city or town?
Yes
No, outside the city/town limits
Name of county
Name of U.S. state or foreign country
ZIP Code

23a
How did this person usually get to work LAST WEEK? If this person usually used more than one method of transportation during the trip, mark the box of the
one used for most of the distance.
Car, truck, or van
Bus or trolley bus
Streetcar or trolley car
Subway or elevated
Railroad
Ferryboat
Taxicab
Motorcycle
Bicycle
Walked
Worked at home
Other method

23b
How many people, including this person, usually rode to work in the car, truck, or van LAST WEEK?
Drove alone
2 people
3 people
4 people
5 or 6 people
7 or more people

24
What time did this person usually leave home to go to work LAST WEEK?
a.m.
p.m.

How many minutes did it usually take this person to get from home to work LAST WEEK?
Minutes

25a
LAST WEEK, was this person on layoff from a job?
Yes
No

25b
LAST WEEK, was this person TEMPORARILY absent from a job or business?
Yes, on vacation, temporary illness, labor dispute, etc.
No

25c
Has this person been informed that he or she will be recalled to work within the next 6 months OR been given a date to return to work?
Yes
No

25d
Has this person been looking for work during the last 4 weeks?
Yes
No

25e
LAST WEEK, could this person have started a job if offered one, or returned to work if recalled?
Yes, could have gone to work
No, because of own temporary illness
No, because of all other reasons (in school, etc.)

26
When did this person last work, even for a few days?
1993 to 1998
1992 or earlier, or never worked

Industry or Employer - Describe clearly this person's chief job activity or business last week. If this person had more than one job, describe the one at which this person worked the most hours. If this person had no job or business last week, give the information for his/her last job or business since 1993.

27a
For whom did this person work? If now on active duty in the Armed Forces, mark this box and print the branch of the Armed Forces.
Name of company, business, or other employer

27b
What kind of business or industry was this? Describe the activity at location where employed. (For example: hospital, newspaper publishing, mail order house, auto repair shop, bank)

27c
Is this mainly - Mark ONE box.
Manufacturing?
Wholesale trade?
Retail trade?
Other (agriculture, construction, service, government, etc.)?

28a
Occupation - What kind of work was this person doing? (For example: registered nurse, personnel manager, supervisor of order department, auto mechanic, accountant)

28b
What were this person's most important activities or duties? (For example: patient care, directing hiring policies, supervising order clerks, repairing
automobiles, reconciling financial records)

29
Was this person - Mark ONE box.
Employee of a PRIVATE FOR PROFIT company or business or of an individual, for wages, salary, or commissions
Employee of a PRIVATE NOT-FOR-PROFIT, tax-exempt, or charitable organization
Local GOVERNMENT employee (city, county, etc.)
State GOVERNMENT employee
Federal GOVERNMENT employee
SELF-EMPLOYED in own NOT INCORPORATED business, professional practice, or farm
SELF-EMPLOYED in own INCORPORATED business, professional practice, or farm
Working WITHOUT PAY in family business or farm

30a
LAST YEAR, 1997, did this person work at a job or business at any time?
Yes
No

30b
How many weeks did this person work in 1997? Count paid vacation, paid sick leave, and military service.
Weeks

30c
During the weeks WORKED in 1997, how many hours did this person usually work each WEEK?
Usual hours worked each WEEK

INCOME IN 1997 - Mark the "Yes" box for each income source received during 1997 and enter the total amount received during 1997 to a maximum of $999,999. Otherwise, mark the "No" box. If net income was a loss, enter the amount and mark the "Loss" box next to the dollar amount. For income received jointly, report, if possible, the appropriate share for each person; otherwise, report the whole amount for only one person and mark the "No" box for the other person. If exact amount is not known, please give best estimate.

31a
Wages, salary, commissions, bonuses, or tips from all jobs - Report amount before deductions for taxes, bonds, dues, or other items.
Yes
Annual amount - Dollars
No

-----------------------------------------------------------------------------------------------------------------------

Questionnaire set 6

2
You said that during the last 6 months - (description of crime.) Did (this/the first) incident happen while you were living here or before you moved to this address?
While living at this address
Before moving to this address

3
(You said that during the last 6 months - (description of crime.)) In what month did (this/the first) incident happen?
Month
Year

4
Altogether, how many times did this type of incident happen during the last 6 months?
Number of incidents

6
About what time did (this/the most recent) incident happen?
After 6 a.m. - 12 noon
After 12 noon - 3 p.m.
After 3 p.m. - 6 p.m.
Don't know what time of day
After 6 p.m. - 9 p.m.
After 9 p.m. - 12 midnight
After 12 midnight - 6 a.m.
Don't know what time of night
Don't know whether day or night

7
In what city, town, or village did this incident occur?
Outside US
Not inside a city/town/village
SAME city/town/village as present residence
DIFFERENT city/town/village from present residence
Don't know

8
In what county and state did it occur?
County
State

9
Is this the same county and state as your present residence?
Yes
No

10
Where did this incident happen?
IN RESPONDENT'S HOME OR LODGING
In own dwelling, own attached garage, or enclosed porch (Include illegal entry or attempted illegal entry of same)
In detached building on own property, such as detached garage, storage shed, etc. (Include illegal entry or attempted illegal entry of same)
In vacation home/second home (Include illegal entry or attempted illegal entry of same)
In hotel or motel room respondent was staying in (Include illegal entry or attempted illegal entry of same)
NEAR OWN HOME
Own yard, sidewalk, driveway, carport, unenclosed porch (does not include apartment yards)
Apartment hall, storage area, laundry room (does not include apartment parking lot/garage)
On street immediately adjacent to own home
AT, IN, OR NEAR a FRIEND'S/RELATIVE'S/NEIGHBOR'S HOME
At or in home or other building on their property
Yard, sidewalk, driveway, carport (does not include apartment yards)
Apartment hall, storage area, laundry room (does not include apartment parking lot/garage)
On street immediately adjacent to their home
COMMERCIAL PLACES
Inside restaurant, bar, nightclub
Inside other commercial building such as store, bank, gas station
Inside office, factory, or warehouse
PARKING LOTS/GARAGES
Commercial parking lot/garage
Noncommercial parking lot/garage
Apartment/townhouse parking lot/garage
SCHOOL
Inside school building
On school property (school parking area, play area, school bus, etc.)
OPEN AREAS, ON STREET OR PUBLIC TRANSPORTATION
In apartment yard, park, field, playground (other than school)
On the street (other than immediately adjacent to own/friend's/relative's/neighbor's home)
On public transportation or in station (bus, train, plane, airport, depot, etc.)
OTHER
Other

11
Did the offender live (here/there) or have a right to be (here/there), for instance, as a guest or a repair person?
Yes
No
Don't know

12
Did the offender actually get INSIDE your (house/apartment /room/garage/
shed/ enclosed porch)?
Yes
No
Don't know

13
Did the offender TRY to get in your (house/apartment/room/garage/shed/
enclosed porch)?
Yes
No
Don't know

14
Was there any evidence, such as a broken lock or broken window, that the offender(s) (got in by force/TRIED to get in by force)?
Yes
No

15
What was the evidence? Anything else?
Window
Damage to window (include frame, glass broken/removed/cracked)
Screen damaged/removed
Lock on window damaged/tampered with in some way
Other
Door
Damage to door (include frame, glass panes or door removed)
Screen damaged/removed
Lock or door handle damaged/tampered with in some way
Other
Other
Other than window or door

16
How did the offender (get in/TRY to get in)?
Let in
Offender pushed his/her way in after door opened
Through OPEN DOOR or other opening
Through UNLOCKED door or window
Through LOCKED door or window - Had key
Through LOCKED door or window - Picked lock, used credit card, etc., other than key
Through LOCKED door or window - Don't know how
Don't know
Other

17a
Was it your school?
Yes
No

17b
In what part of the school building did it happen?
Classroom
Hallway/Stairwell
Bathroom/Locker room
Other (library, gym, auditorium, cafeteria)

17c
Did the incident happen in an area restricted to certain people or was it open to the public at the time?
Open to the public
Restricted to certain people (or nobody had a right to be there)
Don't know
Other

18
Did it happen outdoors, indoors, or both?
Indoors (inside a building or enclosed space)
Outdoors
Both

19
How far away from home did this happen? Was it within a mile, 5 miles, 50 miles or more?
At, in, or near the building containing the respondent's home/next door
A mile or less
Five miles or less
Fifty miles or less
More than 50 miles
Don't know how far

20a
Were you or any other member of this household present when this incident occurred?
Yes
No

20b
Which household members were present?
Respondent only
Respondent and other household member(s)
Only other household member(s), not respondent

21
Did you personally see an offender?
Yes
No

22
Did the offender have a weapon such as a gun or knife, or something to use as a weapon, such as a bottle or wrench?
Yes
No
Don't know

23
What was the weapon? Anything else?
Hand gun (pistol, revolver, etc.)
Other gun (rifle, shotgun, etc.)
Knife
Other sharp object (scissors, ice pick, axe, etc.)
Blunt object (rock, club, blackjack, etc.)
Other

24
Did the offender hit you, knock you down or actually attack you in any
way?
Yes
No

25
Did the offender TRY to attack you?
Yes
No

26
Did the offender THREATEN you with harm in any way?
Yes
No

27
What actually happened? Anything else? Do you mean forced or coerced sexual
intercourse including attempts?
Something taken without permission
Attempted or threatened to take something
Harassed, argument, abusive language
Unwanted sexual contact with force (grabbing, fondling, etc.)
Unwanted sexual contact without force (grabbing, fondling, etc.)
Forcible entry or attempted forcible entry of house/apartment
Forcible entry or attempted forcible entry of car
Damaged or destroyed property
Attempted or threatened to damage or destroy property
Other

28a
How did the offender TRY to attack you? Any other way?
Verbal threat of rape
Verbal threat to kill
Verbal threat of attack other than to kill or rape
Verbal threat of sexual assault other than rape
Unwanted sexual contact with force (grabbing, fondling, etc.)
Unwanted sexual contact without force (grabbing, fondling, etc.)
Weapon present or threatened with weapon
Shot at (but missed)
Attempted attack with knife/sharp weapon
Attempted attack with weapon other than gun/knife/sharp weapon
Object thrown at person
Followed or surrounded
Tried to hit, slap, knock down, grab, hold, trip, jump, push, etc.
Other

28b
How were you threatened? Any other way? Do you mean forced or coerced sexual
intercourse including attempts?
Verbal threat of rape
Verbal threat to kill
Verbal threat of attack other than to kill or rape
Verbal threat of sexual assault other than rape
Unwanted sexual contact with force (grabbing, fondling, etc.)
Unwanted sexual contact without force (grabbing, fondling, etc.)
Weapon present or threatened with weapon
Shot at (but missed)
Attempted attack with knife/sharp weapon
Attempted attack with weapon other than gun/knife/sharp weapon
Object thrown at person
Followed or surrounded
Tried to hit, slap, knock down, grab, hold, trip, jump, push, etc.
Other

29
How were you attacked? Any other way? Do you mean forced or coerced sexual intercourse? Do you mean attempted forced or coerced sexual intercourse?
Raped
Tried to rape
Sexual assault other than rape or attempted rape
Shot
Shot at (but missed)
Hit with gun held in hand
Stabbed/cut with knife/sharp weapon
Attempted attack with knife/sharp weapon
Hit by object (other than gun) held in hand
Hit by thrown object
Attempted attack with weapon other than gun/knife/sharp weapon
Hit, slapped, knocked down
Grabbed, held, tripped, jumped, pushed, etc.
Other

30
Did the offender THREATEN to hurt you before you were actually attacked?
Yes
No
Other

31
What were the injuries you suffered, if any? Anything else? Do you mean forced or coerced sexual intercourse? Do you mean attempted forced or coerced sexual intercourse?
None
Raped
Attempted rape
Sexual assault other than rape or attempted rape
Knife or stab wounds
Gun shot, bullet wounds
Broken bones or teeth knocked out
Internal injuries
Knocked unconscious
Bruises, black eye, cuts, scratches, swelling, chipped teeth
Other

32
Were any of the injuries caused by a weapon other than a gun or knife?
Yes
No

34
Were you injured to the extent that you received any medical care, including self treatment?
Yes
No

35
Where did you receive this care? Anywhere else?
At the scene
At home/neighbor's/friend's
Health unit at work/school, first aid station at a stadium/park, etc.
Doctor's office/health clinic
Emergency room at hospital/emergency clinic
Hospital (other than emergency room)
Other

36
Did you stay overnight in the hospital?
Yes
No

37
How many days did you stay (in the hospital)?
Number of days

38
At the time of the incident, were you covered by any medical insurance, or were
you eligible for benefits from any other type of health benefits program, such as medicaid, Veterans Administration, or Public Welfare?
Yes
No
Don't know

39
What was the total amount of your medical expenses resulting from this
incident (INCLUDING anything paid by insurance)? Include hospital and doctor
bills, medicine, therapy, braces, and any other injury related expenses.
Total amount
No cost
Don't know

40
Did you do anything with the idea of protecting YOURSELF or your PROPERTY
while the incident was going on?
Yes
No/took no action/kept still

41
Was there anything you did or tried to do about the incident while it was going on?
Yes
No/took no action/kept still

42
What did you do? Anything else?
USED PHYSICAL FORCE TOWARD OFFENDER
Attacked offender with gun; fired gun
Attacked with other weapon
Attacked without weapon (hit, kicked, etc.)
Threatened offender with gun
Threatened offender with other weapon
Threatened to injure, no weapon
RESISTED OR CAPTURED OFFENDER
Defended self or property (struggled, ducked, blocked blows, held onto property)
Chased, tried to catch or hold offender
SCARED OR WARNED OFF OFFENDER
Yelled at offender, turned on lights, threatened to call police, etc.
PERSUADED OR APPEASED OFFENDER
Cooperated, or pretended to (stalled, did what they asked)
Argued, reasoned, pleaded, bargained, etc.
ESCAPED OR GOT AWAY
Ran or drove away, or tried; hid, locked door
GOT HELP OR GAVE ALARM
Called police or guard
Tried to attract attention or help, warn others (cried out for help, called children inside)
REACTED TO PAIN OR EMOTION
Screamed from pain or fear
OTHER
Other

43a
Did you take these actions before, after, or at the same time that you were injured?
Actions taken before injury
Actions taken after injury
Actions taken at same time as injury

43b. Did (any of) your action(s) help the situation in any way?
Did your actions help you avoid injury, protect your property, escape from the offender - or were they helpful in some other way?
Yes
No
Don't know

44
How were they helpful? Any other way?
Helped avoid injury or greater injury to respondent
Scared or chased offender off
Helped respondent get away from offender
Protected property
Protected other people
Other

45
Did (any of) your action(s) make the situation worse in any way? Did your actions lead to injury, greater injury, loss of property, make the offender angrier, or make the situation worse in some other way?
Yes
No
Don't know

46
How did they make the situation worse? Any other way?
Led to injury or greater injury to respondent
Caused greater loss of property or damage to property
Other people got hurt (worse)
Offender got away
Made offender angrier, more aggressive, etc.
Other

47
Was anyone present during the incident besides you and the offender? (Other than children under age 12.)
Yes
No
Don't know

48
Did the actions of (this person/any of these people) help the situation in any
way?
Yes
No
Don't know
-----------------------------------------------------------------------------------------------------------------------

Questionnaire set 7

I would like to ask you some questions about hunting and fishing. These questions will deal with the kinds of hunting or fishing you did, where you went, what it cost, and what you bought. All questions refer to the time period between (Date of last interview) and December 31,1991.

1
Did you do any recreational fishing, including shellfishing, from (Date of last interview) to December 31,1991? Please do not include as fishing occasions when you only observed others fish.
Yes
No

2
Did you do any hunting from (Date of last interview) to December 31,1991? Please do not include as hunting occasions when you only observed others hunt.
Yes
No

I will start with hunting in Canada. As a reminder, I would like to mention that you previously reported taking hunting trip(s) in Canada. When answering the following, please include only hunting in Canada that you have not previously reported.

3a
Did you hunt in Canada from (Date of last interview) to December 31,1991?
Yes
No

3b
How many trips did you take in Canada to hunt from (Date of last interview) to December 31?
Trips

3c
How many days did you actually hunt in Canada from (Date of last interview) to December 31?
Days

4
Did you hunt in the United States from (Date of last interview) to December 31,1991?
Yes
No

Please think about ail the hunting you've done from (Date of last interview) to December 31,1991. This includes hunting for big game, small game, migratory birds, and other animals.

5
If you have your references available, please refer to Reference 1, "Game that People Hunt," at this time. Please tell me which kinds of game you hunted from (Date of last interview) to December 31 in the United States. Please do not include game for which you only scouted.

ALL STATES EXCEPT ALASKA AND HAWAII
Big game
Deer
Elk
Bear
Wild Turkey
Other (e.g., Antelope, Moose, etc.)
Small game
Rabbit, Hare
Quail
Grouse/Prairie Chicken
Squirrel
Pheasant
Other (e.g., Chukar/Partridge, etc.)
Migratory birds
Geese
Duck
Dove
Other (e.g., Coot, Rail,Gallinule, Woodcock, Band-tailed Pigeon, etc.)
Other animals
Groundhog (Woodchuck)
Raccoon
Fox
Coyote
Other (e.g., Crow, Prairie Dog, etc.)
ALASKA ONLY
Big game
Deer
Bear
Moose
Other (e.g., Bison,Caribou, Mountain Goat, Muskox, etc.)
Small game
Rabbit, Hare
Ptarmigan
Other (e.g., Grouse, etc.)
Migratory birds
Geese
Duck
Other (e.g., Crane, Black Brant, Snipe, etc.)
Other animals
Fox
Coyote
Wolf
Other (e.g., Lynx, Wolverine, etc.)
HAWAII ONLY
Big game
Deer
Wild Turkey
Wild Sheep
Feral Goat
Feral Pig
Other
Small game
Quail
Pheasant
Chuckar/Partridge
Francolin
Other (e.g., Doves other than Mourning Dove, etc.)
Migratory birds
Mourning Dove
Other
Other animals
Mongoose
Other

Now I will ask you about any big game hunting trips that you have taken in the United States from (Date of last interview) to December 31,1991. Please exclude scouting trips. When answering the following questions, please include only those big game hunting trips that you have not previously reported.

6
In which states did you go big game hunting from (Date of last interview) to December 31?
State

7a
How many trips did you take in (State) to hunt big game?
Trips

7b1
Was this trip a one-day trip; that is, a trip on which you went and returned on the same day?
Yes
No

7b2
Was this trip in (State) PRIMARILY for hunting big game?
Yes
No

7c1
Of these trips, how many were one-day trips; that is, trips on which you went and returned on the same day?
Trips

7c2
Of the (Number in 7a) trips you took in (State) how many were PRIMARILY for hunting big game?
Trips

7d
On how many different days in (State) did you ACTUALLY hunt big game?
Days

7e
On how many of those days were you hunting CHIEFLY for big game rather than some other kind of game?
Days

7f
What kinds of big game did you hunt in (State)?
CONTINENTAL U.S. ONLY
Deer
Elk
Bear
Wild Turkey
Other (e.g., Antelope, Moose, Etc.)
ALASKA
Deer
Bear
Moose
Code
Other (e.g., Bison, Caribou, Mountain Goat, Muskox, etc.)
HAWAII
Deer
Wild Turkey
Wild Sheep
Feral Goat
Feral Pig
Other

7g
On how many different days did you hunt (Species) in (State)?

7h
Approximately how many miles is it one way to the place you hunted big game
most often in (State)?
Miles
Less than 1 mile
Don't know

7i
Did you do any big game hunting in (State) on privately-owned land?
No
Don't know
Yes

How many days?
Days

7j
Did you do any big game hunting in (State) on publicly-owned land; that is,
land owned by the local, State, or Federal Government?
No
Don't know
Yes

How many days?
Days

Now I will ask you about any small game hunting trips that you have taken in the United States from (Date of last interview) to December 31,199l. Please exclude scouting trips. When answering the following questions, please include only those small game hunting trips that you have not previously reported.

8
In which states did you go small game hunting from (Date of last interview) to December 31?

9a
How many trips did you take in (State) to hunt small game?
Trips

9b1
Was this trip a one-day trip; that is; a trip on which you went and returned on the same day?
Yes
No

9b2
Was this trip in (State) PRIMARILY for hunting small game?
Yes
No

9c1
Of these trips, how many were one-day trips; that is, trips on which you went
and returned on the same day?
Trips

9c2
Of the (Number in 9a) trips you took in (State) how many were PRIMARILY for
hunting small game?
Trips

9d
On how many different days in (State) did you ACTUALLY hunt small game?
Days

9e
On how many of those days were you hunting CHIEFLY for small game rather than some other kind of game?
Days

9f
What kinds of small game did you hunt in (State)? Enter all codes that apply.
CONTINENTAL U.S. ONLY
Rabbit, Hare
Quail
Grouse/Prairie Chicken
Squirrel
Pheasant
Other (e.g., Chukar/Partridge, etc.)
ALASKA
Rabbit, Hare
Ptarmigan
Other (e.g., Grouse, etc.)
HAWAII
Quail
Pheasant
Chukar/Partridge
Francolin
Other (e.g., Dove other than Mourning Dove, etc.)

9g
On how many different days did you hunt (Species) in (State)?
Number of days

9h
Approximately how many miles is it one way to the place you hunted small game most often in (State)?
Miles
Less than 1 mile
Don't know

9i
Did you do any small game hunting in (State) on privately-owned land?
No
Don't know
Yes

How many days?
Days

9j
Did you do any small game hunting in (State) on publicly-owned land; that is,
land owned by the local, State, or Federal Government?
No
Don't know
Yes

How many days?
Days

Now I will ask you about any migratory bird hunting trips that you have taken in the United States from (Date of last interview) to December 31,199l. Please exclude scouting trips. When answering the following questions, please include only those migratory bird hunting trips that you have not previously reported.

10
In which states did you go migratory bird hunting from (Date of last interview) to December 31?
State

11a
How many trips did you take in (State) to hunt migratory birds?
Trips

11b1
Was this trip a one-day trip; that is; a trip on which you went and returned on the same day?
Yes
No

11b2
Was this trip in (State) PRIMARILY for hunting migratory birds?
Yes
No

11c1
Of these trips, how many were one-day trips; that is, trips on which you went and returned on the same day?
Trips

11c2
Of the (Number in 11a) trips you took in (State) how many were PRIMARILY for hunting migratory birds?
Trips

11d
On how many different days in (State) did you ACTUALLY hunt migratory birds?
Days

11e
On home many of those days were you hunting CHIEFLY for migratory birds rather than some other kind of game?
Days

11f
What kinds of migratory birds did you hunt in (State)?
CONTINENTAL U.S. ONLY
Geese
Duck
Dove
Other (e.g., Coot, Rail, Gallinule, Woodcock, Band-tailed Pigeon, etc.)
ALASKA
Geese
Duck
Other (e.g., Crane, Black Brant, Snipe, etc.)
HAWAII
Mourning Dove
Other

11g
On how many different days did you hunt (Species) in (State)?
Number of days

11h
Approximately how many miles is it one way to the place you hunted migratory birds most often in (State)?
Miles
Less than 1 mile
Don't know

11i
Did you do any migratory bird hunting in (State) on privately-owned land?
No
Don't know
Yes

How many days?
Days

11j
Did you do any migratory bird hunting in (State) on publicly-owned land; that is, land owned by the local, State, or Federal Government?
No
Don't know
Yes

How many days?
Days

Now I will ask you about any trips for hunting other animals that you have taken in the United States from (Date of last interview) to December 31,1991. Please exclude scouting trips. When answering the following questions, please include only those animal hunting trips that you have not previously reported.

12
In which states did you hunt other animals from (Date of last interview) to
December 31?
State

13a
How many trips did you take in (State) to hun these other animals?
Trips

13b1
Was this trip a one-day trip; that is, a trip on which you went and returned on the same day?
Yes
No

13b2
Was this trip in (State) PRIMARILY for hunting these other animals?
Yes
No
-----------------------------------------------------------------------------------------------------------------------

Questionnaire set 8

Now I'm going to ask you some questions about your activities from (Date of last interview) to December 31, 1991 that involved observing, photographing, or feeding wildlife. "Wildlife" includes mammals, birds, fish, insects, reptiles, and amphibians such as snakes, lizards, and frogs. When answering the following questions, please include only those trips that you have not previously
reported.


1a
From (Date of last interview) to December 31, did you take one or more trips or outings in the United States, of at least one mile, for the PRIMARY purpose of observing, photographing, or feeding wildlife? Do not include trips to zoos, circuses, aquariums, museums, or trips for scouting, hunting, or fishing.
Yes
No

1b
In which states did you take trips or outings to observe, photograph, or feed wildlife?
State

When answering the following questions, please include only those trips taken in Canada that you have not previously reported.

2a
From (Date of last interview) to December 31, did you take one or more trips or outings in Canada for the PRIMARY purpose of observing, photographing, or feeding wildlife? Do not include trips for scouting, hunting, or fishing.
Yes
No

2b
How many trips did you take in Canada to observe, photograph, or feed wildlife?
Trip(s)

2c
From (Date of last interview) to December 31, what is the total number of days you spent doing these activities in Canada?
Day(s)

3a
What is the total number of trips you took in (State) from (Date of last interview) to December PRIMARILY observe,
or wildlife?
Trip(s)

3b
What is total number of days you spent doing these activities in (State) from
(Date of interview) to December 31?
Day(s)

4a
Was this trip in (State) a one-day trip; is, a trip on which you went returned on the same day?
Yes
No

4b
On this trip, (how many days) did you observe wildlife?
Day(s)
None

Photograph wildlife?
Day(s)
None

Feed wildlife?
Day(s)
None

4c
Of these trips in (State), how many were one-day trips; that is, trips in which you went returned on same day?
One-day trip(s)
None

4d
On how of those entered in (Number entered in item 3b) days did you observe wildlife?
Day(s)
None

4e
On how of those entered in (Number entered in item 3b) days did you photograph wildlife?
Day(s)
None

4f
On how of those entered in (Number entered in item 3b) days did you feed wildlife?
Day(s)
None

5
Approximately many miles way is it to place you visited (most often) in (State)?
Miles
Don't know

6a
On your trip(s) in (State) from (Date of last interview) to December 31, did you visit any areas on privately-owned land?
Yes
No
Don't know

6b
On your trip(s) in (State), did you visit any areas on public land; that is, land owned by the local, State, or Federal Government?
Yes
No
Don't know

7a
Which of the following types of sites did you visit to observe, photograph, or feed wildlife in (State) from (Date of last interview) to December 31, 1991?Did you visit:
Ocean side?
Lake or stream side?
Marsh/wetland/swamp?
Woodland?
Brush-covered area?
Open field?
Man-made area (golf course, cemetery, urban park, etc.)?
Other?

On your trip(s) in (State), did you observe, photograph, or feed:

8a
Birds?
Yes
No

Did these include:
Birds of prey, such as hawks, owls, or eagles?
Waterfowl and shorebirds, such as ducks, geese,herons, pelicans, etc.?
Other birds?

8b
Fish?
Yes
No

8c
Land mammals, such as squirrels, coyotes, deer, bears, etc.?
Yes
No

8d
Marine mammals, such as seals, whales, dolphins, etc.?
Yes
No

8e
Other wildlife, such as frogs, turtles, crabs, butterflies, etc.?
Yes
No

Now I would like to ask you some questions about your expenses for all trips or outings that you took in the United States from (Date of last interview) to December 31,199l for the PRIMARY purpose of observing, photographing, or feeding wildlife. For each of these items, please tell me what YOUR SHARE of the expenses was. If you paid for others or if someone else paid for you, INCLUDE ONLY WHAT WAS SPENT FOR YOU.

On your trip(s) in (State), how much was spent for YOUR SHARE of:

10a
Food, drink, and refreshments?
Dollars
None

10b
Lodging at motels, cabins, lodges, campgrounds, etc.?
Dollars
None

10c
Public transportation, including airplanes, trains, or car rentals?
Dollars
None

10d
The round trip cost for transportation by private vehicle?
Dollars
None

10e
Guide fees, pack trip, or package fees?
Dollars
None

10f
Public land use or access fees?
Dollars
None

10g
Private land use or access fees? Do NOT include leases.
Dollars
None

10h
Rental of equipment such as boats, camping equipment, etc.?

Now I would like to ask you some questions about your expenses for all trips or outings that you took in Canada from (Date of last interview) to December 31,199l. If you paid for others or if someone else paid for you, include ONLY YOUR SHARE of the cost. Also, include only what was actually spent within Canadian boundaries. Report all amounts in U.S. currency.

11a
On your trip(s) in Canada how much did you spend on food, drink, and refreshments?
Dollars
None

11b
Lodging at motels, cabins, lodges, campgrounds, etc.?
Dollars
None

11c
Public and private transportation including airplanes, trains, buses, car rentals, and private vehicles? Include only that which was spent within Canadian boundaries.
Dollars
None

11d
Guide fees, pack trip, or package fees?
Dollars
None

11e
Public or private land use or access fees? Do NOT include leases.
Dollars
None

11f
Rental of equipment such as boats, camping equipment, etc?
Dollars
None

Now I'm going to ask some questions about your experiences with wildlife around your home. By "around your home," I mean the area within a one-mile radius of your home.

12a
From (Date of last interview) to December 31, did you take SPECIAL INTEREST in wildlife around your home, other than simply noticing wildlife while doing other activities? By this I mean, did you closely observe wildlife or try to identify types of wildlife you did not know?
Yes
No

12b
Approximately how many days did you do this kind of observing of wildlife?
Day(s)

12c
Which of the following kinds of wildlife did you observe?
Birds
Mammals
Reptiles or amphibians
Insects or spiders
Fish or other wildlife

13a
From (Date of last interview) to December 31, did you photograph any type of wildlife around your home?
Yes
No

13b
On approximately how many different days?
Day(s)

14a
From (Date of last interview) to December 31, did you feed wild birds around your home?
Yes
No

14b
For how many different months did you feed the birds at least once a week?
Month(s)
None

15a
From (Date of last interview) to December 31, did you feed any kind of fish or wildlife, other than birds, around your home?
Yes
No

15b
How many different months did you feed these other kinds of fish or wildlife at least once?
Month(s)

16a
From (Date of last interview) to December 31, did you visit any public parks or publicly-owned natural areas within a one-mile radius of your home, for the purpose of observing, photographing, or feeding wildlife?
Yes
No

16b
On how many days did you visit these areas?
Day(s)

17a
Now I would like to ask you about equipment and other items purchased PRIMARILY for use in observing, photographing, or feeding fish or wildlife. Include only items that were purchased in the United States. (If you have your reference aid available, please refer to Reference A, "Recently Purchased Nonconsumptive Use
Equipment," at this time. Please tell me which items you purchased for yourself or were purchased for you from (Date of last interview) to December 31.
Binoculars, spotting scopes, etc.
Film and developing
Cameras, special lenses, or other photography equipment
Day packs, carrying cases, or special clothing (such as foul weather gear,
camouflage clothing, hiking boots, etc.)
Commercially prepared and packaged wild bird food
Other bulk food used to feed wild birds
Nest boxes, bird houses, feeders, or baths
Magazines or other periodicals specifically devoted to fish or wildlife
Dues or contributions to National, State, or local conservation or wildlife-related organizations
Any other purchases (such as field guides, maps, etc.)?

17b
On (Date of last interview) you reported buying (Equipment/Item). Is/are the (Equipment/Item) you reported today the same you reported previously?
Yes
No

17c
Approximately how much did (Equipment/Item) cost?
Dollars
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Questionnaire set 9

9
The next few questions are about (name's/your) work-related activities LAST YEAR, that is, from January to December 1997. Did (name/you) work at a job or business AT ANY TIME during 1997?
Yes
No
Retired

10
Did (name/you) do any temporary, part-time, or seasonal work, even for a few days, in 1997?
Yes
No
Retired

11
Did (name/you) spend any time on layoff from a job in 1997?
Yes
No

12
When (name/you) were laid off, did (his/her/your) employer give (him/her/you) a date to return to work?
Yes
No
(D,R)

13
(Was/were) (name/you) given any indication that (he/she/you) would be recalled to work within 6 months of being laid off?
Yes
No

14
In which month and year (were/was) (name/you) laid off?
Month
Year

15
Which weeks (were you/was name) on layoff in 1997? (What is your best estimate?)
WEEKS

16
Did (name/you) spend any time looking for work in 1997?
Yes
No

17
Which weeks (were you/was name) looking for work in 1997? (What is your best estimate?)
WEEKS

18
What was the MAIN reason (name/you) did not work in 1997?
Retired
Taking care of home or family
Going to school
Ill or disabled
Could not find work/No work available
Did not want to work
On layoff
Never worked
Other

19
During 1997, which weeks did (name/you) do any work at all, even for only a few hours?
WEEKS

20
Besides the (weeks worked) weeks during which you worked, were there any additional weeks during which you took paid vacation or paid sick leave in 1997?
Yes
No

21
Which weeks did (you/name) take paid vacation or paid sick leave.
WEEKS

22
Did (you/he/she) spend any time on layoff from a job in 1997?
Yes
No

23
When (name/you) (was/were) laid off, did (his/her/your) employer give (him/her/you) a date to return to work?
Yes
No

24
(Was/Were) (he/she/you) given any indication that (he/she/you) would be recalled to work within 6 months of being laid off?
Yes
No

25
Which weeks (were you/was name) on layoff in 1997?
WEEKS

26
Did (you/he/she) spend any time looking for work in 1997?
Yes
No

27
Which weeks did (you/name) look for work?
WEEKS

28
What was the MAIN reason (name/you) worked fewer than 52 weeks during 1997?
On layoff
Ill or disabled
Taking care of home or family
Going to school
Retired
No work available/Could not find work
Child care problems
Vacation
Did not want to work
Other

29
How many employers did (name/you) work for in 1997?

29A
What is the name of the employer or company for which (you/name) worked (the most
weeks/the second most weeks/the third most weeks/the fourth most weeks) in 1997?

30
(Think about the weeks that you worked last year.) (Counting all jobs,) How many hours
did (name/you) USUALLY work per week in 1997?
Hours vary
hours

31
Did (you/he/she) usually work 35 hours or more per week?
Yes
No

32
Which weeks did (you/name) work (for employer's name/for (yourself/himself/herself)/at this job) in 1997?

33
(Think about the weeks that (name/you) worked (for (employer's name)/for
(yourself/himself/herself)/at this job) in 1997.) How many hours a week did (name/you) USUALLY work (for (employer's name)/for (yourself/himself/herself)/at this job)?
Hours vary
hours

34
Did (you/he/she) usually work 35 hours or more per week at this job?

35
(At this job,) (Was/Were) (name/you) (employed by government, by a private company, a non-profit organization, or (was/were) (name/you)) self employed, or working in a family business or farm?
Government
Private for profit company
Non-profit organization (inc. tax exempt and charitable)
Self employed
Working in family business or farm

36
Was that federal, state, or local government?
Federal
State
Local (county, city, township)

37A
(Was/Were) (name/you) paid for (your/his/her) work in the family business or farm?
Yes
No

37B
Was this business incorporated?
Yes
No

38
In what month and year did (name/you) start working (for (employer's name)/ for (yourself/himself/herself)/in the family business or farm/at this job)?
Month
Year

39
What is the MAIN reason (you/name) left this job?
Personal, family (including pregnancy)
Return to school
Health, disability
Retirement
Temporary, seasonal, or intermittent job completed
Slack work, business conditions, or laid off
Unsatisfactory work arrangements (hours, pay, location, etc.)
Fired from job
Other

40
After leaving this job, did you apply for unemployment benefits?
Yes
No

43
What kind of business or industry was this? [What did they make or do where (you/name) worked?]

44A
What was the address of (employer's name/this job)?

44B
In what city/town and state is this employer located?
city
state

45
What kind of work (was/were) (name/you) doing, that is, what was your occupation, as of 1997?

46
What were (name's/your) most important activities or duties at this job?

47
(At this job/ Counting all locations where (this employer) operates,) what is the total number of persons who work (for (employer's name) / with (name/you))?
Under 10
10-24
25-49
50-99
100-499
500-999
1000 or more

50
(The next few questions are about (name's/your) earnings last year.) During 1997, how much did you earn from (fill employer's name/ this job) BEFORE taxes and other deductions?
DOLLAR AMOUNT

Is that weekly, every two weeks, twice monthly, monthly, quarterly, or annually?
Weekly
Every two weeks
Twice monthly
Monthly
Quarterly
Annually

51
(The next few questions are about (name's/your) earnings last year.) During 1997, what (was/were) (name's/your) total earnings from this business/farm AFTER expenses?

52
Is that before or after taxes?
Before
After

53
How much were your total earnings from this business/farm BEFORE taxes?

54
During 1997, how many (periodicity in 50B) pay periods did (name/you) earn (amount in 50A) from (employer's name)?

55
According to my calculations, (name/you) earned (total) dollars altogether BEFORE taxes from (employer's name) in 1997. Does that sound right?
Yes
No

56
What is your best estimate of (name's/your) total earnings BEFORE taxes from (employer's name) during 1997?

57
Does this amount include all tips, bonuses, overtime pay, or commissions (name/you) received from (fill employer's name) in 1997?
Yes
No

58
How much extra did (name/you) earn from tips, bonuses, overtime pay or commissions from (employer's name) in 1997?

59
The next few questions are about fringe benefits. During 1997, did this employer offer a pension or other type of retirement plan to ANY of its employees?
Yes
No
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Questionnaire set 10

1
What were you doing most of LAST WEEK -working, keeping house, or something else?
Working
With a job but not at work
Looking for work
Going to school
Keeping house
Unable to work
Retired
Other

2a
Did you do any work at all LAST WEEK, not counting work around the house?
Yes
No

2b
How many hours did you work LAST WEEK at all jobs?
Hours

2c
Do you USUALLY work 35 hour or more a week at this job?

Yes
What is the reason you worked less than 35 hours LAST WEEK?

No
What is the reason you USUALLY work less than 35 hours a week?

Slack work
Material shortage
Plant or machine repair
New job started during week
Job terminated during week
Could find only part-time work
Labor dispute
Did not want full-time work
Full-time work week under 35 hours
Attends school
Holiday (legal or religious)
Bad weather
Own illness

2d
Did you lose any time or take any time off LAST WEEK for any reason such as illness, holiday, or slack work?
No
Yes

How many hours did you take off?
Hours

2e
Did you work any overtime or at more than one job LAST WEEK?
No
Yes

How many extra hours did you work?

3a
Did you have a job or business from which you were temporarily absent or on layoff LAST WEEK?
Yes
No

3b
Why were you absent from work LAST WEEK?
Own illness
Illness of family
On vacation
Bad weather
New job to begin within 30 days
Temporary layoff (under 30 days)
Indefinite layoff (30 days or more or no definite recall date)
Labor dispute
Other

3c
Are you getting wages or salary for any of the time off LAST WEEK?
Yes
No
Self-employed

3d
Do you usually work 35 hours or more a week at this job?
Yes
No

4a
Have you been looking for work during the past 4 weeks?
Yes
No

4b
What have you been doing in the last 4 weeks to find work? Anything else?
Nothing
Checked with:
State employment agency
Private employment agency
Employer directly
Friends or relatives
Placed or answered ads
School employment service
Other (e.g., JTPA, union or professional register, etc.)

4c
Why did you start looking for work? Was it because you lost or quit a job at that time or was there some other reason?
Lost job
Quit job
Wanted temporary work
Children are older
Enjoy working
Help with family expenses
Other

4d
How many weeks have you been looking for work? How many weeks ago did you start
looking for work? How many weeks ago were you laid off?
Weeks

4e
Have you been looking for full-time or part-time work?
Full-time
Part-time

4f
Is there any reason why you could not take a job LAST WEEK?
No
Yes

Why?
Already has a job
Temporary illness
Going to school
Child care problems
Husband would not permit
Other family or personal reasons
Did not want to work
Other

5
When did you last work at a regular job or business lasting 2 consecutive weeks or more, either full-time or part-time?
Month
Day
Year

6b
Our records show that you were working for (Employer's name) when we last
interviewed you on (Date). Is (Employer's name) the same employer?
Yes
No

6c
Did your last employment change give you:
More pay?
Yes
No

More challenging work?
Yes
No

More authority over other workers?
Yes
No

More responsibility?
Yes
No

Anything else?
Yes
No

7a
When did you first start working for (Employer)?
Month
Day
Year

7b
(Have/had) you ever left (Employer) to work somewhere else since (Date)?
Yes
No

7c
When did you (last) return to (Employer)?
Month
Day
Year

9a
What kind of business or industry (is/was) this? (For example: TV and radio manufacturer, retail shoe store, State Labor Department, farm.)

9b
(Are/Were) you:
An employee of a PRIVATE company, business, or individual for wages, salary, or commissions?

GOVERNMENT employee (Federal, State, county, or local)?
Federal
State
Other

Self-employed in your OWN business, professional practice, or farm? Is this business incorporated?
Yes
No

Working WITHOUT PAY in family business or farm?

9c
(Is/Was) this a nonprofit organization?
Yes
No

9d
(Are/Were) you covered by Social Security or Railroad Retirement on this job?
Yes
No
Don't know

9e
What kind of work (are/were) you doing? (For example: registered nurse, high school chemistry teacher, waitress.)

9f
What (are/were) your most important activities or duties? (For example: typed, kept account books, filed, sold real estate, operated business machine, cleaned buildings.)

11a
Altogether, how much (do/did) you usually earn at this job before deductions? Dollars, cents per hour
Per Day
Per Week
Biweekly (every two weeks)
Twice a month
Month
Year
Other
Don't know
Refused

11b
In the last 12 months (you worked), what was your total pay for (this/that) teaching job, before deductions?
Dollars

11c
How many months of work (does/did) this pay cover?
Months

11d
(Are/Were) you paid by the hour on this job?
Yes
No

11e
How much (do/did) you earn per hour?
Dollars, cents per hour

11f
How many hours per day (do/did) you USUALLY work at this job?
Hours per day

11g
How many hours per week (do/did) you USUALLY work at this job?
Hours per week

11h
Not counting overtime hours, would your employer (allow/have allowed) you to change your work schedule to REDUCE the number of hours you (work/ worked) each week?
Yes
No
Don't know

11i
Counting paid vacations and paid sick leave as weeks of work, how many weeks
per year (do/did) you usually work at (this/that) job?
Weeks per year

12a
(Do/Did) you receive extra pay when you (work,worked) over a certain number of hours?
Yes
No
No, but receive compensating time off

13a
Now, I'd like to ask you a few questions about working at home. (Do/Did) you usually do any of your work for (Employer) at home?
Yes
No

13b
How many hours per week (do/did) you usually work for (Employer) at home?
Hours per week on average
Works at home all the time

13c
When you said earlier that you usually (work/worked) (Number of hours) hours per week, had you already included the (Number of hours) per week that you usually (work/ worked) at home?
Yes
No

13d
Thinking of the number of hours per week that you usually (work/worked) at home and the number of hours per week that you usually (work/worked) at your place of employment, altogether how many hours per week (do/did) you USUALLY work at this job?
Hours per week

13e
(Are/Were) your wages or salary on this job set by a collective bargaining agreement between your employer and a union or employee association?
Yes
No
Don't know

13f
(Are/Were) you a member of that union or employee association?
Yes
No

14a
(Do/Did) you supervise the work of other employees, or tell them what work to do?
Yes
No

14b
About how many people (do/did) you supervise on a day-to-day basis?
Number of people

14c
(Do/Did) you have any say about their pay or promotion?
Yes
No

14d
(Do/Did) any of the employees that you supervise, supervise OTHER employees? Yes
No

14e
(Does/Did) your boss have a supervisor over him or her?
Yes
No

15a
(Have/had) you been promoted at any time since (Date)?
Yes
No
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Questionnaire set 11

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Questionnaire set 12

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