CS. Coversheet

CS. Coversheet module of AHEAD 1995

Start of CS. Coversheet
 
CS1

IS (R NAME) LIVING?

IS (R NAME) LIVING?
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CS1A

IWER: CHOOSE TYPE OF INTERVIEW:

IWER: CHOOSE TYPE OF INTERVIEW:
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CS1B

WAVE 1 PROXY WAS (PROXY NAME). WAVE 2 PROXY IS:

WAVE 1 PROXY WAS (PROXY NAME). WAVE 2 PROXY IS:
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CS2

THE PROXY REPORTER'S RELATIONSHIP TO (R NAME).

THE PROXY REPORTER'S RELATIONSHIP TO (R NAME).
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D224

First we need to update our records. As of (Wave 1 date), when we talked with you, they show that you, ~IF MARRIED: (R NAME), were married. ~Else PARTNERED (R NAME), were living with a partner as if married. ~Else SINGLE (R NAME), were not married or living with a partner. if: WAVE 1 NOT SINGLE

FIRST WE NEED TO UPDATE OUR RECORDS. AS OF (WAVE 1 DATE), WHEN WE TALKED WITH YOU, THEY SHOW THAT YOU, ~IF MARRIED: (R NAME), WERE MARRIED. ~ELSE PARTNERED (R NAME), WERE LIVING WITH A PARTNER AS IF MARRIED. ~ELSE SINGLE (R NAME), WERE NOT MARRIED OR LIVING WITH A PARTNER. IF: WAVE 1 NOT SINGLE
 
If WAVE SINGLE »
 
   
 
D226

(R SPOUSE NAME) still your (Husband/Wife/Partner)? ~Else Is (64)M62(Q205)= still your (Husband/Wife/Partner)?

(R SPOUSE NAME) STILL YOUR (HUSBAND/WIFE/PARTNER)? ~ELSE IS (64)M62(Q205)= STILL YOUR (HUSBAND/WIFE/PARTNER)?
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D227

~IF 1ST HOUSEHOLD (Is (R SPOUSE NAME) still alive?)

~IF 1ST HOUSEHOLD (IS (R SPOUSE NAME) STILL ALIVE?)
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D228

~IF SPOUSE/PARTNER ALIVE In what month and year did you stop living together? ~Else In what month and year did (He/She)die?

~IF SPOUSE/PARTNER ALIVE IN WHAT MONTH AND YEAR DID YOU STOP LIVING TOGETHER? ~ELSE IN WHAT MONTH AND YEAR DID (HE/SHE)DIE?
   
 
D229

YEAR SEPARATE/DIE

IN WHAT YEAR DID YOU STOP LIVING TOGETHER?
   
 
D230

Are you married (to someone else)?

ARE YOU MARRIED (TO SOMEONE ELSE)?
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D231

Are you living with (a/another) partner as if married?

ARE YOU LIVING WITH (A/ANOTHER) PARTNER AS IF MARRIED?
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D233

Are you now married?

ARE YOU NOW MARRIED?
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D234

you living with a partner as if married?

YOU LIVING WITH A PARTNER AS IF MARRIED?
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CS11

~IF 1ST R IWER: ASK IF NECESSARY: Are you living in a nursing home or other health care facility? ~Else IWER: IS R LIVING IN A NURSING HOME OR OTHER HEALTH CARE FACILITY? DEF: A NURSING HOME OR OTHER HEALTH FACILITY PROVIDES ALL OF THE FOLLOWING SERVICES FOR ITS RESIDENTS: DISPENSING OF MEDICATION, 24-HOUR NURSING ASSISTANCE AND SUPERVISION, PERSONAL ASSISTANCE, AND ROOM & MEALS.

~IF 1ST R IWER: ASK IF NECESSARY: ARE YOU LIVING IN A NURSING HOME OR OTHER HEALTH CARE FACILITY? ~ELSE IWER: IS R LIVING IN A NURSING HOME OR OTHER HEALTH CARE FACILITY? DEF: A NURSING HOME OR OTHER HEALTH FACILITY PROVIDES ALL OF THE FOLLOWING SERVICES FOR ITS RESIDENTS: DISPENSING OF MEDICATION, 24-HOUR NURSING ASSISTANCE AND SUPERVISION, PERSONAL ASSISTANCE, AND ROOM & MEALS.
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D241

Are you and your (new) (Husband/Wife/Partner) living ~IF IN NURSING HOME in the same (nursing home/health care facility)? ~Else together in a house or apartment? IWER: THIS QUESTION IS TO TELL WHETHER R'S SPOUSE/PARTNER IS ALSO LIVING IN THE DWELLING OR INSTITUTION WHERE R LIVES.

ARE YOU AND YOUR (NEW) (HUSBAND/WIFE/PARTNER) LIVING ~IF IN NURSING HOME IN THE SAME (NURSING HOME/HEALTH CARE FACILITY)? ~ELSE TOGETHER IN A HOUSE OR APARTMENT? IWER: THIS QUESTION IS TO TELL WHETHER R'S SPOUSE/PARTNER IS ALSO LIVING IN THE DWELLING OR INSTITUTION WHERE R LIVES.
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If NOT D241 = 1 »
 
   
 
D244

In what month and year did you stop living together?

IN WHAT MONTH AND YEAR DID YOU STOP LIVING TOGETHER?

MONTH:

YEAR:
   
 
D245

YEAR STOP LIVE TOGETHER/DIE

IN WHAT YEAR DID YOU STOP LIVING TOGETHER? MONTH: YEAR:
   
 
D246

Is your (new) (Husband/Wife/Partner) living in a nursing home or other health care facility? DEF: A NURSING HOME PROVIDES ALL OF THE FOLLOWING SERVICES FOR ITS RESIDENTS: DISPENSING OF MEDICATION, 24-HOUR NURSING ASSISTANCE AND SUPERVISION, PERSONAL ASSISTANCE, AND ROOM & MEALS.

IS YOUR (NEW) (HUSBAND/WIFE/PARTNER) LIVING IN A NURSING HOME OR OTHER HEALTH CARE FACILITY? DEF: A NURSING HOME PROVIDES ALL OF THE FOLLOWING SERVICES FOR ITS RESIDENTS: DISPENSING OF MEDICATION, 24-HOUR NURSING ASSISTANCE AND SUPERVISION, PERSONAL ASSISTANCE, AND ROOM & MEALS.
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D247

In what month and year did you and your (new) (Husband/Wife/Partner) start living together?

IN WHAT MONTH AND YEAR DID YOU AND YOUR (NEW) (HUSBAND/WIFE/PARTNER) START LIVING TOGETHER?

MONTH: _______ YEAR: __________
 
D248

YEAR ST LIVE W/NEW SP/P

IN WHAT YEAR DID YOU AND YOUR (NEW) (HUSBAND/WIFE/PARTNER)
START LIVING TOGETHER? YEAR:
 
CS17

R ROSTER CONFIRM. IWER: PRESS 1 TO CONFIRM R GRID IS FINISHED. YOU WILL NOT BE ABLE TO AMEND IT AFTER THIS POINT.

R ROSTER CONFIRM. IWER: PRESS 1 TO CONFIRM R GRID IS FINISHED. YOU WILL NOT BE ABLE TO AMEND IT AFTER THIS POINT.
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D345

IN WAVE 1 IW, (R NAME) WAS THE (TYPE R) FOR WAVE 2 IW, (R NAME) IS THE (ASSIGNED TYPE R) ~IF NEW SPOUSE FOR WAVE 2 IW, (R SPOUSE NAME) IS THE (ASSIGNED TYPE R) ~IF HAD W1 SPOUSE IN WAVE 1 IW, (R SPOUSE NAME) WAS THE (TYPE R) FOR WAVE 2 IW, (R SPOUSE NAME) IS THE (ASSIGNED TYPE R) ~Else IN WAVE 1 IW, (R SPOUSE NAME) WAS THE (TYPE R) FOR WAVE 2 IW, (R SPOUSE NAME) IS THE (ASSIGNED TYPE R) IWER: DO YOU NEED TO CHANGE THIS ASSIGNMENT?

IN WAVE 1 IW, (R NAME) WAS THE (TYPE R) FOR WAVE 2 IW, (R NAME) IS THE (ASSIGNED TYPE R) ~IF NEW SPOUSE FOR WAVE 2 IW, (R SPOUSE NAME) IS THE (ASSIGNED TYPE R) ~IF HAD W1 SPOUSE IN WAVE 1 IW, (R SPOUSE NAME) WAS THE (TYPE R) FOR WAVE 2 IW, (R SPOUSE NAME) IS THE (ASSIGNED TYPE R) ~ELSE IN WAVE 1 IW, (R SPOUSE NAME) WAS THE (TYPE R) FOR WAVE 2 IW, (R SPOUSE NAME) IS THE (ASSIGNED TYPE R) IWER: DO YOU NEED TO CHANGE THIS ASSIGNMENT?
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CS20A

WHY ARE YOU CHANGING THIS ASSIGNMENT?

WHY ARE YOU CHANGING THIS ASSIGNMENT?
 
D347

INTERVIEW (R NAME) AS: TYPE:

INTERVIEW (R NAME) AS: TYPE:
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D348

INTERVIEW (R SPOUSE NAME) AS: OR NO SPOUSE -- IS assigned a value of TYPE: S22. SP TYPE

INTERVIEW (R SPOUSE NAME) AS: OR NO SPOUSE -- IS ASSIGNED TYPE: S22. SP TYPE
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CS25

In what month and year did you move to the (nursing home/health care facility) where you are now living?

IN WHAT MONTH AND YEAR DID YOU MOVE TO THE (NURSING HOME/HEALTH CARE FACILITY) WHERE YOU ARE NOW LIVING?
 
CS25B

In what city and state is the (nursing home/health care facility) where you are living?

IN WHAT CITY AND STATE IS THE (NURSING HOME/HEALTH CARE FACILITY) WHERE YOU ARE LIVING?
 
D420

Do you still own or rent a house or apartment outside the facility where you are living?

DO YOU STILL OWN OR RENT A HOUSE OR APARTMENT OUTSIDE THE FACILITY WHERE YOU ARE LIVING?
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D422

Our records show that in (Wave 1 date), (your house or apartment /one of your houses or apartments)was in (HH1 1st ADDR CITY , (HH1 1st ADDR STATE). ~IF IN NEW HH Do you still have the same house or apartment in (CITY)? ~Else Are you still living, all year or part of the year, in that same house or apartment in (CITY, STATE)?

OUR RECORDS SHOW THAT IN (WAVE 1 DATE), (YOUR HOUSE OR APARTMENT /ONE OF YOUR HOUSES OR APARTMENTS)WAS IN (HH1 1ST ADDR CITY , (HH1 1ST ADDR STATE). ~IF IN NEW HH DO YOU STILL HAVE THE SAME HOUSE OR APARTMENT IN (CITY)? ~ELSE ARE YOU STILL LIVING, ALL YEAR OR PART OF THE YEAR, IN THAT SAME HOUSE OR APARTMENT IN (CITY, STATE)?
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D423

~IF IN NURSING HOME Is your house or apartment still in or around (CITY, STATE)? ~Else Do you still live, all year or part of the year in a house or apartment, in or around (CITY, STATE)?

~IF IN NURSING HOME IS YOUR HOUSE OR APARTMENT STILL IN OR AROUND (CITY, STATE)? ~ELSE DO YOU STILL LIVE, ALL YEAR OR PART OF THE YEAR IN A HOUSE OR APARTMENT, IN OR AROUND (CITY, STATE)?
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If ~IF IN NURSING HOME Is your house or apartment still in or around (CITY, STATE)? ~Else Do you still live, all year or part of the year in a house or apartment, in or around (CITY, STATE)? = 5
 
   
 
D425

How many years did you live around (CITY, STATE)? IF LESS THAN ONE YEAR, USE 1 if: NO W1 2ND RESIDENCE

HOW MANY YEARS DID YOU LIVE AROUND (CITY, STATE)? IF LESS THAN ONE YEAR, USE 1 IF: NO W1 2ND RESIDENCE
   
D426

Our records also show that in (Wave 1 date), you had another house or apartment, one in (CITY, STATE). ~IF IN NURSING HOME Do you still have the same house or apartment in (CITY, STATE)? ~Else Are you still living, all year or part of the year, in that same house or apartment in (CITY, STATE)?

OUR RECORDS ALSO SHOW THAT IN (WAVE 1 DATE), YOU HAD ANOTHER HOUSE OR APARTMENT, ONE IN (CITY, STATE). ~IF IN NURSING HOME DO YOU STILL HAVE THE SAME HOUSE OR APARTMENT IN (CITY, STATE)? ~ELSE ARE YOU STILL LIVING, ALL YEAR OR PART OF THE YEAR, IN THAT SAME HOUSE OR APARTMENT IN (CITY, STATE)?
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D429

How many years did you live around (CITY, STATE)? IF LESS THAN ONE YEAR, USE 1

HOW MANY YEARS DID YOU LIVE AROUND (CITY, STATE)? IF LESS THAN ONE YEAR, USE 1
 
CS33

In what city and state is your house or apartment currently located?

IN WHAT CITY AND STATE IS YOUR HOUSE OR APARTMENT CURRENTLY LOCATED?
 
D431

Do you have any other house or apartment where youlive for 2 or more months of the year? IF R REPORTS MORE THAN ONE ADDITIONAL RESIDENCE, ASK ABOUT THE ONE THEY USE MOST.

DO YOU HAVE ANY OTHER HOUSE OR APARTMENT WHERE YOULIVE FOR 2 OR MORE MONTHS OF THE YEAR? IF R REPORTS MORE THAN ONE ADDITIONAL RESIDENCE, ASK ABOUT THE ONE THEY USE MOST.
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CS35

In what city and state is your other residence located?

IN WHAT CITY AND STATE IS YOUR OTHER RESIDENCE LOCATED?
 
D438

Which is your main residence, your home in (CITY, STATE)or the one in (CITY, STATE) DEF: MAIN RESIDENCE, ONE WHERE R SPENDS THE MOST TIME (MTY)

WHICH IS YOUR MAIN RESIDENCE, YOUR HOME IN (CITY, STATE)OR THE ONE IN (CITY, STATE) DEF: MAIN RESIDENCE, ONE WHERE R SPENDS THE MOST TIME (MTY)
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D466

some questions about children and whether any are living with you in (CITY). ~IF IN NURSING HOME IWER: WHEN R LIVES IN NURSING HOME CHANGE ALL RESIDENT CODES IN CHILD GRID TO NONRESIDENT OR DIED.

SOME QUESTIONS ABOUT CHILDREN AND WHETHER ANY ARE LIVING WITH YOU IN (CITY). ~IF IN NURSING HOME IWER: WHEN R LIVES IN NURSING HOME CHANGE ALL RESIDENT CODES IN CHILD GRID TO NONRESIDENT OR DIED.
 
D470

VERIFY AND UPDATE INFORMATION ON CHILDREN & THEIR SPOUSES. PROMPT QUESTIONS FOR NEW CHILDREN ARE IN Q X Qs. REL MARI SP SPOUSE SP R HH TO R SEX NAME LAST STAT R HH NAME CHG Do you (or your) (Husband/Wife/Partner)have any (other) children, step-children, or sons- or daughters-in-law? USE DOWN ARROW TO CHECK FOR MORE PERSONS ON THE GRID. WHEN YOU ARE FINISHED, PRESS F10 TO CONTINUE if:1ST HOUSEHOLD

VERIFY AND UPDATE INFORMATION ON CHILDREN & THEIR SPOUSES. PROMPT QUESTIONS FOR NEW CHILDREN ARE IN Q X QS. REL MARI SP SPOUSE SP R HH TO R SEX NAME LAST STAT R HH NAME CHG DO YOU (OR YOUR) (HUSBAND/WIFE/PARTNER)HAVE ANY (OTHER) CHILDREN, STEP-CHILDREN, OR SONS- OR DAUGHTERS-IN-LAW? USE DOWN ARROW TO CHECK FOR MORE PERSONS ON THE GRID. WHEN YOU ARE FINISHED, PRESS F10 TO CONTINUE IF:1ST HOUSEHOLD
 
D473

Now some questions about children and whether any are living with you in (CITY). ~IN NURSING HOME IWER: WHEN R LIVES IN NURSING HOME CHANGE ALL RESIDENT CODES IN CHILD GRID TO NONRESIDENT OR DIED.

NOW SOME QUESTIONS ABOUT CHILDREN AND WHETHER ANY ARE LIVING WITH YOU IN (CITY). ~IN NURSING HOME IWER: WHEN R LIVES IN NURSING HOME CHANGE ALL RESIDENT CODES IN CHILD GRID TO NONRESIDENT OR DIED.
 
CS42

VERIFY AND UPDATE INFORMATION ON CHILDREN & THEIR SPOUSES. PROMPT QUESTIONS FOR NEW CHILDREN ARE IN Q X Qs. REL MARI SP SPOUSE SP R HH TO R SEX NAME LAST STAT R HH NAME CHG Do you (or your) (Husband/Wife/Partner)have any (other) children, step-children, or sons- or daughters-IN-law? USE DOWN ARROW TO CHECK FOR MORE PERSONS ON THE GRID. WHEN YOU ARE FINISHED, PRESS F10 TO CONTINUE

VERIFY AND UPDATE INFORMATION ON CHILDREN & THEIR SPOUSES. PROMPT QUESTIONS FOR NEW CHILDREN ARE IN Q X QS. REL MARI SP SPOUSE SP R HH TO R SEX NAME LAST STAT R HH NAME CHG DO YOU (OR YOUR) (HUSBAND/WIFE/PARTNER)HAVE ANY (OTHER) CHILDREN, STEP-CHILDREN, OR SONS- OR DAUGHTERS-IN-LAW? USE DOWN ARROW TO CHECK FOR MORE PERSONS ON THE GRID. WHEN YOU ARE FINISHED, PRESS F10 TO CONTINUE
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If NOT 2ND HOUSEHOLD »
 
   
 
D478

I also need to update information about (other) people living with you in your home in (CITY). ~IF IN NURSING HOME: who lived with you back in (Wave 1 date). ~Else living with you in your home. IWER: WHEN R LIVES IN NURSING HOME CHANGE ALL RESIDENT CODES IN GRID TO NONRESIDENT OR DIED.

I ALSO NEED TO UPDATE INFORMATION ABOUT (OTHER) PEOPLE LIVING WITH YOU IN YOUR HOME IN (CITY). ~IF IN NURSING HOME: WHO LIVED WITH YOU BACK IN (WAVE 1 DATE). ~ELSE LIVING WITH YOU IN YOUR HOME. IWER: WHEN R LIVES IN NURSING HOME CHANGE ALL RESIDENT CODES IN GRID TO NONRESIDENT OR DIED.
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D484

I also need to update information about (other) people ~IF IN NURSING HOME: living with you in your home in (CITY). ~Else who lived with you back in (Wave 1 date). ~Else living with you in your home. IWER: WHEN R LIVES IN NURSING HOME CHANGE ALL RESIDENT CODES IN GRID TO NONRESIDENT OR DIED.

I ALSO NEED TO UPDATE INFORMATION ABOUT (OTHER) PEOPLE ~IF IN NURSING HOME: LIVING WITH YOU IN YOUR HOME IN (CITY). ~ELSE WHO LIVED WITH YOU BACK IN (WAVE 1 DATE). ~ELSE LIVING WITH YOU IN YOUR HOME. IWER: WHEN R LIVES IN NURSING HOME CHANGE ALL RESIDENT CODES IN GRID TO NONRESIDENT OR DIED.
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CS49

What is the relationship of (name) to your (Husband/Wife/Partner)?

WHAT IS THE RELATIONSHIP OF (NAME) TO YOUR (HUSBAND/WIFE/PARTNER)?
 
End of CS. Coversheet