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11A-001
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Let me confirm some information about your family. In the previous interview in __________ / ____ (month/year), you ( ). Has there been any change to your marital status? |
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11A-002
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In what month and year was your spouse (or common-law spouse) born? |
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11A-002-1
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Please excuse my asking of the same question, but could you tell us how old your spouse is? |
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11A-003
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What is your spouse’s highest level of education? |
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11A-004
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At the time of our last visit in __________ / ____ (month/year), you ( ). Has there been any change in the situation? |
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11A-004-0
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Could you confirm whether the information accurately represents the situation at the time? |
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11A-004-1
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Has the survival status of the t/nd/rd/th child changed? |
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11A-004-1a
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Let me ask about the spouse of the deceased son/daughter. Which of the following best describes the situation? |
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11A-004-2
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Has the marital status of the h child changed? |
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11A-004-3
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Has there been any change in the place of residence of the t/nd/rd/th child? |
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11A-004-3a
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How long does it take from your home to his/her new residence? |
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11A-004-4
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Has there been any change in the economic status of the t/nd/rd/th child? (If he/she is married and is a full-time homemaker, please answer about the situation of the couple.] |
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11A-004-5
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[To the interviewer: Show Card 11A-004-5-in asking the following question.] Has there been any change in the work or school status of the t/nd/rd/th child? |
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11A-004-6
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Does your t/nd/rd/th child have any children and if yes, how many? |
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11A-004-7
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This is the current status of your t/nd/rd/th child based on what you have just told me. Could you confirm this is correct? |
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11A-004-8
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If the answer to 11A-004 is 1 or if 2 and no increase in the number of children, go to 11A-013- 0; if 2 and any increase in the number of children, go to 11A-005. |
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11A-005
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I would now like to ask you about your additional child(ren) born or adopted since the time of the last interview in __________ / ____ (month/year). |
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11A-005-1
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Let me ask you about your t/nd/rd/th additional child. Is it a son or a daughter? |
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11A-005-2
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Is he/she your biological or adopted son/daughter? |
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11A-005-3
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How old is he/she? Or you may tell me the month and year of his/her birth. |
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11A-005-4
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Where does he/she live? Please choose the answer that best describes the location as seen from your residence as of the time of the last interview. |
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11A-005-4a
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How long does it take from your home to his/her residence? |
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11A-005-5
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Is he/she financially independent? |
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11A-005-6
|
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Which of the following most accurately describes the current status of the child? |
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11A-005-7
|
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Which of the following most accurately describes the current status of the child? |
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11A-005-8
|
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Is he/she married? |
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11A-005-9
|
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Does he/she have any children and if yes, how many? |
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11A-013-0
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If sq09a_013 is 1, 2, or 3, go to 11A-013; otherwise, go to 11A-017-0. |
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11A-013
|
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In the last interview in __________ / ____ (month/year), you said that ( ). Has there been any change in the situation? |
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11A-013-1
|
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How did it changed? |
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11A-015-0
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If sq09a_013 is 1 or 2 and the answer to 11A-013-1 is other than 1 and 3, go to 11A-015-1; otherwise, go to 11A-015-3. |
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11A-015-1
|
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If sq09a_013 is 1 or 2 and the answer to 11A-013-1 is other than 1 and 3, go to 11A-015-1; otherwise, go to 11A-015-3. |
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11A-015-2
|
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Is your father certified as requiring any assistance or care under the Long-term Care Insurance Program? If so, for which level of assistance or care is he certified? Please answer to the best of your ability. |
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11A-015-3
|
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If sq09a_013 is 1 or 3 and the answer to 11A-013-1 is other than 2 and 3, go to 11A-015-4; otherwise, go to 11A-016-0. |
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11A-015-4
|
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In the last interview in __________ / ____ (month/year), you ( ). Is she currently in need of any care and, if so, how many hours of care per day? |
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11A-015-5
|
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Is your mother certified as requiring any assistance or care under the Long-term Care Insurance Program? |
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11A-16-0
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If sq09a_013 is 1 or 2, and the answer to 11A-013-1 is other than 1 and 3, and the answer to 11A-015-1 is 1 or 2, go to 11A-016-1; |
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11A-016-1
|
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How involved are you in your mother's or father's care? Please include the time spent on regular visits to an institutionalized parent. |
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11A-016-2
|
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How involved is your spouse in your father's or mother's care? |
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11A-016-4
|
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Besides you and your spouse, who is/are currently involved in the care of your father and/or mother? |
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11A-017-0
|
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If sq09a_003 is 1, sq09a_018_a is 1, 2, or 3, and the answer to 11A-001 is 1, 3, or 4, go to 11A- 017; if the answer to 11A-001 is 2, go to 11A-020; otherwise, go to 11A-021. |
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11A-017
|
|
In the last interview in __________ / ____ (month/year), you ( ). Has there been any change in the situation? |
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11A-017-1
|
|
How has it changed? |
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11A-018-0
|
|
If sq09a_018_a is 1 or 2 and the answer to 11A-017-1 is other than 1 and 3, go to 11A-018; otherwise, go to 11A-019-0. |
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11A-018
|
|
In the last interview in __________ / ____ (month/year), you ( ). Is he currently in need of any care and, if so, how many hours of care per day? |
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11A-018-1
|
|
Is your father-in-law certified as requiring any assistance or care under the Long-term Care Insurance Program? |
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11A-019-0
|
|
If sq09a_018 is 1 or 3 and the answer to 11A-017-1 is other than 2 and 3, go to 11A-019; otherwise, go to 11A-019-1a. |
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11A-019
|
|
In the last interview in __________ / ____ (month/year), you ( ). Is she currently in need of care and, if so, how many hours of care per day? |
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11A-019-1
|
|
Is your mother-in-law certified as requiring any assistance or care under the Long-term Care Insurance Program? |
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11A-019-1a
|
|
If sq09a_018_a =1 or 2, the answer to 11A-017-1 is other than 1 and 3, the answer to 11A-018 is 1 or 2 |
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11A-019-2
|
|
How involved are you in the care of your father-in-law and/or mother-in-law? Please include the time spent on regular visits to an institutionalized parent-in-law. |
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11A-019-3
|
|
How involved is your spouse in the care of his/her father and/or mother? |
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11A-019-4
|
|
Besides you and your spouse, who is/are currently involved in the care of your father-in-law and/or mother? |
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11A-020
|
|
Now, let me ask about your current spouse’s parents. Are they alive? |
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11A-020-1-1
|
|
How old is your spouse's father? Or you may tell me the month and year of his birth. |
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11A-020-1-2
|
|
Is your spouse’s father currently in need of care and, if so, how many hours of care per day? |
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11A-020-1-3
|
|
Is your spouse's father certified as requiring any assistance or care under the Long-term Care Insurance Program? |
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11A-020-2-1
|
|
I would now like to ask about your spouse's mother. How old is she? Or you may tell me the month and year of her birth. |
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11A-020-2-2
|
|
Is your spouse’s mother currently in need of care and, if so, how many hours of care per day? |
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11A-020-2-3
|
|
Is your spouse's mother certified as requiring any assistance or care under the Long-term Care Insurance Program? If so, for which level of assistance or care is she certified? |
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11A-020-3
|
|
How involved are you in the care of your spouse's father and/or mother? |
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11A-020-4
|
|
How involved is your spouse in the care of his/her father and/or mother? |
|
11A-020-5
|
|
Besides you and your spouse, who is/are currently involved in the care of your spouse’s father and/or mother? |
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11A-021
|
|
Who are you living with? Please indicate the number of live-in family members falling under the each of the following (enter “0” if none). |
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11A-021-1
|
|
Based on what you have just told me, you have a total of “N” family members living together in your house (including yourself). Is this correct? |
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11A-021-2
|
|
Is there anyone who has moved in after the last interview in __________ / ____ (month/year)? If yes, please indicate each such person’s relationship to you. |
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11A-021-3
|
|
Is there anyone who was living with you at the time of the last interview in __________ / ____ (month/year) but is no longer living with you? If yes, who is it and why? |
|
11A-022
|
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[Interviewer read-out: This concludes this section. Thank you for your cooperation. |
