A. Coverscreen

Module A. Coverscreen of HRS 2018

item label type description
A006 Question This survey is intended for [R FNAME], [LAST NAME].Are you [R FNAME]?
A007 Question This survey is intended for [R FNAME], [LAST NAME].Are you [R FNAME]?
A002 Question IS THE RESPONDENT OR THE PROXY FOR THE RESPONDENT WILLING AND ABLE TO DO THE INTERVIEW?
A215 Question HAVE YOU RECEIVED APPROVAL FROM YOUR TL AND THE RESPONDENT TO COMPLETE THIS INTERVIEW WITH THE LIVING PROXY?
A010 Question IS CURRENT WAVE PROXY THE SAME PERSON OR SOMEONE ELSE?
A103 Question DESIGNATE THE PROXY REPORTER'S RELATIONSHIP TO [R FNAME]
A105 Question WHAT IS THE PROXY'S NAME?
A219 Question We can only conduct this interview with an adult. Can you confirm that you are age 18 or older?
A012 Question SELECT ENGLISH OR SPANISH
A013 Question Press ‘1’ or ‘5’ as appropriate to confirm that you have read the above statement to the respondent.
A121 Question What was the date on which [RESPONDENT NAME] died?
A122 Question What was the date on which [RESPONDENT NAME] died?
A123 Question What was the date on which [RESPONDENT NAME] died?
A124 Question At the time of death, was [he/she] in a hospital, in a nursing home, at home, in a hospice facility, or what?
A126 Question In what state and county did [he/she] die?
A127 Question In what state and county did [he/she] die?
A129 Question In what state and county was [his/her] death certificate filed?
A130 Question In what state and county was [his/her] death certificate filed?
A131 Question Was the death expected at about the time it occurred, or was it unexpected?
A133 Question What was the major illness that led to [his/her] death?
A134 Question About how long was it between the start of the final illness and the death: was it one or two hours, less than a day, less than a week, less than a month, less than a year, or was it more than a year?
A017 Question Was R’s FIRST NAME 65 years of age or older at the time [he/she] (died/passed away)?
A216 Question Just to confirm, can you please tell me your age?
A217 Question SELECT "1" TO MARK THIS CASE AS INELIGIBLE
A023 Question Was [R's LAST IW SPOUSE’s/PARTNER’s FIRST NAME] still alive at that time?
A202 Question Were you and R's LAST IW SPOUSE's/PARTNER's FIRST NAME [married/partnered] when [he/she] (died/passed away)?
A025 Question YEAR
A237 Question What kind of facility is that?
A247 Question Do you have a private apartment, private room, or a shared room in this facility?
A031 Question In what month and year did [you/they] stop living together?
A032 Question YEAR
A033 Question Is your [husband/wife/ partner] living in a nursing home or other health care facility?
A034 Question Would [he/she] have said [he/she] was married, or separated?
A027 Question Are you living with (a/another) partner as if married?
A209 Question Are you and your new [wife/husband/partner/spouse] living together [in the same (nursing home/healthcare facility]?
A036 Question In what month and year did [RESPONDENT NAME] and [his/her] (new)[husband/wife/partner/spouse]] start living together?
A037 Question In what month and year did you and your new [husband/wife/partner] start living together?
A210 Question In what month and year did [you/they] stop living together?
A211 Question YEAR
A230 Question Is your [husband/wife/partner/spouse] living in a nursing home or other health care facility?
A231 Question Would [he/she] have said [he/she] was [married/partnered], or separated?
A035 Question At the time of [his/her] death, was [he/she] living with a partner as if married?
A227 Question IS YEAR OF BIRTH CORRECT?
A047 Question PLEASE SELECT THE "NEXT" BUTTON TO PROCEED
A050 Question Which of you is the most knowledgeable about this, you or your [husband/wife/partner]?
A053 Question DO YOU NEED TO CHANGE THIS ASSIGNMENT?
A055 Question CHANGE [R FIRST NAME] TO:
A065 Question In what month and year did [RESPONDENT NAME] move to the (nursinghome/health care facility/hospice) where [he/she] was a resident just before [his/her] death?
A067 Question In what city and state is the (nursing home/health care facility/hospice) where you are living?
A070 Question Do you still own or rent a residence outside the facility where you are living?
A078 Question How many years have you lived in [CURRENT RESIDENCE CITY (X025), STATE (X026)]?
A072 Question Is your residence still in or around [HH's LAST IW 1ST RESIDENCE CITY, STATE]?
A073 Question Do you still have the same residence in HH's LAST IW 2ND RESIDENCE CITY, STATE?
A074 Question Do you still have a home in or around HH's LAST IW 2ND RESIDENCE CITY, STATE?
A075 Question In what city and state is your residence currently located?
A079 Question Do you have any other house or apartment?
A080 Question In what city and state is your other residence located?
A083 Question How many years have you lived in or around [HH's CURRENT OTHER RESIDENCE CITY?
A085 Question Which is your main residence, your home in [HH's LAST IW [1ST RESIDENCE/2ND RESIDENCE] CITY, STATE/NEW CURRENT RESIDENCE CITY, STATE] or your home in HH's [LAST IW 2ND RESIDENCE CITY, STATE/NEW OTHER RESIDENCE CITY, STATE]?
A110 Question Now we're ready to move on to the next topic.
A208A Question Do you [or your [husband/wife/partner]] have any [other] living children or step-children?
A221 Question [Let's start with/ Let's talk about] [Child's Name]. Is all the information we have listed below correct?
A225 Question IS [she/he] still alive?
A226 Question Does [Child's name] [still] live with you?
A958A Question What is [CHILDn FIRST NAME]‘s spouse/partner’s first name?
A960A Question What is [CHILDn‘s NEW SPOUSE/PARTNER FIRST NAME]’s sex?
A971A Question Did CHILDn’s NEW SPOUSE/PARTNER FIRST NAME live with [you/ R’s FIRST NAME’s] [husband/wife/partner]?
A956A Question Does CHILDn‘s NEW SPOUSE/PARTNER FIRST NAME live with your [husband/wife/partner]?
A235 Question Does [she/he] live with [you/R FName]?
A212 Question How many living children did [RESPONDENT NAME] and [her/his] [partner/husband/wife] have?
A213 Question At the time [RESPONDENT NAME] died, how many people lived with[her/him] in [her/his] home in [MAIN RESIDENCE CITY], [RESIDENCE STATE]?
A112 Question SELECT CONTINUE TO CONTINUE THIS EXIT ITERVIEW
A136 Question In the two years preceding [his/her] death, did anyone move into the house or apartment where R’s FIRST NAME was living to help [him/her] but then move out before R’s FIRST NAME died?
A137 Question Who moved in: was it (a child of R’s FIRST NAME's,) a grandchild, another relative, or someone else?
A138 Question Which children?
A139 Question Which child stayed the longest?
A140 Question About how many weeks or months did that [child/person] stay?
A141 Question About how many weeks or months did that [child/person] stay?
A142 Question In the two years preceding [his/her] death, did R’s FIRST NAME move into and then out of someone else's house or apartment?
A143 Question With whom did [he/she] move in: was it (a child of R’s FIRST NAME's,) a grandchild, another relative, or someone else?
A144 Question Which children?
A145 Question With which child did [he/she] stay the longest?
A146 Question About how many weeks or months did R’s FIRST NAME stay with that [child/person]?
A147 Question About how many weeks or months did R’s FIRST NAME stay with that [child/person]?
A148 Question In the two years preceding [his/her] death, did [he/she] or any of [his/her] children move in order to be closer to each other but not living in the same house or apartment?
A149 Question Which child was that?
A150 Question Did CHILDn NAME move or did R’s FIRST NAME move?
A151 Question Was the move intended to be temporary or was it thought of as permanent?
A024 Question MONTH
A045 Question THE RESPONDENT WAS DETERMINED NOT TO HAVE A NEW SPOUSE/PARTNER
A071 Question Are you still living, all or part of the year, in that same residence in HH's LAST IW 1ST RESIDENCE CITY?
Start of A. Coverscreen
 
A006

This survey is intended for [R FNAME], [LAST NAME].Are you [R FNAME]?

[INSTR: THIS SURVEY IS INTENDED FOR [R FIRST NAME (X058AFNAME)], [LAST NAME (X017ARLNAME)].][INSTR: ARE YOU INTERVIEWING [R FNAME], OR DOING A PROXY FOR [R FNAME]? [INSTR: IF YOU HAVE THE WRONG R, SUSPEND THIS CASE AND SELECT THE CORRECT LINE.]
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A007

This survey is intended for [R FNAME], [LAST NAME].Are you [R FNAME]?

[INSTR: THIS SURVEY IS INTENDED FOR [R FIRST NAME (X058AFNAME)], [LAST NAME (X017ARLNAME)].][INSTR: ARE YOU INTERVIEWING [R FNAME], OR DOING A PROXY FOR [R FNAME]? [INSTR: IF YOU HAVE THE WRONG R, SUSPEND THIS CASE AND SELECT THE CORRECT LINE.]
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A002

IS THE RESPONDENT OR THE PROXY FOR THE RESPONDENT WILLING AND ABLE TO DO THE INTERVIEW?

[INSTR: IS THE RESPONDENT OR THE PROXY FOR THE RESPONDENT WILLING AND ABLE TO DO THE INTERVIEW?][INSTR: CHOOSING ‘YES’ WILL CONTINUE THIS INTERVIEW.]
[INSTR: IS THE PROXY FOR THE RESPONDENT WILLING AND ABLE TO DO THE INTERVIEW?][INSTR: CHOOSING ‘YES’ WILL CONTINUE THIS INTERVIEW.]
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A215

HAVE YOU RECEIVED APPROVAL FROM YOUR TL AND THE RESPONDENT TO COMPLETE THIS INTERVIEW WITH THE LIVING PROXY?

HAVE YOU RECEIVED APPROVAL FROM YOUR TL AND THE RESPONDENT TO COMPLETE THIS INTERVIEW WITH THE LIVING PROXY?
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A010

IS CURRENT WAVE PROXY THE SAME PERSON OR SOMEONE Else?

IS CURRENT WAVE PROXY THE SAME PERSON OR SOMEONE ELSE?
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A103

DESIGNATE THE PROXY REPORTER'S RELATIONSHIP TO [R FNAME]

DESIGNATE THE PROXY REPORTER'S RELATIONSHIP TO [R FNAME]
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A105

WHAT IS THE PROXY'S NAME?

WHAT IS THE PROXY'S NAME?
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A219

We can only conduct this interview with an adult. Can you confirm that you are age 18 or older?

WE CAN ONLY CONDUCT THIS INTERVIEW WITH AN ADULT. CAN YOU CONFIRM THAT YOU ARE AGE 18 OR OLDER?
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A012

SELECT ENGLISH OR SPANISH

SELECT ENGLISH OR SPANISH
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A013

Press ‘1’ or ‘5’ as appropriate to confirm that you have read the above statement to the respondent.

PRESS ‘1’ OR ‘5’ AS APPROPRIATE TO CONFIRM THAT YOU HAVE READ THE ABOVE STATEMENT TO THE RESPONDENT.
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A121

What was the date on which [RESPONDENT NAME] died?

MONTH [DROP DOWN]
 
A122

What was the date on which [RESPONDENT NAME] died?

DAY
 
A123

What was the date on which [RESPONDENT NAME] died?

YEAR
 
A124

At the time of death, was [he/she] in a hospital, in a nursing home, at home, in a hospice facility, or what?

AT THE TIME OF DEATH, WAS [HE/SHE] IN A HOSPITAL, IN A NURSING HOME, AT HOME, IN A HOSPICE FACILITY, OR WHAT?
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A126

In what state and county did [he/she] die?

IN WHAT STATE AND COUNTY DID [HE/SHE] DIE?
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A127

In what state and county did [he/she] die?

IN WHAT STATE AND COUNTY DID [HE/SHE] DIE?
 
If In what state and county was [his/her] death certificate filed? was answered Don't know or RF »
 
   
 
A131

Was the death expected at about the time it occurred, or was it unexpected?

WAS THE DEATH EXPECTED AT ABOUT THE TIME IT OCCURRED, OR WAS IT UNEXPECTED?
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A130

In what state and county was [his/her] death certificate filed?

IN WHAT STATE AND COUNTY WAS [HIS/HER] DEATH CERTIFICATE FILED?
 
A133

What was the major illness that led to [his/her] death?

WHAT WAS THE MAJOR ILLNESS THAT LED TO [HIS/HER] DEATH?
 
A134

About how long was it between the start of the final illness and the death: was it one or two hours, less than a day, less than a week, less than a month, less than a year, or was it more than a year?

ABOUT HOW LONG WAS IT BETWEEN THE START OF THE FINAL ILLNESS AND THE DEATH: WAS IT ONE OR TWO HOURS, LESS THAN A DAY, LESS THAN A WEEK, LESS THAN A MONTH, LESS THAN A YEAR, OR WAS IT MORE THAN A YEAR?
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A017

Was R’s FIRST NAME 65 years of age or older at the time [he/she] (died/passed away)?

WAS R’S FIRST NAME 65 YEARS OF AGE OR OLDER AT THE TIME [HE/SHE] (DIED/PASSED AWAY)?
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A216

Just to confirm, can you please tell me your age?

JUST TO CONFIRM, CAN YOU PLEASE TELL ME YOUR AGE?
 
A217

SELECT "1" TO MARK THIS CASE AS INELIGIBLE

SELECT "1" TO MARK THIS CASE AS INELIGIBLE
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A023

Was [R's LAST IW SPOUSE’s/PARTNER’s FIRST NAME] still alive at that time?

WAS [R'S LAST IW SPOUSE’S/PARTNER’S FIRST NAME] STILL ALIVE AT THAT TIME?
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If Was [R's LAST IW SPOUSE’s/PARTNER’s FIRST NAME] still alive at that time? = 1. YES……………...GO TO A024  »
 
   
 
A024

MONTH

MONTH
   
A202

Were you and R's LAST IW SPOUSE's/PARTNER's FIRST NAME [married/partnered] when [he/she] (died/passed away)?

WERE YOU AND R'S LAST IW SPOUSE'S/PARTNER'S FIRST NAME [MARRIED/PARTNERED] WHEN [HE/SHE] (DIED/PASSED AWAY)?
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A024

MONTH

MONTH
 
A025

YEAR

YEAR
 
A237

What kind of facility is that?

WHAT KIND OF FACILITY IS THAT?
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A247

Do you have a private apartment, private room, or a shared room in this facility?

DO YOU HAVE A PRIVATE APARTMENT, PRIVATE ROOM, OR A SHARED ROOM IN THIS FACILITY?
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A031

In what month and year did [you/they] stop living together?

IN WHAT MONTH AND YEAR DID [YOU/THEY] STOP LIVING TOGETHER?
 
If In what month and year did [you/they] stop living together? = 97 »
 
   
 
A033

Is your [husband/wife/ partner] living in a nursing home or other health care facility?

IS YOUR [HUSBAND/WIFE/ PARTNER] LIVING IN A NURSING HOME OR OTHER HEALTH CARE FACILITY?
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A032

YEAR

YEAR
 
A033

Is your [husband/wife/ partner] living in a nursing home or other health care facility?

IS YOUR [HUSBAND/WIFE/ PARTNER] LIVING IN A NURSING HOME OR OTHER HEALTH CARE FACILITY?
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A034

Would [he/she] have said [he/she] was married, or separated?

WOULD [HE/SHE] HAVE SAID [HE/SHE] WAS MARRIED, OR SEPARATED?
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A027

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

ARE YOU LIVING WITH (A/ANOTHER) PARTNER AS IF MARRIED?
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A209

Are you and your new [wife/husband/partner/spouse] living together [in the same (nursing home/healthcare facility]?

ARE YOU AND YOUR NEW [WIFE/HUSBAND/PARTNER/SPOUSE] LIVING TOGETHER [IN THE SAME (NURSING HOME/HEALTHCARE FACILITY]?
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If Are you and your new [wife/husband/partner/spouse] living together [in the same (nursing home/healthcare facility]? = 5. NO »
 
   
 
A210

In what month and year did [you/they] stop living together?

IN WHAT MONTH AND YEAR DID [YOU/THEY] STOP LIVING TOGETHER?
   
A036

In what month and year did [RESPONDENT NAME] and [his/her] (new)[husband/wife/partner/spouse]] start living together?

IN WHAT MONTH AND YEAR DID [RESPONDENT NAME] AND [HIS/HER] (NEW)[HUSBAND/WIFE/PARTNER/SPOUSE]] START LIVING TOGETHER?
 
A037

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?
 
A045

THE RESPONDENT WAS DETERMINED NOT TO HAVE A NEW SPOUSE/PARTNER

THE RESPONDENT WAS DETERMINED NOT TO HAVE A NEW SPOUSE/PARTNER
 
A210

In what month and year did [you/they] stop living together?

IN WHAT MONTH AND YEAR DID [YOU/THEY] STOP LIVING TOGETHER?
 
If In what month and year did [you/they] stop living together? = 97 »
 
   
 
A230

Is your [husband/wife/partner/spouse] living in a nursing home or other health care facility?

IS YOUR [HUSBAND/WIFE/PARTNER/SPOUSE] LIVING IN A NURSING HOME OR OTHER HEALTH CARE FACILITY?
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A211

YEAR

YEAR
 
A230

Is your [husband/wife/partner/spouse] living in a nursing home or other health care facility?

IS YOUR [HUSBAND/WIFE/PARTNER/SPOUSE] LIVING IN A NURSING HOME OR OTHER HEALTH CARE FACILITY?
expand
 
A231

Would [he/she] have said [he/she] was [married/partnered], or separated?

WOULD [HE/SHE] HAVE SAID [HE/SHE] WAS [MARRIED/PARTNERED], OR SEPARATED?
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A035

At the time of [his/her] death, was [he/she] living with a partner as if married?

AT THE TIME OF [HIS/HER] DEATH, WAS [HE/SHE] LIVING WITH A PARTNER AS IF MARRIED?
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A227

IS YEAR OF BIRTH CORRECT?

IS YEAR OF BIRTH CORRECT?
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A047

PLEASE SELECT THE "NEXT" BUTTON TO PROCEED

PLEASE SELECT THE "NEXT" BUTTON TO PROCEED
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A050

Which of you is the most knowledgeable about this, you or your [husband/wife/partner]?

WHICH OF YOU IS THE MOST KNOWLEDGEABLE ABOUT THIS, YOU OR YOUR [HUSBAND/WIFE/PARTNER]?
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A053

DO YOU NEED TO CHANGE THIS ASSIGNMENT?

DO YOU NEED TO CHANGE THIS ASSIGNMENT?
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A055

CHANGE [R FIRST NAME] TO:

CHANGE [R FIRST NAME] TO:
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A065

In what month and year did [RESPONDENT NAME] move to the (nursinghome/health care facility/hospice) where [he/she] was a resident just before [his/her] death?

IN WHAT MONTH AND YEAR DID [RESPONDENT NAME] MOVE TO THE (NURSINGHOME/HEALTH CARE FACILITY/HOSPICE) WHERE [HE/SHE] WAS A RESIDENT JUST BEFORE [HIS/HER] DEATH?
 
A067

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

IN WHAT CITY AND STATE IS THE (NURSING HOME/HEALTH CARE FACILITY/HOSPICE) WHERE YOU ARE LIVING?
 
A070

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

DO YOU STILL OWN OR RENT A RESIDENCE OUTSIDE THE FACILITY WHERE YOU ARE LIVING?
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If Are you still living, all or part of the year, in that same residence in HH's LAST IW 1ST RESIDENCE CITY? = 5. NO……………...GO TO A072 »
 
   
 
A072

Is your residence still in or around [HH's LAST IW 1ST RESIDENCE CITY, STATE]?

IS YOUR RESIDENCE STILL IN OR AROUND [HH'S LAST IW 1ST RESIDENCE CITY, STATE]?
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A078

How many years have you lived in [CURRENT RESIDENCE CITY (X025), STATE (X026)]?

HOW MANY YEARS HAVE YOU LIVED IN [CURRENT RESIDENCE CITY (X025), STATE (X026)]?
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A072

Is your residence still in or around [HH's LAST IW 1ST RESIDENCE CITY, STATE]?

IS YOUR RESIDENCE STILL IN OR AROUND [HH'S LAST IW 1ST RESIDENCE CITY, STATE]?
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A073

Do you still have the same residence in HH's LAST IW 2ND RESIDENCE CITY, STATE?

DO YOU STILL HAVE THE SAME RESIDENCE IN HH'S LAST IW 2ND RESIDENCE CITY, STATE?
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A074

Do you still have a home in or around HH's LAST IW 2ND RESIDENCE CITY, STATE?

DO YOU STILL HAVE A HOME IN OR AROUND HH'S LAST IW 2ND RESIDENCE CITY, STATE?
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A075

In what city and state is your residence currently located?

IN WHAT CITY AND STATE IS YOUR RESIDENCE CURRENTLY LOCATED?
 
A079

Do you have any other house or apartment?

DO YOU HAVE ANY OTHER HOUSE OR APARTMENT?
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A080

In what city and state is your other residence located?

IN WHAT CITY AND STATE IS YOUR OTHER RESIDENCE LOCATED?
 
A083

How many years have you lived in or around [HH's CURRENT OTHER RESIDENCE CITY?

HOW MANY YEARS HAVE YOU LIVED IN OR AROUND [HH'S CURRENT OTHER RESIDENCE CITY?
 
A085

Which is your main residence, your home in [HH's LAST IW [1ST RESIDENCE/2ND RESIDENCE] CITY, STATE/NEW CURRENT RESIDENCE CITY, STATE] or your home in HH's [LAST IW 2ND RESIDENCE CITY, STATE/NEW OTHER RESIDENCE CITY, STATE]?

WHICH IS YOUR MAIN RESIDENCE, YOUR HOME IN [HH'S LAST IW [1ST RESIDENCE/2ND RESIDENCE] CITY, STATE/NEW CURRENT RESIDENCE CITY, STATE] OR YOUR HOME IN HH'S [LAST IW 2ND RESIDENCE CITY, STATE/NEW OTHER RESIDENCE CITY, STATE]?
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A100
 
A208A

Do you [or your [husband/wife/partner]] have any [other] living children or step-children?

DO YOU [OR YOUR [HUSBAND/WIFE/PARTNER]] HAVE ANY [OTHER] LIVING CHILDREN OR STEP-CHILDREN?
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A221

[Let's start with/ Let's talk about] [Child's Name]. Is all the information we have listed below correct?

[LET'S START WITH/ LET'S TALK ABOUT] [CHILD'S NAME]. IS ALL THE INFORMATION WE HAVE LISTED BELOW CORRECT?
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A225

IS [she/he] still alive?

IS [SHE/HE] STILL ALIVE?
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A226

Does [Child's name] [still] live with you?

DOES [CHILD'S NAME] [STILL] LIVE WITH YOU?
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A958A

What is [CHILDn FIRST NAME]‘s spouse/partner’s first name?

WHAT IS [CHILDN FIRST NAME]‘S SPOUSE/PARTNER’S FIRST NAME?
 
A960A

What is [CHILDn‘s NEW SPOUSE/PARTNER FIRST NAME]’s sex?

WHAT IS [CHILDN‘S NEW SPOUSE/PARTNER FIRST NAME]’S SEX?
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A971A

Did CHILDn’s NEW SPOUSE/PARTNER FIRST NAME live with [you/ R’s FIRST NAME’s] [husband/wife/partner]?

DID CHILDN’S NEW SPOUSE/PARTNER FIRST NAME LIVE WITH [YOU/ R’S FIRST NAME’S] [HUSBAND/WIFE/PARTNER]?
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A956A

Does CHILDn‘s NEW SPOUSE/PARTNER FIRST NAME live with your [husband/wife/partner]?

DOES CHILDN‘S NEW SPOUSE/PARTNER FIRST NAME LIVE WITH YOUR [HUSBAND/WIFE/PARTNER]?
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A208A

Do you [or your [husband/wife/partner]] have any [other] living children or step-children?

DO YOU [OR YOUR [HUSBAND/WIFE/PARTNER]] HAVE ANY [OTHER] LIVING CHILDREN OR STEP-CHILDREN?
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A212

How many living children did [RESPONDENT NAME] and [her/his] [partner/husband/wife] have?

HOW MANY LIVING CHILDREN DID [RESPONDENT NAME] AND [HER/HIS] [PARTNER/HUSBAND/WIFE] HAVE?
 
A213

At the time [RESPONDENT NAME] died, how many people lived with[her/him] in [her/his] home in [MAIN RESIDENCE CITY], [RESIDENCE STATE]?

AT THE TIME [RESPONDENT NAME] DIED, HOW MANY PEOPLE LIVED WITH[HER/HIM] IN [HER/HIS] HOME IN [MAIN RESIDENCE CITY], [RESIDENCE STATE]?
 
A112

SELECT CONTINUE TO CONTINUE THIS EXIT ITERVIEW

SELECT CONTINUE TO CONTINUE THIS EXIT ITERVIEW
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A136

In the two years preceding [his/her] death, did anyone move into the house or apartment where R’s FIRST NAME was living to help [him/her] but then move out before R’s FIRST NAME died?

IN THE TWO YEARS PRECEDING [HIS/HER] DEATH, DID ANYONE MOVE INTO THE HOUSE OR APARTMENT WHERE R’S FIRST NAME WAS LIVING TO HELP [HIM/HER] BUT THEN MOVE OUT BEFORE R’S FIRST NAME DIED?
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If In the two years preceding [his/her] death, did anyone move into the house or apartment where R’s FIRST NAME was living to help [him/her] but then move out before R’s FIRST NAME died? = 5. NO »
 
   
 
A142

In the two years preceding [his/her] death, did R’s FIRST NAME move into and then out of someone else's house or apartment?

IN THE TWO YEARS PRECEDING [HIS/HER] DEATH, DID R’S FIRST NAME MOVE INTO AND THEN OUT OF SOMEONE ELSE'S HOUSE OR APARTMENT?
expand
   
A137

Who moved in: was it (a child of R’s FIRST NAME's,) a grandchild, another relative, or someone else?

WHO MOVED IN: WAS IT (A CHILD OF R’S FIRST NAME'S,) A GRANDCHILD, ANOTHER RELATIVE, OR SOMEONE ELSE?
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A138

Which children?

WHICH CHILDREN?
 
A139

Which child stayed the longest?

WHICH CHILD STAYED THE LONGEST?
 
A140

About how many weeks or months did that [child/person] stay?

ABOUT HOW MANY WEEKS OR MONTHS DID THAT [CHILD/PERSON] STAY?
 
A141

About how many weeks or months did that [child/person] stay?

ABOUT HOW MANY WEEKS OR MONTHS DID THAT [CHILD/PERSON] STAY?
(PLEASE TELL ME THE LONGEST STAY IF THERE WAS MORE THAN ONE PERSON WHO STAYED WITH R’S FIRST NAME.)([INSTR: ENTER NUMBER OF WEEKS OR MONTHS])
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A142

In the two years preceding [his/her] death, did R’s FIRST NAME move into and then out of someone else's house or apartment?

IN THE TWO YEARS PRECEDING [HIS/HER] DEATH, DID R’S FIRST NAME MOVE INTO AND THEN OUT OF SOMEONE ELSE'S HOUSE OR APARTMENT?
expand
 
A143

With whom did [he/she] move in: was it (a child of R’s FIRST NAME's,) a grandchild, another relative, or someone else?

WITH WHOM DID [HE/SHE] MOVE IN: WAS IT (A CHILD OF R’S FIRST NAME'S,) A GRANDCHILD, ANOTHER RELATIVE, OR SOMEONE ELSE?
expand
 
A144

Which children?

WHICH CHILDREN?
 
A145

With which child did [he/she] stay the longest?

WITH WHICH CHILD DID [HE/SHE] STAY THE LONGEST?
 
A146

About how many weeks or months did R’s FIRST NAME stay with that [child/person]?

ABOUT HOW MANY WEEKS OR MONTHS DID R’S FIRST NAME STAY WITH THAT [CHILD/PERSON]?
 
A147

About how many weeks or months did R’s FIRST NAME stay with that [child/person]?

(ABOUT HOW MANY WEEKS OR MONTHS DID R’S FIRST NAME STAY WITH THAT [CHILD/PERSON]?)(PLEASE TELL ME THE LONGEST STAY IF THERE WAS MORE THAN ONE PERSON R’S FIRST NAME STAYED WITH.)([INSTR: ENTER NUMBER OF WEEKS OR MONTHS])
expand
 
A148

In the two years preceding [his/her] death, did [he/she] or any of [his/her] children move in order to be closer to each other but not living in the same house or apartment?

IN THE TWO YEARS PRECEDING [HIS/HER] DEATH, DID [HE/SHE] OR ANY OF [HIS/HER] CHILDREN MOVE IN ORDER TO BE CLOSER TO EACH OTHER BUT NOT LIVING IN THE SAME HOUSE OR APARTMENT?
expand
 
A149

Which child was that?

WHICH CHILD WAS THAT?
 
A150

Did CHILDn NAME move or did R’s FIRST NAME move?

DID CHILDN NAME MOVE OR DID R’S FIRST NAME MOVE?
expand
 
A151

Was the move intended to be temporary or was it thought of as permanent?

WAS THE MOVE INTENDED TO BE TEMPORARY OR WAS IT THOUGHT OF AS PERMANENT?
expand
 
End of A. Coverscreen
Start of A. Coverscreen

========================================================================
A006
This survey is intended for [R FNAME], [LAST NAME].Are you [R FNAME]?

[INSTR: THIS SURVEY IS INTENDED FOR [R FIRST NAME (X058AFNAME)], [LAST NAME (X017ARLNAME)].][INSTR: ARE YOU INTERVIEWING [R FNAME], OR DOING A PROXY FOR [R FNAME]? [INSTR: IF YOU HAVE THE WRONG R, SUSPEND THIS CASE AND SELECT THE CORRECT LINE.]
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES………………GO TO A007 BRANCHPOINT
5. NO

========================================================================
A007
This survey is intended for [R FNAME], [LAST NAME].Are you [R FNAME]?

[INSTR: THIS SURVEY IS INTENDED FOR [R FIRST NAME (X058AFNAME)], [LAST NAME (X017ARLNAME)].][INSTR: ARE YOU INTERVIEWING [R FNAME], OR DOING A PROXY FOR [R FNAME]? [INSTR: IF YOU HAVE THE WRONG R, SUSPEND THIS CASE AND SELECT THE CORRECT LINE.]
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES………………GO TO A007 BRANCHPOINT
5. NO

========================================================================
A002
IS THE RESPONDENT OR THE PROXY FOR THE RESPONDENT WILLING AND ABLE TO DO THE INTERVIEW?

[INSTR: IS THE RESPONDENT OR THE PROXY FOR THE RESPONDENT WILLING AND ABLE TO DO THE INTERVIEW?][INSTR: CHOOSING ‘YES’ WILL CONTINUE THIS INTERVIEW.]
[INSTR: IS THE PROXY FOR THE RESPONDENT WILLING AND ABLE TO DO THE INTERVIEW?][INSTR: CHOOSING ‘YES’ WILL CONTINUE THIS INTERVIEW.]
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES

========================================================================
A215
HAVE YOU RECEIVED APPROVAL FROM YOUR TL AND THE RESPONDENT TO COMPLETE THIS INTERVIEW WITH THE LIVING PROXY?

HAVE YOU RECEIVED APPROVAL FROM YOUR TL AND THE RESPONDENT TO COMPLETE THIS INTERVIEW WITH THE LIVING PROXY?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

========================================================================
A010
IS CURRENT WAVE PROXY THE SAME PERSON OR SOMEONE Else?

IS CURRENT WAVE PROXY THE SAME PERSON OR SOMEONE ELSE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. SAME PERSON AS IN PRIOR WAVE
2. DIFFERENT/NEW PERSON
3. NOT KNOWN

========================================================================
A103
DESIGNATE THE PROXY REPORTER'S RELATIONSHIP TO [R FNAME]

DESIGNATE THE PROXY REPORTER'S RELATIONSHIP TO [R FNAME]
- - - - - - - - - - - - - - - - - - - - - - - - -
2. SPOUSE/PARTNER
3. SON
4. STEPSON OR SON OF PARTNER
5. SPOUSE/PARTNER OF DAUGHTER
6. DAUGHTER
7. STEPDAUGHTER OR DAUGHTER OF PARTNER
8. SPOUSE/PARTNER OF SON
9. GRANDCHILD OF R OR SP/P
15. BROTHER
17. SISTER
19. OTHER RELATIVE
20. OTHER INDIVIDUAL
23. PAID HELPER
24. PROFESSIONAL
33. SP/P OF GRANDCHILD
98. DK [HIDE] [HIDE]
99. RF [HIDE]

========================================================================
A105
WHAT IS THE PROXY'S NAME?

WHAT IS THE PROXY'S NAME?
- - - - - - - - - - - - - - - - - - - - - - - - -
DK [HIDE]
RF [HIDE]

========================================================================
A219
We can only conduct this interview with an adult. Can you confirm that you are age 18 or older?

WE CAN ONLY CONDUCT THIS INTERVIEW WITH AN ADULT. CAN YOU CONFIRM THAT YOU ARE AGE 18 OR OLDER?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES, PROXY IS 18 OR OLDER
5. NO, PROXY IS UNDER 18

========================================================================
A012
SELECT ENGLISH OR SPANISH

SELECT ENGLISH OR SPANISH
- - - - - - - - - - - - - - - - - - - - - - - - -
1. ENGLISH
2. SPANISH

========================================================================
A013
Press ‘1’ or ‘5’ as appropriate to confirm that you have read the above statement to the respondent.

PRESS ‘1’ OR ‘5’ AS APPROPRIATE TO CONFIRM THAT YOU HAVE READ THE ABOVE STATEMENT TO THE RESPONDENT.
- - - - - - - - - - - - - - - - - - - - - - - - -
1. CONTINUE
5. CONTINUE WITHOUT RECORDING

========================================================================
========================================================================
========================================================================
========================================================================
A124
At the time of death, was [he/she] in a hospital, in a nursing home, at home, in a hospice facility, or what?

AT THE TIME OF DEATH, WAS [HE/SHE] IN A HOSPITAL, IN A NURSING HOME, AT HOME, IN A HOSPICE FACILITY, OR WHAT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. IN HOSPITAL
2. IN NURSING HOME
3. AT HOME
4. IN HOSPICE FACILITY
7. OTHER (SPECIFY) A125S_________________

========================================================================
A126
In what state and county did [he/she] die?

IN WHAT STATE AND COUNTY DID [HE/SHE] DIE?
- - - - - - - - - - - - - - - - - - - - - - - - -
97. OTHER COUNTRY A128____________________

========================================================================
A127
In what state and county did [he/she] die?

IN WHAT STATE AND COUNTY DID [HE/SHE] DIE?

If In what state and county was [his/her] death certificate filed? (A129) was answered Don't know or RF »

|  ========================================================================
A131
Was the death expected at about the time it occurred, or was it unexpected?

WAS THE DEATH EXPECTED AT ABOUT THE TIME IT OCCURRED, OR WAS IT UNEXPECTED?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. EXPECTED
2. UNEXPECT
7. OTHER (SPECIFY) A132_____________

========================================================================
A130
In what state and county was [his/her] death certificate filed?

IN WHAT STATE AND COUNTY WAS [HIS/HER] DEATH CERTIFICATE FILED?

========================================================================
A133
What was the major illness that led to [his/her] death?

WHAT WAS THE MAJOR ILLNESS THAT LED TO [HIS/HER] DEATH?

========================================================================
A134
About how long was it between the start of the final illness and the death: was it one or two hours, less than a day, less than a week, less than a month, less than a year, or was it more than a year?

ABOUT HOW LONG WAS IT BETWEEN THE START OF THE FINAL ILLNESS AND THE DEATH: WAS IT ONE OR TWO HOURS, LESS THAN A DAY, LESS THAN A WEEK, LESS THAN A MONTH, LESS THAN A YEAR, OR WAS IT MORE THAN A YEAR?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. ONE OR TWO HOURS (OR NO WARNING)
2. LESS THAN A DAY
3. LESS THAN A WEEK
4. LESS THAN A MONTH
5. LESS THAN A YEAR
6. MORE THAN A YEAR

========================================================================
A017
Was R’s FIRST NAME 65 years of age or older at the time [he/she] (died/passed away)?

WAS R’S FIRST NAME 65 YEARS OF AGE OR OLDER AT THE TIME [HE/SHE] (DIED/PASSED AWAY)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. AGE OR BIRTHYEAR REPORTED
2. YES, 65 OR OVER
3. NO, UNDER 65
4. IWER ESTIMATE: AGE 65 OR OVER
5. IWER ESTIMATE: AGE UNDER 65

========================================================================
A216
Just to confirm, can you please tell me your age?

JUST TO CONFIRM, CAN YOU PLEASE TELL ME YOUR AGE?

========================================================================
A217
SELECT "1" TO MARK THIS CASE AS INELIGIBLE

SELECT "1" TO MARK THIS CASE AS INELIGIBLE
- - - - - - - - - - - - - - - - - - - - - - - - -
1. UNDERAGED R - CASE INELIGIBLE………………GO TO END OF IW

========================================================================
A023
Was [R's LAST IW SPOUSE’s/PARTNER’s FIRST NAME] still alive at that time?

WAS [R'S LAST IW SPOUSE’S/PARTNER’S FIRST NAME] STILL ALIVE AT THAT TIME?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES……………...GO TO A024
5. NO

If Was [R's LAST IW SPOUSE’s/PARTNER’s FIRST NAME] still alive at that time? (A023) = 1. YES……………...GO TO A024  »

|  ========================================================================
A024
MONTH

MONTH

========================================================================
A202
Were you and R's LAST IW SPOUSE's/PARTNER's FIRST NAME [married/partnered] when [he/she] (died/passed away)?

WERE YOU AND R'S LAST IW SPOUSE'S/PARTNER'S FIRST NAME [MARRIED/PARTNERED] WHEN [HE/SHE] (DIED/PASSED AWAY)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

========================================================================
A024
MONTH

MONTH

========================================================================
A025
YEAR

YEAR

========================================================================
A237
What kind of facility is that?

WHAT KIND OF FACILITY IS THAT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Nursing home or skilled-nursing facility
2. Memory care center
3. Assisted living facility
4. Rehabilitation center
5. Retirement community
6. Senior living facility
7. Rest home
8. Hospital
9. Hospice
10. Other (Specify): [A238_TypeFacilityOS]

========================================================================
A247
Do you have a private apartment, private room, or a shared room in this facility?

DO YOU HAVE A PRIVATE APARTMENT, PRIVATE ROOM, OR A SHARED ROOM IN THIS FACILITY?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. PRIVATE APARTMENT
2. PRIVATE ROOM
3. SHARED ROOM
7. OTHER

========================================================================
A031
In what month and year did [you/they] stop living together?

IN WHAT MONTH AND YEAR DID [YOU/THEY] STOP LIVING TOGETHER?

If In what month and year did [you/they] stop living together? (A031) = 97 »

|  ========================================================================
A033
Is your [husband/wife/ partner] living in a nursing home or other health care facility?

IS YOUR [HUSBAND/WIFE/ PARTNER] LIVING IN A NURSING HOME OR OTHER HEALTH CARE FACILITY?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

========================================================================
A032
YEAR

YEAR

========================================================================
A033
Is your [husband/wife/ partner] living in a nursing home or other health care facility?

IS YOUR [HUSBAND/WIFE/ PARTNER] LIVING IN A NURSING HOME OR OTHER HEALTH CARE FACILITY?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

========================================================================
A034
Would [he/she] have said [he/she] was married, or separated?

WOULD [HE/SHE] HAVE SAID [HE/SHE] WAS MARRIED, OR SEPARATED?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. MARRIED……………...GO TO X004 BRANCHPOINT
2. SEPARATED……………...GO TO A027


========================================================================
A027
Are you living with (a/another) partner as if married?

ARE YOU LIVING WITH (A/ANOTHER) PARTNER AS IF MARRIED?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO


========================================================================
A209
Are you and your new [wife/husband/partner/spouse] living together [in the same (nursing home/healthcare facility]?

ARE YOU AND YOUR NEW [WIFE/HUSBAND/PARTNER/SPOUSE] LIVING TOGETHER [IN THE SAME (NURSING HOME/HEALTHCARE FACILITY]?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO


If Are you and your new [wife/husband/partner/spouse] living together [in the same (nursing home/healthcare facility]? (A209) = 5. NO »

|  ========================================================================
A210
In what month and year did [you/they] stop living together?

IN WHAT MONTH AND YEAR DID [YOU/THEY] STOP LIVING TOGETHER?

========================================================================
A036
In what month and year did [RESPONDENT NAME] and [his/her] (new)[husband/wife/partner/spouse]] start living together?

IN WHAT MONTH AND YEAR DID [RESPONDENT NAME] AND [HIS/HER] (NEW)[HUSBAND/WIFE/PARTNER/SPOUSE]] START LIVING TOGETHER?

========================================================================
A037
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?

========================================================================
A045
THE RESPONDENT WAS DETERMINED NOT TO HAVE A NEW SPOUSE/PARTNER

THE RESPONDENT WAS DETERMINED NOT TO HAVE A NEW SPOUSE/PARTNER

========================================================================
A210
In what month and year did [you/they] stop living together?

IN WHAT MONTH AND YEAR DID [YOU/THEY] STOP LIVING TOGETHER?

If In what month and year did [you/they] stop living together? (A210) = 97 »

|  ========================================================================
A230
Is your [husband/wife/partner/spouse] living in a nursing home or other health care facility?

IS YOUR [HUSBAND/WIFE/PARTNER/SPOUSE] LIVING IN A NURSING HOME OR OTHER HEALTH CARE FACILITY?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
2. NO

========================================================================
A211
YEAR

YEAR

========================================================================
A230
Is your [husband/wife/partner/spouse] living in a nursing home or other health care facility?

IS YOUR [HUSBAND/WIFE/PARTNER/SPOUSE] LIVING IN A NURSING HOME OR OTHER HEALTH CARE FACILITY?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
2. NO

========================================================================
A231
Would [he/she] have said [he/she] was [married/partnered], or separated?

WOULD [HE/SHE] HAVE SAID [HE/SHE] WAS [MARRIED/PARTNERED], OR SEPARATED?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. [Married/Partnered]……………...GO TO X004 BRANCHPOINT
2. Separated

========================================================================
A035
At the time of [his/her] death, was [he/she] living with a partner as if married?

AT THE TIME OF [HIS/HER] DEATH, WAS [HE/SHE] LIVING WITH A PARTNER AS IF MARRIED?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

========================================================================
A227
IS YEAR OF BIRTH CORRECT?

IS YEAR OF BIRTH CORRECT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

========================================================================
A047
PLEASE SELECT THE "NEXT" BUTTON TO PROCEED

PLEASE SELECT THE "NEXT" BUTTON TO PROCEED
- - - - - - - - - - - - - - - - - - - - - - - - -
1. CONTINUE

========================================================================
A050
Which of you is the most knowledgeable about this, you or your [husband/wife/partner]?

WHICH OF YOU IS THE MOST KNOWLEDGEABLE ABOUT THIS, YOU OR YOUR [HUSBAND/WIFE/PARTNER]?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. RESPONDENT
2. SPOUSE/PARTNER
3. DK [HIDE]/REF: RESPONDENT IS MALE
4. DK [HIDE]/REF: SPOUSE/PARTNER IS MALE
5. DK [HIDE]/REF: SAME SEX COUPLE, RESPONDENT
6. RESPONDENT BOTH FINANCIAL AND FAMILY
7. RESPONDENT NOT FINANCIAL OR FAMILY

========================================================================
A053
DO YOU NEED TO CHANGE THIS ASSIGNMENT?

DO YOU NEED TO CHANGE THIS ASSIGNMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. CHANGE ASSIGNMENTS
5. LEAVE ASSIGNMENT AS STATED……………...GO TO A065 BRANCHPOINT

========================================================================
A055
CHANGE [R FIRST NAME] TO:

CHANGE [R FIRST NAME] TO:
- - - - - - - - - - - - - - - - - - - - - - - - -
1. FINANCIAL R
2. FAMILY R
3. FINANCIAL & FAMILY R
4. NON-FINANCIAL & NON-FAMILY R

========================================================================
A065
In what month and year did [RESPONDENT NAME] move to the (nursinghome/health care facility/hospice) where [he/she] was a resident just before [his/her] death?

IN WHAT MONTH AND YEAR DID [RESPONDENT NAME] MOVE TO THE (NURSINGHOME/HEALTH CARE FACILITY/HOSPICE) WHERE [HE/SHE] WAS A RESIDENT JUST BEFORE [HIS/HER] DEATH?

========================================================================
A067
In what city and state is the (nursing home/health care facility/hospice) where you are living?

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

========================================================================
A070
Do you still own or rent a residence outside the facility where you are living?

DO YOU STILL OWN OR RENT A RESIDENCE OUTSIDE THE FACILITY WHERE YOU ARE LIVING?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

If Are you still living, all or part of the year, in that same residence in HH's LAST IW 1ST RESIDENCE CITY? (A071) = 5. NO……………...GO TO A072 »

|  ========================================================================
A072
Is your residence still in or around [HH's LAST IW 1ST RESIDENCE CITY, STATE]?

IS YOUR RESIDENCE STILL IN OR AROUND [HH'S LAST IW 1ST RESIDENCE CITY, STATE]?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

========================================================================
A078
How many years have you lived in [CURRENT RESIDENCE CITY (X025), STATE (X026)]?

HOW MANY YEARS HAVE YOU LIVED IN [CURRENT RESIDENCE CITY (X025), STATE (X026)]?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. One year or less
95. All my life

========================================================================
A072
Is your residence still in or around [HH's LAST IW 1ST RESIDENCE CITY, STATE]?

IS YOUR RESIDENCE STILL IN OR AROUND [HH'S LAST IW 1ST RESIDENCE CITY, STATE]?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

========================================================================
A073
Do you still have the same residence in HH's LAST IW 2ND RESIDENCE CITY, STATE?

DO YOU STILL HAVE THE SAME RESIDENCE IN HH'S LAST IW 2ND RESIDENCE CITY, STATE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

========================================================================
A074
Do you still have a home in or around HH's LAST IW 2ND RESIDENCE CITY, STATE?

DO YOU STILL HAVE A HOME IN OR AROUND HH'S LAST IW 2ND RESIDENCE CITY, STATE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

========================================================================
A075
In what city and state is your residence currently located?

IN WHAT CITY AND STATE IS YOUR RESIDENCE CURRENTLY LOCATED?

========================================================================
A079
Do you have any other house or apartment?

DO YOU HAVE ANY OTHER HOUSE OR APARTMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

========================================================================
A080
In what city and state is your other residence located?

IN WHAT CITY AND STATE IS YOUR OTHER RESIDENCE LOCATED?

========================================================================
A083
How many years have you lived in or around [HH's CURRENT OTHER RESIDENCE CITY?

HOW MANY YEARS HAVE YOU LIVED IN OR AROUND [HH'S CURRENT OTHER RESIDENCE CITY?

========================================================================
A085
Which is your main residence, your home in [HH's LAST IW [1ST RESIDENCE/2ND RESIDENCE] CITY, STATE/NEW CURRENT RESIDENCE CITY, STATE] or your home in HH's [LAST IW 2ND RESIDENCE CITY, STATE/NEW OTHER RESIDENCE CITY, STATE]?

WHICH IS YOUR MAIN RESIDENCE, YOUR HOME IN [HH'S LAST IW [1ST RESIDENCE/2ND RESIDENCE] CITY, STATE/NEW CURRENT RESIDENCE CITY, STATE] OR YOUR HOME IN HH'S [LAST IW 2ND RESIDENCE CITY, STATE/NEW OTHER RESIDENCE CITY, STATE]?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. HOME IN [LAST IW 1ST RESIDENCE CITY (X026)]
2. HOME IN [NEW CURRENT RESIDENCE CITY, STATE (A075)/First home mentioned]
3. HOME IN [LAST IW 2ND RESIDENCE CITY (X029)]
4. HOME IN [NEW OTHER RESIDENCE CITY, STATE (A080)/Other home mentioned]

========================================================================
A100
A100

========================================================================
A208A
Do you [or your [husband/wife/partner]] have any [other] living children or step-children?

DO YOU [OR YOUR [HUSBAND/WIFE/PARTNER]] HAVE ANY [OTHER] LIVING CHILDREN OR STEP-CHILDREN?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

========================================================================
A221
[Let's start with/ Let's talk about] [Child's Name]. Is all the information we have listed below correct?

[LET'S START WITH/ LET'S TALK ABOUT] [CHILD'S NAME]. IS ALL THE INFORMATION WE HAVE LISTED BELOW CORRECT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

========================================================================
A225
IS [she/he] still alive?

IS [SHE/HE] STILL ALIVE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. ALIVE
4. DECEASED

========================================================================
A226
Does [Child's name] [still] live with you?

DOES [CHILD'S NAME] [STILL] LIVE WITH YOU?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES ……………...GO TO X072 BRANCHPOINT
2. YES, BUT [HE/SHE] IS TEMPORARILY AWAY AND DOES NOT HAVE ANY OTHER PERMANENT ADDRESS (E.G., IN SCHOOL, TRAVELLING) ……………...GO TO X072 BRANCHPOINT
5. NO ……………...GO TO X072 BRANCHPOINT
6. NO, [I HAVE/R HAS] NO CONTACT WITH THIS PERSON ……………...

========================================================================
A958A
What is [CHILDn FIRST NAME]‘s spouse/partner’s first name?

WHAT IS [CHILDN FIRST NAME]‘S SPOUSE/PARTNER’S FIRST NAME?

========================================================================
A960A
What is [CHILDn‘s NEW SPOUSE/PARTNER FIRST NAME]’s sex?

WHAT IS [CHILDN‘S NEW SPOUSE/PARTNER FIRST NAME]’S SEX?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. MALE
2. FEMALE

========================================================================
A971A
Did CHILDn’s NEW SPOUSE/PARTNER FIRST NAME live with [you/ R’s FIRST NAME’s] [husband/wife/partner]?

DID CHILDN’S NEW SPOUSE/PARTNER FIRST NAME LIVE WITH [YOU/ R’S FIRST NAME’S] [HUSBAND/WIFE/PARTNER]?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES ……………...GO TO X058 CHILD LOOP PART TWO
2. YES, BUT [HE/SHE] IS TEMPORARILY AWAY AND DOES NOT HAVE ANY OTHER PERMANENT ADDRESS (E.G., IN SCHOOL, TRAVELLING) ……………...GO TO END OF X058 CHILD LOOP PART TWO
5. NO ……………...GO TO END OF X058 CHILD LOOP PART TWO
6. NO, [I HAVE/R HAS] NO CONTACT WITH [HIM/HER]

========================================================================
A956A
Does CHILDn‘s NEW SPOUSE/PARTNER FIRST NAME live with your [husband/wife/partner]?

DOES CHILDN‘S NEW SPOUSE/PARTNER FIRST NAME LIVE WITH YOUR [HUSBAND/WIFE/PARTNER]?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. RESIDENT
2. AWAY/INST: THE PERSON IS TEMPORARILY AWAY (IN SCHOOL, JAIL, REHAB, ETC.) AND DOES NOT HAVE ANY OTHER PERMANENT ADDRESS
3. AWAY/OTHER: THE PERSON IS TEMPORARILY AWAY (FOR ANOTHER REASON, SUCH AS TRAVELLING) AND DOES NOT HAVE ANY OTHER PERMANENT ADDRESS
4. DIED
5. NONRESIDENT
6. HAVE NO CONTACT
7. DELETE
8. DUPLICATE

========================================================================
A208A
Do you [or your [husband/wife/partner]] have any [other] living children or step-children?

DO YOU [OR YOUR [HUSBAND/WIFE/PARTNER]] HAVE ANY [OTHER] LIVING CHILDREN OR STEP-CHILDREN?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

========================================================================
A212
How many living children did [RESPONDENT NAME] and [her/his] [partner/husband/wife] have?

HOW MANY LIVING CHILDREN DID [RESPONDENT NAME] AND [HER/HIS] [PARTNER/HUSBAND/WIFE] HAVE?

========================================================================
A213
At the time [RESPONDENT NAME] died, how many people lived with[her/him] in [her/his] home in [MAIN RESIDENCE CITY], [RESIDENCE STATE]?

AT THE TIME [RESPONDENT NAME] DIED, HOW MANY PEOPLE LIVED WITH[HER/HIM] IN [HER/HIS] HOME IN [MAIN RESIDENCE CITY], [RESIDENCE STATE]?

========================================================================
A112
SELECT CONTINUE TO CONTINUE THIS EXIT ITERVIEW

SELECT CONTINUE TO CONTINUE THIS EXIT ITERVIEW
- - - - - - - - - - - - - - - - - - - - - - - - -
1. CONTINUE

========================================================================
A136
In the two years preceding [his/her] death, did anyone move into the house or apartment where R’s FIRST NAME was living to help [him/her] but then move out before R’s FIRST NAME died?

IN THE TWO YEARS PRECEDING [HIS/HER] DEATH, DID ANYONE MOVE INTO THE HOUSE OR APARTMENT WHERE R’S FIRST NAME WAS LIVING TO HELP [HIM/HER] BUT THEN MOVE OUT BEFORE R’S FIRST NAME DIED?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

If In the two years preceding [his/her] death, did anyone move into the house or apartment where R’s FIRST NAME was living to help [him/her] but then move out before R’s FIRST NAME died? (A136) = 5. NO »

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A142
In the two years preceding [his/her] death, did R’s FIRST NAME move into and then out of someone else's house or apartment?

IN THE TWO YEARS PRECEDING [HIS/HER] DEATH, DID R’S FIRST NAME MOVE INTO AND THEN OUT OF SOMEONE ELSE'S HOUSE OR APARTMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

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A137
Who moved in: was it (a child of R’s FIRST NAME's,) a grandchild, another relative, or someone else?

WHO MOVED IN: WAS IT (A CHILD OF R’S FIRST NAME'S,) A GRANDCHILD, ANOTHER RELATIVE, OR SOMEONE ELSE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. PARENT
2. CHILD
4. GRANDCHILD
5. RELATIVE-OTHER
6. OTHER INDIVIDUAL

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A138
Which children?

WHICH CHILDREN?

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A139
Which child stayed the longest?

WHICH CHILD STAYED THE LONGEST?

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A140
About how many weeks or months did that [child/person] stay?

ABOUT HOW MANY WEEKS OR MONTHS DID THAT [CHILD/PERSON] STAY?

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A141
About how many weeks or months did that [child/person] stay?

ABOUT HOW MANY WEEKS OR MONTHS DID THAT [CHILD/PERSON] STAY?
(PLEASE TELL ME THE LONGEST STAY IF THERE WAS MORE THAN ONE PERSON WHO STAYED WITH R’S FIRST NAME.)([INSTR: ENTER NUMBER OF WEEKS OR MONTHS])
- - - - - - - - - - - - - - - - - - - - - - - - -
2. WEEKS
4. MONTHS

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A142
In the two years preceding [his/her] death, did R’s FIRST NAME move into and then out of someone else's house or apartment?

IN THE TWO YEARS PRECEDING [HIS/HER] DEATH, DID R’S FIRST NAME MOVE INTO AND THEN OUT OF SOMEONE ELSE'S HOUSE OR APARTMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

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A143
With whom did [he/she] move in: was it (a child of R’s FIRST NAME's,) a grandchild, another relative, or someone else?

WITH WHOM DID [HE/SHE] MOVE IN: WAS IT (A CHILD OF R’S FIRST NAME'S,) A GRANDCHILD, ANOTHER RELATIVE, OR SOMEONE ELSE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. PARENT
2. CHILD
4. GRANDCHILD
5. RELATIVE-OTHER
6. OTHER INDIVIDUAL

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A144
Which children?

WHICH CHILDREN?

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A145
With which child did [he/she] stay the longest?

WITH WHICH CHILD DID [HE/SHE] STAY THE LONGEST?

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A146
About how many weeks or months did R’s FIRST NAME stay with that [child/person]?

ABOUT HOW MANY WEEKS OR MONTHS DID R’S FIRST NAME STAY WITH THAT [CHILD/PERSON]?

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A147
About how many weeks or months did R’s FIRST NAME stay with that [child/person]?

(ABOUT HOW MANY WEEKS OR MONTHS DID R’S FIRST NAME STAY WITH THAT [CHILD/PERSON]?)(PLEASE TELL ME THE LONGEST STAY IF THERE WAS MORE THAN ONE PERSON R’S FIRST NAME STAYED WITH.)([INSTR: ENTER NUMBER OF WEEKS OR MONTHS])
- - - - - - - - - - - - - - - - - - - - - - - - -
2. WEEKS
4. MONTHS

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A148
In the two years preceding [his/her] death, did [he/she] or any of [his/her] children move in order to be closer to each other but not living in the same house or apartment?

IN THE TWO YEARS PRECEDING [HIS/HER] DEATH, DID [HE/SHE] OR ANY OF [HIS/HER] CHILDREN MOVE IN ORDER TO BE CLOSER TO EACH OTHER BUT NOT LIVING IN THE SAME HOUSE OR APARTMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. YES
5. NO

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A149
Which child was that?

WHICH CHILD WAS THAT?

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A150
Did CHILDn NAME move or did R’s FIRST NAME move?

DID CHILDN NAME MOVE OR DID R’S FIRST NAME MOVE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. CHILD MOVED
2. R MOVED
4. BOTH

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A151
Was the move intended to be temporary or was it thought of as permanent?

WAS THE MOVE INTENDED TO BE TEMPORARY OR WAS IT THOUGHT OF AS PERMANENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. PERMANENT MOVE
5. TEMPORARY MOVE

End of A. Coverscreen