A. Coverscreen

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Module A. Coverscreen of HRS 2018

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

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Start of A. Coverscreen

A006 This survey is intended for [R FNAME], [LAST NAME].Are you [R FNAME]? view item details » [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]? view item details » [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? view item details » [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? view item details » 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? view item details » 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] view item details » 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? view item details » 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? view item details » 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 view item details » 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. view item details » PRESS ‘1’ OR ‘5’ AS APPROPRIATE TO CONFIRM THAT YOU HAVE READ THE ABOVE STATEMENT TO THE RESPONDENT. 1. CONTINUE 5. CONTINUE WITHOUT RECORDING

A121 What was the date on which [RESPONDENT NAME] died? view item details » MONTH [DROP DOWN]

A122 What was the date on which [RESPONDENT NAME] died? view item details » DAY

A123 What was the date on which [RESPONDENT NAME] died? view item details » 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? view item details » 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? view item details » IN WHAT STATE AND COUNTY DID [HE/SHE] DIE? 97. OTHER COUNTRY A128____________________

A127 In what state and county did [he/she] die? view item details » IN WHAT STATE AND COUNTY DID [HE/SHE] DIE?

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

	A131 Was the death expected at about the time it occurred, or was it unexpected? view item details » 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? view item details » IN WHAT STATE AND COUNTY WAS [HIS/HER] DEATH CERTIFICATE FILED?

A133 What was the major illness that led to [his/her] death? view item details » 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? view item details » 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)? view item details » 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? view item details » JUST TO CONFIRM, CAN YOU PLEASE TELL ME YOUR AGE?

A217 SELECT "1" TO MARK THIS CASE AS INELIGIBLE view item details » 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? view item details » 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? view item details » = 1. YES……………...GO TO A024 »

	A024 MONTH view item details » MONTH

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

A025 YEAR view item details » YEAR

A237 What kind of facility is that? view item details » 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? view item details » 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? view item details » IN WHAT MONTH AND YEAR DID [YOU/THEY] STOP LIVING TOGETHER?

If In what month and year did [you/they] stop living together? view item details » = 97 »

	A033 Is your [husband/wife/ partner] living in a nursing home or other health care facility? view item details » IS YOUR [HUSBAND/WIFE/ PARTNER] LIVING IN A NURSING HOME OR OTHER HEALTH CARE FACILITY? 1. YES 5. NO

A032 YEAR view item details » YEAR

A033 Is your [husband/wife/ partner] living in a nursing home or other health care facility? view item details » 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? view item details » 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? view item details » 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]? view item details » 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]? view item details » = 5. NO »

	A210 In what month and year did [you/they] stop living together? view item details » 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? view item details » 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? view item details » 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 view item details » THE RESPONDENT WAS DETERMINED NOT TO HAVE A NEW SPOUSE/PARTNER

A210 In what month and year did [you/they] stop living together? view item details » IN WHAT MONTH AND YEAR DID [YOU/THEY] STOP LIVING TOGETHER?

If In what month and year did [you/they] stop living together? view item details » = 97 »

	A230 Is your [husband/wife/partner/spouse] living in a nursing home or other health care facility? view item details » IS YOUR [HUSBAND/WIFE/PARTNER/SPOUSE] LIVING IN A NURSING HOME OR OTHER HEALTH CARE FACILITY? 1. YES 2. NO

A211 YEAR view item details » YEAR

A230 Is your [husband/wife/partner/spouse] living in a nursing home or other health care facility? view item details » 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? view item details » 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? view item details » 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? view item details » IS YEAR OF BIRTH CORRECT? 1. YES 5. NO

A047 PLEASE SELECT THE "NEXT" BUTTON TO PROCEED view item details » 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]? view item details » 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? view item details » 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: view item details » 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? view item details » 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? view item details » 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? view item details » 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? view item details » = 5. NO……………...GO TO A072 »

	A072 Is your residence still in or around [HH's LAST IW 1ST RESIDENCE CITY, STATE]? view item details » 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)]? view item details » 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]? view item details » 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? view item details » 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? view item details » 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? view item details » IN WHAT CITY AND STATE IS YOUR RESIDENCE CURRENTLY LOCATED?

A079 Do you have any other house or apartment? view item details » DO YOU HAVE ANY OTHER HOUSE OR APARTMENT? 1. YES 5. NO

A080 In what city and state is your other residence located? view item details » 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? view item details » 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]? view item details » 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

A208A Do you [or your [husband/wife/partner]] have any [other] living children or step-children? view item details » 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? view item details » [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? view item details » IS [SHE/HE] STILL ALIVE? 1. ALIVE 4. DECEASED

A226 Does [Child's name] [still] live with you? view item details » 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? view item details » WHAT IS [CHILDN FIRST NAME]‘S SPOUSE/PARTNER’S FIRST NAME?

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

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

A138 Which children? view item details » WHICH CHILDREN?

A139 Which child stayed the longest? view item details » WHICH CHILD STAYED THE LONGEST?

A140 About how many weeks or months did that [child/person] stay? view item details » ABOUT HOW MANY WEEKS OR MONTHS DID THAT [CHILD/PERSON] STAY?

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

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? view item details » 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

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? view item details » 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

A144 Which children? view item details » WHICH CHILDREN?

A145 With which child did [he/she] stay the longest? view item details » 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]? view item details » 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]? view item details » (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

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? view item details » 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

A149 Which child was that? view item details » WHICH CHILD WAS THAT?

A150 Did CHILDn NAME move or did R’s FIRST NAME move? view item details » DID CHILDN NAME MOVE OR DID R’S FIRST NAME MOVE? 1. CHILD MOVED 2. R MOVED 4. BOTH

A151 Was the move intended to be temporary or was it thought of as permanent? view item details » WAS THE MOVE INTENDED TO BE TEMPORARY OR WAS IT THOUGHT OF AS PERMANENT? 1. PERMANENT MOVE 5. TEMPORARY MOVE

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

========================================================================

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

========================================================================

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?
- - - - - - - - - - - - - - - - - - - - - - - - -
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

========================================================================

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

========================================================================

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

========================================================================

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

========================================================================

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 ……………...

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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?

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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

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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]?
- - - - - - - - - - - - - - - - - - - - - - - - -
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]

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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]?
- - - - - - - - - - - - - - - - - - - - - - - - -
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

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A208A

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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?

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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]?

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A112

SELECT CONTINUE TO CONTINUE THIS EXIT ITERVIEW

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

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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?
- - - - - - - - - - - - - - - - - - - - - - - - -
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

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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

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