Questionnaire

question

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SPDy 1 59

The next few questions are about fringe benefits. During 1997, did this employer offer a pension or other type of retirement plan to ANY of its employees?   

Yes|No

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SPDy 1 24   

Were you given any indication that you would be recalled to work within 6 months of being laid off? 

Yes|No

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SPDy 1 29a

What is the name of the employer or company for which you worked the most weeks, the second most weeks, the third most weeks, and the fourth most weeks in 1997?

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Spdy 1 35

At this job, were you employed by government, by a private company, a non-profit organization, or were you self employed, or working in a family business or farm?  

Government|Private for profit company|Non-profit organization including tax exempt and charitable|Self employed|Working in family business or farm

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H&F 1 11f

What kinds of migratory birds did you hunt in State?

Geese|Duck|Dove|Other, e.g., Coot, Rail, Gallinule, Woodcock, Band-tailed Pigeon, etc.|ALASKA|Geese|Duck|Other, e.g., Crane, Black Brant, Snipe, etc.|HAWAII|Mourning Dove|Other          CONTINENTAL U.S. ONLY

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H&F 1 5

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

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

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Adcore4 2 211

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

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Adcore4 1 110

How often do you do LIGHT OR MODERATE activities for AT LEAST 10 MINUTES that cause ONLY LIGHT sweating or a SLIGHT to MODERATE increase in breathing or heart rate?         

NUMBER OF TIMES|Never|Unable to do this|Refused|Don't know|TIME PERIOD|Day|Week|Month|Year|Unable to do this type activity|Refused|Don't know

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Adcore4 2 30

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

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

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Adcore4 1 170

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

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Adcore4 2 35

Is that the same place you USUALLY go when you need routine or preventive care, such as a physical examination or check up?    Yes|No|Refused|Don't know

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ChildPrev 3 190

During the past 12 months when practicing Karate or Judo, how often did {child's name}

(a) wear a mouth guard to protect {his/her} mouth and teeth - all or most of the time, some of the time, once in awhile, or never?

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NHI 1 10

What are the names of all persons living or staying here? Start with the name of the person, or one of the persons, who owns or rents this home. What is the name of the next person living or staying here?    

FIRST NAME|MIDDLE NAME|LAST NAME

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NHI 1 90

Do members of any other household on the property live and eat with members of this household?   

Yes|No|Refused|Don't know

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NHI 1 260

What is {PX-name's/your} relationship to {RP-name}?        

Spouse (husband/wife)|Unmarried partner|Child (biological/adoptive/in-law/ step/foster)|Child of partner|Grandchild|Parent (biological/ adoptive/in-law/ step/ foster)|Brother/sister (biological/adoptive/in-law/step/ foster)|Grandparent (grandmother/father)|Aunt/uncle|Niece/nephew|Other relative|Housemate/Roommate|Roomer/Boarder|Other nonrelative|Legal guardian|Ward|Refused|Don't know

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NHI 1 50

I have listed living here NAMES. 

Yes|No|Refused|Don't know

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NHI 1 70

Do the people who do not live and eat here have direct access from the outside or through a common hallway to a separate living quarters?      

Yes|No|Refused|Don't know

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Census2 1 29

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

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Census2 1 17

Because of a physical, mental, or emotional condition lasting 6 months or more, does this person have any difficulty in doing any of the following activities?    

Learning, remembering, or concentrating|Dressing, bathing, or getting around inside the home|Answer if this person is 16 YEARS OLD OR OVER. Going outside the home|alone to shop or visit a doctor's office?|Answer if this person is 16 YEARS OLD OR OVER. Working at a job or|business?

Yes|No

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Census2 1 13

Is this person a CITIZEN of the United States?         

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

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Census2 1 28b

What were this person's most important activities or duties, for example, patient care, directing hiring policies, supervising order clerks, repairing automobiles, reconciling financial records?

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Census2 1 20a

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

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Census2 1 25c

Has this person been informed that he or she will be recalled to work within the next 6 months OR been given a date to return to work?      

Yes|No

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NoncUQ 1 1a

From (Date of last interview) to December 31, did you take one or more trips or outings in the United States, of at least one mile, for the PRIMARY purpose of observing, photographing, or feeding wildlife? Do not include trips to zoos, circuses, aquariums, museums, or trips for scouting, hunting, or fishing. 

Yes|No

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NoncUQ 1 16a

From (Date of last interview) to December 31, did you visit any public parks or publicly-owned natural areas within a one-mile radius of your home, for the purpose of observing, photographing, or feeding wildlife?      

Yes|No          1

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NoncUQ 1 12a

From last interview to December 31, did you take SPECIAL INTEREST in wildlife around your home, other than simply noticing wildlife while doing other activities? By this I mean, did you closely observe wildlife or try to identify types of wildlife you did not know? 

Yes|No

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Adcore 4 1 80

during the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?    

 

Yes|No|Refused|Don't know

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Adcore4 1 20

How old were you when you FIRST started to smoke fairly regularly?    

 

years of age|Never smoked regularly|Refused|Don't know

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Adcore4 1 90

How often do you do vigorous activities for at least 10 minutes that cause heavy sweating or large increases in breathing or heart rate?   

NUMBER OF TIMES|Never|Unable to do this type activity|Refused|Don't know|TIME,PERIOD|Day|Week|Month|Year|Unable to do this Activity|Refused|Don't know

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Census 2 1 6

What is this person's race?        

White|Black, African Am., or Negro|American Indian or Alaska Native, print name of enrolled or principal tribe.|Asia