1987 questions relevant to data included in this report

❑

Old age

❑

Hisp

A. HOUSEHOLD COMPOSITION PAGE

Ia. What ara tha namas of all persons living or staying here? Start with the name of the person or ona of tha persons who owns or rents this home. Enter name in^REFERENCE ^PERSON column.

b. What ara the names of all othar parsons living or staying hers?Enter names in columns.

c. I hava Iistad (readnamas/. Have I missed

- any bebias or small childran? . . . . - any lodgers, boarders, or parsons you amploy who live hers? . . . .

— anyona who USUALLY Iivas hare but is now away from homa

traveling or in a hospital? . . . . - ●nyone alas staying here? . . . .

If “Ye4 namesii

Yes

❑

•1 enter

olumm

❑

d. Do all of the persons you have named usually live hare?

❑

Yes(2) Probe if necessary:

❑

NO (APPLY HOUSEHOLD MEMBERSHIP RULES. Delete nonhouseho/d mambere Dy an “X” from 1 —C2 and enter reason.) Doss —— usually Iiva somawhare elsa?

Ask forallpersons beginning with column 2:

2. What is -- relationship to(raference person)?

3. What is –– date of birth? (Enter date andageand mark sex.)

4. Would you say —— haakh in ganseal is excallent, very good, good, fair, orpoor?

I ¹

1.

^{First name}

Last name

l~12nvfl)120r.lo 1~

I

1 ❑

Excellent 4D Fair

❑

Very good 50 Poor 3

❑

GoDd

L. DEMOGRAPHIC BACKGROUND PAGE

LI ~efer toage.

1a. Did –– EVER serve on active duty in the Armed Forces of the United States?

. —— — —— ——— ——— ————— —— ——— ———.

b. When did –– serve?

[

Vietnam Era (Aug. ’64 to April ’75) . . . . VN Korean War (June ‘50to Jan. ’55) . . . . . . . . KW Mark box in descending order of priorit y. World War II (Sept. ’40 to July ’47) . . . WWII Thus, ifperson served inVietnam and in Korea World Warl (April’ 17to Nov. ’18) . . . . .WWI

mark VN. Post Vietnam (May ’75 to present) . . . PVN

Other Service (all other periods) . . . . . .OS

—— ——— ——— ——— ——— —————— ——— ——— —

d. W~8ALi if :–––a~t~~ duty sar~c= ~era{ed to N~t~~ayGuard or military raserva training?

2a. What is tha highast grade or yaar of ragular school –– has aver attanded?

I

——— —— ————

b. Did “–-–-%ithat(~uibFi~2a)2a) [gr~d~ljaarl?–

— ———-— ——- ———

11

la.

——

–

c–.

❑

Under5(f./P)

❑

5-17 (2)

❑

Ie and over (1/

❑ Yes

❑

No (2)

——— —— ——— — —— —.

lDVN 5

❑

PVN

2DKW 800s

❑

Wwll 9nDK

❑

Wwl

——— —————— ——-.—-—

❑

Yes zDNo (2) 7DDK(2)

——

t

————- ——— ——— ——— —

Inyes 30N0 9CIDK

1 2a. 00

❑

Never attended or

kindergarten fNP)

I

^Elem: ^12345678 ^I

\ High: 9 10 11 12 I

1

^———^College:^—-— ¹^--—² ³ ^———⁴ ⁵ ^{6 +}

—---K.

lnYes 2

❑

No +

Hand Card R. Aak first alternative for first person; ask second alternative for othar persons.

3a. What is tha numbar of tha group or groups which reprasants –– rata?

[Whatis --race?

1

^3a.

Circ/e all that apply

1 –

Aleut, Eskimo, or Americsn Indian 2 – Asian or Pacific Islander

4 – White

5 – Another group not listed – Specify 3 – Black

——

A~k~f-m~l~p~ &i7ri%s~ – - – – – – – – – – – – – – –

-_—— — — —— ——— — ——— —— ——— —

b. Which of thosa groups; that is,(entries in 3a)would you say BEST reprasants –— rata?

——— __— ——— ———

——-c. M~r~ ~bse~v~d_ra-ce-o? r~s>c%~e~t?sio~l~. – – - – – – – – – – – – – – –

Hand Card O.

4a. Are any of thoaa groups –– national origin or ancastry? lWhare did –– ancestors coma from?)

— —— — — -. — —— —— __— ——— ———

——-b. Plaase giva me tha numbar of the group.

Circle allthat app/y.

1 –

Puerto Rican 5 – Chicano

2 – Cuban 6 – Other Latin American

3 – Mexican/Mexicano 7 – Other Spanish

4 – Mexican American

3RM HIS 1 [19871 (5 30.86) Page 42

12345

——

t

——- ——— —————- ———

b.lz. 345

1

^(Specify)

—— ——— ——— ——— —-— — ——

10W 20s 300

4a.

——

❑

Yes (Mark ‘Wisp” box, THEN 4LI 2

❑

No (NP)

———— ———— ———— ———

1234667

II

L. ucmuumnrnlb m-knunuuruu rnu~, vormr . . . .

On Under 18 (NP)

,2 Refer to “Age” and “Wa/Wb” boxes in Cl. ^{I H} Wa box marked (6a)

‘2 R :R’XR%(,b,

m.Earlier you seid that -- has a job or business but did not work last week or the week befora.

Was –- looking for work or on layoff from a job during those 2 weaks?

5a.

❑

Yes (5c) 2

❑

NO(6b)

.-— — ———_ ____ ____ ____ ____ ____ ____ __

J.Earlier you said that —- d;dn’t have a job or business last week or the week before.

Was –– looking for work or on layoff from a job during those 2 waeks?

‘b:

---1II Yes 2

❑

No (NP)

—-—— ———— ____ ____ ____ ____ ____ ____ __ ____ ____

:.Which, iooking fo; wo;k-o; c%ia~t%f from a job?

—-—— ---c.

1 ❑

Looking (6c/ 3

❑

Both (6b)

❑

Layoff (6b) B. Ear~er you said that -— worked Iaet Waek or the week before. Ask 6b.

——- -—— ——- ___ ___ ___ ___ _

I. For who-m d~d-—-—-wo;k~~n;a; n–a;e–o? c–o;p–a;y~b;s;n;ss, organization, or other amployar. i%. E;p~y;r- ‘– --- ‘~ ~E~ ~6~

. ..- --—— —-—- ____ ____ ____ ____ ____ ____ ____ ____ ___ and

:. For whom did –– work at –– lestfull-time job or business Issting 2 consecutive weeks or more? c.

❑

AF f6e) Enter nama of company, business, organization, or other employer, or mark “NEV” or “AF” box in person’s column.

---- ---- -— -- ____ ____ ____ ____ ____ ____ ____ ____ _

1.What kind of business or industry is this?For examp/e, TV and radio manufacturing,

—--— —- ——. . ____ ____ ____ ___

Industry ratail shoe store, State Labor Department, farm.

---- --—- ____ ____ ____ ____ ____ ____ ____ ____ ___

If “AF” in6b/c,mark “AF” box in person’s column without

asking,

—--— ——-. ----__ _

e,

Occupation

1.Whet kind of work wes —— doing? For example, electrical engineer, stock clerk, typist, farmer.

❑

AF (NP)

—--- ———- ____ ____ ____ ____ ____ ____ ____ __ -——— —___ ____ ___

f .-~-hit ‘w&& z L ‘m~s—t

‘kp

ortant act ivities or duties at that job? For example, types, – ~. Duties keeps account books, files, sells cars, operates printing press, finishes concrete.

——— ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ __

Com-p&; ;o-m-e;tr~e; i; ~b––?. ;f ;ot clear, ask:

—-. ——— ___ ___ ___

c lass of worker

~.Was

--An employee of●PRIVATE company,business or

!J.

Salf-amployed in OWN busimcs, professional ^10P ⁵⁰¹

individual for wagas, salary, or commission . . . P practice, or farm? 20 F 6DSE

A FEOERAL govemrrrarrt omploytm? . . . F Ask: Isthe business Incorporated?

ASTATEgovernment employee? . . . ..S Yes . . . . I

30 s 7nwP

A LOCAL gotmrnment employee? . . . L No . . . , . . . ..SE 4D L 8DNEV Working WITHOUT PAY in family busjne~

or farm? . . . ..WP - NEVER WORKED or never worked●t 8

full-rim-joblastImg 2weoksormom . . . ..NEV

)TNOTES

1 [1987) (5 30.861 Page 44

L.DEMOGRAPHIC BACKGROUND PAGE, Continued

Mark box (f under 14. If “Married” refer to household composition and mark accordingly.

?. IS –– now married, widowed, divorced, separated, or has –– never been married?

3a. Was the total combined FAM 1LY income during the past 12 months – that is, yours,(read names, inck!.dlog Armed Forces members /ivina at home)more or lessthan $20,000? Include money from jobs, social security, retirementincome, unemployment payments, public assistance,and so forth. Also include income from interest,dividends, net income from business, farm, or rent, and any other money income received.

Read if necessary.’Income is important in analyzing the health information we collect. For example, this information helps us to learn whether persone in one income group uae certain types of medical care services or have certain conditions more or less often than those in another group.

—- — — — — — — — — — — — — — ——,—

-Read parenthetical phrase !f Armed Forces member living at home or if necessary.

b. Of those income groups, which letter best represents the total combined FAMILY income during the past 12 months (that is, yours, (read names, inc/uding Armed Forces members /iving at home))? Include wages, salaries, and other items we just talked about.

Read if necessary: Income is important in analyzing the health information we collact. For example, thk information helps us to learn whether persons in one income group use certain types of medical care services or have certain conditions more or less often than those in another group.

a.Mark firat appropriate box.

R _________________________________________________

b.Enter person number of respondent.

L3 I Enter person number of first parent listed or mark box.

L4 Enter person number of spouse or mark box

‘OOTNOTES

—

la,

— {a

— 13

— 14

—

❑

Under 14

❑

Married – spouse m H}+

❑

Married – spouse not m HH 3

❑

W!dowed

❑

Divorced 5

❑

Separated 6

❑

Never married

❑

$ Z0,000 or more (HandCard1) 2

❑

Less than $20,000 (HandCardJ)

—————

00DA IODK

0109 IIDL

020C 12DM

03DD 13DN

04DE 1400

05DF 15a P

06n G 16DCJ

07DH 17DR

oeOl 180s

09DJ 19DT

—

20UU 21UV 22DW 23UX 24DY 25UZ 26

❑

.—

❑

Under 17

❑

Present for all questions 2

❑

Present for some questions 3

❑

Not present

— —

Person number(s) of respondent(s)

Person number of parent

❑

None m household

Person number of spouse

❑

None m household

)RM HIS-1(1987) (530 86) Page 46

CARD R

1. Aleut, Eskimo, or American Indian

2. Asian or Pacific Islander

3. Black

4. White

1,...,. ,,, !:,,,

CARD I

u ....$20.000 – $24,999

v .... $25.000 – $29,999

w ... *30*000 – *34,999

x ....$35.000 – $39,999

Y ....$40.000 – *44,999

z ....$45.000 – $49,999

ZZ... +50,000 and over

CARD O

1. Puerto Rican

2. Cuban

3. Mexican/M exicano C.,.“

c.,. o

4. Mexican American

5. Chicano

6. Other Latin American

7. Other Spanish

r-.-s. !,. .,.

CARD J

A . . . . ... Lass thm $1,000 Including loss)

a ... $1,000 – *1,999 c . . . .. . . $2,000- $2,999

D . . . .. .. $3,000- $3,999

E . . . .. .. $4,000- $4,999

F . . . .. .. *5,000 - $5,999

G $6,000 – $6,996 c.#d,

. . . . ... c.,dJ

H . . .. .. $7,000- $7,999

I . . . .. .. . $8,000 – $8,999

J . . .. .. . $9,000 – $9,999

K . . .. .. . $10,000 – $10,999

L . . . .. ... $11,000 – $11,999

M . .. .. . $12,000 – $12,999

N . .. .. . . $13,000 – $13,999

0 . .. .. . . $14,000-$14,999

P . .. . ... $15,000-$15,999

a . .. .. .. $16,000 – $16,999

Take advantage of the Documents produces a

In document Vitaland HealthStatistics (Page 64-69)