That's all the survey questions I have, but now I need to get some information to help us contact you in the future. And again, this information, like your responses to all questions in the interview, is confidential.
I have your home address as [street address line 1] [street address line 2] [city] [state] [zip code]. Is that correct?
R's current street address line 1.
R's current street address line 2.
Apartment where R currently lives.
City where R currently lives.
State where R currently lives.
R's zip code.
Foreign State/Prov where R currently lives.
Foreign Postal Code where R currently lives.
County where R currently lives.
Country where R currently lives.
Is your mailing address the same as your home address?
Enter line 1 of the street address of R's mailing address.
Enter the city of R's mailing address.
Enter the state of R's mailing address.
Enter the zip code of R's mailing address.
Enter the county of R's mailing address.
Enter the country of R's mailing address.
([phone number]= " -4")COMMENT: R's phone number is missing from DLI
We have your home telephone number as [phone number]. Is this correct?
Is there a telephone at your house?
Enter the country code of R's telephone number.
Enter the area code of R's telephone number.
Enter the phone exchange of R's telephone number.
Enter the phone suffix of R's telephone number.
Is this telephone number listed in your name?(INTERVIEWER: IF TELEPHONE LISTED IN MOTHER'S, FATHER'S, OR SPOUSE'S NAME AND R RESIDES IN SAME HOUSEHOLD THEN SELECT YES)
Enter first name of the person in whose name the telephone number is listed.
Enter middle name of the person in whose name the telephone number is listed.
Enter last name of the person in whose name the telephone number is listed.
Enter line 1 of the street address of the person in whose name the telephone number is listed.
Enter the city where the person in whose name the telephone number is listed lives.
Enter the state where the person in whose name the telephone number is listed lives.
Enter the zip code where the person in whose name the telephone number is listed lives.
Enter the county where the person in whose name the telephone number is listed lives.
Enter the country where the person in whose name the telephone number is listed lives.
Is there another telephone number at your home?
Enter the country code of the other telephone number.
Enter the area code of the other telephone number.
Enter the exchange of the other telephone number.
Enter the suffix of the other telephone number.
Enter the first name of the person in whose name the other telephone number is listed.
Enter the middle name of the person in whose name the other telephone number is listed.
Enter the last name of the person in whose name the other telephone number is listed.
Enter the street address of the person in whose name the other telephone number is listed.
Enter the city where the person in whose name the other telephone number is listed lives.
Enter the state where the person in whose name the other telephone number is listed lives.
Enter the zip code where the person in whose name the other telephone number is listed lives.
Enter the county where the person in whose name the other telephone number is listed lives.
Enter the country where the person in whose name the other telephone number is listed lives.
Do you have a cell phone, pager, or FAX number where you can be reached?
Enter the respondent's first email address.
Enter the respondent's second email address.
Enter the respondent's cell phone number.
Enter the respondent's pager number.
Enter the respondent's fax number.
([R is currently employed]=1)COMMENT: R is currently employed
May we contact you at work if we are unable to locate you in the future?
Enter the company's name.
Enter line 1 of the street address where the company is located.
Enter the city where the company is located.
Enter the state where the company is located.
Enter the zip code where the company is located.
Enter the county where the company is located.
Enter the country where the company is located.
Enter the country code of the telephone number at work.
Enter the area code of the telephone number at work.
Enter the exchange of the telephone number at work.
Enter the suffix of the telephone number at work.
Do you expect to move within the next year?
Enter line 1 of the street address where you plan to move.
Enter line 2 of the street address where you plan to move.
Enter the city where you plan to move.
Enter the state where you plan to move.
Enter the zip code where you plan to move.
Enter the county where you plan to move.
Enter the country where you plan to move.
When do you think you might move?
In case we have difficulty getting in touch with you in the future, it would be helpful if we had some information about how to contact people who will always know your whereabouts.
([R's biological mother is alive]=1)COMMENT: R's biological mother is living
We have the following information listed for your mother. Is this information complete and correct?INTERVIEWER: SHOW THE RESPONDENT THE INFORMATION ON THE SCREEN BELOW.First name: [mother's first name]Middle name: [mother's middle name]Last name: [mother's last name]Nickname: [mother's nickname]Street address line 1: [address]Street address line 2: [address]Apartment: [apartment number]City: [city] State: [state] Zip: [zip code]State/Province: [state/province] Postal Code: [post code]Country: [country]Home Phone: [home phone number]Work Phone: [work phone number]Cell Phone: [cell phone number] Pager: [pager number]Fax: [fax number]E-Mail 1: [email address]E-Mail 2: [email address]
Enter mother's first name.
Enter mother's middle name.
Enter mother's last name.
Enter mother's nickname.
Enter line 1 of the street address of mother's mailing address.
Enter line 2 of the street address of mother's mailing address.
Enter apartment number of mother's mailing address.
Enter city of mother's mailing address.
Enter state of mother's mailing address.
Enter zip code of mother's mailing address.
Enter foreign state/province of mother's mailing address.
Enter foreign postal code of mother's mailing address.
([R's biological father is alive]=1)COMMENT: R's biological father is living
We have the following information listed for your father. Is this information complete and correct?INTERVIEWER: SHOW THE RESPONDENT THE INFORMATION ON THE SCREEN BELOW.First name: [father's first name]Middle name: [father's middle name]Last name: [father's last name]Nickname: [father's nickname]Street address line 1: [address]Street address line 2: [address]Apartment: [apartment number]City: [city] State: [state] Zip: [zip code]State/Province: [state/province] Postal Code: [post code]Country: [country]Home Phone: [home phone number]Work Phone: [work phone number]Cell Phone: [cell phone number] Pager: [pager number]Fax: [fax number]E-Mail 1: [email address]E-Mail 2: [email address]
Enter father's first name.
Enter father's middle name.
Enter father's last name.
Enter father's nickname.
Enter line 1 of the street address of father's mailing address.
Enter line 2 of the street address of father's mailing address.
Enter apartment number of faher's mailing address.
Enter city of father's mailing address.
Enter state of father's mailing address.
Enter zip code of father's mailing address.
Enter foreign state/province of father's mailing address.
Enter foreign postal code of father's mailing address.
Enter country of father's mailing address.
Enter the area code of the father's home telephone number.
Enter the exchange of the father's home telephone number.
Enter the suffix of the father's home telephone number.
Enter the area code of the father's work telephone number.
Enter the exchange of the father's work telephone number.
Enter the suffix of the father's work telephone number.
Enter the area code of the father's cell telephone number.
Enter the exchange of the father's cell telephone number.
Enter the suffix of the father's cell telephone number.
Enter the area code of the father's fax number.
Enter the exchange of the father's fax number.
Enter the suffix of the father's fax number.
Enter the area code of the father's pager number.
Enter the exchange of the father's pager number.
Enter the suffix of the father's pager number.
Enter the father's first email address.
Enter the father's second email address.
([this is a good contact]=1)COMMENT: we have contact information for person 1
We have [(first name)] [(last name)] listed as someone who will always know your whereabouts and would be able to contact you in case we have difficulty getting in touch with you in the future. Would this person still be able to contact you?
([this is a good contact]=1)COMMENT: we have contact information for person 2
([this is a good contact]=1)COMMENT: we have contact information for person 3
([good contact reference]=1)COMMENT: contact 1 is still a good contact person
We have the following information listed for [(first name)] [(last name)]. Is this information complete and correct?INTERVIEWER: SHOW THE RESPONDENT THE INFORMATION ON THE SCREEN BELOW.First name: [(first name)]Middle name: [middle name]Last name: [(last name)]Nickname: [nickname]Relationship: [relationship to R]Street address line 1: [address]Street address line 2: [address]Apartment: [apt. number]City: [city] State: [state] Zip: [zip]State/Province: [state/province] Postal Code: [post code]Country: [country]Home Phone: [home phone number]Work Phone: [work phone number]Cell Phone: [cell phone number] Pager: [pager number]Fax: [fax number]E-Mail 1: [email address]E-Mail 2: [email address]
Enter the first name of the first contact.
Enter the middle name of the first contact.
Enter the last name of the first contact.
Enter the nickname of the first contact.
Enter the relationship of the first contact to R.
Enter line 1 of the street address of the first contact.
Enter line 2 of the street address of the first contact.
Enter the apartment number of the first contact.
Enter the city of the first contact.
Enter the state of the first contact.
Enter the zip code of the first contact.
Enter the foreign state/province of the first contact.
Enter the foreign postal code of the first contact.
Enter the country of the first contact.
Enter the area code of the first contact's home telephone number.
Enter the exchange of the first contact's home telephone number.
Enter the suffix of the first contact's home telephone number.
Enter the area code of the first contact's work telephone number.
Enter the exchange of the first contact's work telephone number.
Enter the suffix of the first contact's work telephone number.
Enter the area code of the first contact's cell telephone number.
Enter the exchange of the first contact's cell telephone number.
Enter the suffix of the first contact's cell telephone number.
Enter the area code of the first contact's fax number.
Enter the exchange of the first contact's fax number.
Enter the suffix of the first contact's fax number.
Enter the area code of the first contact's pager number.
Enter the exchange of the first contact's pager number.
Enter the suffix of the first contact's pager number.
Enter the first contact's first email address.
Enter the first contact's second email address.
([good contact reference]=1)COMMENT: contact 2 is still a good contact person
Enter the first name of the second contact.
Enter the middle name of the second contact.
Enter the last name of the second contact.
Enter the nickname of the second contact.
Enter the relationship of the second contact to R.
Enter line 1 of the street address of the second contact.
Enter line 2 of the street address of the second contact.
Enter the apartment number of the second contact.
Enter the city of the second contact.
Enter the state of the second contact.
Enter the zip code of the second contact.
Enter the foreign state/province of the second contact.
Enter the foreign postal code of the second contact.
Enter the country of the second contact.
Enter the area code of the second contact's home telephone number.
Enter the exchange of the second contact's home telephone number.
Enter the suffix of the second contact's home telephone number.
Enter the area code of the second contact's work telephone number.
Enter the exchange of the second contact's work telephone number.
Enter the suffix of the second contact's work telephone number.
Enter the area code of the second contact's cell telephone number.
Enter the exchange of the second contact's cell telephone number.
Enter the suffix of the second contact's cell telephone number.
Enter the area code of the second contact's fax number.
Enter the exchange of the second contact's fax number.
Enter the suffix of the second contact's fax number.
Enter the area code of the second contact's pager number.
Enter the exchange of the second contact's pager number.
Enter the suffix of the second contact's pager number.
Enter the second contact's first email address.
Enter the second contact's second email address.
([good contact reference]=1)COMMENT: contact 3 is still a good contact person
We have the following information listed for [(first name)] [(last name)]. Is this information complete and correct?INTERVIEWER: SHOW THE RESPONDENT THE INFORMATION ON THE SCREEN BELOW.First name: [(first name)]Middle name: [middle name]Last name: [(last name)]Nickname: [nickname]Relationship: [relationship to R]Street address line 1: [address]Street address line 2: [address]Apartment: [apt. number]City: [city] State: [state] Zip: [zip]State/Province: [state/province] Postal Code: [post code]Country: [country]Home Phone: [home phone number]Work Phone: [work phone]Cell Phone: [cell phone number] Pager: [pager number]Fax: [fax number]E-Mail 1: [email address]E-Mail 2: [email address]
Enter the first name of the third contact.
Enter the middle name of the third contact.
Enter the last name of the third contact.
Enter the nickname of the third contact.
Enter the relationship of the third contact to R.
Enter line 1 of the street address of the third contact.
Enter line 2 of the street address of the third contact.
Enter the apartment number of the third contact.
Enter the city of the third contact.
Enter the state of the third contact.
Enter the zip code of the third contact.
Enter the foreign state/province of the third contact.
Enter the foreign postal code of the third contact.
Enter the country of the third contact.
Enter the area code of the third contact's home telephone number.
Enter the exchange of the third contact's home telephone number.
Enter the suffix of the third contact's home telephone number.
Enter the area code of the third contact's work telephone number.
Enter the exchange of the third contact's work telephone number.
Enter the suffix of the third contact's work telephone number.
Enter the area code of the third contact's cell telephone number.
Enter the exchange of the third contact's cell telephone number.
Enter the suffix of the third contact's cell telephone number.
Enter the area code of the third contact's fax number.
Enter the exchange of the third contact's fax number.
Enter the suffix of the third contact's fax number.
Enter the area code of the third contact's pager number.
Enter the exchange of the third contact's pager number.
Enter the suffix of the third contact's pager number.
Enter the third contact's first email address.
Enter the third contact's second email address.
([good contact reference] + [good contact reference] + [good contact reference])
In case we have difficulty getting in touch with you in the future, could you give me the name, address, telephone number, FAX number, and e-mail address of three people who will always know your whereabouts? Please give me information for someone who does not live with you and is not your parent.
INTERVIEWER: DOES THE RESPONDENT HAVE A CONTACT TO PROVIDE?
What is [first name]'s relationship to you?
INTERVIEWER: DOES THE RESPONDENT HAVE ANOTHER CONTACT TO PROVIDE?
And who else will always know your whereabouts? Please tell me about another person who doesn't live with you but might help us get in touch with you in the future.INTERVIEWER: PROBE FOR A LOCATING CONTACT WHO DOES NOT LIVE WITH THE FIRST LOCATING CONTACT OR WITH R.
Enter the first name of the first additional contact.
Enter the middle name of the first additional contact.
Enter the last name of the first additional contact.
Enter the nickname of the first additional contact.
Enter line 1 of the street address of the first additional contact.
Enter line 2 of the street address of the first additional contact.
Enter the apartment number of the first additional contact.
Enter the city of the first additional contact.
Enter the state of the first additional contact.
Enter the zip code of the first additional contact.
Enter the foreign state/province of the first additional contact.
Enter the foreign postal code of the first additional contact.
Enter the country of the first additional contact.
Enter the area code of the first additional contact's home telephone number.
Enter the exchange of the first additional contact's home telephone number.
Enter the suffix of the first additional contact's home telephone number.
Enter the area code of the first additional contact's work telephone number.
Enter the exchange of the first additional contact's work telephone number.
Enter the suffix of the first additional contact's work telephone number.
Enter the area code of the first additional contact's cell telephone number.
Enter the exchange of the first additional contact's cell telephone number.
Enter the suffix of the first additional contact's cell telephone number.
Enter the area code of the first additional contact's fax number.
Enter the exchange of the first additional contact's fax number.
Enter the suffix of the first additional contact's fax number.
Enter the area code of the first additional contact's pager number.
Enter the exchange of the first additional contact's pager number.
Enter the suffix of the first additional contact's pager number.
Enter the first additional contact's first email address.
Enter the first additional contact's second email address.
Enter the first name of the second additional contact.
Correct the first name of the respondent.
Correct the middle name of the respondent.
Correct the last name of the respondent.
Do you have a nickname, streetname, or some name other than your legal one by which most of your friends, neighbors, or relatives know you?
What is your nickname?
May we have your Social Security Number? We often find it useful when trying to locate people for their next interview.
Do you have a driver's license?
Enter the state from respondent's driver's licence.
Enter the number from respondent's driver's licence.
Thank you for providing all of this information. You have been very helpful.