Questionnaire Text

ASEC 2018
ASEC 2017
ASEC 2016
ASEC 2015
ASEC 2014
ASEC 2013
ASEC 2012
ASEC 2011
ASEC 2010
ASEC 2009
top
ASEC 2018
Questionnaire form view entire document:  text  image

VERIFY
I recorded that (name/you) (are/is) not currently covered by a health plan. Is that correct?
1 Yes, is NOT covered
2 No, is covered

top
ASEC 2017
Questionnaire form view entire document:  text  image

VERIFY
I recorded that (name/you) (are/is) not currently covered by a health plan. Is that correct?
1 Yes, is NOT covered
2 No, is covered

top
ASEC 2016
Questionnaire form view entire document:  text  image

VERIFY
I recorded that (name/you) (are/is) not currently covered by a health plan. Is that correct?
1 Yes, is NOT covered
2 No, is covered

top
ASEC 2015
Questionnaire form view entire document:  text  image

VERIFY
I recorded that (name/you) (are/is) not currently covered by a health plan. Is that correct?
1 Yes, is NOT covered
2 No, is covered

top
ASEC 2014

No questionnaire text is available for this sample.


top
ASEC 2013
Questionnaire form view entire document:  text  image

SHIC4
I have recorded that (you/read list of names) (were/was) not covered by a health plan at any time during 2012. Is that correct?
1 Yes
2 No
SHIC4A
Who should be marked as covered? Enter all that apply, separate using the space bar or a comma. Probe: Anyone Else?
Enter persons line number (1-16)

top
ASEC 2012
Questionnaire form view entire document:  text  image

SHIC4
I have recorded that (you/read list of names) (were/was) not covered by a health plan at any time during 2011. Is that correct?
1 Yes
2 No
SHIC4A
Who should be marked as covered? Enter all that apply, separate using the space bar or a comma. Probe: Anyone Else?
Enter persons line number (1-16)

top
ASEC 2011
Questionnaire form view entire document:  text  image

SHIC4
I have recorded that (you/read list of names) (were/was) not covered by a health plan at any time during 2010. Is that correct?
(1) Yes
(2) No
SHIC4A
Who should be marked as covered?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

top
ASEC 2010
Questionnaire form view entire document:  text  image

SHIC4
I have recorded that (you/read list of names) (were/was) not covered by a health plan at any time during 2009. Is that correct?
(1) Yes
(2) No
SHIC4A
Who should be marked as covered?
ENTER ALL THAT APPLY, SEPARATE USING THE SPACE BAR OR A COMMA.
PROBE: Anyone else?
ENTER PERSONS LINE NUMBER (1-16)

top
ASEC 2009
Questionnaire form view entire document:  text  image

SHIC4
I have recorded that (you/read list of names) (were/was) not covered by a health plan at any time during 2008. Is that correct?
(1) Yes
(2) No
SHIC4A
Who should be marked as covered?
ENTER ALL THAT APPLY, SEPARATE USING THE SPACE BAR OR A COMMA.
PROBE: Anyone else?
ENTER PERSONS LINE NUMBER (1-16)