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PDF, 3.8 MB - Substance Abuse and Mental Health Services ...

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D1_26INT<<br />

>D1_26A<<br />

>D1_26B<<br />

>D1_26C<<br />

Are you currently living at or have you recently lived at (address)?<br />

YES [D1_26A]<br />

NO [D1_26D]<br />

Our records indicate that no one in your household (is going to live/lived) at (address) for<br />

most of the time during the months of (3-month quarter field period). Is this correct?<br />

YES (NO ONE IN HH WILL/DID LIVE THERE FOR MOST OF THE TIME)<br />

[D2]<br />

NO ( R STATES SOMEONE (WILL/DID) LIVE THERE FOR MOST OF THE<br />

TIME DURING THE FIELD PERIOD.) [D1_26B]<br />

DON’T KNOW [D1_26C]<br />

Let me verify, (will/did) you or someone in your household live at (address) for at least<br />

half of the time during the three month period of (3-month quarter field period)?<br />

YES (SOMEONE IN HH WILL/DID LIVE THERE FOR MOST OF THE<br />

TIME) [D2]<br />

NO (SOMEONE IN HH WILL/DID NOT LIVE THERE FOR MOST OF THE<br />

TIME) [D2]<br />

DON’T KNOW [D2]<br />

REFUSE [D2]<br />

To the best of your knowledge, (will/did) someone from your household live at (address)<br />

for at least half of the time during the three month period of (3-month quarter field<br />

period)?<br />

YES (SOMEONE IN HH WILL/DID LIVE THERE FOR MOST OF THE<br />

TIME) [ D2]<br />

NO (SOMEONE IN HH WILL/DID NOT LIVE THERE FOR MOST OF THE<br />

TIME) [D2]<br />

DON’T KNOW [D2]<br />

REFUSE [D2]<br />

E-32

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