Interviewer Remarks (Including Environmental Checklist) - NHATS

IR8 IR8 NOT ON FILEQUESTION TEXT:Did you encounter any problems or issues with CAPI?CODES12YesNoIR10IR8A IR8A NOT ON FILEQUESTION TEXT:Describe problems or issues CAPI.ENTER TEXTLength 500IR10 IR10 NOT ON FILEQUESTION TEXT:Did you encounter any problems or issues with administering the performance measures?CODES123YesNoNot AdministeredIR11IR11IR10A IR8A NOT ON FILEQUESTION TEXT:Describe the performance measures problems or issuesENTER TEXTLength 500IR11 IR11 NOT ON FILEQUESTION TEXT:Did you encounter any problems or issues with administering the STROOP task?CODES123YesNoNot AdministeredIR12IR12Page 4 of 10NHATS Round 1 :: IR

ir1areacond4R1 IR15 FORECLOSURE HOUSE SIGNSDISPLAY INSTRUCTIONS:Use “Same Question Stem” display.If at IR15a, do not display question text in brackets.Otherwise, display question text in brackets.QUESTION TEXT:REFER TO THE HOME ENVIRONMENT CHECKLIST EC2a-d ITEMS WHEN ANSWERING THESE QUESTIONS.{[} When standing in front of the SP's home/building, and looking around in every direction, howmuch of the following did you see?{]}{variable text [a-d]}RESPONSE [1] a. Litter, broken glass, or trash, on sidewalks and streets?RESPONSE [2] b. Graffiti on buildings and walls?RESPONSE [3] c. Vacant or deserted houses or storefronts?RESPONSE [4] d. Houses with foreclosure signs?CODES1234NoneA littleSomeA lotPROGRAMMER INSTRUCTIONS:Array the responses and variable text columns in the panel.Display ‘variable text’ in the a-d sequence until all rows have been displayed.IR16ir1condhome1ir1condhome2ir1condhome3ir1condhome4ir1condhome5R1 IR16 BROKEN WINDOWS IN HOMER1 IR16 CRUMBLNG FOUNDTN IN HOMER1 IR16 MISSING BRCKS SIDNG IN HMR1 IR16 ROOF PROBLEM IN HOMER1 IR16 BROKEN STEPS TO HOMEDISPLAY INSTRUCTIONS:Use “Same Question Stem” display.If at IR16a, do not display question text in brackets.Otherwise, display question text in brackets.QUESTION TEXT:REFER TO THE HOME ENVIRONMENT CHECKLIST EC3a-e ITEMS WHEN ANSWERING THESE QUESTIONS{[}Standing in front of the SP's home/building, did it have…{]}{variable text [a-e]}RESPONSE [1] a. any broken or boarded up windows?RESPONSE [2] b. a crumbling foundation or open holes?RESPONSE [3] c. missing bricks, siding, or other outside materials?Page 8 of 10NHATS Round 1 :: IR

RESPONSE [4] d. roof problems (e.g., missing material, sagging, or a hole in roof)?RESPONSE [5] e. uneven walking surfaces or broken steps in the area leading to the home/building?CODES127YESNOCOULD NOT OBSERVEPROGRAMMER INSTRUCTIONS:Array the responses and variable text columns in the panel.Display ‘variable text’ in the a-D sequence until all rows have been displayed.BOXIR19 BOXIR19 NOT ON FILEQUESTION TEXT:If FQ task = code 20 (COMPLETED), go to IR19.Otherwise ENDIR19 IR19 NOT ON FILEQUESTION TEXT:Were there any problems or issues administering the Facility Questionnaire?CODES12YESNOIR20IR19A IR19A NOT ON FILEQUESTION TEXT:Describe problems or issues with administering the Facility Questionnaire.ENTER TEXTLength 500IR20 IR20 NOT ON FILEQUESTION TEXT:Was more than 1 facility respondent needed to complete the Facility Questionnaire?CODES12YESNOIR21IR20A IR20A NOT ON FILEPage 9 of 10NHATS Round 1 :: IR

QUESTION TEXT:Describe why more than 1 facility respondent need to complete the Facility Questionnaire.ENTER TEXTLength 500IR21 ir1fqphrnprsn R1 IR21 FQ IN PERSON OR BY PHONEQUESTION TEXT:Was the Facility Questionnaire completed in person or by telephone?CODES12In personBy PhonePage 10 of 10NHATS Round 1 :: IR