HPTN 068 Study Household Baseline Questionnaire 31 JANUARY .
HPTN 068 StudyHousehold Baseline Questionnaire31 JANUARY 2011-- FINAL -- v1.012345Date of Interview:Interviewer initials:Participant ID Number:Participant's Relationship to Young WomanAre you opening the post- office account?[ ][ ][ ][][]Caregiver Relationship CodesYes 1 No 2
Household RosterInterviewer read out: We would like to start by asking you questions about the people who are part of your household.Interviewer: Read out the membership criteria before proceeding.Coding: List all household members first before proceedingHousehold Membership CriteriaYou are a household member if:(i) You have lived under this "roof" or within the same compound/homestead/stand at least 15 days during the last month OR you arrived here in the last 15 days and this is now your usual residence and(ii) when you are together you share food from a common source with other household members and(iii) you contribute to or share in common assets.1Interviewer:- List names of allindividuals who meet the3 membership criteriaabove.- First list the full name ofthe parent/legal guardian- Don’t forget babiesName2What is [ ]'srelationship toparent/legal3guardian?GenderRelationshipcodeMale 1Female 24Date of birthdd/mm/yyyy5Age in YEARSYears6What is thehighesteducationalqualificationattained by[ ]? If ppt. hasNOSCHOOLINGSkip to #12Education code12What is [ ]'scurrent maritalstatus? Ifanything butmarried, skip11 How much was spent on the following items for [ ] in 2010? to #15Allowancesand otherBooks andTransport toschool related Marital andRand20How manymonths did [ ]spend awayfrom thehousehold inthe last 12months?Coding: If lessthan 1 monthor none, write0 and go to#22.MonthsSA CCT -- Household Questionnaire22Is [ ] receivinga GovernmentGrant, such as21the old ageWhat was the pension ormain reasonchild supportfor his/hergrant? If NOabsence?skip to #26Yes 1Absence CodeNo 223Type ofGovernmentGrant receiving(pick all thatapply)Grant Code7 Is [ ]currentlyenrolled inschool?Coding: askonly forparticipantsages 4-25If NO skip to#10Yes 1No 213Is [ ]'s spouseor partnerlisted on thisroster?If No, skip to#159. How manydays did [.]actually spend8 What grade in school in theis [ ] currently last month inin?total?Education code14Write thespouse orpartner name26Is [ ] receivinga Private2425 When didPension? If NOMonthly Value this personskip to nextof Grants forstart receiving householdthe personthis grant?memberMonth andYes 1RandYearNo 2Days10 Was [ ]enrolled inschool lastyear? If NOskip to #12Yes 1No 215Is [ ]'sbiologicalfather listed onthis roster?16If No, skip toWrite the#17father's name17Is [ ]'sbiologicalmother listedon this roster? 1819If No, skip toWrite theDoes [ ] usually reside here#19mother's name at least 4 nights a week?Yes 1No 227Monthly Valueof PrivatePension for thepersonRandSection: Household RosterPage 2 of 17
Food Spending and ConsumptionInterviewer read out: Now we would like to ask questions about some specific food that may have been eaten in the LAST 30 DAYS. It should not include food that has been bought for resale or exchanged for commercial purposes.Coding:* Read out each item.* For each of the items marked with a yes, ask the other questions.Grown by Household1.1 Was [ ] consumed bythis household in the last30 days?Code1Food itemRed meat (beef, mutton, pork, etc.) NOTcannedChickenPotatoesTomatoesGreen Leaf VegetablesOther vegetablesFruits and nutsEggsMealie argarine, butter, ghee, other fats22 Peanut butter121223Sugar, jam, honey, chocolates and sweetsSoft drinks and juices25 Tinned fruit and lk, cheese, yoghurts and dried milkSampFlour and breadRicePastaBiscuits, cakes, rusksCanned red meatFresh fish and shell fishTinned fishDried peas, lentils, beansOil for cooking2126Breakfast cereal and porridge1227Baby food and baby formulaSalt and spicesSoya productsCoffee and teaReadymade meals brought into thehousehold1212121212121228293031Meals prepared outside the home (incl.32 restaurants and take-aways)33Other food expenditure (specify)1.2 How much of [ ]consumed in the last 30days was grown in yourhomestead yard or fieldsoutside the yard?Quantity1.3 Volume UnitUnit CodesPurchased by Household1.4 If you wanted to buy thementioned amount of [ ] howmuch should you pay in themarket?Rands1.5 How much of [ ]consumed in the last 30days was purchased bythe household?Quantity1.6 Volume UnitUnit CodesBorrowed by Household or Gifts1.7 How much was spenton [ ] in the last 30 days?Rands1.8 How much of [ ]consumed in the last 30 dayswas given or gifted from aneighbor or otherhousehold?1.9 Volume UnitQuantityUnit CodesFood SecurityInterviewer read out: Please think about what has happened in your household in the last 30 days , and tell me you how often you have experienced the following situations whichI will read. The options are never, rarely (1-2 times), sometimes (3-10 times) or often (more than 10 times) in the last 30 days.1How often was there no food at all in your household because there was not enough money to buy enough food?2How often were you or any member of your household hungry when you went to sleep at night because there was not enough food?3How often did you or any member of your household go a whole day without eating anything because there was not enough food?CCT SA - Household QuestionnaireSection: Food Spending and ConsumptionPage 3 of 17
Non-food Spending and ConsumptionInterviewer read out: Now we would like to ask questions about items that have been purchased BY ALL HOUSEHOLD MEMBERS in the LAST 30 DAYS. Please includeitems purchased by every member of the household when providing your answers.Coding:* Read out each item.* For each of the items marked with a yes, ask the other questions.2.1 Did the household 2.2 How much was spentspend money on [ ] inon [ ] in the last 30the last 30 days?days?YesNoRandsPersonal items:1Cigarettes and tobacco2Beer, wine and spirits3Entertainment, such as cinema, music, MNET and DSTV4Sport, including sporting equipment, gym and club membership5Personal care items, such as cosmetics, soap, shampoo and haircuts6Jewellery and watches7Newspapers, stationery, envelopes, stamps and books, excluding school books8Cell phone account and/or airtime9Telephone account (not including cell phone account)10Lotto, gambling and horse-racing11Trips and holidays, excluding transport costs12Ceremonies, such as weddings and funeralsTransport costs:13Car payments, excluding insurance14Petrol, oil and car service15Buses, taxis, trains and air tickets, excluding transport to schoolEnergy, water and municipal rates:16Water17ElectricityOther energy sources, such as wood, paraffin, charcoal/coal, candles, gas, purchasing/charging18batteries and diesel oil for generators19Municipal rates20Levies, for example, sectional title, share block and timeshareInsurance:21Life insurance22Funeral policies or burial societies23Educational policies24Short-term insurance, for example, car, property & fire, and crop insuranceHousehold items:25Kitchen equipment, like pots and pans, cutlery and crockery26Home maintenance and repairs to the dwelling27Bedding, sheets, blankets and towels28Material to make curtains and other household items29Hire purchase (HP) payments on furniture and other household appliances30Furniture and other household appliances bought with cash or by credit cardClothing and shoes:31Adult shoes and clothing (excluding school uniforms) bought with cash or by credit card32Children shoes and clothing (excluding school uniforms) bought with cash or by credit card33Account payments on shoes and clothes, excluding school uniforms34Material to make clothingHealth care:35Medical aid schemes/medical insurance, such as hospital plan36Dentists, doctors or nurses37Hospital fees38Medical supplies, for example, medicines and bandages39Traditional healer's feesEducation:40School fees and tuition41School books, including stationery42Uniforms43Transport to school44School MealsOther school expenses, such as school outings, boarding fees, contributions to school buildings, extra45costs for teachers and extramural activitiesMiscellaneous:46Washing powder, dishwashing liquid, polish and all household cleaners47Creche and childcare outside of the home48Religious and membership dues of organisations, donations to charity49Domestics, in-home childcare, gardeners and other household help50Pets51Toys52Gifts53Income tax paymentsCCT SA - Household 2121111111122222222Section: Non-food Spending and ConsumptionPage 4 of 17
Durable GoodsInterviewer read out: Now we would like to ask you questions about household items which the household may ormay not own.2 How many working [ ]1 How many [ ] did yourdoes the household ownhoueshold own two years ago? now?Type of good(Number)(Number)1 Radio2 Hi-Fi stereo, CD player, MP3 player3 Television4 Satellite dish5 Video cassette recorder, DVD player6 Computer7 Camera8 Cell phone9 Electric stove10 Gas stove11 Paraffin stove12 Microwave13 Fridge/freezer14 Washing machine15 Sewing/knitting machine16 Lounge suite17 Mattress18 Private motor vehicle in running condition19 Commercial motor vehicle in running condition20 Motorcycle/scooter21 Bicycle22 Boat23 Donkey cart or ox cart24 Plough25 Tractor26 Wheelbarrow27 Grinding millCCT SA - Household QuestionnaireSection: Durable GoodsPage 5 of 17
Negative EventsInterviewer read out: Households sometimes experience good and bad events. First we would like to ask you about any bad events your household may have experienced IN THE LAST 12 MONTHS.Coding:* Read out each item.* For each of the items marked with a yes, ask the other questions.Event1234567891011Death of a resident household memberDeath of a friend / non-resident family member you depended on for financial assistanceSerious illness or injury of a household memberWidespread death / disease / theft of livestockMajor crop failure / lossJob loss of a breadwinnerCut off or decrease in remittances to the householdCut off or decrease in government grantsTheft, fire or destruction of household propertyInherited outstanding debt from deceased family memberOther (specify)1.1 Did a [ ] occur inthis household in thelast 12 months?Yes11111111111No222222222221.2 What didyou do to copewith theeffects? (pickall that apply)Coping Codes1.3 Has anyhousehold memberdropped out of schoolor tertiary educationas a result?Yes11111111111No22222222222Positive EventsInterviewer read out: Now we would like to ask you about any good events your household may have experienced IN THE LAST 12 MONTHS.Coding:* Read out each item.* For each of the items marked with a yes, ask the other questions.Event1234567New regular job for a household memberNew or increased remittancesNew government grant (e.g. pension)Inheritance, large gift, lottery winningsBig payment from a firm (e.g. pension payment)Scholarship / bursary for children or adults in the householdOther (specify)2.1 Did a [ ] occur inthis household in thelast 12 months?YesNo121212121212122.3 What was the2.2 What month and year did the [ ] increase in income each 2.4 What was themonth?amount received?happen?MonthYearRandsRandsHousehold Decision-makingInterviewer read out: In this section, we want to ask you how decisions are made within your household.1234567Interviewer: Write the Name of the main decision-makerWho makes decisions about day-to-day household expenditures (e.g., groceries)?1Main decision-makerNameWho makes decisions about large, unusual purchases, such as appliances, vehicles or furniture?Who makes decisions about whether your children go to school?Who makes decisions about where your children should go to school?Who makes decisions about whether a child received medical care?Who makes decisions about who is allowed to live in the household as part of the household (forexample, if a relative or family member does not have a place to stay?)Who makes decisions about where the household should live?CCT SA - Household QuestionnaireSection: Negative and Positive Events and Decision-makingPage 6 of 17
Transfers and Credit Received1 In the last 12 months, has anyone in your 1 Yeshousehold received money or goods from 2 No -- Skip to #7persons who are not members of yourhousehold? For example from children,parents, relatives or friends livingelsewhere?*If no, probe for gifts, money received forfunerals, child support, weddings, goods ormoney to help sick persons – in the last 30days (include transfers for schoolingexpenses, medical expenses, and gifts ofland). Refer back to the household rosteron children with absence from householdand ask about gifts, loans and transfersfrom these children.2 From how many different people didmembers of your household receivemoney, goods, and/or gifts in the last 12months?Now I would like to ask you about all individuals from whom all members of your household have received something in the last 12 months.3 Initials of4 How much have members of your5 Do members of your household6 How much has beenpersonhousehold received from this person in the have to repay any part of thisalready repaid?last 12 months, including money and theamount?value of gifts in kind?1 YesRand2 No -- Skip to Next PersonRand7 Has anyone in your household received money or gifts from any otherorganization other than the government in the last 12 months?* Probe for food transfers from organizations, loans from banks, loans fromchurches, etc.8 What is thetype of theorganization?9 How frequently did the householdmember receive this money or gift?1 Once a week2 Every two weeks3 Once a month4 Every three months5 Every six months6 Once a year7 Less than once a yearOrganization Just onceCodesCCT SA - Household Questionnaire1 Yes2 No -- END MODULE10 Do you have to repay any part of 11 How much hasthis amount?been already repaid?81 Yes2 No -- Skip to Next PersonRandSection: Transfers ReceivedPage 7 of 17
Transfers and Credit Sent1 In the last 12 months, have any members of your household provided1 Yesany money or goods to persons who are not members of your2 No -- END MODULEhousehold? For example to children, parents, relatives or friends livingelsewhere?*If no, probe for gifts, money given for funerals, child support,weddings, goods or money to help sick persons – in the last 12 months(include transfers for schooling expenses, medical expenses, and giftsof land). Refer back to the household roster on children with absencefrom household and ask about gifts, loans and transfers from thesechildren.2 How many different people did all members of your household sendmoney, goods, and/or gifts to in the last 12 months?Now I would like to ask you about all individuals to whom all members of your household have sent something in the last 12 months.3 Initials 4 How much have all members of your household sent to this person in 5 Do members of your6 How much has beenof Person the last 12 months, including money and the value of gifts in kind?household expect any part of already repaid?this amount to be repaid toyou?RandCCT SA - Household Questionnaire1 Yes2 No -- Skip to next personRandSection: Transfers SentPage 8 of 17
AgricultureInterviewer read out: Now we would like to ask you some questions about everything this household grew in the last 12months even if you did not sell any of it. This includes things grown in your homestead yard or fields outside the yard .What crops have these resident household members been growing or cultivating in the last 12 months?Coding:* Read out each item.* For each of the items marked with a yes, ask the other questions.1. Did anyonein thehouseholdgrow this cropin the last 12months?No -- SKIP TONEXT CROP01020304050607Type of cropMaizePumpkinsCow peasBambara groundnutsPeanutsSweet potatoesOther, specify:Yes1111111No2222. Totalamountharvested in 3. Volumethe last season UnitQuantity4. Did you sellany? No -- SKIP TO NEXT 5. TotalCROPamount soldUnit code2222Yes1111111No Quantity2226. VolumeUnitUnit code2222Interviewer read out: Now we would like to ask you some questions about all livestock owned by the household in thelast 12 months.1Has ahouseholdmemberowned [ ]during the last12 months?No -- SKIP TONEXT ANIMALType of animalCattleSheepGoatsPigsDonkeys and06 mules07 Chickens01020304CCT SA - Household QuestionnaireYes111111No2222222How many [ ]are in thehousehold'spossession atthe moment?Number3 Did you earnany income byselling any [ ]in the last 12months?No -- SKIP TONEXT ANIMALYes111111No22224 How muchmoney did youearn in randfrom sellingyour [ ] in thelast 12months?Rands22Section: AgriculturePage 9 of 17
Interviewer read out: Now we would like to ask you some questions about you and the young woman to be enrolled in the study123456789Name of Young Woman to be enrolled in study[populate names from HH roster]Total Number of Dependants including individuals not living with you(not counting you Noneor your spouse/partner):OneTwoThreeFourFiveSixSevenEight or moreHow many brothers and sisters does [NAME] have? Please consider all siblings, Don'tNone -- skip to #4forget half- and step- and adoptive (legal or non-legal) brothers and sisters.OneTwoThreeFourFiveSix or moreHow many of these siblings are presently in the home?NoneOneTwoThreeFourFiveSix or moreHow many years has [NAME] been at her present school?One year or lessTwo yearsThree yearsFour yearsFive years or moreHow many times has [NAME] changed schools since she entered first grade?NoneOnceTwiceThree timesFour timesFive or more timesDid [NAME] ever skip a grade in school?YesNoIn a typical month during the 2010 school year, how many school days did [NAME] miss None -- Skip to #10for any reason?1-2 days3-4 days5-6 days7 or more daysWhat was the main reason for [NAME's] absences?She fell pregnant or had a babyShe became sick or disabledPick only one response.She acquired all the education you wantedNo money for uniformShe was attending initiationShe does't like or are not interested in schoolShe was not doing well in school/failed too many timesShe thought she was too old to continueHer parents told her to stop going to schoolHer boyfriend told her to stop going to schoolShe had to help at homeCaring for own or other’s childShe had a problem with a teacher or school officialShe had a problem with other studentsPoor quality teachingTeachers often absentSchool too dangerous for girlsSchool conflicted with her beliefsSchool too far from homeEducation is more important for boys than girlsOther (specify)SA CCT -- Household QuestionnaireSection: Young Woman EducationPage 10 of 17
1011Since [NAME] started current school year, how many times have you contacted theschool about the following?Her academic performanceHer subjects for this yearHer behavior in schoolParticipating in fund-raising activitiesProviding information for school records (i.e. your address)Doing volunteer workDo you do any of the following at [NAME'S] school?13Belong to a parent-teacher organizationAttend meetings of a parent-teacher organizationTake part in the activities of a parent-teacher organizationAct as a volunteer at her schoolTake part in the activities of a school governing bodyBelong to another organization with the parents from [NAME'S] schoolAre there family rules that are enforced for [NAME] about any of the followingactivities?Maintaining certain school marksDoing homeworkDoing household choresHow often do you talk with [NAME] about her experiences in school?14How often do you talk with [NAME] about her plans for high school?15How often do you talk with [NAME] about her educational plans for after high school?16How often do you help [NAME] with her homework?17Does [NAME] usually come home directly after school?18Are any of the following people at home when [NAME] returns home from school?12NoneOnce or
Code Food item Yes No Quantity Unit Codes Rands Quantity Unit Codes Rands Quantity Unit Codes 1 Red meat (beef, mutton, pork, etc.) NOT . share block and timeshare 1 2 21 Life insurance 1 2 22 Funeral policies or burial societies 1 2 23 Educational policies 1 2 24 Short-term insurance, for example, car, property & fire, and crop insurance 1 2 .
provider specialty, index year (2014-17), baseline anxiety, baseline dyspnea, baseline congestive heart failure, baseline angina pectoris, baseline renal disease, baseline obstructive sleep apnea, baseline pneumonia, age, baseline Elixhauser comorbidity index score, baseline COPD total medical costs, baseline exacerbation episode
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household income and income and savings national income per capita household disposable income household savings income inequality and poverty income inequality poverty rates and gaps household wealth household financial assets household debt non-financial assets by households
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The EBT Household Change Guided Script screen has five (5) steps that must be completed in order. First step, Determine New Household. no script Click the Determine New Household link. Change HHID1 We are going to create a new household for Pepper. no script Click the Create New Household button. Create New HH We will quickly complete the .
the aggregate household consumption vectors (obtained by summing the indivi-dual consumption vectors over all members of the household), the aggregate household income, and the price vector for goods, are related in such a way as to satisfy (1) and (2) above. The Household The household is composed of individuals, but it is clearly more than that.
Examination Procedures Baseline Review CFPB April 2019 ECOA 1 Equal Credit Opportunity Act Baseline Review Modules These ECOA Baseline Review Modules consist of five modules that CFPB examination teams use to conduct ECOA Baseline Reviews to evaluate how institutions’ compliance management systems identify and manage fair lending risks under .
This Business Architecture document follows the approach and principles set out in the ESS Enterprise Architecture Reference Framework (ESS EARF). When relevant, special attention has been given to ensure that the content of the Business Architecture is aligned with widely used reference standards such as GSBPM and GSIM. 1.2 Reader The current Business Architecture document is designed to be a .
