| Question | Answers | Source | Source Link | Dates Used | |
|---|---|---|---|---|---|
| 1 | Thinking about the past 12 months, did you or any of your family members in your household go without health insurance at any time? | • Yes, someone in my family has been uninsured • No, no one in my family has been uninsured | Urban Institute HRMS Survey (March 2020) | http://hrms.urban.org/survey-instrument/ | 03/07/2022-03/16/2022 |
| 2 | Thinking about the past 12 months, did you or any of your family members in your household go without health insurance at any time? | • Yes, someone in my family has been uninsured • No, no one in my family has been uninsured • Do not wish to disclose | Urban Institute HRMS Survey (March 2020) | http://hrms.urban.org/survey-instrument/ | 12/06/2022-12/13/2022 |
| 3 | Who in your household did not have health insurance at any time in the past 12 months? | • Myself • My partner • My child(ren) • Not Listed (please specify) | NA | 03/07/2022-03/16/2022 12/06/2022-12/13/2022 | |
| 4 | In the past month, have you or your child(ren) experienced difficulty accessing medical care for any reason? | • Yes • No • Not applicable, I or my child(ren) did not need medical care • Do not wish to disclose | NA | 12/06/2022-12/13/2022 | |
| 5 | Please say more about your difficulty accessing medical care for yourself or your child(ren). | Open ended response | NA | 12/06/2022-12/13/2022 | |
| 6 | Thinking about the past 12 months, did any of your family members go without health insurance at any time since September 2019 ? | • Yes, someone in my family has been uninsured • No, no one in my family has been uninsured | Urban Institute HRMS Survey (March 2020) | http://hrms.urban.org/survey-instrument/ | 09/21/2020-09/24/2020 10/05/2020-10/08/2020 11/03/2020-11/05/2020 12/01/2020-12/03/2020 01/05/2021-01/07/2021 03/02/2021-03/05/2021 03/31/2021-04/02/2021 04/28/2021-05/01/2021 05/25/2021-05/28/2021 06/23/2021-06/25/2021 07/21/2021-07/23/2021 08/04/2021-08/06/2021 09/15/2021-09/17/2021 11/10/2021-11/16/2021 12/08/2021-12/14/2021 |
| 7 | How many family members did not have health insurance at any time since September 2019? | • 1 to 21 | Urban Institute HRMS Survey (March 2020) | http://hrms.urban.org/survey-instrument/ | 09/21/2020-09/24/2020 10/05/2020-10/08/2020 11/03/2020-11/05/2020 12/01/2020-12/03/2020 01/05/2021-01/07/2021 03/02/2021-03/05/2021 03/31/2021-04/02/2021 04/28/2021-05/01/2021 05/25/2021-05/28/2021 06/23/2021-06/25/2021 07/21/2021-07/23/2021 08/04/2021-08/06/2021 09/15/2021-09/17/2021 11/10/2021-11/16/2021 12/08/2021-12/14/2021 |
| 8 | At any time in the last month, did you DELAY getting medical care (including physical or mental health visits)? | • Yes • No • Unsure | Rapid Modified US Census Household Pulse Survey | https://www2.census.gov/programs-surveys/demo/technical-documentation/hhp/Phase_2_Questionnaire_09_09_2020_English.pdf | 11/03/2020-11/05/2020 12/01/2020-12/03/2020 01/05/2021-01/07/2021 03/02/2021-03/05/2021 03/31/2021-04/02/2021 04/28/2021-05/01/2021 05/25/2021-05/28/2021 06/23/2021-06/25/2021 07/21/2021-07/23/2021 08/04/2021-08/06/2021 09/15/2021-09/17/2021 |
| 9 | In the past month, have you done any of the following: Select all that apply. | • Worked at home while unwell or ill • Worked at a job outside the home while unwell or ill • Used a holiday or time off to catch up on work • None of the above • Not applicable | Developed by RAPID Team | NA | 09/21/2020-09/24/2020 10/05/2020-10/08/2020 11/03/2020-11/05/2020 12/01/2020-12/03/2020 01/05/2021-01/07/2021 03/02/2021-03/05/2021 03/31/2021-04/02/2021 04/28/2021-05/01/2021 05/25/2021-05/28/2021 06/23/2021-06/25/2021 07/21/2021-07/23/2021 08/04/2021-08/06/2021 09/15/2021-09/17/2021 |
| 10 | In the past month, has your child(ren) aged 0-5 done any of the following:Select all that apply. | • Attended school or a learning environment at home while unwell or ill • Attended school or a learning environment in person while unwell or ill • None of the above • Not applicable | Developed by RAPID Team | NA | 09/21/2020-09/24/2020 10/05/2020-10/08/2020 11/03/2020-11/05/2020 12/01/2020-12/03/2020 01/05/2021-01/07/2021 03/02/2021-03/05/2021 03/31/2021-04/02/2021 04/28/2021-05/01/2021 05/25/2021-05/28/2021 06/23/2021-06/25/2021 07/21/2021-07/23/2021 08/04/2021-08/06/2021 09/15/2021-09/17/2021 |