Canadian Survey on Disability - 2022

For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.

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Table of Contents

ENTRY (ENT)

ENTRY (ENT) - Question identifier:ENT_R05

Person selected for this survey

[First Name] [Last Name]

ENTRY (ENT) - Question identifier:ENT_Q05

Please select one of the following:

  • 1: I am completing this survey on behalf of [First Name] [Last Name]
  • 2: I am [First Name] [Last Name] and completing this survey for myself

ENTRY (ENT) - Question identifier:ENT_Q10

Why are you completing this survey on behalf of [First Name] [Last Name]?

  • 01: The person is unable to participate for health reasons
  • 02: The person is absent or unavailable
  • 03: The person does not speak either English or French
  • 04: I am a parent or guardian responding on behalf of a child
  • 05: The person is deceased
  • 06: The person moved to an institution (e.g., hospital, health care facility, etc.)
  • 07: The person no longer lives in Canada
  • 08: Other reason — Specify the reason you are completing the survey on behalf of [First Name] [Last Name]:

ENTRY (ENT) - Question identifier:ENT_R15

Please review the [information about [First Name] [Last Name]/following information]. If incorrect (including spelling), please select the item and enter the correct information.

ENTRY (ENT) - Question identifier:ENT_Q15A

First Name:

Long Answer Length = 25

ENTRY (ENT) - Question identifier:ENT_Q15B

Last name:

Long Answer Length = 25

ENTRY (ENT) - Question identifier:ENT_Q15C

Address (number and street):

Long Answer Length = 80

ENTRY (ENT) - Question identifier:ENT_Q15D

City/Town:

Long Answer Length = 30

ENTRY (ENT) - Question identifier:ENT_Q15E

Province, territory or other:

  • 10: Newfoundland and Labrador
  • 11: Prince Edward Island
  • 12: Nova Scotia
  • 13: New Brunswick
  • 24: Quebec
  • 35: Ontario
  • 46: Manitoba
  • 47: Saskatchewan
  • 48: Alberta
  • 59: British Columbia
  • 60: Yukon
  • 61: Northwest Territories
  • 62: Nunavut
  • 76: United States
  • 77: Outside of Canada and United States

ENTRY (ENT) - Question identifier:ENT_Q15F

Telephone number (including area code):

Long Answer Length = 12

e.g., 123-123-1234

ENTRY (ENT) - Question identifier:ENT_Q20

Please enter your current age.

Min = 0; Max = 121

ENTRY (ENT) - Question identifier:ENT_R25

You indicated that you are completing this survey on behalf of [First Name]. Please provide your name and telephone number. A Statistics Canada interviewer may need to contact you for additional information.

ENTRY (ENT) - Question identifier:ENT_Q25A

First name:

Long Answer Length = 25

ENTRY (ENT) - Question identifier:ENT_Q25B

Last name:

Long Answer Length = 25

ENTRY (ENT) - Question identifier:ENT_Q25C

Telephone number (including area code):

Long Answer Length = 12

e.g., 123-123-1234

SEX AND GENDER (GDR)

SEX AND GENDER (GDR) - Question identifier:GDR_R05

The following questions are about sex at birth and gender.

SEX AND GENDER (GDR) - Question identifier:GDR_Q05

What was your sex at birth?

Sex refers to sex assigned at birth.

  • 1: Male
  • 2: Female

SEX AND GENDER (GDR) - Question identifier:GDR_Q10

What is your gender?

Gender refers to current gender which may be different from sex assigned at birth and may be different from what is indicated on legal documents.

Is it:

  • 1: Male
  • 2: Female
  • 3: Or please specify

SEX AND GENDER (GDR) - Question identifier:GDR_R15

Please verify that all of the information is correct.

Your information

Sex assigned at birth: [Sex]
Gender: [Gender]

DISABILITY SCREENING QUESTIONS (DSQ)

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_R005

The following questions are about difficulties a person may have doing certain activities. Only difficulties or long-term conditions that have lasted or are expected to last for six months or more should be considered.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q005

Do you have any difficulty seeing (even when wearing glasses or contact lenses)?

Would you say:

  • 1: No
  • 2: Sometimes
  • 3: Often
  • 4: Always

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q010

Do you have any difficulty hearing (even when using a hearing aid)?

Would you say:

  • 1: No
  • 2: Sometimes
  • 3: Often
  • 4: Always

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q015

Do you have any difficulty walking, using stairs, using your hands or fingers or doing other physical activities?

Would you say:

  • 1: No
  • 2: Sometimes
  • 3: Often
  • 4: Always

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q020

Do you have any difficulty learning, remembering or concentrating?

Would you say:

  • 1: No
  • 2: Sometimes
  • 3: Often
  • 4: Always

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q025

Do you have any emotional, psychological or mental health conditions?

e.g., anxiety, depression, bipolar disorder, substance abuse, anorexia, etc.

Would you say:

  • 1: No
  • 2: Sometimes
  • 3: Often
  • 4: Always

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q030

Do you have any other health problem or long-term condition that has lasted or is expected to last for six months or more?

Exclude any health problems previously reported.

Would you say:

  • 1: No
  • 2: Sometimes
  • 3: Often
  • 4: Always

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q035

Do you wear glasses or contact lenses to improve your vision?

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q040

[With your glasses or contact lenses, which/Which] of the following best describes your ability to see?

Would you say:

  • 1: No difficulty seeing
  • 2: Some difficulty seeing
  • 3: A lot of difficulty seeing
  • 4: You are legally blind
  • 5: You are blind
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q045

At what age did you begin having [difficulty seeing/a seeing condition]?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q050

How often does this [difficulty seeing/seeing condition] limit your daily activities?

Would you say:

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q055

At what age did this [difficulty seeing/seeing condition] begin to limit your daily activities?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q060

Do you use a hearing aid or cochlear implant?

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q065

[With your hearing aid or cochlear implant, which/Which] of the following best describes your ability to hear?

Would you say:

  • 1: No difficulty hearing
  • 2: Some difficulty hearing
  • 3: A lot of difficulty hearing
  • 4: You cannot hear at all
  • 5: You are Deaf
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q070

At what age did you begin having [difficulty hearing/a hearing condition]?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q075

How often does this [difficulty hearing/hearing condition] limit your daily activities?

Would you say:

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q080

At what age did this [difficulty hearing/hearing condition] begin to limit your daily activities?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_R085

The following questions are about your ability to move around, even when using an aid such as a cane. Only difficulties or long-term conditions that have lasted or are expected to last for six months or more should be considered. Only consider aids that provide minimal support such as a cane, walking stick or crutches.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q085

How much difficulty do you have walking on a flat surface for 15 minutes without resting?

This refers to your regular walking pace.
If you use an aid for minimal support such as a cane, walking stick or crutches, please answer this question based on your ability to walk when using these aids.

Would you say:

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do at all
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q090

How much difficulty do you have walking up or down a flight of stairs, about 12 steps without resting?

This refers to your regular walking pace.
If you use an aid for minimal support such as a cane, walking stick or crutches, please answer this question based on your ability to walk when using these aids.

Would you say:

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do at all
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q095

At what age did you begin having [difficulty walking on flat surfaces/difficulty using the stairs/difficulty walking on flat surfaces and using stairs]?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q100

How often [does this difficulty walking/does this difficulty using stairs/do these difficulties] limit your daily activities?

Would you say:

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q105

At what age did [this difficulty walking/this difficulty using stairs/these difficulties walking and using stairs] begin to limit your daily activities?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_R110

The next questions deal with flexibility and dexterity. Only difficulties or long-term conditions that have lasted or are expected to last for six months or more should be considered.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q110

How much difficulty do you have bending down and picking up an object from the floor?

Would you say:

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do at all
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q115

How much difficulty do you have reaching in any direction, for example, above your head?

Would you say:

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do at all
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q120

At what age did you begin having [difficulty bending and picking up an object/difficulty reaching/difficulty bending and picking up an object and difficulty reaching]?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q125

How often [does this difficulty bending and picking up an object/does this difficulty reaching/do these difficulties] limit your daily activities?

Would you say:

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q130

At what age did [this difficulty bending and picking up an object/this difficulty reaching/these difficulties bending and picking up an object and reaching] begin to limit your daily activities?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q135

How much difficulty do you have using your fingers to grasp small objects like a pencil or scissors?

Would you say:

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do at all
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q140

At what age did you begin having difficulty using your fingers to grasp small objects?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q145

How often does this difficulty using your fingers limit your daily activities?

Would you say:

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q150

At what age did this difficulty using your fingers to grasp small objects begin to limit your daily activities?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_R155

The following questions are about pain due to a long-term condition that has lasted or is expected to last for six months or more.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q155

Do you have pain that is always present?

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q160

Do you [also/blank] have periods of pain that reoccur from time to time?

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q165

At what age did you begin having this pain?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

If you have more than one pain problem, please refer to the pain that bothers you the most.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q170

How often does this pain limit your daily activities?

If your pain is controlled by medication or therapy, please answer this question based on when you are using your medication or therapy.

Would you say:

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q175

At what age did this pain begin to limit your daily activities?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

If you have more than one pain problem, please refer to the pain that bothers you the most.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q180

When you are experiencing this pain, how much difficulty do you have with your daily activities?

If your pain is controlled by medication or therapy, please answer this question based on when you are using your medication or therapy.

Would you say:

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do most activities
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q185

Do you think you have a condition that makes it difficult in general for you to learn? This may include learning disabilities such as dyslexia, hyperactivity, attention problems, etc.

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q190

Has a teacher, doctor or other health care professional ever said that you had a learning disability?

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q195

At what age did you begin having a condition that makes it difficult in general for you to learn?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q200

How often are your daily activities limited by this condition?

Would you say:

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q205

At what age did this learning condition begin to limit your daily activities?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q210

How much difficulty do you have with your daily activities because of this condition?

Would you say:

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do most activities
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q215

Has a doctor, psychologist or other health care professional ever said that you had a developmental disability or disorder? This may include Down syndrome, autism, Asperger syndrome, mental impairment due to lack of oxygen at birth, etc.

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q220

At what age were you diagnosed with a developmental disability or disorder?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q225

How often are your daily activities limited by this condition?

Would you say:

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q230

At what age did this developmental disability or disorder begin to limit your daily activities?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q235

How much difficulty do you have with your daily activities because of this condition?

Would you say:

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do most activities
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_R240

Again, please answer for any conditions that have lasted or are expected to last for six months or more. Please remember that your answers will be kept strictly confidential.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q240

Do you have any emotional, psychological or mental health conditions?

e.g., anxiety, depression, bipolar disorder, substance abuse, anorexia, etc.

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q245

[You mentioned earlier that you have an emotional, psychological or mental health condition./blank] At what age did your [condition/emotional, psychological or mental health condition] begin?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q250

How often are your daily activities limited by this condition?

If the condition is controlled by medication or therapy, please answer this question based on when you are using your medication or therapy.

Would you say:

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q255

At what age did this mental health condition begin to limit your daily activities?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q260

When you are experiencing this condition, how much difficulty do you have with your daily activities?

If the condition is controlled by medication or therapy, please answer this question based on when you are using your medication or therapy.

Would you say:

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do most activities
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q265

Do you have any ongoing memory problems or periods of confusion?

Exclude occasional forgetfulness such as not remembering where you put your keys.

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q270

At what age did you begin having memory problems?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q275

How often are your daily activities limited by this problem?

If the problem is controlled by medication or therapy, please answer this question based on when you are using your medication or therapy.

Would you say:

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q280

At what age did these memory problems begin to limit your daily activities?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q285

How much difficulty do you have with your daily activities because of this problem?

If the problem is controlled by medication or therapy, please answer this question based on when you are using your medication or therapy.

Would you say:

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do most activities
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q290

Do you have any other health problem or long-term condition that has lasted or is expected to last for six months or more?

Exclude any health problems previously reported.

  • 1: Yes — Specify the other health problem or long-term condition
  • 2: No

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q295

At what age did you begin having this health problem or condition?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

If you have more than one other health problem or condition, please answer based on the health problem or condition that limits your daily activities the most.

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q300

How often does this health problem or condition limit your daily activities?

If you have more than one other health problem or condition, please answer based on the health problem or condition that limits your daily activities the most.

Would you say:

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always
  • 9: DK

DISABILITY SCREENING QUESTIONS (DSQ) - Question identifier:DSQ_Q305

At what age did this health problem or condition begin to limit your daily activities?

Min = 0; Max = 121

If since birth or less than 1 year of age, enter ¿0'.

If exact age is unknown, please provide your best estimate.

EPISODIC DISABILITIES (EPD)

EPISODIC DISABILITIES (EPD) - Question identifier:EPD_R05

The next questions deal with changes that you may or may not be experiencing with the impact of your conditions over time. Consider the impact of all conditions or limitations that you have.

EPISODIC DISABILITIES (EPD) - Question identifier:EPD_Q05

Do you ever have periods of one month or more when you do not feel limited in your daily activities due to your overall condition?

Consider the impact of all your limitations at the present time.

  • 1: Yes
  • 2: No

EPISODIC DISABILITIES (EPD) - Question identifier:EPD_Q10

Which of the following describes your ability to do your daily activities?

Consider the impact of all your limitations at the present time.

Is it:

  • 1: Getting better
  • 2: Getting worse
  • 3: Staying about the same
  • 4: You are able to do more activities during some periods but fewer activities during other periods

EPISODIC DISABILITIES (EPD) - Question identifier:EPD_Q15

When you do feel limited, how long do these periods usually last?

Choose the response that best describes your situation.

Is it:

  • 1: Hours
  • 2: Days
  • 3: One to three weeks
  • 4: A month
  • 5: Two to eleven months
  • 6: A year or more

EPISODIC DISABILITIES (EPD) - Question identifier:EPD_Q20

You indicated that you never [go] one month without feeling limited. Do you ever have any shorter periods of time, such as hours, days or weeks, when you do not feel limited due to your overall condition?

  • 1: Yes
  • 2: No

EPISODIC DISABILITIES (EPD) - Question identifier:EPD_Q25

When you do not feel limited, how long do these periods usually last?

Choose the response that best describes your situation.

Is it:

  • 1: Hours
  • 2: Days
  • 3: A week
  • 4: Two to three weeks

EPISODIC DISABILITIES (EPD) - Question identifier:EPD_Q30

Does the intensity of your limitation vary?

"Intensity" refers to the degree of limitation you experience with your daily activities. Choose the response that best describes your situation.

Would you say:

  • 1: No, it is usually about the same
  • 2: Yes, there is usually some variation
  • 3: Yes, there is usually a great deal of variation
  • 9: DK

EPISODIC DISABILITIES (EPD) - Question identifier:EPD_Q35

Now thinking about when you do feel limited, does the intensity of your limitation vary?

"Intensity" refers to the degree of limitation you experience with your daily activities. Choose the response that best describes your situation.

Would you say:

  • 1: No, it is usually about the same
  • 2: Yes, there is usually some variation
  • 3: Yes, there is usually a great deal of variation
  • 9: DK

EPISODIC DISABILITIES (EPD) - Question identifier:EPD_Q40

You indicated that, at the current time, [your ability to do daily activities is getting better/your ability to do daily activities is getting worse/your ability to do daily activities is staying about the same/you are able to do more activities during some periods but fewer during other periods]. Thinking about the future, which of the following statements best describes how you think your limitations with daily activities will be five years from now?

Would you say:

  • 1: [My] limitations will likely be gone
  • 2: [My] limitations will likely lessen, but not be gone
  • 3: [My] limitations will likely be about the same as now
  • 4: [My] limitations will likely become greater
  • 5: Things are so unpredictable that [I don't] know what to expect in the future
  • 9: DK

MAIN CONDITION (MC)

MAIN CONDITION (MC) - Question identifier:MC_R05

You indicated earlier that you have a condition or health problem that limits your daily activities.

MAIN CONDITION (MC) - Question identifier:MC_Q05

What is the main medical condition which causes you the most difficulty or limits your activities the most?

Long Answer Length = 80

If you have more than one main medical condition, please select the one which causes you the most difficulty or limits your activities the most.

Specify the main medical condition

MAIN CONDITION (MC) - Question identifier:MC_Q10

Is the cause of your main condition work-related?

Main medical condition: ^MC_Q05 response

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

MAIN CONDITION (MC) - Question identifier:MC_Q15

Which of the following describe this work-related cause?

Main medical condition: ^MC_Q05 response

Select all that apply.

Would you say:

  • 1: Work accident or injury
  • 2: Stress or trauma
  • 3: Abuse or violence
  • 4: Exposure to loud noises
  • 5: Exposure to toxins, chemicals or poor air quality
  • 6: Undetermined cause
  • 7: Other work-related cause
  • 9: DK

MAIN CONDITION (MC) - Question identifier:MC_Q15A

Is this a repetitive motion injury?

  • 1: Yes
  • 2: No

MAIN CONDITION (MC) - Question identifier:MC_Q20

Is the cause of your main condition [also/blank] non-work-related?

Main medical condition: ^MC_Q05 response

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

MAIN CONDITION (MC) - Question identifier:MC_Q25

Which of the following describe this non-work-related cause?

Main medical condition: ^MC_Q05 response

Select all that apply.

Would you say:

  • 01: Evident at birth
  • 02: Hereditary (i.e., genetic)
  • 03: Disease or illness
  • 04: Stress or trauma
  • 05: Abuse or violence
  • 06: Exposure to loud noises
  • 07: Exposure to toxins, chemicals or poor air quality
  • 08: Motor vehicle accident or injury
  • 09: Other type of accident or injury
  • 10: Aging
  • 11: Lifestyle
  • 12: Undetermined cause
  • 13: Other non-work-related cause
  • 99: DK

MAIN CONDITION (MC) - Question identifier:MC_Q30

Do you have a second condition that causes you difficulty or limits your activities?

  • 1: Yes
  • 2: No

MAIN CONDITION (MC) - Question identifier:MC_Q35

What is that condition?

Long Answer Length = 80

MAIN CONDITION (MC) - Question identifier:MC_Q40

Is the cause of your second condition work-related?

Second medical condition: ^MC_Q35 response

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

MAIN CONDITION (MC) - Question identifier:MC_Q45

Which of the following describe this work-related cause?

Second medical condition: ^MC_Q35 reponse

Select all that apply.

Would you say:

  • 1: Work accident or injury
  • 2: Stress or trauma
  • 3: Abuse or violence
  • 4: Exposure to loud noises
  • 5: Exposure to toxins, chemicals or poor air quality
  • 6: Undetermined cause
  • 7: Other work-related cause
  • 9: DK

MAIN CONDITION (MC) - Question identifier:MC_Q45A

Is this a repetitive motion injury?

  • 1: Yes
  • 2: No

MAIN CONDITION (MC) - Question identifier:MC_Q50

Is the cause of your second condition [also/blank] non-work-related?

Second medical condition: ^MC_Q35 response

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

MAIN CONDITION (MC) - Question identifier:MC_Q55

Which of the following describe this non-work-related cause?

Second medical condition: ^MC_Q35 response

Select all that apply.

Would you say:

  • 01: Evident at birth
  • 02: Hereditary (i.e., genetic)
  • 03: Disease or illness
  • 04: Stress or trauma
  • 05: Abuse or violence
  • 06: Exposure to loud noises
  • 07: Exposure to toxins, chemicals or poor air quality
  • 08: Motor vehicle accident or injury
  • 09: Other type of accident or injury
  • 10: Aging
  • 11: Lifestyle
  • 12: Undetermined cause
  • 13: Other non-work-related cause
  • 99: DK

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH)

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_R05

Now, some questions about assistive aids, devices or technologies that you may use to help with a hearing condition.

Assistive aids, devices or technologies are devices or tools designed or adapted to help a person perform a particular task or activity.

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_Q05

Because of your condition, do you use any of the following?

Select all that apply.

Do you use:

  • 01: Hearing aid
  • 02: Cochlear implant or other implant
  • 03: Closed captioning or subtitles for television or movies
  • 04: Visual or vibrating alarms or alerts
  • 05: Amplifiers (e.g., FM, loop systems or infra-red)
  • 06: Video relay services (VRS)
  • 07: Telephone-related devices (e.g., volume controllers, flashers or TTY)
  • 08: Video chatting or video calling
  • 09: Other assistive aid, device or technology — Specify other assistive aid, device or technology
  • 10: None

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_Q10

Are there any assistive aids, devices or technologies for a hearing condition that you think you need but do not have?

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_Q15

Which assistive aids, devices or technologies do you need but do not have?

Select all that apply.

Would you say:

  • 01: Hearing aid
  • 02: Cochlear implant or other implant
  • 03: Closed captioning or subtitles for television or movies
  • 04: Visual or vibrating alarms or alerts
  • 05: Amplifiers (e.g., FM, loop systems or infra-red)
  • 06: Video relay services (VRS)
  • 07: Telephone-related devices (e.g., volume controllers, flashers or TTY)
  • 08: Video chatting or video calling
  • 09: Other assistive aid, device or technology — Specify other assistive aid, device or technology
  • 10: None

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_Q20

Why do you not have a hearing aid?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_Q25

Why do you not have a cochlear implant or other implant?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_Q30

Why do you not have closed captioning or subtitles for television or movies?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_Q35

Why do you not have visual or vibrating alarms or alerts?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_Q40

Why do you not have amplifiers?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_Q45

Why do you not have video relay services (VRS)?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_Q50

Why do you not have telephone-related devices?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_Q55

Why do you not have video chatting or video calling?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_Q60

Why do you not have [AADH_Q15 Category 09 response/the other assistive aid, device or technology]?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_R65

The next questions ask about ways you may communicate to help with a hearing condition.

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_Q65

Do you lip read?

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_Q70

Do you use sign language such as ASL or LSQ?

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_Q75

How often do you use sign language?

Is it:

  • 1: Every day
  • 2: At least once a week
  • 3: At least once a month
  • 4: At least once every six months
  • 5: Less than once every six months

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_Q80

Do you ever use a sign language interpreter?

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - HEARING (AADH) - Question identifier:AADH_Q85

How often do you use a sign language interpreter?

Is it:

  • 1: Every day
  • 2: At least once a week
  • 3: At least once a month
  • 4: At least once every six months
  • 5: Less than once every six months

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV)

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV) - Question identifier:AADV_R05

Now some questions about assistive aids, devices or technologies that you may use to help with a seeing condition.

Assistive aids, devices or technologies are devices or tools designed or adapted to help a person perform a particular task or activity.

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV) - Question identifier:AADV_Q05

Because of your condition, do you use any of the following?

Select all that apply.

Do you use:

  • 01: Eye glasses or contact lenses
  • 02: White cane (e.g., identification cane, support cane, mobility cane, long cane)
  • 03: Recording equipment (Exclude recording features on a cell phone or smartphone.)
  • 04: Braille Refreshable Display device, braille notetaker, braille reading materials or manual brailler
  • 05: Magnifiers (Exclude screen magnification software.)
  • 06: Large print reading materials
  • 07: Dark lined paper or dark ink pens
  • 08: Device with oversized buttons or oversized print on buttons (e.g., remote control or telephone)
  • 09: Audio or described video for television programs
  • 10: Closed-circuit devices (e.g., CCTV)
  • 11: Low-tech vision aides (e.g., monocular, binocular, biopics, etc.)
  • 12: Talking products (e.g., GPS navigation device, watch, kitchen timer, alarm clock, etc.)
  • 13: Other assistive aid, device or technology — Specify other assistive aid, device or technology
  • 14: None

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV) - Question identifier:AADV_Q10

Are there any assistive aids, devices or technologies for a seeing condition that you think you need but do not have?

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV) - Question identifier:AADV_Q15

Which assistive aids, devices or technologies do you need but do not have?

Select all that apply.

Would you say:

  • 01: Eye glasses or contact lenses
  • 02: White cane (e.g., identification cane, support cane, mobility cane, long cane)
  • 03: Recording equipment (Exclude recording features on a cell phone or smartphone.)
  • 04: Braille Refreshable Display device, braille notetaker, braille reading materials or manual brailler
  • 05: Magnifiers (Exclude screen magnification software.)
  • 06: Large print reading materials
  • 07: Dark lined paper or dark ink pens
  • 08: Device with oversized buttons or oversized print on buttons (e.g., remote control or telephone)
  • 09: Audio or described video for television programs
  • 10: Closed-circuit devices (e.g., CCTV)
  • 11: Low-tech vision aides (e.g., monocular, binocular, biopics, etc.)
  • 12: Talking products (e.g., GPS navigation device, watch, kitchen timer, alarm clock, etc.)
  • 13: Other assistive aid, device or technology — Specify other assistive aid, device or technology
  • 14: None

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV) - Question identifier:AADV_Q20

Why do you not have eye glasses or contact lenses?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV) - Question identifier:AADV_Q25

Why do you not have a white cane?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV) - Question identifier:AADV_Q30

Why do you not have recording equipment?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV) - Question identifier:AADV_Q35

Why do you not have a Braille Refreshable Display device, braille note taker, braille reading materials or manual brailler?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV) - Question identifier:AADV_Q40

Why do you not have magnifiers?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV) - Question identifier:AADV_Q45

Why do you not have large print reading materials?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV) - Question identifier:AADV_Q50

Why do you not have dark lined paper or dark ink pens?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV) - Question identifier:AADV_Q55

Why do you not have a device with oversized buttons or oversized print on buttons?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV) - Question identifier:AADV_Q60

Why do you not have audio or described video for television programs?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV) - Question identifier:AADV_Q65

Why do you not have closed-circuit devices?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV) - Question identifier:AADV_Q70

Why do you not have low-tech vision aids?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV) - Question identifier:AADV_Q75

Why do you not have talking products?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - VISION (AADV) - Question identifier:AADV_Q80

Why do you not have [AADV_Q15 Category 13 response/the other assistive aid, device or technology]?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM)

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_R005

Now some questions about assistive aids, devices or technologies that you may use for moving around, to help with bending or reaching or to help with fine motor skills.

Assistive aids, devices or technologies are devices or tools designed or adapted to help a person perform a particular task or activity.

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q005

Because of your condition, do you use any of the following?

Select all that apply.

Do you use:

  • 01: Cane, walking stick or crutches
  • 02: Walker
  • 03: Scooter
  • 04: Manual wheelchair
  • 05: Motorized wheelchair
  • 06: Orthopaedic footwear (e.g., shoes, sandals, etc.)
  • 07: Orthotic or brace
  • 08: Prosthetic device or artificial limb
  • 09: Grasping tool or reach extender
  • 10: Adapted tools, utensils or special grips
  • 11: Device for dressing (e.g., button hook, zipper pull, long-handled shoe horn)
  • 12: Device with oversized buttons (e.g., remote control or telephone)
  • 13: None

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_R010

The next questions are about assistive aids, devices or technologies and accessibility features you may use in your residence to help with moving around, to help with bending or reaching or to help with fine motor skills.

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q010

Because of your condition, at your residence, do you use any of the following?

Select all that apply.

Do you use:

  • 01: Bathroom aids (e.g., raised toilet seat, grab bars, shower or bathtub chair)
  • 02: Walk-in bath or shower
  • 03: Patient lift (e.g., Hoyer lift, sling, sit to stand)
  • 04: Access ramp or a ground-level entrance
  • 05: Elevator, stair lift or a platform or porch lift
  • 06: Automatic or easy to open doors
  • 07: Extra railings (other than on stairs)
  • 08: None

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q015

Because of your condition, at your residence, do you have any of the following?

Select all that apply.

Do you have:

  • 1: Widened doorways or hallways
  • 2: Adjusted (lowered or raised) counters in the kitchen or bathroom
  • 3: None

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q020A

Do you use any other assistive aid, device or technology or accessibility feature for moving around, to help with bending or reaching or to help with fine motor skills?

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q020B

What is the other assistive aid, device or technology that you use?

Long Answer Length = 80

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q025

Are there any assistive aids, devices or technologies for moving around, to help with bending or reaching or to help with fine motor skills that you think you need but do not have?

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q030

Which of the following assistive aids, devices or technologies do you need but do not have?

Select all that apply.

Would you say:

  • 01: Cane, walking stick or crutches
  • 02: Walker
  • 03: Scooter
  • 04: Manual wheelchair
  • 05: Motorized wheelchair
  • 06: Orthopaedic footwear (e.g., shoes, sandals, etc.)
  • 07: Orthotic or brace
  • 08: Prosthetic device or artificial limb
  • 09: Grasping tool or reach extender
  • 10: Adapted tools, utensils or special grips
  • 11: Device for dressing (e.g., button hook, zipper pull, long-handled shoe horn)
  • 12: Device with oversized buttons (e.g., remote control or telephone)
  • 13: Bathroom aids (e.g., raised toilet seat, grab bars, shower or bathtub chair)
  • 14: Walk-in bath or shower
  • 15: Patient lift (e.g., Hoyer lift, sling, sit to stand)
  • 16: Access ramp or a ground-level entrance
  • 17: Elevator, stair lift or a platform or porch lift
  • 18: Automatic or easy to open doors
  • 19: Extra railings (other than on stairs)
  • 20: Widened doorways or hallways
  • 21: Adjusted (lowered or raised) counters in the kitchen or bathroom
  • 22: Other assistive aid, device or technology — Specify other assistive aid, device or technology
  • 23: None

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q035

Why do you not have a cane, walking stick or crutches?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q040

Why do you not have a walker?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q045

Why do you not have a scooter?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q050

Why do you not have a manual wheelchair?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q055

Why do you not have a motorized wheelchair?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q060

Why do you not have orthopaedic footwear?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q065

Why do you not have an orthotic or brace?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q070

Why do you not have a prosthetic device or artificial limb?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q075

Why do you not have a grasping tool or reach extender?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q080

Why do you not have adapted tools, utensils or special grips?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q085

Why do you not have a device for dressing?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q090

Why do you not have a device with oversized buttons?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q095

Why do you not have bathroom aids?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q100

Why do you not have a walk-in bath or shower?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q105

Why do you not have a patient lift?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q110

Why do you not have an access ramp or a ground-level entrance?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q115

Why do you not have an elevator, a stair lift or a platform or porch lift?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q120

Why do you not have automatic or easy to open doors?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q125

Why do you not have extra railings (other than on stairs)?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q130

Why do you not have widened doorways or hallways?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q135

Why do you not have adjusted (lowered or raised) counters in the kitchen or bathroom?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - MOBILITY AND AGILITY (AADM) - Question identifier:AADM_Q140

Why do you not have [AADM_Q030 Category 22 response/the other assistive aid, device or technology]?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - LEARNING AND DEVELOPMENTAL (AADL)

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - LEARNING AND DEVELOPMENTAL (AADL) - Question identifier:AADL_R05

Now some questions about assistive aids, devices or technologies that you may use to help with learning or developmental difficulties.

Assistive aids, devices or technologies are devices or tools designed or adapted to help a person perform a particular task or activity.

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - LEARNING AND DEVELOPMENTAL (AADL) - Question identifier:AADL_Q05

Because of your condition, do you use any of the following?

Select all that apply.

Do you use:

  • 01: Recording equipment or a portable note-taking device
  • 02: Reading aids (e.g., reading focus cards, optical character recognition (OCR), etc.)
  • 03: Writing and spelling aids (e.g., portable spell checker, abbreviation expanders, electronic dictionary, word prediction software, etc.)
  • 04: Math aids (e.g., electronic math worksheets, talking calculator, etc.)
  • 05: Alternative keyboard with overlays
  • 06: Bliss board
  • 07: Other assistive aid, device or technology — Specify other assistive aid, device or technology
  • 08: None

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - LEARNING AND DEVELOPMENTAL (AADL) - Question identifier:AADL_Q10

Are there any assistive aids, devices or technologies for learning that you think you need but do not have?

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - LEARNING AND DEVELOPMENTAL (AADL) - Question identifier:AADL_Q15

Which assistive aids, devices or technologies do you need but do not have?

Select all that apply.

Would you say:

  • 01: Recording equipment or a portable note-taking device
  • 02: Reading aids (e.g., reading focus cards, optical character recognition (OCR), etc.)
  • 03: Writing and spelling aids (e.g., portable spell checker, abbreviation expanders, electronic dictionary, word prediction software, etc.)
  • 04: Math aids (e.g., electronic math worksheets, talking calculator, etc.)
  • 05: Alternative keyboard with overlays
  • 06: Bliss board
  • 07: Other assistive aid, device or technology — Specify other assistive aid, device or technology
  • 08: None

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - LEARNING AND DEVELOPMENTAL (AADL) - Question identifier:AADL_Q20

Why do you not have recording equipment or a portable note-taking device?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - LEARNING AND DEVELOPMENTAL (AADL) - Question identifier:AADL_Q25

Why do you not have reading aids?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - LEARNING AND DEVELOPMENTAL (AADL) - Question identifier:AADL_Q30

Why do you not have writing and spelling aids?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - LEARNING AND DEVELOPMENTAL (AADL) - Question identifier:AADL_Q35

Why do you not have math aids?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - LEARNING AND DEVELOPMENTAL (AADL) - Question identifier:AADL_Q40

Why do you not have an alternative keyboard with overlays?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - LEARNING AND DEVELOPMENTAL (AADL) - Question identifier:AADL_Q45

Why do you not have a Bliss board?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - LEARNING AND DEVELOPMENTAL (AADL) - Question identifier:AADL_Q50

Why do you not have [AADL_Q15 Category 07 response/the other assistive aid, device or technology]?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA)

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_R005A

The following questions are about various assistive aids, devices or technologies that you may use for any of your conditions.

You may feel that some of these questions do not apply to you or may seem similar to questions already asked, but it is important that we ask the same questions of everyone.

Please exclude medication taken for your conditions, as this is included in a later section.

Assistive aids, devices or technologies are devices or tools designed or adapted to help a person perform a particular task or activity.

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_R005B

Because of your condition, do you use any of the following?

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q005A

A. A cell phone, smartphone or smartwatch with specialized features or apps to help with your condition

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q005B

B. A computer, laptop or tablet with specialized software or apps or other adaptations to help with your condition

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q010

Because of your condition, do you use speech to text, text to speech or voice recognition software?

e.g., Dragon Naturally Speaking, Kurzweil 3000, Windows Speech Recognition, etc.

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q015

Because of your condition, do you use screen magnification software?

e.g., ZoomText, Windows Magnifier, Zoom (macOS)

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q020

Because of your condition, do you use a screen reader?

e.g., JAWS, NVDA, Apple VoiceOver, Windows Narrator

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q025

Because of your condition, do you use any other specialized software or apps or adaptations on your devices to help with a condition?

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q030

Because of your condition, do you use a device for playing audio books or e-books?

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q035

Are audio books or e-books generally available in an accessible format for your condition?

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q040

Because of your condition, do you use any of the following?

Select all that apply.

Do you use:

  • 01: Service animal (e.g., guide, hearing ear or mobility dog, specially-trained emotional support or therapy animal)
  • 02: Orthopaedic footwear (e.g., shoes, sandals, etc.)
  • 03: Orthotic or brace
  • 04: Supportive devices (e.g., therapeutic cushions or pillows, special chairs or an adjustable bed)
  • 05: Electrotherapy device for pain (e.g., TENS machine)
  • 06: Voice amplifier
  • 07: Diabetic aids (e.g., blood glucose monitor or needles)
  • 08: Oxygen supplies
  • 09: Smart home devices (e.g., Google Home, Amazon Echo (Alexa), smart lights or thermostats, etc.)
  • 10: Other assistive aid, device or technology — Specify other assistive aid, device or technology
  • 11: None

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q045

Are there any assistive aids, devices or technologies or specialized equipment that you think you need but do not have?

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q050

Which assistive aids, devices or technologies or specialized equipment do you need but do not have?

Select all that apply.

Would you say:

  • 01: Cell phone, smartphone or smartwatch with specialized features or apps
  • 02: Computer, laptop or tablet with specialized software or apps or other adaptations
  • 03: Speech to text, text to speech or voice recognition software
  • 04: Screen magnification software
  • 05: Screen reader
  • 06: Other software or apps or adaptations on your devices to help with a condition
  • 07: Device for playing audio books or e-books
  • 08: Service animal (e.g., guide, hearing or mobility dog, specially-trained emotional support or therapy animal)
  • 09: Orthopaedic footwear (e.g., shoes, sandals, etc.)
  • 10: Orthotic or brace
  • 11: Supportive devices (e.g., therapeutic cushions or pillows, special chairs or an adjustable bed)
  • 12: Electrotherapy device for pain (e.g., TENS machine)
  • 13: Voice amplifier
  • 14: Diabetic aids (e.g., blood glucose monitor or needles)
  • 15: Oxygen supplies
  • 16: Smart home devices (e.g., Google Home, Amazon Echo (Alexa), smart lights or thermostats, etc.)
  • 17: Other assistive aid, device or technology — Specify other assistive aid, device or technology
  • 18: None

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q055

Why do you not have a cellphone, smartphone or smartwatch with specialized features or apps?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q060

Why do you not have a computer, laptop or tablet with specialized software or apps or other adaptations?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q065

Why do you not have speech to text, text to speech or voice recognition software?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q070

Why do you not have screen magnification software?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q075

Why do you not have a screen reader?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q080

Why do you not have other software or apps or adaptations on your devices to help with a condition?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q085

Why do you not have a device for playing audio books or e-books?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q090

Why do you not have a service animal?

Select all that apply.

Is it:

  • 1: Cost
  • 2: Do not want one
  • 3: Not available (e.g., unsure how or where to get one, not available locally, on a waiting list, etc.)
  • 4: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q095

Why do you not have orthopaedic footwear?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q100

Why do you not have an orthotic or brace?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q105

Why do you not have supportive devices?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q110

Why do you not have an electrotherapy device for pain?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q115

Why do you not have a voice amplifier?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q120

Why do you not have diabetic aids?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q125

Why do you not have oxygen supplies?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q130

Why do you not have smart home devices?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q135

Why do you not have [AADA_Q050 Category 17 response/the other assistive aid, device or technology]?

Select all that apply.

Is it:

  • 1: Cost (e.g., not covered by insurance, too expensive to purchase or repair, etc.)
  • 2: Do not want to or not willing to upgrade from current aid or assistive device
  • 3: Not available (e.g., unsure how or where to get aid or assistive device, not available locally, on a waiting list, etc.)
  • 4: Available aids cannot be adapted
  • 5: Other reasons

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q140

Thinking of all the assistive aids, devices or technologies that you use because of your condition, in the past 12 months, did you have any expenses for the purchase, repair or maintenance of your assistive aids, devices or technologies for which you will not be reimbursed?

Include amounts not covered by insurance such as exclusions, deductibles and expenses over limits.

Include amounts paid for by another family member living in the same household.

Exclude amounts for which you have been or will be reimbursed by any insurance or government program.

  • 1: Yes
  • 2: No

ASSISTIVE AIDS, DEVICES OR TECHNOLOGIES - ALL (AADA) - Question identifier:AADA_Q145

What is the total amount of these expenses for which you will not be reimbursed?

Include amounts not covered by insurance such as exclusions, deductibles and expenses over limits.

Include amounts paid for by another family member living in the same household.

Exclude amounts for which you have been or will be reimbursed by any insurance or government program.

Is it:

  • 1: Less than $100
  • 2: $100 to less than $200
  • 3: $200 to less than $500
  • 4: $500 to less than $1,000
  • 5: $1,000 to less than $2,000
  • 6: $2,000 to less than $5,000
  • 7: $5,000 or more
  • 9: DK

MEDICATION USE (MED)

MEDICATION USE (MED) - Question identifier:MED_R05

The next questions are about the use of prescription medications taken for any conditions that have lasted or are expected to last for six months or more.

MEDICATION USE (MED) - Question identifier:MED_Q05

Because of your condition, do you take any prescription medications at least once a week?

Include over-the-counter medications such as low dose aspirin only if the medication was prescribed by a doctor or health professional for your condition.

  • 1: Yes
  • 2: No

MEDICATION USE (MED) - Question identifier:MED_Q10

Because of your condition, do you [also/blank] take any prescription medications less often than once a week such as monthly or every few months?

Include injections administered by a healthcare professional for your condition as well as self-administered medication.

Include over-the-counter medications such as low dose aspirin only if the medication was prescribed by a doctor or health professional for your condition.

  • 1: Yes
  • 2: No

MEDICATION USE (MED) - Question identifier:MED_Q15

In the past 12 months, were you ever unable to get prescription medications you were supposed to take because of the cost?

  • 1: Yes
  • 2: No

MEDICATION USE (MED) - Question identifier:MED_Q20

In the past 12 months, did you ever take prescription medication less often than you were supposed to because of the cost?

  • 1: Yes
  • 2: No

MEDICATION USE (MED) - Question identifier:MED_Q25

Thinking of all the prescription medications you have taken in the past 12 months, did you have any expenses for prescription medications, for which you will not be reimbursed?

Include amounts not covered by insurance such as exclusions, deductibles and expenses over limits.

Include amounts paid for by another family member living in the same household.

Exclude amounts for which you have been or will be reimbursed by any insurance or government program.

Would you say:

  • 1: Yes
  • 2: No
  • 3: Have not taken any prescription medications in the past 12 months

MEDICATION USE (MED) - Question identifier:MED_Q30

What is the amount of these expenses for which you will not be reimbursed?

Include amounts not covered by insurance such as exclusions, deductibles and expenses over limits.

Include amounts paid for by another family member living in the same household.

Exclude amounts for which you have been or will be reimbursed by any insurance or government program.

Is it:

  • 1: Less than $500
  • 2: $500 to less than $1,000
  • 3: $1,000 to less than $2,000
  • 4: $2,000 to less than $5,000
  • 5: $5,000 to less than $7,500
  • 6: $7,500 to less than $10,000
  • 7: $10,000 or more
  • 9: DK

CANNABIS USE (CAN)

CANNABIS USE (CAN) - Question identifier:CAN_R05

The next questions are about the use of cannabis for medical purposes. The term "cannabis" refers to marijuana, hashish, hash oil, CBD oil or any other product of the cannabis plant.

CANNABIS USE (CAN) - Question identifier:CAN_Q05

In the past 12 months, have you used cannabis for medical purposes, either with or without a medical document?

Your answers will be kept confidential and used only for statistical purposes.

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

CANNABIS USE (CAN) - Question identifier:CAN_Q10

In the past 12 months, how often did you use cannabis for medical purposes?

Is it:

  • 1: Once or twice
  • 2: Monthly
  • 3: Weekly
  • 4: Daily or almost daily
  • 5: Did not use cannabis in the past 12 months
  • 9: DK

CANNABIS USE (CAN) - Question identifier:CAN_Q15

Do you have a medical document from a health care professional to use cannabis?

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

HELP RECEIVED (HRE)

HELP RECEIVED (HRE) - Question identifier:HRE_R05

Now, some questions on help you may receive with your daily activities because of any of your conditions.

HELP RECEIVED (HRE) - Question identifier:HRE_Q05

Because of your condition, do you usually receive help with any of the following activities?

Include help received from family, friends, neighbours and from organizations, whether paid or unpaid.

Select all that apply.

Help with:

  • 01: Preparing meals
  • 02: Everyday housework (e.g., dusting or tidying up)
  • 03: Heavy household chores (e.g., yard work, snow removal or spring cleaning)
  • 04: Getting to appointments or running errands (e.g., shopping for groceries or other essential items)
  • 05: Looking after personal finances (e.g., making bank transactions or paying bills)
  • 06: Personal care (e.g., washing, dressing or taking medication)
  • 07: Basic medical care at home (e.g., blood or urine tests, injections, etc.)
  • 08: Moving around inside residence
  • 09: Other type of help — Specify the other type of help you usually receive
  • 10: Do not receive any help

HELP RECEIVED (HRE) - Question identifier:HRE_Q10

Because of your condition, do you need more help than you usually receive with any of the following activities?

Include help received from family, friends, neighbours and from organizations, whether paid or unpaid.

Select all that apply.

Would you say:

  • 01: Preparing meals
  • 02: Everyday housework (e.g., dusting or tidying up)
  • 03: Heavy household chores (e.g., yard work, snow removal or spring cleaning)
  • 04: Getting to appointments or running errands (e.g., shopping for groceries or other essential items)
  • 05: Looking after personal finances (e.g., making bank transactions or paying bills)
  • 06: Personal care (e.g., washing, dressing or taking medication)
  • 07: Basic medical care at home (e.g., blood or urine tests, injections, etc.)
  • 08: Moving around inside residence
  • 09: [HRE_Q05 Category 09 response/Other type of help you usually receive]
  • 10: None of the above

HELP RECEIVED (HRE) - Question identifier:HRE_Q15

Because of your condition, do you need help with any of the following activities?

Select all that apply.

Would you say:

  • 01: Preparing meals
  • 02: Everyday housework (e.g., dusting or tidying up)
  • 03: Heavy household chores (e.g., yard work, snow removal or spring cleaning)
  • 04: Getting to appointments or running errands (e.g., shopping for groceries or other essential items)
  • 05: Looking after personal finances (e.g., making bank transactions or paying bills)
  • 06: Personal care (e.g., washing, dressing or taking medication)
  • 07: Basic medical care at home (e.g., blood or urine tests, injections, etc.)
  • 08: Moving around inside residence
  • 09: Other type of help — Specify the other type of help you need
  • 10: Do not need any help

HELP RECEIVED (HRE) - Question identifier:HRE_Q20

Thinking of all the help you receive with your activities because of your condition, how often do you usually receive help?

Include help received from family, friends, neighbours and from organizations, whether paid or unpaid.

Is it:

  • 1: Daily
  • 2: At least once a week
  • 3: At least once a month
  • 4: Less than once a month

HELP RECEIVED (HRE) - Question identifier:HRE_Q25

Who helps you with your activities?

Select all that apply.

Is it:

  • 1: Family member living with you
  • 2: Family member not living with you
  • 3: Friend or neighbour
  • 4: Organization or individual you pay
  • 5: Organization or individual you do not pay

HELP RECEIVED (HRE) - Question identifier:HRE_Q25A

Which family member living with you?

Select all that apply.

Is it:

  • 1: Spouse or partner
  • 2: Parent or guardian
  • 3: Brother or sister
  • 4: Son or daughter
  • 5: Other family member

HELP RECEIVED (HRE) - Question identifier:HRE_Q25B

Which family member not living with you?

Select all that apply.

Is it:

  • 1: Spouse or partner
  • 2: Parent or guardian
  • 3: Brother or sister
  • 4: Son or daughter
  • 5: Other family member

HELP RECEIVED (HRE) - Question identifier:HRE_Q30

Thinking of all the help you receive because of your condition, in the past 12 months, did you have any expenses for help received, for which you will not be reimbursed?

Include amounts not covered by insurance such as exclusions, deductibles and expenses over limits.

Include amounts paid for by another family member living in the same household.

Exclude amounts for which you have been or will be reimbursed by any insurance or government program.

  • 1: Yes
  • 2: No

HELP RECEIVED (HRE) - Question identifier:HRE_Q35

What is the amount of these expenses for which you will not be reimbursed?

Include amounts not covered by insurance such as exclusions, deductibles and expenses over limits.

Include amounts paid for by another family member living in the same household.

Exclude amounts for which you have been or will be reimbursed by any insurance or government program.

Is it:

  • 1: Less than $500
  • 2: $500 to less than $1,000
  • 3: $1,000 to less than $2,000
  • 4: $2,000 to less than $5,000
  • 5: $5,000 to less than $7,500
  • 6: $7,500 to less than $10,000
  • 7: $10,000 or more
  • 9: DK

HEALTH CARE THERAPIES AND SERVICES (HTS)

HEALTH CARE THERAPIES AND SERVICES (HTS) - Question identifier:HTS_R05

The next questions are about the contact you have with health care and social service providers because of any of your conditions.

HEALTH CARE THERAPIES AND SERVICES (HTS) - Question identifier:HTS_Q05

During the past 12 months, did you receive any of the following therapies or services on a regular basis because of your condition?

Select all that apply.

Did you receive:

  • 01: Physiotherapy, massage therapy or chiropractic treatments
  • 02: Speech therapy
  • 03: Occupational therapy
  • 04: Counselling services from a psychologist, psychiatrist, psychotherapist or social worker
  • 05: Support group services, drop-in center services or telephone information or support lines
  • 06: Life sustaining therapies or specialized medical care (e.g., injections, catheter or colostomy care, wound care, chemotherapy, dialysis, etc.)
  • 07: Addiction services
  • 08: Life skills program or services (e.g., learning skills for independence)
  • 09: Naturopathic, homeopathic or osteopathic treatments
  • 10: Acupuncture
  • 11: Nutrition or dietary services
  • 12: Specialized vision care from an ophthalmologist, optometrist or optician (Exclude regular eye exams.)
  • 13: Other therapy or service — Specify the other therapy or service received
  • 14: None

HEALTH CARE THERAPIES AND SERVICES (HTS) - Question identifier:HTS_Q05A

During the past 12 months, have you spent 14 hours or more per week receiving life sustaining therapies or specialized medical care?

  • 1: Yes
  • 2: No

HEALTH CARE THERAPIES AND SERVICES (HTS) - Question identifier:HTS_Q10

During the past 12 months, did you need to receive more of the following therapies or services because of your condition?

Select all that apply.

Would you say:

  • 01: Physiotherapy, massage therapy or chiropractic treatments
  • 02: Speech therapy
  • 03: Occupational therapy
  • 04: Counselling services from a psychologist, psychiatrist, psychotherapist or social worker
  • 05: Support group services, drop-in center services or telephone information or support lines
  • 06: Life sustaining therapies or specialized medical care (e.g., injections, catheter or colostomy care, wound care, chemotherapy, dialysis, etc.)
  • 07: Addiction services
  • 08: Life skills program or services (e.g., learning skills for independence)
  • 09: Naturopathic, homeopathic or osteopathic treatments
  • 10: Acupuncture
  • 11: Nutrition or dietary services
  • 12: Specialized vision care from an ophthalmologist, optometrist or optician (Exclude regular eye exams.)
  • 13: [HTS_Q05 Category13 response/Other therapy or service]
  • 14: None

HEALTH CARE THERAPIES AND SERVICES (HTS) - Question identifier:HTS_Q15

Why didn't you receive more of the therapies or services that you needed?

Select all that apply.

Was it:

  • 1: Cost (e.g., too expensive, no or limited insurance)
  • 2: No longer available
  • 3: Prevented by health condition
  • 4: Transportation not available
  • 5: Office hours not convenient
  • 6: Other reason - Specify the other reason

HEALTH CARE THERAPIES AND SERVICES (HTS) - Question identifier:HTS_Q20

During the past 12 months, which of the following therapies or services did you need on a regular basis because of your condition but did not receive?

Select all that apply.

Would you say:

  • 01: Physiotherapy, massage therapy or chiropractic treatments
  • 02: Speech therapy
  • 03: Occupational therapy
  • 04: Counselling services from a psychologist, psychiatrist, psychotherapist or social worker
  • 05: Support group services, drop-in center services or telephone information or support lines
  • 06: Life sustaining therapies or specialized medical care (e.g., injections, catheter or colostomy care, wound care, chemotherapy, dialysis, etc.)
  • 07: Addiction services
  • 08: Life skills program or services (e.g., learning skills for independence)
  • 09: Naturopathic, homeopathic or osteopathic treatments
  • 10: Acupuncture
  • 11: Nutrition or dietary services
  • 12: Specialized vision care from an ophthalmologist, optometrist or optician (Exclude regular eye exams.)
  • 13: Other therapy or service — Specify the other therapy or service that you needed but did not receive
  • 14: None

HEALTH CARE THERAPIES AND SERVICES (HTS) - Question identifier:HTS_Q25

Why didn't you receive the therapies or services that you needed on a regular basis?

Select all that apply.

Was it:

  • 01: Cost (e.g., too expensive, no or limited insurance)
  • 02: Not available in community
  • 03: On a waiting list
  • 04: Transportation not available
  • 05: Could not get a referral
  • 06: Office hours not convenient
  • 07: Didn't know where or how to find them
  • 08: Other reason — Specify the other reason

HEALTH CARE THERAPIES AND SERVICES (HTS) - Question identifier:HTS_Q30

Thinking of all the therapies or services you receive because of your condition, in the past 12 months, did you have any expenses for therapies or services, for which you will not be reimbursed?

Include amounts not covered by insurance such as exclusions, deductibles and expenses over limits.

Include amounts paid for by another family member living in the same household.

Exclude amounts for which you have been or will be reimbursed by any insurance or government program.

  • 1: Yes
  • 2: No

HEALTH CARE THERAPIES AND SERVICES (HTS) - Question identifier:HTS_Q35

What is the amount of these expenses for which you will not be reimbursed?

Include amounts not covered by insurance such as exclusions, deductibles and expenses over limits.

Include amounts paid for by another family member living in the same household.

Exclude amounts for which you have been or will be reimbursed by any insurance or government program.

Is it:

  • 1: Less than $500
  • 2: $500 to less than $1,000
  • 3: $1,000 to less than $2,000
  • 4: $2,000 to less than $5,000
  • 5: $5,000 to less than $7,500
  • 6: $7,500 to less than $10,000
  • 7: $10,000 or more
  • 9: DK

EDUCATION (EDU)

EDUCATION (EDU) - Question identifier:EDU_R05

The next questions are on education.

EDUCATION (EDU) - Question identifier:EDU_Q05

Are you currently attending a school, college, CEGEP or university?

Report only attendance for courses that can be used as credits towards a certificate, diploma or degree. Distance learning for credit is included.

  • 1: Yes
  • 2: No

EDUCATION (EDU) - Question identifier:EDU_Q10

When did you last attend school, college, CEGEP or university?

Was it:

  • 1: 2021 or 2022
  • 2: Between 2017 and 2020
  • 3: Before 2017
  • 4: Never
  • 9: DK

EDUCATION (EDU) - Question identifier:EDU_Q15

Did you have your condition when you were attending school?

  • 1: Yes
  • 2: No

EDUCATION (EDU) - Question identifier:EDU_Q20

What type of educational institution [are you attending/did you attend]?

Select all that apply.

[Is/Was] it:

  • 1: Elementary, junior high school or high school
  • 2: Trade school, college, CEGEP or other non-university institution
  • 3: University

EDUCATION (EDU) - Question identifier:EDU_Q25

[Are/Were] you enrolled as a full-time or part-time student?

Each educational institution classifies students as full-time or part-time depending on the type of program, and number of courses, credits or hours of instruction.

Would you say:

  • 1: Full-time student
  • 2: Part-time student
  • 3: Both full-time and part-time student

EDUCATION (EDU) - Question identifier:EDU_Q30

[Are/Were] you studying part-time because of your condition?

  • 1: Yes
  • 2: No

EDUCATION (EDU) - Question identifier:EDU_Q35

Because of your condition, [do/did] you require adapted or modified building features to attend school?

e.g., accessible classrooms, adapted washrooms, ramps, elevators, etc.

  • 1: Yes
  • 2: No

EDUCATION (EDU) - Question identifier:EDU_Q40

[Do/Did] you require any of the following features?

Select all that apply.

Would you say:

  • 1: Accessible classrooms
  • 2: Adapted washrooms
  • 3: Accessible residences
  • 4: Accessible buildings, excluding residences
  • 5: Another feature — Specify the other feature
  • 6: None of the above

EDUCATION (EDU) - Question identifier:EDU_Q45

Which of the following features were made available to you?

Select all that apply.

Would you say:

  • 1: Accessible classrooms
  • 2: Adapted washrooms
  • 3: Accessible residences
  • 4: Accessible buildings, excluding residences
  • 5: [EDU_Q40 Category 5 response/Other features]
  • 6: None of the above

EDUCATION (EDU) - Question identifier:EDU_Q50

[Do/Did] you require specialized transportation to attend school?

  • 1: Yes
  • 2: No

EDUCATION (EDU) - Question identifier:EDU_Q55

[Is/Was] specialized transportation available to you?

  • 1: Yes
  • 2: No

EDUCATION (EDU) - Question identifier:EDU_Q60

[Do/Did] you need any assistive devices, support services, modification to curriculum or additional time for testing to follow your courses?

  • 1: Yes
  • 2: No

EDUCATION (EDU) - Question identifier:EDU_Q65

Which of the following [do/did] you need?

Select all that apply.

Would you say:

  • 01: Cell phone, smartphone or smartwatch with specialized features or apps to help with your condition
  • 02: Computer, laptop or tablet with specialized software or apps or other adaptations to help with your condition
  • 03: Recording equipment or a portable note-taking device
  • 04: Device for playing audio books or e-books
  • 05: Textbooks in e-format
  • 06: Screen magnification software
  • 07: Magnifiers
  • 08: Closed-circuit devices (e.g., CCTV)
  • 09: Large print reading materials
  • 10: Braille Refreshable Display device, braille note taker, braille reading materials or a manual brailler
  • 11: Educational assistant or tutor
  • 12: Sign language interpreter
  • 13: Attendant care services
  • 14: Speech therapist
  • 15: Special education classes
  • 16: Modified or adapted course curriculum
  • 17: Individualized Education Plan (e.g., IEP, PLP)
  • 18: Extended time to take tests and exams
  • 19: Sensory objects (e.g., fidget toys)
  • 20: Quiet room or sensory room
  • 21: Another aid or service — Specify the other aid or service
  • 22: None of the above

EDUCATION (EDU) - Question identifier:EDU_Q70

Which of the following were made available to you?

Select all that apply.

Would you say:

  • 01: Cell phone, smartphone or smartwatch with specialized features or apps to help with your condition
  • 02: Computer, laptop or tablet with specialized software or apps or other adaptations to help with your condition
  • 03: Recording equipment or a portable note-taking device
  • 04: Device for playing audio books or e-books
  • 05: Textbooks in e-format
  • 06: Screen magnification software
  • 07: Magnifiers
  • 08: Closed-circuit devices (e.g., CCTV)
  • 09: Large print reading materials
  • 10: Braille Refreshable Display device, braille note taker, braille reading materials or a manual brailler
  • 11: Educational assistant or tutor
  • 12: Sign language interpreter
  • 13: Attendant care services
  • 14: Speech therapist
  • 15: Special education classes
  • 16: Modified or adapted course curriculum
  • 17: Individualized Education Plan (e.g., IEP, PLP)
  • 18: Extended time to take tests and exams
  • 19: Sensory objects (e.g., fidget toys)
  • 20: Quiet room or sensory room
  • 21: [EDU_Q65 Category 21 response/Other aid or service]
  • 22: None of the above

EDUCATIONAL EXPERIENCES (EEX)

EDUCATIONAL EXPERIENCES (EEX) - Question identifier:EEX_R05

Now some questions about your experience at school.

EDUCATIONAL EXPERIENCES (EEX) - Question identifier:EEX_Q05

[Have you ever discontinued/Did you discontinue] your formal education or training because of your condition?

  • 1: Yes
  • 2: No

EDUCATIONAL EXPERIENCES (EEX) - Question identifier:EEX_R10

Because of your condition, did you experience any of the following?

EDUCATIONAL EXPERIENCES (EEX) - Question identifier:EEX_Q10A

A.Did you begin school later than most other people your age

  • 1: Yes
  • 2: No

EDUCATIONAL EXPERIENCES (EEX) - Question identifier:EEX_Q10B

B. Did you ever attend a special education school or special education classes in a regular school

  • 1: Yes
  • 2: No

EDUCATIONAL EXPERIENCES (EEX) - Question identifier:EEX_Q10C

C. Did you take fewer courses or subjects than you otherwise would have

  • 1: Yes
  • 2: No

EDUCATIONAL EXPERIENCES (EEX) - Question identifier:EEX_Q10D

D. Was your choice of courses or careers influenced

  • 1: Yes
  • 2: No

EDUCATIONAL EXPERIENCES (EEX) - Question identifier:EEX_Q10E

E. Was your education interrupted for long periods of time

  • 1: Yes
  • 2: No

EDUCATIONAL EXPERIENCES (EEX) - Question identifier:EEX_Q10F

F. Did you have any additional expenses for your schooling

  • 1: Yes
  • 2: No

EDUCATIONAL EXPERIENCES (EEX) - Question identifier:EEX_Q10G

Because of your condition, did you ever go back to school for retraining?

Retraining means to update or improve one's skills or to learn new skills or knowledge with a view to adapting to the requirements of the job market.

  • 1: Yes
  • 2: No

EDUCATIONAL EXPERIENCES (EEX) - Question identifier:EEX_Q15A

Because of your condition, did it take you longer to achieve your present level of education?

  • 1: Yes
  • 2: No

EDUCATIONAL EXPERIENCES (EEX) - Question identifier:EEX_Q15B

How much longer did it take?

Min = 0; Max = 10

Round year to nearest whole number. If less than 6 months, enter ¿0'. If 6 months to 1 year, enter ¿1'.

EDUCATIONAL EXPERIENCES (EEX) - Question identifier:EEX_Q20

Because of your condition, did you experience bullying at school?

Bullying is when one person hurts or threatens someone else physically, verbally or in writing. Bullying can include pushing, shoving, kicking, hitting or writing mean or threatening notes, Internet posts or text messages.

  • 1: Yes
  • 2: No

EDUCATIONAL BACKGROUND (EDB)

EDUCATIONAL BACKGROUND (EDB) - Question identifier:EDB_Q05

What is the highest certificate, diploma or degree that you have completed?

Is it:

  • 1: Less than high school diploma or its equivalent
  • 2: High school diploma or a high school equivalency certificate
  • 3: Trades certificate or diploma
  • 4: College, CEGEP or other non-university certificate or diploma (other than trades certificates or diplomas)
  • 5: University certificate or diploma below the bachelor's level
  • 6: Bachelor's degree (e.g., B.A., B.A. (Hons), B.Sc., B.Ed., LL.B.)
  • 7: University certificate, diploma or degree above the bachelor's level
  • 9: DK

EDUCATIONAL BACKGROUND (EDB) - Question identifier:EDB_Q10

In what year did you complete your highest certificate, diploma or degree?

Min = 1922; Max = 2022

EDUCATIONAL BACKGROUND (EDB) - Question identifier:EDB_Q15

What was the major field of study of the highest certificate, diploma or degree you completed?

Long Answer Length = 80

Please be specific. For example: health care attendant, medical laboratory technology, early childhood education, civil engineering.

If you were in a trade or journeyperson program, list the area of specialization e.g., auto mechanics, hairstyling, carpentry.

Wherever possible, report the sub-category of specialization within a broad area of training - especially for graduate studies or other advanced training.

If you specialized in more than one field of study, report the area in which the greatest number of credits or courses was obtained.

Specify major field of study of highest certificate, diploma or degree completed

LABOUR MARKET ACTIVITIES MINIMAL (LMAM)

LABOUR MARKET ACTIVITIES MINIMAL (LMAM) - Question identifier:LMAM_R01

Many of the following questions concern your activities last week. Last week is the week beginning on Sunday and ending Saturday of last week.

LABOUR MARKET ACTIVITIES MINIMAL (LMAM) - Question identifier:LMAM_Q01

Last week, did you work at a job or business?

Last week is the week beginning on Sunday and ending Saturday of last week.

Select ¿Yes' if you worked at least one hour:
• for pay (wages, salary, etc.)
• in self-employment.

Select ¿No' if you:
• were away from work for the entire week for a reason such as vacation, illness, work schedule or layoff
• did not have a job or business.

Would you say:

  • 1: Yes
  • 2: No
  • 3: Completely prevented from working

LABOUR MARKET ACTIVITIES MINIMAL (LMAM) - Question identifier:LMAM_Q02

Last week, did you have a job or business from which you were absent?

Last week is the week beginning on Sunday and ending Saturday of last week.

Select ¿Yes' if you:
• were away from work for the entire week for a reason such as vacation, illness, parental leave or work schedule
• were self-employed with a business but no work was available.

Select ¿No' if you:
• did not have a job or business
• or had a casual job, but no work was available.

  • 1: Yes
  • 2: No

LABOUR MARKET ACTIVITIES MINIMAL (LMAM) - Question identifier:LMAM_Q03

What was the main reason you were absent from work last week?

  • 01: Own illness or disability
  • 02: Caring for own children
  • 03: Caring for adult family member
  • 04: Maternity or parental leave
  • 05: Other personal or family responsibilities
  • 06: Vacation
  • 07: Labour dispute (strike or lockout) (Employees only)
  • 08: Temporary layoff due to business conditions (Employees only)
  • 09: Seasonal layoff (Employees only)
  • 10: Casual job, no work available (Employees only)
  • 11: Work schedule (e.g., 10 days on, 10 days off, employees only)
  • 12: Self-employed, no work available (Self-employed only)
  • 13: Seasonal business (Excluding employees.)
  • 14: Other — Specify the main reason you were absent from work last week

LABOUR FORCE STATUS (LMA2)

LABOUR FORCE STATUS (LMA2) - Question identifier:LMA2_Q01

Did you do anything to find work during the past four weeks?

This refers to activities such as looking at job ads, placing or answering job ads, contacting employers or agencies, etc.
The activity could have been done in person, by telephone, on the Internet, through newspapers, etc.

  • 1: Yes
  • 2: No

LABOUR FORCE STATUS (LMA2) - Question identifier:LMA2_Q02

Last week, did you have a job to start at a definite date in the future?

Last week is the week beginning on Sunday and ending Saturday of last week.

  • 1: Yes
  • 2: No

LABOUR FORCE STATUS (LMA2) - Question identifier:LMA2_Q03

Will you start that job in the next four weeks?

  • 1: Yes
  • 2: No

LABOUR FORCE STATUS (LMA2) - Question identifier:LMA2_Q04

How many hours did you want to work per week?

Would it be:

  • 1: 30 or more hours
  • 2: Less than 30 hours

LABOUR FORCE STATUS (LMA2) - Question identifier:LMA2_Q05

Could you have worked last week [if you had been recalled/if a suitable job had been offered]?

  • 1: Yes
  • 2: No

LABOUR FORCE STATUS (LMA2) - Question identifier:LMA2_Q06

What was the main reason that you were not available to work last week?

  • 01: Own illness or disability
  • 02: Caring for own children
  • 03: Caring for an adult family member
  • 04: Other personal or family responsibilities
  • 05: Going to school
  • 06: Vacation
  • 07: Already have a job
  • 08: Other — Specify the main reason you were not available to work last week

CLASS OF WORKER (LMA3)

CLASS OF WORKER (LMA3) - Question identifier:LMA3_R01

Now some questions about the job or business at which you usually work the most hours.

CLASS OF WORKER (LMA3) - Question identifier:LMA3_Q01

Were you an employee or self-employed?

Select ¿Employee' if you worked:
• for pay (wages, salary, tips or commissions).

Select ¿Self-employed' if you worked:
• for your own business, farm or professional practice
• as an independent contractor, painter, babysitter, etc.

Would you say:

  • 1: Employee
  • 2: Self-employed
  • 3: Working in a family business without pay

SELF-EMPLOYED (SEMP)

SELF-EMPLOYED (SEMP) - Question identifier:SEMP_Q05

What are the reasons you became self-employed?

Select all that apply.

Would you say:

  • 01: Independence, flexibility or freedom
  • 02: Due to nature of job
  • 03: Wanted to have your own business or be your own boss
  • 04: Family business or other business opportunity
  • 05: Personal choice
  • 06: Health condition
  • 07: Higher income
  • 08: Could not find work with employer or lack of job availability
  • 09: Retirement
  • 10: Personal or family responsibilities
  • 11: Laid off or lost job
  • 12: Other reason

JOB TENURE (JT)

JOB TENURE (JT) - Question identifier:JT_Q05

In which year did you start working for the employer you had last week?

Min = 1950; Max = 2022

For multiple jobs, please think about the job where you work the most hours.

JOB TENURE (JT) - Question identifier:JT_Q10

In which month did you start working for the employer you had last week?

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December
  • 99: DK

JOB TENURE (JT) - Question identifier:JT_Q15

In which year did you start working at your current business?

Min = 1950; Max = 2022

JOB TENURE (JT) - Question identifier:JT_Q20

In which month did you start working at your current business?

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December
  • 99: DK

INDUSTRY (LMA4)

INDUSTRY (LMA4) - Question identifier:LMA4_Q01

What was the full name of your business?

Long Answer Length = 50

Enter the full name of the business. If there is no business name, enter your full name.

Specify the full name of your business

INDUSTRY (LMA4) - Question identifier:LMA4_Q02

Last week, for whom did you work?

Long Answer Length = 50

Enter the full name of the company, business, government department or agency, or person.

Specify who you worked for

INDUSTRY (LMA4) - Question identifier:LMA4_Q03

What kind of business, industry or service was this?

Long Answer Length = 50

Examples: new home construction, primary school, municipal police, wheat farm, retail shoe store, food wholesale, car parts factory, federal government

Specify the kind of business, industry or service

OCCUPATION (LMA5)

OCCUPATION (LMA5) - Question identifier:LMA5_R01

The following questions refer to the work or occupation in which you spent most of your time.

OCCUPATION (LMA5) - Question identifier:LMA5_Q01

What kind of work were you doing?

Long Answer Length = 50

Examples: legal secretary, plumber, fishing guide, wood furniture assembler, secondary school teacher, computer programmer

Specify the kind of work you were doing

OCCUPATION (LMA5) - Question identifier:LMA5_Q02

What were your most important activities or duties?

Long Answer Length = 50

Examples: prepared legal documents, installed residential plumbing, guided fishing parties, made wood furniture products, taught mathematics, developed software

Specify your most important activities or duties

WORKPLACE (WKPL)

WORKPLACE (WKPL) - Question identifier:WKPL_Q05

In this job, are you a union member or covered by a union contract or collective agreement?

  • 1: Yes
  • 2: No

WORKPLACE (WKPL) - Question identifier:WKPL_Q10

About how many persons are employed at [your current business/the location where you now work]?

Is it:

  • 1: Less than 20
  • 2: 20 to 99
  • 3: 100 to 500
  • 4: Over 500
  • 9: DK

USUAL HOURS OF WORK (LMA6)

USUAL HOURS OF WORK (LMA6) - Question identifier:LMA6_Q01

[Excluding overtime, on average, how many paid hours do you usually work per week/On average, how many hours do you usually work per week]?

Min = 0.0; Max = 168.0

If necessary, enter a decimal value e.g., 32.5.

PART-TIME EMPLOYMENT (PT)

PART-TIME EMPLOYMENT (PT) - Question identifier:PT_Q05

What is the main reason you usually work less than 30 hours per week?

Is it:

  • 01: Temporary illness
  • 02: Health condition
  • 03: Caring for own children
  • 04: Caring for an adult family member
  • 05: Other personal or family responsibilities
  • 06: Going to school
  • 07: Economic conditions
  • 08: Could not find work with 30 or more hours per week
  • 09: Job is part-time or contract / More hours not available
  • 10: Personal preference (e.g., do not want to work more than 30 hours)
  • 11: Other reason — Specify the reason for working less than 30 hours per week

PERMANENT WORK (PW)

PERMANENT WORK (PW) - Question identifier:PW_Q05

Is your job permanent, or is there some way that it is not permanent?

It is a permanent job if the employer did not hire the employee on the understanding that the job would last only for a fixed duration, until a given date or until the end of the project.

Would you say:

  • 1: Permanent
  • 2: Not permanent (e.g., seasonal, temporary, term, casual)

PERMANENT WORK (PW) - Question identifier:PW_Q10

In what way is your job not permanent?

Is it:

  • 1: Seasonal job
  • 2: Temporary, term or contract job (e.g., non-seasonal)
  • 3: Casual job
  • 4: Work done through a temporary help agency
  • 5: Student job
  • 6: Apprenticeship, internship or articling position
  • 7: Other reason — Specify the reason why job is not permanent

PERIODS OF UNEMPLOYMENT (POU)

PERIODS OF UNEMPLOYMENT (POU) - Question identifier:POU_Q05

Have you had any periods of unemployment in the past five years?

Exclude any periods you were away from work for reasons such as vacation, illness, parental leave or work schedule.

  • 1: Yes
  • 2: No

PERIODS OF UNEMPLOYMENT (POU) - Question identifier:POU_Q10

How many different periods of unemployment did you have?

Exclude any periods you were away from work for reasons such as vacation, illness, parental leave or work schedule.

Is it:

  • 1: One
  • 2: Two
  • 3: Three or more
  • 9: DK

EMPLOYMENT DETAILS (EDE)

EMPLOYMENT DETAILS (EDE) - Question identifier:EDE_Q05

Because of your condition, have you ever done any of the following?

Select all that apply.

Have you:

  • 1: Changed the kind of work you do
  • 2: Changed the amount of work you do
  • 3: Changed jobs
  • 4: Began working from home
  • 5: Taken an absence from work of one month or more
  • 6: None of the above

EMPLOYMENT DETAILS (EDE) - Question identifier:EDE_Q10

Does your condition limit the amount or kind of work you can do at your present job or business?

  • 1: Yes
  • 2: No

EMPLOYMENT DETAILS (EDE) - Question identifier:EDE_Q15

Where were you employed when you first experienced work limitations?

Were you:

  • 1: Working with current employer or business
  • 2: Working elsewhere
  • 3: Not working

EMPLOYMENT DETAILS (EDE) - Question identifier:EDE_Q20

Are you now doing the same kind of work as you were doing at the time you first experienced work limitations?

  • 1: Yes
  • 2: No

EMPLOYMENT DETAILS (EDE) - Question identifier:EDE_Q25

Is your condition the reason you are now doing a different kind of work?

  • 1: Yes
  • 2: No

EMPLOYMENT DETAILS (EDE) - Question identifier:EDE_Q30

Do you believe that your condition makes it difficult for you to change jobs or to advance at your present job?

Would you say:

  • 1: Yes, very difficult
  • 2: Yes, difficult
  • 3: No, not difficult

EMPLOYMENT DETAILS (EDE) - Question identifier:EDE_Q35

Why do you believe that your condition makes it difficult for you to change jobs or advance at your present job or business?

Select all that apply.

Would you say:

  • 1: Discrimination or stigma because of condition
  • 2: Condition limits number of hours that can be worked
  • 3: Condition limits ability to search for a job
  • 4: Difficult to obtain required supports or accommodations
  • 5: Adapting to a new work environment would be difficult
  • 6: Other reason
  • 7: None of the above

EMPLOYMENT DETAILS (EDE) - Question identifier:EDE_Q40

Have you told your employer about your condition?

  • 1: Yes
  • 2: No

EMPLOYMENT DETAILS (EDE) - Question identifier:EDE_Q45

Considering your experience, education and training, how qualified do you feel for the job you held last week?

Would you say:

  • 1: Overqualified
  • 2: Qualified
  • 3: Underqualified
  • 9: DK

LOOKING FOR WORK (LW)

LOOKING FOR WORK (LW) - Question identifier:LW_Q05

What did you do to find work during the past four weeks?

The activity could have been done in person, by telephone, on the Internet, through newspapers, etc.

Select all that apply.

Would you say:

  • 01: Contacted employers directly
  • 02: Looked at job ads
  • 03: Placed or answered job ads
  • 04: Contacted a government employment agency (e.g., Service Canada or a provincial/territorial employment centre)
  • 05: Contacted a private employment agency
  • 06: Contacted a union
  • 07: Contacted friends or relatives
  • 08: Other method to find work — Specify the other method to find work

LOOKING FOR WORK (LW) - Question identifier:LW_Q10

As of last week, how many weeks have you been looking for work?

Min = 0; Max = 999

Include full weeks only. e.g., if 3 weeks and 6 days, please enter ¿3'.

LOOKING FOR WORK (LW) - Question identifier:LW_Q15

In what kind of business, industry or service were you looking for work?

Long Answer Length = 80

e.g., new home construction, primary school, municipal police, wheat farm, retail shoe store, food wholesale, car parts factory, federal government

Specify the kind of business, industry or service

LOOKING FOR WORK (LW) - Question identifier:LW_R20

Have any of the following caused you difficulty in finding work?

LOOKING FOR WORK (LW) - Question identifier:LW_Q20A

A. Not knowing how or where to look for work

  • 1: Yes
  • 2: No

LOOKING FOR WORK (LW) - Question identifier:LW_Q20B

B. Not knowing the type of job you wanted

  • 1: Yes
  • 2: No

LOOKING FOR WORK (LW) - Question identifier:LW_Q20C

C. Not having the work experience required for available jobs

  • 1: Yes
  • 2: No

LOOKING FOR WORK (LW) - Question identifier:LW_Q20D

D. Not having enough education or training for available jobs

  • 1: Yes
  • 2: No

LOOKING FOR WORK (LW) - Question identifier:LW_Q20E

E. Not having the means of transportation to get to available jobs

  • 1: Yes
  • 2: No

LOOKING FOR WORK (LW) - Question identifier:LW_Q20F

F. A shortage of jobs

  • 1: Yes
  • 2: No

LOOKING FOR WORK (LW) - Question identifier:LW_Q20G

G. Your age

e.g., too young or too old

  • 1: Yes
  • 2: No

LOOKING FOR WORK (LW) - Question identifier:LW_Q20H

H. Your health condition limits your search for work

  • 1: Yes
  • 2: No

LOOKING FOR WORK (LW) - Question identifier:LW_Q20I

I. Personal and family responsibilities

  • 1: Yes
  • 2: No

LOOKING FOR WORK (LW) - Question identifier:LW_Q20J

J. You experienced discrimination in the past

  • 1: Yes
  • 2: No

LOOKING FOR WORK (LW) - Question identifier:LW_Q20K

K. You experienced accessibility issues when applying for work

  • 1: Yes
  • 2: No

LOOKING FOR WORK (LW) - Question identifier:LW_Q25

You reported that you did not have the means of transportation to get to available jobs. Was this due to not having available accessible transportation?

  • 1: Yes
  • 2: No

PAST JOB ATTACHMENT (PJA)

PAST JOB ATTACHMENT (PJA) - Question identifier:PJA_Q05

Have you ever worked at a job or business?

  • 1: Yes
  • 2: No

PAST JOB ATTACHMENT (PJA) - Question identifier:PJA_Q10

When did you last work?

Min = 1922; Max = 2022

Enter year.
Include work and working without pay at a family farm or business.
Exclude volunteer work, housework, maintenance or repairs for your own home.

PAST JOB ATTACHMENT (PJA) - Question identifier:PJA_Q15

In which month did you last work?

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December
  • 99: DK

CLASSIFICATION OF RETIREMENT (RETC)

CLASSIFICATION OF RETIREMENT (RETC) - Question identifier:RETC_Q05

At this time, do you consider yourself retired?

  • 1: Yes
  • 2: No

CLASSIFICATION OF RETIREMENT (RETC) - Question identifier:RETC_Q10

Would that be completely retired or partly retired?

  • 1: Completely retired
  • 2: Partly retired

CLASSIFICATION OF RETIREMENT (RETC) - Question identifier:RETC_Q15

Have you ever retired from a job or business?

  • 1: Yes
  • 2: No

CLASSIFICATION OF RETIREMENT (RETC) - Question identifier:RETC_Q20

After retirement, some people return to work and later retire again. Have you retired more than one time?

  • 1: Yes
  • 2: No

CLASSIFICATION OF RETIREMENT (RETC) - Question identifier:RETC_Q25

When did you [last/blank] retire?

Min = 1922; Max = 2022

RETIREMENT DETAILS (RDE)

RETIREMENT DETAILS (RDE) - Question identifier:RDE_Q05

Did you retire because of your condition?

Would you say:

  • 1: Yes, completely
  • 2: Yes, partially
  • 3: No

RETIREMENT DETAILS (RDE) - Question identifier:RDE_Q10

In [year], did you retire from a job or business or did you stop looking for work?

  • 1: Retired from job or business
  • 2: Stopped looking for work

RETIREMENT DETAILS (RDE) - Question identifier:RDE_Q15

Was this retirement voluntary?

  • 1: Yes
  • 2: No

UNEMPLOYED DETAILS (UDE)

UNEMPLOYED DETAILS (UDE) - Question identifier:UDE_Q05

When you last worked, how many hours did you usually work per week?

Min = 1; Max = 168

If necessary, enter a decimal value e.g., 32.5

UNEMPLOYED DETAILS (UDE) - Question identifier:UDE_Q10

Were you an employee or self-employed?

Select "Employee" if you worked for pay including wages, salary, tips or commissions.

Select "Self-employed" if you worked for your own business, farm or professional practice, as an independent contractor, painter, babysitter, etc.

Would you say:

  • 1: Employee
  • 2: Self-employed
  • 3: Working in a family business without pay

UNEMPLOYED DETAILS (UDE) - Question identifier:UDE_Q15

What was the full name of your business?

Long Answer Length = 50

Enter the full name of the business. If there is no business name, enter your full name.

Specify the full name of your business

UNEMPLOYED DETAILS (UDE) - Question identifier:UDE_Q20

For whom did you work?

Long Answer Length = 50

Enter the full name of the company, business, government department or agency or person.

Specify who you worked for

UNEMPLOYED DETAILS (UDE) - Question identifier:UDE_Q25

What kind of business, industry or service was this?

Long Answer Length = 50

Examples: new home construction, primary school, municipal police, wheat farm, retail shoe store, food wholesale, car parts factory, federal government

Specify the kind of business, industry or service

UNEMPLOYED DETAILS (UDE) - Question identifier:UDE_Q30

What kind of work were you doing?

Long Answer Length = 50

Examples: legal secretary, plumber, fishing guide, wood furniture assembler, secondary school teacher, computer programmer

Specify the kind of work you were doing

UNEMPLOYED DETAILS (UDE) - Question identifier:UDE_Q35

What were your most important activities or duties?

Long Answer Length = 50

Examples: prepared legal documents, installed residential plumbing, guided fishing parties, made wood furniture products, taught mathematics, developed software

Specify your most important activities or duties

UNEMPLOYED DETAILS (UDE) - Question identifier:UDE_Q40

Does your condition limit the amount or kind of work you can do at a job or business?

  • 1: Yes
  • 2: No

UNEMPLOYED DETAILS (UDE) - Question identifier:UDE_Q45

Were you working at a job or business at the time you became limited in the kind or amount of work you can do?

  • 1: Yes
  • 2: No

UNEMPLOYED DETAILS (UDE) - Question identifier:UDE_Q50

Does your condition affect your ability to look for work?

  • 1: Yes
  • 2: No

UNEMPLOYED DETAILS (UDE) - Question identifier:UDE_Q55

Because of your condition, are you limited in your ability to do any of the following?

Select all that apply.

Would you say:

  • 1: Work at a full-time job
  • 2: Work at a part-time job
  • 3: Neither

UNEMPLOYED DETAILS (UDE) - Question identifier:UDE_Q60

Did you tell your previous employer about your condition?

  • 1: Yes
  • 2: No

NOT IN THE LABOUR FORCE DETAILS (NDE)

NOT IN THE LABOUR FORCE DETAILS (NDE) - Question identifier:NDE_Q05

When you last worked, how many hours did you usually work per week?

Min = 1; Max = 168

If necessary, enter a decimal value e.g., 32.5.

NOT IN THE LABOUR FORCE DETAILS (NDE) - Question identifier:NDE_Q10

Were you an employee or self-employed?

Select "Employee" if you worked for pay including wages, salary, tips or commissions.

Select "Self-employed" if you worked for your own business, farm or professional practice or as an independent contractor, painter, babysitter, etc.

Would you say:

  • 1: Employee
  • 2: Self-employed
  • 3: Working in a family business without pay

NOT IN THE LABOUR FORCE DETAILS (NDE) - Question identifier:NDE_Q15

What was the full name of your business?

Long Answer Length = 50

Enter the full name of the business. If there is no business name, enter your full name.

Specify the full name of your business

NOT IN THE LABOUR FORCE DETAILS (NDE) - Question identifier:NDE_Q20

For whom did you work?

Long Answer Length = 50

Enter the full name of the company, business, government department or agency or person.

Specify who you worked for

NOT IN THE LABOUR FORCE DETAILS (NDE) - Question identifier:NDE_Q25

What kind of business, industry or service was this?

Long Answer Length = 50

Examples: new home construction, primary school, municipal police, wheat farm, retail shoe store, food wholesale, car parts factory, federal government

Specify the kind of business, industry or service

NOT IN THE LABOUR FORCE DETAILS (NDE) - Question identifier:NDE_Q30

What kind of work were you doing?

Long Answer Length = 50

Examples: legal secretary, plumber, fishing guide, wood furniture assembler, secondary school teacher, computer programmer

Specify the kind of work you were doing

NOT IN THE LABOUR FORCE DETAILS (NDE) - Question identifier:NDE_Q35

What were your most important activities or duties?

Long Answer Length = 50

Examples: prepared legal documents, installed residential plumbing, guided fishing parties, made wood furniture products, taught mathematics, developed software

Specify your most important activities or duties

NOT IN THE LABOUR FORCE DETAILS (NDE) - Question identifier:NDE_Q40

Does your condition completely prevent you from working at a job or business?

  • 1: Yes
  • 2: No

NOT IN THE LABOUR FORCE DETAILS (NDE) - Question identifier:NDE_Q45

Is there some type of workplace arrangement or modification that would enable you to work at a paid job or business such as modified or different duties or technical aids?

  • 1: Yes
  • 2: No

NOT IN THE LABOUR FORCE DETAILS (NDE) - Question identifier:NDE_Q50

Does your condition limit the amount or kind of work you could do at a job or business?

  • 1: Yes
  • 2: No

NOT IN THE LABOUR FORCE DETAILS (NDE) - Question identifier:NDE_Q55

Were you working at a job or business at the time you became [completely unable to work/limited in the amount or kind of work you could do]?

  • 1: Yes
  • 2: No

NOT IN THE LABOUR FORCE DETAILS (NDE) - Question identifier:NDE_Q60

Does your condition affect your ability to look for work?

  • 1: Yes
  • 2: No

NOT IN THE LABOUR FORCE DETAILS (NDE) - Question identifier:NDE_Q65

Have you looked for work in the past two years?

  • 1: Yes
  • 2: No

NOT IN THE LABOUR FORCE DETAILS (NDE) - Question identifier:NDE_Q70

Some people have encountered barriers which have discouraged them from looking for work. Thinking about your own experience, indicate which of the following situations might apply to you.

Select all that apply.

Would you say:

  • 01: Your expected employment income would be less than your current income
  • 02: You would lose additional supports (e.g., drug plan or housing)
  • 03: Lack of specialized transportation
  • 04: Family responsibilities prevent you from working
  • 05: Past attempts to find work have been unsuccessful
  • 06: Family or friends discourage you from working
  • 07: You have experienced discrimination in the past
  • 08: You feel your training or experience is not adequate for the current job market
  • 09: Few jobs available in the local area
  • 10: You experienced accessibility issues when applying for work
  • 11: Health condition
  • 12: Age
  • 13: Other barrier — Specify the other barrier
  • 14: None

NOT IN THE LABOUR FORCE DETAILS (NDE) - Question identifier:NDE_Q75

Did you tell your previous employer about your condition?

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

LABOUR MARKET ATTACHMENT (LA)

LABOUR MARKET ATTACHMENT (LA) - Question identifier:LA_Q05

Did you want a job last week?

  • 1: Yes
  • 2: No

LABOUR MARKET ATTACHMENT (LA) - Question identifier:LA_Q10

What was the main reason you did not look for work last week?

Was it:

  • 01: Temporary illness
  • 02: Health condition
  • 03: Caring for own children
  • 04: Caring for an adult family member
  • 05: Other personal or family responsibilities
  • 06: Going to school
  • 07: Waiting for recall to former job
  • 08: Waiting for replies from employers
  • 09: Believed no work is available in the area
  • 10: Believed no work is available suited to skills
  • 11: Fear of prejudice or discrimination
  • 12: No reason
  • 13: Other reason for not looking for work

LABOUR MARKET ATTACHMENT (LA) - Question identifier:LA_Q15

Could you have worked last week if a suitable job had been offered?

  • 1: Yes
  • 2: No

LABOUR MARKET ATTACHMENT (LA) - Question identifier:LA_Q20

What was the main reason you were not available to work last week?

Was it:

  • 01: Temporary illness
  • 02: Health condition
  • 03: Caring for own children
  • 04: Caring for an adult family member
  • 05: Other personal or family responsibilities
  • 06: Going to school
  • 07: Vacation
  • 08: Already have a job
  • 09: Other reason — Specify main reason for not being available for work last week

LABOUR MARKET ATTACHMENT (LA) - Question identifier:LA_Q25

Do you think that you will look for work any time in the next 12 months?

  • 1: Yes
  • 2: No

LABOUR MARKET ATTACHMENT (LA) - Question identifier:LA_Q30

Why do you think that you will look for work any time in the next 12 months?

Select all that apply.

Would you say:

  • 1: You expect your condition to improve
  • 2: There will be changes or improvements in the workplace
  • 3: You will be taking training
  • 4: Will be graduating from school
  • 5: Another reason
  • 6: No reason

PERIODS OF EMPLOYMENT (POE)

PERIODS OF EMPLOYMENT (POE) - Question identifier:POE_Q05

Have you had any periods of employment in the last 12 months; that is to say, periods when you had a job or business?

  • 1: Yes
  • 2: No

PERIODS OF EMPLOYMENT (POE) - Question identifier:POE_Q10

How many different periods of employment did you have?

Was it:

  • 1: One
  • 2: Two
  • 3: Three or more

PERIODS OF EMPLOYMENT (POE) - Question identifier:POE_Q15

What was the length of the longest period of employment?

Was it:

  • 1: Under three months
  • 2: Three to five months
  • 3: Six months or more

WORKPLACE TRAINING (WTR)

WORKPLACE TRAINING (WTR) - Question identifier:WTR_R05

The next few questions deal with job-related training paid for or provided by your employer or company.

WORKPLACE TRAINING (WTR) - Question identifier:WTR_Q05

In the past 12 months, have you received any classroom training related to your job?

Include all training activities which have a predetermined format, including a pre-defined objective, specific content and progress that may be monitored and/or evaluated.
Include courses, workshops and seminars.

  • 1: Yes
  • 2: No

WORKPLACE TRAINING (WTR) - Question identifier:WTR_Q10

During the last 12 months of your previous employment, did you receive any classroom training related to your job?

Include all training activities which have a predetermined format, including a pre-defined objective, specific content and progress that may be monitored and/or evaluated.
Include courses, workshops and seminars.

  • 1: Yes
  • 2: No

WORKPLACE TRAINING (WTR) - Question identifier:WTR_Q15

In the past 12 months, have you received any on-the-job training?

  • 1: Yes
  • 2: No

WORKPLACE TRAINING (WTR) - Question identifier:WTR_Q20

During the last 12 months of your previous employment, did you receive any on-the-job training?

  • 1: Yes
  • 2: No

WORKPLACE TRAINING (WTR) - Question identifier:WTR_Q25

In the past 12 months, did you participate in any work-related training that was not paid for or provided by an employer?

  • 1: Yes
  • 2: No

WORKPLACE TRAINING (WTR) - Question identifier:WTR_Q30

Who paid for this training?

Would you say:

  • 1: Paid for it yourself
  • 2: Provided by government program
  • 3: Provided by non-profit organization or other agency for free
  • 4: Other
  • 9: DK

WORKPLACE TRAINING (WTR) - Question identifier:WTR_Q35

In the past 12 months, did you want to take some work-related training courses?

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

WORKPLACE TRAINING (WTR) - Question identifier:WTR_Q40

Did any of the following prevent you from taking any work-related training courses?

Select all that apply.

Would you say:

  • 01: Location was not physically accessible
  • 02: Courses were not adapted to the needs of your condition
  • 03: You requested courses but were denied them by employer
  • 04: Your condition
  • 05: Inadequate transportation
  • 06: Too costly
  • 07: Too busy
  • 08: Other reason
  • 99: DK

WORKPLACE TRAINING (WTR) - Question identifier:WTR_Q45

Why did you not want to take any work-related training courses?

Select all that apply.

Would you say:

  • 01: Location was not physically accessible
  • 02: Courses were not adapted to the needs of your condition
  • 03: You requested courses but were denied them by employer
  • 04: Your condition
  • 05: Inadequate transportation
  • 06: Too costly
  • 07: Too busy
  • 08: Other reason
  • 09: No reason

EMPLOYMENT MODIFICATIONS (EMO)

EMPLOYMENT MODIFICATIONS (EMO) - Question identifier:EMO_Q05

Because of your condition, [do/would] you require any of the following to be able to work?

Select all that apply.

Would you say:

  • 01: Modified or different duties
  • 02: Working from home
  • 03: Modified hours or days or reduced work hours
  • 04: Human support (e.g., reader, sign language interpreter, job coach or personal assistant)
  • 05: Technical aids (e.g., voice synthesizer, TTY, infrared system or portable note-taker)
  • 06: Computer, laptop or tablet with specialized software or other adaptations (e.g., braille, screen magnification software, voice recognition software or a screen reader)
  • 07: Communication aids (e.g., braille or large print reading material or recording equipment)
  • 08: Modified or ergonomic workstation
  • 09: Special chair or back support
  • 10: Handrails, ramps, widened doorways or hallways
  • 11: Adapted or accessible parking
  • 12: Accessible elevators
  • 13: Adapted washrooms
  • 14: Specialized transportation
  • 15: Other equipment, help or work arrangement — Specify the other equipment, help or work arrangement
  • 16: None of the above

EMPLOYMENT MODIFICATIONS (EMO) - Question identifier:EMO_Q10

Which of the following have been made available to you?

Select all that apply.

Would you say:

  • 01: Modified or different duties
  • 02: Working from home
  • 03: Modified hours or days or reduced work hours
  • 04: Human support (e.g., reader, sign language interpreter, job coach or personal assistant)
  • 05: Technical aids (e.g., voice synthesizer, TTY, infrared system or portable note-taker)
  • 06: Computer, laptop or tablet with specialized software or other adaptations (e.g., braille, screen magnification software, voice recognition software or screen reader)
  • 07: Communication aids (e.g., braille or large print reading material or recording equipment)
  • 08: Modified or ergonomic workstation
  • 09: Special chair or back support
  • 10: Handrails, ramps, widened doorways or hallways
  • 11: Adapted or accessible parking
  • 12: Accessible elevators
  • 13: Adapted washrooms
  • 14: Specialized transportation
  • 15: [EMO_Q05 Category 15 response/Other equipment, help or work arrangement]
  • 16: None of the above

EMPLOYMENT MODIFICATIONS (EMO) - Question identifier:EMO_Q15

Did you ask your employer for the workplace accommodations that have not been made available to you?

  • 1: Yes
  • 2: No

EMPLOYMENT MODIFICATIONS (EMO) - Question identifier:EMO_Q20

Why have you not received the workplace accommodations that you need?

Select all that apply.

Would you say:

  • 1: Too expensive (e.g., purchase, maintenance or repair)
  • 2: Employer or supervisor refused request
  • 3: On a waiting list
  • 4: Not available locally
  • 5: Other reason — Specify the other reason you have not received workplace accommodations

EMPLOYMENT MODIFICATIONS (EMO) - Question identifier:EMO_Q25

Is your employer aware that you need the workplace accommodations?

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

EMPLOYMENT MODIFICATIONS (EMO) - Question identifier:EMO_Q30

Why have you not asked for the workplace accommodations needed?

Select all that apply.

Would you say:

  • 01: Uncomfortable asking
  • 02: Did not want to cause difficulty for employer
  • 03: Did not think employer could afford or find proper accommodations
  • 04: Did not want to disclose the need for accommodation
  • 05: Concerned about reaction of co-workers
  • 06: Fear of negative outcomes
  • 07: Condition is not severe enough
  • 08: Lack of awareness or understanding by employer with respect to accommodation requests
  • 09: Been refused in the past
  • 10: Other reason — Specify the other reason you have not asked for workplace accommodations

EMPLOYMENT MODIFICATIONS (EMO) - Question identifier:EMO_Q35

Did you ask your previous employer for the workplace accommodations that have not been made available?

  • 1: Yes
  • 2: No

EMPLOYMENT MODIFICATIONS (EMO) - Question identifier:EMO_Q40

Why did you not receive the workplace accommodations needed?

Select all that apply.

Would you say:

  • 1: Too expensive (e.g., purchase, maintenance or repair)
  • 2: Employer or supervisor refused request
  • 3: On a waiting list
  • 4: Not available locally
  • 5: Other reason — Specify the other reason you did not receive workplace accommodations

EMPLOYMENT MODIFICATIONS (EMO) - Question identifier:EMO_Q45

Was your previous employer aware that you needed the workplace accommodations?

Would you say:

  • 1: Yes
  • 2: No
  • 9: DK

EMPLOYMENT MODIFICATIONS (EMO) - Question identifier:EMO_Q50

Why did you not ask for the workplace accommodations needed?

Select all that apply.

Would you say:

  • 01: Uncomfortable asking
  • 02: Did not want to cause difficulty for employer
  • 03: Did not think employer could afford or find proper accommodations
  • 04: Did not want to disclose the need for accommodation
  • 05: Concerned about reaction of co-workers
  • 06: Fear of negative outcomes
  • 07: Condition is not severe enough
  • 08: Lack of awareness or understanding by employer with respect to accommodation requests
  • 09: Been refused in the past
  • 10: Other reason — Specify the other reason you did not ask for workplace accommodations

LABOUR FORCE DISCRIMINATION (LFD)

LABOUR FORCE DISCRIMINATION (LFD) - Question identifier:LFD_Q05

In the past five years, do you believe that because of your condition, you have been refused a job interview?

If the question is not applicable to your situation, please select "No".

  • 1: Yes
  • 2: No

LABOUR FORCE DISCRIMINATION (LFD) - Question identifier:LFD_Q10

In the past five years, do you believe that because of your condition, you have been refused a job?

If the question is not applicable to your situation, please select "No".

  • 1: Yes
  • 2: No

LABOUR FORCE DISCRIMINATION (LFD) - Question identifier:LFD_Q15

In the past five years, do you believe that because of your condition, you have been refused a job promotion?

If the question is not applicable to your situation, please select "No".

  • 1: Yes
  • 2: No

LABOUR FORCE DISCRIMINATION (LFD) - Question identifier:LFD_Q20

Do you consider yourself to be disadvantaged in employment because of your condition?

  • 1: Yes
  • 2: No

LABOUR FORCE DISCRIMINATION (LFD) - Question identifier:LFD_Q25

Do you believe that your current employer or any potential employer would be likely to consider you disadvantaged in employment because of your condition?

  • 1: Yes
  • 2: No

VETERANS (VAC)

VETERANS (VAC) - Question identifier:VAC_Q05

Have you ever served in the Canadian military?

Canadian military service includes service with the Regular Force or Primary Reserve Force as an Officer or Non-Commissioned Member. It does not include service with the Cadets (COATS), the Supplementary Reserve or the Canadian Rangers.

  • 1: Yes
  • 2: No

VETERANS (VAC) - Question identifier:VAC_Q10

Are you currently a member of the Canadian Armed Forces?

Include Regular or Reserve Forces.

  • 1: Yes
  • 2: No

VETERANS (VAC) - Question identifier:VAC_Q15

In what year did you release from the Canadian Armed Forces?

Min = 1914; Max = 2022

INTERNET USE (IU)

INTERNET USE (IU) - Question identifier:IU_R05

Now some questions about the use of the Internet.

INTERNET USE (IU) - Question identifier:IU_Q05

During the past 12 months, have you used the Internet for personal use, from any location?

Exclude business and school-related use.

  • 1: Yes
  • 2: No

INTERNET USE (IU) - Question identifier:IU_Q10

Why have you not used the Internet during the past 12 months for personal use?

Select all that apply.

Is it:

  • 01: Cost of service or equipment
  • 02: No need, no interest or no time
  • 03: Too difficult to use the Internet (e.g., lack of confidence, knowledge, skills or training)
  • 04: Limited due to health condition
  • 05: Confidentiality, security or privacy concerns
  • 06: Limited or no access to Internet
  • 07: No Internet-ready device available in dwelling (e.g., desktop, laptop or tablet computer)
  • 08: Require specialized adaptations or software
  • 09: Too many websites are inaccessible
  • 10: Other reason

INTERNET USE (IU) - Question identifier:IU_Q15

During the past 12 months, what activities did you perform on the Internet to interact with any level of government?

Include all federal, provincial and local government services in Canada.
Exclude activities performed solely for your job.

Select all that apply.

Have you:

  • 01: Filed your income taxes on your own (i.e., not submitted by someone else)
  • 02: Paid a government service fee, tax, fine or ticket (e.g., driver's licence renewal, parking ticket)
  • 03: Researched information (e.g., bylaws, regulations, programs or services)
  • 04: Expressed your opinion or provided feedback during an online government consultation relating to government policies or programs
  • 05: Downloaded a government form that was submitted in person (e.g., passport renewal application, Old Age Security application, driver's licence renewal, building permit)
  • 06: Submitted a form or application for a government program or service online
  • 07: Accessed an account for a government program or service (e.g., My Account, accounts associated with driver's licences or health cards, public library account)
  • 08: Communicated with a government organization by email or via social networking
  • 09: Other activities
  • 10: None

INTERNET USE (IU) - Question identifier:IU_Q20

During the past 12 months, when using the Internet to interact with government officials, websites or services in Canada, did you encounter any of the following problems?

Select all that apply.

Was it:

  • 01: Difficult to find the correct website
  • 02: Difficult to find the information you needed on the website
  • 03: The website was experiencing technical difficulties
  • 04: The information provided on the website was missing or out-dated
  • 05: The website's functions were not compatible with your Internet-connected device
  • 06: You had concerns for your security or privacy
  • 07: Accessibility issues related to your condition
  • 08: Other problems
  • 09: Did not encounter any problems

INTERNET USE (IU) - Question identifier:IU_Q25

What are the reasons you have not used the Internet to interact with government officials, websites or services in Canada during the past 12 months?

Select all that apply.

Was it:

  • 01: No need, not interested or no time
  • 02: Too difficult to find the correct website or information on the website
  • 03: Easier to contact the government in person or by telephone
  • 04: Concern for security or privacy
  • 05: Never thought of searching or communicating that way
  • 06: Accessibility issues related to your condition
  • 07: Other reason — Specify the other reason you have not used the Internet to interact with government officials, websites or services
  • 08: None of the above

INTERNET USE (IU) - Question identifier:IU_Q30

During the past three months, what other activities have you done over the Internet?

Select all that apply.

Have you:

  • 01: Communicated with others (e.g., emails, social networking, video calls, dating sites, sharing sites, blogs, meetings, family events, etc.)
  • 02: Accessed information (e.g., news, directions, researched information on health, products, services or community events, etc.)
  • 03: Searched for employment
  • 04: Conducted online banking
  • 05: Attended regular school classes (e.g., high school, university or other post-secondary classes, etc.)
  • 06: Took training courses or workshops
  • 07: Made a donation to a charity
  • 08: Booked appointments
  • 09: Purchased goods or services
  • 10: Sold goods or services
  • 11: Tracked fitness or health
  • 12: Other online activities
  • 13: None of these activities

ACCESSIBILITY BARRIERS (BAR)

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_R05A

We now want you to think about accessibility barriers that might limit your access to different areas and activities in your daily life due to your condition. By barriers we mean something that could be removed, modified, or done differently.

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_R05B

In the past 12 months, have you experienced barriers with any of the following features inside or outside public spaces because of your condition(s)?

Select "Not applicable" if the barrier is not relevant to your condition or you just do not do that activity. For example, stairs may not be a relevant barrier for someone with a hearing condition.

Select "Never" if you never or almost never experience the barrier even though it might be relevant to your condition.

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q05A

A. Entrances or exits to buildings

e.g., steps, lack of ramps, difficult to open doors, etc.

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q05B

B. Floorplans inside buildings

e.g., confusing layouts, narrow aisles, stairs, etc.

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q05C

C. Lighting or sound levels inside buildings

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q05D

D. Public washrooms

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q05E

E. Wait lines

e.g., for services, stores, restaurants, etc.

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q05F

F. Self-serve technology

e.g., ATMs, store checkouts, kiosks, automated check-ins, etc.

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q05G

G. Announcements or alarms

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q05H

H. Signs or directions

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q05I

I. Pedestrian signals at intersections or crosswalks

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q05J

J. Sidewalks when covered in ice or snow

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q05K

K. Sidewalks in general

e.g., poor condition, width, slope, etc.

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_R10

In the past 12 months, have you experienced any barriers in terms of behaviours, misconceptions or assumptions made about you from any of the following because of your condition(s)?

Select "Not applicable" if the barrier is not relevant to your condition or you just do not do that activity.

Select "Never" if you never or almost never experience the barrier even though it might be relevant to your condition.

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q10A

A. Family or close friends

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q10B

B. Staff of a business

e.g., bank tellers, salespersons, servers, etc.

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q10C

C. Medical or health care professionals

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q10D

D. Staff of government services or programs

e.g., income, housing, employment support, etc.

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_R15

In the past 12 months, have you experienced barriers communicating in any of the following situations because of your condition(s)?

"Communicating" includes both understanding and being understood.

Select "Not applicable" if the barrier is not relevant to your condition or you just do not do that activity.

Select "Never" if you never or almost never experience the barrier even though it might be relevant to your condition.

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q15A

A. In person with family or close friends

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q15B

B. In person with medical or health care professionals

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q15C

C. In person with others such as the general public, customer service or government representatives

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q15D

D. By voice over the phone with family or close friends

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q15E

E. By voice over the phone with medical or health care professionals

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q15F

F. By voice over the phone with others such as the general public, customer service or government representatives

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q15G

G. With an automated phone message system

e.g., understanding or following pre-recorded instructions, etc.

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q15H

H. Using video conferencing

e.g., webcam, Skype, Zoom, etc.

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q15I

I. Using social media or online chat forums to interact with others

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_R20

In the past 12 months, have you experienced barriers using the Internet for any of the following activities because of your condition(s)?

Select "Not applicable" if the barrier is not relevant to your condition or you just do not do that activity.

Select "Never" if you never or almost never experience the barrier even though it might be relevant to your condition.

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q20A

A. Online banking or online shopping

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q20B

B. Online booking for appointments, services or reservations

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

ACCESSIBILITY BARRIERS (BAR) - Question identifier:BAR_Q20C

C. Online access to government information, services or supports

  • 1: Not applicable
  • 2: Never
  • 3: Sometimes
  • 4: Often
  • 5: Always

GENERAL HEALTH (GH)

GENERAL HEALTH (GH) - Question identifier:GH_R05

Now, some questions about your health. By health, we mean not only the absence of disease or injury but also physical, mental and social well-being.

GENERAL HEALTH (GH) - Question identifier:GH_Q05

In general, how is your health?

Would you say:

  • 1: Excellent
  • 2: Very good
  • 3: Good
  • 4: Fair
  • 5: Poor

GENERAL HEALTH (GH) - Question identifier:GH_Q10

In general, how is your mental health?

Would you say:

  • 1: Excellent
  • 2: Very good
  • 3: Good
  • 4: Fair
  • 5: Poor

HOUSEBOUND (HB)

HOUSEBOUND (HB) - Question identifier:HB_Q05

Do you consider yourself housebound due to your condition?

You are considered housebound when you are unable to leave your home environment due to your condition.

Exclude being housebound due to COVID-19 pandemic restrictions imposed by government or public health officials.

Would you say:

  • 1: No
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always

HOUSEBOUND (HB) - Question identifier:HB_Q10

What are the reasons you [rarely/sometimes/often/always] consider yourself housebound?

Select all that apply.

Would you say:

  • 01: You do not feel safe when you leave your home
  • 02: Your condition or health problem fluctuates
  • 03: Your condition or health problem is aggravated when you go out
  • 04: You have mobility restrictions
  • 05: Your social connections outside the home are limited
  • 06: No motivation, lack desire or not interested
  • 07: Financial reasons
  • 08: No attendant or companion is available to help you
  • 09: Accessible transportation is not available to you or is unreliable
  • 10: The places you want to go are not accessible to you
  • 11: Weather conditions or seasonal limitations
  • 12: Other reason — Specify the other reason you consider yourself housebound

SOCIAL ISOLATION (SI)

SOCIAL ISOLATION (SI) - Question identifier:SI_R05

The next questions are about how you feel about different aspects of your life.

SOCIAL ISOLATION (SI) - Question identifier:SI_Q05

How often do you feel that you lack companionship?

Would you say:

  • 1: Hardly ever
  • 2: Some of the time
  • 3: Often
  • 9: DK

SOCIAL ISOLATION (SI) - Question identifier:SI_Q10

How often do you feel left out?

Would you say:

  • 1: Hardly ever
  • 2: Some of the time
  • 3: Often
  • 9: DK

SOCIAL ISOLATION (SI) - Question identifier:SI_Q15

How often do you feel isolated from others?

Would you say:

  • 1: Hardly ever
  • 2: Some of the time
  • 3: Often
  • 9: DK

SOCIAL ISOLATION (SI) - Question identifier:SI_Q20

Do you have any relatives or friends who you feel close to, that is, who you feel at ease with, can talk to about what is on your mind, or call on for help?

Relatives include all persons related by blood, marriage or adoption. Include aunts, uncles, cousins, in-laws, etc.

  • 1: Yes
  • 2: No

SOURCES OF INCOME (SNC)

SOURCES OF INCOME (SNC) - Question identifier:SNC_R05A

Now a question about personal income sources.

SOURCES OF INCOME (SNC) - Question identifier:SNC_Q05A

Did you receive income from any of the following sources for the year ending December 31, 2021?

Select all that apply.

Income from:

  • 01: Employment (Include wages, salaries, commissions and tips.)
  • 02: Self-employment (Include wages, salaries, commissions and tips.)
  • 03: Workers' Compensation
  • 04: Employment Insurance or Quebec Parental Insurance Plan (Exclude Short-term disability sickness benefit.)
  • 05: Pension plan benefits (Exclude disability benefits.)
  • 06: Social assistance or welfare (Exclude disability benefits or income from provincial or territorial programs such as ODSP, DSP, AISH, PPMB, etc.)
  • 07: Disability Benefits (Include income from federal, provincial or territorial programs such as Disability benefits from Canada Pension Plan, Quebec Pension Plan or Veterans Affairs, ODSP, DSP, AISH, PPMB, etc. as well as private benefits or programs.)
  • 08: Federal or provincial COVID-19 emergency benefits
  • 09: Other sources (e.g., other government income, child tax benefit, child support, education allowances and scholarships, Northern Allowance, spousal support, honoraria)
  • 10: No personal income source

SOURCES OF INCOME (SNC) - Question identifier:SNC_Q05B

Which of the following pension plan benefits did you receive?

Exclude disability benefits

Select all that apply.

Was it:

  • 1: Canada Pension Plan (CPP)
  • 2: Quebec Pension Plan (QPP)
  • 3: Old Age Security (OAS) or Guaranteed Income Supplement (GIS)
  • 4: Provincial or Territorial pension plan
  • 5: Private or employment related pension plan
  • 6: Other retirement pensions and annuities

SOURCES OF INCOME (SNC) - Question identifier:SNC_Q05C

Which of the following disability plan benefits did you receive?

Select all that apply.

Was it:

  • 01: Canada Pension Plan Disability (CPP-D) benefits
  • 02: Quebec Pension Plan Disability benefits
  • 03: Employment Insurance short-term disability sickness benefit (Include Quebec Parental Insurance (QPIP) disability benefits)
  • 04: Provincial or territorial disability programs (e.g., ODSP, DSP, AISH, PPMB)
  • 05: Private or employment related disability insurance plan
  • 06: Motor vehicle accident insurance disability
  • 07: Veterans Affairs Disability benefits
  • 08: Registered Disability Savings Plan (RDSP)
  • 09: Other disability plan benefits

FOOD SECURITY (FS)

FOOD SECURITY (FS) - Question identifier:FS_R05

The following statements may describe the food situation for your household in the past 12 months. Please indicate if the statement was often true, sometimes true or never true for [you/you and other household members] in the past 12 months.

FOOD SECURITY (FS) - Question identifier:FS_Q05A

A. The food that [you/you and other household members] bought just didn't last, and there wasn't any money to get more

Would you say:

  • 1: Often true
  • 2: Sometimes true
  • 3: Never true

FOOD SECURITY (FS) - Question identifier:FS_Q05B

B. [You/You and other household members] couldn't afford to eat balanced meals

Would you say:

  • 1: Often true
  • 2: Sometimes true
  • 3: Never true

FOOD SECURITY (FS) - Question identifier:FS_Q10

In the past 12 months, since last ^CurrentMonth, did [you/you or other adults in your household] ever cut the size of your meals or skip meals because there wasn't enough money for food?

  • 1: Yes
  • 2: No

FOOD SECURITY (FS) - Question identifier:FS_Q15

How often did this happen?

Was it:

  • 1: Almost every month
  • 2: Some months but not every month
  • 3: Only 1 or 2 months

FOOD SECURITY (FS) - Question identifier:FS_Q20

In the past 12 months, did you personally ever eat less than you felt you should because there wasn't enough money to buy food?

  • 1: Yes
  • 2: No

FOOD SECURITY (FS) - Question identifier:FS_Q25

In the past 12 months, were you personally ever hungry but didn't eat because you couldn't afford enough food?

  • 1: Yes
  • 2: No

HOMELESSNESS (HOM)

HOMELESSNESS (HOM) - Question identifier:HOM_R05

The following question is about homelessness.

HOMELESSNESS (HOM) - Question identifier:HOM_Q05

Have you ever experienced homelessness where you have been without a secure and stable place to live?

This could include sleeping in shelters, on the streets, in your car, or living temporarily with others.

  • 1: Yes
  • 2: No

COVID-19 (COV)

COVID-19 (COV) - Question identifier:COV_R05

Now some questions about the COVID-19 pandemic.

COVID-19 (COV) - Question identifier:COV_Q05

Which of the following best describes the impact of the COVID-19 pandemic on your ability to meet financial obligations such as rent or mortgage payments, utilities and groceries?

Would you say:

  • 1: Major impact
  • 2: Moderate impact
  • 3: Minor impact
  • 4: No impact
  • 5: Too soon to tell

COVID-19 (COV) - Question identifier:COV_Q10

During the COVID-19 pandemic, did you lose your job, become laid off or have reduced work hours?

Would you say:

  • 1: Yes
  • 2: No
  • 3: Not applicable

COVID-19 (COV) - Question identifier:COV_Q15

Have you ever tested positive for COVID-19?

  • 1: Yes
  • 2: No

COVID-19 (COV) - Question identifier:COV_Q20

Have you ever been vaccinated against COVID-19?

  • 1: Yes
  • 2: No

SEXUAL ORIENTATION (SOR)

SEXUAL ORIENTATION (SOR) - Question identifier:SOR_Q01

What is your sexual orientation?

Would you say you are:

  • 1: Heterosexual
  • 2: Lesbian or gay
  • 3: Bisexual
  • 4: Or please specify — Specify your sexual orientation

SELF-IDENTIFICATION (DIS)

SELF-IDENTIFICATION (DIS) - Question identifier:DIS_Q05

Do you identify as a person with a disability?

  • 1: Yes
  • 2: No

FUTURE SURVEYS (SUR)

FUTURE SURVEYS (SUR) - Question identifier:SUR_R05

Statistics Canada is planning a series of short, 15-20 minute surveys about important social topics. These surveys will be sent out in the near future and will ask about a wide variety of issues that affect Canadian society. By participating in this survey series, you will be able to share your opinions and thoughts on these issues and compare your ideas with those of other Canadians.

FUTURE SURVEYS (SUR) - Question identifier:SUR_Q05

Would you like to sign-up for future surveys?

  • 1: Yes
  • 2: No (Note: Your household will remain eligible for other Statistics Canada surveys.)

FUTURE SURVEYS (SUR) - Question identifier:SUR_R10

Please provide the following information so we can email or text you to participate in this survey series.

FUTURE SURVEYS (SUR) - Question identifier:SUR_Q10A

Email address

Long Answer Length = 80

Example: user@example.gov.ca

FUTURE SURVEYS (SUR) - Question identifier:SUR_Q10B

Cellular number

Long Answer Length = 12

Example: 123-123-1234

FUTURE SURVEYS (SUR) - Question identifier:SUR_R15

Thank you for signing up. We will contact you soon

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