BOOK EN
CHILD’S BOOK OF
COGNITIVE ABILITY
2005
MEXICAN FAMILY LIFE SURVEY
(THE RESPONDENT SHOULD BE A HOUSEHOLD MEMBER BETWEEN THE AGES
OF 5 AND 12 YEARS OLD)
INDIVIDUAL ID
HOUSEHOLD ID
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BOOK INTERVIEW RESULT
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GEOGRAPHIC LOCATION
1. State
"THIS SURVEY HAS BEEN AUTHORIZED BY THE LAW OF GEOGRAPHY AND
STATISTICS INFORMATION; CHAPTER V. ACCORDING TO ARTICLE 38° OF THIS
LAW. THE INFORMATION WILL BE KEPT STRICTLY CONFIDENTIAL"
2. Municipality
3. Community
4. A.G.E.B.
5. Control Number
6. Strata
7. Fieldwork Number
RESPONDENT
Name
LS (Household Member Identification)
Age
COGNITIVE ABILITY (SECTION ECN)
ECN 01
SECTION ECN
ECN 02
BOOK EN-1
2005
COGNITIVE ABILITY (SECTION ECN)
ECN 03
SECTION ECN
ECN 04
BOOK EN-2
2005
COGNITIVE ABILITY (SECTION ECN)
ECN 05
SECTION ECN
ECN 06
BOOK EN-3
2005
COGNITIVE ABILITY (SECTION ECN)
ECN 07
SECTION ECN
ECN 08
BOOK EN-4
2005
COGNITIVE ABILITY (SECTION ECN)
ECN 09
SECTION ECN
ECN 10
BOOK EN-5
2005
COGNITIVE ABILITY (SECTION ECN)
ECN 11
SECTION ECN
ECN 12
BOOK EN-6
2005
COGNITIVE ABILITY (SECTION ECN)
ECN 13
SECTION ECN
ECN 14
BOOK EN-7
2005
COGNITIVE ABILITY (SECTION ECN)
ECN 15
SECTION ECN
ECN 16
BOOK EN-8
2005
COGNITIVE ABILITY (SECTION ECN)
ECN 17
SECTION ECN
ECN 18
BOOK EN-9
2005
INTERVIEW SESSION NOTES (SECTION NE)
FILL OUT THIS SECTION AFTER COMPLETING THE BOOK.
NE01.
WHO ELSE WAS PRESENT DURING THE
INTERVIEW?
(CIRCLE ALL THAT APPLY)
A.
B.
C.
D.
E.
F.
NOBODY
A 5-YEARS OLD BOY OR LESS
AN OVER 5-YEARS-OLD BOY
SPOUSE/COUPLE
A HOME-MEMBER ADULT
A NON-HOME-MEMBER ADULT
NE04.
WAS THE RESPONDENT (…) ?
1.
2.
3.
NE02.
1.
2.
3.
WHICH WERE THE CONDITIONS OF THE PLACE
WHERE DEVELOP THE INTERVIEW?
VERY CALM
FEW CALM
WITH NOISE
NE03.
1.
2.
3.
4.
5.
WHAT IS YOUR EVALUATION ON THE SERIOUSNESS
AND ATTENTIVENESS OF THE RESPONDENT?
EXCELLENT
GOOD
FAIR
NOT SO GOOD
VERY BAD
CALM
NERVOUS
ANXIOUS
NE07. NOTES
SECTION NE
BOOK EN-10
2005
VISIT LOG
NUMBER OF VISITS
DATE OF VISIT
DAY
MONTH
HRS.
DATE OF NEXT VISIT
ANSWERED SECTIONS
VISIT RESULT
(SEE CODES)
TIME OF INTERVIEW
MIN.
HRS.
MIN.
DAY
MONTH
1
I
I
I
ECN
NE
I
I
I
I
2
I
I
I
ECN
NE
I
I
I
I
3
I
I
I
ECN
NE
I
I
I
I
4
I
I
I
ECN
NE
I
I
I
I
5
I
I
I
ECN
NE
I
I
I
I
6
I
I
I
ECN
NE
I
I
I
I
TOTAL TIME OF THE INTERVIEW
I
I
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VISIT RESULTS
STAFF RECORD
POSTS
NAME
CODE
SIGNATURE
DELIVERY DATE
HOUSEHOLD INTERVIEWER
HOUSEHOLD TEAM
SUPERVISOR
EDITOR
STATE COORDINATOR
INTERVIEW RESULTS
20. Complete and correct
21. Incomplete due to new appointment
22. Respondent refused to continue
23. Respondent not found in successive visits
24. Other (specify)_________________________
25. Respondent refused to provide information
26. Respondent not found
27. Respondent could not provide information
28. Other (specify) __________________________