Have you ever Yes Yes Yes Yes Yes ⃝ ⃝ ⃝ ⃝ ⃝ served on active duty No [SKIP to Q 27] No [SKIP to Q 27] No [SKIP to Q 27] No [SKIP to Q 27] No [SKIP to Q 27] ⃝ ⃝ ⃝ ⃝ ⃝ in the US Know Doesn’t Know Doesn’t Know Doesn’t Know Know ⃝ ⃝ ⃝ ⃝ ⃝ Forces? Refused Refused Refused Refused Refused ⃝ ⃝ ⃝ ⃝ ⃝ [such as the Army, Navy, Air Force, Marine Corps, or Coast Guard] Head of Household Person 2 Person 3 Person 4 Person 5 Were you ever called Yes Yes Yes Yes Yes ⃝ ⃝ ⃝ ⃝ ⃝ into active duty as a No No No No No ⃝ ⃝ ⃝ ⃝ ⃝ member of the Doesn’t Know Doesn’t Know Doesn’t Know Know Doesn’t Know ⃝ ⃝ ⃝ ⃝ ⃝ National Guard or as a Reservist? Refused Refused Refused Refused Refused ⃝ ⃝ ⃝ ⃝ ⃝ Head of Household Person 2 Person 3 Person 4 Person 5 Do you use Veteran’s Yes Yes Yes Yes Yes ⃝ ⃝ ⃝ ⃝ ⃝ Administration (VA) No No No No No ⃝ ⃝ ⃝ ⃝ ⃝ Medical or Health Know Doesn’t Know Doesn’t Know Doesn’t Know Know ⃝ ⃝ ⃝ ⃝ ⃝ Care Services? Refused Refused Refused Refused Refused ⃝ ⃝ ⃝ ⃝ ⃝ Head of Household Person 2 Person 3 Person 4 Person 5 Where do you Hospital Hospital Hospital Hospital Hospital ⃝ ⃝ ⃝ ⃝ ⃝ usually go for Clinic Clinic Clinic Clinic Clinic ⃝ ⃝ ⃝ ⃝ ⃝ healthcare services? Emergency Room Emergency Room Emergency Room Emergency Room Emergency Room ⃝ ⃝ ⃝ ⃝ ⃝ [Please select one] VA VA VA VA VA ⃝ ⃝ ⃝ ⃝ ⃝ Nowhere Nowhere Nowhere Nowhere Nowhere ⃝ ⃝ ⃝ ⃝ ⃝ Doesn’t Know Doesn’t Know Doesn’t Know Know Doesn’t Know ⃝ ⃝ ⃝ ⃝ ⃝ Refused Refused Refused Refused Refused ⃝ ⃝ ⃝ ⃝ ⃝
Have you ever served on active duty in the US Forces? [such as the Army, Navy, Air Force, Marine Corps, or Coast Guard] ⃝ Yes ⃝ No [SKIP to Q 27] ⃝ Know ⃝ Refused ⃝ Yes ⃝ No [SKIP to Q 27] ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No [SKIP to Q 27] ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No [SKIP to Q 27] ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No [SKIP to Q 27] ⃝ Know ⃝ Refused Head of Household Person 2 Person 3 Person 4 Person 5 Were you ever called into active duty as a member of the National Guard or as a Reservist? ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused Head of Household Person 2 Person 3 Person 4 Person 5 Do you use Veteran’s Administration (VA) Medical or Health Care Services? ⃝ Yes ⃝ No ⃝ Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Doesn’t Know ⃝ Refused ⃝ Yes ⃝ No ⃝ Know ⃝ Refused Head of Household Person 2 Person 3 Person 4 Person 5 Where do you usually go for healthcare services? [Please select one] ⃝ Hospital ⃝ Clinic ⃝ Emergency Room ⃝ VA ⃝ Nowhere ⃝ Doesn’t Know ⃝ Refused ⃝ Hospital ⃝ Clinic ⃝ Emergency Room ⃝ VA ⃝ Nowhere ⃝ Doesn’t Know ⃝ Refused ⃝ Hospital ⃝ Clinic ⃝ Emergency Room ⃝ VA ⃝ Nowhere ⃝ Doesn’t Know ⃝ Refused ⃝ Hospital ⃝ Clinic ⃝ Emergency Room ⃝ VA ⃝ Nowhere ⃝ Know ⃝ Refused ⃝ Hospital ⃝ Clinic ⃝ Emergency Room ⃝ VA ⃝ Nowhere ⃝ Doesn’t Know ⃝ Refused