| LP127916-7 | How much difficulty do you have managing your money, such as keeping track of your expenses or paying bills | COMPONENT | 1 |
| LP127917-5 | How much difficulty do you have walking for a quarter of a mile, that is about 2 or 3 blocks | COMPONENT | 1 |
| LP127918-3 | How much difficulty do you have walking up 10 steps without resting | COMPONENT | 1 |
| LP127919-1 | How much difficulty do you have stooping, crouching, or kneeling | COMPONENT | 1 |
| LP127920-9 | How much difficulty do you have lifting or carrying something as heavy as 10 pounds, like a sack of potatoes or rice | COMPONENT | 1 |
| LP127921-7 | How much difficulty do you have doing chores around the house, like vacuuming, sweeping, dusting or straightening up | COMPONENT | 1 |
| LP127922-5 | How much difficulty do you have preparing your own meals | COMPONENT | 1 |
| LP127923-3 | How much difficulty do you have standing up from an armless straight chair | COMPONENT | 1 |
| LP127924-1 | How much difficulty do you have getting in or out of bed | COMPONENT | 1 |
| LP127925-8 | How much difficulty do you have eating, like holding a fork, cutting food or drinking from a glass | COMPONENT | 1 |
| LP127926-6 | How much difficulty do you have dressing yourself, including tying shoes, working zippers, and doing buttons | COMPONENT | 1 |
| LP127927-4 | How much difficulty do you have sitting for about 2 hours | COMPONENT | 1 |
| LP127928-2 | How much difficulty do you have reaching up over your head | COMPONENT | 1 |
| LP127929-0 | How much difficulty do you have using your fingers to grasp or handle small objects | COMPONENT | 1 |
| LP127930-8 | How much difficulty do you have going out to things like shopping, movies, or sporting events | COMPONENT | 1 |
| LP127931-6 | How much difficulty do you have participating in social activities, visiting friends, attending clubs or meetings or going to parties | COMPONENT | 1 |
| LP127932-4 | How much difficulty do you have doing things to relax at home or for leisure, reading, watching TV, sewing, listening to music | COMPONENT | 1 |
| LP127933-2 | How much difficulty do you have pushing or pulling large objects like a living room chair | COMPONENT | 1 |
| LP127934-0 | What is the main type of housing in your neighborhood | COMPONENT | 1 |
| LP127935-7 | Many shops, stores, markets, or other places to buy things I need are within easy walking distance of my home | COMPONENT | 1 |
| LP127936-5 | It is within a 10-15 minute walk to a transit stop, such as bus, train, trolley, or tram, from my home | COMPONENT | 1 |
| LP127937-3 | There are sidewalks on most of the streets in my neighborhood | COMPONENT | 1 |
| LP127938-1 | There are facilities to bicycle in or near my neighborhood, such as special lanes, separate paths or trails, shared use paths for cycles and pedestrians | COMPONENT | 1 |
| LP127939-9 | My neighborhood has several free or low-cost recreation facilities, such as parks, walking trails, bike paths, recreation centers, playgrounds, public swimming pools, etc | COMPONENT | 1 |
| LP127940-7 | The crime rate in my neighborhood makes it unsafe to go on walks at night | COMPONENT | 1 |
| LP127941-5 | I can be physically active during my free time on most days | COMPONENT | 1 |
| LP127942-3 | I can ask my parent or other adult to do physically active things with me | COMPONENT | 1 |
| LP127943-1 | I can be physically active during my free time on most days even if I could watch TV or play video games instead | COMPONENT | 1 |
| LP127944-9 | I can be physically active during my free time on most days even if it is very hot or cold outside | COMPONENT | 1 |
| LP127945-6 | I can ask my best friend to be physically active with me during my free time on most days | COMPONENT | 1 |
| LP127946-4 | I can be physically active during my free time on most days even if I have a lot of homework | COMPONENT | 1 |
| LP127947-2 | I have the coordination I need to be physically active during my free time on most days | COMPONENT | 1 |
| LP127948-0 | I can be physically active during my free time on most days no matter how busy my day is | COMPONENT | 1 |
| LP127949-8 | Circumstances in which you could exercise 3 time per week in the next 3 months | COMPONENT | 1 |
| LP127950-6 | Degree of confidence for exercising 3 times per week in the next 3 months | COMPONENT | 1 |
| LP128194-0 | Are you sick today | COMPONENT | 1 |
| LP128195-7 | Do you have allergies to medications, food, or any vaccine | COMPONENT | 1 |
| LP128196-5 | Have you ever had a serious reaction after receiving a vaccination | COMPONENT | 1 |
| LP128197-3 | Do you have a long-term health problem with heart disease, lung disease, asthma, kidney disease, metabolic disease, diabetes, anemia, or other blood disorder | COMPONENT | 1 |
| LP128198-1 | Do you have cancer, leukemia, AIDS, or any other immune system problem | COMPONENT | 1 |
| LP128199-9 | Do you take cortisone, prednisone, other steroids, or anticancer drugs, or have you had radiation treatments | COMPONENT | 1 |
| LP128200-5 | Have you had a seizure, brain, or other nervous system problem | COMPONENT | 1 |
| LP128201-3 | During the past Y, have you received a transfusion of blood or blood products, or have you been given immune gamma globulin or an antiviral drug | COMPONENT | 1 |
| LP128202-1 | Are you pregnant, or is there a chance you could become pregnant during the next month | COMPONENT | 1 |
| LP128203-9 | Have you received any vaccinations in the past 4 weeks | COMPONENT | 1 |
| LP128204-7 | Is the child sick today | COMPONENT | 1 |
| LP128205-4 | Does the child have allergies to medications, food, or any vaccine | COMPONENT | 1 |
| LP128206-2 | Has the child had a serious reaction to a vaccine in the past | COMPONENT | 1 |
| LP128207-0 | Has the child had a seizure or a brain problem | COMPONENT | 1 |
| LP128208-8 | Does the child have cancer, leukemia, AIDS, or any other immune system problem | COMPONENT | 1 |