 




	USER DOCUMENTATION

	FOR THE

	AREA RESOURCE FILE (ARF)

	February 2001 Release




















	National Center for Health Workforce Information & Analysis
	Bureau of Health Professions
	Health Resources and Services Administration
	Department of Health and Human Services








































The Area Resource File is made available by the Bureau of Health Professions.  Reproduction for re-use or resale is not authorized without the expressed permission of the Bureau.  Further, data from the American Dental Association, the American Hospital Association, the American Medical Association, and InterStudy are subject to copyright restrictions; these data may not be copied or reproduced in whole or in part without the prior consent of the copyright owner. 





	ARF USER DOCUMENTATION
	CONTENTS	

I.	DATA ELEMENT DESCRIPTIONS AND REFERENCES	  1

	A.	CODES AND CLASSIFICATIONS	  1
		A-1)	Header for ARF	  1
		A-2)	State and County Codes	  1
		A-3)	Census County Group Codes	  7
		A-4)	County Typology Codes	 7
		A-5)	MSA, PMSA and CMSA Codes, Names and Levels	  9
		A-6)	Rural/Urban Continuum Codes	  12
		A-7)	Urban Influence Codes	  14
		A-8)	BEA Economic Area Codes and Names, Component Economic Area Codes and Names and Area Type Codes	 16
		A-9)	Federal Region Code and Census Region and Division Codes and Names	  18
		A-10)	Professional Standards Review Organization (PSRO) Codes	 19
		A-11)	Mathematica Policy Research Sampling Unit Codes	  20
		A-12)	Medicare Prevailing Charges Locality Codes	  22
		A-13)	Veterans Administration Codes	  24
		A-14)	Contiguous Counties	 25
		A-15)	Health Service Area Codes	 27
		A-16)	Area Health Education Center (AHEC) Codes and Names	 27
		A-17)	HPSA Codes	 28
		A-18)	SSA Beneficiary State and County Codes	  29

	B.	HEALTH PROFESSIONS	  29
		B-1)	Physicians	  29
		B-2)	Dentists and Dental Hygienists	  39
		B-3)	Optometrists	  43
		B-4)	Pharmacists	  45
		B-5)	Podiatrists	  46
		B-6)	Veterinarians	  47
		B-7)	Nurses	  48
		B-8)	Physician Assistants 	  50
		B-9)	Occupational Therapists	  51
		B-10)	Psychology and Social Work Teachers	  52
		B-11)	Psychologists	  52
		B-12)	Sociologists	  52
		B-13)	Social Workers	  52
		B-14)	Decennial Census Occupation Data	  53
		B-15)	National Health Service Corps (NHSC) Sites	  54

	C.  HEALTH FACILITIES	  54
		C-1)	Hospital Type	  55
		C-2)	Hospital Services (or Facilities)	  57
		C-3)	Hospital Employment	  58
		C-4)	Nursing Homes	  58
		C-5)	Provider of Services	  62
		C-6)	Health Maintenance Organizations	  62
	
	D.	UTILIZATION	  64
		D-1)	Utilization Rate	  64
		D-2)	Inpatient Days	  64
		D-3)	Outpatient Visits	  65
		D-4)	Surgical Operations and Operating Rooms	  65

	E.	EXPENDITURES	  66
		E-1)	Hospital Expenditures	  66
		E-2)	Medicare Managed Care Market Penetration	  66
		E-3)	Medicare Adjusted Average Per Capita Cost (AAPCC)	  66
		E-4)	Medicare Expenditure and Enrollment Data	  68
		E-5)	Medicare Prevailing Charges Data	  69

	F.	POPULATION	  72
		F-1)	Population Counts and Number of Families and Households	  73
		F-2)	Population Percents	  79
		F-3)	Population Estimates	  80
		F-4)	Labor Force	  82
		F-5)	Per Capita Incomes	  84
		F-6)	Income	  88
		F-7)	Persons and Families Below Poverty Level	  90
		F-8)	Median Family Income	  91
		F-9)	Household Income	  92
		F-10)	Social Security Program Beneficiaries	  94
		F-11)	Supplemental Security Income Program Recipients	  94
		F-12)	Aid to Families with Dependent Children and General Assistance	  95
		F-13)	Crime Data	  99
		F-14)	5Year Infant Mortality Rates	  99
		F-15)	Infant Mortality Data	  100
		F-16)	Mortality Data	  101
		F-17)	Total Deaths	  104
		F-18)	Cancer Mortality Rate Data	  104
		F-19)	Natality Data	  104
		F-20)	Births in Hospitals	  106
		F-21)	Total Births	  106
		F-22)	Education	  106
		F-23)	Census Housing Data	  107
		F-24)	Veteran Population	  109
		F-25)	Retail Trade	  110
		F-26)	Family Income	  110

	G.	ENVIRONMENT	  110
		G-1)	Land Area	  110
		G-2)	Population Centroid	  111
		G-3)	Climatic Data	  111
		G-4)	Population Per Square Mile	  112
		G-5)	Water Hardness Index	  112
		G-6)	Farm Data	  113

II.	TECHNICAL INFORMATION	  115

	A.	FILE SPECIFICATIONS	  115

	B.	MISSING VALUES ON ARF	  115

	C.	FLAGS CONTAINED ON THE ARF	  115

	D.	CRITERIA FOR DATA INCLUSION ON THE ARF	  116


III.	DOCUMENTATION	  117

	A.	TECHNICAL DOCUMENTATION OF ARF	  117

	B.	SAS LAYOUT OF ARF	  117





I.	DATA ELEMENT DESCRIPTIONS AND REFERENCES


	A.	CODES AND CLASSIFICATIONS


		A-1)	Header for ARF

		The 45character header for ARF was placed at the beginning of each record to enhance the use of the county file.  The header includes the State and County Code, Date of the File, Date of Creation, and File Length.  The file length equals the length of the file without the 45byte header.  Therefore the actual record length is the file length plus 45 bytes.

		Note that beginning with the February 2001 version of the ARF, data are broken out for all Virginia independent cities and Alaska boroughs/census areas for all data from 1992 through the current. The modified FIPS code is carried as the secondary entity field (positions 12-16) of the header. This field should be used when matching with previous versions of the ARF. 

		Additionally, beginning with the February 2001 updates to the ARF, to the extent data were available for U.S. possessions and territories they are included on the file. Any sources having territory data available are noted in applicable User Documentation  references.


		A-2)	State and County Codes

	 FIPS State Code:

		This code was established by National Bureau of Standards, U.S. Department of Commerce in 1968.  It is standard throughout the Federal government and published in Federal Information Processing Standards Publication June 15, 1970.  The basic structure is a sequential ascending two-digit number, with spaces for all possible new states.

		The following table lists the FIPS State Code, the twocharacter State Name Abbreviation used on ARF and the State Name:

      			FIPS CODE		ABBREVIATION		STATE
			01					AL						Alabama
			02					AK						Alaska
			04					AZ						Arizona
			05					AR						Arkansas
			06					CA						California
			08					CO						Colorado
			09					CT						Connecticut
			10					DE						Delaware
			11					DC						District of Columbia
			12					FL						Florida
			13					GA						Georgia
			15					HI						Hawaii
			16					ID						Idaho
			17					IL						Illinois
			18					IN						Indiana
			19					IA						Iowa
			20					KS						Kansas
			21					KY						Kentucky
			22					LA	 					Louisiana
			23					ME 						Maine
			24					MD						Maryland
			25					MA						Massachusetts
			26					MI						Michigan
			27					MN						Minnesota
			28					MS						Mississippi
			29					MO 						Missouri
			30					MT						Montana
			31					NE						Nebraska
			32					NV						Nevada
			33					NH						New Hampshire
			34					NJ						New Jersey
			35					NM						New Mexico
			36					NY						New York
			37					NC						North Carolina
			38					ND						North Dakota
			39					OH						Ohio
			40					OK						Oklahoma
			41					OR						Oregon
			42					PA						Pennsylvania
			44					RI						Rhode Island
			45					SC						South Carolina
			46					SD						South Dakota
			47					TN						Tennessee
			48					TX						Texas
			49					UT						Utah
			50					VT 						Vermont
			51					VA 						Virginia
			53					WA						Washington
			54					WV						West Virginia
			55					WI						Wisconsin
			56					WY						Wyoming

		
             Additionally for data variables added to the February 2001 ARF, the following codes are             included for sources where available:

			66                            GU						Guam
			72					PR						Puerto Rico
			78					VI						Virgin Islands	

	Modified FIPS County Codes:

		The FIPS County Codes were established by National Bureau of Standards, U.S. Department of Commerce in 1968, and are published in Federal Information Processing Standards Publication  Counties and County Equivalents of the United States and the District of Columbia.  The current version of this publication is No. 64 dated August 31, 1990 with all revisions through July 1999.  The basic structure of the codes is sequential, ascending, threedigit odd numbers.  

		Effective with the February 2001 release, the County Codes used in the Area Resource File are those published in FIPS, including all Alaska boroughs and census areas and Virginia independent cities.  Unless otherwise noted in this document these data are broken out for all data years of 1992 and later.  Earlier years of data are combined for the Virginia independent cities and Alaska as noted below:

			1)	The County Code of 001 has been entered for Alaska and includes data for the entire state of Alaska for data prior to 1992. Data for 1992 and later are zero filled on this record since the detailed records are broken out on the file.

			2)	Most independent cities were included in their original counties because much of the data on the file previously was only available for counties and could not be separated into county and independent city segments.

				On earlier versions of the ARF, the following were carried as independent cities but were recoded in the ARF modified FIPS as noted (therefore when merging data from the new release and old versions, the Secondary Entity field should be used to match records):
													ARF
													MODIFIED
				COUNTY			STATE			FIPS 			FIPS
				Baltimore City		Maryland		007				510
				St. Louis City		Missouri		191				510
				Carson City			Nevada			025				510

				The following cities were previously combined into their original counties.  Therefore, all the data for the city on earlier versions of the ARF and for data prior to 1992 are included in the original county (e.g., the independent city of Bristol, Va., is added into Washington county.)

																		ARF
													ORIGINAL			MODIFIED
				CITY				STATE			COUNTIES			FIPS			FIPS
				Kalawao County	Hawaii			Maui				009				005
   				Bedford			Virginia		Bedford			019				515
				Bristol				Virginia		Washington			191				520
				Buena Vista		Virginia		Rockbridge			163				530
				Charlottesville		Virginia		Albemarle			003				540
				Clifton Forge		Virginia		Alleghany			005				560
				Colonial Heights	Virginia		Chesterfield			041				570
				Covington			Virginia		Alleghany			005				580
				Danville			Virginia		Pittsylvania			143				590
				Emporia 			Virginia		Greensville 			081				595
				Fairfax				Virginia		Fairfax				059				600
				Falls Church		Virginia		Fairfax				059				610
				Franklin			Virginia		Southampton		175				620
				Fredericksburg		Virginia		Spotsylvania		177				630
				Galax				Virginia		Grayson 			077				640
				Harrisonburg		Virginia		Rockingham		165				660
				Hopewell			Virginia 		Prince George		149				670
				Lexington 			Virginia 		Rockbridge 		163				678
				Lynchburg 			Virginia		Campbell			031				680
				Manassas 			Virginia		Prince William		153 			683
				Manassas Park		Virginia		Prince William		153 			685
				Martinsville			Virginia		Henry				089				690
				Norfolk				Virginia		Norfolk			129*			710
				Norton				Virginia		Wise 				195				720
				Petersburg			Virginia		Dinwiddie 			053				730
				Poquoson 			Virginia 		York				199				735
				Portsmouth			Virginia		Norfolk			129*			740
				Radford 			Virginia		Montgomery		121				750
				Richmond 			Virginia		Henrico 			087				760
				Roanoke			Virginia		Roanoke			161				770
				Salem				Virginia		Roanoke			161				775
				South Boston**		Virginia		Halifax				083				780
				Staunton 			Virginia 		Augusta			015				790
				Suffolk 				Virginia 		Suffolk City		123***			800
				Waynesboro		Virginia 		Augusta			015				820
				Williamsburg		Virginia		James City			095				830
				Winchester			Virginia		Frederick			069				840

				Note:	    *	FIPS does not have a code for Norfolk since it is no longer a county.  The ARF designation of Norfolk city (FIPS Code 51710) includes the independent cities of Norfolk and Portsmouth, Virginia for data prior to 1992.  1992 and later data are contained in the independent cities of Norfolk (51710) and Portsmouth (51740).
						  **	South Boston is no longer an independent city as of June 1995.
						***	Nansemond county became Nansemond city December 15, 1973.  Nansemond city became a part of the city of Suffolk December 15, 1979.  On ARF versions prior to the 2001 release, Suffolk independent city was recoded into ARF modified FIPS 51123.  On the 2001 ARF, the Suffolk independent city code is now the standard FIPS code of 51800.

				The following Virginia independent cities have been carried as separate entities on the ARF since November 1984:

				CITY									FORMER COUNTY ALLOCATION 
				(NEW MOD FIPS CODE)				(OLD MOD FIPS CODE)
				Alexandria (51510)						Arlington (51013)
				Chesapeake (51550)						Norfolk (51129)
				Hampton (51650)						Hampton/Newport News City (51084)
				Newport News (51700)					Hampton/Newport News City (51084)
				Virginia Beach (51810)					Norfolk (51129)

				To the extent possible, historical data on ARF at the time of the change were modified to separate data for these independent cities from data for their former counties.  Where independent city data could not be broken out from county data, this fact has been noted in the sections of this User Documentation which describe the individual data elements and/or sources.  Where this has occurred, the data are reported on ARF in the original county (or for Hampton/Newport News Cities, in Newport News51650) and the city is zerofilled.  

		FIPS Publication Change Notices, issued by the U.S. Department of Commerce, National Institute of Standards and Technology (NIST) state:

				1)	Effective July 1999, Yellowstone National Park (30113) is legally part of Gallatin County and Park County in Montana.  Source data on the ARF either report Yellowstone National Park separately or as a part of Park County.  Therefore, as of the February 2000 ARF release, Yellowstone National Park data are combined with Park County (30067) Montana.  Any exceptions are noted in this User Documentation.

				2)	Effective July 1999, NIST revised the Dade County, Florida FIPS code from 12025 to 12086 to keep the new official name Miami-Dade County in alphanumeric sequence.  This code has been revised on the February 2000 ARF and should be taken into consideration when comparing with historic files.

				3)	In January 1983, LaPaz County, Arizona (04012) was formed from the northern portion of Yuma County, Arizona (04027), which still exists with reduced boundaries.  As of February 1995, LaPaz County and Yuma County are carried as separate records on the ARF.  The new LaPaz County (04012) record should be combined with Yuma County (04027) when comparing data with historic files for consistency.

4) In June 1981, Cibola County, New Mexico (35006) was formed from portions of Valencia County, New Mexico (35061), which still exists with reduced boundaries.  As of February 1995, Cibola County and Valencia County are carried as separate records on the ARF.  The new Cibola County (35006) record should be combined with Valencia County (35061) when comparing data with historic files for consistency.

				 5)	In September 1979, Ste. Genevieve, Missouri (29193) was renumbered so that the county falls in alphabetical order.  The FIPS State and County Code is now 29186.

				 6)	In September 1979, Washabaugh County, South Dakota (46131) merged with Jackson County, South Dakota (46071).  The merged entity retains the name of Jackson and the code of 46071.  On ARF, historical data for Washabaugh County have been combined with Jackson County.

				 7)	Yellowstone National Park (Part), Wyoming (56047) was dropped as an entity.  The county was dropped from ARF, and all nonzero fields were weighted by population and split between Park County, Wyoming (56029), and Teton County, Wyoming (56039).

8) In June 1970, Ormsby County was incorporated as the independent city of Carson City, Nevada.  Carson City is carried as 32510 on the ARF.

Note:	Effective with the February 2001 release of the ARF, boroughs and census        areas of Alaska are broken out rather than aggregated to the state level. Some    historic source data were not reported in the currently defined FIPS areas. These areas have been separated into multiple areas. In these instances they are reported on the ARF in the area of greater population and noted in the appropriate reference in this user documentation. These differences are as follows:

1) In 6/86, Kobuk, AK (02140) became Northwest Arctic (02188); data on the  ARF are included in Northwest Arctic.
2) In 1/90, Aleutians, AK (02010) separated into Aleutians West, AK (02016) and Aleutians East (02013); data on the ARF are included in Aleutians West.
3) In 2/92, Skagway-Yakutat-Angoon, AK (02231) separated into Skagway-Hoonah-Angoon (02232) and Yakutat (02282); data on the ARF are included in Skagway- Hoonah-Angoon.


		A-3)	Census County Group Codes

		The Census County Group Codes are groups of counties smaller than a state, but larger than a county, which are geographically adjacent and have similar characteristics.  There are 410 County Group Codes.  These codes were extracted from the 1970 County Group Reference File obtained from the Bureau of the Census.

		Note:		Data are not available for:
					06039  Madera, California
				

		A-4)	County Typology Codes

		The 1989 County Typology Codes are from Economic Research Service (ERS), U.S. Department of Agriculture.  The 1989 classification system is based on counties designated as nonmetropolitan in 1993 (based on population and commuting data from the 1990 Census).  The typology includes six mutually exclusive economic types: five types (farming, mining, manufacturing, government and services) reflect dependence on particular economic specializations; a sixth type, termed nonspecialized, contains those counties not classified as having any of the five economic specializations.  The classification scheme also identifies five overlapping rural policyrelevant types: retirementdestination, Federal lands, persistent poverty, commuting and transfersdependent.  Codes for each of these variables are defined as:

		CODE			DESCRIPTION
		   00			Nonmetro other county
		   01			Nonmetro farming county
		   08			Metro county
		   99			Missing value

		Economic Types:

		Farmingdependent:  Farming contributed a weighted annual average of 20 percent or more of total labor and proprietor income over the 3 years from 1987 to 1989.

		Miningdependent:  Mining contributed a weighted annual average of 15 percent or more of total labor and proprietor income over the 3 years from 1987 to 1989.

		Manufacturingdependent:  Manufacturing contributed a weighted annual average of 30 percent or more of total labor and proprietor income over the 3 years from 1987 to 1989.

		Governmentdependent:  Government activities contributed a weighted annual average of 25 percent or more of total labor and proprietor income over the 3 years from 1987 to 1989.

		Servicesdependent:  Service activities (private and personal services, agricultural services, wholesale and retail trade, finance and insurance, transportation and public utilities) contributed a weighted annual average of 50 percent or more of total labor and proprietor income over the 3 years from 1987 to 1989.

		Nonspecialized:  Counties not classified as a specialized economic type over the 3 years from 1987 to 1989.

		Policy Types:

		Retirementdestination:  The population aged 60 years and over in 1990 increased by 15 percent or more during 198090 through inmovement of people.
		Federal lands:  Federally owned lands made up 30 percent or more of a county's land area in the year 1987.

		Commuting:  Workers aged 16 years and over commuting to jobs outside their county of residence were 40 percent or more of all the county's workers in 1990.

		Persistent poverty:  Persons with povertylevel income in the preceding year were 20 percent or more of total population in each of 4 years: 1960, 1970, 1980, and 1990.

		Transfers-dependent:  Income from transfer payments (Federal, state, and local) contributed a weighted annual average of 25 percent or more of total personal income over the 3 years from 1987 to 1989.

		Note:	1)	Labor and proprietor income data are revised estimates released by the Bureau of Economic Analysis in 1990.
				2)	For 1989 data, Alaska was carried as a statewide record (02001) on the ARF, therefore these codes were given a missing value code (99).  No data prior to 1992 were updated when Alaska boroughs and census areas were broken out; therefore these codes were not updated on the broken out Alaska records.
				3)	The typology codes for Virginia counties which include independent cities are based on the characteristics of the county plus each city (or cities) combined with that county.  The following note any exceptions to standard combinations:
						The code for Carroll County, Virginia (51035) includes characteristics from the Virginia city of Galax which is normally included in Grayson County (51077).
						Arlington County, Virginia (51013) and Alexandria City (51510) have the same code reflecting the combined characteristics of Arlington  Alexandria.
						Chesapeake City, Virginia (51550) and Norfolk/Portsmouth Cities (51710) have the same code reflecting the combined characteristics of Chesapeake  Norfolk  Portsmouth.
- York County, Virginia (51199which also includes Poquoson), Hampton City (51650) and Newport News City (51700) have the same code reflecting the combined characteristics of YorkPoquosonHamptonNewport News.
As with Alaska boroughs and census areas, these codes were not updated on the newly broken out Virginia independent city records.
4) Data for Menominee County, Wisconsin (55078) were combined with Shawano County, Wisconsin (55115) on the source data.  Therefore, they have the same code on the ARF reflecting the combined characteristics of MenomineeShawano.
5) These codes were not updated for the newly added US territories of Guam, Puerto Rico and Virgin Islands.

		A-5)	MSA, PMSA and CMSA Codes, Names and Levels

		The Metropolitan Areas (MAs) were announced by the Office of Management and Budget in OMB Bulletin No. 9904 to be effective June 30, 1999.  They are a revision of the MA standards published on March 30, 1990 and the demographic data drawn from the 1990 Decennial Census.

		The previous term Standard Metropolitan Statistical Area (SMSA) was changed to describe two metropolitan areas, Metropolitan Statistical Area (MSA) and Primary Metropolitan Statistical Area (PMSA).  The current standards provide that each newly qualifying MSA must include at least: one city with 50,000 or more inhabitants, or a Census Bureau-defined urbanized area (of at least 50,000 inhabitants) and a total metropolitan population of at least 100,000 (75,000 in New England).  

		Under the standards, the county (or counties) that contains the largest city becomes the "central county" (counties), along with any adjacent counties that have at least 50 percent of their population in the urbanized area surrounding the largest city.  Additional "outlying counties" are included in the MSA if they meet specified requirements of commuting to the central counties and other selected requirements of metropolitan character (such as population density and percent urban).  In New England, the MSAs are defined in terms of cities and towns rather than counties.

		An area that meets these requirements for recognition as an MSA and also has a population of one million or more may be recognized as a CMSA if: separate component areas can be identified within the entire area by meeting statistical criteria specified in the standards, and local opinion indicates there is support for the component areas.

		If recognized, the component areas are designated PMSAs, and the entire area becomes a CMSA.  PMSAs, like the CMSAs that contain them, are composed of entire counties, except in New England where they are composed of cities and towns.  If no PMSAs are recognized, the entire area is designated as an MSA.

		On the ARF, the fields for MSA code and PMSA code were combined into one field, MSA/PMSA Codes, as were MSA names and PMSA names combined to form MSA/PMSA Names.  The MSA/PMSA and CMSA names have been abbreviated so as not to exceed 35 characters.  

		In order to use county figures for New England in the same manner as other parts of the country with respect to MSA/PMSA's, ARF has used the New England Metropolitan State Economic Areas or population of the towns to resolve problems of MSA/PMSA's with partial counties or counties which cross MSA/PMSA's.  With this resolution, several MSA/PMSA's have been redefined and several are not present on ARF as follows:

	1120 Boston, MANH PMSA	
		Bristol County, MA (25005)  Included in MSA/PMSA 6480 on the ARF
		Essex County, MA (25009)
		Middlesex County, MA (25017)
		Norfolk County, MA (25021)
		Plymouth County, MA (25023)
		Suffolk County, MA (25025)
		Worcester County, MA (25027)  Included in MSA/PMSA 9240 on the ARF
		Rockingham County, NH (33015)
	
	1160 Bridgeport, CT PMSA	
		Fairfield County (09001)
		New Haven County (09009)  Included in MSA/PMSA 5480 on the ARF

	1200 Brockton, MA PMSA (Not Present on the ARF)	
		Bristol County (25005) Included in MSA/PMSA 6480 on the ARF
		Norfolk County (25021) Included in MSA/PMSA 1120 on the ARF
		Plymouth County (25023) Included in MSA/PMSA 1120 on the ARF

	1930 Danbury, CT PMSA (Not Present on the ARF)	
		Fairfield County (09001)  Included in MSA/PMSA 1160 on the ARF
		Litchfield County (09005)  Included in MSA/PMSA 3280 on the ARF

	2600 FitchburgLeominster, MA PMSA (Not Present on the ARF)	
		Middlesex County (25017)  Included in MSA/PMSA 1120 on the ARF
		Worcester County (25027)  Included in MSA/PMSA 9240 on the ARF

	3280 Hartford, CT MSA	
		Hartford County (09003)
		Litchfield County (09005)
		Middlesex County (09007)
		New London County (09011)  Included in MSA/PMSA 5520 on the ARF
		Tolland County (09013)
		Windham County (09015)

	4160 Lawrence, MANH PMSA (Not Present on the ARF)	
		Essex County, MA (25009)  Included in MSA/PMSA 1120 on the ARF
		Rockingham County, NH (33015)  Included in MSA/PMSA 1120 on the ARF

	
	4560 Lowell, MANH PMSA (Not Present on the ARF)	
		Middlesex County, MA (25017)  Included in MSA/PMSA 1120 on the ARF
		Hillsborough County, NH (33011)  Included in MSA/PMSA 5350 on the ARF

	4760 Manchester, NH PMSA	
		Hillsborough County (33011)  Included in MSA/PMSA 5350 on the ARF
		Merrimack County (33013)
		Rockingham County (33015)  Included in MSA/PMSA 1120 on the ARF

	5400 New Bedford, MA PMSA (Not Present on the ARF)	
		Bristol County (25005)  Included in MSA/PMSA 6480 on the ARF
		Plymouth County (25023)  Included in MSA/PMSA 1120 on the ARF

	5480 New HavenMeriden, CT PMSA	
		Middlesex County (09007)  Included in MSA/PMSA 3280 on the ARF
		New Haven County (09009)

	5520 New LondonNorwich, CTRI MSA	
		Middlesex County, CT (09007)  Included in MSA/PMSA 3280 on the ARF
		New London County, CT (09011)
		Windham County, CT (09015)  Included in MSA/PMSA 3280 on the ARF
		Washington County, RI (44009)  Included in MSA/PMSA 6480 on the ARF

	6400 Portland, ME MSA	
		Cumberland County (23005)
		York County (23031)  Included in MSA/PMSA 6450 on the ARF

	6450 PortsmouthRochester, NHME PMSA	
		Rockingham County, NH (33015)  Included in MSA/PMSA 1120 on the ARF
		Strafford County, NH (33017)
		York County, ME (23031)

	8040 StamfordNorwalk, CT PMSA (Not Present on the ARF)	
		Fairfield County (09001)  Included in MSA/PMSA 1160 on the ARF

	8880 Waterbury, CT PMSA (Not Present on the ARF)	
		Litchfield County (09005)  Included in MSA/PMSA 3280 on the ARF
		New Haven County (09009)  Included in MSA/PMSA 5480 on the ARF

	9240 Worcester, MACT PMSA	
		Hampden County, MA (25013)  Included in MSA/PMSA 8000 on the ARF
		Worcester County, MA (25027)
		Windham County, CT (09015)  Included in MSA/PMSA 3280 on the ARF

	

	MSA's and PMSA's are categorized by their 1990 population as follows:

		1 = Level A = Areas of 1 million or more
		2 = Level B = Areas of 250,000 to 999,999
		3 = Level C = Areas of 100,000 to 249,999
		4 = Level D = Areas of less than 100,000

  
		A-6)	Rural/Urban Continuum Codes

		The 1995 Rural/Urban Continuum Codes are from RuralUrban Continuum Codes for Metro and Nonmetro Counties, Department of Agriculture.  The codes form a classification scheme that distinguishes metropolitan counties by size and nonmetropolitan counties by degree of urbanization or proximity to metropolitan areas.  All U.S. counties and county equivalents are grouped according to the official metropolitan status announced by the Office of Management and Budget in June 1993, when the current population and commuting criteria were first applied to results of the 1990 Census of Population.  The 1995 codes are a revised version of the 1993 Rural/Urban Continuum Codes and are defined as follows:

		CODE				METROPOLITAN COUNTIES (0-3)
		00		Central counties of metropolitan areas of 1 million population or more
		01		Fringe counties of metropolitan areas of 1 million population or more
		02		Counties in metropolitan areas of 250,000  1,000,000 population
		03		Counties in metropolitan areas of less than 250,000 population

							NONMETROPOLITAN COUNTIES (4-9)
		04		Urban population of 20,000 or more, adjacent to a metropolitan area
		05		Urban population of 20,000 or more, not adjacent to a metropolitan area
		06		Urban population of 2,50019,999, adjacent to a metropolitan area
		07		Urban population of 2,50019,999, not adjacent to a metropolitan area
		08		Completely rural (no places with a population of 2,500 or more) adjacent to a metropolitan area
		09		Completely rural (no places with a population of 2,500 or more) not adjacent to a metropolitan area

		99		Missing Value

		Note:	1)	  Adjacent =	Counties physically adjacent to one or more MSA's and having at least 2 percent of the employed labor force in the nonmetropolitan county commuting to central metropolitan counties.
   2)	The rural/urban code for Virginia counties which include independent cities are                    based on the characteristics of the county plus each city (or cities) combined with               that county. Therefore on the ARF, these codes have been assigned to both the                     county and any independent city, which was formerly a part of that county.                           Additionally the source file has combined some counties with similar                                    characteristics. The list below identifies the codes carried on the ARF for those                    areas not on the source file:
	
        		ASSIGNED RURAL/URBAN
                             					CODE OF COUNTIES THEY 
        FIPS CODES AND NAMES OF            	WERE COMBINED WITH                   COUNTIES/CITIES ON THE ARF:                  ON THE FILE:


                                             Alaska


02013
     Aleutians East
02010     
Aleutian Islands
02016
     Aleutians West
02010
Aleutian Islands
02060
     Bristol Bay
02010
Aleutian Islands
02070
     Dillingham
02010
Aleutian Islands
02185
     North Slope Borough
02050
Bethel Census Area
02188
     Northwest Artic Borough
02050
Bethel Census Area
02201
     Pr of Wales-Outer Ketchikan
02130
Ketchikan Gateway Borough
02220
     Sitka Borough
02100
Haines Borough
02240
     S.E. Fairbanks Census Area
02090
Fairbanks North Star Borough
02282
     Yukutat
02100
Haines Borough
02290
     Yukon-Koyukuk Census Area
02050
Bethel Census Area






                                            Hawaii



15005
     Kalawao
15009
Maui







                                           Virginia



51510
     Alexandria
51013
Arlington

51515
     Bedford city
51019
Bedford county
51520
     Bristol
51191
Washington
51530
     Buena Vista
51163
Rockbridge
51540
     Charlottesville
51003
Albemarle

51560
     Clifton Forge
51005
Alleghany

51570
     Colonial Heights
51041
Chesterfield
51580
     Covington
51005
Alleghany

51590
     Danville
51143
Pittsylvania
51595
     Emporia
51081
Greensville
51600
     Fairfax
51059
Fairfax

51610
     Falls Church
51059
Fairfax

51620
     Franklin
51175
Southhampton
51630
     Fredricksburg
51177
Spotsylvania
51640
     Galax
51035
Carroll

51650
     Hampton
51199
York

51660
     Harrisonburg
51165
Rockingham
51670
     Hopewell
51149
Prince George
51678
     Lexington
51163
Rockbridge
51680
     Lynchburg
51031
Campbell

51683
     Manassas
51153
Prince William
51685
     Manassas Park
51153
Prince William
51690
     Martinsville
51089
Henry

51700
     Newport News
51199
York

51710
     Norfolk
51550
Chesapeake
51720
     Norton
51195
Wise

51730
     Petersburg
51053
Dinwiddie

51735
     Poquoson
51199
York

51740
     Portsmouth
51550
Chesapeake
51750
     Radford
51121
Montgomery
51760
     Richmond
51087
Henrico

51770
     Roanoke
51161
Roanoke

51775
     Salem
51161
Roanoke

51790
     Staunton
51015
Augusta

51820
     Waynesboro
51015
Augusta

51830
     Williamsburg
51095
James City (county)
51840
     Winchester
51069
Fredrick







                                       Wisconsin



55078
Menominee
55115
Shawano



		A-7)	Urban Influence Codes

		The 1993 Urban Influence Codes are from A County-Level Measure of Urban Influence, Population, Labor and Income Branch, Rural Economy Division, U.S. Department of Agriculture's Economic Research Service (ERS).  The Urban Influence codes classify all U.S. counties into 9 categories based on the size of the MSA, in the case of metro counties, and adjacency to MSAs and size of largest city in the case of nonmetro counties.  The codes complement the 1993 ERS Rural/Urban Continuum Codes and were revised December 1996.

		METRO
		01	Large  Central and fringe counties of metro areas of 1 million population or more 
		02	Small  Counties in metro areas of fewer than 1 million population 

		NONMETRO
		03	Adjacent to a large metro area with a city of 10,000 or more
		04	Adjacent to a large metro area without a city of at least 10,000
		05	Adjacent to a small metro area with a city of 10,000 or more
		06	Adjacent to a small metro area without a city of at least 10,000
		07	Not adjacent to a metro area and with a city of 10,000 or more
		08	Not adjacent to a metro area and with a city of 2,500 to 9,999 population 
		09	Not adjacent to a metro area and with no city or a city with a population less than 2,500

		99	Missing Value

		Note:	1)	Adjacent =	Counties physically adjacent to one or more MSA's and having at least 2 percent of the employed labor force in the county commuting to central metropolitan counties.  The metro-nonmetro definition is based on Office of Management and Budget definition as of June 1, 1993.
2) Denali, Alaska (02068) was assigned a missing code of 99 on the ARF since no Code was available in the source. The source file area Skagway-Yakutat-Angoon, AK (02231) no longer exists; this code was assigned to Skagway-Hoonah-Angoon, AK (02232) and Yakutat, AK (02282) on the ARF.
				3)	The Urban Influence code for Virginia counties that include independent cities are based on the characteristics of the county plus each city (or cities) combined with that county.  
	
        	ASSIGNED RURAL/URBAN
        	CODE OF COUNTIES THEY 
        FIPS CODES AND NAMES OF		WERE COMBINED WITH                   COUNTIES/CITIES ON THE ARF:                  ON THE FILE:


                                             Alaska


02013
     Aleutians East
02010     
Aleutian Islands
02016
     Aleutians West
02010
Aleutian Islands
02060
     Bristol Bay
02010
Aleutian Islands
02070
     Dillingham
02010
Aleutian Islands
02185
     North Slope Borough
02050
Bethel Census Area
02188
     Northwest Artic Borough
02050
Bethel Census Area
02201
     Pr of Wales-Outer Ketchikan
02130
Ketchikan Gateway Borough
02220
     Sitka Borough
02100
Haines Borough
02240
     S.E. Fairbanks Census Area
02090
Fairbanks North Star Borough
02282
     Yukutat
02100
Haines Borough
02290
     Yukon-Koyukuk Census Area
02050
Bethel Census Area






                                            Hawaii



15005
     Kalawao
15009
Maui







                                           Virginia



51510
     Alexandria
51013
Arlington

51515
     Bedford city
51019
Bedford county
51520
     Bristol
51191
Washington
51530
     Buena Vista
51163
Rockbridge
51540
     Charlottesville
51003
Albemarle

51560
     Clifton Forge
51005
Alleghany

51570
     Colonial Heights
51041
Chesterfield
51580
     Covington
51005
Alleghany

51590
     Danville
51143
Pittsylvania
51595
     Emporia
51081
Greensville
51600
     Fairfax
51059
Fairfax

51610
     Falls Church
51059
Fairfax

51620
     Franklin
51175
Southhampton
51630
     Fredricksburg
51177
Spotsylvania
51640
     Galax
51035
Carroll

51650
     Hampton
51199
York

51660
     Harrisonburg
51165
Rockingham
51670
     Hopewell
51149
Prince George
51678
     Lexington
51163
Rockbridge
51680
     Lynchburg
51031
Campbell

51683
     Manassas
51153
Prince William
51685
     Manassas Park
51153
Prince William
51690
     Martinsville
51089
Henry

51700
     Newport News
51199
York

51710
     Norfolk
51550
Chesapeake
51720
     Norton
51195
Wise

51730
     Petersburg
51053
Dinwiddie

51735
     Poquoson
51199
York

51740
     Portsmouth
51550
Chesapeake
51750
     Radford
51121
Montgomery
51760
     Richmond
51087
Henrico

51770
     Roanoke
51161
Roanoke

51775
     Salem
51161
Roanoke

51790
     Staunton
51015
Augusta

51820
     Waynesboro
51015
Augusta

51830
     Williamsburg
51095
James City (county)
51840
     Winchester
51069
Fredrick







                                       Wisconsin



55078
     Menominee
55115
Shawano



		A-8)	BEA Economic Area Codes and Names, Component Economic Area Codes 
		 		and Area Type Codes

		The 1994 BEA Economic Area Codes and Names, Component Economic Area (CEA) Codes and Names and Area Type Codes are from the Detailed Code File for Definitions of BEA Component Economic Areas and the Final Redefinitions of the BEA Economic Areas issued by the Bureau of Economic Analysis, U.S. Department of Commerce.  BEA Economic Areas, originally called OBE Economic Areas, were first delineated in 1969.  The Economic Area and CEA Area Names reflect the metropolitan area names used in OMB announcements and the nonmetropolitan area names are usually the largest cities within the associated CEA's.  Economic areas including a Consolidated Metropolitan Statistical Area (CMSA) are always named for the CMSA.

		There are 172 Economic Areas.  The Economic Area Code was assigned after the areas were defined, beginning with 1 in northern Maine, continuing south to Florida, then north to the Great Lakes, continuing in a serpentine pattern to the west coast, and ending with Alaska and Hawaii.

		There are 348 CEAs.  The CEA code generally is the FIPS code for the metropolitan area serving as the CEA's node (area).  Codes for the 38 nonmetropolitan nodes were assigned and are distinguished by having '95' in the first two positions.

		The first position of the Area Type Code is the initial assignment status of the county in the economic area redefinition process and is defined below; the second position is '0' if the initial assignment was not changed, it is '1' in cases where the assignment was changed during the analytical refinement processes, and it is '2' for the two cases where the CEA assignments of counties were changed following public comment on their preliminary assignments.  Initial assignment status codes are:

			CODE					DEFINITION
			   1		A CEA's nodal county within an MSA or NECMA
			   2		A CEA's nodal county within a PMSA
			   3		A CEA's nonmetropolitan node
			   4		Part of the Main Labor Hinterlands for a CEA node
			   5		Part of the NewspaperReadership Hinterlands for a CEA node
			   6		Part of the Secondary Labor Hinterlands for a CEA node
			   7		One of 68 counties requiring special assignment processes
			   9		Missing Value

		Hinterland assignments are made only if a candidate county is contiguous to at least one county already assigned to a CEA.  Subject to that constraint: The main labor hinterlands are nonnodal counties whose main commuting flow is (1) directly to a CEA node, or (2) to another nonnodal county whose main flow is directly to a CEA node, or (3) to another nonnodal county whose main flow is to another nonnodal county whose main flow is directly to a CEA node.  Newspaperreadership hinterlands are nonnodal counties, not in the main labor hinterlands, whose main source of newspapers is within a CEA node or the main labor hinterlands.  Secondary labor hinterlands are counties that require the newspaperreadership hinterlands in order to establish contiguity or a main commuting flow to a county in one of the emerging CEA's.

		Note:	1)	The BEA names have been abbreviated so as not to exceed 35 characters.  The complete name for the BEA Economic Area Code 3 and CEA Code 1123 is BostonWorcesterLawrenceLowellBrockton, MANHRIVT.  The complete name for the CEA Code 5483 is New HavenBridgeportStamfordDanbury Waterbury, CT.  The complete name for the CEA Code 7460 is San Luis ObispoAtascaderoPaso Robles, CA.
				2)	Lamar (28073) and Forrest (28035) counties in Mississippi were declared in late 1994 by OMB to constitute the new Hattiesburg MSA.  County codes for these counties do not reflect this change.  They would each be given an assignment code of 10 to reflect their current status.  This change did not affect the development of the Hattiesburg Component Economic Area.
3) Denali, AK (02068) was not available on the source file. It was assigned the statewide value of 171 for Economic Area Code and Anchorage, AK for the Economic Area name. It was assigned a missing value code of 99 for the Area Type Code and 9999 for the Component Economic Area Code.
				4)	Codes and names for Skagway-Yakutat-Angoon, AK (02231) on the source file were assigned to Skagway-Hoonah-Angoon, AK (02232) and Yakutat, AK (02282).  


		A-9)	Federal Region Code and Census Region and Division Codes and Names

		These are the codes for the ten Federal Regional Offices from the Department of Health and Human Services.  The Federal Region Codes, Regional Office names and the states within each region are as follows:

			CODE						DEFINITION
			  01			Boston R.O.   (Maine, Vermont, Mass., Conn., R.I., N.H.)
			  02 		New York R.O.   (N.Y., N.J., Puerto Rico, Virgin Islands)
			  03 		Philadelphia R.O.   (Penn., Del., D.C., Maryland, Va., W. Va.)
			  04 		Atlanta R.O.   (Ala., Fla., Georgia, Ky., Miss., N.C., S.C., Tenn.)
			  05 		Chicago R.O.   (Ill., Indiana, Minn., Michigan, Ohio, Wisconsin)
			  06 		Dallas R.O.   (Arkansas, N.M., Oklahoma, Texas, Louisiana)
			  07 		Kansas City R.O.   (Iowa, Kansas, Missouri, Nebraska)
			  08 		Denver R.O.   (Colo., Montana, N.D., S.D., Utah, Wyoming)
			  09 		San Francisco R.O.   (Ariz., Calif., Hawaii, Nev., Trust Territories)
			  10 		Seattle R.O.   (Alaska, Idaho, Oregon, Washington)

		The Census Region Codes and Names and Census Division Codes and Names were taken from the NCHWIA HSA ACCESS System.  The codes and names are as follows:

		    ACCESS
		SYSTEM CODES		   NAME						STATES INCLUDED

	Region		Division

	  1						Northeast
				  1					  New England			Maine,Vermont, Massachusetts,
 															New Hampshire, Connecticut,
															Rhode Island

				  2					  Middle Atlantic		New York, New Jersey,
															Pennsylvania

	  2						Midwest
				  3					  East North Central  	Ohio, Michigan, Indiana,
															Illinois, Wisconsin

				  4				  	  West North Central  	Minnesota, Iowa, Missouri,
															Kansas, Nebraska, South Dakota,
															North Dakota

	  3						South
				  5					  South Atlantic			Delaware, Maryland,
															District of Columbia,
															Virginia, West Virginia,
															North Carolina, South Carolina,
															Georgia, Florida

				  6					  East South Central  	Kentucky, Tennessee,
															Mississippi, Alabama

				  7				  	  West South Central  	Arkansas, Louisiana, Texas,
															Oklahoma
	  4						West
				  8					  Mountain				Montana, Wyoming, Colorado,
															New Mexico, Arizona, Utah,
															Idaho, Nevada

				  9					  Pacific					Washington, Oregon,
															California, Alaska, Hawaii


		A-10)	Professional Standards Review Organization (PSRO) Codes

		NCHWIA assigned a fourdigit numerical code to each proposed PSRO area as designated by the Secretary of DHHS.  These areas were delineated for the purpose of defining geographical areas over which each PSRO, whose function is to monitor the quality of health care, will have jurisdiction.  The PSRO areas presently on ARF are those as listed in the Federal Register dated March 18, 1974, with a few exceptions for those PSRO's which are comprised of parts of counties.  The ARF reflects all PSRO updates through July, 1979.

		Note:	1)	Since the county is the base unit on ARF, NCHWIA made exceptions to the PSRO defined for parts of Southern California  Los Angeles County, CA (06037) is defined as a single PSRO.
				2)	In Massachusetts, PSRO's are defined by township rather than by county.  On ARF, the county has been assigned the PSRO Code corresponding to the townships within the county which have the greatest total population.
				3)	In Montana, the PSRO code for Park County (30067) does not include Yellowstone National Park (30113).

		A-11)	Mathematica Policy Research Sampling Unit Codes

		The Mathematica Policy Research (MPR) Sampling Unit IDs and Primary Sampling Unit (PSU) Numbers were added to ARF for each county included in the MPR Physician Capacity Utilization Telephone Surveys (1973 and 1974), the Telephone Resurvey of Physician Capacity Utilization (1975), and the 1979 Resurvey of Private Practice Physicians (Sampling Unit ID only).  The codes were obtained from the Report on the Telephone Resurvey of Physician Capacity Utilization, 1975, Volume III, Mathematica Policy Research, and the Final Report, 1979 Resurvey of Private Practice Physicians, Appendix A, Mathematica Policy Research.

		The following table summarizes the numbers of PSU's and type of areas surveyed in each of the MPR physician surveys:

	NUMBERS OF PSU'S INCLUDED IN THE MPR PHYSICIAN
	SURVEYS, BY YEAR, AND TYPE OF AREA

														   Years Surveyed
	Type of Sampling Unit					1973		1974		1975		1979
	Large SMSA's							 100		   0		 	100		 	100
	Small SMSA's							   0		  	  56		 56		  	 56
	Nonmetropolitan Areas  Random		   0		  	  50		100		 	100
	Nonmetropolitan Areas  Nonrandom				  	  13		  2		   	  0

		Note:	1)	50 nonmetropolitan PSU's were selected in 1974.  These PSU's were resurveyed in 1975 and 1979.  An additional 50 nonmetropolitan PSU's were selected and surveyed in 1975, and were resurveyed in 1979.
				2)	13 nonrandomlyselected nonmetropolitan areas were surveyed in 1974.  Of these areas, two were subsequently surveyed once again, in 1975.

		Three types of sampling unit ID numbers were added to ARF:

					FIPS SMSA codes;
					MPR SMSA codes; and
					MPR nonmetropolitan area (NMA) codes.

	MPR's 1973, 1974 and 1975 surveys used both types of SMSA code, as well as the nonmetropolitan area codes.  The 1979 survey used only FIPS SMSA codes and MPR nonmetropolitan area codes.  Accordingly, five types of Sample and PSU Numbers were identified and added to ARF.  These are:

			1)	FIPS SMSA code for counties in metropolitan PSU's or MPR NMA code for counties in nonmetropolitan PSU's in the 1973 or 1974 Surveys (197374 Mathematica Sample Unit IDFirst Year).

			2)	MPR SMSA code for counties in metropolitan PSU's or MPR NMA code for counties in nonmetropolitan PSU's in the 1973 or 1974 Surveys (197374 Mathematica PSU NumberFirst Year).  For a nonmetropolitan county, the NMA code will be the same in fields 1 and 2.

			3)	FIPS SMSA code for counties in metropolitan PSU's or MPR NMA code for counties in nonmetropolitan PSU's in the 1975 Resurvey (1975 Mathematica Sample Unit IDSecond Year).

			4)	MPR SMSA code for counties in metropolitan PSU's or MPR NMA code for counties in nonmetropolitan PSU's in the 1975 Resurvey (1975 Mathematica PSU NumberSecond Year).  For a nonmetropolitan county, the NMA code will be the same in fields 3 and 4.

			5)	FIPS SMSA code for counties in metropolitan PSU's or MPR NMA code for counties in nonmetropolitan PSU's in the 1979 Resurvey (1979 Mathematica Sample Unit IDThird Year).

		Each of the five fields is 7 characters long and has the following format:

					Positions 14:	Sample or PSU Number (as defined above)
					Position     5:	'L' for Large Metropolitan area;
									'S' for Small Metropolitan area; or
									'N' for Nonmetropolitan area.
					Positions 67:	Year of the survey  '73', '74', '75' or '79'.

		Counties which were not surveyed in one year have the fields for that year zerofilled.  Counties that were never surveyed in the MPR studies have the fields for all years zerofilled.  Note that the Sample Unit ID numbers change for some areas from the first to the second survey year because of changes in SMSA definitions.

		For New England, the following decisions were made:  When a New England county was partially coded into several SMSA's, that SMSA which agrees with ARF's SMSA definition for the county was chosen for the Mathematica Sample Unit ID; the corresponding Mathematica PSU Number was coded.

		Note:	1)	PSU's 902 and 909 were excluded from the 1979 survey.
				2)	Nine counties contained in the 100 nonmetropolitan PSU's surveyed in both 1975 and 1979 have been redefined as metropolitan PSU's since 1975.  A definition change also took place in Washington, D.C. SMSA (PSU# 8840) to include the independent cities of Manassas and Manassas Park, Virginia.
				3)	New London County, CT (FIPS Code 09011) was given the Mathematica Sample Unit ID 3280 and the PSU No. 0333.
				4)	When linking the Public Use Files and the Area Means File to ARF, data for the Mathematica Sample Unit ID 2600 must be recoded into 9240; 4160 must be recoded into 1120.  The corresponding PSU No. 0263 must be recoded into 0891; and 0421 recoded into 0120.


		A-12)	Medicare Prevailing Charges Locality Codes

		The Medicare Prevailing Charges Locality Codes consist of Region, State, Carrier and Locality Codes.  For 1984, the codes were obtained from the Health Care Financing Administration (HCFA) Prevailing Charges Tape.  The 1978 Codes, consisting of the 1978 Region, 1978 State, 1978 Carrier, and 1978 Locality Codes, were obtained from the NCHWIA Enhanced Medicare File.

		The Medicare Prevailing Charges Locality Codes have the following format:

			Region 	the twodigit numeric Federal Region Office Code for the locality.  (See A9 for definition.)

			State 	a twodigit numeric code, different from the FIPS State Codes, which identifies the state of the carrier serving the locality.

			Carrier 	the insurance company handling Medicare claims for a locality.

			Locality 	a twodigit code representing an area served by the carrier; this number ranges from 01 to "n", where "n" is the number of localities for that particular carrier.  For the purpose of making reasonable charge determinations, a locality is identified as a geographic area for which a carrier derives the prevailing charges for services.  Usually, a locality is a political or economic subdivision of a State which should include a crosssection of the population with respect to economic and other characteristics.

		Most Medicare Prevailing Charges Localities follow county boundaries and encompass one or more counties.  There are some states, however, where Medicare has broken out a metropolitan area and assigned it a different Locality Code from the county or counties containing that city or metropolitan area.  These states and other exceptions are listed in the notes below.

		Note:	1)	For 1984, the following exceptions were made:
					a)	Arizona (FIPS State Code 04), Mississippi (28), Missouri (29), Nevada (32), New Mexico (35), New York (36), North Carolina (37), Oklahoma (40), Oregon (41), and Washington (53):  Counties containing cities which are broken out have been coded into the locality for that city.
					b)	Los Angeles County, California (FIPS Code 06037) contains eight localities.  The eight localities are all handled by the same carrier.  On ARF the first locality, locality 18, is indicated as the Los Angeles locality.  See Section E5 for a discussion of the procedure used in determining the prevailing charges for Los Angeles.
					c)	The Connecticut (FIPS State Code 09) localities cross county boundaries.  On ARF the counties have been coded into the following localities:
							001  Fairfield  locality 02  Southwest
							003  Hartford  locality 01  Northwest and North Central
							005  Litchfield  locality 01  Northwest and North Central
							007  Middlesex  locality 04  Northeast and Southeast
							009  New Haven  locality 03  South Central
							011  New London  locality 04  Northeast and Southeast
							013  Tolland  locality 01  Northwest and North Central
							015  Windham  locality 04  Northeast and Southeast
					d)	Iowa:  Cedar (FIPS Code 19031), Johnson (FIPS Code 19102), and Muscatine (FIPS Code 19139) counties are coded into the Iowa City locality.
					e)	Kentucky:  Fayette (FIPS Code 21067) and Jefferson (FIPS Code 21111) counties are coded into the "Metropolitan" locality; the 42 counties containing "urban" cities are coded into the "Urban" locality.  All other counties are coded into the "Rural" locality.
					f)	Massachusetts (FIPS State Code 25) counties have been coded into the localities which correspond to the ARF SMSA definitions, as follows:
							001 	Barnstable  locality 02  Rural
							003 	Berkshire  locality 01  Pittsfield SMSA
							005 	Bristol  locality 02  Fall River, MARI SMSA
							007 	Dukes  locality 02  Rural
							009 	Essex  locality 01  Boston SMSA
							011 	Franklin  locality 02  Rural
							013 	Hampden  locality 01  SpringfieldChicopeeHolyoke, MACT SMSA
							015 	Hampshire  locality 01  SpringfieldChicopeeHolyoke, MACT SMSA
							017 	Middlesex  locality 01  Boston SMSA
							019 	Nantucket  locality 02  Rural
							021 	Norfolk  locality 01  Boston SMSA
							023 	Plymouth  locality 01  Brockton SMSA
							025 	Suffolk  locality 01  Boston SMSA
							027 	Worcester  locality 01  Worcester SMSA
					g)	The Pennsylvania (FIPS State Code 42) localities cross county boundaries.  In all such cases on ARF, the county is assigned to the most urban of the localities in which it is contained.
					h)	The Prevailing Charges State Code for Illinois (FIPS State Code 17) was incorrectly coded as 11 in the source data.  This code was changed to 12 on the ARF.
					i)	The Prevailing Charges State Code for Alaska (FIPS State Code 02) was incorrectly coded as 51 in the source data.  This code was changed to 50 on the ARF.
				2) 	 For 1978 the following exceptions were made:
					a)	Arizona (FIPS State Code 04), Mississippi (28), Missouri (29), Nevada (32), New Mexico (35), New York (36), North Carolina (37), Oklahoma (40), and Oregon (41):  Counties containing cities which are broken out have been coded into the locality for that city.
					b)	Los Angeles County, California (FIPS Code 06037) contains eight localities.  The eight localities are all handled by the same carrier.  On ARF the first locality, locality 18, is indicated as the Los Angeles locality.  See Section E5 for a discussion of the procedure used in determining the prevailing charges for Los Angeles.
					c)	Iowa:  Cedar (FIPS Code 19031), Johnson (FIPS Code 19102), and Muscatine (FIPS Code 19139) counties are coded into the Iowa City locality.
					d)	Kentucky:  Fayette (FIPS Code 21067) and Jefferson (FIPS Code 21111) counties are coded into the "Metropolitan" locality; the 42 counties containing "urban" cities are coded into the "Urban" locality.  All other counties are coded into the "Rural" locality.
					e)	Massachusetts (FIPS State Code 25) counties have been coded into the localities which correspond to the ARF SMSA definitions, as follows:
							001 	Barnstable  locality 02  Rural
							003 	Berkshire  locality 01  Pittsfield SMSA
							005 	Bristol  locality 02  Fall River, MARI SMSA
							007 	Dukes  locality 02  Rural
							009 	Essex  locality 01  Boston SMSA
							011 	Franklin  locality 02  Rural
							013 	Hampden  locality 01  SpringfieldChicopeeHolyoke, MACT SMSA
							015 	Hampshire  locality 01  SpringfieldChicopeeHolyoke, MACT SMSA
							017 	Middlesex  locality 01  Boston SMSA
							019 	Nantucket  locality 02  Rural
							021 	Norfolk  locality 01  Boston SMSA
							023 	Plymouth  locality 01  Brockton SMSA
							025 	Suffolk  locality 01  Boston SMSA
							027 	Worcester  locality 01  Worcester SMSA
					f)	Pennsylvania:  Part of Pittsburgh (in Allegheny County  42003), and part of Philadelphia (in Philadelphia County  42101) are assigned the locality "Areas of Medical Schools/Specialty Hospitals"; Allegheny and Philadelphia counties have been coded to this locality.
					g)	In Texas, the "Statewide" locality (260) is not used.


		A-13)	Veterans Administration Codes

		1988 and 1978 Veterans Administration (VA) Codes were obtained from the Veterans Administration.  The codes include VA Primary Service Area Code, VA Medical District Code, and VA Medical Region Code.  The VA Medical Region Code is defined as follows:

					1 = NorthEastern
					2 = MidAtlantic
					3 = SouthEastern
					4 = Great Lakes
					5 = MidWestern
					6 = Western
					7 = SouthWestern

		Note:	1)	The independent cities have been recoded in their county of origin.  As a result, the following Virginia independent cities have been affected for Primary Service Area Code and Medical District Code:

													FIPS		VA SOURCE CODE	  ARF CODE
					Primary Service Area Code		51590				558				658
													51640				658				621
													51678				652				658
													51780				558				652

					Medical District Code				51590				 08				07
													51640				 07				08
													51780				 08				07
				2)	Primary Service Area Code data for Park County, MT (30067) do not include Yellowstone National Park (30113).

	The 1978, 1990 and 1995-1999 Veteran Population data are also carried on the file; refer to Section F24 below.


		A-14)	Contiguous Counties

		Contiguous Counties were taken from the United States Department of Commerce, Bureau of the Census, Map of Boundaries of Counties and County Equivalents as of January 1, 1970, U.S. Government Printing Office, 1971, Stock Number 0424798. Revisions made to reflect Alaska boroughs and census areas and Virginia independent cities were coded from the U.S. Bureau of the Census, United States County Outline (base map) Counties and Equivalent Areas of the United States of America as of the year 2000. These fourteen fields contain, for a given county, the FIPS State and County Codes for all counties contiguous to that county.  There can be a maximum of fourteen counties contiguous to a given county.  Unused fields are zerofilled.  Thus, if a county has three counties contiguous to it, the fields for Contiguous Counties # 414 will be zerofilled.

		Counties are considered contiguous by water rights to other counties when they both border the same body of water.  Islands and peninsulas are considered contiguous to neighboring counties by either water rights or accessibility.

		The following Hawaiian counties are considered contiguous by water rights:


					COUNTY					CONTIGUOUS TO:
					Hawaii (15001)				Maui (15009)
	
					Honolulu (15003)			Kauai (15007) 
												Maui (15009)
					
					Kauai (15007) 				Honolulu (15003) 

					Maui (15009) 				Hawaii (15001) 
												Honolulu (15003) 
												
		The following New York City counties are considered contiguous even though some are separated by water:

					COUNTY					CONTIGUOUS TO:
					Bronx, N.Y. (36005) 		Bergen, N.J. (34003)
												New York, N.Y. (36061)
												Queens, N.Y. (36081)
												Westchester, N.Y. (36119)

					Kings, N.Y. (36047) 			New York, N.Y. (36061)
												Queens, N.Y. (36081)
												Richmond, N.Y. (36085)

					New York, N.Y. (36061)		Bronx, N.Y. (36005) 
												Kings, N.Y. (36047) 
												Queens, N.Y. (36081)
												Richmond, N.Y. (36085)

					Queens, N.Y. (36081)		Bronx, N.Y. (36005) 
												Kings, N.Y. (36047) 
												Nassau, N.Y. (36059) 
												New York, N.Y. (36061)

					Richmond, N.Y. (36085) 	Essex, N.J. (34013)
												Hudson, N.J. (34017) 
												Middlesex, N.J. (34023)
												Union, N.J. (34039) 
												Kings, N.Y. (36047) 
												New York, N.Y. (36061)




		A-15)	Health Service Area Codes

		Health Service Area Codes were obtained from the National Center for Health Statistics.  The specific source reference is Vital and Health Statistics  Health Service Areas for the United States, Makuc DM, Haglund B, Ingram DD, Kleinman JC, Feldman JJ, November 1991.  A health service area is defined as one or more counties that are relatively selfcontained with respect to the provision of routine hospital care.  Service areas that include more than one county are characterized by travel between the counties for routine hospital care.


		A-16)	Area Health Education Center (AHEC) Codes and Names

		Area Health Education Centers (AHEC's) are independent, nonprofit organizations which link the academic resources of university health care centers with communitybased health service delivery systems in medically underserved areas.  Primarily funded by cooperative agreements awarded by the Bureau of Health Professions/HRSA under Section 781 of the Public Health Service Act, AHEC's determine the manpower and resource needs of scarcity areas, and coordinate the activities of health profession students who are provided by cooperating medical and osteopathic schools and universities.  (These students serve 10% of their clinical training at AHEC sites in underserved areas, thereby redistributing health personnel to areas of need and increasing the services provided to the community.)  The individual activities and programs administered by the regional AHEC projects are determined by the needs and problems of the localities they serve.

		The 1998 Area Health Education Center data were defined from a list of AHEC's developed by the Division of Medicine, Bureau of Health Professions.  The codes are four digits; the first two digits are the FIPS State Code, the second two digits indicate the number of the center within the state.

		The AHEC Program Year of Initiation is the calendar year in which the program was first funded.  The AHEC Center Year of Initiation is the calendar year in which the center was first funded (planning year included).

		Note:	1)	Los Angeles County, California (06037) is in three AHEC's: Central, Drew and Los Angeles Basin.  On the ARF, Central is the AHEC carried for Los Angeles.  The Drew and Los Angeles Basin AHEC's consist of only Los Angeles county, therefore these AHEC's are not present on the ARF.
2) Bronx County, New York (36005) is in two AHEC's:  North Bronx and South Bronx. On the ARF, South Bronx is the AHEC carried for Bronx.  The North Bronx AHEC consists of only Bronx county, therefore this AHEC is not present on the ARF.  
3) Alaska AHEC?s are not available at the census/borough level.
	


	A-17)	HPSA Codes

		The 1998 and 2000 Health Professional Shortage Area (HPSA) codes for Primary Medical Care, Dentists and Mental Health Professionals are from the Bureau of Primary Health Care. HPSA data for Primary Care Physicians, Dentists, and Mental Health Professionals are defined as follows:


			1)	For Critical Physician Shortage, the identifying CHP Agency must have indicated a shortage of physicians in primary care (i.e., M.D.'s and D.O.'s practicing general or family medicine, internal medicine, pediatrics, obstetrics/gynecology, and those general surgeons who spend 50% or more of their patient care time in primary care practice).  The proposed shortage area must have a primary care physiciantopopulation ratio of less than 1:4000.

			2)	For Critical Dental Shortage, the identifying CHP Agency must have indicated a shortage of dentists in general practice.  If the area is an entire county, the overall dentisttopopulation ratio (including both general and specialty dentists) in the county within which the area is located must be less than 1:5000.

			3)	The criteria for psychiatric HPSAs were expanded to mental health HPSAs in 1992 as published in the Federal Register, Vol. 57, No. 14; Wednesday, January 22, 1992.  To be designated as having a shortage of mental health professionals a geographic area must meet the following criteria where core mental health professionals of core professionals include those psychiatrists, clinical psychologists, clinical social workers, psychiatric nurse specialists, and marriage and family therapists who meet the definitions set forth in the ruling.  Refer to the Federal Register publication for more information.
					A.	The area is a rational area for the delivery of mental health services.
					B.	One of the following conditions prevails within the area:

						1.	The area has:	a)	population-to-core-mental-health-professional ratio greater than or equal to 6,000:1 and a population-to-psychiatrist ratio greater than or equal to 20,000:1 or
											b)	a population-to-core-professional ratio greater than or equal to 9,000:1 or
											c)	a population-to-psychiatrist ratio greater than or equal to 30,000:1;
						2.	The area has unusually high needs for mental services, and has:
											a)	population-to-core-mental-health-professional ratio greater than or equal to 4,500:1 and a population-to-psychiatrist ratio greater than or equal to 15,000:1 or
											b)	a population-to-core-professional ratio greater than or equal to 6,000:1, or
											c)	a population-to-psychiatrist ratio greater than or equal to 20,000:1;
D. Mental health professionals in contiguous areas are overutilized, excessively distant or inaccessible to residents of the area under consideration. 

			Note:  The 1998 Mental Health HPSA code for Halifax, VA (51083) on the ARF is coded as             partial, which reflects the combination of a whole HPSA for Halifax and no HPSA for            South Boston, of which Halifax is comprised.

			4)	Since April 1980, HPSA data classify counties as follows:
					0 = None of the county designated as a shortage area;
					1 = The whole county was designated as a shortage area;
					2 = One or more parts of the county was designated as a shortage area.

			Note: 2000 HPSAs are provided on the ARF for the US territories of Guam, Puerto                                                   Rico and Virgin Islands.  1998 HPSAs are not updated for the territories.


		A-18)	SSA Beneficiary State and County Codes

		The Social Security Administration's (SSA) Office of Research, Evaluation and Statistics (ORES) Beneficiary State and County Codes are used for beneficiary record coding, including the Supplemental Security Income (SSI) program.  The code consists of a two-byte state and three-byte county code.

		Note:	1)	The SSA code system provides a "Statewide" code designation (XX999) for all states.  On the Alaska statewide record on the ARF, it is assigned this code (02999).  Otherwise, the "Statewide" codes are not carried on the ARF. 
2) There are two SSA beneficiary codes used to identify Los Angeles County, California (05200 and 05210).  However, since FIPS has only one code for Los Angeles, only 05200 is assigned to this county.
3) Data for Park County, Montana (30067) do not include Yellowstone National Park (30113).
				 

	B.	HEALTH PROFESSIONS

		B-1)		Physicians

	M.D. Physicians:

		The 1979, 1983, 1985, 1986, 19881990, and 19921999 AMA NonFederal M.D. Specialty data were obtained from the respective year's American Medical Association Physician Masterfiles (Copyright).  The totals contained on the file are for Total NonFederal M.D.'s and are broken out by Specialty and Major Professional Activity for 1990, 1995 and 1999.  Total and Inactive M.D.'s by Gender are for 1989, 1995 and 1999.  M.D.'s by Specialty and Age are for 1989, 1995 and 1999.  M.D.'s by Country/State of Graduation are for 1985, 1995 and 1999.  The reporting period for data through 1986 and for 1995-1999 is as of December 31 of the respective year; 1988 through 1993 is as of January 1 of the respective year.  1994 was compiled by the AMA for the reporting periods of January 1 and December 31.  Data carried on the ARF are for January 1, 1994 which corresponds with the data published in the 1995/96 edition of the Physician Characteristics and Distribution in the U.S.

		Note:	1)	Major Professional Activity classifications are reported by the physician in the Census of Physicians? Practice Arrangements questionnaire.  Total Patient Care includes Office Based (includes Locum Tenens in 1997), Hospital Residents, Clinical Fellows (1986-January 1994) and Hospital Based FullTime (FT) Staff.  Total Hospital Based includes Hospital Residents, Clinical Fellows (1986-January 1994) and Hospital Based FT Staff.  Other Professional Activity includes Administration, Medical Teaching, Research and Other.
				2)	Office Based Practice includes physicians engaged in seeing patients.  Physicians may be in solo practice, in group practice, twophysician practice, or other patient care employment.  It also includes physicians in patient services such as those provided by pathologists and radiologists.  1997 Locum Tenens, which are reported separately in the Physician Characteristics and Distribution in the U.S., are also included.
				3)	Hospital Based Practice includes physicians employed under contract with hospitals to provide direct patient care. 
				4)	Residents (all years) includes any physician in supervised practice of medicine among patients in a hospital or in its outpatient department with continued instruction in the science and art of medicine by the staff of the facility.  Beginning with the December 31, 1994 data, also incudes clinical fellows in advanced training 
					in the clinical divisions of medicine, surgery, and other specialty fields preparing for practice in a given specialty.  These physicians are engaged primarily in patient care. In the 1986 through January 1, 1994 data, Clinical Fellows was carried as a separate category.  As a result of this change there are a larger number of Residents as compared to earlier years and Residents fields were assigned new Field numbers.
				5)	Clinical Fellows includes physicians in an educational training program distinct from an accredited residency program.  Clinical Fellows are engaged primarily in patient care.  In the 1986 and later data, the category of Clinical Fellows was added to the Hospital Based Practice group and the Total Patient Care group.  Beginning with the December 31, 1994 data, Clinical Fellows were combined with Residents.  Prior to 1986, Clinical Fellows were included in the Research category.  As a result of this change, there are fewer physicians in Research and a larger number in Hospital Based and Total Patient Care for 1986 and later, compared to earlier years.
				6)	Medical Teaching includes physicians with teaching appointments in medical schools, hospitals, nursing schools, or other institutions of higher learning.
				7)	Medical Research includes physicians in activities (whether funded or unfunded) performed to develop new medical knowledge, potentially leading to publication.  Also includes physicians in research fellowship programs distinct from an accredited residency program and primarily engaged in nonpatient care.
				8)	Administration includes physicians in administrative activities in a hospital, health facility, health agency, clinic, group or any other organization.
				9)	Other Activity includes physicians employed by insurance carriers, pharmaceutical companies, corporations, voluntary organizations, medical societies, associations, grants, foreign countries, etc.
			     10)	Inactive includes physicians who are retired, semiretired, working parttime, temporarily not in practice, or not active for other reasons and indicated they worked twenty hours or less per week.
			     11)	Not Classified includes physicians who did not provide information on their type of practice or their present employment.
			     12)	Physicians fields contain only active physicians with classified activity unless specifically stated that inactive and/or not classified are included.
			     13)	A physician's selfdesignated practice specialty is determined, like major professional activity, by the physician from a list of codes included in the physician on the Physicians' Practice Arrangments questionnaire.
			     14)	The following subspecialties are included in Total General Practice:
						General Practice
						Family Practice, General (Family Practice prior to 1993)
						Family Practice Subspecialties (beginning in 1993)
			     15)	The following subspecialties are included in Medical Specialties Total:
						Allergy and Immunology (beginning in 1990)
						Allergy (prior to 1990)
						Cardiovascular Disease
						Dermatology
						Gastroenterology
						Internal Medicine, General (Internal Medicine prior to 1986)
						Internal Medicine Subspecialties (beginning in 1986)
						Pediatrics, General (Pediatrics prior to 1990)
						Pediatric Subspecialties (beginning in 1990)
						Pediatric Allergy (prior to 1990)
						Pediatric Cardiology
						Pulmonary Disease
			     16)	The following subspecialties are included in Surgical Specialties Total:
						Colon/Rectal Surgery
						General Surgery
						Neurological Surgery
						ObstetricsGynecology, General (OB/Gyn prior to 1990)
						ObstetricsGynecology Subspecialties (beginning in 1990)
						Ophthalmology
						Orthopedic Surgery
						Otolaryngology
						Plastic Surgery
						Thoracic Surgery
						Urology
			     17)	The following subspecialties are included in Other Specialties Total:
						Aerospace Medicine
						Anesthesiology
						Child Psychiatry
						Diagnostic Radiology
						Emergency Medicine (beginning in 1981)
						Forensic Pathology
						General Preventive Medicine
						Medical Genetics (beginning in January 1994)
						Neurology
						Nuclear Medicine (beginning in 1981)
						Occupational Medicine
						Psychiatry
						Pathology, Anatomic/Clinical
						Physical Medicine/Rehabilitation
						Public Health (prior to 1999)
						Radiology
						Radiation Oncology (Therapeutic Radiology prior to 1986)
						Other Specialties
						Unspecified
			     18)	The subspecialty Nuclear Medicine was broken out of Radiology in 1981.
			     19)	The subspecialty Emergency Medicine was broken out of Other Specialty in 1981.
			     20)	The subspecialty Therapeutic Radiology was changed to Radiation Oncology in the 1986 and later data.  The data are the same.
			     21)	In 1986, Internal Medicine was broken into General Internal Medicine and Internal Medicine Subspecialties.  The following are included in 1990 Internal Medicine Subspecialties:
						Diabetes
						Endocrinology
						Geriatrics
						Hematology
						Infectious Diseases
						Nephrology
						Nutrition
						Medical Oncology
						Rheumatology
					The following are included in 1995 Internal Medicine Subspecialties:
						Diabetes
						Endocrinology, Diabetes & Metabolism
						Hematology (Internal Medicine)
						Hepatology
						Hematology/Oncology
						Cardiac Electrophysiology
						Infectious Diseases
						Clinical & Laboratory Immunology (Internal Medicine)
						Geriatrics Medicine (Internal Medicine)
						Sports Medicine (Internal Medicine)
						Nephrology
						Nutrition
						Medical Oncology
						Rheumatology
					The following are included in 1999 Internal Medicine Subspecialites:
						Adolescent Medicine
						Critical Care Medicine (Internal Medicine)
						Diabetes
						Endocrinology, Diabetes & Metabolism
						Hematology (Internal Medicine)
						Hepatology
						Hematology/Oncology
						Cardiac Electrophysiology
						Infectious Diseases
						Clinical & Laboratory Immunology (Internal Medicine)
						Intervention Cardiology
						Internal Medicine (Psychiatry)
						Geriatric Medicine
						Sports Medicine (Internal Medicine)
						Nephrology
						Nutrition
						Medical Oncology
						Pulmonary Critical Care Medicine
						Rheumatology
						Internal Medicine (Neurology)
			     22)	In 1990, Pediatrics was broken into General Pediatrics and Pediatric Subspecialties.  The following are included in 1990 Pediatrics Subspecialties:
						Adolescent Medicine
						NeonatalPerinatal Medicine
						Pediatric Allergy
						Pediatric Endocrinology
						Pediatric Pulmonology
						Pediatric HematologyOncology
					The following are included in 1995 Pediatric Subspecialties:
						Adolescent Medicine
						Pediatric Critical Care Medicine
						NeonatalPerinatal Medicine
						Pediatric Allergy
						Pediatric Endocrinology
						Pediatric Infectious Disease
						Pediatric Pulmonology
						Medical Toxicology (Pediatrics)
						Pediatric Emergency Medicine
						Pediatric Gastroenterology
						Pediatric Hematology/Oncology
						Clinical & Laboratory Immunology (Pediatrics)
						Pediatric Nephrology
						Pediatric Rheumatology
						Sports Medicine (Pediatrics)
					The following are included in 1999 Pediatric Subspecialties:
						Adolescent Medicine
						Pediatric Critical Care Medicine
						Internal Medicine/Pediatrics
						NeonatalPerinatal Medicine
						Pediatric Anesthesiology 
						Pediatric Allergy
						Pediatric Endocrinology
						Pediatric Infectious Disease
						Pediatric Pulmonology
						Medical Toxicology (Pediatrics)
						Pediatric Emergency Medicine (Pediatrics)
						Pediatric Gastroenterology
						Pediatric Hematology/Oncology
						Clinical & Laboratory Immunology (Pediatrics)
						Pediatric Nephrology
						Pediatric Rheumatology
						Sports Medicine (Pediatrics)
			     23)	In 1990, Obstetrics and Gynecology was broken into General Obstetrics and Gynecology, and Obstetrics and Gynecology Subspecialties.  The following are included in 1990 Obstetrics and Gynecology Subspecialties:
						Gynecological Oncology
						Gynecology
						Maternal and Fetal Medicine
						Obstetrics
						Reproductive Endocrinology
					The following are included in 1995 and 1999 Obstetrics and Gynecology Subspecialties:
						Gynecological Oncology
						Gynecology
						Maternal and Fetal Medicine
						Obstetrics
						Critical Care Medicine (Obstetrics and Gynecology)
						Reproductive Endocrinology
			     24)	In 1993, Family Practice was broken into General Family Practice and Family Practice Subspecialties.  The following are included in 1995 Family Practice Subspecialties:
						Geriatric Medicine (Family Practice)
						Sports Medicine (Family Practice)
					The following are included in 1999 Family Practice Subspecialties:
						Geriatric Medicine (Family Practice)
						Sports Medicine (Family Practice)
						Psychiatry (Family Practice)
			     25)	In 1999, the specialty Public Health was included in General Preventive Medicine.																				
			     26)	1995 and 1999 Primary Care is defined as Office Based MDs for General Practice, General Family Practice, General Internal Medicine and General Pediatrics.  This definition is different than past years, therefore it will not be comparable with prior years.  The 1985 Primary Care data includes Office Based MDs for General Practice, Family Practice, Internal Medicine, Pediatrics, and Obstetrics and Gynecology.
			     27)	The following are the definitions of Country and State locations of Medical Graduates:
						In US	 			=	US Graduate
						In State				=	Same state of school and practice
						Contiguous State		=	Contiguous states of school and practice
						Other State			=	States of school and practice are not same or contiguous
						Canada				=	Graduate of Canadian school
						International			=	International medical graduate (formerly Foreign medical graduates)
				28)	Beginning with the 1999 AMA information, data are carried on the ARF for the following US territories: Puerto Rico and the Virgin Islands.

		The 1990, 1995 and 1999 AMA Federal M.D. Specialty data were obtained from the 1990, 1995 and 1999 American Medical Association Physician Masterfiles (Copyright).  The totals contained on the file are for Total Federal M.D.'s and are broken out by Specialty and Major Professional Activity.

		Note:	1)	Federal status is defined as fulltime employment by the federal government, including the Army, Navy, Air Force, Veteran's Administration, the Public Health Service and other federally funded agencies.
				2)	Major Professional Activity classifications are reported by the physician in the Census of Physicians' Practice Arrangements questionnaire.
				3)	Office Based Practice includes physicians engaged in seeing patients.  Physicians may be in solo practice, in group practice, two-physician practice, or other patient care employment.  It also includes physicians in patient services such as those provided by pathologists and radiologists.  Beginning with the 1993 data, there have been no Office Based Federal M.D.s reported.  
				4)	Residents (all years) include any physician in supervised practice of medicine among patients in a hospital or in its outpatient department with continued instruction in the science and art of medicine by the staff of the facility.  Also includes clinical fellows in advanced training in the clinical divisions of medicine, surgery, and other specialty field preparing for practice in a given specialty.  These physicians are engaged primarily in patient care.  Clinical Fellows were combined with Residents on the ARF for the 1990 data.  Beginning with the December 31, 1994 data, the AMA started reporting Clinical Fellows as part of the Residents category.
				5)	Hospital Based Staff includes physicians employed under contract with hospitals to provide direct patient care.
				6)	Other Professional Activity includes Administration, Medical Teaching, Research, and Other.  See above notes for AMA Non-Federal M.D. data definitions.
				7)	Physicians fields contain only active physicians with classified activity unless specifically stated that inactive and/or not classified are included.
				8)	A physician's selfdesignated practice specialty is determined, like major professional activity, by the physician from a list of codes included in the physician on the Physicians' Practice Arrangements questionnaire.
				9)	The following subspecialties are included in Total General Practice:  General Practice Family Practice, General (Family Practice prior to 1993) Family Practice Subspecialties (beginning in 1993).
9) In 1990, Obstetrics and Gynecology was broken into Obstetrics and Gynecology, and Obstetrics and Gynecology Subspecialties.  For 1990, the following are included in Obstetrics and Gynecology Subspecialties:

						Gynecology
						Gynecological Oncology
						Maternal and Fetal Medicine
						Obstetrics
						Reproductive Endocrinology
					In 1995 and 1999, the following are included in Obstetrics and Gynecology Subspecialties:
						Gynecological Oncology
						Gynecology
						Maternal and Fetal Medicine
						Obstetrics
						Critical Care Medicine (Obstetrics and Gynecology)
						Reproductive Endocrinology
			     11)	The following subspecialties are included in Other Medical Subspecialties:
						Allergy and Immunology
						Cardiovascular Disease
						Dermatology
						Gastroenterology
						Pediatric Subspecialties
						Pediatric Cardiology
						Pulmonary Disease
						Internal Medicine Subspecialties
			     12)	The following subspecialties are included in Other Surgical Subspecialties:
						Colon & Rectal Surgery
						Neurological Surgery
						Ophthalmology
						Orthopedic Surgery
						Otolaryngology
						Plastic Surgery
						Thoracic Surgery
						Urological Surgery
			     13)	The following subspecialties are included in Other Other Subspecialties:
						Aerospace Medicine
						Anesthesiology
						Child Psychiatry
						Diagnostic Radiology
						Emergency Medicine
						Forensic Pathology
						General Preventive Medicine
						Medical Genetics (beginning in January 1994)
						Neurology
						Nuclear Medicine
						Occupational Medicine
						Public Health (prior to 1999)
						Physical Health
						Physical Medicine & Rehabilitation
						Pathology, Anatomic/Clinical
						Radiology
						Radiation Oncology
						Other Specialty
						Unspecified

		1970-1983, 1985 and 1986 NonFederal M.D.'s were obtained from Physician Characteristics and Distribution in the U.S., published by the Center for Health Services Research and Development of the American Medical Association in each respective year.


		The 1975 AMA M.D. data were obtained from the Physician Specialty File which is the result of processing the 1975 AMA Biographic Data Tapes.

		Estimates for 1940, 1950, and 1960 Total Active NonFederal M.D.'s come from AMA punch cards.  AMA estimates were used rather than Census estimates because Census estimates occasionally included interns and residents as well as chiropractors, dentists, and veterinarians in the physician counts when enumerators failed to properly differentiate the response of "doctor".  1960 data for Alaska (02001), and New York City Counties (FIPS 36005 Bronx, 36047 Kings, 36061 New York, 36081 Queens, 36085 Richmond) were taken from the Health Manpower Source Book, Section 10, DHHS, Public Health Service Pub. No. 263.

		Note:	1)	1940 and 1950 M.D.'s are not available for Alaska (02001), Weston County, Wyoming (56045), or any of the Hawaii counties (Hawaii (15001), Honolulu (15003), Kauai (15007), Maui (15009)).
				2)	1960 data for Alaska, Hawaii, and the New York City counties of Bronx, Kings, New York, Queens, and Richmond are as of the middle of the calendar year 1959.
				3)	1960 data for the state of Hawaii are not broken out by county; they are all contained in Honolulu (FIPS 15003); the other Hawaii counties (FIPS 15001 Hawaii, 15007 Kauai, 15009 Maui) are zerofilled.
				4)	The 1960 data for Bronx, N.Y. (FIPS 36005) are included in New York County (FIPS 36061); Bronx, N.Y. is zerofilled.
				5)	1960 M.D.'s in Alaska and Hawaii include all NonFederal M.D.'s. Active NonFederal M.D.'s are not available for these states for 1960.
				6)	1960 M.D.'s are not available for Weston County, Wyoming (FIPS 56045).
				7)	Total Active NonFederal M.D.'s for St Louis City (FIPS 29510) for 1960 are from Health Manpower Source Book, Section 10, Physicians' Age, Type of Practice, and Location, DHEW, Public Health Service, Table A, 1959.
				8)	1940, 1950 and 1960 data for the independent cities of Hampton and Newport News, Virginia are included in York County (51199).  Hampton (51650) and Newport News (51700) are zerofilled for these fields.
				9)	1940, 1950 and 1960 data for the independent city of Galax, Virginia are included in Carroll County (51035), rather than Grayson County (51077).
			     10)	1940, 1950 and 1960 data for Charles City County, Virginia (51036) are not reported.
11) Data could not be obtained to break out 1940, 1950 and 1960 Total Active NonFederal M.D.'s for the Virginia independent cities of Alexandria, Chesapeake and Virginia Beach from their former counties.
	

M.D. and D.O. Physicians:

		The field 1990 M.D. and D.O. Physicians was obtained from the 1990 Census of Population and Housing:  Equal Employment Opportunity (EEO) File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1990 census sample (approximately one out of every six housing units and persons in group quarters), and are estimates of the actual figures that would have been obtained from a complete count.  Refer to the Decennial Census Occupation Data notes for additional information.

		The field 1980 M.D. and D.O. Physicians was obtained from the 1980 Census of Population and Housing:  Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1980 census sample (approximately 19percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count.

		Note:	Data for the following entity was not available from the source file:  
				Suffolk City, Virginia (51800).

D.O. Physicians:

		The 1998 D.O. data are from the American Osteopathic Association.  Data are available by specialty, by practice type, by gender, board certification, primary care status and by age for all non-Federal D.O.?s.  Inactive D.O.?s are not included.  The Intern/Resident field includes all D.O.?s in a training program such as an internship, residency, preceptorship, subspecialty training, or fellowship.  In 1998, there were no D.O.'s reported for 1011 counties.

		The 1995 D.O. data are from the American Osteopathic Association.  These data include D.O.'s by Specialty and by Active or Intern/Resident status for Federal and NonFederal.  In 1995, there were no D.O.'s reported for 1280 counties.

		Note:	1)	Interns/Residents fields include osteopathic and allopathic.
				2)	Twelve D.O.s who stated their specialty as General Practice were included in Family Practice on the source data.

		The 1989 D.O. data are from the American Osteopathic Association.  These data include Total Active D.O.'s and D.O.'s by Specialty and Gender for Federal and NonFederal.  In 1989, there were no D.O.'s reported for 1358 counties.  Non Primary Care D.O. data include all specialties except General Practice, General Internal Medicine, Obstetrics and Gynecology and Pediatrics.

		The 1987 D.O. data are from the 1987 American Osteopathic Microdata Tape.  These data include Total Active Federal and NonFederal D.O.'s, Total Active Federal D.O.'s, and Total Active NonFederal D.O.'s. In 1987 there were no D.O.'s reported for 1417 counties.

		Data for 1981 NonFederal D.O.'s are from the 1981 American Osteopathic Association Microdata Tape.  These data include Total NonFederal D.O.'s, Total Active NonFederal D.O.'s, NonFederal D.O.'s by Major Professional Activity (including Inactive and Not Classified), and NonFederal Office Based D.O.'s by Specialty.  In 1981, there were no D.O.'s reported for 1593 counties.


		Data for 1978 and 1976 Active NonFederal D.O.'s in Primary Care Specialties are from the Bureau of Community Health Services D.O. CountyLevel Tapes.  Primary care specialties include General Practice, Internal Medicine, Pediatrics and Ob/Gyn.

		Note:	1)	The 1976 data were updated to include Total Active NonFederal D.O.'s and Active NonFederal D.O.'s in Patient Care.
				2)	Two invalid FIPS County Codes which were previously miscoded into nonexistent counties in the 1976 data were adjusted.  The affected counties are Linden, NJ (FIPS 34039) erroneously coded as 34049; and Woodland, CA (FIPS 06113) erroneously coded as 06119.
				3)	1976 data are not available for Virginia independent cities.  Refer to A2.

		Data on the 1974 and 1971 Total Active NonFederal D.O.'s are from the 1974 and 1971, respectively, American Osteopathic Association Tapes.

		Note:	1)	All D.O. totals include respondents to the survey only.
				2)	Data are not available for Virginia independent cities.  Refer to A2.


	B-2)	Dentists and Dental Hygienists

	Dentists:

		The 1998 Total Professionally Active Dentists, Dentists by Professional Activity, Private Practice Full-Time and Part-Time Non-Federal Dentists,  Dentists by Age, Dentists by Gender and Dentists by Specialty are from the Survey Center, American Dental Association 1998 Distribution of Dentists in the United States by Region and State (Copyright). Dentists by age, by specialty and by gender are those non-federal dentists in private practice and include both full time and part time dentists.  

		Note:	1) County location could not be determined for the following number of dentists:

							


							Total Dentists		Non-Federal Dentists
							Unknown County	Unknown County
 
			Alabama						97				94
			Alaska							7					5
			Arizona						110					101
			Arkansas						41					40
			California					1032					990
			Colorado						91					79
			Connecticut						72					71
			Delaware						16					16
			District of Columbia				25					25
			Florida							255					243
			Georgia						131					127
			Hawaii							26					25
			Idaho							45					40
			Illinois							271					262
			Indiana							125					124
			Iowa							69					69
			Kansas			 				48					46
			Kentucky						122					120
			Louisiana						99					96
			Maine							11					11
			Maryland						178					171
			Massachusetts					235					233
			Michigan						234					230
			Minnesota						121					120
			Mississippi						54					44
			Missouri						80					77
			Montana						12					10
			Nebraska						54					51
			Nevada							25					23
			New Hampshire					15					14
			New Jersey						257					251
			New Mexico						32					23
			New York						737					727
			North Carolina					143					129
			North Dakota					11					8
			Ohio							243					234
			Oklahoma						67					58
			Oregon							91					89
			Pennsylvania					322					313
			Rhode Island					13					12	
			South Carolina					74					67
			South Dakota					14					13
			Tennessee						136					131
			Texas							453					431
			Utah							84					81
			Vermont						7					7
			Virginia						197					173
			Washington					165					151
			West Virginia					33					33
			Wisconsin						89					87
			Wyoming						10					7
			Unknown State/County			14					14
		2)	1998 dental source data contains data for Aleutians Island, AK (02010), which was broken into Aleutians East (02013) and Aleutians West (02016). These data are included in Aleutians West on the ARF because this area has a greater population.			

		The 1995 Total Professionally Active Dentists, Total Private Practice Non-Federal Dentists, Total Dentists by Age, Total Practicing (FullTime and PartTime) Dentists, Dentists by Gender, Dentists by Specialty and 1991 Total Professionally Active Dentists and Total Private Practice Non-Federal are taken from the American Dental Association 1995 State and County Demographic Reports (Copyright). The data provided in the reports are derived from the 1993-1995 Census of Dentists and are estimates based on a 91 percent response.  

		Note:	1)	Total Professionally Active include dentists whose primary or secondary occupation is dental related.  This includes the fields Total Full-time and Total Part-time Private Practice, Graduate Students, State and Local Government, Armed Forces and Other Federal Service, and Hospital Staff/Other Organization, as well as other data by occupation types not carried on the ARF.
				2)	Total Private Practice Dentists include those engaged in private practice as either a primary or secondary occupation. 
				3)	Full-time Private Practice and Part-time Private Practice include only dentists who indicated they were in private practice as a primary occupation. 
				4)	The sum of Dentists, Private Practice, General Practice + Pediatrics and Dentists, Private Practice, Other Specialties and the sum of the fields Private Practice Dentists by Age Categories are one less than the field Total Private Practice in Jefferson County, Louisiana (22051).
				5)	The sum of the fields Private Practice Dentists by Gender is three less than the field Total Private Practice in Columbia County, New York (36021).
				6)	Other Specialties includes: Oral & Maxillofacial Surgery, Endodontics, Orthodontics, Periodontics, Prosthodontics, Oral Pathology, and Public Health.
				7)	The fields 1991 Total Professionally Active Dentists and 1991 Total Private Practice Dentists were calculated using data provided by the source.

		The field 1990 Dentists was obtained from the 1990 Census of Population and Housing:  Equal Employment Opportunity (EEO) File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1990 census sample (approximately one out of every six housing units and persons in group quarters), and are estimates of the actual figures that would have been obtained from a complete count.  Refer to the Decennial Census Occupation Data notes for additional information.


		The 1987 Total Active NonFederal Dentists, Total Dentists by Age, Total Practicing (FullTime and PartTime) Dentists; Dental Graduates, Interns and Residents, and Total Dentists by (Govt, Hosp, Other Organization) category are taken from the American Dental Association Dental Tape provided by the Division of Associated and Dental Health Professions, Bureau of Health Professions.

		The 1981 Total Active NonFederal Dentists; Total Dentists by Age; Total Practicing (FullTime and PartTime) Dentists; Dental Interns and Residents; and Total Dentists by (Govt, Hosp, Other Organization) category are taken from the American Dental Association Dental Tape provided by the Division of Dentistry, Bureau of Health Professions.

		The field 1980 Dentists was obtained from the 1980 Census of Population and Housing:  Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1980 census sample (approximately 19percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count.

		Note:	Data for the following entity was not available from the source file:
				Suffolk City, Virginia (51800)

		The 1976 Total Active NonFederal Dentists, Total Patient Care Dentists, and Total Practicing (FullTime and PartTime) Dentists are taken from the American Dental Association Dental Tape provided by the Division of Dentistry, Bureau of Health Professions.

		Note:	1)	226 counties were not updated with the Active NonFederal Dentists as none were reported for them.
				2)	Data are not available for Virginia independent cities.  Refer to A2.

		The 1974 and 1972 Licensed Dentists are taken from the Dental Register, the Division of Dentistry, Bureau of Health Professions.

		Note:	1)	In 1974, there are no data available for:
					Pennsylvania (FIPS State Code 42)
				2)	In 1974, Total Instate Dentists for California are reported as 14,254.  The county totals equal 14,253.
				3)	In 1974, Chicago dentists were included in DuPage, Illinois (17043) in the Dental Register.

		Licensed Dentists for 1971 are from the Dental Register of the State Licensing Boards for all States except Pennsylvania and Indiana  dentist data for Pennsylvania are for the year 1968; and for Indiana are for the year 1969.

		Note:	Data are not available for Virginia independent cities.  Refer to A2.

	
	Dental Hygienists:

		The field 1990 Dental Hygienists was obtained from the 1990 Census of Population and Housing:  Equal Employment Opportunity (EEO) File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1990 census sample (approximately one out of every six housing units and persons in group quarters), and are estimates of the actual figures that would have been obtained from a complete count.  Refer to the Decennial Census Occupation Data notes for additional information.

		The field 1980 Dental Hygienists was obtained from the 1980 Census of Population and Housing:  Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1980 census sample (approximately 19percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count.

		Note:	Data for the following entity was not available from the source file:
				Suffolk City, Virginia (51800)

		The 1974 Licensed Dental Hygienists are from the National Center of Health Statistics supported by the Division of Dentistry, Bureau of Health Manpower.

		Note:	There are no data available for:
				Pennsylvania (FIPS State Code 42)

		The 1972 Licensed Dental Hygienists are listed in the Number Licensed Hygienists, Located Instate, By County Location:  Dec. 31, 1972 from the Census Bureau supported by the Division of Dentistry, Bureau of Health Manpower.

		Note:	There are no data available for the following counties:
				Menominee, Wisconsin (55078)


		B-3)		Optometrists

		The field 1990 Optometrists was obtained from the 1990 Census of Population and Housing:  Equal Employment Opportunity (EEO) File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1990 census sample (approximately one out of every six housing units and persons in group quarters), and are estimates of the actual figures that would have been obtained from a complete count.  Refer to the Decennial Census Occupation Data notes for additional information.

		The field 1980 Optometrists was obtained from the 1980 Census of Population and Housing:  Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1980 census sample (approximately 19percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count.

		Note:	Data for the following entity was not available from the source file:
				Suffolk City, Virginia (51800)

		The 1979 through 1981 Total Active (Federal and NonFederal) and Active NonFederal Optometrists data have been calculated as follows:

		1979 Total Active Optometrists is equal to the number of 1978 Total Active Optometrists plus the number of 1979 Total Active Optometrist Graduates.

		1980 Total Active Optometrists is equal to the number of 1978 Total Active Optometrists plus the number of 1979 and 1980 Total Active Optometrist Graduates.


		1981 Total Active Optometrists is equal to the number of 1978 Total Active Optometrists plus the number of 1979, 1980 and 1981 Total Active Optometrist Graduates.

		Active NonFederal Optometrists have been calculated in the same way.  The 1978 values were taken from the National Center for Health Statistics 1978 National Inventory of Optometrists Tape described below.  The 19791981 graduate figures were extracted from the 1983 Association of Schools and Colleges of Optometry Survey of Recent Graduates of Optometry Schools Tape.  Optometrists reporting foreign or military (APO/FPO) addresses have been excluded from the file.

		The 1978 Total Active (Federal and NonFederal) and Active NonFederal Optometrists are extracted from the National Center for Health Statistics 1978 National Inventory of Optometrists Tape.

		Out of the Total Optometrist count of 24,336, 413 had invalid FIPS Codes and could not be processed.  The tape included information for 2,904 Optometrists obtained from the 1978 Blue Book of Optometrists.  The activity status could not be determined for these Optometrists; therefore, they are not included in the ARF counts.  In addition, 1,262 responded with an activity code of "No" and 144 had an activity code of "Not Available".

		Note:	An Optometrist is defined as "Active" if the Activity Status Code on the source file indicates Active (1).

		The 1972 Active NonFederal Optometrists (Weighted) are from the 197273 Inventory of Optometrists conducted by the American Optometric Association and supported by the Bureau of Health Manpower.

		Note:	1)	There are actually eight fewer records on the original input file than the documentation states (19,638 as opposed to 19,646).
				2)	On the enhanced file, 54 optometrists have been left out of the counts since they did not report their county of practice.

		Data on the characteristics of 1968 Active Optometrists, which are stored on the file but not tabulated, are from the 1968 Vision and Eye Care Manpower Survey of Optometrists.

		Note:	Data are not available for Virginia independent cities.  Refer to A2.


		B-4)		Pharmacists

		The field 1990 Pharmacists was obtained from the 1990 Census of Population and Housing:  Equal Employment Opportunity (EEO) File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1990 census sample (approximately one out of every six housing units and persons in group quarters), and are estimates of the actual figures that would have been obtained from a complete count.  Refer to the Decennial Census Occupation Data notes for additional information.

		The field 1980 Pharmacists was obtained from the 1980 Census of Population and Housing:  Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1980 census sample (approximately 19percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count.

		Note:	Data for the following entity was not available from the source file:
				Suffolk City, Virginia (51800)

		The 1980 Total Pharmacists and Active Pharmacists were extracted from the NCHS 1980 Pharmacy Manpower Information Project Tape.

		Note:	Out of the Total Pharmacists count of 160,664, 55,688 could not be processed due to invalid FIPS Codes; of these, only 5,488 were Active Pharmacists.  104,406 Total Pharmacists and 104,125 Active Pharmacists were included on the file.

		The 197374 Active Pharmacists are from the 197374 Inventory of Pharmacists, American Association of Colleges of Pharmacy and supported by the Bureau of Health Manpower.

		Note:	Many counties have zeroes for Active Pharmacists for 197374, and it is not sure whether the data are missing or that zero is the actual number of Active Pharmacists.

		Data on the number of 1966 Active Pharmacists are from a survey conducted by the National Association of Boards of Pharmacy, in cooperation with the National Center for Health Statistics.  This was a questionnaire sent with a licensing renewal form to each pharmacist at the appropriate renewal time.  State data on pharmacists are available in Pharmacy Manpower U.S., 1966.

		Note:	1)	There are no data available for the following counties:
						Hawaii, Hawaii (15001)
						Honolulu, Hawaii (15003)
						Kauai, Hawaii (15007)
						Maui, Hawaii (15009)
						Menominee, Wisconsin (55078)
						Weston, Wyoming (56045)
				2)	Data are not available for Virginia independent cities.  Refer to A2.


		B-5)		Podiatrists

		The field 1990 Podiatrists was obtained from the 1990 Census of Population and Housing:  Equal Employment Opportunity (EEO) File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1990 census sample (approximately one out of every six housing units and persons in group quarters), and are estimates of the actual figures that would have been obtained from a complete count.  Refer to the Decennial Census Occupation Data notes for additional information.

		
		The field 1980 Podiatrists was obtained from the 1980 Census of Population and Housing:  Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1980 census sample (approximately 19percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count.

		Note:	Data for the following entity was not available from the source file:
				Suffolk City, Virginia (51800)

		The 1980 Podiatrists by Age data are from the American Podiatry Association (APA Data Tape).  The podiatrists are those who applied for membership in the APA.  The counts of Podiatrists (Total and by Age) include federal and nonfederal; active and inactive; parttime and retired podiatrists.  337 podiatrists are not included in the counts on ARF because of unknown county codes.

		Note:	Data are not available for Virginia independent cities.
				Refer to A2.

		The 1974 Total Active Podiatrists (Weighted) are from the Podiatrists Tape created by the National Center for Health Statistics.  Podiatrist counts include federal and nonfederal podiatrists.	

	Note:	In 1974, the following counties have weighting factors less than 1.03 (lowest range per documentation):

						38015	1.00
						38017	1.00
						38035	1.00
						38101	1.00
						41003	1.02
						41005	1.02
						41011	1.02
						41019	1.02
						41029	1.02
						41033	1.02
						41035	1.02
						41039	1.02
						41043	1.02
						41045	1.02
						41047	1.02
						41051	1.02
						41065	1.02
						41067	1.02
						46013	1.00
						46029	1.00
						46035	1.00
						46099	1.00
						46103	1.00
						46135	1.00

		Data on the number of 1968 Total Active Podiatrists is from unpublished State Licensing lists provided by the American Podiatry Association.

		Note:	Data are not available for Virginia independent cities.
				Refer to A2.


		B-6)		Veterinarians

		The field 1990 Veterinarians was obtained from the 1990 Census of Population and Housing:  Equal Employment Opportunity (EEO) File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1990 census sample (approximately one out of every six housing units and persons in group quarters), and are estimates of the actual figures that would have been obtained from a complete count.  Refer to the Decennial Census Occupation Data notes for additional information.

		The field 1980 Veterinarians was obtained from the 1980 Census of Population and Housing:  Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1980 census sample (approximately 19percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count.

		Note:	Data for the following entity was not available from the source file:
				Suffolk City, Virginia (51800)

	
		B-7)		Nurses

	R.N.'s:

		The field 1990 Registered Nurses was obtained from the 1990 Census of Population and Housing:  Equal Employment Opportunity (EEO) File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1990 census sample (approximately one out of every six housing units and persons in group quarters), and are estimates of the actual figures that would have been obtained from a complete count.  Refer to the Decennial Census Occupation Data notes for additional information.

		The field 1980 Registered Nurses was obtained from the 1980 Census of Population and Housing:  Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1980 census sample (approximately 19percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count.

		Note:	Data for the following entity was not available from the source file:
				Suffolk City, Virginia (51800)

		Data on the 1977 Total Estimated Employed R.N.'s, FullTime Estimated Employed R.N.'s, and PartTime Estimated Employed R.N.'s are from the 1977 American Nurses Association Inventory of Registered Nurses Data Tape of revised estimates.  These data have been adjusted by the ANA for nonresponse.

		The data were calculated as follows:

		1)	Total Estimated Employed R.N.'s are taken from the column titled "Estimated Employed R.N.'s".

		2)	FullTime Estimated R.N.'s = The Sum of (FullTime R.N.'s * Weight), where Weight = 	The Sum of the Estimated Employed R.N.'s
						/The Sum of the Total Employed R.N.'s.
			The sums apply to all components included in the county.
		3)	PartTime Estimated R.N.'s = The Sum of (PartTime R.N.'s * Weight), where the Weight and Sums are defined as in 2) above.

		The data for Virginia are defined as the summing of Virginia independent cities data and their respective county data, except the independent cities of Alexandria, Chesapeake, Hampton, Newport News and Virginia Beach, Virginia which are maintained separately on ARF as county equivalents.

		Data on the number of 1972 Active Registered Nurses (Total Employed in Nursing) are from the 1972 American Nurses Association Tape.

		Note:	Data are not available for Virginia independent cities.
				Refer to A2.

		Data on the number of 1972 Employed Registered Nurses are from the 1972 American Nurses Association Inventory of Registered Nurses publication.  The number of Employed R.N.'s is that number which the Division of Nursing reported as "Estimated Employed R.N.'s" after adjustment for nonresponse.

		Note:	Data could not be obtained to separate the independent city of Alexandria, Virginia (51510) from its former county, Arlington, Virginia (51013).  Therefore, on ARF, 1972 Estimated R.N.'s for both Alexandria City and Arlington County are reported in 51013, and 51510 is zerofilled.

		Data on the number of 1966 Registered Nurses are on the file, but are not used in tabulations.  They are from the 1966 Inventory of Registered Nurses conducted by the American Nurses Association.

		Note:	Data are not available for Virginia independent cities.  Refer to A2.

	L.P.N.'s:

		The field 1990 Licensed Practical Nurses was obtained from the 1990 Census of Population and Housing:  Equal Employment Opportunity (EEO) File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1990 census sample (approximately one out of every six housing units and persons in group quarters), and are estimates of the actual figures that would have been obtained from a complete count.  Refer to the Decennial Census Occupation Data notes for additional information.

		The field 1980 Licensed Practical Nurses was obtained from the 1980 Census of Population and Housing:  Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1980 census sample (approximately 19percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count.


		Note:	Data for the following entity was not available from the source file:
				Suffolk City, Virginia (51800) 

		Data on the number of 1974 Total Licensed Practical Nurses and Employed Licensed Practical Nurses are from the 1974 American Nurses Association Inventory of Licensed Practical Nurses publication.  The number of Employed L.P.N.'s is that number which the Division of Nursing reported as "Estimated Employed L.P.N.'s" after adjustment for nonresponse.

		Note:	This publication reports that the number of Employed L.P.N.'s is greater than the number of Total L.P.N.'s for Los Angeles, CA (FIPS Code 06037).

		Data on the number of 1967 Licensed Practical Nurses are from the 1967 Inventory of Licensed Practical Nurses conducted by the American Nurses Association.

		Note:	Data are not available for Virginia independent cities.	 Refer to A2.


		B-8)		Physician Assistants 

		The fields 1999 Physician Assistants; 1999 Physician Assistants, Female; and 1999 Physician Assistants, Male were obtained from data provided by the American Association of Physician Assistants (AAPA). Of the 28,433 identified, approximately 269 could not be identified by gender.	

		The fields 1998 Physician Assistants; 1998 Physician Assistants, Female; and 1998 Physician Assistants, Male were obtained from data provided by the American Association of Physician Assistants (AAPA).  The AAPA estimated that there were 31,301 individuals believed to be in clinical practice in 1998, but only 26,233 were able to be identified by county location.  Therefore, in using the data contained on the Area Resource File it should be noted that there is a 16% undercounting of Physician Assistants.  Additionally, of the 26,233 identified, approximately 203 could not be identified by gender.

		The field 1990 Physician Assistants was obtained from the 1990 Census of Population and Housing:  Equal Employment Opportunity (EEO) File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1990 census sample (approximately one out of every six housing units and persons in group quarters), and are estimates of the actual figures that would have been obtained from a complete count.  Refer to the Decennial Census Occupation Data notes for additional information.

		The number of 1981 Total Physician Assistants was taken from the June 1983 American Academy of Physician Assistants File.

		Note:	1)	Four records on the source file did not have valid county codes; these counts are not included on ARF.  Additionally, Physician Assistants reporting foreign or military (APO/FPO) addresses were excluded from ARF.
				2)	Where business zip code was not available, home zip code was used when available. Of the 11,399 records on the source file, 7133 had blank business zip codes; 4252 of these had a home zip code available.  1691 of the 10,406 records counted are believed to have outofdate addresses, but have been included as the best available information.
				3)	Physician Assistants were reported in 1508 counties.

		The field 1980 Physicians Assistants was obtained from the 1980 Census of Population and Housing:  Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1980 census sample (approximately 19percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count.

		Note:	Data for the following entity was not available from the source file:
				Suffolk City, Virginia (51800)				


		The number of 1980 NonFederal Certified Physician Assistants was taken from the Physician Assistant File obtained from the National Center For Health Services Research.

		Note:	1)	488 records on the source file did not have county codes; these counts are not included on ARF.
				2)	Physician Assistants were reported in 1354 counties.


		B-9)		Occupational Therapists

		The field 1990 Occupational Therapists was obtained from the 1990 Census of Population and Housing:  Equal Employment Opportunity (EEO) File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1990 census sample (approximately one out of every six housing units and persons in group quarters), and are estimates of the actual figures that would have been obtained from a complete count.  Refer to the Decennial Census Occupation Data notes for additional information.

		The number of 1982 Total Occupational Therapists is taken from the 1982 American Occupational Therapy Association Membership Tape.  Occupational Therapists reporting foreign or military (APO/FPO) addresses have been excluded from the file.

		The field 1980 Occupational Therapists was obtained from the 1980 Census of Population and Housing:  Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1980 census sample (approximately 19percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count.

		Note:	Data for the following entity was not available from the source file:
				Suffolk City, Virginia (51800)


		B-10)	Psychology and Social Work Teachers

		The fields 1990 Psychology and Social Work Teachers were obtained from the 1990 Census of Population and Housing:  Equal Employment Opportunity (EEO) File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1990 census sample (approximately one out of every six housing units and persons in group quarters), and are estimates of the actual figures that would have been obtained from a complete count.  Refer to the Decennial Census Occupation Data notes for additional information.


		B-11)	Psychologists

		The field 1990 Psychologists was obtained from the 1990 Census of Population and Housing:  Equal Employment Opportunity (EEO) File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1990 census sample (approximately one out of every six housing units and persons in group quarters), and are estimates of the actual figures that would have been obtained from a complete count.  Refer to the Decennial Census Occupation Data notes for additional information.


		B-12)	Sociologists

		The field 1990 Sociologists was obtained from the 1990 Census of Population and Housing:  Equal Employment Opportunity (EEO) File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1990 census sample (approximately one out of every six housing units and persons in group quarters), and are estimates of the actual figures that would have been obtained from a complete count.  Refer to the Decennial Census Occupation Data notes for additional information.


		B-13)	Social Workers

		The field 1990 Social Workers was obtained from the 1990 Census of Population and Housing:  Equal Employment Opportunity (EEO) File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1990 census sample (approximately one out of every six housing units and persons in group quarters), and are estimates of the actual figures that would have been obtained from a complete count.  Refer to the Decennial Census Occupation Data notes for additional information.




		B-14)	Decennial Census Occupation Data

		The 1990 Decennial Census healthrelated occupation data come from the 1990 Census of Population and Housing:  Equal Employment Opportunity (EEO) File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1990 census sample (approximately one out of every six housing units and persons in group quarters), and are estimates of the actual figures that would have been obtained from a complete count.

		Note:	1)	The data on labor force status were related to the reference week, the calendar week preceding the date on which respondents completed their questionnaires or were interviewed by enumerators.  This week is not the same for all respondents since the enumeration was not completed in one week.
				2)	Civilian Labor Force consists of persons classified as employed or unemployed in accordance with the criteria described below.
				3)	Employed is defined as all civilians 16 years old and over who were either (1) "at work"  those who did any work at all during the reference week as paid employees, worked in their own business or profession, worked on their own farm, or worked 15 hours or more as unpaid workers on a family farm or in a family business; or (2) were "with a job but not at work"  those who did not work during the reference week but had jobs or businesses from which they were temporarily absent due to illness, bad weather, industrial dispute, vacation, or other personal reasons.  Excluded from the employed are persons whose only activity consisted of work around the house or unpaid volunteer work for religious, charitable, and similar organizations; also excluded are persons on active duty in the United States Armed Forces.
				4)	Unemployed is defined as all civilians 16 years old and over who were (1) neither "at work" nor "with a job but not at work" during the reference week, and were (2) looking for work during the last 4 weeks, and were (3) available to accept a job.  Also included as unemployed are civilians who did not work at all during the reference week and were waiting to be called back to a job from which they had been laid off.

		The 1980 Decennial Census healthrelated occupation data come from the 1980 Census of Population and Housing:  Equal Employment Opportunity (EEO) Special File which provides counts of the civilian labor force by detailed occupation.  The data are based on the 1980 census sample (approximately 19percent of the nation's housing units and persons in group quarters), and are estimates of the actual figures that would have resulted from a complete count.

		Note:	Data for the following entity was not available from the source file:
				Suffolk City, Virginia (51800)


		B-15)	National Health Service Corps (NHSC) Sites

		The National Health Service Corps (NHSC) Sites data for 1986 including:  Number of Staffed Rural Sites; Number of Staffed Urban Sites; Number of Approved but Unstaffed Sites; Number of Terminated Sites; and the Current Staff Level for M.D.'s, Physician Extenders (Nurse Practitioners, Physician Assistants, and Midwives), R.N.'s, D.D.S.'s, and Other Personnel, were obtained from the 1986 NHSC Site Tapes, respectively.

		There were 1567 counties updated for the 1986 NHSC data.



	C.  HEALTH FACILITIES

	1970, 1975, and 19801999 Hospital Data:

		All hospital data are from the AHA Annual Survey of Hospitals (Copyright) reporting for a twelvemonth period:  preferably October 1 through September 30 of the following year.  The year of the data on ARF refers to latter year; e.g., 1999 data are from the October 1, 1998 through September 30, 1999 survey.  For 1977 and subsequent years, these data have been taken from the American Hospital Association Hospital Facilities Tapes.  For 1976 and before, these data were extracted from NCHS Hospital Facilities Tapes.  Some of these data have been published in the AHA Guide to the Health Care Field.  Copies of the questionnaires used are published in the AHA Guide to the Health Care Field.  

		The reliability of the data is only as good as the hospitals' responses to the AHA Hospital Surveys for the respective years.  For hospitals not responding to the survey, AHA reports previouslyreported data for approximately 50 general data fields. These include: hospital ID, type of control, service type, name and address, length of stay, total beds, number of bassinets and all of the accreditation and affiliation codes.  These data are carried on the Facility-Level Hospital File as reported by the AHA.  In 1999, AHA reported data for 6,050 U.S.and 65 hospitals in U.S. territories.  Of these 6,115 total hospitals, 1,180 failed to respond, and AHA provided previouslyreported data for the fields described above.

		For hospitals that did respond to the survey, but did not respond to particular fields, the AHA has estimated the data for some of these fields.  Refer to the AHA file documentation for identification of the specific fields.

		To be reported as a "hospital", an institution must have at least six inpatient beds, cribs or pediatric bassinets which shall be continually available for the care of patients.

		Note:	1)	Beginning with 1998 AHA hospital information, data are carried on the ARF for the following U.S. territories: Puerto Rico, Guam and, and Virgin Islands.
				2)	For 1994-1999 and prior to 1983, beds by hospital type fields were calculated using the AHA hospital tape variable "Beds Set Up and Staffed at End of Reporting Period".  For 1983-1993, the same fields were taken from the AHA hospital tape variable "Statistical Beds".  The variable "Statistical Beds" was derived by adding the total number of beds available each day during the hospital's reporting period and dividing this figure by the total number of days in this reporting period.  These changes were used to agree with the procedure AHA uses for its published figures. 
				3)	Neonatal Intensive Care and Neonatal Intermediate Care Beds are excluded from Bassinets Set Up and Staffed.
				4)	Other Long-Term Care, Beds Set Up and Other Care, Beds Set Up may vary from year to year depending on what specialties are broken out that year.
				5)	The survey reports hospitals in Baltimore and St. Louis cities as being in Baltimore and St. Louis counties, respectively.  The county codes for these hospitals have been changed on the hospital files and all fields reaggregated for ARF for these four counties:  Baltimore, Maryland (24005); Baltimore City, Maryland (24510); St. Louis, Missouri (29189); and St. Louis City, Missouri (29510).



		C-1)	Hospital Type

	Short Term General Hospitals:

		Short Term General Hospitals are those coded as follows by the American Hospital Association:  Length of Stay = '1', Shortterm; Type of Service = '10', General medical and surgical.  These hospitals provide nonspecialized care, and the majority of their patients stay for fewer than 30 days.

	Short Term NonGeneral Hospitals:

		Short Term NonGeneral Hospitals are those coded as follows by the American Hospital Association:  Length of Stay = '1', Shortterm; Type of Service not equal '10', General medical and surgical.  These hospitals provide specialized care, and the majority of their patients stay for fewer than 30 days.

	Short Term Hospitals:

		Short Term Hospitals are those coded as follows by the American Hospital Association:  Length of Stay = '1'.  These hospitals may provide either non-specialized or specialized care, and the majority of their patients stay for fewer than 30 days.

	Long Term Hospitals:

		Long Term Hospitals are those coded as follows by the American Hospital Association:  Length of Stay = '2', Longterm.  These hospitals may provide either nonspecialized or specialized care, and the majority of their patients stay for 30 or more days.

	
	Short Term NonGeneral and Long Term Hospitals:

		Short Term NonGeneral and Long Term Hospitals are those coded by the American  Hospital Association as either:	
			1)	Short Term NonGeneral Hospitals (see definition above), or 
			2)	Long Term Hospitals (see definition above).

	Short Term Community Hospitals:

		The following definition of "Community Hospitals" was obtained from the American Hospital Association:  "Community hospitals are defined as all nonfederal shortterm general and other special hospitals, excluding hospital units of institutions." (Children's hospitals are also included in this type of hospital).

		1980, 1985, 1990, 1995, 1998 and 1999 Short Term Community Hospitals are those coded as follows:

		Yr. of Current Data		=	Current year, eg., '1999';
		Yr. Deleted from file	=	'0';
		Hospital Control			=	State, County, City, CityCounty or 
									Hospital District/Authority Government, Nonfederal; 		
									ChurchOperated or Other NotForProfit, Nongovernment;
									Individual, Partnership or Corporation, ForProfit, Nongovernment;
		Hospital Type			=	General Medical and Surgical;
									Obstetrics and Gynecology;
									Eye, Ear, Nose and Throat;
									Rehabilitation;
									Orthopedic;
									Other Specialty;
									Children's General Medical and Surgical;
									Children's Eye, Ear, Nose and Throat;
									Children's Rehabilitation;
									Children's Orthopedic;
									Children's Other Specialty;
		Length of Stay			=	Shortterm.

	Length of Stay (LOS):

		Beginning with the 1994 data, Length of Stay (LOS) is defined as the following:

	If a separate long-term unit is reported and long-term admissions are greater than one-half of total admissions, then LOS is 2; otherwise LOS is 1.

	If a separate long-term unit is not reported and the ratio of inpatient days to admissions is thirty or greater, then LOS is 2; otherwise LOS is 1. 

		Prior to the 1994 data, Length of Stay was defined as the following:

	If separate shortterm and longterm units were reported and shortterm admissions were greater than longterm admissions, then LOS was coded as 1 (short term); if longterm admissions were greater than shortterm admissions, then LOS was coded as 2 (long term).

	If separate units were not reported and the ratio of discharge days to discharges was less than 30, then LOS was coded as 1 (short term); if the ratio of discharge days to discharges was 30 or greater, then LOS was coded as 2 (long term).

	If separate units, discharges and discharge days were not reported and the ratio of inpatient days to admissions is less than 30, then LOS was coded as 1 (short term); if the ratio of inpatient days to admissions is 30 or greater, then LOS was coded as 2 (long term).


	Short Term General Osteopathic Hospitals:

		1990, 1995, 1998 and 1999 Short Term AOHA Hospitals were obtained from the 1990, 1995, 1998 and 1999 AHA Hospital Files and are defined as follows:  Length of Stay = '1', General Service Code = '10', and Registered Osteopathic Hospital = '1'.

		1980 and 1985 AOHA Hospital data have been added to ARF based on the following criteria:	All osteopathic hospitals published in the AOHA Directories for 1980 and 1985 with more than six beds were matched to the Hospital Tapes from the American Hospital Association.  Those osteopathic hospitals which were defined by AHA and NCHS as being short term (code 1) and general (code 10) were added to ARF for these years.

		Note:	1)	Hospitals which are reported in the AOHA Directory but are reported as closed on the AHA Hospital tape for the same year are not included in the ARF AOHA Hospital figures.
				2)	Two hospitals were reported in the AOHA Directories for 1985 that had no match on the AHA Hospital tape.  Therefore, these facilities are not reported in the AOHA Hospital figures.

	Veterans Administration Hospitals:

		1998 and 1999 Veterans Administration Hospitals are those coded as follows by the American Hospital Association:  Hospital Control = '45'.


		C-2)	Hospital Services (or Facilities)

		The number of short term general hospitals or hospital subsidiaries which report that they provide certain inpatient and outpatient services was extracted from the 1998 and 1999 AHA Hospital Files.  The availability of a subset of these services are published in the AHA Guide to the Health Care Field (termed as "Facility Codes") for all hospital types.


		C-3)	Hospital Employment

		1986, 1991, 1996, 1998 and 1999 FullTime Equivalent Personnel and number of Personnel by Occupational Category and Type of Hospital were extracted from the 1986, 1991, 1996, 1998 and 1999 AHA Hospital Files, respectively.

		Note:	1)	Personnel fields include full-time (35 hours or more) and part-time (less than 35 hours) personnel who were on the hospital/facility payroll as of September 30, even if the facility's reporting period ended on a different date.  Religious orders for whom dollar equivalents were reported are included.  Private duty nurses, volunteers and all personnel whose salary is financed entirely by outside research grants are excluded.  Physicians and dentists who are paid on a fee basis are also excluded.
				2)	Nursing home personnel are included in all personnel fields except #FTE Total Hospital Personnel and Total Hospital Personnel, Full-Time and Part-Time.
				3)	Fulltime equivalent personnel are calculated by AHA as the number of fulltime personnel plus onehalf the number of parttime personnel.
				4)	1996, 1998 and 1999 # FTE Total Facility Personnel for Short Term General Hospitals and for ShortTerm NonGeneral and Long Term Hospitals includes Physicians and Dentists, R.N.s, L.P.N.s and L.V.Ns, Medical and Dental Residents/Interns, Other Trainees and the AHA category Other Personnel.  1986 and 1991 #FTE Total Facility Personnel includes Physicians and Dentists, R.N.s, L.P.N.s and L.V.N.s, Medical and Dental Residents/Interns, Other Trainees and the AHA category Other Hospital Personnel. 
				5)	# FTE Other Trainees includes all trainees except Medical and Dental Residents/Interns.
				6)	1986 and 1991 # FTE Other Hospital Personnel for Short Term General Hospitals and for Short Term NonGeneral and Long Term Hospitals includes Medical and Dental Residents/Interns, and the AHA category Other Hospital Personnel.
				7)	1998 and 1999 # FTE All Other Personnel for Veteran's Hospitals includes L.P.N.s and L.V.N.s, Medical and Dental Residents/Interns, Other Trainees and the AHA category Other Personnel.

	
	C-4)	Nursing Homes

		The 1991 Nursing Home and Board and Care Home data are from the 1991 National Health Provider Inventory (NHPI).  The NHPI was conducted by the National Center for Health Statistics (NCHS) in cooperation with the Bureau of the Census.  Data contained on the ARF for Nursing and Board and Care Homes are number of facilities, number of beds, and number of residents.  These data are broken out by ownership class, hospital based and total certified.  The number of Nursing and Board and Care homes with certified Medicare or Medicaid beds, number of residents in these facilities and by ownership class are also carried.  Two fields are being carried which exclude Board and Care homes:  number of Nursing Homes and number of Nursing Home beds.
	

	Ownership Classes:
			1.  Profit (code 1)
			2.  NonProfit (code 2)
			3.  Government (codes 35)

		Note:	1)	A Nursing Home is a facility having three beds or more, and is either licensed as a Nursing Home, certified as a nursing facility under Medicare or Medicaid, identified as a nursing care unit of a retirement center or determined to provide nursing or medical care.
				2)	A Board and Care home (formerly called residential care home) is a generic term used in the NHPI to describe a residential setting that provides either routine general protective oversight, or assistance with activities necessary for independent living, to mentally or physically limited persons.  Any such facility that was licensed or certified was eligible for inclusion in the inventory.
				3)	Facilities for the mentally retarded, including Intermediate Care Facilities for the Mentally Retarded (ICFMR), were excluded for all fields on the ARF except for 24 facilities which were primarily a nursing home and happened to be certified as an ICFMR.
				4)	Many facilities were found to have invalid or incorrect FIPS codes.  They were resolved using the address and zip code.  The FIPS code adjustment resulted in nine facilities being coded into a different state.  Five facilities were changed from Rhode Island to Illinois, three facilities were changed from South Carolina to Michigan and one facility was changed from Minnesota to Missouri.
				5)	The NHPI contained 8,578 nonreporting Board and Care homes that were excluded from followup and 262 facilities who refused to participate in the survey.  These facilities had no FIPS codes or addresses to determine a FIPS code, therefore they were not updated to the ARF.
				6)	Occupancy rate can be determined by dividing the number of residents by the total number of beds.  Variations in reporting among facilities can produce an occupancy that is greater than 100% for a county.
				7)	Edits were performed by NCHS on total beds and total residents.  Whenever these fields were blank, data from other fields were examined and used to replace these missing values.

		The 1986 Nursing Home and Board and Care Home data are from the 1986 Inventory of Longterm Care Places obtained from the National Center for Health Statistics (NCHS).  Data contained on the ARF are number of facilities, number of beds, and number of residents.	
	These data are broken out by ownership class, hospital based and total.  The following fields are also carried: number of Medicarecertified skilled beds, number of Medicaidcertified skilled beds, number of Medicaidcertified intermediate beds, the number of nursing homes containing each of these types of beds and total number of residents in nursing homes that have these types of beds.

		Ownership Classes:
			1.	Profit (code 1)
			2.	NonProfit (code 2)
			3.	Government (codes 34)

		Note:	1)	Board and Care Homes (also known as residential care facilities) cannot be excluded from the data.  As a result, the 1986 data may not be comparable to earlier years of data.
				2)	Data include the following facilities:  skilled nursing facilities (SNF's), intermediate care facilities (ICF's), licensed but uncertified nursing homes, and board and care homes (e.g., homes for the aged, personal care homes).
				3)	Edits were conducted by NCHS to correct inconsistencies between data items.  For missing items, every attempt was made to impute data from existing information, but when this was not possible, 1982 data was substituted when it was available.
				4)	Many nursing homes had incorrect FIPS Codes.  They were resolved using the address and zip code.
				5)	Inconsistencies between the technical documentation and the raw data were clarified after consulting with NCHS.  Fields requiring adjustments include:  the identification number, type of facility, type of ownership and hospitalbased  nursing home.
				6)	Occupancy rate can be determined by dividing the number of residents by the total number of beds.  Variations in reporting among nursing homes can produce an occupancy rate that is greater than 100% for a county.

		The 1982 Nursing Home data are from the 1982 National Master Facility Inventory (NMFI) Nursing Homes and Residential Care Homes Tape obtained from the National Center for Health Statistics (NCHS).  Data contained on the ARF are number of facilities, number of beds, and number of residents.  These data are broken out by ownership class and total.  The following fields are also carried:  number of Medicarecertified and Medicaidcertified skilled beds, number of Medicaidcertified intermediate beds, the number of nursing homes containing each of these types of beds and the total number of residents in nursing homes that have these types of beds.
		Ownership Classes:
			1.	Government (codes 1119)
			2.	NonProfit (codes 2022)
			3.	Profit (codes 2325)
			4.	Hospital Based ('H' in facility identification)

		Note:	1)	Residential and Family Care Homes were excluded from the data.
				2)	Many nursing homes had incorrect FIPS Codes.  They were resolved using the address and zip code.
				3)	The following imputations were made to the data by NCHS:
					a)	1980 data were used for approximately 500 nursing homes in New York.
					b)	Some states issue a nursing home license and a residential license for the same facility.  Whenever this occurred, it created duplicate homes but not duplicate beds.  Every effort was made to unduplicate the homes in such situations.
					c)	Hospital based nursing homes were obtained from the Health Care Financing Administration.  The data from these facilities were imputed.
				4)	Occupancy rate can be determined by dividing the number of residents by the total number of beds.  Variations in reporting among nursing homes can produce an occupancy rate that is greater than 100% for a county.

		The 1978 and 1976 Nursing Home data are from the edited Nursing Home File which is based on the 1978 and 1976 MFI data respectively.  The 1980, 1973 and 1971 Nursing and Personal Care Home data are from 1980, 1973 and 1971 Master Facility Inventory (MFI) Nursing Home and Other Health Facilities tapes obtained from the National Center for Health Statistics.  Data contained on ARF are number of facilities, number of beds, and number of residents.  These data are broken out by ownership class (3 classes) and total.  For 1980 and 1978, the following fields are also carried:  number of Medicarecertified skilled beds, number of Medicaidcertified skilled beds, number of Medicaidcertified intermediate beds, the number of nursing homes containing each of these types of beds (3 fields), and the number of residents in these nursing homes that have these types of beds.

		Ownership Classes:
			1.	Government (codes 1119)
			2.	NonProfit (codes 2022)
			3.	Profit (codes 2325)

		For 1978, the National Master Facility Inventory tape only carried nursing homes.  The facilities selected for inclusion on ARF are "Nursing or personal care homes" (Codes '31''35' in 1976 and 1978; Codes '01''06' in 1973 ; '01''09' in 1971).

		Note:	1)	1980 source data does not include hospital based nursing homes.
				2)	Residential Care Homes were excluded from the 1980 data on the ARF.
				3)	For 1978, due to low response rates to the MFI survey, the MFI tape used the 1976 names, addresses and data for the following states:
						California
						District of Columbia
						New York
						North Carolina
				4)	In the 1978 source data, one nursing home in Arizona was assigned an invalid FIPS Code of 04014.  It was not added to the ARF, because its actual county could not determined from the data available.
				5)	The following counties each had one facility assigned an invalid FIPS codes.  The proper FIPS Codes were assigned using the source address field to verify location.
						27073  Lac Qui Parle, Minnesota
						48325  Medina, Texas
						48375  Potter, Texas
						51153  Prince William, Virginia
						54107  Wood, West Virginia
				



		C-5)	Provider of Services

		The 1994 and 1999 Provider of Services data are from the Health Care Financing Administration's Online Survey and Certification Reporting System (OSCAR) database.  The data carried on the ARF include the number of active Medicare-approved providers for the following types of facilities:

		
	HCFA PROVIDER TYPE					CATEGORY OF PROVIDER
		Skilled Nursing Facilities (SNF), including:
			- SNF/NF, Dually Certified 							Category 02
			- SNF/NF, Distinct Part 								Category 03
			- SNF 												Category 04
		Home Health Agencies 									Category 05
		Nursing Facilities 										Category 10
		Rural Health Clinics 									Category 12
		Ambulatory Surgical Centers 								Category 15
		Hospices 												Category 16
		Community Mental Health Centers 						Category 19
		Screening Mammography (1994 only)					Category 20
		Federally Qualified Centers (1999 only)					Category 21

	Note:		1)  Aleutians, AK (02010) was broken into Aleutians East and Aleutians West. Data from the source that were reported in Aleutians, AK were put in Aleutians West (02016) on the ARF. 
2) Beginning with 1999 provider information, the HCFA provider data on the ARF includes data for Puerto Rico, Guam, and the Virgin Islands.
3) Data for mammography centers are no longer collected by HCFA since the centers are not certified; therefore these data are not available for 1999.


		C-6)	Health Maintenance Organizations

		Number of 1998 HMOs in the County and 1998 HMO Enrollment in the County, total and by model type and federal status are from the InterStudy County Surveyor Database, Version 8.2 (Copyright), as of January 1, 1998.

Note:	1)	Number of HMOs in the County, including by model type and federal status, include an HMO if there is any enrollment population for that HMO in the county. Therefore, one HMO could be counted several times if that plan serves people in several counties.  These counts cannot be summed to higher geographic levels for this reason.
2) HMO enrollment figures pertain to only the enrolled population within the county and can therefore be aggregated to higher geographic levels.  InterStudy collected county enrollment information from roughly half of the HMOs in the country.  Most of the remaining HMOs provided enrollment by metro area.  The metro area enrollments were allocated to the counties in the MSA according to the relative sizes of their population.  The residual enrollment not included in a metro area was assigned to the rural counties in the HMOs? service area according to the relative sizes of their population.  HMOs were not able to account for all their enrollment at the county level.  The County Surveyor database accounts for slightly more than 97 percent of the total HMO enrollment in the country.
3) Number of HMOs and Enrollment are reported for Traditional, IPA, Network and Mixed model types.  These are defined as follows:

* Traditional includes staff and group model types.  The staff model includes HMOs that deliver health services through a physician group that is employed by the HMO.  The group model includes HMOs that contract with one independent group practice to provide health services.
* The IPA model includes HMOs that contract directly with the physicians in independent practices; and/or contract with one or more associations of physicians in independent practice; and/or contract with one or more multi-specialty group practices, but are predominantly organized around solo/single specialty practices.
* The Network model includes HMOs that contract with two or more independent group practices, possibly including a staff group, to provide health services.  While a network may contain a few solo practices, it is predominantly organized around groups.
* Mixed model types include any HMO using a combination of the model types listed above.
	4)	There are five HMOs, located in 36 counties, with an unknown model type.  The data for these HMOs are included in the Total HMO fields.  Therefore, the sum of data by model type does not equal the total fields for these counties.
	5)	HMO Penetration Rate in the County is total HMO enrollment divided by total population in the county.  InterStudy used total population as of July, 1997 in this calculation.
			6)	For those instances where an HMO did not respond to the questionnaire, Interstudy                         used statesupplied information, Blue Cross/Blue Shield Association data, or the                              most current available data from a prior directory.

		The 1976 - 1999 Number of HMO's  were obtained from the National HMO Censuses of Prepaid Plans conducted by the Office of Health Maintenance Organizations, Public Health Service, in each of the years 19761980; from the National HMO Censuses (Copyright) conducted by InterStudy in 19811986; from InterStudy Edge (Copyright) conducted by InterStudy in 19871990, from the InterStudy Competitive Edge (Copyright) conducted by InterStudy in 1991 and from the InterStudy Competitive Edge HMO Directory (Copyright) conducted by InterStudy in 19921999.  In 1989 through 1999, the censuses were as of July 1 of the respective year.  In 1976, 19801984, 1986 and 1988, censuses were as of June.  In 1987, censuses were as of March.  In 1977 and 1978, the censuses were as of August; and in 1979 and 1985, the censuses used were as of December.  The 1976 and 1979 Federally Qualified HMO's were obtained from the Office of Health Maintenance Organizations.

		Note:	1)	Number of HMO's are reported by the location of the headquarters.  Each plan is counted only once in the county location of its headquarters.  This field can therefore be summed to higher geographic levels to determine total HMO plans.
2) Headquarters may be located in a county where there are no enrollees.  For example, in 1997, Prudential HealthCare HMO-Connecticut is headquartered in Sufferin, New York.  Therefore, on the ARF this HMO is included in Rockland County, New York (36087) even though its members reside in Connecticut. These counts are provided primarily as an unduplicated count of the number of HMO plans for use in aggregating to higher geographic levels.
				3)	1999 data include HMO?s located in U.S. possessions. HMO?s are located in Guam and in Puerto Rico.
				4)	Beginning in 1991, InterStudy provided HMO addresses and reported the HMO's alphabetically within state.  Prior to 1991 InterStudy provided no addresses and reported HMO's within the appropriate metropolitan area.   Because of this change in method of reporting, several HMO's on the ARF will appear to have changed counties between 1991 and prior years when in fact they have not.  In 1991 all HMO's were coded into the county where the reported address was.  Thus, while comparing 1991 with historic data on a county basis will result in differences approximately 10 percent of the time, the locations are similar enough that metropolitan areas should be consistent across time.

				
				 
		D.	UTILIZATION


		All Hospital Utilization data are from the AHA Annual Survey of Hospitals (Copyright) reporting for 12month periods in 1970, 1975 and 19801999.  These data have been extracted from an AHA Hospital Tape for 19771999, and an NCHS Hospital Tape for all other years; and have been published in the AHA Guide to the Health Care Field.  See Section C above for information concerning the sources and definitions of hospital types.  The utilization figures available can be broken down into the following four categories:


		D-1)	Utilization Rate

		The utilization rate is the result of dividing the total inpatient days by the product of 365 times the number of beds.  This differs from the figure published in the AHA Guide to the Health Care Field in that the latter includes an adjustment for the number of outpatients seen.


		D-2)	Inpatient Days

		Inpatient Days for short term general hospitals are available for 1970, 1975 and 19801999.  Inpatient Days in short term nongeneral and long term hospitals are available for 1980, 1985 and 1990-1999.  Inpatient Days are also available for selected individual short term hospitals and long term hospitals for 1998 and 1999.  Inpatient Days for short term community hospitals are available for 1980, 1985, 1990, 1995, 1998 and 1999.  Inpatient Days for short term general osteopathic hospitals are available for 1980, 1985, 1990, 1995, 1998 and 1999.  Inpatient Days in veterans hospitals are available for 1998 and 1999.

		Note:	Neonatal Intensive Care and Neonatal Intermediate Care Inpatient Days are excluded from Newborn Days.

		Total Inpatient Days for short term general osteopathic hospitals are available for 1980 and 1985 from the Hospital File for hospitals which have been identified as osteopathic in the American Osteopathic Hospital Association Directory for the appropriate year.


		D-3)	Outpatient Visits

		Outpatient utilization consists of emergency visits, other visits (including clinic and referred visits), and total visits.  Total Outpatient Visits for short term general hospitals are available for 1970, 1975, 1980 and 19851999 and for short term nongeneral hospitals are available for 1980, 1985, and 19901999.  Total Outpatient Visits in Veterans hospitals are available for 1998 and 1999, and for long term hospitals are available for 1980, 1985 and 19901999.


		D-4)	Surgical Operations and Operating Rooms

		1980, 1985, 1990, 1995, 1998 and 1999 number of Surgical Operations by Patient Status (i.e., inpatient versus outpatient) are tallied for short term general hospitals, and short term nongeneral and long term hospitals which were open in each of the respective years.  Number of Surgical Operations are available for Veterans hospitals which were open in 1998 or 1999.

	 Note:   	      1999 Number of Operating Rooms appeared to be invalid on the 1999 AHA                     		      Hospital File for facilities in these counties: Miami Children?s Hospital in Miami-                                  Dade, Florida (12086) reported having 4292 operating rooms, Stewart-Webster                                 	      Hospital in Stewart, Georgia (13259) reported 367 operating rooms, and Blackford                           	      County Hospital in Blackford, Indiana (18009) reported 291 operating rooms.                                   	      Because these numbers were out of line with 1998 and earlier data, the 1998 reported                             figures  were used for 1999. 

	







	E.	EXPENDITURES


		E-1)		Hospital Expenditures

		The total reported hospital expenditures and the number of hospitals reporting expenses for short term general hospitals, short term nongeneral and long term hospitals are recorded for the years 1980, 1985, 1990, 1995, 1998 and 1999; and for Veterans Hospitals for 1998 and 1999.

		
		E-2)		Medicare Managed Care Market Penetration

		The 1997 through 2000 Number of Medicare Beneficiaries, Number of Managed Care Enrollees, and Percent Managed Care Penetration are from the Medicare Managed Care Market Penetration for All Medicare Plan Contractors Data Files, December 1997, December 1998, December 1999, and December 2000, respectively, Health Care Financing Administration (HCFA).

		Note:	1)	The December 2000 and December 1997 files use both December eligibles and December enrollees whereas the December 1998 and December 1999 files used December eligibles and January enrollees. 
				2)	The 1997-1999 source data files have two records for Los Angeles County, California (06037).  Los Angeles County was recalculated by summing these records.
				3)	The 1997-1999 source data files carries Washabaugh County, South Dakota separately from Jackson County, South Dakota.  On the ARF, these counties are combined (refer to section A-2).  Therefore, data for Jackson County, South Dakota was recalculated by summing the data for these records.
				4)	Beginning with the 1999 managed care information, data are available on the ARF for Puerto Rico as well as US counties.


		E-3)		Medicare Adjusted Average Per Capita Cost (AAPCC)

		The 1997 through 2001 Medicare Part A Aged Payment Rate, Medicare Part B Aged Payment Rate, and  Part A and B Aged Payment Rate were obtained from the Health Care Financing Administration's Adjusted Average Per Capita Cost (AAPCC) File. The AAPCC is a prospective estimate of Medicare cost levels by demographic category, in the feeforservice sector of the geographic area.  Part A payment rates are for hospital insurance for persons 65 and older.  Part B payment rates are for supplementary medical insurance for persons 65 and older.  The Part A and B rates are the sum of the Part A and Part B rates.  

		The AAPCC methodology adjusts for age, sex, Medicaid status, working status, and institutional status of the Medicare beneficiaries in a given county.  Also below are the tables containing the demographic cost factors used in this adjustment.  Each factor relates the Medicare cost for a person in that demographic cell to the cost for the average Medicare beneficiary (Factor = 1.00).

		To calculate the actual per capita rates of payment, the AAPCC rates must be multiplied by the demographic cost factors.  The calculation of this monthly payment must be computed separately for Part A and Part B using the following steps:

		1.	Using the State and County of residence, select the appropriate standardized per capita rate.

2. Using the tables (listed below) of the demographic cost factors with the proper Part (A or B) and age group, select the appropriate factor for the specific sex (male or female) and status (Institutionalized, Medicaid, Medicare, and Working Aged).

		3.	Multiply the rate (Step 1) by the factor (Step 2) to calculate the monthly payment.




		1997-2001 DEMOGRAPHIC COST FACTORS FOR THE AGED

			PART A  Hospital Insurance

			Institutional	      N o n  I n s t i t u t i o n a l
					Non	Working
	MALE:			Medicaid	Medicaid	Aged
	85 & Over	2.25	 2.60	 1.35	 .90
	80  84 		2.25	 2.35	 1.20	 .80
	75  79 		2.25	 1.95	 1.05	 .70
	70  74		2.25	 1.50	  .85	 .45
	65  69 		1.75	 1.15	  .65	 .40
	
	FEMALE:
	85 & Over	2.10	 2.10	 1.20	 .80
	80  84 		 2.10	1.70	 1.05	 .70
	75  79 		 2.10	1.45	  .85	 .55
	70  74 		 1.80	1.05	  .70	 .45
	65  69 		 1.45	 .80	  .55	 .35





			PART B  Supplementary Medical Insurance
	
			Institutional	      N o n  I n s t i t u t i o n a l
					Non	Working
	MALE:			Medicaid	Medicaid	Aged
	85 & Over	1.95	 1.70	 1.15	1.00
	80  84 		1.95	 1.70	 1.15	 .90
	75  79 	 	1.95	 1.55	 1.10	 .80
	70  74 	 	1.80	 1.35	 0.95	 .65
	65  69 	 	1.60	 1.10	  .80	 .45
	
	FEMALE:
	85 & Over	1.65	 1.25	 1.00	 .85
	80  84 		1.65	 1.25	  .95	 .75
	75  79 		1.65	 1.25	  .95	 .70
	70  74 		1.65	 1.15	  .85	 .55
	65  69 		1.50	 1.05	  .70	 .40
	
			Note:  The source data file carries data for Washabaugh County, South Dakota and JacksonCounty, South Dakota.  These counties are combined on the ARF (refer to section A-2).  Therefore, only the data for Jackson County, South Dakota is carried on the ARF.  See the table below for the rates for Washabaugh County, South Dakota.


						1998	1998	1998
						MEDICARE	MEDICARE	MEDICARE
						PART A	PART B	PART A/B
			 			AGED	AGED	AGED	SSA
					COUNTY	PAY RATE	PAY RATE	PAY RATE	CODE
					Jackson, South Dakota	$ 210.84	  $ 156.16	$ 367.00	43350
					Washabaugh, South Dakota	210.84	156.16	367.00	43650

						1997	1997	1997
						MEDICARE	MEDICARE	MEDICARE
						PART A	PART B	PART A/B
			 			AGED	AGED	AGED	SSA
					COUNTY	PAY RATE	PAY RATE	PAY RATE	CODE
					Jackson, South Dakota	$ 184.83	 $  87.68	$ 272.51	43350
					Washabaugh, South Dakota	239.07	109.29	348.36	43650
			
	
		E-4)		Medicare Expenditure and Enrollment Data
	
		The 1999 Medicare enrollment data are from Medicare County Enrollment as of July 1,          1999 Aged and Disabled 3/2000 Update, Health Care Financing Administration (HCFA).
		
		The 1998 Medicare Enrollment data are from Medicare County Enrollment as of July 1, 1998 Aged and Disabled 3/99 Update, Health Care Financing Administration (HCFA).

			Note:	1) 	Data have been screened and suppressed by HCFA to protect the privacy of beneficiaries.  These instances are represented as zero on the data file for these variables.
2)  On the source data, each state included a data record for county unknown,          which was not included on the ARF.
3)  The reported HCFA Medicare area names for Alaska were not always FIPS         boroughs or census areas. Data have been put in the following FIPS areas as        noted:
			
		MEDICARE NAME:					FIPS CENSUS AREA:
											
		Aluetian									Aleutians West 				(02016)
		Angoon									Skagway-Hoonah-Angoon	(02232)
		Barrow-North Slope						North Slope					(02185)
		Bristol Bay Borough						Bristol Bay					(02060)
		Bristol Bay								Dillingham					(02070)
		Cordova-McCarthy						Valdez-Cordova				(02261)
		Fairbanks								Fairbanks Northstar			(02090)
		Kenai-Cook Inlet							Kenai Peninsula				(02122)
		Ketchikan								Ketchikan Gateway 			(02130)
		Kobuk									Northwest Arctic				(02188)
		Kodiak									Kodiak Island				(02150)
            	Kuskokwin								Bethel						(02050)
		Matanuska								Matanuska-Susitna			(02170)
		Seward									Kenai Peninsula				(02122)
		Skagway-Yakutat							Skagway-Hoonah-Angoon	(02232)
		Upper Yukon								Yukon-Koyukuk				(02290)
		Valdez-Chitna-Whitier					Valdez-Cordova				(02261)

					4)	 Beginning with the 1999, Medicare Enrollment, data are provided on the ARF for the following U.S. Territories: Guam, Puerto Rico, and the Virgin Islands. In the Virgin Islands, St. Thomas and St. John are reported combined. On the ARF, the data are carried in St. Thomas (78030) and St. John (78020) will be zero filled.

		

		E-5)		Medicare Prevailing Charges Data

		The 1984 Medicare Prevailing Charges indices were determined by calculating the sum of selected procedures for specialists, general practitioners and for the combination of specialists and general practitioners.  (The procedures selected for each category were the ones comprising the top 85 percent of expenditures at the national leveli.e., the average procedure rate times the national number of procedures for that category were multiplied to derive the national expenditures for the procedure).  Total national expenditures for the selected procedures was then divided into the total national expenditures for a selected procedure which was then multiplied by the county value for the same procedure.  All selected procedures were processed this way and summed together resulting in an overall index for prevailing charges at the county level.  For counties not having data reported for all procedures used in the calculation, the proportion of procedures reported was determined and the figure weighted accordingly to get a representative index.  The 1984 Prevailing Charges indices will become the baseline figures for future year indices.

		The procedures used in the calculation are:

	SPECIALIST:
	Routine Hospital Visit						 Brief Followup; Internist
	Limited Hospital Visit						 Followup; Internist
	Minimum Office Visit						 Established Patients; Internist
	Prostate										 Transurethral Electroscution; Urologist
	Intermediate Hospital Visit					 Followup; Internist
	EKG										 Internist
	Intermediate Office Visit						 Followup; Internist
	Limited Office Visit							 Followup; Internist
	Initial Hospital Visit							 Comprehensive; Internist
	Comprehensive Consultation					 Internist
	Initial Hospital Visit							 Intermediate; Internist
	Initial Hospital Visit							 Brief; Internist
	Extensive Office Visit							 Followup; Internist
	Routine Office Visit							 Brief Followup, Established Patients; Internist
	Initial Office Visit							 Brief; Internist
	Hip Replacement 							 Artificial; Orthopedic Surgery
	Coronary Bypass 								 Cardiovascular Surgeon
	Psychotherapy								 One Hour
	Podiatric Office Visit							 Followup; Podiatrist
	Chiropractic Office Visit						 Chiropractic; Chiropractor
	Extensive Hospital Visit						 Followup; Internist
	Extraction Of Lens							 Ophthalmologist
	Colectomy									 General Surgeon
	Initial Office Visit							 Comprehensive, New Patients; Internist
	Urinalysis									 Laboratory
	Initial Office Visit							 Limited, New Patients; Internist
	Twelve Chemical Test						 Laboratory
	Chest XRay									 Two Views; Radiologist
	Eye Exam									 Initial Complete; Ophthalmologist
	Comprehensive Office Visit					 Followup; Internist
	Psychotherapy								 Half Hour
	Reduction Of Fracture						 Orthopedic Surgeon
	Blood Count									 Complete; Laboratory
	Repair Hernia								 General Surgeon
	Cholecystectomy 							 General Surgeon
	Blood Sugar									 Laboratory
	EKG Interpretation							 Report Only; Internist
	Limited Consultation							 Internist

	GENERAL PRACTICE:
	Routine Hospital Visit						  Brief Followup
	EKG
	Prostate										  Transurethral Electroscution
	Limited Hospital Visit						  Followup
	Routine Office Visit							  Followup, Established Patients
	Limited Office Visit							  Followup
	Minimum Office Visit						  Established Patients
	Initial Office Visit							  Limited, For New Patients
	Initial Hospital Visit							  Comprehensive
	Intermediate Office Visit						  Followup
	Extraction Of Lens		
	Intermediate Hospital Visit					  Followup
	Initial Hospital Visit							  Brief

	COMBINED:
	Specialty, Routine Hospital Visit				 Brief Followup; Internist
	Specialty, Limited Hospital Visit				 Followup; Internist
	Specialty, Minimum Office Visit 				 Established Patients; Internist
	Specialty, Prostate							 Transurethral Electroscution; Urologist
	Specialty, Intermediate Hospital Visit			 Followup; Internist
	Specialty, EKG								 Internist
	Specialty, Intermediate Office Visit				 Followup; Internist
	Specialty, Limited Office Visit					 Followup; Internist
	Specialty, Initial Hospital Visit					 Comprehensive; Internist
	Specialty, Comprehensive Consultation			 Internist
	General Practice, Routine Hospital Visit			 Brief Followup
	Specialty, Initial Hospital Visit					 Intermediate; Internist
	Specialty, Initial Hospital Visit					 Brief; Internist
	Specialty, Extensive Office Visit 				 Followup; Internist
	Specialty, Routine Office Visit					 Brief Followup, Established Patients; Interns
	Specialty, Initial Office Visit					 Brief; Internist
	Specialty, Hip Replacement					 Artificial; Orthopedic Surgery
	Specialty, Coronary Bypass					 Cardiovascular Surgeon
	Specialty, Psychotherapy						 One Hour
	Specialty, Podiatric Office Visit				 Followup; Podiatrist
	Specialty, Chiropractic Office Visit				 Chiropractic; Chiropractor
	Specialty, Extensive Hospital Visit				 Followup; Internist
	Specialty, Extraction Of Lens					 Ophthalmologist
	General Practice, EKG
	General Practice, Prostate						 Transurethral Electroscution
	Specialty, Colectomy							 General Surgeon
	Specialty, Initial Office Visit					 Comprehensive, New Patients; Internist
	General Practice, Limited Hospital Visit			 Followup
	General Practice, Routine Office Visit			 Followup, Established Patients
	Specialty, Urinalysis							 Laboratory
	Specialty, Initial Office Visit 					 Limited, New Patients; Internist
	Specialty, Twelve Chemical Test 				 Laboratory
	Specialty, Chest XRay						 Two Views; Radiologist
	General Practice, Limited Office Visit			 Followup
	Specialty, Eye Exam							 Initial Complete; Ophthalmologist
	Specialty, Comprehensive Office Visit			 Followup; Internist
	Specialty, Psychotherapy						 Half Hour
	Specialty, Reduction Of Fracture				 Orthopedic Surgeon
	Specialty, Blood Count						 Complete; Laboratory
	General Practice, Minimum Office Visit			 Established Patients
	Specialty, Repair Hernia						 General
	General Practice, Initial Office Visit				 Limited, For New Patients
	Specialty, Cholecystectomy					 General Surgeon
	Specialty, Blood Sugar						 Laboratory
	General Practice, Initial Hospital Visit			 Comprehensive
	Specialty, EKG Interpretation					 Report Only; Internist
	General Practice, Intermediate Office Visit		 Followup
	Specialty, Limited Consultation 				 Internist
	Specialty, Eye Exam							 Comprehensive; Ophthalmologist
	Specialty, CAT ScanHead					 Radiologist
	General Practice, Extraction Of Lens

		The 1984 Medicare Prevailing Charges data were obtained from the Health Care Financing Administration (HCFA) Medicare Prevailing Charges tapes.  The data included on the ARF are the 75th percentile charge for 110 procedures, thirty of which apply to general practitioners and specialists, all others apply to specialists only.  In the cases where no GP screens or where no Specialist screens are used for some localities, those fields are zerofilled.

		All counties within a particular locality have been assigned the Medicare Prevailing Charges for that locality.  Locality definitions change slightly across years; for detailed changes refer to the maps in the Medicare Prevailing Charges Directories for the appropriate years.	Most Medicare Prevailing Charges localities follow county boundaries and encompass one or more counties.  For more information on locality codes refer to Section A12 above.

		Note:	Los Angeles County contains eight localities; the screens used to calculate the indices included on ARF are the weighted averages of these eight for each procedure, where only those screens based on actual claims in the locality are included in the weighted average. When there are no such claims available, the median value of these eight is used as the screen for that procedure.  


	F.	POPULATION

		Note:	1)	For 1980 and 1990 Census Data, data from the Census STF1A are 100% response data, data from the Census STF3A are weighted from the sample data.
				2)	Eightyseven 1980 Census fields are noted in the technical documentation as having a flag as the first byte of the field.  This is a suppression flag that is equal to '0' when data are available, and '1' when they are not.  1980 Census fields with no suppression flag indicated on the technical documentation do not have suppressed data.  (Refer to Section II. C below for flag definitions.)


		F-1)		Population Counts and Number of Families and Households

	2000 Census Population Counts:
		
	2000 Census population by race/ethnicity are from the US Bureau of Census, www.census.gov, using American Fact Finder feature to download table GCT-PL Race and Hispanic or Latino: 2000. The race categories for Census 2000 are defined as follows:

White - persons having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American - persons having origins in any of the Black racial groups in Africa.

American Indian and Alaska Native - persons having origins in any of the peoples of North and South America.

Asian ? persons having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent.

Native Hawaiian and other Pacific Islander ? persons having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Some Other Race (one race) ? persons of one race who were unable to identify with the five races mentioned above.

Two or More Races ? persons having origins in more than one race as defined above.

	When comparing 2000 Census data to prior years, it is important to note that the questionnaire for Census 2000 was revised to permit reporting of more than one race. Approximately 2.4 percent of the total population reported being two or more races. For further information regarding differences between the 2000 Census and earlier ones, refer to the census website www.census.gov.
 
	The federal government considers race and Hispanic origin to be two separate and distinct concepts. Persons of Hispanic origin can be of any race.

		Note:  Data are included on the ARF for Puerto Rico for the 2000 Census population.

	1990 Census Population Counts:

		1990 Census age, race, and gender data are from the 1990 Census of Population and Housing:  Summary Tape File 1A (STF1A), or Summary Tape File 3A (STF3A).  Individuals of Hispanic Origin are included in the counts by race (White, Black, American Indian/Eskimo/Aleut, Asian/Pacific Islander, and Other).  Therefore when calculating a total, Hispanic Origin should not be included in the calculation.  Hispanic Origin individuals are shown by total as well as by race and origin.  NonWhite data includes Black data.

	1980 Census Population Counts:

		1980 Census age, race and gender data are from the 1980 Census of Population and Housing:  Summary Tape File 1A (STF1A), or Summary Tape File 3A (STF3A).  NonWhite data were derived by subtracting White from Total; NonWhite includes Black.

	
	1970 Census Population Counts:

		1970 Census population is from the 1970 Census Population Tape (known as the BHME Population Tape).

		Note:		Data are not available for Virginia independent cities.  Refer to A2.

	1980 Population for Special Age Groups:

		1980 Persons Aged 18 Years and Older and Aged 65 Years and Older are from the 1983 County and City Data Book File, U.S. Bureau of the Census.

		1980, 1985, 19901998 Total Persons/QuasiIndividuals:

		All Persons/QuasiIndividual estimates come from the U.S. Department of Commerce, Bureau of Economic Analysis (BEA), Regional Economic Measurement Division.  1993 through 1998 are from the Regional Economic Information System (REIS) CD-ROM, and earlier years are from the Local Area Personal Income (LAPI) tapes as noted below:

					YEAR OF DATA			SOURCE FILE
					1998						1969-98 REIS CD-ROM
					1997						1969-97 REIS CD-ROM
					1996						196996 REIS CD-ROM
					1995						196995 REIS CD-ROM
					1994						196994 REIS CD-ROM
					1993						196993 REIS CD-ROM
					1992						196992 LAPI Tape
					1991						196991 LAPI Tape
					1990						196990 LAPI Tape
					1985						196986 LAPI Tape
					1980						195982 LAPI Tape

				Persons are defined as individuals, nonprofit institutions serving individuals, private noninsured welfare funds, and private trust funds.  The last three are referred to as "quasiindividuals" and make up only a small part of the total number of persons.  These quasiindividuals are nonprofit in character and are distinguishable from business enterprises in that they are organizations that either function to serve individuals directly or are established on their behalf.  Nonprofit institutions include religious organizations, social and athletic clubs, labor organizations, and other private nonprofit agencies that furnish services to individuals.  Private noninsured welfare funds include funds providing group health insurance, group life insurance, workers' compensation, and supplemental unemployment benefits.  Examples of private trust funds are a decedent's estate, a trust fund for minors, and a public official's blind trust.

		Note:	1)	Beginning with 1995, Total Persons/Quasi-Individuals data for Menominee County, Wisconsin (55078) and Shawano County, Wisconsin (55115) are carried separately on the source data.  1980, 1985 and 19901994 Total Persons/QuasiIndividuals data for these counties are included in Shawano County (55115) in the source data, and the fields for Menominee County have been zero-filled .
				2)	1985 and 19901998 Total Persons/QuasiIndividuals data for the Virginia city of Galax (normally included in Grayson county  51077) have been included in Carroll county (51035) in the source data.
				3)	1985 and 19901998 Total Persons/QuasiIndividuals data for the Virginia city of Colonial Heights (normally included in Chesterfield county  51041) have been included in Dinwiddie county (51053) in the source data. 
                               4)	The 1992-1998 source data combines several Hawaii and Virginia counties and independent cities. The following lists the county in which each was combined.

				SOURCE FILE AREA			      	       COMBINED WITH 
														FIPS COUNTY
											Hawaii
				Kalawao County  (15005)            			Maui			(15009)

											Virginia
				Bedford City      	(51515)					Bedford			(51019)
				Bristol			(51520)					Washington		(51191)
				Buena Vista		(51530)					Rockbridge		(51163)
				Charlottesville	(51540)   				Albemarle		(51003)
				Clifton Forge	(51560)					Alleghany		(51005)
				Colonial Heights	(51570)					Chesterfield		(51041)
				Covington		(51580)					Alleghany		(51005)
				Danville			(51590)					Pittsylvania		(51143)
				Emporia			(51595)					Greensville		(51081)
				Fairfax City		(51600)					Fairfax			(51059)
				Falls Church		(51610)					Fairfax			(51059)
				Franklin			(51620)					Southampton	(51175)
				Fredricksburg	(51630) 					Spotsylvania		(51177)
				Galax			(51640)					Carroll			(51135)
				Harrisonburg	(51660)					Rockingham		(51165)
				Hopewell		(51670)					Prince George	(51149)
				Lexington		(51678)					Rockbridge		(51163)
				Lynchburg		(51680)					Campbell		(51031)
				Manassas		(51683)					Prince William	(51153)
				Manassas Park	(51685)					Prince William	(51153)
				Martinsville		(51690)					Henry			(51089)
				Norton			(51720)					Wise			(51195)
				Petersburg		(51730)					Dinwidde		(51053)
				Poquoson		(51735)					York			(51199)
				Radford			(51750)					Montgomery		(51121)
				Salem			(51775)					Roanoke		(51161)
				South Boston	(51780)					Halifax			(51083)
				Staunton		(51790)					Augusta			(51015)
				Waynesboro		(51820)					Augusta			(51015)
				Winchester		(51840)					Frederick		(51069)
				
	1980 Median Age:

		1980 Median Age is from the 1983 County and City Data Book File.  The field has one
      implied decimal place.

		Note:	Data for Park County, MT (30067) do not include Yellowstone National Park (30113).

	Rural Farm Population:

		1990 Farm Population data are from the County and City Data Book, 1994, CDROM, a statistical abstract supplement published by the Bureau of the Census, U.S. Department of Commerce.  The data on farm population were obtained from a sample of the population as part of the 1990 Census of Population and Housing, conducted by the Bureau of the Census.  Farm population covers all persons in households living in farm residences as of April 1, 1990.  An occupied onefamily house or mobile home is classified as a farm residence if:  (1) the housing unit is located on a property of 1 acre or more, and (2) at least $1,000 worth of agricultural products were sold from the property (or yard in the case of a tenants household) in 1989.  Group quarters and housing units that are in multiunit buildings or vacant are not included as farm residences.

		1980 Rural Farm Population is from the 1983 County and City Data Book File.  Farm population covers all persons living in rural areas on farms as of April 1, 1980.

	Marriages and Divorces:

		1990 Percent Females Divorced and Numbered Divorced Females fields are from the 1990 Census of Population and Housing, STF3A.  Data on marital status are tabulated only for persons 15 years old and over.

		1980 Percent Females Divorced and Numbered Divorced Females fields are from the 1980 Census of Population and Housing, STF3A.  Data on marital status are tabulated only for persons 15 years old and over.

		Note:	Data for Park County, MT (30067) do not include Yellowstone National Park (30113).

		The 1980 Total Marriages and Total Divorces fields are from the 1983 County and City Data Book File.  The first position of these fields is the 1983 CCDB flag.  (Refer to Section II. C below for flag definition.)

		Population for Foreign and Urban Populations:

		1990 Census Urban Population Counts are from the 1990 Census of Population and Housing, STF3A.  The Census Bureau defines "urban" as consisting of territory, persons, and housing units in:  1) Places of 2,500 or more persons incorporated as cities, villages, boroughs (except in Alaska and New York), and towns (except in the six New England States, New York and Wisconsin), but excluding the rural portions of "extended cities," 2) Census designated places of 2,500 or more persons; 3) Other territory, incorporated or unincorporated, included in urbanized areas.

		1980 Census Urban Population Counts are from the 1980 Census of Population and Housing, STF3A.  As defined by the Census Bureau, the urban population comprises all persons living in urbanized areas which is a population concentration of at least 50,000 inhabitants, generally consisting of a central city and the surrounding, closely settled, contiguous territory (suburbs).  Also included are persons living in places of 2,500 or more inhabitants outside urbanized areas.

		1990 Foreign Born Population was calculated using 1990 Percent Foreign Born Population and 1990 Census Population from the County and City Data Book, 1994, CDROM.  See Percent Foreign Born Population for the definition of foreign born and special notes.
	
	Note:	The calculation for 1990 Foreign Born Population is:
				(1990 Census Population * 1990 % Foreign Born Population)/100.

	Non-English Speaking Persons:

		1990 NonEnglish Speaking Persons by age data are from the 1990 Census of Population and Housing, STF3A.  These fields include persons who reported they spoke a language other than English and indicated their ability to speak English "not well" or "not at all."

		1980 NonEnglish Speaking Persons 18+ data are from the 1980 Census of Population and Housing, STF3A.  This field includes persons who speak a language other than English at home and if their ability to speak English is not well or not at all.

	Number of Families and Households:

		1990 Family, Household, and Group Quarters data are from the 1990 Census of Population and Housing, STF1A.  Traditional Families are defined to include total households with a married couple with or without children.  Single Parent Households are defined to include male and female householders with related children.

		1980 Number of MarriedCouple Families is from the 1983 County and City Data Book File.

		1980 Number of Households, Number of Persons in Households, and Number of Persons in Group Quarters data are from 1980 Census of Population, Supplementary Reports:  Population and Households by States and Counties:  1980, PC 80S12, U.S. Department of Commerce, Bureau of the Census.

		1980 Family and Other Household data are from the 1980 Census of Population and Housing, STF3A.
	
	1960 Population Counts:

		1960 Census Population counts are published in Census of Population 1960, the Eighteenth Decennial Census of the United States.

		Note:	1)	1960 Census Population for the independent cities of Hampton and Newport News, Virginia are included in York County (51199).  Hampton (51650) and Newport News (51700) are zerofilled for this field.  
				2)	1960 Census Population for the independent city of Galax, Virginia is included in Carroll County (51035), rather than Grayson County (51077).  
				3)	1960 Census Population for Charles City County, Virginia (51036) is not reported.	
				4)	Data could not be obtained to break out 1960 Census Population for the Virginia independent cities of Alexandria, Chesapeake and Virginia Beach from their former counties.	
				5)	The reported figures were changed to hundreds for consistency on the ARF in 9/90.

	1950 Population Counts:

		1950 Census Population counts are published in 1950 Census of Population, Volume I, Number of Inhabitants.

		Note:	1)	1950 Census Population for the independent cities of Hampton and Newport News, Virginia are included in York County (51199).  Hampton (51650) and Newport News (51700) are zerofilled for this field.  
				2)	1950 Census Population for the independent city of Galax, Virginia is included in Carroll County (51035), rather than Grayson County (51077).  
				3)	1950 Census Population for Charles City County, Virginia (51036) is not reported.	
				4)	Data could not be obtained to break out 1950 Census Population for the Virginia independent cities of Alexandria, Chesapeake and Virginia Beach from their former counties.	
				5)	The reported figures were changed to hundreds for consistency on the ARF in 9/90.

	1940 Census Population Counts:

		1940 Census Population counts are published in Sixteenth Census of the U.S. 1940, Population Volume I, Number of Inhabitants.


		Note:	1)	1940 Census Population for the independent cities of Hampton and Newport News, Virginia are included in York County (51199).  Hampton (51650) and Newport News (51700) are zerofilled for this field.  
				2)	1940 Census Population for the independent city of Galax, Virginia is included in Carroll County (51035), rather than Grayson County (51077).  
				3)	1940 Census Population for Charles City County, Virginia (51036) is not reported.	
				4)	Data could not be obtained to break out 1940 Census Population for the Virginia independent cities of Alexandria, Chesapeake and Virginia Beach from their former counties.	
				5)	The reported figures were changed to hundreds for consistency on the ARF in 9/90.


		F-2)		Population Percents

	1990 Population Percents and Percent Urban Population:

		1990 Percent Population by Race or National Origin were calculated from the 1990 Census of Population and Housing:  Summary Tape File 1A (STF1A).  1990 Percent Urban Population was calculated from the 1990 Census of Population of Housing, STF3A.  See Population for Foreign and Urban Population for the definition of urban.

		Note:	Data for Park County, MT (30067) do not include Yellowstone National Park (30113).

	1980 Population Percents:

		1980 Percent Population by Race or National Origin, and 1980 Percent Urban Population were calculated from the 1980 Census of Population and Housing, STF3A.

		Note:	Data for Park County, MT (30067) do not include Yellowstone National Park (30113).

	1990 Percent Foreign Born Population:

		1990 Percent Foreign Born Population data are from the County and City Data Book, 1994, CDROM, a statistical abstract supplement published by the Bureau of the Census, U.S. Department of Commerce.  Data were obtained as part of the 1990 decennial census.  Foreign born includes persons born outside the United States, Puerto Rico, or an outlying area of the United States.  The small number of persons who were born in a foreign country but have at least one American parent are not included in this category.  Persons not reporting place of birth were assigned the birthplace of another family member or were allocated the response of another person with similar characteristics.  Percent Foreign Born Population has one implied decimal place. 

		Note:	1)	Percent Foreign Born Population rounds to less than half of the unit of measure shown in the following counties:
					01131  Wilcox, Alabama 
					13271  Telfair, Georgia 
					20123  Mitchell, Kansas 
					21159  Martin, Kentucky 
					21181  Nicolas, Kentucky 
					21231  Wayne, Kentucky 
					22025  Catahoula, Louisiana 
					28019  Choctaw, Mississippi 
					28143  Tunica, Mississippi 
					29173  Ralls, Missouri 
					39163  Vinton, Ohio 
					47175  Van Buren, Tennessee
				2)	Data for Park County, MT (30067) do not include Yellowstone National Park (30113).


		F-3)		Population Estimates

		The 1999 Population Estimates and 1999 Population 65+ are from County  Population Estimates and Demographic Components of Population Change: Annual Time Series, July 1, 1990 to July 1, 1999 from the U.S. Bureau of the Census. 1999 Population Estimates for the Municipios of Puerto Rico are included from (PR-99-1) Estimates of the Population of Puerto Rico Municipos, July 1, 1999 and Demographic Components of Population Change: April 1,1990 to July 1, 1999. 1999 Population Estimates for Guam are from the U.S. Bureau of the Census? Components of  Growth for Puerto Rico and Insular Areas for 1990-1999.

		The 1998 Population Estimates and 1998 Population Estimates 65+ are from Estimates of the Population of Counties and Demographic Components of Population Change: Annual Time Series, July 1, 1990 to July 1, 1998 from the Bureau of the Census.  

		The 1997 Population Estimates and 1997 Population Estimates 65+ are from Estimates of the Population of Counties and Demographic Components of Population Change: Annual Time Series, July 1, 1990 to July 1, 1997 from the Bureau of the Census.

		Note:	Effective July 1, 1997, the entire city of Takoma Park has been included in Montgomery County, MD (24031).  Prior to July 1, 1997, part of Takoma Park city had been included in Prince George's County, MD (24033). 

		The 1996 Population Estimates and 1996 Population Estimates 65+ are from Estimates of the Population of Counties and Demographic Components of Population Change: Annual Time Series, July 1, 1990 to July 1, 1996 from the Bureau of the Census.

		1999 Population Estimates by Gender, Race and Hispanic Origin data are from Estimates of the Population of Counties by Age, Sex, Race and Hispanic Origin: 1990 to 1999, U.S. Bureau of the Census. 1998 Population Estimates by Gender, Race and Hispanic Origin data are from Estimates of the Population of Counties by Age, Sex, Race and Hispanic Origin: 1990 to 1998, U.S. Bureau of the Census.  1997 Population Estimates by Gender, Race and Hispanic Origin data are from Estimates of the Population of Counties by Age, Sex, Race and Hispanic Origin: 1990 to 1997, U.S. Bureau of the Census.  1991-1996 Population Estimates by Gender, Race and Hispanic Origin data are from Estimates of the Population of Counties by Age, Sex, Race and Hispanic Origin: 1990 to 1996, U.S. Bureau of the Census.  These data are estimates of the resident population for July 1 of the respective year.  Male and female population fields are carried for White Non-Hispanic; White Hispanic; Black; American Indian/Eskimo/Aleut; Asian/Pacific Islander; and Total Hispanic.

		Note: 	1)	Total White population can be calculated by adding White Non-Hispanic and White Hispanic.
				2)	Individuals of Hispanic Origin are included in the counts by race for Black; American Indian/Eskimo/Aleut and Asian/PacificIslander.  Therefore when calculating total population, Hispanic Origin should not be included in the calculation.

		The 1993-1995 Population Estimates and 19911995 Population Estimates 65+ are from State and County Population Estimates Components of Change 199095 from the Bureau of the Census.  The data are as of July 1 for the respective year.

		1991 and 1992 Population Estimates are from Population of States and Counties 19901992 from the Bureau of the Census.  The data are as of July 1 for the respective year. 

		Note:	No data were available for Denali, AK (02068) and for Yakutat, AK (02282).

		19831988 Population Estimates are from Local Population Estimates, Bureau of the Census, Series P26, Provisional Estimates of the Population of Counties:  July 1, 19831988 for the respective year.

		Note:	The 1983 and 1984 Population Estimates were not available for the District of Columbia. The Population Estimates from P25 State Series were used.

		1973-1978 and 1982 Population Estimates are from the FederalState Cooperative Program for Population Estimates, Bureau of the Census, Series P26, Estimates of the Population (By State) Counties and Metropolitan Areas:  July 1, 19731978 for the respective year.

		Note:	1)	Muscogee County, Georgia (Modified FIPS Code 13215) consists of consolidated government totals for years 19731978.  
				2)	1978 data are not available for Virginia independent cities.  Refer to A2.

		1971 and 1972 Population Estimates are from the Current Population Reports, Bureau of the Census, for the respective year.


		F-4)		Labor Force

		The 19871999 Labor Force data are from the Local Area Unemployment Statistics File, for each respective year, obtained from the Bureau of Labor Statistics.  Data are for persons 16 years and older, and include the following:  Civilian Labor Force, Number Employed, Number Unemployed and Unemployment Rate.

		The 19871999 Unemployment Rate is carried as a percentage with one implied decimal place. Rates for 1987-91 were recalculated for Virginia counties which include independent cities.  The following formula was used:

		Unemployment Rate = (Number Unemployed / Civilian Labor Force) * 100

		Note:	1) 1999 data are available for Puerto Rico.
				2) No data for Kalawao, HI are reported on the source file for 1992-99
				3) The source file Alaska State total for 1994 persons (F0978694) is 6053, but                                                      the sum of the counties is 6055; therefore the sum of this field on the ARF                                                        will differ from the source file state total by 2.
				4) The source file Alaska State total for 1993 persons (F0978693) is 5979, but                                                       the sum of the counties is 5980; therefore the sum of this field on the ARF                                                        will differ from the source file state total by 1.

		The 1990 Employment and Labor Force data are from the 1990 Census of Population and Housing, STF3A.

		Note:	1)	The data on labor force status and journey to work were related to the reference week, the calendar week preceding the date on which the respondents completed their questionnaires or were interviewed by enumerators.  This week is not the same for all respondents since the enumeration was not completed in one week.
				2)	Public transportation includes bus or trolley bus, streetcar or trolley car, subway or elevated, railroad, ferry or taxicab.
				3)	White collar workers include the following:  managerial and professional specialty occupations; and technical, sales and administrative support occupations.
				4)	Persons were identified as having a work disability if they had a health condition that had lasted for 6 or more months and which limited the kind or amount of work they could do at a job or business.
				5)	Data for Park County, Montana (30067) do not include Yellowstone National Park (30113)

		The 1985 and 1986 Labor Force data are from Labor Force, Employment and Unemployment Estimates for States, Labor Market Areas, Counties and Selected Cities (Supplement No. 2), Bureau of Labor Statistics.  Data are for persons 16 years and older, and include the following:  Civilian Labor Force, Number Employed, Number Unemployed and Unemployment Rate.

		The 1979 and 1980 Employment and Labor Force data are from the 1980 Census of Population and Housing, STF3A.  

		Note:	Data for Park County, Montana (30067) do not include Yellowstone National Park (30113).

		The following 1980 Labor Force data are from the Bureau of Labor Statistics Annual Averages Tapes for 1980:

		1.  Civilian Labor Force, Persons 16 Years and Older
		2.  Number Employed, Persons 16 Years and Older
		3.  Number Unemployed, Persons 16 Years and Older
		4.  Unemployment Rate, Persons 16 Years and Older

	The Unemployment Rate, which is carried as a percentage with one implied decimal place, was recalculated for Virginia counties to include independent cities in the appropriate counties (where necessary), and for Alaska according to the formula:

		Unemployment Rate = Number Unemployed / Civilian Labor Force.

		The 1977 data were also recalculated for counties in Connecticut and Rhode Island since the locality divisions used by BLS for these states are the LMA's (Labor Market Areas).  Rhode Island towns were weighted and summed into corresponding counties using the 1975 population contained in the Series P25, No. 687 Pamphlet, 1973 (Revised) and 1975 Population Estimates and 1972 (Revised) and 1974 Per Capita Income Estimates for Counties, Incorporated Places, and Selected Minor Civil Divisions in Rhode Island.  Connecticut towns were weighted and summed into the corresponding counties using the Estimated Populations in Connecticut as of July 1, 1977 published by the Connecticut State Department of Health.

		Note:	The following county had no data reported for the indicated years:
					Chavez, New Mexico (35005)			1977, 1980
	 




		F-5)		Per Capita Incomes

	19751998 Per Capita Income:

		All Per Capita Income estimates come from the U.S. Department of Commerce, Bureau of Economic Analysis (BEA), Regional Economic Measurement Division.  1993 through 1998 are from the Regional Economic Information System (REIS) CDROM, and earlier years are from the Local Area Personal Income (LAPI) tapes as noted below:




					YEAR OF DATA			SOURCE FILE
					1998						1969-98 REIS CD-ROM
					1997						1969-97 REIS CD-ROM
					1996						196996 REIS CDROM
					1995						196995 REIS CDROM
					1994						196994 REIS CDROM
					1993						196993 REIS CDROM
					1992						196992 LAPI Tape
					1991						196991 LAPI Tape
					1990						196990 LAPI Tape
					1989						196989 LAPI Tape
					1988						196988 LAPI Tape
					1987						196987 LAPI Tape
					198586					196986 LAPI Tape
					198384					195984 LAPI April 1986 Tape
					197582					195982 LAPI April 1984 Tape

		Per Capita Income is the total personal income of the residents of a given area divided by the resident population of the area.  Personal income is the income received by persons from all sources, that is, from participation in production, from both government and business transfer payments, and from government interest.  Personal income is the sum of wage and salary disbursements, other labor income, proprietors' income, rental income of persons, personal dividend income, personal interest income, and transfer payments, less personal contributions for social insurance.  In computing Per Capita Income, BEA used the Bureau of the Census county population totals as of July 1.

		Note:	1)	Prior to 1992, the Per Capita Income data for Alaska and Virginia counties which include independent cities, have been calculated as a weighted average.  The independent cities of Alexandria, Chesapeake, Hampton, Newport News and Virginia Beach, Virginia are maintained separately on ARF as county equivalents.
				2)	Beginning with 1995, Per Capita Income data for Menominee County, Wisconsin (55078) and Shawano County, Wisconsin (55115) are carried separately on the source data file.  19751994 Per Capita Income data for these counties are included in Shawano County on the source data, and the fields for Menominee County have been zero-filled.
				3)	19851998 Per Capita Income data for the Virginia city of Galax (normally included in Grayson county  51077) have been included in Carroll county (51035) in the source data.
4) 19851998 Per Capita Income data for the Virginia city of Colonial Heights (normally included in Chesterfield county  51041) have been included in Dinwiddie county (51053) in the source data.
5) The 1992-1998 source data combines several Hawaii and Virginia counties and independent cities. The following lists the county in which each was combined.



				SOURCE FILE AREA			      	       COMBINED WITH 
														FIPS COUNTY
											Hawaii
				Kalawao County  (15005)            			Maui			(15009)


											Virginia
				Bedford City      	(51515)					Bedford			(51019)
				Bristol			(51520)					Washington		(51191)
				Buena Vista		(51530)					Rockbridge		(51163)
				Charlottesville	(51540)   				Albemarle		(51003)
				Clifton Forge	(51560)					Alleghany		(51005)
				Colonial Heights	(51570)					Chesterfield		(51041)
				Covington		(51580)					Alleghany		(51005)
				Danville			(51590)					Pittsylvania		(51143)
				Emporia			(51595)					Greensville		(51081)
				Fairfax City		(51600)					Fairfax			(51059)
				Falls Church		(51610)					Fairfax			(51059)
				Franklin			(51620)					Southampton	(51175)
				Fredricksburg	(51630) 					Spotsylvania		(51177)
				Galax			(51640)					Carroll			(51135)
				Harrisonburg	(51660)					Rockingham		(51165)
				Hopewell		(51670)					Prince George	(51149)
				Lexington		(51678)					Rockbridge		(51163)
				Lynchburg		(51680)					Campbell		(51031)
				Manassas		(51683)					Prince William	(51153)
				Manassas Park	(51685)					Prince William	(51153)
				Martinsville		(51690)					Henry			(51089)
				Norton			(51720)					Wise			(51195)
				Petersburg		(51730)					Dinwidde		(51053)
				Poquoson		(51735)					York			(51199)
				Radford			(51750)					Montgomery		(51121)
				Salem			(51775)					Roanoke		(51161)
				South Boston	(51780)					Halifax			(51083)
				Staunton		(51790)					Augusta			(51015)
				Waynesboro		(51820)					Augusta			(51015)
				Winchester		(51840)					Frederick		(51069)
				

		1987 Per Capita Income Estimate is from Population (1988) and Per Capita Income (1987) Estimates:  Governmental Units, Bureau of the Census.  1985 Per Capita Income Estimate is from Population (1986) and Per Capita Income (1985) Estimates:	Governmental Units, Bureau of the Census.

		The Census Per Capita Income (PCI) figure is the estimated average amount per person of total money income received during the calendar year for all persons residing in a given political jurisdiction.  The estimates are based on the 1970 census and have been updated using rates of change developed from various administrative record sets and compilations, mainly from the Internal Revenue Service (IRS) and the Bureau of Economic Analysis (BEA).

		The PCI estimates are based on a money income concept.  Total money income is defined by the Bureau of the Census for statistical purposes as the sum of:

				Wage and salary income
				Net nonfarm selfemployment income
				Net farmselfemployment income
				Social Security and railroad retirement income
				Public assistance income
				All other income such as interest, dividends, veteran's payments, pensions, 		
					unemployment insurance, alimony, etc.

		The total represents the amount of income received before deductions for personal income taxes, Social Security, bond purchases, union dues, Medicare deductions, etc.

		Note:	The Per Capita Income data for Alaska and counties which include independent cities, have been calculated as a weighted average.  The independent cities of Alexandria, Chesapeake, Hampton, Newport News and Virginia Beach, Virginia are maintained separately on ARF as county equivalents.  


		1977 Per Capita Income:

		1977 Per Capita Income Estimates is from the Population Estimates and Projections Tape, Bureau of the Census, Series P25.  See above for Bureau of the Census definition of Per Capita Income.

		Note:	The Per Capita Income for Alaska and Virginia counties which include independent cities, has been calculated as a weighted average.  (Weighting is by 1978 Population.)  The independent cities of Alexandria, Chesapeake, Hampton, Newport News and Virginia Beach, Virginia are maintained separately on ARF as county equivalents.

		1975 Per Capita Income:

		1975 Per Capita Income Estimates is from the 1976 Revenue Sharing Tape obtained from the Data Users Services Division, Bureau of the Census.  See above for Bureau of the Census definition of Per Capita Income.

		Note:	1)	Per capita income has been calculated as a weighted average for Virginia counties which include independent cities, except the cities of Alexandria, Chesapeake, Hampton, Newport News and Virginia Beach, Virginia which are maintained separately on ARF as county equivalents.
				2)	Data for Alaska were obtained from the published Population Estimates and Projections, Bureau of the Census, Series P25, No. 741, 1976 Populations Estimates and 1975 and 1974 Revised Per Capita Income Estimates for Census Divisions, Bouroughs, and Incorporated Places in Alaska.
				3)	Data for the following counties were not available on the tape:
						Honolulu, Hawaii (15003)
						Baltimore City, Maryland (24510)
						St. Louis City, Missouri (29510)
						Carson City, Nevada (32510)
						Suffolk City, Virginia (51800)
						Norfolk, Virginia (51710)
						Hampton City, Virginia (51650)
						Newport News City, Virginia (51700)

		1974 Per Capita Income:

		1974 Per Capita Income Estimates is published in the Population Estimates and Projections, Bureau of the Census, Series P25, 1975 Population and 1974 Per Capita Income Estimates for Counties and Incorporated Places (By State).  See above for Bureau of the Census definition of Per Capita Income.

		Note:	1)	Per capita income has been calculated as a weighted average for Alaska and for Virginia counties which include independent cities, except the cities of Alexandria, 
					Chesapeake, Hampton, Newport News and Virginia Beach, Virginia which are maintained separately on ARF as county equivalents.
				2)	Data for the District of Columbia (Modified FIPS Code 11001) are not published in this source document, however a Per Capita Income estimate of $5659 was obtained from the Bureau of the Census.
				3)	Data for Yellowstone National Park (part), Wyoming (Modified FIPS Code 56047) are not published in this source document, however a Per Capita Income estimate of $4249 was obtained from the Bureau of the Census.

		
		1972 Per Capita Income:

		1972 Per Capita Income Estimates is published in the Population Estimates and Projections, Bureau of the Census, Series P25, 1973 Population and 1972 Per Capita Income Estimates for Counties and Incorporated Places (By State).  See above for Bureau of the Census definition of Per Capita Income.

		Note:	1)	Per capita income has been calculated as a weighted average for Alaska and Virginia counties which include independent cities, except the cities of Alexandria, Chesapeake, Hampton, Newport News and Virginia Beach, Virginia which are maintained separately on ARF as county equivalents.  
				2)	Data for the District of Columbia (Modified FIPS Code 11001) are not available from the source; this figure is $4901 according to the Bureau of the Census.


	F-6)	Income

		19751998 Total Personal Income:

		All Total Personal Income estimates comes from the U.S. Department of Commerce, Bureau of Economic Analysis (BEA), Regional Economic Measurement Division.  1993 through 1998 are from the Regional Economic Information System (REIS) CDROM and earlier years are from the Local Area Personal Income (LAPI) tapes as noted below:


					YEAR OF DATA			SOURCE FILE
					1998						1969-98 REIS-CD-ROM
					1997						1969-97 REIS CD-ROM
					1996						196996 REIS CDROM
					1995						196995 REIS CDROM
					1994						196994 REIS CDROM
					1993						196993 REIS CDROM
					1992						196992 LAPI Tape
					1991						196991 LAPI Tape
					1990						196990 LAPI Tape
					1989						196989 LAPI Tape
					1988						196988 LAPI Tape
					1987						196987 LAPI Tape
					198586					196986 LAPI Tape
					198384					195984 LAPI April 1986 Tape
					197582					195982 LAPI April 1984 Tape

		Personal Income is the income received by persons from all sources, that is, from participation in production, from both government and business transfer payments, and from government interest.  Personal income is the sum of wage and salary disbursements, other labor income, proprietors' income, rental income of persons, personal dividend income, personal interest income, and transfer payments, less personal contributions for social insurance.

		Note:	1)	Beginning with 1995, Total Personal Income data for Menominee County, Wisconsin (55078) and Shawano County, Wisconsin (55115) are carried separately on the source data file.  19751994 Total Personal Income for these counties are included in Shawano County on the source data, and the fields for Menominee County have been zero-filled.
				2)	19851998 Total Personal Income data for the Virginia city of Galax (normally included in Grayson county  51077) have been included in Carroll county (51035) in the source data.
				3)	19851998 Total Personal Income data for the Virginia city of Colonial Heights (normally included in Chesterfield county  51041) have been included in Dinwiddie county (51053) in the source data.
				4)	The 1992-1998 source data combines several Hawaii and Virginia counties and independent cities. The following lists the county in which each was combined.

				SOURCE FILE AREA			      	       COMBINED WITH 
														FIPS COUNTY
											Hawaii
				Kalawao County  (15005)            			Maui			(15009)

											Virginia
				Bedford City      	(51515)					Bedford			(51019)
				Bristol			(51520)					Washington		(51191)
				Buena Vista		(51530)					Rockbridge		(51163)
				Charlottesville	(51540)   				Albemarle		(51003)
				Clifton Forge	(51560)					Alleghany		(51005)
				Colonial Heights	(51570)					Chesterfield		(51041)
				Covington		(51580)					Alleghany		(51005)
				Danville			(51590)					Pittsylvania		(51143)
				Emporia			(51595)					Greensville		(51081)
				Fairfax City		(51600)					Fairfax			(51059)
				Falls Church		(51610)					Fairfax			(51059)
				Franklin			(51620)					Southampton	(51175)
				Fredricksburg	(51630) 					Spotsylvania		(51177)
				Galax			(51640)					Carroll			(51135)
				Harrisonburg	(51660)					Rockingham		(51165)
				Hopewell		(51670)					Prince George	(51149)
				Lexington		(51678)					Rockbridge		(51163)
				Lynchburg		(51680)					Campbell		(51031)
				Manassas		(51683)					Prince William	(51153)
				Manassas Park	(51685)					Prince William	(51153)
				Martinsville		(51690)					Henry			(51089)
				Norton			(51720)					Wise			(51195)
				Petersburg		(51730)					Dinwidde		(51053)
				Poquoson		(51735)					York			(51199)
				Radford			(51750)					Montgomery		(51121)
				Salem			(51775)					Roanoke		(51161)
				South Boston	(51780)					Halifax			(51083)
				Staunton		(51790)					Augusta			(51015)
				Waynesboro		(51820)					Augusta			(51015)
				Winchester		(51840)					Frederick		(51069)
				
		
		1979 Personal Income data are from the 1980 Census of Population and Housing, STF3A.

		These fields include the sum of family income in 1979, total money income received in the calendar year 1979 by all family members 15 years old and over; and 1979 income for unrelated individuals 15 years old and over (persons not included in family income).

		1980 Income from Manufacturing, Income from Retail Trade, Income from Services, and Total Labor/Proprietors Income were extracted from the 19751980 Local Area Personal Income, U.S.  Department of Commerce, Bureau of Economic Analysis, June 1982.

		Note:	1)	Menominee, Wisconsin (55078) is included in Shawano, Wisconsin (55115).
				2)	Zero values express suppressed data for 1980 Income from Manufacturing except for the following counties:
						Clark, ID. 			16033			Billings, ND.			38007
						Owsley, KY. 			21189			Slope, ND.			38087  
						Robertson, KY. 		21201			Mellette, SD.			46095  
						Issaquena, MS. 		28055			Kenedy, TX.			48261  
						Golden Valley, MT. 	30037			King, TX.			48269  
						Petroleum, MT. 		30069			Kinney, TX.			48271  
						Treasure, MT. 		30103			Grant, SD.			46051  
						Banner, NE. 			31007			Hartley, TX.			48205  
						Loup, NE. 			31115			Irion, TX.			48235  
						Mc Pherson, NE. 		31117			Loving, TX.			48301  
						Wheeler, NE. 		31183			Mc Mullen, TX.		48311  
						Esmeralda, NV. 		32009
				3)	Zero values express suppressed data for 1980 Income from Retail Trade except for the following county:
						Loving, TX. (48301)	
				4)	Zero values express suppressed data for 1980 Income from Services except for the following counties:
						Borden, TX. (48033)
						Loving, TX. (48301)


		F-7)		Persons and Families Below Poverty Level

		The 1993, 1995 and 1997 Estimates of Persons in Poverty; Estimate of Persons Age 0-17 in Poverty; and Estimate of Children 5-17 in Families in Poverty data are from the Bureau of Census' Small Area Income Poverty Estimates (SAIPE) files for the representitive years. In addition, Percent Persons in Poverty, Percent Persons Age 0-17 in Poverty and Percent Persons Age 5-17 in Families in Poverty data are available for 1997. One implied decimal place is carried for each of these percent fields. The SAIPE are constructed from statistical models based, in part, on summary data from 1993, 1995 and 1997 federal income tax returns (respectively), data about participation in the Food Stamp program, and the previous census.

		Note:  Alaska state records differ from the sum of the county data for the following                                         		fields:
											       Source State Total			Sum of Counties
					1995 Persons in Poverty			   60,735					60,732
					1995 Persons Age 0-17 in Poverty	   25,270					25,268
					1993 Persons Age 0-17 in Poverty	   30,628					30,626	


		The 1989 Persons and Families Below Poverty Level data are from the 1990 Census of Population and Housing, STF3A.

		Note:	1)	A family consists of a householder and one or more other persons living in the same household who are related to the householder by birth, marriage, or adoption.  All persons in a household who are related to the householder are regarded as members of his or her family.  A household can contain only one family for purposes of census tabulations.  Not all households contain families since a household may comprise a group of unrelated persons or one person living alone.
				2)	Poverty statistics are based on a definition originated by the Social Security Administration in 1964 and subsequently modified by Federal interagency committees in 1969 and 1980 and prescribed by the Office of Management and Budget in Directive 14 as the standard to be used by Federal agencies for statistical purposes.  For more information refer to the 1990 Census of Population and Housing Summary Tape File 3 Technical Documentation.

		The 1979 Persons and Families Below Poverty Level data are from the 1980 Census of Population and Housing, STF3A.

		Note:	Data for Park County, MT (30067) do not include Yellowstone National Park (30113).

		The 1979 Related Children (Under 18 Years Old) Below Poverty Level and Related Children (Under 18 Years Old) with Poverty Status Determined fields are from the 1983 County and City Data Book File.


		F-8)		Median Family Income

		The 1989 Median Family Income data are taken from the 1990 Census of Population and Housing, STF3A.

		Note:	1)	When counties and/or cities were combined into one FIPS code, the data from the area with the higher population was used.
				2)	Data for Park County, MT (30067) do not include Yellowstone National Park (30113).

		The 1979 Median Family Income data are taken from the 1980 Census of Population and Housing, STF3A.

		Note:	1)	When an independent city has been recoded into its original county on ARF, Median Family Income is estimated from the fields giving families by income ranges on the source file.
				2)	The 1979 Median Family Income by Race data are estimated based on the number of families within income ranges.  Where there is a large number of families of the particular race in the county, the Median Family Income estimate will usually be within a few hundred dollars of the actual median.  However if the number of families in the county is very small, the accuracy of the estimate decreases.  In particular, if there are less than 50 families of the race and the estimated median income is between $25,000 and $49,999, the estimate may be very poor.  In these cases, it is better to view the median as falling within the $25,000 to $49,999 range rather than the particular number given.  In a few cases, the Median Family Income by Race data would have been greater than $50,000; in these cases the Median Family Income has been set to $50,000.
				3)	Data for Park County, MT (30067) do not include Yellowstone National Park (30113).


		F-9)		Household Income

		The 1993, 1995 and 1997 Estimates of Median Household Income is from the Bureau of Census' Small Area Income Poverty Estimates (SAIPE).  The SAIPE are constructed from statistical models based, in part, on summary data from 1993, 1995 and 1997 (respectively) federal income tax returns, data about participation in the Food Stamp program, and the previous census.

			Note:	1993 and 1995 data for Park County, MT (30067) do not include Yellowstone National Park (30113).

		The 1989 Household Income data are taken from the 1990 Census of Population and Housing, STF3A.  Income of households includes the income of the householder and all other persons 15 years old and over in the household, whether related to the householder or not, received in the calendar year 1989.

		Note:	1)	A household includes all the persons who occupy a housing unit.  A housing unit is a house, an apartment, a mobile home, a group of rooms, or a single room that is occupied (or if vacant, is intended for occupancy) as a separate living quarters.  Separate living quarters are those in which the occupants live and eat separately from any other persons in the building and which have direct access from outside of the building or through a common hall.
				2)	Total income is the algebraic sum of the amounts reported separately for wage or salary income; net nonfarm selfemployment income; net farm self employment income; interest, dividend, or net rental or royalty income; Social Security or railroad retirement income; public assistance or welfare income; retirement or disability income; and all other income.

		1989 Median Household Income data are from the County and City Data Book, 1994, CDROM, a statistical abstract supplement published by the Bureau of the Census, U.S. Department of Commerce.  Data were obtained as part of the 1990 decennial census.  Median income divides the income distribution into two equal parts, one having incomes above the median and the other having incomes below the median.  It is based on the total number of households, including those with no income.  Income of households includes the income of the householder and all other persons 15 years and over in the household, whether related to the householder or not.

		Note:	1)	Data could not be weighted for the independent cities that are combined into their original counties.  Therefore, Median Household Income data carried on the ARF are for the county only and do not include independent city data.  The following is a list of the independent cities and the Median Household Income for those cities as reported on the source data:


											FIPS				MEDIAN HOUSEHOLD
					CITY					CODE				INCOME
					Kalawao, HI				15005				$10,000
					Bedford, VA				51515				$22,787
					Bristol, VA				51520				$19,226
					Buena Vista, VA			51530				$23,929
					Charlottesville, VA		51540				$24,190
					Clifton Forge, VA			51560				$20,659
					Colonial Heights, VA 		51570				$34,472
					Covington, VA			51580				$20,913
					Danville, VA 			51590				$20,413
					Emporia, VA			51595				$21,009
					Fairfax, VA				51600				$50,913
					Falls Church, VA			51610				$51,011
					Franklin, VA			51620				$20,357
					Fredericksburg, VA		51630				$26,614
					Galax, VA				51640 				$20,263
					Harrisonburg, VA			51660				$25,312
					Hopewell, VA 			51670				$26,934
					Lexington, VA			51678				$21,361
					Lynchburg, VA			51680				$23,726
					Manassas, VA			51683				$46,674
					Manassas Park, VA		51685				$39,076
					Martinsville, VA			51690				$22,446
					Norton, VA				51720				$15,460
					Petersburg, VA			51730				$21,309
					Poquoson, VA			51735				$43,236
					Portsmouth, VA*			51740				$24,601
					Radford, VA				51750				$19,487
					Richmond, VA			51760				$23,551
					Roanoke, VA			51770				$22,591
					Salem, VA				51775				$29,047
					South Boston, VA			51780				$20,401
					Staunton, VA			51790				$25,366
					Waynesboro, VA			51820				$26,668
					Williamsburg, VA		51830				$25,393
					Winchester, VA			51840				$26,086

					* ARF FIPS Code 51710 includes the independent cities of Norfolk and Portsmouth, Virginia.  Median Household Income data carried on the ARF are for Norfolk city only and do not include data for Portsmouth City.
				2)	Data for Park County, MT (30067) do not include Yellowstone National Park (30113).


		F-10)	Social Security Program Beneficiaries

		1990 (December) Social Security Program Beneficiaries, Number and Rate are from the County and City Data Book, 1994, CDROM, a statistical abstract supplement published by the Bureau of the Census, U.S. Department of Commerce.  Data were obtained from the U.S. Social Security Administration, OASDI Beneficiaries by State and County, December 1990.  Social Security Beneficiaries Rate is per 1,000 resident population enumerated as of April 1, 1990 and has one implied decimal place.  The oldage, survivors, and disability insurance program (OASDI) provides monthly benefits for retired and disabled workers and their dependents and to survivors of insured workers.  To be eligible for benefits, a worker must have had a specified period of employment in which OASDI taxes were paid.  A worker becomes eligible for full retirement benefits at age 65, although reduced benefits may be obtained up to 3 years earlier.  Survivor benefits are payable to widows, widowers, and other dependents of deceased insured workers.

		F-11)	Supplemental Security Income Program Recipients

		1991 (December) Supplemental Security Income Program Recipients data are from the County and City Data Book, 1994, CDROM, a statistical abstract supplement published by the Bureau of the Census, U.S. Department of Commerce.  Data were obtained from the U.S. Social Security Administration, Supplemental Security Income State and County Data, December 1991.

		Under the direction of the Social Security Administration, the Supplemental Security Income (SSI) program provides cash payments in accordance with nationwide eligibility requirements to persons with limited income and resources who are aged, blind, or disabled.  Under the SSI program, each person living in his or her own household is provided a cash payment from the Federal Government that is sufficient, when added to the person's countable income (the total gross money income of an individual less certain exclusions), to bring the total monthly income up to a specified level (the Federal benefit rate).  If the individual or couple is living in another household, the guaranteed level is reduced by onethird.

		The data cover persons with Federal SSI payments and/or federally administered State supplementation.  States have the option to supplement the Federal SSI payment for all or selected categories of recipients.  The data are for persons with Federal SSI payments only for the following States:  NH, CT, IN, IL, MN, MO, ND, NE, VA, NC, SC, KY, AL, OK, ID, WY, CO, NM, AZ, OR, and AK; these States have Stateadministered supplementation.  Data for TX and WV cover Federal SSI payments only; no State supplementary payments are made.


		F-12)	Aid to Families with Dependent Children and General Assistance

		1980 Aid to Families with Dependent Children (AFDC) and General Assistance (GA) data are taken from the tapes of data from the HEW Publication Public Assistance Recipients and Cash Payments by State and County.

		Note:	1)	For all years, AFDC and GA fields for New York City which comprises the Bronx (36005), Kings (36047), New York (36061), Queens (36081), and Richmond (36085) Counties were grouped together on the source.	The ARF fields were calculated for these counties by taking the weighted average of the fields based on the population estimates from the P26 Census pamphlet for each year.
				2)	For 1980 Lincoln (27081), Lyon (27083), and Murray (27101) Counties in Minnesota are grouped together on the source.  The ARF fields were calculated for these counties by taking the weighted average of the fields based on the population estimates from the P26 Census pamphlet for each year.
				3)	For 1980, Faribault (27043), Watowan (27165), and Martin (27091) Counties in Minnesota are grouped together on the source.  The ARF fields were calculated for these counties by taking the weighted average of the fields based on the population estimates from the P26 Census pamphlet for each year.
				4)	For 1980, Sherman (41055) is included with Wasco (41065) County and Wheeler (41069) is included with Gilliam (41021) County in Oregon on the source.  The ARF fields were calculated for these counties by taking the weighted average of the fields based on the population estimates from the P26 Census pamphlet for each year.
				5)	For 1980, General Assistance tables are estimated and unavailable by county for Connecticut.
				6)	For 1980, in Montana, the following counties have estimated General Assistance:  Blaine (30005), Chouteau (30015), Deer Lodge (30023), Powell (30077) and Yellowstone (30111).
				7)	For 1980, AFDC total families in North Carolina are double counted for 121 families with at least one child at home and one child in foster care.
				8)	The 1980 state totals of AFDC payments and General Assistance payments do not match the published state totals.  In order to avoid unauthorized disclosure of information, payment totals were not given in the source for any county with a singlecase entry.  If a state had only one county with a singlecase entry, the payment total for another county is also deleted.

					For 1980, the following counties have blanked out GA payments in the source and have values of zero on ARF:
						04001  Apache, Arizona
						04011  Greenlee, Arizona
						06015 - Del Norte, California
						06021 - Glenn, California
						06103  Tehana, California
						06106  Trinity, California
						06109  Tuloumne, California
						08007  Archuleta, Colorado
						08017  Cheyenne, Colorado
						08023  Costilla, Colorado
						08039  Elbert, Colorado
						08057  Jackson, Colorado
						08065  Lake, Colorado
						08075  Logan, Colorado
						08105  Rio Blanco, Colorado
						13033  Burke, Georgia
						13065  Clinch, Georgia
						13133  Greene, Georgia
						13145  Harris, Georgia
						13159  Jasper, Georgia
						13173  Lanier, Georgia
						17013  Calhoun, Illinois
						17155  Putnam, Illinois
						20023  Cheyenne, Kansas
						20039  Decatur, Kansas
						20053  Ellsworth, Kansas
						20063  Gove, Kansas
						20081  Haskell, Kansas
						20089  Jewell, Kansas
						20137  Norton, Kansas
						20179  Sheridan, Kansas
						20207  Woodson, Kansas
						28007  Attala, Mississippi
						28157  Wilkinson, Mississippi
						29057  Dade, Missouri
						29171  Putnam, Missouri
						29197  Schuyler, Missouri
						29199  Scotland, Missouri
						30003  Big Horn, Montana
						30007  Broadwater, Montana
						30025  Fallon, Montana
						30031  Gallatin, Montana
						30045  Judith Basin, Montana
						30061  Mineral, Montana
						30069  Petroleum, Montana
						30083  Richland, Montana
						30085  Roosevelt, Montana
						30089  Sanders, Montana
						30095  Stillwater, Montana
						35003  Catron, New Mexico
						35011  DeBaca, New Mexico
						38003  Barnes, North Dakota
						38043  Kidder, North Dakota
						38045  LaMoure, North Dakota
						38049  McHenry, North Dakota
						38061  Mountrail, North Dakota
						38075  Renville, North Dakota
						38105  Williams, North Dakota
						40035  Craig, Oklahoma
						40045  Ellis, Oklahoma
						40099  Murray, Oklahoma
						40103  Noble, Oklahoma
						40127  Pushmataha, Oklahoma
						40153  Woodward, Oklahoma
						46027  Clay, South Dakota
						46033  Custer, South Dakota
						46055  Haakon, South Dakota
						46081  Lawrence, South Dakota
						46115  Spink, South Dakota
						46121  Todd, South Dakota
						49025  Kane, Utah
						49031  Piute, Utah
						49051  Wasatch, Utah
						51021  Bland, Virginia
						51025  Brunswick, Virginia
						51043  Clarke, Virginia
						51005  Clifton Forge city, Virginia
						51081  Emporia city, Virginia
						51113  Madison, Virginia
						51117  Mecklenburg, Virginia
						51173  Smyth, Virginia
						55011  Buffalo, Wisconsin
						55013  Richland, Wisconsin
						56009  Converse, Wyoming
						56035  Sublette, Wyoming
						56045  Weston, Wyoming

					For 1980, the following counties have blanked out AFDC payments in the source and have values of zero on ARF:
						30037  Golden Valley, Montana
						30057  Madison, Montana
						31117  McPherson, Nebraska
						31171  Thomas, Nebraska
						32011  Eureka, Nevada
						32029  Storey, Nevada
						38007  Billings, North Dakota
						38087  Slope, North Dakota
						48235  Irion, Texas
						48421  Sherman, Texas
						48431  Sterling, Texas
						49009  Daggett, Utah
						49055  Wayne, Utah
				9)	The following 1980 state totals do not match the published totals for the indicated reasons and by the amounts listed:

				AFDC		AFDC	GA	GA
	STATE	FIPS	REASON*	RECIPIENTS		PAYMENTS	RECIPIENTS	PAYMENTS

	Connecticut	09	Foster Care	2169	$	 444,799	
	Georgia	13	Foster Care	1534	$	 193,914
	Illinois	17	Foster Care	4200	$	 750,500
			Transportation	0	$	  10,001
			Voided Warrants		$	 1,782,057
	Louisiana	22	Foster Care	2074	$	 365,219
	Massachusetts	25	Foster Care	2280	$	 553,655
	Missouri	29	Retroact. Payments	0	$	 702,099
	Montana	30	State Supplement	14	$	 2,700
	Nebraska	31	State Wards	225	$	 40,696
	New Jersey	34	Foster Care	1071	$	 89,900
			Parent Program				 10,265	$ 604,829
	Oklahoma	40	Foster Care	 644	$	 108,430
	Oregon	41	Foster Care	1601	$	 527,983
			Adjustment	0	$	 3,468
	Pennsylvania	42	Foster Care	5933	$	 1,638,398
	South Carolina	45	Retroact. Payments	0	$	 26,775
	Texas	48	Foster Care	2695	$	 711,114
	West Virginia	54	Foster Care	572	$	 139,033
	Wisconsin	55	Tribal Council	100	$	 11,075
	Wyoming	56	Foster Care	53	$	 18,054

	*		For further explanation of the reasons given for AFDC and GA state totals not matching the published totals, refer to the source publications.





	F-13)	Crime Data

		1991 Serious Crimes Known to Police  Total, Violent and Rate are from the County and City Data Book, 1994, CDROM, a statistical abstract supplement published by the Bureau of the Census.  Data were obtained from the U.S. Federal Bureau of Investigation.  The first position of all these fields is the 1994 CCDB flag.  (See Section II. C for a definition of the flag.) Through the voluntary contribution of crime statistics by law enforcement agencies across the United States, the Uniform Crime Reporting (UCR) Program provides periodic assessments of crime in the Nation as measured by offenses coming to the attention of the law enforcement community.  Program contributors compile and submit their crime data in one of two means:  either directly to the FBI or through the State UCR Programs.  Data on serious crimes have not been adjusted for underreporting; this may affect comparability.

		Note:	1)	Total Serious Crimes include murder and nonnegligent manslaughter, forcible rape, robbery, aggravated assault, burglary, larcenytheft and motor vehicle theft.  These crimes are known as Crime Index offenses.  Arson was added as the eighth Index offense in 1979 but is not included in Total Serious Crimes. 
				2)	Violent Serious Crimes include murder and nonnegligent manslaughter, forcible rape, robbery and aggravated assault.
				3)	Serious Crime Rates are per 100,000 resident population estimated for 1991 by the FBI. 


		F-14)	5Year Infant Mortality Rates

	197579 through 198488 and 198993 through 1994-98 Infant Mortality Rate Data:

		The 197579 through 198488 and 198993 through 1994-98 5Year Infant Mortality Rate data are calculated fields using existing data on the ARF.  (Original Data Sources are:  NCHS Natality Tapes and NCHS Mortality Tapes).  The rate is per 1000 births and one implied decimal place is carried.  Rates were calculated according to the following formula:

		5Year Infant Mortality Rate = (5Yr Infant Deaths < 1 Year * 1000) / 5Yr Live Births

		Note:	1)	Beginning with the 1989-93 data, NCHS changed the method of tabulating live birth by race from race of child to race of mother.
				2)	Beginning with the 1994 natality and mortality data, LaPaz, AZ (04012) was broken out of Yuma, AZ (04027) by NCHS.  However, on the ARF LaPaz data will remain combined with Yuma until five years of data are available.
				3)	The data for Cibola, NM (35006) are combined with Valencia, NM (35061) in the 198286 mortality rate and earlier years.  Data for the 198387 mortality rate and later years are carried separately.

	197478 Infant Mortality Rate Data:

		The 197478 5Year Infant Mortality Rate data are from the Medically Underserved Area Data System.  The number of births and infant deaths for these years (Total, White and NonWhite) on the file are also from the MUA System.

		The rate is per 1000 births and one implied decimal place is carried.  For counties/cities summed from the original source, the rates were recalculated according to the following formula:

		5Year Infant Mortality Rate = (5Yr Infant Deaths < 1 Year * 1000) / 5Yr Live Births

	196670 Infant Mortality Rate Data:

		The 196670 5Year Infant Mortality Rate is an average mortality rate for infants under one year of age for the years 19661970.  These rates are from the NCHS Mortality tape.  Weighted averages have been calculated for Virginia counties which include independent cities and for Alaska.  The rate is per 1000 births and one implied decimal place is carried.


		Note:	1)	Loving County, Texas (Modified FIPS Code 48301) had a mortality rate of 2500 on the mortality tape which was extremely high and was assumed to be a keypunch error; it was changed to 250.
				2)	Charles City, Virginia was keypunched incorrectly as 51039 on the mortality tape; the rate was put into 51036 which is the correct Charles City, Virginia code.
				3)	Data are not available for Virginia independent cities.  Refer to A2.
				4)	Yellowstone, Montana (modified FIPS Code 30111) includes mortality data for Yellowstone Park, Montana.


	195660 Infant Mortality Rate Data:

		The 195660 5Year Infant Mortality Rate was obtained from data created by the Information Sciences Research Institute for the Bureau of Community Health Services.  The rate is per 1000 births and one implied decimal place is carried.

		Note:	1)	Menominee, Wisconsin (55078) was organized as an independent county in 1962 from Oconto (55083) and Shawano (55115) counties.  ISRI estimated the number of live births and infant deaths for Menominee for the period 19561960 to compute the infant mortality rate for that period.  ISRI accordingly adjusted the infant mortality rates for Oconto and Shawano counties, so that these rates do not include the births and deaths attributed to Menominee for 19561960.
				2)	Data are not available for Virginia independent cities.  Refer to A2.


		F-15)	Infant Mortality Data

		The NCHS Mortality Data Tapes were obtained from the National Center for Health Statistics, Scientific and Technical Information Branch.  The number of infant deaths extracted for a county are based on place of residence; nonresidents of the US are excluded.  Averages are provided rather than actual data for each year because of data use restrictions required by NCHS beginning with 1989 data.  These restrictions prohibit releasing countylevel information where there are fewer than three occurrences.  Rather than suppress data for certain counties, averages were calculated.  One implied decimal place is carried on the Infant Death fields.

		Note:	1)	1970 data are not available for Virginia independent cities.  Refer to A2.
				2)	Mortality data in the ARF through 1978 were classified according to the Eighth Revision of the International Classification of Diseases.  Beginning in the data year 1979, causeofdeath data were coded using the Ninth Revision of the International Classification of Diseases (ICD9).  As such, there are some comparability differences across these years.  The more major differences are described in pages 5 through 9 of the NCHS Monthly Vital Statistics Report, dated February 29, 1980.
				3)	Historic data broken out for Alaska that were coded in the source data as Skagway-Yakutat-Angoon (02231) which no longer exists were reported on the ARF as Skagway-Hoonan Angoon (02232). Data reported in Aleutians, AK (02010) which no longer exists are reported on the ARF as Aleutians West (02016). Data reported in Kobuk, AK (02140) which no longer exists are reported on the ARF as Northwest Arctic (02188).


		F-16)	Mortality Data

	19881990, 19921994, and 1996-1998 Mortality Average Data:

		The 19881990, 19921994, and 1996-1998 Mortality Average Data are calculated fields using 1988, 1989 and 1990; 1992, 1993, and 1994; and 1996, 1997, and 1998 Mortality Detail Data Files obtained from the National Center for Health Statistics.  Averages are provided rather than actual data for each year because of data use restrictions required by NCHS beginning with 1989 data.  These restrictions prohibit releasing countylevel information where there are fewer than three occurrences.  Rather than suppress data for certain counties, averages were calculated.  The number of deaths for a county are based on the place of residence; nonresidents of the U.S. are excluded.  Averages were calculated according to the following formula:

			3Year Mortality Average = (1996 Deaths + 1997 Deaths + 1998 Deaths)/3 

		Note:	1)	The Number of Deaths by Cause fields are calculated using the Ninth Revision 34 Causes of Deaths adapted for use by the Division of Vital Statistics, NCHS.  The following lists categories included in each field with the Ninth Revision of the International Classification of Diseases (ICD-9) codes in parenthesis:
					?	Infectious and Parasitic Diseases
						-	Tuberculosis (010-018)
						-	Syphilis (090-097)
						-	Residual of infectious and parasitic diseases (001-009, 020-041, 042-044, 045-088, 098-139)
					?	Malignant Neoplasms
						-	Malignant neoplasms of digestive organs and peritoneum (150-159)
						-	Malignant neoplasms of respiratory and intrathoracic organs (160-165)
						-	Malignant neoplasms of breast (174-175)
						-	Malignant neoplasms of genital organs (179-187)
						-	Malignant neoplasms of urinary organs (188-189)
						-	Leukemia (204-208)
						-	Other malignant neoplasms (140-149, 170-173, 190-203)
					?	Cerebrovascular Diseases (430-438) - Prior to 1992-94 included in Other Cardiovascular Diseases
					?	Ischemic Heart Disease (410-414)
					?	Other Cardiovascular Diseases
						-	Rheumatic fever and rheumatic heart disease (390-398)
						-	Hypertensive heart disease with or without renal disease (402, 404)
						-	Other heart diseases (415-429)
						-	Hypertension with or without renal disease (401, 403)
						-	Atherosclerosis (440)
						-	Other diseases of arteries, arterioles and capillaries (441-448)
					?	Influenza and Pneumonia (480-487)
					?	Chronic Obstructive Pulmonary Diseases (formerly called Bronchitis, Emphysema, Asthma)
						-	Chronic obstructive pulmonary diseases and allied conditions (490-496)
					?	Chronic Liver Disease and Cirrhosis (571)
					?	Motor Vehicle Accidents (E810-E825)
					?	Suicide (E950-E959).  Prior to 1992-94 included in Other External Causes
					?	Homicide and Legal Intervention (E960-E978).  Prior to 1992-94 included in Other External Causes
					?	Other External Causes
						-	All other accidents and adverse effects (E800-E807, E826-E949)
						-	All other external causes (E980-E999)
					?	Diabetes (250) - Prior to 1992-94 included in Deaths from Other Causes
					?	Deaths from Other Causes
						-	Ulcer of stomach and duodenum (531-533)
						-	Nephritis, nephrotic syndrome and nephrosis (580-589)
						-	Complications of pregnancy, childbirth and the puerperium (630-676)
						-	Congenital anomalies (740-759)
						-	Certain conditions originating in the perinatal period (760-779)
						-	Symptoms, signs and ill-defined conditions (780-799)
						-	All other diseases (residual)
				2)	Human Immunodeficiency Virus (HIV:ICD-9 042-044) infection is also included in Infectious and Parasitic Diseases.
				3)	In 1995, the number of reported deaths occurring in Alaska are in error for some of the selected causes because NCHS did not receive changes resulting from amended records and because of errors in processing the cause of death data.  Differences are concentrated among selected causes of death, principally Symptoms, signs and ill-defined conditions (ICD-9 780-799) and External Causes.  Motor vehicle accidents are under-reported by 9, Suicides by 13, and Homicides by 1.  Refer to the 1995 NCHS Mortality Detail Data File Documentation for further information.
				4)	In 1988-1991 for HIV deaths occurring in Georgia in counties where three or fewer residents died, the county code was not reported at the request of the Georgia Department of Human Resources, Division of Public Health.  Therefore, the total deaths reported will differ slightly from those reported in the NCHS mortality documentation.
				5)	Historic data broken out for Alaska that were coded in the source data as Skagway-Yakutat-Angoon (02231) which no longer exists were reported on the ARF as Skagway-Hoonan Angoon (02232). Data reported in Aleutians, AK (02010) which no longer exists are reported on the ARF as Aleutians West (02016). Data reported in Kobuk, AK (02140), which no longer exists, are reported on the ARF as Northwest Arctic (02188).


	1970-1988 Mortality Data:

		1970-1988 Mortality Data are from the Mortality Data Tape, obtained from the National Center for Health Statistics, Scientific and Technical Information Branch.  The number of deaths for a county are based on the place of residence; nonresidents of the US are excluded.

		Note:	1)	197074 data are not available for Virginia independent cities.  Refer to A2.
				2)	For causeofdeath data beginning in 1987, NCHS began separately classifying and coding human immunodeficiency virus (HIV) infection.  On the ARF, these deaths are included in the category Infectious and Parasitic Diseases.  They are also broken out separately on the ARF.  Prior to 1987 deaths involving HIV infection were classified into several different categories:  All Other Endocrine and Metabolic Diseases and Immunity Disorders, All Other Infectious and Parasitic Diseases, Malignant Neoplasms, and to a number of other causes.  In 1987, of the 2,126,342 resident deaths reported in the United States, 13,468 were reported as attributed to HIV infection.  Because of the change in reported causeofdeath classifications, the 
					1987 causeofdeath data are not strictly comparable with data for previous years.  Refer to the 1987 NCHS Mortality Detailed Data documentation for additional information.  
				3)	In 1988, for HIV deaths occurring in Georgia in counties where three or fewer such residents died, the county code was not reported at the request of the Georgia Department of Human Resources, Division of Public Health.  Therefore, the total deaths reported will differ slightly from those reported in the NCHS mortality documentation.  
				4)	Mortality data in the ARF through 1978 were classified according to the Eighth Revision of the International Classification of Diseases.  Beginning in the data year 1979, causeofdeath data were coded using the Ninth Revision of the International Classification of Diseases (ICD9).  As such, there are some comparability differences across these years.  The more major differences are described in pages 5 through 9 of the NCHS Monthly Vital Statistics Report, dated February 29, 1990. 


		
		F-17)	Total Deaths

		The field 1998 Total Deaths is from the Bureau of Census, County Population Estimates and Demographic Components of Population Change: Annual Time Series, July 1, 1990 to July 1, 1999 file.  The field 1997 Total Deaths is from the Bureau of the Census, Estimates of the Population of Counties and Demographic Components of Population Change:  Annual Time Series, July 1, 1990 to July 1, 1998.  The reporting period is from July 1, 1997 to July 1, 1998.  The field 1996 Total Deaths is from the Bureau of the Census, Estimates of the Population of Counties and Demographic Components of Population Change:  Annual Time Series, July 1, 1990 to July 1, 1997.  The reporting period is from July 1, 1996 to July 1, 1997.  The field 1995 Total Deaths is from the Bureau of the Census, Estimates of the Population of Counties and Demographic Components of Population Change:  Annual Time Series, July 1, 1990 to July 1, 1996.  The reporting period is from July 1, 1995 to July 1, 1996.  The fields 1993 and 1994 Total Deaths are from the Bureau of the Census, States and County Populations Estimates and Components of Change 1990-1995.  The reporting periods are from July 1, 1993 to July 1, 1994 for 1993 data and from July 1, 1994 to July 1, 1995 for 1994 data.  According to the Census Bureau Projection Office, data are derived from death certificates and are based on place of residence (not occurrence). 
 

		F-18)	Cancer Mortality Rate Data

		The Cancer Mortality data are from the U.S. Cancer Mortality Rates and Trends 1950-79 tape created through an NCI/EPA Interagency Agreement on Environmental Carcinogenesis.  The data include Cancer Mortality rates ageadjusted to the 1970 U.S. population for four racesex groups.

		Note:	Data were not reported for:
					Weston, WY (56045)


		F-19)	Natality Data

	19881990, 1992-1994, and 1996-1998 Natality Average Data:

		The 19881990, 1992-1994, and 1996-1998 Natality Average data are calculated fields using the 1988, 1989 and 1990; 1992, 1993 and 1996; and 1996, 1997 and 1998 Natality Detail Data Files obtained from the National Center for Health Statistics.  These tapes contain information for live births only and do not include data on stillborns.  The number of births averages are provided rather than actual data for each year because of data use restrictions required by NCHS beginning with 1989 data.  These restrictions prohibit releasing countylevel information where there are fewer than three occurrences.  Rather than suppress data for certain counties, averages were calculated.  The number of births for a county are based on place of residence of the mother; nonresidents of the U.S. are excluded.  Averages were calculated according to the following formula:

			3Year Natality Average = (1996 Births + 1997 Births + 1998 Births)/3

	Note:	1)	Beginning in 1993, NCHS did not report the fields for Race of Child.  Race, therefore, was determined using the Race of Mother fields.  All natality data prior to the 1991-93 averages were by Race of Child.  NCHS determined this as follows:  (1) when both parents were of the same race, the child was assigned to that race; (2) when the parents were of different races and one parent was white, the child was assigned to the race of the other parent; (3) when parents were of different races and neither was white, the child was assigned to the race of the father except if either parent was Hawaiian, the child was assigned to Hawaiian; and (4) if race was missing for one parent the child was assigned to the race of the other parent.

				With this new classification by race of mother, the number of births classified as white for the 1992-94 and later averages will increase and the number for all other racial groups will decrease.  For example, the percent difference in the number of live births by race of mother compared with race of child for 1991 are as follows:


	White	   2.2
	Black	-  6.4
	American Indian	- 20.9
	Chinese	-  5.4
	Japanese	- 15.8
	Hawaiian	- 30.9
	Filipino	-  4.5
	Other Asian or Pacific Islander	-  7.6

				This change in classification should be taken into account when analyzing trend data. For more detailed information regarding the rationale for this change refer to the NCHS Detail Natality Data File Documentation.				
			2)	Historic data broken out for Alaska that were coded in the source data as Skagway-
				Yakutat-Angoon (02231) which no longer exists were reported on the ARF as Skagway-
				Hoonan Angoon (02232). Data reported in Aleutians, AK (02010) which no longer exists  				are reported on the ARF as Aleutians West (02016). Data reported in Kobuk, AK (02140)
				which no longer exists are reported on the ARF as Northwest Artic (02188).

	19691988 Natality Data:

		The 19691988 Natality Data Tapes were obtained from the National Center for Health Statistics, Scientific and Technical Information Branch.  These tapes contain information for live births only and do not include data on stillborns.  The number of birth extracted for a county are based on place of residence of the mother; non residents of the U.S. are excluded.  1968 Total Births are from Table 21, Total Births by Place of Residence in the Vital Statistics of the United States, 1968, Volume I, Natality, DHHS, 1970.

		Note:	1)	For 1968 Births, data for Weston County, Wyoming (56045) and Hawaii counties (Hawaii (15001), Honolulu (15003), Kauai (15007), Maui (15009)), are for 1967 rather than 1968.  
				2)	For 1969 Total Births and 1970 Births in Hospitals, data are not available for Virginia independent cities.


		F-20)	Births in Hospitals

		1980, 1985, 19901999 Births in Hospitals in short term general hospitals are from the AHA Annual Survey of Hospitals. (Copyright.)

		1970 Births in Hospitals are from the NCHS Natality File.

		Note:	Data are not available for Virginia independent cities.  Refer to A2.


		F-21)	Total Births

		The field 1998 Total Births is from U.S. Bureau of the Census, County Population Estimates and Demographic Components of Population Change; Annual Time   series, July 1, 1990 to July 1, 1999 file. The field 1997 Total Births is from the Bureau of the Census, Estimates of the Population of Counties and Demographic Components of Population Change:  Annual Time Series, July 1, 1990 to July 1, 1998.  The reporting period is from July 1, 1997 to July 1, 1998.  The field 1996 Total Births is from the Bureau of the Census, Estimates of the Population of Counties and Demographic Components of Population Change:  Annual Time Series, July 1, 1990 to July 1, 1997.  The reporting period is from July 1, 1996 to July 1, 1997.  The field 1995 Total Births is from the Bureau of the Census, Estimates of the Population of Counties and Demographic Components of Population Change:  Annual Time Series, July 1, 1990 to July 1, 1996.  The reporting period is from July 1, 1995 to July 1, 1996.  The fields 1993 and 1994 Total Births are from the Bureau of the Census, States and County Populations Estimates and Components of Change 1990-1995.  The reporting periods are from July 1, 1993 to July 1, 1994 for 1993 data and from July 1, 1994 to July 1, 1995 for 1994 data.  According to the Census Bureau Projection Office, data are derived from birth certificates and are based on place of residence (not occurrence).  


		F-22)	Education

		1990 persons aged 25 years or more and persons aged 25 years or more with less than nine years of school, with high school or more, with four years of college or more are from the 1990 Census of Population and Housing, STF3A.

		Note:	1)	The response categories for persons who have attended college were modified from earlier censuses because there was some ambiguity in interpreting responses in terms of the number of years of college completed.  For instance, it was not clear whether "completed the fourth year of college," "completed the senior year of college," and "college graduate" were synonymous.  Research conducted shortly before the census suggests that these terms were more distinct in 1990 than in earlier decades, and this change may have threatened the ability to estimate the number of "college graduates" from the number of persons reported as having completed the fourth or a higher year of college.  It was even more difficult to make inferences about postbaccalaureate degrees and "Associate" degrees from highest year of college completed.  Thus, comparisons of postsecondary educational attainment in this and earlier censuses should be made with great caution.
				2)	Data for Park County, MT (30067) do not include Yellowstone National Park (30113).

		1980 persons aged 25 years or more; persons aged 25 yrs or more with less than nine years of school, with high school or more, with four years of college or more and median school year are from the 1980 Census of Population and Housing, STF3A.  The median school year has one implied decimal place carried.  When Virginia independent cities are recoded to their original county on ARF, the median school year is estimated using the field giving persons by range of school years completed from the original source.  Where the median would have been 16 or more years, it has been set to 16.

		Note:	1)	Fields with persons with high school or more includes persons with any college.
				2)	Data for Park County, MT (30067) do not include Yellowstone National Park (30113).


		F-23)	Census Housing Data

	1990 Census Housing Statistics:

		The 1990 Housing data are from the 1990 Census of Population and Housing, STF1A or STF3A.

		Note:	1)	A household includes all the persons who occupy a housing unit.  A housing unit is a house, an apartment, a mobile home, a group of rooms, or a single room that is occupied (or if vacant, is intended for occupancy) as a separate living quarters.  Separate living quarters are those in which the occupants live and eat separately from any other persons in the building and which have direct access from outside of the building or through a common hall.  
				2)	A housing unit is classified as occupied if it is the usual place of residence of the person or group of persons living in it at the time of enumeration, or if the occupants are only temporarily absent; that is, away on vacation or business.  
				3)	When counties and/or cities were combined into one FIPS code, the data from the area with the higher population was used for Median Home Value and Median Gross Rent.
				4)	Data for Park County, Montana (30067) do not include Yellowstone National Park (30113).

		1990 Percent of Occupied Housing Units with 1.01 or More Persons per Room is from the County and City Data Book, 1994, CDROM, a statistical abstract supplement published by the Bureau of the Census, U.S. Department of Commerce.  Data were obtained as part of the 1990 decennial census.  Persons per room is obtained by dividing the number of persons in each occupied housing unit by the number of rooms in the unit.  Persons include the householder, occupants related to the householder, and lodgers, roomers, boarders, and anyone else occupying the housing unit.  The data represent the percent of occupied housing units having more occupants than separate rooms.  This field has one implied decimal place.

		Note:	Data could not be weighted for the independent cities that are combined into their original counties.  Therefore, Percent of Occupied Housing Units with 1.01 or More Persons per Room data carried on the ARF are for the county only and do not include independent city data.  The following is a list of the independent cities and the Percent of Occupied Housing Units with 1.01 or More Persons per Room for those cities as reported on the source data:

											FIPS				% UNITS W/ 1+
				CITY						CODE				PERSONS PER ROOM

				Kalawao, HI					15005					4.8
				Bedford, VA					51515					1.7
				Bristol, VA					51520					1.2
				Buena Vista, VA				51530					1.8
				Charlottesville, VA			51540					3.0
				Clifton Forge, VA			51560					0.9
				Colonial Heights, VA			51570					0.9
				Covington, VA				51580					1.5
				Danville, VA				51590					2.6
				Emporia, VA				51595					4.4
				Fairfax, VA					51600					3.0
				Falls Church, VA				51610					3.0
				Franklin, VA				51620					2.5
				Fredericksburg, VA			51630					2.7
				Galax, VA					51640					2.0
				Harrisonburg, VA			51660					1.3
				Hopewell, VA				51670					2.7
				Lexington, VA				51678					1.2
				Lynchburg, VA				51680					1.8
				Manassas, VA				51683					3.1
				Manassas Park, VA			51685					4.0
				Martinsville, VA				51690					2.4
				Norton, VA					51720					1.8
				Petersburg, VA				51730					4.3
				Poquoson, VA				51735					1.0
			   	Portsmouth, VA*				51740					4.3
				Radford, VA					51750					0.9
				Richmond, VA				51760					3.1
				Roanoke, VA				51770					2.0
				Salem, VA					51775					0.9
				South Boston, VA			51780					2.7
				Staunton, VA				51790					1.2
				Waynesboro, VA				51820					1.8
				Williamsburg, VA			51830					1.5
				Winchester, VA				51840					2.5

				*	ARF FIPS Code 51710 includes the independent cities of Norfolk and Portsmouth, Virginia.  Percent of Occupied Housing Units with 1.01 or More Persons per Room data carried on the ARF are for Norfolk city only and do not include data for Portsmouth city.

	1980 Census Housing Statistics:

		The 1980 Housing data and Median Gross Rent data are from the 1980 Census of Population and Housing, STF3A.  The Median Gross Rent data for independent cities on ARF have been computed from the fields giving housing units by ranges of rent on the original source; where this would have been $500 or more per month, it has been set to $500.

			Note:	Data for Park County, MT (30067) do not include Yellowstone National Park (30113).


	1983 County and City Data Book Housing Statistics:

		The 1980 Number of Occupied Housing Units Lacking Complete Plumbing Facilities for Exclusive Use, Number of Occupied Housing Units with 1.01 or More Persons per Room, and Median Home Value (OwnerOccupied Noncondominium Housing Units) fields are from the 1983 County and City Data Book File.

			Note:	Data for Park County, MT (30067) do not include Yellowstone National Park (30113).


		F-24)	Veteran Population
		
	1999 Veteran Population as of July 1, 1999 is from Veteran Population Projections by  County and Age Groups: July 1999 from the Veterans Administration.

	Note:  The only U.S. territory data available were summary data for Puerto Rico, so these are not                included on the ARF.

		1998 Veteran Population as of July 1, 1998 is from Veteran Population Projections by County and Age Groups: July 1998 from the Veterans Administration.

		1997 Veteran Population as of July 1, 1997 is from Veteran Population Projections by County and Age Groups: July 1997 from the Veterans Administration.

		1996 Veteran Population as of July 1, 1996 is from Veteran Population Projections by County and Age Groups: July 1996 from the Veterans Administration.

		1995 Veteran Population as of July 1, 1995 is from Number of Estimated Veterans by Age, Sex, and County: July 1, 1995 from the Veterans Administration.

		1990 Veteran Population as of 3/31/90 was obtained from the Veterans Administration.  This data does not reflect 1990 Decennial Census results.  They were not available at the time the file was created.

		1978 Veteran Population as of 3/31/78 was obtained from the Veterans Administration.  The VA Codes are also contained on the ARF; See A13.

		Note:	Data are not available for Virginia independent cities.  Refer to A2.


		F-25)	Retail Trade

		The 1981 Income from Retail/Wholesale Trade data were obtained from the 1983 County and City Data Book.  (Refer to Section II. C below for flag definition.)


		F-26)	Family Income

		1979 Family Income data are from the 1980 Census Population and Housing, STF3A.  NonWhite Family Incomes were calculated by subtracting White from Total.




	G.	ENVIRONMENT


		G-1)	Land Area

		1990 Land Area data are from the County and City Data Book, 1994, CDROM, a statistical abstract supplement published by the Bureau of the Census, U.S. Department of Commerce.  Land area measurements are shown to the nearest square mile and include dry land and land temporarily or partially covered by water.  Land area was calculated from the specific set of boundaries recorded for the counties in the Census Bureau's geographic data base.  The accuracy of any area measurement figure is limited by the inaccuracy inherent in (1) the location and shape of the various boundary features in the data base, and (2) rounding affecting the last digit in all operations that compute and/or sum the area measurements.

		Note:	Although land area is a historic field, it has been broken out for Alaska boroughs and census areas, Virginia independent cities, and the U.S. territories of Guam, Puerto Rico, and the Virgin Islands in order to permit calculating population densities.


		G-2)	Population Centroid

		The Latitude and Longitude of the Population Centroid data are from the 1970 Census Population Centroid Tape.  The data were prepared by computing the center of population for each county from all the enumeration districts in the county.  The center value is reported in decimal degrees of longitude and latitude to four decimal places on the ARF.

		Note:	1)	Virginia independent cities were weighted as a part of the original county using the 1970 Census formula for the population centroid latitude and longitude.
2) Data for Park County, MT (30067) do not include Yellowstone National Park (30113).


		G-3)	Climatic Data

		The Climatic data fields are from the tape developed in support of the investigation into the industrial correlates of environmentrelated mortality by System Sciences, Inc.  The original source for these fields was the U.S.  Department of Commerce, National Oceanic and Atmospheric Administration, and Environmental Data Service.  All variables except Elevation are means based on the years 194170.  Counties with more than one weather station include the data for the station closest to the county's population center(s).  For those counties not having a weather station, the U.S. Weather Bureau's climate regions were used to extrapolate data from other similar climatic areas.  Those variables included are:

					. Mean Temperature for January and July
					. Mean Precipitation for January and July
					. Mean Annual Temperature and Precipitation
					. Hours of Sunlight for January and July
					. Mean Relative Humidity for January and July
					. Elevation

		Note:	1)	Data were not available for Alaska or Hawaii and these fields are equal to zero.  
				2)	On the source file, New York City was combined into one county; therefore, the following New York City counties have all been assigned these data:  
									Bronx (36005) 
									Kings (36047) 
									New York (36061) 
									Queens (36081) 
									Richmond (36085) 
				3)	On the source file, climatic data for the Virginia independent cities of Alexandria, Chesapeake, Hampton, Newport News and Virginia Beach were combined with data for their original counties.  On ARF, these independent cities have each been assigned the same data as their original counties.
				4)	Data for Park County, MT (30067) do not include Yellowstone National Park (30113).


		G-4)	Population Per Square Mile

		1994 Population per Square Mile was calculated using 1994 Population Estimates and 1990 Land Area from the Bureau of the Census.  The field has one implied decimal place.

			Note:	Data for Park County, MT (30067) do not include Yellowstone National Park (30113).

		1980 Population per Square Mile is from the 1983 County and City Data Book File.  The field has one implied decimal place, and the first position of the field is the 1983 CCDB flag.  (Refer to Section II. C below for flag definition.)

			Note:	Data for Park County, MT (30067) do not include Yellowstone National Park (30113).

	
		G-5)	Water Hardness Index

		The Water Hardness Index was extracted from the tape developed in support of the investigation into the industrial correlates of environmentrelated mortality by System Sciences, Inc.  The index, describing the hardness of drinking water, was based on the U.S. Department of Labor reports on the hardness of ground and surface water.  As defined by System Sciences, Inc., "the measure of water hardness is based on the presence of alkaline earths (principally calcium and magnesium) and is expressed as equivalent calcium carbonate and measured in parts per million".  The index values are defined as follows:

												ESTIMATES OF
												CALCIUM CARBONATE
					INDEX VALUE				PARTS PER MILLION
						1								< 60
						2								60120
						3								120180
						4								180240
						5								> 240

		Note:	1)	Data were not available for Alaska or Hawaii and these fields are equal to zero.
				2)	On the source file, New York City was combined into one county; therefore, the following New York City counties have all been assigned these data:
								Bronx				(36005)
								Kings				(36047)
								New York			(36061)
								Queens				(36081)
								Richmond			(36085)
				3)	On the source file, water hardness index data for the Virginia independent cities of Alexandria, Chesapeake, Hampton, Newport News and Virginia Beach were combined with data for their original counties.  On ARF, these independent cities have each been assigned the same data as their original counties.


		G-6)	Farm Data

		The 1987 Number of Farms and Land in Farms (Acres) are from the County and City Data Book, 1994, CDROM, a statistical abstract supplement published by the Bureau of the Census, U.S. Department of Commerce.  Data were obtained as part of the 1987 Census of Agriculture.  1987 Farmlands as a Percent of Total Land was calculated using 1987 Land in Farms and 1990 Land Area from the County and City Data Book, 1994, CDROM.  The definition of a farm, in use since 1974, covers any place from which $1,000 or more of agricultural products were produced and sold, or normally would have been sold, during the census year.  Farmland refers to all land under control of a farm operator, including land not actually under cultivation or not used for pasture or grazing.  Rentfree land is included as part of the farm only if the operator has sole use of it.  Land that is used for pasture or grazing on a perhead basis and neither owned nor leased by the farm operator is not included, except for grazing lands that are controlled by grazing associations and leased on a peracre basis.  Farmland as a Percent of Total Land has one implied decimal place.

		Note:	1)	1987 data for Baltimore City, Maryland, which are normally carried as 24510 on the ARF, have been included in Baltimore County (24005) in the source data.	
				2)	1987 data for St. Louis City, Missouri, which are normally carried as 29510 on the ARF, have been included in St. Louis County (29189) in the source data.  
				3)	1987 data for Alexandria City, Virginia, which are normally carried as 51510 on the ARF, have been included in Fairfax County (51059) in the source data.  
				4)	1987 data for Hampton City, Virginia, which are normally carried as 51650 on the ARF, and Newport News City, Virginia, which are normally carried as 51700 on the ARF, have been included in York County (51199) in the source data.  
				5)	1987 data for Norfolk City (51710) and Portsmouth City (51740), Virginia have been included in Chesapeake City (51550) in the source data.  
				6)	1987 Farmland data have been suppressed to avoid disclosure of confidential information in the following counties:  
							06075  San Francisco, California 
							08091  Ouray, Colorado 
							08111  San Juan, Colorado 
							12037  Franklin, Florida 
							12129  Wakulla, Florida 
							25001  Barnstable, Massachusetts  
							25025  Suffolk, Massachusetts 
							26083  Keweenaw, Michigan 
							26153  Schoolcraft, Michigan 
							32015  Lander, Nevada 
							32021  Mineral, Nevada 
							35001  Bernalillo, New Mexico 
							35028  Los Alamos, New Mexico 
							36005  Bronx, New York 
							36041  Hamilton, New York 
							37043  Clay, North Carolina 
							37055  Dare, North Carolina 
							51013  Arlington, Virginia 
							51127  New Kent, Virginia 
							54045  Logan, West Virginia 
							54059  Mingo, West Virginia 
							55078  Menominee, Wisconsin 
							55079  Milwaukee, Wisconsin 
				7)	The calculation for 1987 Farmlands as a Percent of Total Land is:
						(1987 Land in Farms (Acres)/(1990 Land Area (Sq Miles)*640))*100


II.	TECHNICAL INFORMATION


	A.	FILE SPECIFICATIONS

		The Area Resource File is currently contained on one 9 track 6250 reel of tape, a 3480 cartridge, or CD-ROM, with the following specifications:

					Record Length			=	31662
					Block Size				=	31662
					Number of Records		=	  3224


	B.	MISSING VALUES ON ARF

		Missing values are carried on the Area Resource File as zeroes.  Specific instances of missing data are shown in the Notes above by field.  The user should be aware of missing values when interpreting data.


	C.	FLAGS CONTAINED ON THE ARF

		The following flags are used on the ARF to denote suppressed data values for data fields indicated in the Technical Documentation as containing suppressed data:

		1980 Census Flags:
			0		Indicates data are available
			1		Indicates data are not available

		1994 County and City Data Book File Flags:
			0		Data present;
			1		Data are incomplete;
			2		Data not available.

		1983 County and City Data Book File Flags:
			0		Data present;
			3		Data not available;
			4		Data suppressed to avoid disclosure of confidential data;
			5		Data not applicable;
			6		Data suppressed; does not meet publication standards;
			7		Value greater than 0 but less than half the unit shown; or
			8		Base of derived figure too small to meet statistical standards for reliability.

		
					

		
	D.	CRITERIA FOR DATA INCLUSION ON THE ARF

		The criteria for data to be included on the ARF are 1)  that data be available for practically all of the U.S., 2)  that it be accurate, or at least generally accurate if no better data exist, 3)  that it be current or part of a useful time-series, and 4)  that the data be potentially useful for the analysis of health occupation supply and requirements.

III.	DOCUMENTATION


	A.	TECHNICAL DOCUMENTATION OF ARF

		The ARF Technical Documentation is another available source of reference to the fields on ARF.  The documentation organizes the data items into seven major categories as does this user documentation.  Information included in the technical documentation is the field number, columns of location on tape, general field characteristics, source, year of the data, and date the item was put on the file.


	B.	 SAS LAYOUT OF ARF

		This layout is used in conjunction with the technical documentation.  The field's number and format is in reference to the fields on the technical documentation.


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