SSA Survey of Ticket to Work Beneficiaries

SCHULMAN, RONCA AND BUCUVALAS, INC. STUDY NUMBER 3493

145 EAST 32ND STREET October 9, 2006

NEW YORK, NEW YORK 10016 OMB No. 0960-NEW

Exp Date:

SSA Ticket to Work Beneficiary Survey

TELEPHONE NUMBER: ___ ___ ___ ‑ ___ ___ ___ ‑ ___ ___ ___ ___

Interviewer:________________________________________

Interview Date: ____/____/2006

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C ONTACT INFORMATION:

Name

Address

City, State and ZIP

Telephone Number

Introduction

Hello, this is ___________________ with the national research firm of SRBI calling on behalf of the Social Security Administration. We are conducting a survey of Social Security beneficiaries’ interests and activities, and the different ways you may learn about Social Security programs.

We want to assure you of the privacy and confidentiality of your responses. The Privacy Act requires us to notify you that we are authorized to collect this information by section 702 of the Social Security Act. You do not have to provide the information requested. This survey is not part of the official Social Security benefits eligibility determination, and the information you provide will in no way affect your benefits. However, the information you provide will be used to help us improve beneficiary satisfaction with Social Security programs and improve the way we communicate with you and other beneficiaries about the Social Security Ticket to Work and other programs. Your individual answers will be kept completely confidential.

NOTE TO INTERVIEWER: SAY THE FOLLOWING TO THE RESPONDENT: “WE ESTIMATE THAT IT WILL TAKE 15 MINUTES TO COMPLETE THIS STUDY. DO YOU WANT TO COMMENT ON THIS TIME ESTIMATE?” If the respondent says no, go on. If the respondent says yes, read the “PAPERWORK REDUCTION ACT STATEMENT” THAT APPEARS AT THE END OF THE QUESTIONNAIRE.

NOTE TO INTERVIEWER: IF RESPONDENT ASKS ABOUT THE PAPERWORK REDUCTION ACT READ “PAPERWORK REDUCTION ACT REFFERENCE” THAT APPEARS AT THE END OF THE QUESTIONNAIRE.

S1. May I speak to [CONTACT PERSON]?

Speaking.....................1 SKIP TO Q1

New person comes to phone.......2 REREAD INTRODUCTION

Not available/bad time.......3 ARRANGE CALLBACK

No longer lives here............4 NON LOCATE

Refused......................5 REFUSED AT S1

IF BENEFICIARY, SKIP TO Q1

S2. What is your relationship to (BENEFICIARY NAME)?

Spouse/partner........1

Child.....................2

Parent................3

Sibling...................4

Other relative........5

Nurse/paid caregiver......6

Representative payee..7

Other non-relative........8

S2a1. Are you at least 18 years old?

Yes................1

No....................2 SKIP TO QS2b

S2a. Are you familiar with (BENEFICIARY’S NAME)’s daily routine?

Yes................1 SKIP TO Q1

No....................2

S2b. Can you please give me the name and telephone number of the person who would be able to answer questions concerning (BENEFICIARY’S NAME)’s daily routine?

Yes................1

No....................2 THANK AND END

Don’t know (vol)...3 THANK AND END

Refuse (vol)..........4 THANK AND END

ENTER NAME: __________________________________________

ENTER PHONE NUMBER WITH AREA CODE: ___________________

READ TO PARTICIPANT: “On behalf of the Social Security Administration, I would like to remind you that the information you provide will in no way affect your benefits.

1. The first question deals with different ways to get information about Social Security programs. If you wanted to get more information about a Social Security program that you might be interested in, would you definitely, probably, probably not or definitely not ...[READ ANSWERS EVERY THIRD TIME IF NEEDED]

	Definitely would	Probably would	Probably not	Definitely not	DK (vol)	Ref (vol)
a. Write Social Security	1	2	3	4	5	6
b. Call Social Security	1	2	3	4	5	6
c. Go to the Social Security Website	1	2	3	4	5	6
d. Go to a Social Security office	1	2	3	4	5	6
e. Read a Social Security newsletter	1	2	3	4	5	6
f. Attend a seminar in your community	1	2	3	4	5	6
g. Read a packet from the library	1	2	3	4	5	6

2. Where would you go to get information about Social Security programs that would help (you/BENEFICIARY’S NAME) find work? Any where else? [MULTIPLE RECORD – DO NOT READ]

Listen to radio 1

Watch cable or satellite television program 2

Watch network television programs 3

Read local newspapers 4

Read national newspapers 5

Read magazines 6

Read fliers in the mail 7

Write Social Security 8

Call Social Security 9

Go to the Social Security Website 10

Go to a Social Security office 11

Read an Social Security newsletter 12

Attend a seminar in your community 13

Read a packet from the library 14

Other, specify _________ 15

3. This next series of questions is about using the Internet. How often do you use the Internet? Would you say...

Daily......................1

A few times a week............2

Weekly.....................3

A few times a month...........4

Monthly....................5

Less than once a month........6

Never......................7 SKIP TO Q6

Refuse........................8

4. Have you ever used the Internet to ...READ LIST AND MULTIPLE RECORD?

	Yes	No	DK (VOL)	Ref (vol)
a. View a bill or statement on line	1	2	3	4
b. Make travel reservations on line	1	2	3	4
c. Order a product on line	1	2	3	4
d. Pay a bill on line	1	2	3	4
e. Look at job opportunities on line	1	2	3	4
f. Post (your/BENEFICIARY’S NAME) resume on line	1	2	3	4
g. Research government benefits	1	2	3	4
h. Use a chat room	1	2	3	4
i. Read the news	1	2	3	4
j. Look at advertisements	1	2	3	4
k. None of these	1	2	3	4

5a. Have you ever visited the Social Security website?

Yes.................1

No......................2 SKIP TO Q6

(VOL) Not sure......3 SKIP TO Q6

5b. About how many times in the past year have you visited the Social Security website?

ENTER NUMBER: __________

Range 0-10. More than 10 = 10. Don’t know= 11. Refused = 12.

READ TO PARTICIPANT: “Again, I would like to remind you that the information you provide will in no way affect your benefits.

6. During the past two weeks, did you ...[READ LIST AND MULTIPLE RECORD]?

	Yes	No	DK (VOL)	Ref (vol)
a. Go to the doctor’s or therapist’s office	1	2	3	4
b. Go to a pharmacy	1	2	3	4
c. Go to the library	1	2	3	4
d. Go to a bank	1	2	3	4
e. Go to the grocery	1	2	3	4
f. Go to the post office	1	2	3	4
g. Drive a car	1	2	3	4
h. Ride taxi, bus, or subway	1	2	3	4
i. Go to school, class, or training	1	2	3	4
j. Go out to eat	1	2	3	4
k. Go to a movie	1	2	3	4
l. Go to a play, concert or show	1	2	3	4
m. Attend a club or other group meeting	1	2	3	4
n. Do some other activity (specify) ____________	1	2	3	4
o. None of these	1	2	3	4

6a. During the past two weeks, how many times did you [FILL IN ALL ACTIVITIES MENTIONED IN Q1a-Q1n]?

ENTER NUMBER: __________

Range = 1 to 30; 31 plus = 30; DK = 98; Refuse = 99

7. How often do you [READ ITEM] – would you say daily, a few times a week, weekly, a few times a month, monthly, less than once a month or never? [ROTATE ORDER. READ ANSWER CATEGORIES EVERY THIRD ITEM.]

	Daily	A few times a week	Once a week	A few times a month	Once a month	Never	DK (vol)	Ref (vol)
a. Listen to radio	1	2	3	4	5	6	7	8
b. Watch cable or satellite television program	1	2	3	4	5	6	7	8
c. Watch network television programs	1	2	3	4	5	6	7	8
d. Read local newspapers	1	2	3	4	5	6	7	8
e. Read national newspapers	1	2	3	4	5	6	7	8
f. Read magazines	1	2	3	4	5	6	7	8
g. Read fliers in the mail	1	2	3	4	5	6	7	8

IF Q7a EQ 1-3, ASK Q8a. ELSE SKIP TO Q9a

8a. When do you generally listen on the radio? RECORD ALL ANSWERS.

During weekday mornings 1

During weekday afternoons 2

During weekday evenings 3

Weekend mornings 4

Weekend afternoons 5

Weekend evenings 6

Don’t know (vol) 7

Refuse (vol) 8

8b. What radio stations do you regularly listen to during the day? [ACCEPT CALL LETTERS, FREQUENCY, OR TYPE OF SHOW (OLDIES, TALK, SPORTS, ETC)] Any other station? [MULTIPLE MENTION]

________________________________________________________________

Don’t know = 98; Refuse = 99

IF Q7b. and/or Q7c. EQ 1-3, ASK Q9a. ELSE SKIP TO Q9c1

9a. What type(s) of network or cable television programs do you generally watch? RECORD ALL ANSWERS

	Yes	No	DK (VOL)	Ref (vol)
1. Animation or cartoons	1	2	3	4
2. Business and Finance	1	2	3	4
3. Daytime game shows	1	2	3	4
4. Daytime soap operas	1	2	3	4
5. Educational programming	1	2	3	4
6. Health and fitness	1	2	3	4
7. News or other current affairs programs	1	2	3	4
8. Home and garden shows	1	2	3	4
9. Shopping	1	2	3	4
10. Sports	1	2	3	4
11. Talk shows	1	2	3	4
12. Movie channels	1	2	3	4
13. Music channels	1	2	3	4
14. Some other program, specify _________	1	2	3	4

IF Q7b. and/or Q7c. EQ 1-3, ASK Q9b1

9b1. When do you generally watch television? RECORD ALL ANSWERS

During weekday mornings 1

At noon on weekdays 2

During weekday afternoons 3

During weekday evenings 4

Weekend mornings 5

Weekend afternoons 6

Weekend evenings 7

Don’t know (vol) 8

Refuse (vol) 9

9b2. What local television station do you watch most often for local news? [ACCEPT CALL LETTERS, CHANNEL, OR NETWORK AFFILIATION]

________________________________________________________________

None = 0; Don’t know = 98; Refuse = 99

IF Q7d EQ 1-3, ASK Q9c1. ELSE SKIP TO Q9c2.

9c1. What local newspapers do you generally read? Any other? [MULTIPLE MENTION]

______________________________________________________________________

None = 0; Don’t know = 98; Refuse = 99

IF Q7e EQ 1-3, ASK Q9c2. ELSE SKIP TO Q9d1.

9c2. Which of the following national newspapers do you read at least once a week? [ROTATE AND RECORD ALL ANSWERS.]

	Yes	No	DK (VOL)	Ref (vol)
1. New York Times	1	2	3	4
2. Washington Post	1	2	3	4
3. LA Times	1	2	3	4
4. Chicago Tribune	1	2	3	4
5. USA Today	1	2	3	4
6. National Enquirer	1	2	3	4
7. The Star	1	2	3	4
8. Wall Street Journal	1	2	3	4

9c3. What other national newspapers, if any, do you read? Any other?

________________________________________________________________

Don’t know = 98; Refuse = 99

IF Q7f EQ 1-3, ASK Q9d1

9d1. Which of the following magazines do you read at least once a month? [ROTATE AND RECORD ALL ANSWERS.]

	Yes	No	DK (VOL)	Ref (vol)
1. News magazines, like Time and Newsweek	1	2	3	4
2. Arts and entertainment magazines like Rolling Stone, TV Guide, or Art Times	1	2	3	4
3. Business, finance and money magazines like Fortune or Forbes	1	2	3	4
4. Car or motorcycle magazines	1	2	3	4
5. Computers and electronic magazines	1	2	3	4
6. Cooking and Gourmet magazines	1	2	3	4
7. Ethnic magazines like Ebony, Essence, or Jet	1	2	3	4
8. Fashion, style and beauty magazines	1	2	3	4
9. Health and fitness magazines	1	2	3	4
10. Hobbies, crafts and collectibles magazines	1	2	3	4
11. Home and Garden magazines	1	2	3	4
12. Parenting and families magazines	1	2	3	4
13. Puzzles and games magazines	1	2	3	4
14. Science and nature magazines like National Geographic	1	2	3	4
15. Sports magazines like Sports Illustrated, Field & Stream, or American Angler	1	2	3	4
16. Travel magazines	1	2	3	4

9d2. What other types of magazines, if any, do you read at least monthly? Anything else?

Don’t know = 98; Refuse = 99

READ TO PARTICIPANT: “I would like to remind you once again that the information you provide will in no way affect your benefits.”

10a. Have you called or visited any government offices in the past month?

Yes................1

No....................2 SKIP TO Q11a

Don’t know (vol)...3 SKIP TO Q11a

Refuse (vol)..........4 SKIP TO Q11a

10b. Which government offices have you called or visited in the past month?

	Yes	No	DK (VOL)	Ref (vol)
1. Social Security Administration	1	2	3	4
2. Center for Medicare and Medicaid Services	1	2	3	4
3. Department of Veterans Affairs (VA)	1	2	3	4
4. Internal Revenue Service	1	2	3	4
5. Other federal agency (specify)_____	1	2	3	4
6. State health or disability agency	1	2	3	4
7. State Department of Motor Vehicles	1	2	3	4
8. Other state agency (specify)_____	1	2	3	4
9. City or county agency (specify) _____	1	2	3	4

11a. Are there any organizations in your community that you might ask for help with applying for government benefits or getting information about government programs?

Yes................1

No....................2 SKIP TO Q12

Don’t know (vol)...3 SKIP TO Q12

Refuse (vol)..........4 SKIP TO Q12

11b. What organization(s) would you be likely to go to for help? Any other organizations? [MULTIPLE MENTION]

__________________________________________________________________

Don’t know = 98; Refuse = 99

12. The next few questions deal with a specific type of program. In the past three months have you seen or heard about any Social Security Administration programs that would help someone find work?

Yes................1

No.....................2 SKIP TO Q13

Don’t know (vol)...3 SKIP TO Q13

Refuse (vol)...........4 SKIP TO Q13

12a. Where did you see or hear about this/these program(s)? Any place else? [MULTIPLE RECORD – DO NOT READ]

On the radio 1

On cable or satellite television program 2

On network television programs 3

In the local newspapers 4

In a national newspapers 5

In a magazines 6

On fliers in the mail 7

In writing from Social Security 8

Over the phone from Social Security 9

On the Social Security Website 10

At the Social Security office 11

In the Social Security newsletter 12

At a seminar in my community 13

In a packet from the library 14

Other, specify _________ 15

13. Did (you/BENEFICIARY’S NAME) ever receive an information package on the Ticket to Work program from the Social Security Administration?

Yes................1

No.....................2 Don’t know (vol)...3

Refuse (vol)...........4

14a. Have (you/BENEFICIARY’S NAME) ever used the Ticket to Work program?

Yes................1

No.....................2 SKIP TO Q14c

Don’t know (vol)...3 SKIP TO D1

Refuse (vol)...........4 SKIP TO D1

14b. Why did (you/BENEFICIARY’S NAME) use the program? [DO NOT READ LIST. MULTIPLE RECORD.]

Flexible...................................1

Lots of options.................................2

Easy to use................................3

Had the training I was interested in............4

Recommended by family/friend...............5

Recommended by doctor...........................6

Used it before.............................7

Needed training to get a job....................8

Recommended by Case Manager, job coach, or

other service professional..............9

Other (specify) _________________...............10

ALL SKIP TO D1

14c. Why haven’t (you/BENEFICIARY’S NAME) used the program? [DO NOT READ LIST. MULTIPLE RECORD.]

Don’t want/need employment.................1

Don’t want to lose SSA payments.................2

Don’t want to lose health coverage.........3

Don’t trust SSA.................................4

Too disabled/not able to work..............5

Fear of failure.................................6

Too complicated to apply...................7

Don’t know enough about it......................8

Other (specify) _________________..........9

Now, a few last questions for statistical purposes...

D1. INTERVIEWER: RECORD SEX IF KNOWN. IF NOT KNOWN, ASK: Are you...?

Male...............1

Female.................2

D2. Do you consider yourself to be of Hispanic, Latino or Spanish origin?

Yes........1

No.............2

D3. Which of the following best describes you? (You may choose one or more.)

American Indian or Alaska Native...................1

Asian...................................................2

Black or African American..........................3

Native Hawaiian or Other Pacific Islander...............4

White..............................................5

D4. What is the last year or grade of school you completed?

No high school.................1

Some high school..................2

High school graduate...........3

Technical post-secondary..........4

Some college...................5

Four year college graduate........6

Post Graduate degree...........7

Don’t know (vol)..................8

Refuse (vol)...................9

D5. Are you now married, widowed, divorced, separated or have you never married?

Married...............................1

Widowed...................................2 SKIP TO D6

Divorced..............................3 SKIP TO D6

Separated.................................4 SKIP TO D6

Never married.........................5 SKIP TO D6

D5a. Do you and your spouse live in the same household?

Yes.........1

No..............2

D6. How many adults 18 years of age or older live in the household, including yourself?

Enter number of adults: ____

Range 0-10. More than 10 = 10. Don’t know= 11. Refused = 12.

D6a. How many children less than 18 years of age live in the household?

Enter number of children: ____

D7. Which of the following categories best describes your 2005 household income before taxes?

$15,000 or less….................1

$15,001 to $25,000...................2

$25,001 to $35,000...............3

$35,001 to $50,000...................4

$50,001 to $75,000...............5

$75,001 to $100,000..................6

Over $100,000....................7

D8. Which of the following best describes your living situation?

You live alone...........................1

You live with your parents, guardians,

spouse, or other relatives................2

You live with friends or roommates.......3

You live in a supervised group home..........4

That completes the interview. What you've told us is very important, and we'd like to thank you for your time and assistance. If you have any other questions about the survey later on, you can call us toll-free at 1-888-772-4269 ext. 3493.

PAPERWORK REDUCTION ACT REFERENCE: The Paperwork Reduction Act states that agencies may not collect information from the public without approval from the Office of Management and Budget (OMB). The OMB approval number for this survey is 0960–XXXX. We estimate that it will take about 15 minutes to complete this survey. This includes the time it will take to listen to the questions and give your responses.

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