Attachment A
2007 Annual Social and Economic Supplement
Items Booklet - Feb/March/April 2007
2007 ANNUAL SOCIAL AND ECONOMIC SUPPLEMENT
CPS FIELD REPRESENTATIVE / CATI INTERVIEWER
U.S. DEPARTMENT OF COMMERCE
Bureau of the Census
MOVER
>HH32b< Did (name of reference person) live at this address during the week
of November 19, 2006?
<1> Yes
<2> No
===>_
>HH32d< Did any of the following household members live here during the
week of November 19, 2006?
NAME NAME
(Person 1) (person 9)
(Person 2) (person 10)
(Person 3) (person 11)
(Person 4) (person 12)
(Person 5) (person 13)
(Person 6) (person 14)
(Person 7) (person 15)
(Person 8) (person 16)
<1> Yes
<2> No
===>_
FAMILY INCOME
>S_FAMINC< I am going to read a list of income categories. Which category represents the total combined income of all members of this FAMILY during the past 12 months)? This includes money from jobs, net income from business, farm or rent, pensions, dividends, interest, social security payments and any other money income received by members of this FAMILY who are 15 years of age or older.
<1> Less than $5,000 <9> 30,000 to 34,999
<2> 5,000 to 7,499 <10> 35,000 to 39,999
<3> 7,500 to 9,999 <11> 40,000 to 49,999
<4> 10,000 to 12,499 <12> 50,000 to 59,999
<5> 12,500 to 14,999 <13> 60,000 to 74,999
<6> 15,000 to 19,999 <14> $75,000 to 99,999
<7> 20,000 to 24,999 <15> 100,000 to 149,000
<8> 25,000 to 29,999 <16> 150,000 to more
===>__
INTRODUCTION TO MARCH
>Pr_incom< **WORDING OF INTRODUCTION IS OPTIONAL**
The questions you just answered were about your job and economic status last week.
The next set of questions ask about your job and economic status last year.
ENTER <1> TO CONTINUE
ENTER <F1> FOR IMPORTANCE OF RESPONDING
===>_
>Q29a< Did (name/you) work at a job or business at any time during 2006?
<1> Yes
<2> No
===>_
>Q29b< Did (you/he/she) do any temporary, part-time, or seasonal work even for a few days during
2006?
<1> Yes
<2> No
===>_
>Q30< Even though (name/you) did not work in 2006, did (you/he/she) spend any time trying to find
a job or on layoff?
<1> Yes
<2> No
===>_
>Q31< How many different weeks (were/was) (name/you) looking for work or on layoff from a job?
<1-52>
===>__
>Q32< What was the main reason (you/he/she) did not work in 2006?
READ CATEGORIES IF NECESSARY.
<1> Ill, or disabled and unable to work
<2> Retired
<3> Taking care of home or family
<4> Going to school
<5> Could not find work
<6> Doing something else
===>_
>Q33< During 2006 in how many weeks did (name/you) work even for a few hours? Include paid vacation and sick leave as work.
ENTER NUMBER OF WEEKS <1-52> OR <M> IF RESPONDENT CAN ONLY ANSWER IN MONTHS
===>__
>Q33mon< ENTER NUMBER OF MONTHS WORKED
===>__
<1-12>
>Q33ver< Then (name/you) worked about (number) weeks. Is that correct?
<1> Yes
<2> No -- back to Q33 and obtain estimate
===>_
>Q35< Did (name/you) lose any full weeks of work in 2006 because (you/he/she) (were/was)
on layoff from a job or lost a job?
NUMBER OF WEEKS WORKED IN 2006: (number)
<1> Yes
<2> No
<7> Mistake made in number of weeks worked in 2006 -- (Specify -Q35SP)
===>_
>Q36< You said (name/you) worked about (number) (week/weeks) in 2006. How many OF
THE REMAINING (number) WEEKS (were/was) (you/he/she) looking for work or on layoff
from a job?
<0> None
===>__
>Q37< Were the (number) weeks (name/you) (were/was) looking for work or on layoff all in one
stretch?
<1> Yes -- one stretch
<2> No -- two stretches
<3> No -- 3 or more stretches
===>_
>Q38< What was the main reason (name/you) (were/was) not working or looking for work in the
remaining weeks of 2006?
<1> Ill, or disabled and unable to work
<2> Taking care of home or family
<3> Going to school
<4> Retired
<5> No work available
<6> Other (SPECIFY - Q38SP)
===>_
>Q39< For how many employers did (name/you) work in 2006? If more than one at the same time,
only count it as one employer.
<1> One
<2> Two
<3> Three or more
===>_
>Q41< In the (one week/weeks) that (name/you) worked, how many hours did (you/he/she) (work
that week?/usually work per week?)
ENTER NUMBER OF HOURS
===>__
>Q43< During 2006, were there one or more weeks in which (name/you) worked less than
35 hours? Exclude time off with pay because of holidays, vacation, days off, or sickness.
<1> Yes
<2> No
===>_
>Q44< In the weeks that (name/you) worked, how many weeks did (name/you) work less
than 35 hours in 2006?
NUMBER OF WEEKS WORKED IN 2006: (number)
(NUMBER OF WEEKS WAS REPORTED IN ITEM Q33)
<1-52>
===>__
>Q45< What was the main reason (name/you) worked less than 35 hours per week?
<1> Could not find a full time job
<2> Wanted to work part time or only able to work part time
<3> Slack work or material shortage
<4> Other reason
===>_
>Q46< What was (name's/your) longest job during 2006?
Was it:
(IO1NAM:) (name of employer)
(IO1IND:) (kind of business or industry)
(IO1OCC:) (occupation)
(IO1DT:) (duties)
(duties)
CLASS OF WORKER: (PRIVATE/FEDERAL GOVERNMENT/STATE GOVERNMENT/LOCAL GOVERNMENT/WORKING WITHOUT PAY IN FAMILY BUS./SELF EMPLOYED--INCORPORATED/SELF EMPLOYED--UNINCORPORATED)
<1> Same as listed
<2> Different job
===>_
>Q47a< For whom did (name/you) work(?/at) (blank/(your/his/her) (blank/longest job during
2006?)
NAME OF COMPANY, BUSINESS, ORGANIZATION OR OTHER EMPLOYER
(((IO1NAM:) (entry))/If longest job last year is military job, enter Armed Forces)
(blank/<ENTER> Same as IO1NAM /<N> No work done at all during 2006)
===>__________________________________________________________
>Q47b< What kind of business or industry is this?
FOR EXAMPLE: TV AND RADIO MFG., RETAIL SHOE STORE, FARM
(((IO1IND:) (entry))/If longest job last year is military job, enter NA)
(blank/<ENTER> Same as IO1IND/blank)
===>__________________________________________________________
>Q47b1< Is this business or organization mainly manufacturing, retail trade, wholesale trade, or something else?
<1> Manufacturing
<2> Retail trade
<3> Wholesale trade
<4> Something else
(((IO1MFG:)(entry)/If longest job last year is military job; enter <4>)
(blank/<ENTER>Same as IO1MFG/blank)
===>
>Q47c< What kind of work (were/was) (you/he/she) doing?
FOR EXAMPLE: ELECTRICAL ENGINEER, STOCK CLERK, TYPIST
(<H> REFER TO CURRENT AND LONGEST JOBS/blank)
(((IO1OCC): entry)/If longest job last year is military job, enter Armed Forces)
(<S> Same as IO1OCC/Blank)
===>__________________________________________________________
>Q47d1< What were (your/his/her) most important activities or duties?
FOR EXAMPLE: TYPES, KEEPS ACCOUNT BOOKS, FILES, SELLS CARS,
OPERATES PRINTING PRESS, FINISHES CONCRETE.
(((IO1DT): entry)/If longest job last year is military job, enter NA) (entry 2/blank)
(<ENTER> Same as IO1DT/Blank)
===>__________________________________________________________
>Q47d2< ===>__________________________________________________________
>Q47E1< (ASK ONLY IF NECESSARY) (Were/Was) (you/name) employed by government, by a PRIVATE company, a non-profit organization, or (were/was) (you/name) self employed or working in a family business?
<1> Government
<2> private for profit company
<3> Non-profit organization including tax exempt and charitable organizations
<4> Self employed
<5> Working in family business
===> _
>Q47E1a< Would that be the federal, state, or local government?
<1> Federal
<2> State
<3> Local (county, city, township)
===>__
>Q47E1b< Was this business incorporated?
<1> Yes
<2> No
===>__
>Q47E1c< Are you the owner of the business?
<1> Yes
<2> No
===>__
>Q4788< Counting all locations where (this employer/(name/you)) (operates/operate), what is the total number of persons who work for ((name's/your) employer)/(name/you))?
<1> under 10
<2> 10-24
<3> 25-99
<4> 100-499
<5> 500-999
<6> 1,000+
===>__
EARNED INCOME
>Q48aa< How much did (name/you) earn from this employer before taxes and other deductions
during 2006?
Enter dollar amount $ .00 Enter <0> for None
READ IF NECESSARY: Is this a weekly, every other week, twice a month, monthly or yearly amount?
Per <1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
Q48aap ==>___
>Q48a1< For how many (weekly/every other week/twice a month/monthly) pay periods did (name/you) earn (fill from Q48a) from this employer in 2006?
____
>Q48aC2< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL ANNUAL EARNINGS ENTERED IS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===>__
>Q48aV< According to my calculations (name/you) earned (total) dollars altogether from this employer in 2006 before deductions. Does that sound about right?
<1> Yes
<2> No
===>__
>Q48a2< What is your best estimate of (name's/your) correct total amount of earnings from this employer during 2006 before deductions?
PREVIOUS ENTRIES: Q48aa: (amount)
Q48aap: (periodicity)
Q48a1: (number of pay periods)
Enter dollar amount $ .00
>Q48a3< Does this amount include all tips, bonuses, overtime pay or commissions (name/you) may have received from this employer in 2006?
<1> Yes
<2> No
===>__
>Q48aad< How much did (name/you) earn in tips, bonuses, overtime pay or commissions from this employer in 2006?
Enter dollar amount $ .00
>Q48b< What were (name's/your) net earnings from this (business/farm) after expenses during
2006?
IF RESPONSE IS "BROKE EVEN" THEN ENTER 1.
<0> None
<ENTER> Lost Money
Enter dollar amount $ .00
>Q48b_char< ENTER <L> FOR LOST MONEY
===>__
>Q48BL< ENTER AMOUNT OF MONEY LOST IN 2006.
===>$___,___ .00 ENTER ANNUAL AMOUNT ONLY.
>Q48bp< Is this an annual, quarterly, monthly, weekly, or other amount?
Per <1> Annual
<2> Quarterly
<3> Monthly
<4> Weekly
<5> Other
Q48bp ==>___
>Q48b1a< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL ANNUAL BUSINESS LOSS ENTERED IS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===>__
>Q48b1b< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL ANNUAL BUSINESS INCOME ENTERED IS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===>__
>Q48b2< What is your best estimate of (name's/your) ANNUAL net earnings from this business/farm after expenses in 2006?
PREVIOUS ENTRIES: Q48b: (amount)
Q48b1: (periodicity)
Enter dollar amount $ .00
>Q48b2L< What is your best estimate of (name's/your) ANNUAL net LOSS from this business/farm
after expenses in 2006?
PREVIOUS ENTRIES: Q48b: (amount)
Q48b1: (periodicity)
Enter dollar amount $ .00
>Q48b3< What were (name's/your) net earnings from this (business/farm) during the FIRST quarter of 2006?
IF RESPONSE IS "BROKE EVEN," ENTER 1.
<0> None
<ENTER> Lost Money
Enter dollar amount $ .00
>Q48b3_char< ENTER <L> FOR LOST MONEY
===>__
>Q48b3L< ENTER AMOUNT OF MONEY LOST IN THE FIRST QUARTER OF 2006.
===>$___,___ .00 ENTER ANNUAL AMOUNT ONLY
>Q48b4< What were (name's/your) net earnings from this (business/farm) during the SECOND quarter of 2006?
IF RESPONSE IS "BROKE EVEN," ENTER 1.
<0> None
<ENTER> Lost Money
Enter dollar amount $ .00
>Q48b4_char< ENTER <L> FOR LOST MONEY
===>__
>Q48b4L< ENTER AMOUNT OF MONEY LOST IN THE SECOND QUARTER OF 2006.
===>$___,___ .00 ENTER ANNUAL AMOUNT ONLY
>Q48b5< What were (name's/your) net earnings from this (business/farm) during the THIRD quarter of 2006?
IF RESPONSE IS "BROKE EVEN," ENTER 1.
<0> None
<ENTER> Lost Money
Enter dollar amount $ .00
>Q48b5_char< ENTER <L> FOR LOST MONEY
===>__
>Q48b5L< ENTER AMOUNT OF MONEY LOST IN THE THIRD QUARTER OF 2006.
===>$___,___ .00 ENTER ANNUAL AMOUNT ONLY
>Q48b6< What were (name's/your) net earnings from this (business/farm) during the FOURTH quarter of 2006?
IF RESPONSE IS "BROKE EVEN," ENTER 1.
<0> None
<ENTER> Lost Money
Enter dollar amount $ .00
>Q48b6_char< ENTER <L> FOR LOST MONEY
===>__
>Q48b6L< ENTER AMOUNT OF MONEY LOST IN THE FOURTH QUARTER OF 2006.
===>$___,___ .00 ENTER ANNUAL AMOUNT ONLY
>Q48b7< Does this amount include all tips, bonuses, overtime pay or commissions (name/you) may have received in 2006?
<1> Yes
<2> No
===>__
>Q48bad< How much did (name/you) earn in tips, bonuses, overtime pay or commissions in 2006?
Enter dollar amount $ .00
>Q49a< Did (name/you) earn money from any other work (you/he/she) did during 2006?
<1> Yes
<2> No
===>_
>Q49B1d< How much did (name/you) earn from all other employers before taxes and other deductions
during 2006?
Enter dollar amount $ .00
<0> none
READ IF NECESSARY: Is this a weekly, every other week, twice a month, monthly or
yearly amount?
Per <1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
>Q49B1p< ==>___
>Q49B11< For how many (weekly/every other week/twice a month/monthly) pay periods did (name/you) earn (fill from Q49B1) from all other employers in 2006?
______
>Q49B1C< *** DO NOT READ TO THE RESPONDENT ***
THE TOTAL ANNUAL EARNINGS ENTERED FROM ALL OTHER EMPLOYERS IS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===>
>Q49B1V< According to my calculations (name/you) earned (total) dollars altogether from all other
employers in 2006. Does that sound about right?
<1> Yes
<2> No
===>__
>Q49B12< What is your best estimate of (name's/your) correct total amount of earnings from all other employers during 2006?
PREVIOUS ENTRIES: Q49b1d: (amount)
Q49b1p: (periodicity)
Q49b11: (number of pay periods)
Enter dollar amount $ .00
>Q49B13< Does this amount include all tips, bonuses, overtime pay or commissions (name/you) may
have received from all other employers in 2006?
<1> Yes
<2> No
===>__
>Q49B1A< How much did (name/you) earn in tips, bonuses, overtime pay or commissions from all
other employers in 2006?
Enter dollar amount $ .00
>Q49b2< How much did (name/you) earn from (his/her/your) own business after expenses?
(IF RESPONSE IS "BROKE EVEN" THEN ENTER 1.)
FOR AMOUNTS $1,000,000 AND OVER, ENTER $999,999
<0> None <ENTER> Lost money
===>$___,___ .00 ENTER ANNUAL AMOUNT ONLY
>Q49b2_char< ENTER <L> FOR LOST MONEY
===>__
>Q49b3< FOR AMOUNTS $10,000 AND OVER, ENTER $9,999
===>$___,___ .00 ENTER ANNUAL AMOUNT LOST ONLY
>Q49b4< How much did (name/you) earn from (his/her/your) farm after expenses?
(IF RESPONSE IS "BROKE EVEN" THEN ENTER 1.)
FOR AMOUNTS $1,000,000 AND OVER, ENTER $999,999
<0> None <ENTER> Lost money
===>$___,___ .00 ENTER ANNUAL AMOUNT ONLY
>Q49b4_char< ENTER <L> FOR LOST MONEY
===>__
>Q49b5< FOR AMOUNTS $10,000 AND OVER, ENTER $9,999
===>$___,___ .00 ENTER ANNUAL AMOUNT LOST ONLY
UNEMPLOYMENT AND WORKERS COMPENSATION
>Q51A1< At any time during 2006 did (names/you) receive any State or Federal unemployment
compensation?
<1> Yes
<2> No
===>__
>Q51A1p< What is the easiest way for you to tell us (name's/your) State or Federal
unemployment compensation; weekly, every other week, twice a month, monthly, or yearly?
<1> Weekly
<2> Every other week (bi-weekly)
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q51A11< How much did (name\you) receive (weekly/ every other week/twice a month/monthly/ ) in
State or Federal unemployment compensation during 2006?
Enter dollar amount $
>Q51A1C< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL STATE OR FEDERAL UNEMPLOYMENT COMPENSATION RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===>
>Q51A12< How many (weekly/ every other week/twice a month/monthly) payments did (name/you) receive from State or Federal unemployment compensation during 2006?
_____
<1-52>
>Q51A13< According to my calculations (name/you) received (total) dollars altogether from State or
Federal unemployment compensation during 2006. Does that sound about right?
<1> Yes
<2> No
===>__
>Q51A14< What is your best estimate of the correct total amount (name/you) received from State or
Federal unemployment compensation during 2006?
PREVIOUS ENTRIES: Q51A11: (amount)
Q51A1p: (periodicity)
Q51A12: (number of pay periods)
ENTER DOLLAR AMOUNT $ .00
>Q51A2< At any time during 2006 did (name/you) receive any Supplemental Unemployment Benefits?
<1> Yes
<2> No
===>_
>Q51A2p< What is the easiest way for you to tell us (name's/your) Supplemental Unemployment Benefits; weekly, every other week, twice a month, monthly, or yearly?
<1> Weekly
<2> Every other week (bi-weekly)
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q51A21< How much did (name\you) receive (weekly/ every other week/twice a month/monthly/ ) in
Supplemental Unemployment Benefits during 2006?
Enter dollar amount $ .00
>Q51A2C< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL SUPPLEMENTAL UNEMPLOYMENT BENEFITS RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===>__
>Q51A22< How many (weekly/ every other week/twice a month/monthly) payments did (name/you)
receive from Supplemental Unemployment Benefits during 2006?
_____
<1-52>
>Q51A23< According to my calculations (name/you) received (total) dollars altogether from Supplemental Unemployment Benefits during 2006. Does that sound about right?
<1> Yes
<2> No
===>__
>Q51A24< What is your best estimate of the correct total amount (name/you) received from
Supplemental Unemployment Benefits during 2006?
PREVIOUS ENTRIES: Q51A21: (amount)
Q51A2p: (periodicity)
Q51A22: (number of pay periods)
Enter dollar amount $ .00
>Q51A3< At any time during 2006 did (name/you) receive any Union Unemployment or Strike
Benefits?
<1> Yes
<2> No
===>_
>Q51A3p< What is the easiest way for you to tell us (name's/your) Union Unemployment or Strike
Benefits; weekly, every other week, twice a month, monthly, or yearly?
<1> Weekly
<2> Every other week (bi-weekly)
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q51A31< How much did (name\you) receive (weekly/every other week/twice a month/monthly/ ) in
Union Unemployment or Strike Benefits during 2006?
Enter dollar amount $ .00
>C251A3< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL UNION UNEMPLOYMENT OR STRIKE BENEFITS RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===>__
>Q51A32< How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive from Union Unemployment or Strike Benefits during 2006?
______
<1-52>
>Q51A33< According to my calculations (name/you) received (total) dollars altogether from Union
Unemployment or Strike Benefits during 2006. Does that sound about right?
<1> Yes
<2> No
===>__
>Q51A34< What is your best estimate of the correct total amount (name/you) received from Union
Unemployment or Strike Benefits during 2006?
PREVIOUS ENTRIES: Q51A31: (amount)
Q51A3p: (periodicity)
Q51A32: (number of pay periods)
Enter dollar amount $ .00
>Q52a< During 2006 did (name/you) receive any Worker's Compensation payments or other
payments as a result of a job related injury or illness?
EXCLUDE SICK PAY AND DISABILITY RETIREMENT.
<1> Yes
<2> No
===>__
>Q52b< What was the source of these payments?
<1> State Worker's Compensation
<2> Employer or employer's insurance
<3> Own insurance
<4> Other
===>_
>Q52cp< What is the easiest way for you to tell us (name's/your) Worker's Compensation; weekly, every other week, twice a month, monthly, or yearly?
<1> Weekly
<2> Every other week (bi-weekly)
<3> Twice a month
<4> Monthly
<5> Yearly
===>_
>Q52c1< How much did (name\you) receive (weekly/every other week/twice a month/monthly/ ) in Worker's Compensation during 2006?
Enter dollar amount $ .00
>Q52cC2< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL WORKER'S COMPENSATION RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===>_
>Q52c2< How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive from Worker's Compensation during 2006?
______
<1-52>
>Q52c3< Then (name/you) received (total) dollars altogether from Worker's Compensation during 2006. Does that sound about right?
<1> Yes
<2> No
===>___
>Q52c4< What is your best estimate of the correct total amount (name/you) received from Worker's Compensation during 2006?
PREVIOUS ENTRIES: Q52c1: (amount)
Q52cp: (periodicity)
Q52c2: (number of pay periods)
Enter dollar amount $ .00
SOCIAL SECURITY
>Q56a< During 2006 did (anyone in this household/you) receive any Social Security payments from
the U.S. Government?
<1> Yes
<2> No
===>__
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q56b<
______________________________________________________________________________________
**READ ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Who received Social Security | (person 2) payments either for themselves | (person 3)
or as combined payments with | (person 4)
other family members? | (person 5)
| (person 6)
ENTER LINE NUMBER OF PARENT OR | (person 7)
GUARDIAN FOR PAYMENTS MADE TO | (person 8)
CHILDREN UNDER AGE 15. | (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
>Q56dp< What is the easiest way for you to tell us (name's/your) Social Security payment; monthly, quarterly or yearly?
<1> monthly
<2> quarterly
<3> yearly
==>___
>Q56d< How much did (name/you) receive (monthly/quarterly/ ) in Social Security
payments in 2006?
( \<ENTER> already included)
Enter dollar amount $ .00
>Q56d_char< ENTER <A> FOR ALREADY INCLUDED
===>__
>Q56d1< What is the amount of the Social Security payment (name/you) received last month?
Enter dollar amount $ .00
>Q56d2< For how many (months/quarters) did (name/you) receive Social Security in 2006?
______
<1-12>
>Q56d3< Is this (amount from Q56d/amount from Q56d1) before or after the (66.60/78.20) per month Medicare deduction?
<1> after
<2> before
===>__
>Q56d4< Was the cost of living increase the only change which occurred in monthly payments?
<1> Yes
<2> No
===>__
>Q56dC2< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL SOCIAL SECURITY RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===>__
>Q56d5< According to my calculations (name/you) received (total) dollars altogether from Social Security in 2006. Does that sound about right?
<1> Yes
<2> No
===>__
>Q56d6< What is your best estimate of the correct amount (name\you) received in Social Security
during 2006?
PREVIOUS ENTRIES: Q56d1: (amount)
Q56dp: (periodicity)
Q56d2: (number of pay periods)
Q56d3: (amount added per month)
Q56d4: (cost of living subtracted per month)
Enter dollar amount $ .00
>SSR< What were the reasons (name/you) (was/were) getting Social Security in 2006?
MARK ALL THAT APPLY.
PROBE: Any other reason?
<1> Retired
<2> Disabled
<3> Widowed
<4> Spouse
<5> Surviving child
<6> Dependent child
<7> On behalf of surviving, dependent or disabled children
<8> Other
===>__
NOTE: THIS ITEM DOES NOT APPEAR IF ONLY ONE CHILD IN THE HOUSEHOLD
>SSC<
______________________________________________________________________________________
**READ ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Which children under age 15 | (person 2)
were receiving Social Security | (person 3)
in 2006? | (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
. | (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
>SSCR< What were the reasons (Child's name/the children) (was/were) getting Social Security in
2006?
MARK ALL THAT APPLY.
PROBE: Any other reason?
<1> Disabled child/children
<2> Surviving child/children
<3> Dependent child/children
<4> Other
===>__
SOCIAL SECURITY FOR CHILDREN
>Q56f< Did anyone in this household receive any Social Security income in 2006 that we have not
already counted on behalf of children in this household?
INCLUDES ALL CHILDREN UNDER 19 YEARS OF AGE
<1> Yes
<2> No
Social Security income previously reported will appear here
===>_
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q56g<
______________________________________________________________________________________
**READ ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Who received these Social Security | (person 2)
payments? | (person 3)
| (person 4)
ENTER LINE NUMBER OF PARENT OR | (person 5)
GUARDIAN | (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
>Q56ip< What is the easiest way for you to tell us( name's/your) Social Security payment for children in this household; monthly, quarterly or yearly?
<1> monthly
<2> quarterly
<3> yearly
==>___
>Q56i< How much did (name/you) receive (monthly/quarterly/ ) in Social Security payments for children in this household in 2006?
<ENTER> already included
Enter dollar amount $ .00
>Q56i_char< ENTER <A> FOR ALREADY INCLUDED
===>__
>Q56i1< What is the amount of the Social Security payment (name/you) received for children in this household last month?
Enter dollar amount $ .00
>Q56i2< For how many (months/quarters) did (name/you) receive Social Security in 2006?
______
<1-12>
>Q56i3< Was the cost of living increase the only change which occurred in monthly payments for children in this household?
<1> Yes
<2> No
===>___
>Q56iC2< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL SOCIAL SECURITY RECEIVED FOR CHILDREN IN THIS HOUSEHOLD IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===>___
>Q56i4< According to my calculations (name/you) received (total) dollars altogether for children in
this household from Social Security in 2006. Does that sound about right?
<1> Yes
<2> No
===>
>Q56i5< What is your best estimate of the correct amount (name\you) received in Social Security
for children in this household during 2006?
PREVIOUS ENTRIES: Q56i1: (amount)
Q56ip: (periodicity)
Q56i2: (number of pay periods)
Q56i3: (cost of living subtracted per month)
Enter dollar amount $ .00
NOTE: THIS ITEM DOES NOT APPEAR IF ONLY ONE CHILD IN THE HOUSEHOLD
>CSS<
______________________________________________________________________________________
**READ ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Which children under age 19 were | (person 2)
receiving Social Security in 2006? | (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __
>CRSS< What were the reasons (Child's name/the children) (was/were) getting Social Security in 2006?
MARK ALL THAT APPLY.
PROBE: Any other reason?
<1> Disabled child/children
<2> Surviving child/children
<3> Dependent child/children
<4> Other
===>__
SUPPLEMENTAL SECURITY INCOME (SSI)
>Q57a< During 2006 did (anyone in this household receive:/you receive:)
Any SSI payments, that is, Supplemental Security Income?
NOTE: SSI ARE ASSISTANCE PAYMENTS TO LOW-INCOME AGED, BLIND AND DISABLED PERSONS AND COME FROM STATE OR LOCAL WELFARE OFFICES, THE FEDERAL GOVERNMENT, OR BOTH.
<1> Yes
<2> No
===>_
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q57b<
______________________________________________________________________________________
**READ ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Who received SSI? | (person 2)
SUPPLEMENTAL SECURITY INCOME | (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
Q57cp< What is the easiest way for you to tell us (name's/your) Supplemental Security Income payment; monthly, quarterly or yearly?
<1> monthly
<2> quarterly
<3> yearly
===> __
>Q57c< How much did (name/you) receive (monthly/quarterly/ ) in Supplemental Security
Income payments in 2006?
Enter dollar amount $ .00
>Q57c1< What is the amount of the Supplemental Security Income payment (name/you) received last month?
Enter dollar amount $ .00
>Q57c2< For how many (months/quarters) did (name/you) receive Supplemental Security Income in 2006?
______
<1-12>
>Q57c3< Was the cost of living increase the only change which occurred in monthly payments?
<1> Yes
<2> No
===> __
>Q57cC2< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL SUPPLEMENTAL SECURITY INCOME RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q57c4< According to my calculations (name/you) received (total) dollars altogether from Supplemental Security Income in 2006. Does that sound about right?
<1> Yes
<2> No
===> __
>Q57c5< What is your best estimate of the correct amount (name\you) received in Supplemental Security Income during 2006?
PREVIOUS ENTRIES: Q57c1: (amount)
Q57cp: (periodicity)
Q57c2: (number of pay periods)
Q57c3: (amount subtracted per month)
Enter dollar amount $ .00
>SSIR< What were the reasons (name/you) (was/were) getting Supplemental Security Income in 2006?
MARK ALL THAT APPLY.
PROBE: Any other reason?
<1> Disabled
<2> Blind
<3> On behalf of a disabled child
<4> On behalf of a blind child
<5> Other
===>__
NOTE: THIS ITEM DOES NOT APPEAR IF ONLY ONE CHILD IN THE HOUSEHOLD
>SSIC<
______________________________________________________________________________________
**READ ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Which children under age 15 | (person 2)
were receiving Supplemental Security | (person 3)
Income in 2006? | (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
>Q57d< Did anyone in this household receive any Supplemental Security Income in 2006 that we have not already counted on behalf of children in this household?
INCLUDES ALL CHILDREN UNDER 18 YEARS OF AGE
<1> Yes
<2> No
<H> (Help) Supplemental Security Income previously reported
===>_
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q57e<
______________________________________________________________________________________
**READ ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Who received these Supplemental | (person 2)
Security Income payments? | (person 3)
| (person 4)
ENTER LINE NUMBER OF | (person 5)
PARENT OR GUARDIAN | (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
|
>Q57ip< What is the easiest way for you to the Supplemental Security Income (name/you) received on
behalf of children?
<1> monthly
<2> quarterly
<3> yearly
==>___
>Q57i< How much did (name/you) receive (monthly/quarterly/ ) in Supplemental Security
Income on behalf of children in 2006?
Enter dollar amount $ .00
>Q57i1< What is the amount of the Supplemental Security Income payment (name/you) received on behalf of children last month?
Enter dollar amount $ .00
>Q57i2< For how many (months/quarters) did (name/you) receive Supplemental Security Income on behalf of children in 2006?
______
<1-12>
>Q57i3< Was the cost of living increase the only change which occurred in monthly
payments?
<1> Yes
<2> No
===>___
>Q57iC2< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL SUPPLEMENTAL SECURITY INCOME RECEIVED IN 2006 ON BEHALF OF CHILDREN WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===>__
>Q57i4< According to my calculations (name/you) received (total) dollars altogether from
Supplemental Security Income on behalf of children in 2006. Does that sound about
right?
<1> Yes
<2> No
===>__
>Q57i5< What is your best estimate of the correct amount (name\you) received in Supplemental Security Income on behalf of children during 2006?
PREVIOUS ENTRIES: Q57i1: (amount)
Q57cp: (periodicity)
Q57c2: (number of pay periods)
Q57c3: (amount subtracted per month)
Enter dollar amount $ .00
>RSSI< What were the reasons (name/you) (was/were) getting Supplemental Security Income on behalf of children in 2006?
MARK ALL THAT APPLY.
PROBE: Any other reason?
<1> On behalf of a disabled child/children
<2> On behalf of a blind child/children
<3> Other
===>__
NOTE: THIS ITEM DOES NOT APPEAR IF ONLY ONE CHILD IN THE HOUSEHOLD
>CSSI<
______________________________________________________________________________________
**READ ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Which children under age 18 were | (person 2)
receiving Supplemental Security Income | (person 3)
in 2006? | (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16) __ __ __ __ __ __ __ __ |
|
|
PUBLIC ASSISTANCE
>Q59A88< At any time during 2006, even for one month, did (anyone in this household/you) receive any
CASH assistance from a state or county welfare program such as (State Program Name)?
INCLUDE CASH PAYMENTS FROM:
WELFARE OR WELFARE TO WORK PROGRAMS,
(STATE PROGRAM NAMES AND/OR ACRONYMS)
TEMPORARY ASSISTANCE FOR NEEDY FAMILIES PROGRAM (TANF)
AID TO FAMILIES WITH DEPENDENT CHILDREN (AFDC)
GENERAL ASSISTANCE/EMERGENCY ASSISTANCE PROGRAM,
DIVERSION PAYMENTS,
REFUGEE CASH AND MEDICAL ASSISTANCE PROGRAM,
GENERAL ASSISTANCE FROM BUREAU OF INDIAN AFFAIRS OR
TRIBAL ADMINISTERED GENERAL ASSISTANCE.
DO NOT INCLUDE FOOD STAMPS, SSI, ENERGY ASSISTANCE, WIC, SCHOOL MEALS, OR TRANSPORTATION, CHILD CARE, RENTAL OR EDUCATION ASSISTANCE.
<1> Yes <2> No ==>_
NOTE: THIS ITEM DOES NOT APPEAR FOR HOUSEHOLDS WITH NO CHILDREN
>Q59A89< Just to be sure, in 2006, did anyone receive CASH assistance from a state or county welfare program, on behalf of CHILDREN in the household?
<1> Yes
<2> No
______________________________________________________________________________________
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q59b_88<
______________________________________________________________________________________
| LN NAME RELATION
| (person 1)
Who received this CASH assistance | (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
>Q59C8< From what type of program did (name/you) receive the CASH assistance? Was it a welfare
or welfare-to-work program such as (new state program name), General Assistance,
Emergency Assistance, or some other program?
MARK ALL THAT APPLY.
PROBE: Any other program?
<1> (STATE PROGRAM NAME)/welfare/AFDC
<2> General Assistance
<3> Emergency Assistance/short-term cash assistance
<4> Some other program (Specify)
===> __
>Q59C8S< What type of program?
________________________________________
>Q59ep< What is the easiest way for you to tell us (name's/your) CASH assistance payments; weekly, every other week, twice a month, monthly or yearly?
<1> Weekly
<2> Every other week (bi-weekly)
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q59e< During 2006, how much CASH assistance did (name/you) receive (per week/every other
week/twice a month/monthly/ )?
Enter dollar amount $ .00
>Q59e2< How many (weekly/every other week/twice a month/monthly) cash assistance payments did (name/you) receive in 2006?
______
<1-52>
>Q59eC2< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL AMOUNT APPEARS OUT OF RANGE. THE TOTAL CASH ASSISTANCE PAYMENTS RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===>___
>Q59e3< According to my calculations (name/you) received (total) dollars altogether in cash assistance from a state or county program in 2006. Does that sound about right?
<1> Yes
<2> No
===>__
>Q59e4< What is your best estimate of the correct amount of cash assistance (name\you) received during 2006?
PREVIOUS ENTRIES: Q59e: (amount)
Q59ep: (periodicity)
Q59e2: (number of pay periods)
Enter dollar amount $ .00
>Q59f< Was the cash assistance for adults AND children, or JUST children?
<1> Both adults AND children
<2> Children only
<3> Adults only
==>
______________________________________________________________________________________
NOTE: THIS ITEM DOES NOT APPEAR IF ONLY ONE PERSON IN THE HOUSEHOLD
>Q59g<
______________________________________________________________________________________
**READ ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
(Who/Which children) in your household | (person 2)
was the cash assistance for? | (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
PROBE: Anyone else? | (person 10)
| (person 11)
ENTER ALL THAT APPLY | (person 12)
<0> None <96> All | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
|
>Q60A88< At any time during 2006 did (anyone in this household receive:/you receive:) Any Veterans' (VA) payments?
INCLUDE ASSISTANCE RECEIVED BY CHILDREN OF VETERANS
<1> Yes
<2> No
===>_
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q60b_88<
______________________________________________________________________________________
**READ ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Who received Veterans' (VA) payments? | (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
|
>Q60c8< What type of Veterans' payments did (name/you) receive?
MARK ALL THAT APPLY.
PROBE: Any other reason?
<1> Service-connected disability compensation
<2> Survivor Benefits
<3> Veterans' pension
<4> Educational assistance (including assistance received by children of veterans
<5> Other Veterans' payments
===>__
>Q60D88< (Are/Is) (name/you) required to fill out an annual income questionnaire for
the Department of Veterans' Affairs?
<1> Yes
<2> No
===>_
>Q60V1p< What is the easiest way for you to tell us (name's/your) (fill from first answer
in Q60c-88); weekly, every other week, twice a month, monthly or yearly?
<1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q60V1< How much did (name/you) receive (weekly/every other week/twice a month/
monthly/ ) before deductions in (fill from first answer in Q60c-88) in 2006?
Enter dollar amount $ .00
>Q60V12< How many (weekly/every other week/twice a month/monthly) payments did (name/you)
receive in (fill from first answer in Q60c-88) in 2006?
______
<1-52>
>Q60V1C< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (FILL FROM FIRST ANSWER IN Q60c-88) RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===>__
>Q60V13< According to my calculations (name/you) received (total) dollars altogether from (fill from first answer in Q60c-88) in 2006. Does that sound about right?
<1> Yes
<2> No
===> __
>Q60V14< What is your best estimate of the correct amount (name\you) received from (fill from first
answer in Q60c_88) during 2006?
PREVIOUS ENTRIES: Q60V1: (amount)
Q60V1p: (periodicity)
Q60V12: (number of pay periods)
Enter dollar amount $ .00
>Q60V2p< What is the easiest way for you to tell us (name's/your) (fill from second answer
in Q60c_88); weekly, every other week, twice a month, monthly or yearly?
<1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q60V2< How much did (name/you) receive (weekly/every other week/twice a month/
monthly/ ) in (fill from second answer in Q60c_88) in 2006?
Enter dollar amount $ .00
>Q60V22< How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in (fill from second answer in Q60c_88) in 2006?
______
<1-52>
>Q60V2C< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (FILL FROM SECOND ANSWER IN Q60c_88) RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===>__
>Q60V23< According to my calculations (name/you) received (total) dollars altogether from (fill from
second answer in Q60c_88) in 2006. Does that sound about right?
<1> Yes
<2> No
===> __
>Q60V24< What is your best estimate of the correct amount (name\you) received from (fill from
second answer in Q60c-88) during 2006?
PREVIOUS ENTRIES: Q60V2: (amount)
Q60V2p: (periodicity)
Q60V22: (number of pay periods)
Enter dollar amount $ .00
>Q58a< Did (you/anyone in this household) receive any survivor benefits in 2006 such as widow's pensions, estates, trusts, insurance annuities, or any other survivor benefits, (other than Social Security/other than VA benefits/other than Social Security or VA benefits)?
<1> Yes
<2> No
===>__
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q58b<
______________________________________________________________________________________
**ASK ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Who received this income? | (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
>Q58c< What was the source of this income?
ASKING ABOUT: (name) (blank/--CURRENT RESPONDENT)
<2> Company or union survivor pension (INCLUDE PROFIT SHARING)
<3> Federal Government survivor (CIVIL SERVICE) pension
<4> U.S. Military retirement survivor pension
<5> State/Local government survivor pension
<6> U.S. Railroad retirement survivor pension
<7> Worker's compensation survivor pension
<8> Black Lung survivor pension
<9> Regular payments from estates or trusts
<10> Regular payments from annuities or paid-up insurance policies
<11> Other or don't know (SPECIFY) --ENTER LAST
MARK ALL THAT APPLY.
PROBE: Any other reason?
>Q58Cs1< SPECIFY OTHER SOURCE OF INCOME AS SURVIVOR OR WIDOW
ENTER "SURVIVOR BENEFITS" IF THE ANSWER IS "DON'T KNOW"
===>_____________________________________________________________
>Q58E1p< What is the easiest way for you to tell us (name's/your) (fill from first answer in Q58c1 or Q58cs1); weekly, every other week, twice a month, monthly or yearly?
<1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q58E1< How much did (name/you) receive (weekly/every other week/twice a month/monthly/ ) in (fill from first answer in Q58c1 or Q58cs1) in 2006?
Enter dollar amount $ .00
>Q58E12< How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in (fill from first answer in Q58c1 or Q58cs1) in 2006?
______
<1-52>
>Q58E1C< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (FILL FROM FIRST ANSWER IN Q58c1 or Q58cs1) PAYMENTS RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q58E13< According to my calculations (name/you) received (total) dollars altogether from (fill from
first answer in Q58c1 or Q58cs1) in 2006. Does that sound about right?
<1> Yes
<2> No
===> __
>Q58E14< What is your best estimate of the correct amount (name\you) received from (fill from first answer in Q58c1 or Q58cs1) during 2006?
PREVIOUS ENTRIES: Q58E1: (amount)
Q58E1p: (periodicity)
Q58E12: (number of pay periods)
Enter dollar amount $ .00
>Q58E2p< What is the easiest way for you to tell us (name's/your) (fill from second answer in Q58c2 or Q58cs1); weekly, every other week, twice a month, monthly or yearly?
<1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q58E2< How much did (name/you) receive (weekly/every other week/twice a month/monthly/ ) in (fill from second answer in Q58c2 or Q58cs1) in 2006?
Enter dollar amount $ .00
>Q58E22< How many (weekly/every other week/twice a month/monthly) payments did (name/you)
receive in (fill from second answer in Q58c2 or Q58cs1) in 2006?
<1-52>
>Q58E2C< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (FILL FROM SECOND ANSWER IN Q58c2 or Q58cs1) RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===>___
>Q58E23< According to my calculations (name/you) received (total) dollars altogether from (fill from
second answer in Q58c2 or Q58cs1) in 2006. Does that sound about right?
<1> Yes
<2> No
===>
>Q58E24< What is your best estimate of the correct amount (name\you) received from (fill from second answer in Q58c2 or Q58cs1) during 2006?
PREVIOUS ENTRIES: Q58E2: (amount)
Q58E2p: (periodicity)
Q58E22: (number of pay periods)
Enter dollar amount $ .00
>Q58E3p< What is the easiest way for you to tell us (name's/your) (fill from third answer in Q58c3 or Q58cs1); weekly, every other week, twice a month, monthly or yearly?
<1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q58E3< How much did (name/you) receive (weekly/every other week/twice a month/monthly/ ) in (fill from third answer in Q58c3 or Q58cs1) in 2006?
Enter dollar amount $ .00
>Q58E32< How many (weekly/every other week/twice a month/monthly) payments did (name/you)
receive in (fill from third answer in Q58c3 or Q58cs1) in 2006?
_______
<1-52>
>Q58E3C< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (FILL FROM THIRD ANSWER IN Q58c3 or Q58cs1) RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q58E33< According to my calculations (name/you) received (total) dollars altogether from (fill from third answer in Q58c3 or Q58cs1) in 2006. Does that sound about right?
<1> Yes
<2> No
===> __
>Q58E34< What is your best estimate of the correct amount (name\you) received from (fill from third answer in Q58c3 or Q58cs1) during 2006?
PREVIOUS ENTRIES: Q58E2: (amount)
Q58E2p: (periodicity)
Q58E22: (number of pay periods)
Enter dollar amount $ .00
>Q59a< (Do you/Does anyone in this household) have a health problem or disability which prevents (you/them) from working or which limits the kind or amount of work (you/they) can do?
<1> Yes
<2> No
===> __
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q59b<
______________________________________________________________________________________
**ASK ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Who is that? | (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
|
>Q60a< (Did you/Is there anyone in this household who) ever (retire or leave/retired or left) a job for health reasons?
<1> Yes
<2> No
===>_
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q60b<
______________________________________________________________________________________
**ASK ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Who is that? | (person 2)
| (person 3)
| (person 4)
| (person 5) | (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
|
>Q61b< Did (name/you) receive any income in 2006 as a result of (your/his/her) health problem,
(other than Social Security/other than VA benefits/other than Social Security or VA benefits)?
(blank/IF AMOUNT WAS REPORTED PREVIOUSLY AS COMPENSATION FROM A JOB)
(blank/RELATED INJURY OR ILLNESS, THEN ENTER PRECODE 2.)
(blank/AMOUNT PREVIOUSLY REPORTED IN (Q52cT) WAS: $(amount))
<1> Yes
<2> No
>Q61c< What was the source of this income?
ASKING ABOUT: (name) (blank/--CURRENT RESPONDENT)
PROBE: Any other income related to this health condition or disability?
(blank/<2> Worker's compensation)
<3> Company or union disability
<4> Federal Government (CIVIL SERVICE) disability
<5> U.S. Military retirement disability
<6> State or Local government employee disability
<7> U.S. Railroad retirement disability
<8> Accident or disability insurance
<9> Black Lung miner's disability
<10> State temporary sickness
<11> Other or don't know - SPECIFY - ENTER LAST
MARK ALL THAT APPLY.
PROBE: Any other reason?
===>__
>Q61cs1< SPECIFY OTHER SOURCE OF INCOME FROM HEALTH PROBLEM OR DISABILITY
ENTER "OTHER HEALTH PROBLEM/DISABILITY" IF THE ANSWER IS "DON'T KNOW"
===>______________________________________________________
>Q61E1p< What is the easiest way for you to tell us (name's/your) (first fill from Q61c1 or Q61cs1)
payments; weekly, every other week, twice a month, monthly or yearly?
<1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q61E1< How much did (name/you) receive (weekly/every other week/twice a month/monthly/ ) before deductions in (first fill from Q61c1 or Q61cs1) payments in 2006?
Enter dollar amount $ .00
>Q61E12< How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in (first fill from Q61c1 or Q61cs1) payments in 2006?
_____
<1-52>
>Q61E1C< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (FIRST FILL FROM Q61c1 or Q61cs1) PAYMENTS RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===>
>Q61E13< According to my calculations (name/you) received (total) dollars altogether from (first fill
from Q61c1 or Q61cs1) payments in 2006. Does that sound about right?
<1> Yes
<2> No
===>
>Q61E14< What is your best estimate of the correct amount (name\you) received from (first fill from Q61c1 or Q61cs1) payments during 2006?
PREVIOUS ENTRIES: Q61E1: (amount)
Q61E1p: (periodicity)
Q61E12: (number of pay periods)
Enter dollar amount $ .00
>Q61E2p< What is the easiest way for you to tell us (name's/your) (second fill from Q61c2 or Q61cs1) payments; weekly, every other week, twice a month, monthly or yearly?
<1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q61E2< How much did (name/you) receive (weekly/every other week/twice a month/monthly/ ) in (second fill from Q61c2 or Q61cs1) payments in 2006?
Enter dollar amount $ .00
>Q61E22< How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in (second fill from Q61c2 or Q61cs1) payments in 2006?
_____
<1-52>
>Q61E2C< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (SECOND FILL FROM Q61c2 or Q61cs1) PAYMENTS RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===>
>Q61E23< According to my calculations (name/you) received (total) dollars altogether from (second fill from Q61c2 or Q61cs1) payments in 2006. Does that sound about right?
<1> Yes
<2> No
===>__
>Q61E24< What is your best estimate of the correct amount (name\you) received from (second fill from Q61c2 or Q61cs1) payments during 2006?
PREVIOUS ENTRIES: Q61E2: (amount)
Q61E2p: (periodicity)
Q61E22: (number of pay periods)
Enter dollar amount $ .00
>Q62a< During 2006, did (you/anyone in this household) receive any pension or retirement income from a previous employer or union, or any other type of retirement income (other than Social Security/other than VA benefits/ other than Social Security or VA benefits)?
<1> Yes
<2> No
===> __
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q62b<
______________________________________________________________________________________
**ASK ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Who received pension or | (person 2)
retirement income? | (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
| (person 11)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
>Q62c< What was the source of (name's/your) income?
<1> Company or union pension (INCLUDE PROFIT SHARING)
<2> Federal Government (CIVIL SERVICE) retirement
<3> U.S. Military retirement
<4> State or Local government pension
<5> U.S. Railroad Retirement
<6> Regular payments from annuities or paid up insurance policies
<7> Regular payments from IRA, KEOGH or 401(k) accounts
<8> Other sources or don't know -- SPECIFY -- ENTER LAST
MARK ALL THAT APPLY.
PROBE: Any other pension or retirement income?
===>_
>Q62cs1< ENTER OTHER SOURCE OF PENSION OR RETIREMENT INCOME
ENTER "OTHER PENSION OR RETIREMENT" IF THE ANSWER IS "DON'T KNOW"
===>__________________________________________________________
>Q62E1p< What is the easiest way for you to tell us (name's/your) (first fill from 62c1 or 62cs1); weekly, every other week, twice a month, monthly or yearly?
<1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q62E1< How much did (name/you) receive (weekly/every other week/twice a month/monthly/ ) in (first fill from 62c1 or 62cs1) in 2006?
Enter dollar amount $ .00
>Q62E12< How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in (first fill from 62c1 or 62cs1) in 2006?
______
<1-52>
>Q62E1C< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (FIRST FILL FROM 62c1 or 62cs1) PAYMENTS RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q62E13< According to my calculations (name/you) received (total) dollars altogether from (first fill from 62c1 or 62cs1) in 2006. Does that sound about right?
<1> Yes
<2> No
===> __
>Q62E14< What is your best estimate of the correct amount (name\you) received from (first fill from 62c1 or 62cs1) during 2006?
PREVIOUS ENTRIES: Q62E1: (amount)
Q62E1p: (periodicity)
Q62E12: (number of pay periods)
Enter dollar amount $ .00
>Q62E2p< What is the easiest way for you to tell us (name's/your) (second fill from 62c2 or 62cs1); weekly, every other week, twice a month, monthly or yearly?
<1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q62E2< How much did (name/you) receive (weekly/every other week/twice a month/
monthly/ ) in (second fill from 62c2 or 62cs1) in 2006?
Enter dollar amount $ .00
>Q62E22< How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in (second fill from 62c2 or 62cs1) in 2006?
_____
<1-52>
>Q62E2C< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (SECOND FILL FROM 62c2 or 62cs1) RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q62E23< According to my calculations (name/you) received (total) dollars altogether from (second fill from 62c2 or 62cs1) in 2006. Does that sound about right?
<1> Yes
<2> No
===> __
>Q62E24< What is your best estimate of the correct amount (name\you) received from (second fill from 62c2 or 62cs1) during 2006?
PREVIOUS ENTRIES: Q62E2: (amount)
Q62E2p: (periodicity)
Q62E22: (number of pay periods)
Enter dollar amount $ .00
>Q62E3p< What is the easiest way for you to tell us (name's/your) (third fill from 62c3 or 62cs1); weekly, every other week, twice a month, monthly or yearly?
<1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q62E3< How much did (name/you) receive (weekly/every other week/twice a month/
monthly/ ) in (third fill from 62c3 or 62cs1) in 2006?
Enter dollar amount $ .00
>Q62E32< How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in (third fill from 62c3 or 62cs1) in 2006?
______
<1-52>
>Q62E3C< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL (THIRD FILL FROM 62c3 or 62cs1) RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q62E33< According to my calculations (name/you) received (total) dollars altogether from (third fill from 62c3 or 62cs1) in 2006. Does that sound about right?
<1> Yes
<2> No
===>
>Q62E34< What is your best estimate of the correct amount (name\you) received from (third fill from 62c3 or 62cs1) during 2006?
PREVIOUS ENTRIES: Q62E1: (amount)
Q62E1p: (periodicity)
Q62E12: (number of pay periods)
Enter dollar amount $ .00
INTEREST
>Q63A1< At anytime during 2006, did (you/anyone in this household):
Have money in any kind of money market fund, interest earning checking account, or
savings account?
<1> Yes
<2> No
===>_
>Q63A2< Have any savings bonds?
<1> Yes
<2> No
===>_
>Q63A3< Have any treasury notes, IRAs, certificates of deposit, or any other investments which pay interest?
<1> Yes
<2> No
===>
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q63b<
______________________________________________________________________________________
**ASK ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Which members of this household ages 15 | (person 2)
and over had (interest earning accounts | (person 3)
or money market funds/savings bonds/ | (person 4)
treasury notes, IRAs, CDs, or any other | (person 5)
investments which pay interest)? | (person 6)
| (person 7)
INCLUDE EACH IN CASES OF | (person 8)
JOINT ACCOUNTS OR OWNERSHIP | (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
>Q63c< How much did (name/you) receive in interest from these sources during 2006, including even
small amounts reinvested or credited to accounts?
ONLY INCLUDE INTEREST RECEIVED FROM U. S. SAVINGS BONDS CASHED DURING 2006
SEPARATE AMOUNTS FOR JOINT OWNERSHIP
(blank/<ENTER> Already included)
<0> None
Enter dollar amount $ .00
>Q63c_char< ENTER <A> FOR ALREADY INCLUDED
===>__
>Q63cp< READ IF NECESSARY: Is this a weekly, every other week, twice a month,
monthly, quarterly, every 6 months, or yearly amount?
<1>Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Quarterly
<6> Every 6 months
<7> Yearly
==>___
>Q63c2< How many (weekly/every other week/twice a month/monthly/quarterly/every 6 months) payments did (name/you) receive in interest income in 2006?
______
<1-52>
>Q63cC2< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL INTEREST INCOME RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q63c3< According to my calculations (name/you) received (total) dollars altogether from interest income in 2006. Does that sound about right?
<1> Yes
<2> No
===> __
>Q63c4< What is your best estimate of the correct amount (name\you) received from interest payments during 2006?
PREVIOUS ENTRIES: Q63c: (amount)
Q63cp: (periodicity)
Q63c2: (number of pay periods)
Enter dollar amount $ .00
>Q64a< (blank/At any time during 2006 did (anyone in this household ages 15 and over/you))
Own any shares of stock in corporations (PAUSE) or any mutual fund shares?
<1> Yes
<2> No
===> __
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q64b<
______________________________________________________________________________________
**ASK ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Which members of this household? | (person 2)
| (person 3)
| (person 4)
INCLUDE EACH PERSON IN | (person 5)
CASE OF JOINT OWNERSHIP | (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
>Q64c< How much did (name/you) receive in dividends from stocks (mutual funds) during 2006, including dividends that were reinvested?
SEPARATE AMOUNTS FOR JOINT OWNERSHIP
(blank/<ENTER> Already included)
<0> None
>Q64c_char< ENTER <A> FOR ALREADY INCLUDED
===>__
Enter dollar amount $ .00
>Q64cp< READ IF NECESSARY: Is this a weekly, every other week, twice a month, monthly, quarterly, every 6 months, or yearly amount?
<1>Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Quarterly
<6> Every 6 months
<7> Yearly
==>___
>Q64c2< How many (weekly/every other week/twice a month/monthly/quarterly/every 6 months) payments did (name/you) receive in dividends from stocks (mutual funds) in 2006?
______
<1-52>
>Q64cC2< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL DIVIDEND PAYMENTS RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q64c3< According to my calculations (name/you) received (total) dollars altogether from dividend payments in 2006. Does that sound about right?
<1> Yes
<2> No
===> __
>Q64c4< What is your best estimate of the correct amount (name\you) received from dividend payments during 2006?
PREVIOUS ENTRIES: Q64c: (amount)
Q64cp: (periodicity)
Q64c2: (number of pay periods)
Enter dollar amount $ .00
>Q65A1< During 2006 did (you/anyone in this household): Own any land, business property, apartments, or houses which were rented to others?
<1> Yes
<2> No
===> __
>Q65A2< Receive income from royalties or from roomers or boarders? (exclude amounts paid by relatives)
<1> Yes
<2> No
===> __
>Q65A3< Receive income from estates or trusts? (exclude estates or trusts already reported)
<1> Yes
<2> No
===> __
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q65b<
______________________________________________________________________________________
**ASK ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Who received this (income/rent)? | (person 2) | (person 3)
INCLUDE EACH IN CASES OF JOINT | (person 4)
OWNERSHIP. FOR SELF-EMPLOYED | (person 5)
PERSONS, DETERMINE IF INCOME | (person 6)
WAS ALREADY INCLUDED | (person 7)
| (person 8)
| (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
| (person 13)
ENTER ALL THAT APPLY | (person 14)
| (person 15)
__ __ __ __ __ __ __ __ | (person 16)
|
__ __ __ __ __ __ __ __ |
>Q65c< How much did (name/you) receive in income from rent (blank/, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts) AFTER EXPENSES during 2006?
SEPARATE AMOUNTS FOR JOINT OWNERSHIP
IF RESPONSE IS “BROKE EVEN” THEN ENTER 1.
<ENTER> Already included
<ENTER> None
<ENTER> Lost
Enter dollar amount $ .00
>Q65c_char< ENTER <A> FOR ALREADY INCLUDED
ENTER <L>
FOR LOST MONEY
ENTER <X> FOR NONE
===>__
>Q65cL< ENTER AMOUNT OF MONEY LOST IN 2006.
===>$___,___ .00
>Q65cp< Is this an annual, quarterly, monthly, weekly, or other amount?
Per <1> Annual
<2> Quarterly
<3> Monthly
<4> Weekly
<5> Other
Q65cp ==>___
>Q65c2< What is your best estimate of (name's/your) ANNUAL net income from rent (blank/, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts) AFTER EXPENSES in 2006?
PREVIOUS ENTRIES: Q65c: (amount)
Q65cp: (periodicity)
Enter dollar amount $ .00
>Q65cC2< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL SUPPLEMENTAL SECURITY INCOME RECEIVED IN 2006 ON BEHALF OF CHILDREN WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
Q65c2L< What is your best estimate of (name's/your) ANNUAL LOSS from rent (blank/, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts) AFTER EXPENSES in 2006?
PREVIOUS ENTRIES: Q65cL: (amount)
Q65c1: (periodicity)
Enter dollar amount $ .00
>Q66a< During 2006 did (you/anyone in this household) attend school beyond the high school level including a college, university, or other schools? (include vocational, business, or trade schools)
<1> Yes
<2> No
===> __
>Q66b< Did (you/anyone in this household) receive any educational assistance for tuition, fees, books, or living expenses during 2006?
EXCLUDE LOANS, ASSISTANCE FROM HOUSEHOLD MEMBERS, AND VA EDUCATIONAL BENEFITS
<1> Yes
<2> No
===> _
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q66c<
______________________________________________________________________________________
**ASK ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Which member received assistance? | (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
>Q66d< What type of assistance did (name/you) receive?
EXCLUDE ASSISTANCE FROM HOUSEHOLD MEMBERS
<2> Pell Grant
<3> Assistance from a welfare or social service office
<4> Some other government assistance
<5> Scholarships, grants, etc.
<6> Other assistance (employers, friends, etc.)
MARK ALL THAT APPLY.
PROBE: Any other assistance?
===>_
>Q69F88< How much did (name/you) receive in Pell Grants during 2006?
FOR AMOUNTS $10,000 AND OVER, ENTER $9,999
===>$___,___ .00 ENTER ANNUAL AMOUNT ONLY
>Q66hp< What is the easiest way for you to tell us (name's/your) educational assistance during 2006; weekly, every other week, twice a month, monthly or yearly?
<1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q66h< (blank/Aside from the Pell Grant assistance,) (How/how) much did (name/you) receive
(weekly/every other week/twice a month/monthly/ ) in educational assistance during 2006?
Enter dollar amount $ .00
>Q66h2< How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in educational assistance in 2006?
_____
<1-52>
>Q66hC2< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL EDUCATIONAL ASSISTANCE RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q66h3< According to my calculations (name/you) received (total) dollars altogether from educational assistance in 2006. Does that sound about right?
<1> Yes
<2> No
===> __
>Q66h4< What is your best estimate of the correct amount (name\you) received from educational assistance during 2006?
PREVIOUS ENTRIES: Q66h: (amount)
Q66hp: (periodicity)
Q66h2: (number of pay periods)
Enter dollar amount_____
CHILD SUPPORT AND ALIMONY
>Q70a< During 2006 did (anyone in this household/you) receive: Any child support payments?
<1> Yes
<2> No
===> __
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q70b<
______________________________________________________________________________________
**ASK ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Who received these payments? | (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
>Q70cp< What is the easiest way for you to tell us (name's/your) child support payments; weekly, every other week, twice a month, monthly or yearly?
<1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
===> __
>Q70c< How much did (name/you) receive (weekly/every other week/twice a month/monthly/ ) in
child support payments in 2006?
Enter dollar amount $ .00
>Q70c2< How many (weekly/every other week/twice a month/monthly) child support payments did (name/you) receive in 2006?
_____
<1-52>
>Q70cC2< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL CHILD SUPPORT PAYMENTS RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q70c3< According to my calculations (name/you) received (total) dollars altogether from child support payments in 2006. Does that sound about right?
<1> Yes
<2> No
===> __
>Q70c4< What is your best estimate of the correct amount (name\you) received from child support payments during 2006?
PREVIOUS ENTRIES: Q70c: (amount)
Q70cp: (periodicity)
Q70c2: (number of pay periods)
Enter dollar amount $ .00
>Q71a< (blank/During 2006 did (anyone in this household receive:/you receive:) Any alimony payments?
<1> Yes
<2> No
===> __
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q71b<
______________________________________________________________________________________
**ASK ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Who received these payments | (person 2)
during 2006? | (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
>Q71cp< What is the easiest way for you to tell us (name's/your) alimony payments; weekly,
every other week, twice a month, monthly or yearly?
<1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q71c< How much did (name/you) receive (weekly/every other week/twice a month/monthly/ ) in alimony payments in 2006?
Enter dollar amount $ .00
>Q71c2< How many (weekly/every other week/twice a month/monthly) alimony payments did (name/you) receive in 2006?
_______
<1-52>
>Q71cC2< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL ALIMONYPAYMENTS RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q71c3< According to my calculations (name/you) received (total) dollars altogether from alimony
payments in 2006. Does that sound about right?
<1> Yes
<2> No
===> __
>Q71c4< What is your best estimate of the correct amount (name\you) received from alimony payments during 2006?
PREVIOUS ENTRIES: Q71c: (amount)
Q71cp: (periodicity)
Q71c2: (number of pay periods)
Enter dollar amount $ .00
>Q72a< (blank/During 2006 did (anyone in this household receive:/you receive:)
(Any other/Any) regular financial assistance from friends or relatives not living in this household?
DO NOT INCLUDE LOANS
<1> Yes
<2> No
===> __
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q72b<
______________________________________________________________________________________
**ASK ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Who received this assistance? | (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8) | (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
>Q72cp< What is the easiest way for you to tell us (name's/your) regular financial assistance; weekly, every other week, twice a month, monthly or yearly?
<1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q72c< How much did (name/you) receive (weekly/every other week/twice a month/monthly/ )
in regular financial assistance in 2006?
Enter dollar amount $ .00
>Q72c2< How many (weekly/every other week/twice a month/monthly) payments did (name/you)
receive in regular financial assistance in 2006?
_____
<1-52>
>Q72cC2< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL REGULAR FINANCIAL ASSISTANCE PAYMENTS RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q72c3< According to my calculations (name/you) received (total) dollars altogether from regular financial assistance in 2006. Does that sound about right?
<1> Yes
<2> No
===> __
>Q72c4< What is your best estimate of the correct amount (name\you) received from regular financial assistance during 2006?
PREVIOUS ENTRIES: Q72c: (amount)
Q72cp: (periodicity)
Q72c2: (number of pay periods)
Enter dollar amount $ .00
>Q73A1< During 2006, did (anyone in this household/you) receive income from: hobbies, home businesses, farms, or business interests not already covered?
<1> Yes
<2> No
=== __
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q73A1b<
______________________________________________________________________________________
**ASK ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Who received this income? | (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7) | (person 8)
| (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
>Q73A1c< What was the source of this income?
SPECIFY ASKING ABOUT: (name/name--CURRENT RESPONDENT)
===>______________________________________________________
>Q731p< What is the easiest way for you to tell us (name's/your) income from hobbies, home business, farms, or business interest not already covered during 2006; weekly, every other week, twice a month, monthly or yearly?
<1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
>Q731< How much did (name/you) receive (weekly/every other week/twice a month/monthly/ ) in
income from hobbies, home business, farms, or business interest not already covered during
2006?
Enter dollar amount $ .00
>Q7312< How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in income from hobbies, home business, farms, or business interest not already covered in 2006?
_____
<1-52>
>Q731C2< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL INCOME FROM HOBBIES, HOME BUSINESS, FARMS, OR BUSINESS INTEREST NOT ALREADY COVERED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q7313< According to my calculations (name/you) received (total) dollars altogether from hobbies, home business, farms, or business interest not already covered in 2006. Does that sound about right?
<1> Yes
<2> No
===> __
>Q7314< What is your best estimate of the correct amount (name\you) received from hobbies, home business, farms, or business interest not already covered during 2006?
PREVIOUS ENTRIES: Q731: (amount)
Q731p: (periodicity)
Q7312: (number of pay periods)
Enter dollar amount $ .00
>Q73A2< During 2006, did (anyone in this household/you) receive income from:
Any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money income not already covered?
<1> Yes
<2> No
===> __
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q73A2b<
______________________________________________________________________________________
**ASK ONLY IF NECESSARY** | LN NAME RELATION
| (person 1)
Who received this income? | (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
>Q73A2c< What was the source of this income?
SPECIFY ASKING ABOUT: (name/name--CURRENT RESPONDENT)
===>______________________________________________________
>Q732p< What is the easiest way for you to tell us (name's/your) income from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money not already covered during 2006; weekly, every other week, twice a month, monthly or yearly?
<1> Weekly
<2> Every other week
<3> Twice a month
<4> Monthly
<5> Yearly
==>___
>Q732< How much did (name/you) receive (weekly/every other week/twice a month/monthly/ ) in
income from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money not already covered during 2006?
Enter dollar amount $ .00
>Q7322< How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in income from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money not already covered in 2006?
_______
<1-52>
>Q732C2< *** DO NOT READ TO THE RESPONDENT ***
THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL INCOME FROM ANY SEVERANCE PAY, WELFARE, EMERGENCY ASSISTANCE, OTHER SHORT-TERM CASH ASSISTANCE, FOSTER CHILD CARE PAYMENTS, OR ANY OTHER MONEY NOT ALREADY COVERED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q7323< According to my calculations (name/you) received (total) dollars altogether from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money not already covered in 2006. Does that sound about right?
<1> Yes
<2> No
===> __
>Q7324< What is your best estimate of the correct amount (name\you) received from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money not already covered during 2006?
PREVIOUS ENTRIES: Q732: (amount)
Q732p: (periodicity)
Q7322: (number of pay periods)
Enter dollar amount $ .00
HEALTH INSURANCE
>SHI1< These next questions are about health insurance coverage during the calendar year 2006. The questions apply to ALL persons of ALL ages.
ENTER <P> TO PROCEED
===>_
>SHI2< At any time in 2006, (were you/was anyone in this household) covered by a health insurance plan provided through (their/your) current or former employer or union? (MILITARY HEALTH INSURANCE WILL BE COVERED LATER IN ANOTHER QUESTION.)
<1> Yes
<2> No
===>
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>SHI3<
______________________________________________________________________________________
| LN NAME RELATION
Who in this household were policyholders? | (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>SHI4<
_____________________________________________________________________________________
| LN NAME RELATION
In addition to (you/name), | (person 1)
who else in this household | (person 2)
was covered by (name's/your) plan? | (person 3)
| (person 4)
PROBE: Anyone else? | (person 5)
| (person 6)
ENTER ALL THAT APPLY | (person 7)
ENTER <96> FOR ALL | (person 8)
ENTER <0> FOR NONE | (person 9)
| (person 10)
| (person 11)
| (person 12)
| (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
>SHI5< Did (name's/your) plan cover anyone living outside this household?
<1> Yes
<2> No
===> __
>SHI6< Did (name's/your) former or current employer or union pay for all, part, or none of the
health insurance premium?
(NOTE: REPORT HERE EMPLOYER'S CONTRIBUTION TO EMPLOYEE'S HEALTH INSURANCE PREMIUMS, NOT THE EMPLOYEE'S MEDICAL BILLS.)
<1> All
<2> Part
<3> None
===>_
>SHI7< At anytime during 2006, (were you/was anyone in this household) covered by a health insurance plan that (you/they) PURCHASED DIRECTLY FROM AN INSURANCE COMPANY, that is, not related to current or past employment?
<1> Yes
<2> No
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>SHI8<
______________________________________________________________________________________
| LN NAME RELATION
Who in this household were policyholders? | (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>SHI9<
______________________________________________________________________________________
| LN NAME RELATION
In addition to (you/name), | (person 1)
who else in this household | (person 2)
was covered by (name's/your) plan? | (person 3)
| (person 4)
PROBE: Anyone else? | (person 5)
| (person 6)
ENTER ALL THAT APPLY | (person 7)
ENTER <96> FOR ALL | (person 8)
ENTER <0> FOR NONE | (person 9)
| (person 10)
| (person 11)
| (person 12)
| (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
>SHI10< Did (name/your) plan cover anyone living outside this household?
<1> Yes
<2> No
===> __
>SHI11< At any time in 2006, (were you/was anyone in this household) covered by the health plan of someone who does not live in this household?
<1> Yes
<2> No
===> __
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>SHI12<
______________________________________________________________________________________
| LN NAME RELATION
Who was that? | (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
|
>SHI13< At any time in 2006, (were you/was anyone in this household) covered by Medicare?
READ IF NECESSARY: Medicare is the health insurance for person 65 years old and over or persons with disabilities
<1> Yes
<2> No
===> __
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>SHI14< Who was that?
__________________________________________________________________________________
| LN NAME RELATION
Who was that? | (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
>SHI15< At any time in 2006, (were you/was anyone in this household) covered by Medicaid/(fill state name)?
READ IF NECESSARY: Medicaid/ (fill state name) is the government assistance program
that pays for health care.
<1> Yes
<2> No
===> __
State fills for item SHI15:
Alabama SOBRA or Patient 1st
Arizona Arizona Health Care Cost Containment System (AHCCCS)
Arkansas ARKids First or ConnectCare
California Medi-Cal
Connecticut Connecticut Medical Assistance Program
Delaware Diamond State Health Plan
D.C. DC Healthy Families
Florida MediPass
Georgia Georgia Better Health Care
Hawaii QUEST
Idaho Healthy Connections
Indiana Hoosier Healthwise
Iowa IowaCare
Kansas HealthConnect
Kentucky Kentucky Patient Access and Care Program (KenPAC)
Louisiana CommunityCARE
Maine MaineCare
Maryland HealthChoice or Medical Assistance
Massachusetts MassHealth
Michigan Medicaid or Healthy Kids Program
Minnesota Minnesota Medical Assistance Plan (Medicaid) Program or MinnesotaCare
Missouri MCPlus
Montana Passport to Health or Healthy Choices or TeamCare
Nevada Nevada Medicaid
New Hampshire Healthy Kids Gold
New Jersey NJ Family Care
New Mexico Salud!
North Carolina Carolina Access or Health Check
Ohio Healthy Start or Healthy Families
Oklahoma SoonerCare
Oregon Oregon Health Plan (OHP)
Pennsylvania HealthChoices
Rhode Island Rite Care, Neighborhood Health Plan, United Healthcare, or Blue Chip
South Carolina South Carolina Partners for Health
South Dakota South Dakota Medicaid Managed Care Program
Tennessee TennCare
Texas STAR+PLUS
Utah Utah Primary Care Network
Vermont Vermont Health Access Plan (VHAP), Dr. Dynosaur, or PC Plus
Washington Healthy Options
West Virginia Physician Assured Access System (PAAS) or Mountain Health Trust
Wisconsin BadgerCare or Healthy Start Medical Assistance Program
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>SHI16<
______________________________________________________________________________________
| LN NAME RELATION
Who was that? | (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
>SHI17< How many months during 2006, (were/was) (name/you) covered by Medicaid/(local name)?
ENTER NUMBER OR MONTHS
===>__ (1-12)
>SHI21< In (state), the (fill state CHIP pgm name) program (also) helps families get health insurance for CHILDREN. (Just to be sure,) Were any of the children in this household covered by that program?
READ IF NECESSARY: (fill state CHIP pgm name) is the name of (state)’s CHIP program. It is the same as the Children’s Health Insurance Program, which helps pay for children’s health care.
<1> Yes (any covered/all covered)
<2> No (none covered)
===>__
State fills for item SHI21:
Alabama ALL Kids
Alaska Denali Kid Care
Arizona KidsCare or SOBRA for Children
Arkansas ARKids First
California Healthy Families Program
Colorado Child Health Plan Plus or CHP+
Connecticut HUSKY Plan
Delaware Delaware Health Children Program
D.C. DC Healthy Families
Florida Florida KidCare or MediKids or Healthy Kids or Children’s Medical
Services (CMS)
Georgia PeachCare for Kids
Hawaii QUEST
Idaho Idaho Children’s Health Insurance Program (CHIP)
Illinois KidCare
Indiana Hoosier Healthwise
Iowa Health and Well Kids in Iowa (HAWK-I)
Kansas HealthWave
Kentucky KCHIP (Kentucky Children’s Health Insurance Program)
Louisiana LaCHIP (pronounced “la” CHIP)
Maine MaineCare
Maryland Maryland Children’s Health Program
Massachusetts MassHealth
Michigan MIChild (pronounced My Child)
Minnesota MinnesotaCare
Mississippi Mississippi Children’s Health Insurance Plan (CHIP)
Missouri MC+ for Kids or Healthy Children and Youth Program
Montana Montana Children’s Health Insurance Plan (CHIP)
Nebraska Kids Connection
Nevada Nevada Check Up
New Hampshire New Hampshire Healthy Kids Silver
New Jersey NJ Family Care
New Mexico New Mexikids
New York Child Health Plus (CHPlus)
North Carolina N.C. Health Choice for Children
North Dakota Healthy Steps
Ohio Healthy Start
Oklahoma SoonerCare
Oregon Oregon Health Plan
Pennsylvania Pennsylvania Children’s Health Insurance Program (CHIP)
Rhode Island Rite Care
South Carolina Partners for Healthy Children
South Dakota South Dakota Children’s Health Insurance Program (CHIP)
Tennessee TennCare
Texas TexCare Partnership
Utah Utah Children’s Health Insurance Program (CHIP)
Vermont Dr. Dynasaur or Vermont Health Access Plan (VHAP)
Virginia FAMIS
Washington Washington Children’s Health Insurance Program (CHIP)
West Virginia West Virginia Children’s Health Insurance Program (CHIP)
Wisconsin BadgerCare
Wyoming Wyoming KidCare
>SHI22< Who was that?
________________________________________________________________________________________
| LN NAME RELATION
Who was that? | (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
>SHI18< At any time in 2006, (were you/was anyone in this household) covered by TRICARE, CHAMPUS, CHAMPVA, VA, military health care, or Indian Health Service?
NOTE: "CHAMPVA" IS THE CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE DEPARTMENT OF VETERAN'S AFFAIRS.
<1> Yes
<2> No
===> __
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>SHI19<
________________________________________________________________________________________
| LN NAME RELATION
Who was that? | (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
|
>SHI20< What plan (were/was) (name/you) covered by?
<1> TRICARE, CHAMPUS or military health care
<2> CHAMPVA
<3> VA
<4> Indian Health Service
<5> Other (Specify -SHI20S)
===>_
SHIC1< Other than the plans I have already talked about, during 2006, was anyone in this household covered by a health insurance plan (such as the [use fill specified for particular state shown below] plan or any other type of plan/of any other type)?
<1> Yes
<2> No
===> __
Fills for State-specific health insurance programs for low-income uninsured individuals (to be used in SHIC1).
Alaska...................... General Relief Medical
Arizona.................... Medically needy/Medically Indigent (MN/MI), Eligible Low Income Children (ELIC),
Eligible Assistance Children (EAC)
California.................. Indigent Care Program
Colorado................... Old Age Pension and Medical, Adult Foster Care
Connecticut................ General Assistance Program
District of Columbia.... Medical Charities Program
Idaho........................ Indigent Medical Program
Illinois...................... General Assistance
Indiana...................... Assistance to Residents in County Homes (ARCH)
Kansas...................... MediKan General Assistance
Maine....................... Foster Care
Maryland................... Subsidized Adoption (SA), Primary Care for Medically Indigent
Massachusetts............. Emerg Aid for Elderly, Disabled & Children
Michigan................... State Medical Program Expenditures
Minnesota.................. General Assistance Medical Care
Missouri.................... State Medical Program
Nebraska................... State Disability Program
Nevada..................... Medical General Assistance
New Hampshire........... General Assistance
New Jersey................ General Assistance Medical
New Mexico.............. Special Medical Needs Program
New York................. Family Health Plus (FHPLUS)
North Dakota.............. General Assistance Medical
Ohio......................... Disability Assistance
Pennsylvania.............. State-Funded Medical Services
Rhode Island............... General Public Assistance Program
South Dakota............... Chronic Renal Program, County Poor Relief
Tennessee................... State-Funded Medical Assistance Program, Children’s Case Mgmt.
Texas....................... Indigent Health Care Program
Utah.......................... FY98, Utah Medical Assistance Program (UMAP)
Vermont..................... General Assistance–Emergency Care
Virginia..................... State/Local Hospitalization
Washington................. General Assistance Unemployable Program (GA-U), Medically Indigent (MI)
West Virginia.............. State Foster Care, Adult Protective Services
Wisconsin................... General Relief Block Grant, WisconCare
Wyoming.................... Minimum Medical Program, Adult and child, State License Shelter Care, State Foster
Care Children, Residential Treatment Centers-non-JACHO
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>SHIC2<
________________________________________________________________________________________
| LN NAME RELATION
Who has insurance? | (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
ENTER ALL THAT APPLY | (person 11)
| (person 12)
| (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
(Ask SHIC3 for each person listed in SHIC2)
>SHIC3< What type of health insurance did (was/were) (name/you) covered by in 2006? Any other type of plan?
<1> Medicare
<2> Medicaid
<3> TRICARE or CHAMPUS
<4> CHAMPVA ("CHAMPVA" IS THE CIVILIAN HEALTH AND MEDICAL
PROGRAM OF THE DEPARTMENT OF VETERAN'S AFFAIRS.)
<5> VA health care
<6> Military health care
<7> Children’s Health Insurance Program (CHIP)
<8> Indian Health Service
<9> Other government health care
<10> Employer/union-provided (policyholder)
<11> Employer/union-provided (as dependent)
<12> Privately purchased (policyholder)
<13> Privately purchased (as dependent)
<14> Plan of someone outside the household
<15> Other (Specify -SHIC3S)
===>__
>SHIC41< [HOUSEHOLD ROSTER OF PERSONS NOT COVERED AT ALL DURING 2006]
________________________________________________________________________________________
| LN NAME RELATION
I have recorded that (name/you) (was/were) | (person 1)
not covered by a health plan at any time during | (person 2)
2006. Is that correct? | (person 3)
| (person 4)
<1> Yes, (not covered/none covered) | (person 5)
<2> No | (person 6)
| (person 7)
>SHIC4a< Who should be marked as covered? | (person 8)
| (person 9)
PROBE: Anyone else? | (person 10)
| (person 11)
ENTER ALL THAT APPLY | (person 12)
| (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
(Ask SHIC6 for each person listed in SHIC5)
>SHIC6< What type of health insurance (was/were) (name/you) covered by in 2006? Any other type of plan?
<1> Medicare
<2> Medicaid
<3> TRICARE or CHAMPUS
<4> CHAMPVA ("CHAMPVA" IS THE CIVILIAN HEALTH AND MEDICAL
PROGRAM OF THE DEPARTMENT OF VETERAN'S AFFAIRS.)
<5> VA health care
<6> Military health care
<7> Children’s Health Insurance Program (CHIP)
<8> Indian Health Service
<9> Other government health care
<10> Employer/union-provided (policyholder)
<11> Employer/union-provided (as dependent)
<12> Privately purchased (policyholder)
<13> Privately purchased (as dependent)
<14> Plan of someone outside the household
<15> Other/Specify
===>__
>SHIC6s< ENTER OTHER TYPE OF HEALTH INSURANCE COVERED BY IN 2006.
===>_______________________________________________________
>SHI24< An important factor in evaluating a person's or family's health insurance situation is their current health status and/or the current health status of other family members.
ENTER <P> TO PROCEED
===>_
>SHI25< Would you say (name's/your) health in general is:
<1> Excellent
<2> Very good
<3> Good
<4> Fair
<5> Poor
===>_
EMPLOYER'S PENSION PLAN
>Q74a< Other than Social Security did the (ANY) employer or union that (name/you) worked for in 2006 have a pension or other type of retirement plan for any of its employees?
<1> Yes
<2> No
===> __
>Q74b< (Were/Was) (name/you) included in that plan?
<1> Yes
<2> No
===> __
>Q75< Did (you/anyone in this household) have an IRA, Keogh, or employee retirement plan such as a 401k, 403b, or thrift plan in 2006?
<1> Yes
<2> No
>Q76< Did (you/anyone in this household) have an Individual Retirement Account, that is, an IRA in (your/his or her) own name in 2006?
<1> Yes
<2> No
>Q76a< Who is that?
Probe: Anyone Else?
ENTER ALL THAT APPLY
NAME NAME
(Person 1) (person 9)
(Person 2) (person 10)
(Person 3) (person 11)
(Person 4) (person 12)
(Person 5) (person 13)
(Person 6) (person 14)
(Person 7) (person 15)
(Person 8) (person 16)
<1> Yes
<2> No
Amount:$0,000,000.
>Q76cC2< *** DO NOT READ TO THE RESPONDENT *** THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL IRA ACCOUNT WITHDRAWAL IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q77< Did (you/anyone in this household) have a Keogh account in (your/his or her) own name in 2006?
<1> Yes
<2> No
>Q77a< Who is that?
Probe: Anyone Else?
ENTER ALL THAT APPLY
NAME NAME
(Person 1) (person 9)
(Person 2) (person 10)
(Person 3) (person 11)
(Person 4) (person 12)
(Person 5) (person 13)
(Person 6) (person 14)
(Person 7) (person 15)
(Person 8) (person 16)
<1> Yes
<2> No
>Q77c< How much did (you/he/she) withdraw from (your/his/her) Keogh accounts during 2006?
Amount:$0,000,000.
>Q77cC2< *** DO NOT READ TO THE RESPONDENT *** THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL KEOGH ACCOUNT WITHDRAWAL IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q78< During 2006, did (you/anyone in this household) participate in an employee retirement plan such as a 401k, 403b, or thrift plan? Such a plan allows employees to defer part of their salary and not have to pay taxes on their deferred salary until they retire or make a withdrawal.
<1> Yes
<2> No
>Q78a< Who is that?
Probe: Anyone Else?
ENTER ALL THAT APPLY
NAME NAME
(Person 1) (person 9)
(Person 2) (person 10)
(Person 3) (person 11)
(Person 4) (person 12)
(Person 5) (person 13)
(Person 6) (person 14)
(Person 7) (person 15)
(Person 8) (person 16)
>Q78b< Did (you/he/she) make any withdrawals from (your/his/her) 401k, 403b, or thrift plan in 2006?
<1> Yes
<2> No
>Q78c< How much did (you/he/she) withdraw from (your/his/her) 401k, 403b, or thrift plan during 2006?
Amount:$0,000,000.
>Q78cC2< *** DO NOT READ TO THE RESPONDENT *** THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL 401K, 403B, OR THRIFT PLAN ACCOUNT WITHDRAWAL IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q78d< Did (you/he/she) re-invest or "roll over" any of the money into an IRA or some other kind of retirement plan in 2006?
<1> Yes
<2> No
>Q78e< (Do/Does) (you/he/she) plan to re-invest or roll over any of the money?
<1> Yes
<2> No
>Q78f< How much (did/do/does) (you/he/she) (<blank>/plan to) re-invest or “roll over” into an IRA or some other kind of retirement plan?
Amount:$0,000,000.
>Q78fC2< *** DO NOT READ TO THE RESPONDENT *** THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL AMOUNT RE-INVESTED/PLANNED TO RE-INVEST INTO AN IRA OR SOME OTHER KIND OF RETIREMENT PLAN WAS/IS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
SCHOOL LUNCHES
>Q80<
________________________________________________________________________________________
| LN NAME RELATION
During 2006 which of the | (person 1)
children ages 5 to 18 in this | (person 2)
household usually ate a complete | (person 3)
lunch offered at school? | (person 4)
| (person 5)
PROBE: Anyone else? | (person 6)
| (person 7)
| (person 8)
ENTER ALL THAT APPLY | (person 9)
<96> All | (person 10)
<0> None | (person 11)
| (person 12)
| (person 13)
| (person 14)
__ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ |
>Q83<
________________________________________________________________________________________
| LN NAME RELATION
During 2006 which of the children | (person 1)
in this household received free or reduced | (person 2)
price lunches because they qualified | (person 3)
for the Federal School Lunch program? | (person 4)
| (person 5)
[DISPLAY ROSTER OF CHILDREN AGE 5 TO 18] | (person 6)
| (person 7)
| (person 8)
ENTER ALL THAT APPLY | (person 9)
<96> All | (person 10)
<0> None | (person 11)
| (person 12)
| (person 13)
| (person 14)
__ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __
>Q85< Is this public housing, that is, is it owned by a local housing authority or other public agency?
<1> Yes
<2> No
===> __
>Q86< Are you paying lower rent because the Federal, State, or local government is paying part of the cost?
<1> Yes
<2> No
===> __
>SPHS8< Is this through Section 8 or through some other government program?
<1> Section 8
<2> Some other government program
<3> Not sure
===> __
>Q87< Did (you/anyone in this household) get food stamps at any time during 2006?
<1> Yes
<2> No
===> __
>Q88<
________________________________________________________________________________________
| LN NAME RELATION
Which of the people now living | (person 1)
here were covered by food | (person 2)
stamps during 2006? | (person 3)
| (person 4)
LIST ALL HOUSEHOLD MEMBERS | (person 5)
COVERED BY FOOD STAMPS | (person 6)
REGARDLESS OF AGE | (person 7)
| (person 8)
PROBE: Anyone else? | (person 9)
| (person 10)
ENTER ALL THAT APPLY | (person 11)
ENTER <96> FOR ALL | (person 12)
ENTER <0> FOR NONE | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
>Q90p< What is the easiest way for you to tell us the value of the food stamps; monthly or yearly?
<1> Monthly
<2> Yearly
<A> Already included with TANF/AFDC payment
==>___
>Q90< What is the (monthly/ ) value of food stamps received in 2006?
Enter dollar amount $ .00
>Q902< How many months were food stamps received in 2006?
______
<1-12>
>Q90C2< *** DO NOT READ TO THE RESPONDENT *** THE ANNUAL RATE APPEARS OUT OF RANGE. THE TOTAL FOOD STAMPS PAYMENTS RECEIVED IN 2006 WAS (AMOUNT). IS THIS A CORRECT ENTRY?
<1> Yes
<2> No
===> __
>Q903< According to my calculations (total) dollars was received altogether from food stamps in 2006. Does that sound about right?
<1> Yes
<2> No
===> __
>Q904< What is your best estimate of the correct amount received from food stamps during 2006?
PREVIOUS ENTRIES: Q90: (amount)
Q90p: (periodicity)
Q902: (number of pay periods)
Enter dollar amount
>SWRWIC< At any time during 2006, (were you/was anyone in this household) on WIC, the Women, Infants, and Children Nutrition Program?
<1> Yes
<2> No
===> __
>SWRW<
________________________________________________________________________________________
| LN NAME RELATION
Who received WIC? | (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
ENTER ALL THAT APPLY | (person 11)
| (person 12)
| (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
ENERGY ASSISTANCE
>Q93< The government has an energy assistance program which helps pay heating costs. This assistance can be received directly by the household or it can be paid directly to the electric company, gas company, or fuel dealer.
Since October 1, 2006, (have you/has this household) received assistance of this type from the federal, state, or local government?
<1> Yes
<2> No
===> __
>Q93PR1< Do you remember receiving an additional or unexpected check that was sent during the winter to help pay heating costs?
<1> Yes
<2> No
===> __
>Q93PR2< Was it used to pay heating costs?
<1> Yes
<2> No
===> __
>Q94< Altogether, how much energy assistance has been received since October 1, 2006?
FOR AMOUNTS $25,000 AND OVER, ENTER $24,999
===>$___,___ .00 ENTER ANNUAL AMOUNT ONLY
NEW WELFARE REFORM
>SWR1< At any time during 2006, did (you/anyone in this household) receive any of the following types of assistance from a state or county welfare agency or a case manager:
Transportation assistance to help (you/them) get to work or school or training, such as gas vouchers, bus passes, or help repairing a car?
<1> Yes
<2> No
===> __
>SWR2< Any child care services or assistance in 2006 so (you/they) could go to work or school or training?
<1> Yes
<2> No
===> __
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>SWR4<
________________________________________________________________________________________
| LN NAME RELATION
Who received Transportation assistance? | (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
ENTER ALL THAT APPLY | (person 11)
| (person 12)
| (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>SWR5<
________________________________________________________________________________________
| LN NAME RELATION
Who received child care | (person 1)
services or assistance? | (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
ENTER ALL THAT APPLY | (person 11)
| (person 12)
| (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
>SWR7< At any time during 2006, did (you/anyone in this household):
Attend GED classes or receive training to improve basic reading or math skills?
<1> Yes
<2> No
==> _
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>SWR8<
________________________________________________________________________________________
| LN NAME RELATION
Who received this type of training? | (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
ENTER ALL THAT APPLY | (person 11) | (person 12)
| (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
|
>SWR9< [ /At any time during 2006, did (you/anyone in this household):]
Attend job readiness training to learn about resume writing, job interviewing, or building self-esteem?
<1> Yes
<2> No
==> _
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>SWR10<
________________________________________________________________________________________
| LN NAME RELATION
Who received this type of training? | (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
ENTER ALL THAT APPLY | (person 11)
| (person 12)
| (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
>SWR11< [ /At any time during 2006, did (you/anyone in this household):]
Attend a job search program or job club, OR use a job resource center to find out about jobs, to schedule job interviews, or to fill out applications?
<1> Yes
<2> No
==> _
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>SWR12<
________________________________________________________________________________________
| LN NAME RELATION
Who did that? | (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
ENTER ALL THAT APPLY | (person 11)
| (person 12)
| (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
>SWR13< [ /At any time during 2006, did (you/name):]
Attend training to learn a specific job skill, such as computer skills, car repair, nursing, child care work, or some other job skill?
<1> Yes
<2> No
===> __
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>SWR16<
________________________________________________________________________________________
| LN NAME RELATION
Who received this type of training? | (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
ENTER ALL THAT APPLY | (person 11)
| (person 12)
| (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
>SWR17< /At any time during 2006, did (you/anyone in this household):]
Participate in a work experience program, such as a community service job in order to receive cash assistance?
<1> Yes
<2> No
===>
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>SWR18<
________________________________________________________________________________________
| LN NAME RELATION
Who participated in that program? | (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
ENTER ALL THAT APPLY | (person 11)
| (person 12)
| (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
MIGRATION
>MIGSAM< (Was (reference person's name)/Were you) living in this house (or apartment) one year ago?
<1> Yes, this house (apt)
<2> No, different house in U.S.
<3> No, outside the U.S.
===> __
>MIGPLC< Name of city/town/post office
Enter correct city, town, post office or press ENTER for SAME
_______________________CURRENT: (city)
>MIGSTA< Name of State
Enter state or press ENTER for SAME
_______________________CURRENT: (state)
>MIGZIP< ZIP Code
Enter zipcode or press ENTER for SAME
____ CURRENT: (zip code)
>MIGCLM< Did (reference person's name/you) live inside the city limits of (place name)?
<1> Yes, inside city limits
<2> No, outside city limits or post office name only
>MIGCOU< What (county/parish) is (place name) in?
________________________
Note: Enter "IND CITY" if an independent city, not in a county.
>S_MIGCN1< What country did (reference person's name/you) live in one year ago?
>MI1RES< What was [your/name] main reason for moving?
FAMILY- RELATED REASONS (1-3)
EMPLOYMENT- RELATED REASONS (4-8)
HOUSING- RELATED REASONS (9-13)
OTHER REASONS (14-18)
<1> change in marital status
<2> to establish own household
<3> other family reason
<4> new job or job transfer
<5> to look for work or lost job
<6> to be closer to work/easier commute
<7> retired
<8> other job-related reason
<9> wanted to own home, not rent
<10> wanted new or better house/ apartment
<11> wanted better neighborhood/less crime
<12> wanted cheaper housing
<13> other housing reason
<14> to attend or leave college
<15> change of climate
<16> health reasons
<17> natural disaster (hurricane, tornado, etc.)
<18> other reason (Specify)
===> __
>MI1s< What was the reason for moving?
ENTER VERBATIM RESPONSE
____________________________
>MIGALL<
________________________________________________________________________________________
(There are (number) other persons | LN NAME RELATION
in this household ages 1 year or over/ ). | (person 1)
Did (all of these persons/person name) | (person 2)
live with (reference person's name/you) | (person 3)
in (this house/name of country/name | (person 4)
of city, State) one year ago? | (person 5)
| (person 6)
<1> Yes, all lived with reference person/you | (person 7)
<2> No, some or all did not live with | (person 8)
reference person/you | (person 9)
| (person 10)
| (person 11)
| (person 12)
___ | (person 13)
| (person 14)
| (person 15)
| (person 16)
>MIGM<
________________________________________________________________________________________
| LN NAME RELATION
Which of the other members of this | (person 1)
household did NOT live with | (person 2)
(reference person's name/you) one year ago? | (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
ENTER ALL THAT APPLY | (person 11)
| (person 12)
| (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
>NXTSAM< Did (NEXTMOVER's name/you) live in this house one year ago?
<1> Yes, this house (apt)
<2> No, different house in U.S.
<3> No, outside the U.S.
===> __
>NXTPLC< Name of city/town/post office
Enter correct city, town, post office or press ENTER for SAME
_______________________CURRENT: (city)
>NXTSTA< Name of State
Enter state or press ENTER for SAME
_______________________CURRENT: (state)
>NXTZIP< ZIP Code
Enter zipcode or press ENTER for SAME
____ CURRENT: (zip code)
>NXTCLM< Did (NEXTMOVER's name/you) live inside the city limits of (place name)?
<1> Yes, inside city limits
<2> No, outside city limits or post office name only
>NXTCOU< What (county/parish) is (place name) in?
________________________
>S_NXTCN1< What country did (NEXTMOVER's name/you) live in one year ago?
>NX1RES< What was [your/name] main reason for moving?
FAMILY- RELATED REASONS (1-3)
EMPLOYMENT- RELATED REASONS (4-8)
HOUSING- RELATED REASONS (9-13)
OTHER REASONS (14-18)
<1> change in marital status
<2> to establish own household
<3> other family reason
<4> new job or job transfer
<5> to look for work or lost job
<6> to be closer to work/easier commute
<7> retired
<8> other job-related reason
<9> wanted to own home, not rent
<10> wanted new or better house/ apartment
<11> wanted better neighborhood/less crime
<12> wanted cheaper housing
<13> other housing reason
<14> to attend or leave college
<15> change of climate
<16> health reasons
<17> natural disaster (hurricane, tornado, etc.)
<18> other reason (Specify)
===> __
>NX1OTH< What was the reason for moving?
ENTER VERBATIM RESPONSE
____________________________
>Q95< Did (you/anyone in this household) PAY for the care of (your/their) ( child/ children) while they worked in 2006?
[INCLUDE PRESCHOOL AND NURSERY SCHOOL; DO NOT INCLUDE KINDERGARTEN OR GRADE/ELEMENTARY SCHOOL]
<1> Yes
<2> No
===> __
>Q95A<
________________________________________________________________________________________
| LN NAME RELATION
Which children needed care | (person 1)
while their parents worked? | (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
PROBE: Anyone else? | (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
|
>Q96< Now, for the last few questions, we would like to get some CURRENT information.
You said earlier that (no one in your household/someone in your household/you) received cash assistance from a state or county welfare program in 2006. WITHIN THE LAST 30 DAYS, did (anyone in this household/you) receive any CASH assistance from a state or county welfare program such as (State Program Name)?
INCLUDE CASH PAYMENTS FROM:
WELFARE OR WELFARE TO WORK PROGRAMS,
(STATE PROGRAM NAMES AND/OR ACRONYMS)
TEMPORARY ASSISTANCE FOR NEEDY FAMILIES PROGRAM (TANF)
AID TO FAMILIES WITH DEPENDENT CHILDREN (AFDC)
GENERAL ASSISTANCE/EMERGENCY ASSISTANCE PROGRAM,
DIVERSION PAYMENTS,
REFUGEE CASH AND MEDICAL ASSISTANCE PROGRAM,
GENERAL ASSISTANCE FROM BUREAU OF INDIAN AFFAIRS OR
TRIBAL ADMINISTERED GENERAL ASSISTANCE.
DO NOT INCLUDE FOOD STAMPS, SSI, ENERGY ASSISTANCE, WIC, SCHOOL MEALS,
OR TRANSPORTATION, CHILD CARE, RENTAL OR EDUCATION ASSISTANCE.
<1> Yes <2> No ==>__
NOTE: THIS ITEM DOES NOT APPEAR FOR HOUSEHOLDS WITH NO CHILDREN
>Q97< Just to be sure, WITHIN THE LAST 30 DAYS, did anyone receive CASH assistance from a state or
county welfare program, on behalf of CHILDREN in the household?
<1> Yes
<2> No
NOTE: THIS ITEM DOES NOT APPEAR FOR SINGLE PERSON HOUSEHOLDS
>Q96A<
________________________________________________________________________________________
| LN NAME RELATION
| (person 1)
Who received this CASH assistance? | (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
PROBE: Anyone else? | (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
ENTER ALL THAT APPLY | (person 13)
| (person 14)
__ __ __ __ __ __ __ __ | (person 15)
| (person 16)
__ __ __ __ __ __ __ __ |
|
| File Type | application/msword |
| File Title | 2006 Annual Social and Economic Supplement |
| Author | Bureau of the Census |
| Last Modified By | Bureau of the Census |
| File Modified | 2006-09-21 |
| File Created | 2005-06-20 |