Field Test of Survey of Income & Program Participation, Event History Calendar

Control Card
FR Code: __________________

Control Number:

FR Code: __________________

Was a Debit Card Promised? Circle: Y N

Household Address:

FR Code: __________________

OMB #: 0607-0725
Expiration Date: 08/31/2010
Form Name: SIPP-EHC2008CC

IF YES, Debit Card # _______________________________________

Household Contact Name: _____________________________ Household Contact Phone #_______________________

NOTICE – Your report to the U.S. Census Bureau is confidential by law (Title 13,
U.S. Code). It may be seen only by individuals who are sworn for life to protect the
confidentiality of these data and may be used only for statistical purposes.

Total Number of HH Members age 15+: ______

A1

FIRST NAME

SECTION 2: Household Demographics

A3

A2

MIDDLE NAME

B

LAST NAME

C

Relationship
to Person 1

Sex

D

SECTION 3: Spouse/Parent Relationships

E

Date of Birth
MM/DD/YYYY

Age

F

G

Hispanic

Race
Code(s)

H

I

J

K

L

M

(15+)

(15+)
Ever in
Armed
Forces?

(15+)
Marital
Status
Code

Spouse lives
here?
Enter line #

Mother lives
here?
Enter line #

Father lives
here?
Enter line #

Educ
Code

Person line #

Person line #

SECTION 1: Household Members

/

/

Y

N

Y

N

1

F

/

/

Y

N

Y

N

2

M

F

/

/

Y

N

Y

N

3

4

M

F

/

/

Y

N

Y

N

4

5

M

F

/

/

Y

N

Y

N

5

6

M

F

/

/

Y

N

Y

N

6

1

M

F

2

M

3

[Person 1]

PERSON LINE # (HH ROSTER): First, I need to list all the people who live or stay at this address – that is, people who live and sleep here most of the time.
Let’s begin with the name of the person or one of the persons who owns or rents this home.
C. RELATIONSHIP: Please look at Flashcard A [RELATIONSHIPS] and tell me what is (your / …’s) relationship to [PERSON 1]?
(1) Husband/Wife
(2) Unmarried Partner
(3) Child (biological/step/adopted)
(4) Grandchild
(5) Mother/Father
(8) Foster Child
(9) Housemate/Roommate
(10) Roomer/Boarder
(11) Other Non-Relative

(6) Brother/Sister

(7) Other Relative (uncle/cousin/mother-in-law/father-in-law/etc.)

F. HISPANIC: (Are you / Is …) Spanish, Hispanic, or Latino?
G. RACE: Please choose one or more races from Flashcard B [RACE] that (you / …) consider(s) (your/him/her)self to be. [MARK 6 FOR “OTHER”]
(1) White
(2) Black or African American
(3) American Indian or Alaska Native
(4) Asian
(5) Native Hawaiian or Other Pacific Islander
H. EDUCATION: Please look at Flashcard C [EDUCATION]. What is the highest level of school (you have / … has) completed, or the highest degree (you have / he/she has) received?
J. MARITAL STATUS: (Are you / Is …) currently (1) married, (2) widowed, (3) divorced, (4) separated, or (5) (have you / has …) never been married?

SECTION 4: Instructions
1) IF THERE ARE MORE THAN 12 PERSONS, WRITE DOWN THE NUMBER OF PERSONS WHO DID NOT GET LISTED. IF 12 OR FEWER PEOPLE, ENTER ‘0’. _________
2) CIRCLE THE PERSON LINE NUMBER IN THE FIRST COLUMN TO INDICATE RESPONDENT FOR THIS CONTROL CARD.
3) IN COLUMN E, CIRCLE THE AGES OF PERSONS AGE 15 AND OLDER.
4) COUNT TOTAL NUMBER OF PERSONS AGE 15 AND OLDER. RECORD HERE AND TEXT BOX AT TOP. _________
5) COMPLETE AN EVENT HISTORY CALENDAR WITH EACH PERSON AGE 15 AND OLDER (IF AT ALL POSSIBLE), OR WITH A PROXY IF PERSON IS UNAVAILABLE.

RECORD EACH VISIT ON “CONTACT LOG”
INTRODUCTION:
Hello, I’m _________ from the U.S. Census Bureau. Here is my ID card. We are conducting a survey on the
economic situation of people who live in the United States, and I have some questions to ask you. We sent a
letter to your address describing our study and letting you know that I’d be visiting. Did you get that letter?
SHOW LETTER IF NECESSARY, AND DESCRIBE STUDY AS NEEDED.
CC RESPONDENT MUST BE A MEMBER OF THE HOUSEHOLD AT LEAST 15 YEARS OLD.
BEGIN FILLING HH ROSTER. LIST OWNER / RENTER ON LINE 1.

Control Card

A1

FIRST NAME

SECTION 2: Household Demographics

A2

MIDDLE NAME

A3

B

LAST NAME

C

Relationship
to Person 1

Sex

D

SECTION 3: Spouse/Parent Relationships

E

Date of Birth
MM/DD/YYYY

Age

F

G

Hispanic

Race
Code(s)

H

I

J

K

L

M

(15+)

(15+)
Ever in
Armed
Forces?

(15+)
Marital
Status
Code

Spouse lives
here?
Enter line #

Mother lives
here?
Enter line #

Father lives
here?
Enter line #

Educ
Code

Person line #

Person line #

SECTION 1: Household Members

7

M

F

/

/

Y

N

Y

N

7

8

M

F

/

/

Y

N

Y

N

8

9

M

F

/

/

Y

N

Y

N

9

10

M

F

/

/

Y

N

Y

N

10

11

M

F

/

/

Y

N

Y

N

11

12

M

F

/

/

Y

N

Y

N

12

CONTACT LOG

2008 EHC OUTCOME CODES
INCOMPLETE CASES
202 Started – No interview or insufficient partial
204 Partial – Need callback items only
206 Partial – One or more persons incomplete (no callback items)
COMPLETED CASES
201 Completed interview - regular
203 Complete partial interview – Missing callback items, No Type Z’s, No further FU possible
207 Complete partial interview – with Type Z’s lines, no further FU possible
TYPE A NONINTERVIEWS
213 Language Problem
214 Unable to locate
216 No One Home (NOH)
217 Temporarily Absent (TA)
218 HH Refused
219 Other occupied (specify)
TYPE B NONINTERVIEWS
223 Entire HH on active duty in Armed Forces
224 Entire HH age 14 or under
225 Temporarily occupied w/ persons with URE
226 Vacant
233 Other (specify)

TYPE C NONINTERVIEWS
240 Demolished
241 House or trailer moved
245 Condemned (and unoccupied)
248 Type-C, Other (specify)

Date
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Time
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FR Code

Outcome

Notes/Appointments

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