EHC Event History Calendar questions

B

Residences – When did [you/NAME] move into this current residence? [Have you / Has HE-SHE] lived here continuously since then? [Where live before that? When/What months? Etc.]
ASK FOR EACH RESIDENCE: [Is/Was] this residence Public Housing, Section 8, or part of another housing program?

C

Current Residence: RECORD ONLY WHETHER IT IS
Pub Housing (PH), Sec 8 (S8), Oth Prog (OP), (NONE)

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Former Address: RECORD ADDRESS AND
Pub Housing (PH), Sec 8 (S8), Oth Prog (OP), (NONE)

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Former Address: RECORD ADDRESS AND
Pub Housing (PH), Sec 8 (S8),Oth Prog (OP), (NONE)

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jun

Jul

Aug

Sep

Oct

Nov

Dec

School Enrollment -- [Enrolled in school now?]

[ ]-YES Æ [When start? Continuous? Any other times in 2007? When?/What months?]
[ ]-NO Æ [Enrolled at any time in 2007?] [ ]-Yes [ ]-No
[When?/What months?]
Jan

(“enrollment “ = regular school/college/vocational
education leading to degree/certificate)

D

Mar

Apr

May

Labor Force – Now I’d like you to consider work [you do / NAME does] for pay. This includes a regular job or business, but I also want you to think about any other work for
pay, no matter how small, including odd jobs, moonlighting, consulting, on-call work, day labor, and one-time jobs. [Are you / Is NAME] working for pay now?
[ ]-YES Æ [When start? Continuous? Any other times in 2007? When?/What months?]
[ ]-NO Æ [Any paid work in 2007, no matter how small?] [ ]-Yes [ ]-No
[When?/What months?]
#1 Employer
Occupation
CHECK ONE:
Employer
Self-Employed
Other
Ending pay rate:
#2 Employer
Occupation
CHECK ONE:
Employer
Self-Employed
Other
Ending pay rate:

J

A

N

F

E

B

M

A

R

A

P

R

M

A

Y

J

U

N

J

U

L

A

U

G

S

E

P

O

C

T

N

O

V

D

E

C

J

A

N

F

E

B

M

A

R

A

P

R

M

A

Y

J

U

N

J

U

L

A

U

G

S

E

P

O

C

T

N

O

V

D

E

C

J

A

N

F

E

B

M

A

R

A

P

R

M

A

Y

J

U

N

J

U

L

A

U

G

S

E

P

O

C

T

N

O

V

D

E

C

Avg hrs/
wk ►

Avg hrs/
Wk ►

#3 Employer
Occupation
Avg hrs/
CHECK ONE:
Employer
Self-Employed
Other
wk ►
Ending pay rate:
* * * * * RECORD ADDITIONAL EMPLOYERS ON NEXT PAGE * * * * *
E

Feb

Employment Summary –

(1) ADD ACROSS ALL PAID WORK TO SHOW SPELLS OF PAID EMPLOYMENT IN 2007.
(2) IF ANY GAPS: [Looking for work during [period] when not working for pay?] [ ]-Yes [ ]-No [When?/What months?] MARK ALL “GAPS” WITH Y’s (LOOKING) AND N’s (NOT LOOKING), AS APPROPRIATE.

(1) Spells of paid employment (combined)

J

A

N

F

E

B

M

A

R

A

P

R

M

A

Y

J

U

N

J

U

L

A

U

G

S

E

P

O

C

T

N

O

V

D

E

C

G

S

E

P

O

C

T

N

O

V

D

E

C

(2) Spells of looking (Y) and not looking (N) for work

F

Unpaid Labor – Did [you / NAME] do any unpaid work in a family business or farm, either now or at any time during 2007? [ ]-Yes [ ]-No
J

A

N

F

E

B

M

A

R

A

P

R

M

A

Y

J

EHC Introduction:
Many of the questions in this interview ask about calendar year 2007. By "calendar year" we mean the entire 12 months between January 1st and December 31st, 2007.
The questions ask about where (you / ...) lived, school enrollment, employment and unemployment, government programs, health insurance, and assets.
SELF-RESPONSE INTERVIEW:
PROXY INTERVIEW:

START WITH SECTION A, "LANDMARK EVENTS."
COPY ALREADY-REPORTED LANDMARKS TO THIS EHC; START WITH SECTION B, "RESIDENCES."

U

N

[When?/What months?]
J

U

L

A

U

Control Number:______________________________
LINE # OF HH Member: ___ ___

D

Labor Force (continued)
Now I’d like you to consider work [you do / NAME does] for pay. This includes a regular job or business, but I also want you to think about any other work for
pay, no matter how small, including odd jobs, moonlighting, consulting, on-call work, day labor, and one-time jobs. [Are you / Is NAME] working for pay now?
[ ]-YES Æ [When start? Continuous? Any other times in 2007? When?/What months?]
[ ]-NO Æ [Any paid work in 2007, no matter how small?] [ ]-Yes [ ]-No
[When?/What months?]
#4 Employer
Occupation
CHECK ONE:
Employer
Self-Employed
Other
Ending pay rate:

J

A

N

F

E

B

M

A

R

A

P

R

M

A

Y

J

U

N

J

U

L

A

U

G

S

E

P

O

C

T

N

O

V

D

E

C

J

A

N

F

E

B

M

A

R

A

P

R

M

A

Y

J

U

N

J

U

L

A

U

G

S

E

P

O

C

T

N

O

V

D

E

C

Avg hrs/
wk ►

#5 Employer
Occupation

Avg hrs/
CHECK ONE:
Employer
Self-Employed
Other
wk ►
Ending pay rate:
* * * * * RETURN TO PAGE 1 AND CONTINUE WITH SECTION E * * * * *

G

Workers Insurance Programs
Unemployment – IF NOT EMPLOYED NOW: [Are you/Is NAME] currently receiving unemployment benefits?

IF EMPLOYED NOW: Did [you/NAME] receive unemployment benefits at any time during 2007?
[ ]-Yes Æ FILL CALENDAR [When?/What months?]
[ ]-No Æ GO TO WORKERS COMP

[ ] -YES Æ [When start? Continuous? Other times in 2007? When?What months?]
[ ] -NO Æ [Any time in 2007?] [ ]-Yes [ ]-No
[When?/What months?]

FOR ALL REPORTED MONTHS OF RECEIPT ASK: [How much (now/most recently)? When did that amount start? Amount differ for any month?] IF NECESSARY: [How much before that? When?/What months?]
Jan

$

Feb

$

Mar

$

Apr

$

May

$

Jun

$

Jul

$

Aug

$

Sep

$

Oct

$

Nov

$

Dec

$

Disability – [Are you/Is NAME] currently receiving any income due to a disability?
[ ]-YES Æ [When start? Continuous? Other times in 2007? When?/What months?]
[ ]-NO Æ [Any time in 2007?] [ ]-Yes [ ]-No
[When?/What months?]
FOR ALL REPORTED MONTHS OF RECEIPT ASK: [How much (now/most recently)? When did that amount start? Amount differ for any month?] IF NECESSARY: [How much before that? When?/What months?]
Jan

$

Feb

$

Mar

$

Apr

$

May

$

Jun

$

Jul

$

Aug

$

Sep

$

Oct

$

Nov

$

Dec

$

Workers Compensation – [Are you/Is NAME] currently receiving workers compensation?
[ ]-YES Æ [When start? Continuous? Other times in 2007? When?/What months?]
[ ]-NO Æ [Any time in 2007?] [ ]-Yes [ ]-No
[When?/What months?]
FOR ALL REPORTED MONTHS OF RECEIPT ASK: [How much (now/most recently)? When did that amount start? Amount differ for any month?] IF NECESSARY: [How much before that? When?/What months?]
Jan

$

Feb

$

Mar

$

Apr

$

May

$

Jun

$

Jul

$

Aug

$

Sep

$

Oct

$

Nov

$

Dec

$

Control Number: ______________________________
LINE # OF HH Member: ___ ___

H

Social Security

[USE “99” FOR NON-HH BENEFICIARIES]

Social Security – [Do you/does NAME] receive Social Security Retirement now?
[ ]-YES Æ [When start? Continuous? Other times in 2007? When?/What months?]
[ ]-NO Æ [Any time in 2007?] [ ]-Yes [ ]-No
[When?/What months?]
FOR ALL REPORTED MONTHS OF RECEIPT ASK: [How much (now/most recently)? When did that amount start? Amount differ for any month?] IF NECESSARY: [How much before that? When?/What months?]
Jan

Who do those benefits cover? (Who are they for?)
Person number(s) of beneficiaries ____________________

$

Feb

$

Mar

$

Apr

$

May

$

Jun

$

Jul

$

Aug

$

Sep

$

Oct

$

Nov

$

Dec

$

*IF RECEIVES SOCIAL SECURITY ASK:
Medicare Part B deduction – Some people who receive Social Security have an automatic deduction to pay for Medicare Part B. [Do you/does NAME] have the Medicare Part B Deduction now?
[ ]-YES Æ [When start? Continuous? Other times in 2007? When?/What months?]
[ ]-NO Æ [Any time in 2007?] [ ]-Yes [ ]-No
[When?/What months?]
FOR ALL REPORTED MONTHS OF DEDUCTION ASK: [How much (now/most recently)? When did that deduction amount start? Amount differ for any month?] IF NECESSARY: [How much before that? When?/What months?]
Jan

$

I

Social Welfare

Feb

$

Mar

$

Apr

$

May

$

Jun

$

Jul

$

Aug

$

Sep

$

Oct

$

Nov

$

Dec

$

[USE “99” FOR NON-HH BENEFICIARIES]

Temporary Assistance for Needy Families (TANF) - Some people receive financial support in the form of Temporary Assistance for Needy Families, or TANF. [Do you/does NAME] get TANF now?
[ ]-YES Æ [When start? Continuous? Other times in 2007? When?/What months?]
[ ]-NO Æ [Any time in 2007?] [ ]-Yes [ ]-No
[When?/What months?]
FOR ALL REPORTED MONTHS OF RECEIPT ASK: [How much (now/most recently)? When did that amount start? Amount differ for any month?] IF NECESSARY: [How much before that? When?/What months?]
Jan

Who do those benefits cover? (Who are they for?)
Person number(s) of beneficiaries ______________________

$

Feb

$

Mar

$

Apr

$

May

$

Jun

$

Jul

$

Aug

$

Sep

$

Oct

$

Nov

Dec

$

$

Food Stamps – Some people receive financial support in the form of Food Stamps. [Do you/does NAME] get Food Stamps now?
[ ]-YES Æ [When start? Continuous? Other times in 2007? When?/What months?]
[ ]-NO Æ [Any time in 2007?] [ ]-Yes [ ]-No
[When?/What months?]
FOR ALL REPORTED MONTHS OF RECEIPT ASK: [How much (now/most recently)? When did that amount start? Amount differ for any month?] IF NECESSARY: [How much before that? When?/What months?]
Jan

Who do those benefits cover? (Who are they for?)
Person number(s) of beneficiaries ______________________

$

Feb

$

Mar

$

Apr

$

May

$

Jun

$

Jul

$

Aug

$

Sep

$

Oct

$

Nov

Dec

$

$

(FEMALES ONLY) WIC – Some people receive supplemental foods, health care referrals, or nutrition education through a program called Women, Infants and Children, or WIC. [Do you/does NAME] receive WIC benefits now?
[ ]-YES Æ [When start? Continuous? Other times in 2007? When?/What months?]
[ ]-NO Æ [Any time in 2007?] [ ]-Yes [ ]-No
[When?/What months?]
Jan

Who do those benefits cover? (Who are they for?)

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Person number(s) of beneficiaries ______________________

Supplemental Security Income (SSI) – Some people receive financial support for persons who are elderly, disabled, or blind in the form of Supplemental Security Income payments, or SSI. [Do you/does NAME] get SSI now?
[ ]-YES Æ [When start? Continuous? Other times in 2007? When?/What months?]
[ ]-NO Æ [Any time in 2007?] [ ]-Yes [ ]-No
[When?/What months?]
FOR ALL REPORTED MONTHS OF RECEIPT ASK: [How much (now/most recently)? When did that amount start? Amount differ for any month?] IF NECESSARY: [How much before that? When?/What months?]
Jan

Who do those benefits cover? (Who are they for?)
Person number(s) of beneficiaries ______________________

$

Feb

$

Mar

$

Apr

$

May

$

Jun

$

Jul

$

Aug

$

Sep

$

Oct

$

Nov

$

Dec

$

Control Number: _________________________________
LINE # OF HH Member: ___ ___

J

Health Insurance

[PROBE FOR MULTIPLE TYPES OF HEALTH INSURANCE, INCLUDING MULTIPLE TYPES AT THE SAME TIME]
Employer-Sponsored Coverage
INCLUDES COVERAGE FROM A SPOUSE’S OR PARENT’S
EMPLOYER/UNION, ALSO FORMER EMPLOYERS/UNIONS

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Medicare (MAINLY FOR ELDERLY)

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Medicaid, SCHIP, etc. (MAINLY FOR LOW INCOME)

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Military or VA Coverage

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Other Health Insurance
CHECK ONE:
-School
-Parent/relative

-Other (specify: ________________________ )

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Uninsured

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Directly-Purchased Coverage
INCLUDES PLANS OBTAINED THROUGH TRADE GROUPS
AND MEMBERSHIP ORGS SUCH AS THE ABA OR AARP

[Are you/Is NAME] covered by any
kind of health coverage or health
plan now?

[ ]-YES Æ

EXAMPLES OF STATE NAMES
FOR MEDICAID / SCHIP /
MEDICAL ASSISTANCE / ETC.
IL

KidCare, AllKids,
FamilyCare, Health
Connect

MD

Health Choice, Maryland
Children’s Health
Program

NY
TX

SCHIP, Child Health
Plus (CHPlus)
STAR, STAR PLUS,
Primary Care Case
Management ( PCCM),
Texas CHIP

(1) Is that through… [ ] an employer or union? Æ FILL CALENDAR IN EMPLOYER ROW
[ ] the government? Æ ASK 2
[ ] or some other way? Æ ASK 5
( [ ]-D [ ]-R ) Æ FILL CALENDAR IN OTHER ROW
(2) Is it through a job with the government?

[ ]-Yes Æ ASK 3
[ ]-No (or [ ]-D [ ]-R ) Æ ASK 4

(3) Is it related to military service or the VA?

[ ]-Yes Æ FILL CALENDAR IN MILITARY ROW
[ ]-No (or [ ]-D [ ]-R ) Æ FILL CALENDAR IN EMPLOYER ROW

(4) What type of government plan is it? Is it…
[ ] Medicare? Æ FILL CALENDAR IN MEDICARE ROW
[ ] Medicaid, SCHIP, or some other government assistance plan? [SEE BOX AT LEFT] Æ FILL CALENDAR IN MEDICAID ROW
[ ] or is it related to military service or the VA? Æ FILL CALENDAR IN MILITARY ROW
( [ ]-D [ ]-R ) Æ FILL CALENDAR IN OTHER ROW
(5) Was it…

[ ] directly purchased from an insurance company? Æ FILL CALENDAR IN DIRECT-PURCHASE ROW
[ ] or is it through school, a parent or relative, or something else? Æ FILL CALENDAR IN OTHER ROW
* * * * * * * * * * * * * * WHEN CALENDAR IS COMPLETE FOR REPORTED COVERAGE, ASK ABOUT ALL OTHER COVERAGE TYPES FOR 2007, THEN Æ (9) * * * * * * * * * * * * * * * * * * * * *
[ ]-NO Æ
( [ ]-D [ ]-R )

(6) Just to be sure, [are you / is NAME] now covered by….

[ ] Medicare?
[ ] Medicaid, SCHIP, or some other government assistance plan? [SEE BOX AT LEFT]
[ ] or anything related to military service or the VA?
IF ANY COVERAGE NOW Æ CHECK AND FILL CALENDAR; THEN ASK ABOUT ALL OTHER COVERAGE TYPES FOR 2007
IF NONE Æ ASK (7)

(7) So [you have / NAME has] no coverage now, is that correct?

[ ]-Correct, no coverage now Æ ASK (8)
[ ]-NO, COVERED NOW Æ ASK (1-5) TO DETERMINE TYPE; FILL CALENDAR AS INSTRUCTED

(8) How about during 2007? At any time from January 1st through the end of December [were you / was NAME] covered by any type of health coverage or health plan?
[ ]-Yes Æ ASK (1-5) TO DETERMINE TYPE; FILL CALENDAR AS INSTRUCTED
* * * * * * * * * * * * * * * * * * * * WHEN CALENDAR IS COMPLETE FOR REPORTED COVERAGE, ASK ABOUT ALL OTHER COVERAGE TYPES FOR 2007, THEN Æ (9) * * * * * * * * * * * * * *
[ ]-No Æ MARK CALENDAR “UNINSURED” FOR ALL OF 2007; END HEALTH INSURANCE SECTION
(9) CHECK FOR COVERAGE “GAPS;” CONFIRM UNINSURED AND MARK UNINSURED PERIODS ON CALENDAR; END HEALTH INSURANCE SECTION
Control Number: ____________________________________
LINE # OF HH Member: ____ __

Control Number: ____________________________

Date: _______/_______/2008

ENTER LINE # OF HH Member: ___ ___

FR Code: ____________________

OMB #: 0607-0725
Expiration Date: 08/31/2010
Form Name: SIPP-EHC2008CAL
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.

2007 EVENT HISTORY CALENDAR

CHECK ONE: [ ] Self response
[ ] Proxy – Enter Line # of Proxy ___ ____

A

Landmark Events
First, I want to ask you about what we call
“landmark events” – important things that
happened to you last year. These events are
often very useful in helping people recall when
other things happened. So, take a moment to
think about major events in your life in 2007. For
example: Were there any births or deaths of
people important to you? Did you get married,
divorced, or separated? Did you get promoted?
Did you have a serious injury or illness? When
did these events occur?

K

WINTER
January

SPRING

February

March

April

SUMMER
May

June

August

September

WINTER

October

November

December

Started
before
January
2007

Cont’d.
into
2008

Assets
General Assets –
Here are some questions about assets [you/NAME] may
have owned during 2007. First, retirement accounts -- At
any time in 2007 did [you/NAME] own…

Owned in
2007?

K1

An Individual Retirement Account (IRA) or a Keogh
Account?

Y

N

K2

A 401(k), 403(b), or thrift plan?

Y

N

Individual
or Joint?

Enter line
#

U.S. Government savings bonds?

Y

N

K10

In 2007, did [you/NAME] own any other assets that
produced income, such as rental property, mortgages
which provided payments, or any other financial
investments?

I

J

[ ]-Yes Æ CONTINUE WITH K11
[ ]-No Æ END
( [ ]-D [ ]-R ) Æ END

Owned in
2007?

Special Assets

Next are assets that can be owned individually or co-owned with someone else. At any time
in 2007 did [you/NAME] own any…

K3

July

FALL

Individual or
Joint?

K11

Did [you/NAME] own any municipal or corporate bonds?

Y

N

I

J

K12

U.S. Government securities?

Y

N

I

J

K13

How about mortgages that provide payments?

Y

N

I

J

K4

interest-earning checking accounts?

Y

N

I

J

K14

Any rental property?

Y

N

I

J

K5

any savings accounts?

Y

N

I

J

K15

Royalties?

Y

N

I

J

K6

money market deposit accounts, or money market
funds?

Y

N

I

J

K16

or any other financial investments?

Y

N

I

J

K7

How about certificates of deposit, or CDs?

Y

N

I

J

K8

Any mutual funds (apart from retirement accounts)?

Y

N

I

J

K9

Or stocks (apart from retirement accounts)?

Y

N

I

J

CHECK POINT: ARE ANY BOXES CIRCLED ‘Y’ IN K4 - K9?
IF YES ´ ASK K11 – K16
IF NO ´ ASK K10

Enter line
#

FOR EACH OWNED ASSET ASK: Did [you/NAME] own [asset] individually, or was it jointly with someone else?
CIRCLE “I” OR “J”
IF JOINT ASK: Who were the other owners?
ENTER LINE #’s OF ALL CO-OWNERS
[USE “99” FOR NON-HH CO-OWNERS]