OMB Number: 0970-0033 
Expiration Date: XX/XX/XXXX


QUESTIONNAIRE FOR 

ANNUAL SURVEY 

OF 

REFUGEES 

NOTE: For the re-interview cases, items Q.1a thru Q.1k should only be used for verification. In addition, items marked 
with asterisk, Q.2a*, Q.2b*, Q.3a*— Q.3d*, Q.4a*, Q.4c*, and Q.4d* should not be re-administered. Refer to 
ASR Training Manual. 

Office of Refugee Resettlement
Administration for Children and Families
Department of Health and Human Services


ASR-1
ENGLISH


Arrington Dixon and Associates, Inc. 2401 Shannon Place, SE Washington, D.C. (202) 889-0123 



INTRODUCTORY STATEMENT 

We are with Arrington Dixon and Associates, Inc. We are calling in connection with a survey that we are conducting 
for the U.S. Office of Refugee Resettlement concerning the adjustment to life in the United States of refugees and certain 
other recent immigrants. 

About two weeks ago we sent you a letter describing this survey. As indicated in that letter, any information that you 
give us will be held in confidence and will be used for statistical purposes only. Today we would like to talk to you 
further about your life in this country. 

If you have no questions, we would like to proceed with the interview. 

ORR-9 

Public reporting burden for this collection of information is estimated to average 40 minutes per response, including 
the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of 
information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of 
information unless it displays a currently valid OMB Control Number. 

Send comments regarding this burden estimate or any other aspect of this collection of information, including 
suggestions for reducing this burden, to: Reports Clearance Office, Administration for Children and Families, 
Department of Health and Human Services, 370 L'Enfant Promenade, Washington, D.C. 20447; and to: Office of 
Management and Budget, Paperwork Reduction Project, OMB Control Number 0970-0033, Washington, D.C. 20403. 

Arrington Dixon and Associates, Inc. 2401 Shannon Place, SE Washington, D.C. (202) 889-0123 

EN-2 



Household ID Number _________________________ 

Interviewer's Name _________________________ Code ___/ ___/ ___ 

Date of Interview _________________________ 

Time Interview Started _________________________ AM PM 

ATTEMPTS TO CONTACT INTERVIEWEE 

1. _________________ 5. __________________ 9. _________________ 
2. _________________ 6. __________________ 10. _________________ 
3. _________________ 7. __________________ 
4. _________________ 8. __________________ 
TOTAL NUMBER OF ATTEMPTS TO CONTACT INTERVIEWEE _______________ 

NAME OF RESPONDENT 

Last Middle First 

CURRENT ADDRESS 

Street# Street Name Apt.# 

City State Zip Code 

TELEPHONE (_______) ______________________________ 
Area Code 

Arrington Dixon and Associates, Inc. 2401 Shannon Place, SE Washington, D.C. (202) 889-0123 

EN-3 



Q.1 We would like to start by asking you a few questions about each person who lives here, or who is staying or 
visiting here and has no other home. Let us start with the person who has overall responsibility, that is the 
person in whose name your home is rented, owned, or is being bought: the head of the household. (RECORD 
ANSWERS ON ATTACHED HOUSEHOLD CONTROL CHART). 
a. What is the name of the Head of the household, and of each of the other members of the 
household? (PROBE: ARE THERE OTHER PERSONS WHO USUALLY LIVE HERE 
BUT ARE TEMPORARILY ABSENT?) 
FOR EACH HOUSEHOLD MEMBER ASK (VERIFY): 

b. What is ... relationship to the head of household? 
c. What is ... current marital status? 
01 Now married (note: spouse need not live in household) 
02 Divorced 
03 Legally separated 
04 Never married 
05 Widowed 
06 Other (SPECIFY)_______________ 

d. What was ... age at last birthday? 
e. What was ... date of birth? 
f. Is ... male or female? 
g. What is ... country of birth? 
h. What is ... country of citizenship? 
i. What is ... ethnic origin? 
j. What month and year did ... enter the U.S. to stay? 
k. In what State did ... originally resettle? 
Arrington Dixon and Associates, Inc. 2401 Shannon Place, SE Washington, D.C. (202) 889-0123 

EN-4 



Now I want to ask some questions only of persons in your household who are 16 years old or older. 

Q.2a* How many years of schooling did ... complete before coming to the U.S.? 

Q.2b* What was the highest degree or certificate that ... obtained before coming to the U.S.? 

01 None
02 Primary
03 Training in refugee camp
04 Technical school certification
05 Secondary (or high school diploma)
06 University degree (other than medical)
07 Medical degree
08 Other (SPECIFY) ______________
(-9) DK/ (-8) RA/ (-7) NA


Q.3a* Before coming to the U.S., was ...: (If in a refugee camp prior to the U.S., what type of employment did the 
person hold before that?) 

01 Not employed (skip to Q.3d) 
02 Civil servant (civilian in local or national government) 
03 In the military 
04 Employee in private sector 
05 Self-employed 
06 Student 
07 Other (SPECIFY) ___________________ 
(-9) DK/ (-8) RA/ (-7) NA 

Q.3b* What kind of work (activities) did ... perform before coming to the U.S.? (e.g., lawyer, typist, farmer, teacher, 
electrician, student) 

Q.3c* What were the most important activities or duties in this job? 

Q.3d* Was ... in a prison or reeducation camp prior to coming to the U.S.? 

01 No
Yes. How long was ... there? 


(-9) DK/ (-8) RA/ (-7) NA 

Arrington Dixon and Associates, Inc. 2401 Shannon Place, SE Washington, D.C. (202) 889-0123
PK (-7) – DON’T KNOW RA (-8) – REFUSE TO ANSWER NA (-7) – NOT APPLICABLE


EN-5 



Q.4a* At the time of arrival in the U.S., how well did ... speak English? 
01 Very well 
02 Well 
03 Not well 
04 Not at all 
(-9) DK/ (-8) RA/ (-7) NA 
Q.4b How well does ... speak English now? 
01 Very well 
02 Well 
03 Not well 
04 Not at all 
(-9) DK/ (-8) RA/ (-7) NA 
Q.4c* Before coming to the U.S. did ... have any English language instruction? 
01 No (skip to Q.4e) 
02 Yes 
(-9) DK/ (-8) RA/ (-7) NA 
Q.4d* (If yes to Q.4c) Altogether how many weeks did ... attend English language instruction before coming to the 
U.S.? 
Q.4e Within the past 12 months, has ... attended an English language training program? 
01 No (skip to Q.5a) 
02 Yes 
(-6) High school student (skip to Q.5a) 
(-9) DK/ (-8) RA/ (-7) NA 
Q.4f Within the past 12 months, how many weeks did ... attend English language training? 
Q.4g Within the past 12 months, did the English language class that ... attended in the U.S. meet every day or less 
frequently? 
01 Every day 
02 2 to 6 times a week 
03 Once a week 
(-9) DK/ (-8) RA/ (-7) NA 
Q.4h Within the past 12 months, how many hours a day was ... in English language training? 
Q.4j Is ... currently enrolled in an English language training program? 
01 No 
02 Yes 
(-9) DK/ (-8) RA/ (-7) NA 
Q.4k What type of organization gave the English language training program? (Most recent program if more than 
one) 
School or university 
Employer program 
Religious organization 
Refugee service agency (state/local government) 
Refugee mutual assistance association (MAA) 
Private individual/group 
Other (SPECIFY)________________ 
(-9) DK/ (-8) RA/ (-7) NA 

Arrington Dixon and Associates, Inc. 2401 Shannon Place, SE Washington, D.C. (202) 889-0123
PK (-7) – DON’T KNOW RA (-8) – REFUSE TO ANSWER NA (-7) – NOT APPLICABLE


EN-6 



Q.5a Did ... work at a job anytime last week? 
01 No (skip to Q.11a) 
02 Yes (go to Q.5b) 
(-9) DK/ (-8) RA/ (-7) NA (skip to Q.11a) 

(FOR PERSONS WHO WORKED LAST WEEK) 

Q.5b Did ... work at more than one job last week? 
01 No (skip to Q.6a) 
02 Yes (go to Q.5c) 
(-9) DK/ (-8) RA/ (-7) NA (skip to Q.6a) 

Q.5c How many jobs did ... work at last week? 

Q.6a How many hours did ... work at his/her primary job last week? (Primary job means the job worked at for the 
greatest number of hours) 

Q.6b How many hours did ... work at all jobs last week? 

Q.7 How much money per hour did ... receive at his/her primary job last week? 
(If knows hourly wage, skip Q.8a & Q8b. If not, continue with Q.8a.) 

Q.8a How much did ... earn before taxes from that job? 

Q.8b On what basis is that amount computed? 
01 Weekly 
02 Bi-weekly 
03 Monthly 
04 Yearly 

If ... worked at second job last week, ask Q.9 If ... worked only one job last week, skip to Q.18a 

(SECOND JOB ONLY) 

Q.9 How much money per hour did ... receive from his/her second job last week? 
(If knows hourly wage, skip to Q.18a. If not, continue with Q.10a) 
Q.10a How much did ... earn before taxes from that job? 
Q.10b On what basis is that amount computed? 

01 Weekly
02 Bi-weekly
03 Monthly
04 Yearly


(Skip to Q.18a) 

Arrington Dixon and Associates, Inc. 2401 Shannon Place, SE Washington, D.C. (202) 889-0123
PK (-7) – DON’T KNOW RA (-8) – REFUSE TO ANSWER NA (-7) – NOT APPLICABLE


EN-7 



Q.11a Has ... ever worked since coming to the U.S. to stay? 
01 Never worked in the U.S. (skip to Q.13) 
Yes -- How many weeks has it been since ... had a job? 
(-9) DK/(-8) RA/ (-7) NA (skip to Q.12) 

Q.11b (If yes to 11a, otherwise skip to Q.12) Since coming to the U.S., in how many weeks has ... ever worked? 

Q.12 Was ... temporarily absent or on layoff from a job or business last week? 
01 No 
02 Yes 
(-9) DK/ (-8) RA/ (-7) NA 
Q.13 Has ... been looking for work during the last 4 weeks? 
01 No (skip to Q.17) 
02 Yes 
(-9) DK/ (-8) RA/ (-7) NA (skip to Q.17) 
Q.14 What has ... done to find a job? Has he/she checked with: (multiple answer may be given) 
01 Nothing 
02 Refugee mutual assistance association (MAA) 
03 Refugee service agency 
04 Public employment agency 
05 Private employment agency 
06 Advertisements 
07 Sponsor 
08 Other refugees 
09 Friends (not refugees) 
11 Other (SPECIFY)_____________ 
Q.15 How many weeks has ... been looking for a job? 
Q.16 What caused ... to begin looking for work? (multiple answer may be given) 
01 New arrival in the U.S. 
02 Lost job 
03 Quit job 
04 Finished school 
05 Training ended 
06 Moved to a new area 
07 Medical problem ended 
08 Other (SPECIFY) 
09 Eligibility for cash and/or medical assistance ended 
(Skip to Q.18a IF WORKED; OR to Q.24a IF NEVER WORKED) 

Q.17 Why is ... not looking for a job? (multiple answer may be given) 
01 Limited English 
02 Attending school or training 
03 Poor health or handicap 
04 Child care or family responsibilities 
05 Believes no work is available 
06 Tried to find work but couldn't 
08 Age 
07 Other (SPECIFY)______________ 
Go to Q.24a if never worked 

Arrington Dixon and Associates, Inc. 2401 Shannon Place, SE Washington, D.C. (202) 889-0123
PK (-7) – DON’T KNOW RA (-8) – REFUSE TO ANSWER NA (-7) – NOT APPLICABLE


EN-8 



Q.18a In the last year, how many weeks did ... work? 

Q.18b How many hours per week did ... usually work? 

Q.18c What were ...'s total earnings before taxes from all jobs in the past 12 months? 

Q.18d When did ... get his/her first job in the U.S.? 

Q.18e Did the income that ... received from his/her first job disqualify ... from receiving cash assistance (such as RCA, 
AFDC/TANF, or GA)? 

01 No 
02 Yes 
03 Was not receiving cash assistance at that time 
(-9) DK/ (-8) RA/ (-7) NA 

Q.19b What kind of business or industry is this? (e.g., hospital, electronic parts manufacturing, social service 
agency) 

Q.19c What kind of work does(did) .. perform? (e.g., nurse, assembly line worker, typist, supervisor) 

Q.20 Is (was) ... a: 
01 
02 
03 
04 
05 
06 
07 
Employee of a private company, business, or individual (go to Q.22a) 
Federal government employee (go to Q.22a) 
State government employee (go to Q.22a) 
Local government employee (go to Q.22a) 
Self-employed (go to Q.21) 
Working without pay in family business (skip to Q.24a) 
Other (SPECIFY) _____________ 

(-9) DK/ (-8) RA/ (-7) NA 

Q.21 [IF SELF-EMPLOYED] 
a. What kind of business is it? (e.g., restaurant, tailor shop, grocery store) 
b. How many other refugees does ... employ? 
c. How many total employees does ... have? 
(-9) DK/ (-8) RA/ (-7) NA 

Arrington Dixon and Associates, Inc. 2401 Shannon Place, SE Washington, D.C. (202) 889-0123
PK (-7) – DON’T KNOW RA (-8) – REFUSE TO ANSWER NA (-7) – NOT APPLICABLE


EN-9 



[FOR EMPLOYEE ONLY] 

Q.22a What did ... do to find this job? Did he/she check with: 

01 Voluntary agency (agency that helped with initial U.S. resettlement) 
02 Refugee mutual assistance association (MAA) 
03 Refugee service agency 
04 Public Employment Agency 
05 Private Employment Agency 
06 Advertisements 
07 Sponsor 
08 Other refugees 
09 Friends (not refugees) 
111 Religious Institution 
112 College/Job Training 
113 Self 
114 Relative 
11 Other (SPECIFY)_____________ 
(-9) DK/ (-8) RA/ (-7) NA 

Q.24a Within the past 12 months, has...attended any job-training program? 

01 No (skip to Q.25a)
02 Yes
(-9) DK/ (-8) RA/ (-7) NA


Q.24b How many weeks did that training last? 

Q.24c Did the job-training class meet every day or less frequently? 

01 Every day
02 2 to 6 times a week
03 Once a week


Q.24d How many hours a day did the job-training class meet? 

Q.24e For what kind of work (occupation) did this training prepare ...? (e.g., electronics assembler, welder, typist, 
nurse, childcare provider) 

Arrington Dixon and Associates, Inc. 2401 Shannon Place, SE Washington, D.C. (202) 889-0123
PK (-7) – DON’T KNOW RA (-8) – REFUSE TO ANSWER NA (-7) – NOT APPLICABLE


EN-10 



Q.25a Within the past 12 months, has ... attended school or university (other than to take English language training 

or the job-training class indicated in the previous question)?
01 No (skip to Q.26b)
02 Yes
(-9) DK/ (-8) RA/ (-7) NA


Q.25b Was ... attending school or university in order to obtain a degree or certificate? 
01 No (skip to Q.26b) 
02 Yes 
(-9) DK/ (-8) RA/ (-7) NA 

Q.25c What degree or certificate was ... attempting to earn? 
01 High school certificate or equivalency 
02 Associate degree 
03 Bachelor's degree 
04 Master's or Doctorate degree 
05 Professional school degree (e.g., MD, LLB, DDS) 
06 Other (SPECIFY) ___________ 
(-9) DK/ (-8) RA/ (-7) NA 

Q.25d Has ... received this degree or certificate? 
01 No (skip to Q.26b) 
02 Yes 
(-9) DK/ (-8) RA/ (-7) NA 

Q.25e In what year did ... receive this degree or certificate? 

Q.26b How many months has ... lived at this residence? 

Q.26c Did ... live at this residence a year ago? 
01 No 
02 Yes (skip to Q.27a) 
(-9) DK/ (-8) RA/ (-7) NA 

Q.26d Did ... live in this state a year ago? 
01 No 
02 Yes (skip to Q.27a) 
(-9) DK/ (-8) RA/ (-7) NA 

Q.26e In which state did ... live a year ago? 
01 Not in the U.S. (skip to Q.27a) 

Specify state 

(-9) DK/ (-8) RA/ (-7) NA 

Q.26f What was the primary reason that ... moved to this state? 

Arrington Dixon and Associates, Inc. 2401 Shannon Place, SE Washington, D.C. (202) 889-0123
PK (-7) – DON’T KNOW RA (-8) – REFUSE TO ANSWER NA (-7) – NOT APPLICABLE


EN-11 



Q.27a (For persons in the U.S. 12 months or longer): Has ... applied to adjust his/her immigration status to that of 

a permanent U.S. resident? 

01 No (skip to Q.27c) 

02 Yes (ask Q.27b) 

(-9) DK/ (-8) RA/ (-7) NA 
Q.27b When did ... apply for adjustment to permanent resident status? (If application date is given, skip to Q.28) 
Q.27c Does ... plan to adjust his/her immigration status in the future? 

01 No 

02 Yes 

03 Did not know he/she had to apply to become a permanent resident 

Q.28 Does this person have a physical, mental, or other health condition that has lasted for 6 or more months and which: 
a. Limits the kind or amount of work this person can do at a job?
01 No
02 Yes
b. Prevents this person from working at a job?
01 No
02 Yes
Q.29a During the past 12 months, how were ...'s medical expenses paid? (may indicate more than one) 

01 No medical expenses 

02 Self or household members 

03 Other relatives or friends 

04 Sponsor/sponsoring agency 

05 Religious organization 

06 Medicaid or Refugee medical assistance 

07 Other government source 

08 Insurance through own employment (e.g., Blue Cross) 

09 Insurance through family member's employment 

11 Other source (SPECIFY) __________________ 

Q.29b What is ... usual source of medical care? 
01 No regular source 
02 Private physician 
03 Emergency room at a hospital 
04 Health clinic 
05 Folk healer 
06 Other (SPECIFY)__________________ 

Q.29c Was there any time in the past 12 months when ... was not covered either by refugee medical assistance, 

Medicaid, or private health insurance? 

01 Covered in all months 

Yes -- number of months not covered: _______ 

(-1) Not covered 1 month or less 

(-3) Not covered in any month (skip to Q.30a) 

Q.29d What type of health insurance coverage did ... have in the past 12 months? (indicate all that apply) 
Insurance through own or family member's employment 
Private insurance unrelated to employment 
Medicaid or refugee medical assistance 
Other government health care 
Other insurance (SPECIFY)________________ 

Arrington Dixon and Associates, Inc. 2401 Shannon Place, SE Washington, D.C. (202) 889-0123
PK (-7) – DON’T KNOW RA (-8) – REFUSE TO ANSWER NA (-7) – NOT APPLICABLE


EN-12 



Now we would like to ask a few questions about the household. 

Q.30a FOOD STAMPS - In the past 12 months, have one or more persons in your household received food stamps? 

01 No (skip to Q.31a)
02 Yes
(-9) DK/ (-8) RA/ (-7) NA (skip to Q.31a)


Q.30b Who received them? (circle person #s in whose name the assistance was received) 

Q.30c What was the total cash value per month? (household) 

Q.30d How many months in the past 12 months were food stamps received? 

Q.31a AFDC/TANF - In the past 12 months, have one or more persons in your household received cash assistance 
through the Aid to Families with Dependent Children (AFDC) program or Temporary Assistance to Needy 
Families (TANF) program? 

01 No (skip to Q.31f)
02 Yes
(-9) DK/ (-8) RA/ (-7) NA (skip to Q.31f)


Q.31b Which household members received such assistance? (circle person #s in whose name the assistance was 
received) 

Q.31c What was the cash amount received each month? (household) 

Q.31d How many months in the past 12 months was the AFDC or TANF received? 

Q.31e In the last month, was AFDC/TANF received? 
01 No 
02 Yes 
(-9) DK/ (-8) RA/ (-7) NA 
Q.31f Since coming to the United States, in how many months have one or more persons in your household received 
AFDC or TANF? 
(A) 
(B) 
Every month 
No months 
Number of months: ____________ 
(-9) DK/ (-8) RA/ (-7) NA 

Arrington Dixon and Associates, Inc. 2401 Shannon Place, SE Washington, D.C. (202) 889-0123
PK (-7) – DON’T KNOW RA (-8) – REFUSE TO ANSWER NA (-7) – NOT APPLICABLE


EN-13 



Q.32a RCA - In the past 12 months, have one or more persons in your household received assistance through the 
Refugee Cash Assistance (RCA) program? 
01 No (skip to Q.33a) 
02 Yes 
(-9) DK/ (-8) RA/ (-7) NA (skip to Q.33a) 
Q.32b Which household members received such assistance? (circle person #s in whose name the assistance was 
received) 
Q.32c What was the cash amount received each month? (household) 
Q.32d How many months in the past 12 months was RCA received? 
Q.32e In the last month, was RCA received? 
01 No 
02 Yes 
(-9) DK/ (-8) RA/ (-7) NA 
Q.33a SSI - In the past 12 months, have one or more persons in your household received Supplemental Security 
Income (SSI)? 
01 No (skip to Q.33f) 
02 Yes 
(-9) DK/ (-8) RA/ (-7) NA (skip to Q.33f) 
Q.33b Which household members received such assistance? (circle person #s in whose name the assistance 
was received) 
Q.33c What was the cash amount received each month? (household) 
Q.33d How many months in the past 12 months was SSI received? 
Q.33e In the last month, was SSI received? 
01 No 
02 Yes 
(-9) DK/ (-8) RA/ (-7) NA 
Q.33f Since coming to the U.S., in how many months have one or more persons in your household received SSI? 
(A) Every month 
(B) No months 
Number of months: ____________ 
(-9) DK/ (-8) RA/ (-7) NA 

Arrington Dixon and Associates, Inc. 2401 Shannon Place, SE Washington, D.C. (202) 889-0123
PK (-7) – DON’T KNOW RA (-8) – REFUSE TO ANSWER NA (-7) – NOT APPLICABLE


EN-14 



Q.34a GA - In the past 12 months, have one or more persons in your household received income from General 

Assistance (GA)? 

01 No (skip to Q.34f) 

02 Yes 

(-9) DK/ (-8) RA/ (-7) NA (skip to Q.34f) 

Q.34b Which household members received such assistance? (circle person #s in whose name the assistance was 
received) 

Q.34c What was the cash amount received each month? (household) 

Q.34d How many months in the past 12 months was GA received? 

Q.34e In the last month, was GA received? 

01 No 

02 Yes 

(-9) DK/ (-8) RA/ (-7) NA 

Q.34f Since coming to the U.S., in how many months have one or more persons in your household received GA? 

(A) Every month 
(B) No months 
Number of months: ____________
(-9) DK/ (-8) RA/ (-7) NA


Q.35a CASH - In the past 12 months, have one or more persons in your household received cash assistance directly 

from a voluntary agency, sponsor, religious organization, or MAA? 

01 No (skip to Q.36a) 

02 Yes 

(-9) DK/ (-8) RA/ (-7) NA (skip to Q.36a) 

Q.35b What type of organization or person gave such assistance? 

01 Voluntary agency 

02 Religious organization 

03 Refugee mutual assistance association (MAA) 

04 Sponsor 

05 Other individual or family member 

06 Other organization (SPECIFY) 

(-9) DK/ (-8) RA/ (-7) NA 

Q.35c Which household members received such assistance? (circle person #s in whose name the assistance was 
received) 

Q.35d What was the cash amount received each month? (household) 

Q.35e How many months in the past 12 months was this private assistance received? 

Arrington Dixon and Associates, Inc. 2401 Shannon Place, SE Washington, D.C. (202) 889-0123
PK (-7) – DON’T KNOW RA (-8) – REFUSE TO ANSWER NA (-7) – NOT APPLICABLE


EN-15 



Q.36a OTHER INCOME - Within the past 12 months has anyone in the household received income from any other 
source on a regular basis (such as interest from savings accounts, net rental income, child support, 
unemployment compensation or retirement income)? 

01No (skip to Q.38a)
02 Yes
(-9) DK/ (-8) RA/ (-7) NA (skip to Q.38a)


Q.36b Who received the income? (circle person #s in whose name income was received) 

Q.36c What was the cash amount received on average each month? (household) 

Q.36d How many months was this income received in the past 12 months? 

Q.36f What was the source of that income? ( more than one answer can be given) 

01 Interest income
02 Net rental income
03 Child support
04 Unemployment compensation
05 Retirement income
06 Other (SPECIFY)___________________
(-9) DK/ (-8) RA/ (-7) NA


Q.38a Is this house or apartment 

01 Rented for cash rent 
02 Owned by you or someone in this household with or without a mortgage or loan 
03 Occupied without payment of cash rent 
(-9) DK/ (-8) RA/ (-7) NA 

Q.38b How much is the total monthly payment for this housing unit? (For owners, include total mortgage payment, 
taxes, insurance and utilities; for renters include rent plus utilities - gas, electricity and heating oil - if paid 
separately) 

Q.38c Is this housing unit in a public housing project, that is, is it owned by a local housing authority or other local 

public agency?
01 No
02 Yes
(-9) DK/ (-8) RA/ (-7) NA


THAT WAS OUR FINAL QUESTION. THANK YOU VERY MUCH FOR YOUR PARTICIPATION IN THIS
SURVEY.


INTERVIEWER: Remember to answer the questions on the following page.


Arrington Dixon and Associates, Inc. 2401 Shannon Place, SE Washington, D.C. (202) 889-0123
PK (-7) – DON’T KNOW RA (-8) – REFUSE TO ANSWER NA (-7) – NOT APPLICABLE


EN-16 



FOR INTERVIEWER ONLY 

A. Time Interview Ended _________________________ (Please, use military time) 
B. General Responsiveness of Respondent 
01 Willing
02 Neutral
03 Reluctant


C. List Difficulties, if any, With the Interview 
D. Language in which Interview was Conducted E. Interviewer's Ethnicity 
RS Russian RS Russian 
VN Vietnamese VN Vietnamese 
LA Laotian LA Lao 
CB Cambodian CB Cambodian 
HM Hmong HM Hmong 
SP Spanish SP Cuban/other Hispanic 
AH Amharic ET Ethiopian 
HA Creole HA Haitian 
CN Chinese CN Chinese 
RO Romanian RO Romanian 
PL Polish PL Polish 
AN Armenian AN Armenian 
UP Ukrainian UP Ukrainian 
AR Arabic IZ Iraqi 
IR Farsi IR Iranian 
AF Afghan AF Afghan 
SO Somalian SO Somalian 
BU Bulgarian BU Bulgarian 
SR Serbo-Croatian SR Serbian 
EN English 
Other (SPECIFY) __________ Other (SPECIFY) __________ 

END 

Arrington Dixon and Associates, Inc. 2401 Shannon Place, SE Washington, D.C. (202) 889-0123 

EN-17