Wave 1 Module Item Wave 1 Module Items Booklet

Items Booklet for
Specification:
Section: Recipiency History Module
Mark One Only
Earlier I recorded that [fill TEMPNAME] [fill RECEIVFIL]
[fill PATANFFIL1], or AFDC [fill MONTHXFIL] Have there been any
other times before this past [fill MONTH1] when [fill TEMPNAME]
[fill WASWERE] authorized to receive AFDC, or TANF, or any other state
cash assistance program for [fill TEMPNAME] and [fill HISHER]
children?

CURADC

(1) Yes
(2) No
@

EVERGARD

Mark One Only
ASK OR VERIFY:
Some benefit programs are designed to help needy
children. [fill HAVHAS] [fill TEMPNAME] ever had
any children, or served as a child's legal guardian?
(1) Yes
(2) No
@
Mark One Only
[fill C_HAVHAS] [fill TEMPNAME] EVER
|NAMES
applied for AFDC, [fill TANFFIL1],
|(display children's names for whom R is a
[fill TANFFIL2][if TANFFIL2 ne <>], [endif]|mom,dad or guardian)
[fill TANFFIL3][if TANFFIL3 ne <>], [endif]|
or any other cash assistance program for
|
[fill TEMNAME] or [fill CHILDFIL]
|
|
|
(1) Yes
|
(2) No
|
|
@
|

RECVAFDC

Mark One Only
[fill REFERFIL]
And [fill C_HAVHAS] [fill HESHE] ever
RECEIVED AFDC, or TANF, or any other
state cash assistance program for
[fill SELF]and [CHILDFIL]?
(1) Yes
(2) No
@

Wednesday, August 22, 2007

APLAFDC

|NAMES
|(display children's name
| for whom R is a mom, dad,
| or guardian)
|
|
|
|
|
|
|
|
|
|
|
|
|

Page 1 of 14

Survey:
Section: Recipiency History Module

Items Booklet

ADCWHEN1

Mark One Only
Earlier I recorded that the most recent
time [fill TEMPNAME]started receiving
[fill PATANFFIL1] was [fill TIMEFIL].

|NAMES
|(display children's names
| for whom R is a mom, dad,
| or guardian)
Was that the first time [fill HESHE] had
|
ever received AFDC, [fill TANFFIL1],
|
[fill TANFFIL2] [if TANFFIL2 ne <>],
|
[endif][fill TANFFIL3][if TANFFIL3 ne <>], |
[endif] or any other state cash assistance |
program for [fill SELF] and [CHILDFIL]
|
|
(1) [fill MONTHFIL] [FILL YEARFIL]
|
was first time on public assistance |
(2) On public assistance before
|
@
Multiple Entry
When did [fill TEMPNAME] first start
receiving AFDC, or TANF, or some other
state cash assistance program for
[fill SELF]and [CHILDFIL]
MONTH: @MTH
YEAR: @YR

ADCWHEN2
|NAMES
|(display children's names
| for whom R is a mom, dad,
| or guardian)
|
|
|
|
|
|
|
|

Multiple Entry
WE WANT TO KNOW WHEN THE PERSON FIRST RECEIVED AFDC/TANF
ON HIS/HER OWN, OR IN HIS/HER OWN NAME - E.G.,
AS THE "HEAD" OF [fill HISHER] OWN FAMILY - NOT AS A CHILD
WHOSE PARENT(S) RECEIVED IT

AFDCWHEN

When did [fill TEMPNAME] first start receiving those AFDC or
TANF (or other) benefits on [fill HISHER] own, or in [fill HISHER]
own name?
MONTH:
YEAR:

@MTH
@YR

ENTER (N) DID NOT EVER RECEIVE PUBLIC ASSISTANCE ON HIS/HER OWN, OR
IN HIS/HER OWN NAME

Page 2 of 14

Wednesday, August 22, 2007

Items Booklet

Survey:
Section: Recipiency History Module

Multiple Entry
[fill BEFOREFIL] did [fill TEMPNAME]
last receive AFDC or TANF (or some other
state cash assistance program for
[fill SELF] and [CHILDFIL]?
MONTH:
YEAR:

@MTH
@YR

TMAFDCLG
|NAMES
|(display children's names
| for whom R is a mom, dad,
| or guardian)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|

Mark One Only
DO NOT READ TO RESPONDENT
ENTRY ILLOGICAL. MEANS THAT: Assistance ended before beginning date.
PRESS F1 TO BACKUP AND CORRECT/(P) TO PROCEED @
Mark One Only

AL_TMAFDCLG

ADC1TIME

[fill REFERFIL]
And did [fill HESHE] receive that cash assistance every month
between [fill DATEONEFIL] and [fill DATETWOFIL]?
(1) Yes
(2) No
@
Mark One Only
SEPARATE RECEIPT SPELLS REQUIRE A BREAK OF AT LEAST ONE MONTH
OF NO RECEIPT (E.G., DO NOT COUNT SIMPLE "RE-CERTIFICATION" AS
A BREAK BETWEEN TWO SPELLS OF RECEIPT)

AFDCTIME

How many separate times did [fill TEMPNAME] go on
public assistance [fill RECEIPTFIL]?
@
Mark One Only
Earlier I recorded that [fill TEMPNAME] [fill RECEIVFIL]
Supplemental Security Income, or SSI, [fill MONTHXFIL] Have there been
any other times before this past [fill MONTH1] when [fill TEMPNAME]
[fill WASWERE] authorized to receive SSI benefits [fill CHILDFIL]?

CURSSI

(1) Yes
(2) No
@
Mark One Only
[fill BENEFITSFIL]

APLSSI

(1) Yes
(2) No
@
Wednesday, August 22, 2007

Page 3 of 14

Survey:
Section: Recipiency History Module
Mark One Only

Items Booklet

RECVSSI

[fill REFERFIL]
[fill C_HAVHAS] [fill HESHE] EVER received SSI benefits
[fill CHILDFIL]?
(1) Yes
(2) No
@
Mark One Only
Earlier I recorded that the most recent time [fill TEMPNAME]
started receiving SSI benefits was [fill TIMEFIL].

SSIWHEN1

Was that the first time [fill HESHE] had EVER received SSI,
or had [fill HESHE] received SSI benefits before then [fill CHILDFIL]?
(1) [fill MONTHFIL] [FILL YEARFIL] was first time on SSI
(2) On SSI before
@
Multiple Entry
When did [fill TEMPNAME] first start receiving SSI benefits
[fill CHILDFIL]?

SSIWHEN2

MONTH: @MTH
YEAR: @YR
Multiple Entry
WE WANT TO KNOW WHEN THE PERSON FIRST RECEIVED SSI IN HIS/HER]
OWN NAME OR AS THE PARENT/GUARDIAN OF A CHILD BENEFICIARY - NOT AS
A CHILD BENEFICIARY HIM/HERSELF

SSIWHEN

When did [fill TEMPNAME] first start receiving SSI benefits in
[fill HISHER] own name [fill CHILDFIL]
MONTH:
YEAR:

@MTH
@YR

ENTER (N) DID NOT RECEIVE SSI IN HIS/HER OWN NAME
Multiple Entry
[fill BEFOREFIL] did [fill TEMPNAME]
last receive SSI benefits [fill CHILDFIL]?
MONTH:
YEAR:

@MTH
@YR

Mark One Only
DO NOT READ TO RESPONDENT
ENTRY ILLOGICAL. MEANS THAT: Assistance ended before beginning date.
PRESS F1 TO BACKUP AND CORRECT/(P) TO PROCEED @

Page 4 of 14

TMSSILNG

AL_TMSSILNG

Wednesday, August 22, 2007

Items Booklet

Survey:
Section: Recipiency History Module

Mark One Only
Earlier I recorded that [fill TEMPNAME]
[fill EARLIERFIL] Have there been any
other times before this past [fill MONTH1] when [fill TEMPNAME]
[fill WASWERE] authorized to receive food stamps?

CURFS

(1) Yes
(2) No
@
Mark One Only
[if APLSSI eq <2> and APLSSI onpath]
How about Food Stamps...? ([fill C_HAVHAS] [fill TEMPNAME]
ever applied for Food Stamps in [fill HISHER] own name?)
[else]
[fill C_HAVHAS] [fill TEMPNAME] ever applied for Food Stamps
in [fill HISHER] own name?[endif]

APLFS

(1) Yes
(2) No
@
Mark One Only
What about when [fill TEMPNAME] [fill WASWERE] on
[fill INCOMEFIL] before this past [MONTH1]?

APLFS2

(Did [fill TEMPNAME] apply for Food Stamps then?)
(1) Yes
(2) No
@
Mark One Only

RECVFS

[fill REFERFIL]
And [fill C_HAVHAS] [fill HESHE] EVER been authorized to
receive Food Stamps?
(1) Yes
(2) No
@
Mark One Only
What about when [fill TEMPNAME] [fill WASWERE] on [fill
TANFFIL1], [fill TANFFIL2][if TANFFIL2 ne <>], [endif][fill
TANFFIL3][if TANFFIL3 ne <>], [endif]or AFDC [or] [SSI]] before
this past[MONTH1]?

RECVFS2

(fill C_WASWERE) [fill TEMPNAME] also authorized to receive
Food Stamps then?)
(1) Yes
(2) No
@

Wednesday, August 22, 2007

Page 5 of 14

Survey:
Section: Recipiency History Module
Mark One Only
Earlier I recorded that the most recent time [fill TEMNAME]
started receiving Food Stamps was [fill TIMEFIL].

Items Booklet

FSWHEN1

Was that the first time [fill HESHE] had EVER received Food Stamps,
or had [fill HESHE] been on Food Stamps before then?
(1) [fill MONTHFIL][fill YEARFIL] was first time
on Food Stamps
(2) On Food Stamps before
@
Mark One Only
What about when [fill TEMPNAME] [fill WASWERE] on
[fill INCOMEFIL] before [fill BEGDATE]?

RECVFS3

(Did [fill TEMPNAME] also receive Food Stamps then?)
(1) Yes
(2) No
Multiple Entry
When did [fill TEMPNAME] first start receiving Food Stamps?

FSWHEN2

MONTH: @MTH
YEAR: @YR
ENTER (N) DID NOT RECEIVE FOOD STAMPS IN HIS/HER OWN NAME BEFORE
Multiple Entry
WE WANT TO KNOW WHEN THE PERSON FIRST RECEIVED FOOD STAMPS
ON HIS/HER OWN, OR IN HIS/HER OWN NAME - E.G., AS
THE "HEAD" OF HIS/HER FAMILY - NOT AS A CHILD WHOSE PARENT(S)
RECEIVED THEM

FSWHEN

When did [fill TEMPNAME] first start receiving Food Stamps on
[fill HISHER] own, or in [fill HISHER] own name?
MONTH:
YEAR:

@MTH
@YR

ENTER (N) DID NOT RECEIVE SSI ON HIS/HER OWN, OR IN
HIS/HER OWN NAME BEFORE
Multiple Entry
[fill BEFOREFIL] did [fill TEMPNAME]
last receive food stamps?
MONTH:
YEAR:

@MTH
@YR

Mark One Only
DO NOT READ TO RESPONDENT
ENTRY ILLOGICAL. MEANS THAT: Assistance ended before beginning date.
PRESS F1 TO BACKUP AND CORRECT/(P) TO PROCEED @

Page 6 of 14

TMFSLONG

AL_TMFSLONG

Wednesday, August 22, 2007

Items Booklet

Survey:
Section: Recipiency History Module
Mark One Only

FS1TIME

[fill REFERFIL]
And did [fill HESHE] receive Food Stamps every month
between [FSWHEN date] and [TMFSLONG date]?
(1) Yes
(2) No
@
Mark One Only
IF RECEIPT WAS CONTINUOUS, DO NOT COUNT SIMPLE "RE-CERTIFICATION"
AS A BREAK BETWEEN TWO SPELLS OF RECEIPT; SEPARATE RECEIPT SPELLS
REQUIRE A BREAK OF AT LEAST ONE MONTH OF NO RECEIPT

TMFSTIME

How many separate times did [fill TEMPNAME] go on
Food Stamps between [fill RECEIPTFIL]?
@

Wednesday, August 22, 2007

Page 7 of 14

Survey:
Section: Employment History Module
Mark One Only
Now I have some questions about [fill PTEMPNAME]
general work history.

Items Booklet

EMPHINTRO

PRESS "ENTER" TO CONTINUE
@
Mark One Only
Earlier I recorded that [fill TEMPNAME] started [fill HISHER]
[fill JOBBIZNAMEFIL] in [fill JOBBIZMONFIL] of
[JOBBIZYRFIL]. [fill C_WASWERE] [fill HESHE] working at some other
job before [fill JOBBIZFIL], or [fill WASWERE]
[fill HESHE] not working?
(1)
(2)

WK1BEFOR

Working at another job/business
Not working

@
Mark One Only
Before [fill JOBBIZSTRTFIL], in what
year did [fill TEMPNAME] last work at a paid job or business?

WK1LSTJB

ENTER (N) FOR NO PRIOR JOB/BUSINESS
YEAR:

@
Mark One Only

WK1WRK15

ASK OR VERIFY:
So, before the [fill JOBBIZFIL] that started in [fill JOBBIZMONFIL]
[fill JOBBIZYRFIL], [fill TEMPNAME] was about [fill AGEFIL] when
[fill HESHE] last worked before that – is that right?
(1)
(2)

Yes; correct
No (backup and correction WK1LSTJB entry)

@
Mark One Only
In what month was that?
MONTH:

WK1LWRKM

@

Mark One Only
[fill B4JOBBIZFIL] what
year did [fill TEMPNAME] last work at a paid job or business?

LSTWRKY1

ENTER (N) FOR NEVER WORKED
YEAR:

@
Mark One Only

LSTWRK15

ASK OR VERIFY:
So [fill TEMPNAME] [fill WASWERE] about [fill AGEFIL] when [fill HESHE]
last worked – is that right?
(1)
(2)

Yes; correct
No (backup and correction LSTWRKY1 entry)

@

Page 8 of 14

Wednesday, August 22, 2007

Items Booklet

Survey:
Section: Employment History Module

Mark One Only
In what month was that?
MONTH:

LSTWRKM1

@

Mark One Only
Before [fill MONTH1], in what year did [fill TEMPNAME]
last work at a paid job or business?

PRVJOBYR

ENTER (N) FOR NEVER WORKED AT ANOTHER JOB/BUSINESS
YEAR:

@
Mark One Only

PRVJOB15

ASK OR VERIFY:
So [fill TEMPNAME] was about [fill AGEFIL] when [fill HESHE]
last worked – is that right?
(1)
(2)

Yes; correct
No (backup and correction PRVJOBYR entry)

@
Mark One Only
In what month was that?
MONTH:

@

Mark One Only
In what year did [fill TEMPNAME] START
that[fill PREVIOUSFIL] job or business?
YEAR:

PRVJOBMN

FRMRYR

@
Mark One Only

FRMRYR15

ASK OR VERIFY:
So [fill TEMPNAME] [fill WASWERE] about [fill AGEFIL]
when [fill HESHE] started that work –
is that right?
(1)
(2)

Yes; correct (within 1 year)
No (backup and correction FRMRYR entry)

@
Mark One Only
In what month was that?
MONTH:

FRMRMN

@

Mark One Only
[fill INCLUDEAFFIL] was
the first job or business [fill TEMPNAME] had that lasted
6 straight months or more?

FIRST6JOB

ENTER EITHER NAME OF EMPLOYER OR TYPE OF WORK
COUNT ANY JOB OR BUSINESS, EITHER FULL-TIME OR PART-TIME
ENTER (N) FOR NEVER WORKED 6 STRAIGHT MONTHS AT A JOB OR BUSINESS
1st 6+ month job/busines:
@
Wednesday, August 22, 2007

Page 9 of 14

Survey:
Section: Employment History Module
Multiple Entry
How old [fill WASWERE] [fill HESHE] when
[fill HESHE] [fill STARTEDWRKFIL]?

Items Booklet

SIXMTHYR

(Or do you remember the year?)
COUNT ANY JOB OR BUSINESS, EITHER FULL-TIME OR PART-TIME.
[fill ALSOAFFIL]
ENTER (N) FOR NEVER WORKED 6 STRAIGHT MONTHS AT A JOB OR BUSINESS
AGE:

@1

OR
CALENDAR YEAR:

@2

Mark One Only

SIXMTH15

ASK OR VERIFY:
So [fill TEMPNAME] [fill WASWERE] about [fill AGE] when
[fill HISHER] first long-term job or business started – is that right?
(1)
(2)

Yes; correct (within 1 year)
No (back up and correct SIXMTHYR entry)

Mark One Only
That would be around [fill MAKEMTHYR].
Is that correct?
(1)
(2)

YRSIXMTH

Yes
No

@

I'm sorry.

Mark One Only
What year was it?

SXMTHYR2

ENTER START YEAR OF THE PERSON'S FIRST "6-STRAIGHT-MONTH OR MORE"
JOB OR BUSINESS
YEAR:

@
Mark All That Apply

NO6ALL

SHOW FLASHCARD K
[fill WHYNOWRKFIL] at a paid job or
business [fill AFTER15FIL]
ENTER ALL THAT APPLY
RE-ENTER PRECODE TO DELETE
ENTER (N) FOR NO MORE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)

Taking care of a minor child
Taking care of an elderly family member
Taking care of a disabled but non-elderly family member
Other family or home responsibilities
Own illness or disability
Could not find work
Did not want to work
Going to school
Other

@KEY

Page 10 of 14

Wednesday, August 22, 2007

Items Booklet

Survey:
Section: Employment History Module

Mark One Only
What is the main reason?
(– the main reason [fill HESHE] never worked [fill 6MOSFIL]
at a paid job or business?)
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill

NO6REASN

NO6ALL1FIL]
NO6ALL2FIL]
NO6ALL3FIL]
NO6ALL4FIL]
NO6ALL5FIL]
NO6ALL6FIL]
NO6ALL7FIL]
NO6ALL8FIL]
NO6ALL9FIL]

@
Mark One Only
In what month was that?

SIXMTHMN

@
Mark One Only
During all the time [fill TEMPNAME]
[fill WORKEDTILFIL] [fill HESHE]
mostly [fill WORKFIL] 35 or more hours per week?
(1)
(2)

WRK35HR

Yes
No

@
Mark One Only
We've been talking about when [fill TEMPNAME] [fill HAVHAS]
worked. Next are questions about when [fill HESHE] [fill WASWERE]
NOT working.

ANY6OFF

[fill SINCEFIL] [fill THEYEARFIL] [fill SIXMTHFIL], [fill WERETHEREFIL]
any times when [fill TEMPNAME] did not work for 6 straight
months or more?
(1)
(2)

Yes
No

@
Mark One Only
How many times [fill HASFIL] that [fill HAPPENFIL]?

HOWMANY6

([fill BETWNFIL], how many times [fill BEENFIL] out
of work for 6 months or more?)
@

Wednesday, August 22, 2007

Page 11 of 14

Survey:
Section: Employment History Module

Items Booklet

TIMEOFF

Multiple Entry
TIME PERIOD: SINCE [fill SIXMNTHYR]
or
BETWEEN [fill SIMNTHYR] AND [fill LSTWKFIL]
or
BETWEEN [fill SIXMTHYR] AND [fill PRVJOBFIL]
or
BETWEEN [fill SIXMTHYR] AND [fill WKLSTFIL]
[fill COUNTFIL] what was the total amount of time that
[fill TEMPNAME] spent out of work [fill PERIODFIL]?
H
@NM
(1) MONTHS
(2) YEARS
@MY
Mark One Only
DO NOT READ TO RESPONDENT
ENTRY ILLOGICAL. MEANS THAT: number of years greater than amount of work.
PRESS F1 TO BACK UP AND CORRECT/(P) TO PROCEED @
Mark One Only
If ANY6OFF=<1>, display:
Since [fill SIXMTHFIL] [fill HAVHAS] [fill TEMPNAME] had any
long periods off work because [fill HESHE] [fill WASWERE] taking
care of someone else -- specifically, a child, an elderly person, or a
disabled person?

AL_TIMEOFF

OFF6MTH

Else, display:
Since [fill LASTYRFIL], have there been any
periods of time when [fill TEMPNAME] [fill WASWERE] off work for
6 months or more because [fill HESHE] [fill WASWERE] taking
care of someone else -- specifically, a child, an elderly person, or a
disabled person?
(1) Yes
(2) No
@
Multiple Entry
When did this happen most recently – from what year to
what year?
FROM:

@NOWRKFR

TO:

NOWRKSPL

@TO

ENTER (P) FOR "TO THE PRESENT TIME"

Page 12 of 14

Wednesday, August 22, 2007

Items Booklet

Survey:
Section: Employment History Module

NWALL

Mark All That Apply
ASK OR VERIFY
Who [fill HAVEWEREFIL] [fill TEMPNAME] [fill BEENFIL] taking
care of [fill ATTIMEFIL]?
READ CATEGORIES IF NECESSARY
ENTER ALL THAT APPLY
RE-ENTER PRECODE TO DELETE
ENTER (N) FOR NO MORE
(1)
(2)
(3)

A minor child
An elderly family member
A disabled but non-elderly family member

@KEY
Mark One Only
Which one would you say [fill ISWASFIL] [fill PTEMPNAME] main
caregiving responsibility?
[if NWALL@1 eq <1>](1)
[if NWALL@2 eq <2>](2)
[if NWALL@3 eq <3>](3)

NWRESN

A minor child
An elderly family member
A disabled but non-elderly family member

@
Mark One Only
Since [fill OTHDATEFIL], were there any OTHER long periods of
time when [fill TEMPNAME] didn't work because
[fill HESHE] [fill WASWERE] caring for someone else -- specifically, a
child, or elderly, or disabled person?

OTHTIMES

(1) Yes
(2) No
@
Mark One Only
How many other times did this happen?

CNTOTHR

@
Multiple Entry
When was the first time this happened – from what year to what year?
FROM:

@FSTYRFRM

TO:

FRSTYR

@FSTYRTO

Mark All That Apply

FRSTALL

ASK OR VERIFY
Who [fill WASWERE] [fill TEMPNAME] taking care of at that time?
READ CATEGORIES IF NECESSARY
ENTER ALL THAT APPLY
RE-ENTER PRECODE TO DELETE
ENTER (N) FOR NO MORE
(1)
(2)
(3)

A minor child
An elderly family member
A disabled but non-elderly family member

@KEY

Wednesday, August 22, 2007

Page 13 of 14

Survey:
Section: Employment History Module

Items Booklet

Mark One Only
Which one would you say was [fill PTEMPNAME] main
care-giving responsibility (at that earlier time)?
[if FRSTALL@1 eq <1>](1)
[if FRSTALL@2 eq <2>](2)
[if FRSTALL@3 eq <3>](3)

FRSTRSN

A minor child
An elderly family member
A disabled but non-elderly family member

@

Page 14 of 14

Wednesday, August 22, 2007