Example instruments for pre-testing

Attached in this file are examples of instruments that would be used for pre-testing under an approved generic clearance.

Attachment 1

Employment, Retention and Advancement Project 42-Month Survey

June 21, 2005

(OMB NO.: 0970-0285)

SECTION C: EMPLOYMENT HISTORY

CATI: RECORD START TIME

The next questions are about all paid jobs you currently have or have had. This includes self-employment, such as paid baby-sitting, construction, housekeeping jobs, maintenance, yard work or any other jobs you've had. Again, I would like to remind you that your answers will remain entirely confidential.

C1. Are you currently working for pay?

1 YES (GO TO C1a )

2 YES, CURRENTLY ON LEAVE (GO TO C1a )

3 NO (GO TO C3)

4 LAID OFF (GO TO C4)

7 DON’T KNOW (GO TO C3)

8 REFUSED (GO TO C3)

C1a. How many jobs do you currently have? (SELF-EMPLOYMENT OR TEMPORARY OR "TEMP" WORK IN THE SAME FIELD COUNTS AS ONE JOB.)

________ [RANGE = 1 – 15]

NUMBER

97 DON’T KNOW

98 REFUSED

CATI: IF C1a= 1, 97, 98, GO TO C4.

C2. For whom do you usually work the most hours? PROBE: What is your employer’s name?

IF HOURS THE SAME: Who have you worked for the longest?

__________________________________________

EMPLOYER’S NAME

96 SELF-EMPLOYED

97 DON’T KNOW

98 REFUSED

CATI: IF “96” (SELF-EMPLOYED), CREATE TEXT BOX FOR INTERVIEWER TO INSERT JOB NAME FOR USE AS C2/C4 TEXT FILL IN SUBSEQUENT QUESTIONS.

CATI: IF C1a > 1, GO TO INSTRUCTIONS PRIOR TO C5a.

CATI: IF C1 = 4. FILL WITH CODE “1.”

C3. Have you ever worked for pay at all? (Please don't count unpaid experience.)

1 YES (GO TO C4)

2 NO (GO TO C3a)

7 DON’T KNOW (GO TO C3a)

8 REFUSED (GO TO C3a)

C3a. A lot of people have irregular, odd, or side jobs, or do extra work to make ends meet. Have you ever done any work like that for pay?

1 YES (GO TO C4)

2 NO (GO TO D1)

7 DON’T KNOW (GO TO D1)

8 REFUSED (GO TO D1)

CATI: FOR TEXT FILLS IN REMAINDER OF THIS SECTION, USE FIRST CHOICE IF R IS STILL EMPLOYED (C1 = 1 OR 2). USE SECOND CHOICE IF R IS NOT CURRENTLY EMPLOYED (C1 = 3, 4, 7, OR 8).

C4. I'd like to ask you some questions about your (current/most recent) job. Please tell me where you (work/worked). PROBE: What (is/was) your employer's name?

__________________________________________

EMPLOYER’S NAME

96 SELF-EMPLOYED

97 DON’T KNOW

98 REFUSED

CATI: IF “96” (SELF-EMPLOYED), CREATE TEXT BOX FOR INTERVIEWER TO INSERT JOB NAME FOR USE AS C2/C4 TEXT FILL IN SUBSEQUENT QUESTIONS.

INTERVIEWER: The next questions refer to your current/most recent job. Please think of the job you just told me about as your current/most recent job.

C5a. What state (is/was) that in?

01 CALIFORNIA

02 ILLINOIS

03 OHIO

04 OREGON

05 TEXAS

95 OTHER, SPECIFY:___________________________

97 DON’T KNOW

98 REFUSED

C5c. Would you describe this job as:

C5c_1. Seasonal work, meaning you were hired for only a few weeks or months?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

C5c_2. Work for a “temp” agency?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

C5c_3. An occasional odd job, meaning you were hired for only a few hours or days?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

CATI: IF C1 = 1 OR 2, INSERT END DATE OF “77 / 7777” TO DESIGNATE STILL WORKING.

C6. What month and year did you start (CATI: IF C1 = 3, 4,7, OR 8 INSERT “and end”) this job?

START: ___ ___/___ ___ ___ ___ [RANGE MONTH = 1 – 12, 77, 97, 98]

MONTH YEAR

END: ___ ___/___ ___ ___ ___ [RANGE YEAR = 1980 – CURRENT YEAR,

MONTH YEAR 7777, 9997, 9998]

97 DON’T KNOW MONTH 9997 DON’T KNOW YEAR

98 REFUSED MONTH 9998 REFUSED YEAR

CATI: IF END DATE EARLIER THAN RAD, THEN SKIP TO D1.

C7. What kind of work (do/did) you do on this job?

INTERVIEWER: ENTER VERBATIM RESPONSE. PROBE AS NEEDED.

97 DON’T KNOW

98 REFUSED

C8. What do they make or what service do they provide? INTERVIEWER: ENTER VERBATIM RESPONSE. PROBE AS NEEDED.

97 DON’T KNOW

98 REFUSED

C9. Including yourself, about how many people (work/worked) at your (current/most recent) place of employment, including managers, supervisors, and part-time employees?

01 1-4

02 5-9

03 10-19

04 20-49

05 50-99

06 100-249

07 250-499

08 500+

97 DON’T KNOW

98 REFUSED

CATI: IF C5c_3 = 1 (R WORKS AN OCCASIONAL ODD JOB), GO TO C10-C11a..

C10. (Now/Just before you left), including overtime, how many hours per week (do/did) you usually work on this job at [C2/C4 EMPLOYER NAME]? IF MORE THAN 60 HOURS, VERIFY ANSWER IS HOURS PER WEEK.

[RANGE = 1 – 90]

HOURS/WEEK

97 DON’T KNOW

98 REFUSED

C11. (Does/Did) the number of hours you work(ed) from week to week change:

1 a lot,

2 a fair amount,

3 a little, or

4 hardly at all?

7 DON’T KNOW

8 REFUSED

C11a. How many days per week (do/did) you usually work?

[RANGE 1 – 7]

DAYS/WEEK

97 DON’T KNOW

98 REFUSED

CATI: IF C5c_3 = 1 (R WORKS AN OCCASIONAL ODD JOB), skip C12-C13a.

C12. Which of the following best describes your usual weekly work schedule at your job during the last month you worked? Did you work a:

1. regular daytime shift,

2. regular evening shift,

03 regular night shift,

04 rotating shift (one that changes regularly from days to evenings to nights),

05 split shift (one consisting of two distinct periods each day),

06 an irregular schedule (one that changes from day to day), or

95 something else (SPECIFY)?_______________________________________________

97 DON’T KNOW

98 REFUSED

C12a. Did your usual shift include working on a weekend day—Saturday or Sunday?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

CATI: IF R IS CURRENTLY WORKING (C1=1 OR 2) ASK C13. ELSE GO TO C14.

C13. During the past four weeks, how many days did you miss more than half of the day from your job because of personal or family reasons, including vacation? (RANGE 0-28 DAYS MISSED)

__________

97 DON’T KNOW

98 REFUSED

CATI: IF C13 = “0,” GO TO C14.

I’m going to read you a list of reasons why people miss work. Please tell me which of these applied to you in the last four weeks.

C13a. Did you miss work because:

	YES	NO	DON’T KNOW	REFUSED
a. you were on vacation ?	1	2	7	8
b. you were sick?	1	2	7	8
c. you were caring for a sick family member?	1	2	7	8
d. you had problems with child care?	1	2	7	8
e. you had problems with transportation?	1	2	7	8
f. you had some other reason? (SPECIFY) ___________________________________	1	2	7	8

C14. What (is/was) your earnings (now/just before you left) before taxes? Please include tips, commissions, and regular overtime pay. INTERVIEWER: IF R’S JOB IS ON AN IRREGULAR SCHEDULE OR A COMMISSION BASIS, PROBE FOR HOW MUCH R MAKES IN A TYPICAL WEEK.

$ ___ ___ ___ ,___ ___ ___.___ ___ [RANGE 000000.01 – 999999.94]

AMOUNT

999999.97 DON’T KNOW

999999.98 REFUSED

CATI: IF C14 IS 999999.97 (DON’T KNOW) OR 999999.98 (REFUSED), GO TO INSTRUCTION BEFORE C17.

C15. (Is/Was) that:

01 per hour,

02 per week,

03 every 2 weeks,

04 twice a month,

05 once a month,

06 per year,

07 per day, or

95 some other way (GO TO C15a)?

97 DON’T KNOW

98 REFUSED

CATI: IF C15 NOT EQUAL 95 THEN GO TO C16.

C15a Please estimate what you (make/made) in a typical week. INTERVIEWER: Round to the nearest whole dollar.

$ ___ ___ ___ ___ [RANGE 1 – 9995]

9997 DON’T KNOW

9998 REFUSED

C16. (Is/Was) that before or after taxes?

1 BEFORE

2 AFTER

7 DON’T KNOW

8 REFUSED

CATI: IF C5c_3 = 1 (R WORKS AN OCCASIONAL ODD JOB), GO TO C24. IF C2 OR C4 = 96 (SELF EMPLOYED) AND C5c_3 IS NOT EQUAL TO 1 (R WORKS AN OCCASIONAL ODD JOB), GO TO C20.

C17. Which of the following benefits are available to you on your job, even if you are not receiving them?

INTERVIEWER: SELECT “YES” IF R WILL EVENTUALLY BE OFFERED BENEFITS.

	YES	NO	DON’T KNOW	REFUSED
a. Sick days with full pay?	1	2	7	8
b. Paid vacation?	1	2	7	8
c. Paid holidays other than Christmas and New Year’s Day?	1	2	7	8
d. Dental benefits, including any offered at a cost to you?	1	2	7	8
e. A retirement or 401K plan?	1	2	7	8
f. A health plan or medical insurance, including any offered at a cost to you?	1	2	7	8

CATI: IF C17f = 1 (YES), THEN ASK C18. ELSE GO TO C20.

C18. (Are/Were) you enrolled in the health or medical insurance plan offered by your employer?

1 YES (GO TO C20)

2 NO (GO TO C19)

7 DON’T KNOW (GO TO C20)

8 REFUSED (GO TO C20)

C19. What is the main reason you didn’t enroll in your employer’s health insurance plan? Was it that:

(MARK ONE)

1 you were covered by Medicaid or (CATI: INSERT APPROPRIATE STATE INSURANCE PROGRAM NAME),

2 you were covered by another insurance plan,

3 the cost was too expensive,

4 you hadn’t worked long enough, or

5 some other reason ? (SPECIFY)____________________________

7 DON’T KNOW

8 REFUSED

C20. Did you have a change in your earnings since you started this job?

1. YES

2. NO

7 DON’T KNOW

8 REFUSED

C20a. Did you have a change in the number of hours since you started this job?

1. YES

2. NO

7 DON’T KNOW

8 REFUSED

CATI: IF C20=1, ASK C21; ELSE GO TO INSTRUCTIONS BEFORE C22.

C21. What were your starting earnings for this job—that is, how much were your earnings when you started this job? Please include tips, commissions, regular overtime pay and earnings, before taxes. IF R’S JOB IS ON AN IRREGULAR SCHEDULE OR A COMMISSION BASIS, PROBE FOR HOW MUCH R MADE IN A TYPICAL WEEK.

$ ___ ___ ___ ,___ ___ ___.___ ___ [RANGE 000000.01 – 999999.94]

AMOUNT

999999.97 DON’T KNOW

999999.98 REFUSED

CATI: IF C21 IS 999999.97 (DON’T KNOW) OR 999999.98 (REFUSED), GO TO INSTRUCTIONS BEFORE C22.

C21a. Was that:

01 per hour,

02 per week,

03 every 2 weeks,

04 twice a month,

05 once a month,

06 per year,

07 per day, or

95 some other way? (Go to C21b)

97 DON’T KNOW

98 REFUSED

CATI: IF C21a NOT EQUAL 95, THEN GO TO C21c.

C21b. Please estimate what you made in a typical week. INTERVIEWER: Round to the nearest whole dollar.

$ ___ ___ ___ ___ [RANGE 1 – 9995]

9997 DON’T KNOW

9998 REFUSED

C21c. Was that before or after taxes?

1 BEFORE

2 AFTER

7 DON’T KNOW

8 REFUSED

CATI: IF C20a =1 ASK C22; ELSE SKIP TO C23a.

C22. Including overtime, how many hours per week did you work when you began this job?

__________________ [RANGE = 1 = 90]

HOURS/WEEK

97. DON’T KNOW

98. REFUSED

C22a. How many days per week did you usually work when you began this job?

[RANGE 1 – 7]

DAYS/WEEK

97 DON’T KNOW

98 REFUSED

CATI: IF C2 OR C4 = 96 (SELF EMPLOYED), GO TO C24.

CATI: END RECORD TIME

CATI: IF C5c_3 = 1 (R WORKS AN OCCASIONAL ODD JOB), skip C23a-C23c.

C23a. (Have you received/did you receive) a promotion while working for [C2/C4 EMPLOYER NAME], meaning that you moved to a higher position or job title?

1 YES (GO TO C24)

2 NO

7 DON’T KNOW

8 REFUSED

C23b. (Is/Was) your job one in which there (is/was) a possibility that you could move up or be promoted?

1 YES

2 NO (GO TO C24)

7 DON’T KNOW

8 REFUSED

C23c. (Do/Did) you think you (are/were) likely to move up or be promoted while you (are/were) working at this job?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

C24. Think about your (current/most recent) job. How often (does/did) it require you to:

	DAILY (1)	WEEKLY (2)	MONTHLY (3)	NEVER (4)
a. Talk with customers face to face – daily, weekly, monthly, or never?
b. Talk over the phone with customers– daily, weekly, monthly, or never?
c. Read instructions or reports– daily, weekly, monthly, or never?
d. Write letters or memos – (daily, weekly, monthly, or never)?
e. Work with a computer, such as word processing or data entry?
f. Work with another electronic machine such as a cash register, bar code scanner, or calculator?
g. Do arithmetic, including making change?
h. Fill out forms?
i. Keep a close watch over gauges, dials, or instruments of any kind?
j. Supervise other people who report to you?

CATI: FOR C24a THROUGH C24j, DON’T KNOW = 7, REFUSED = 8.

C25. (Are/Were) you a member of a labor union or an employee association like a union at this job?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

C25a How did you find this job?

01 EMPLOYMENT PROGRAM

02 ONE STOP

03 SCHOOL PLACEMENT OFFICE/JOB COUNSELOR

04 PRIVATE EMPLOYMENT AGENCY

05 TEMP AGENCY

06 NEWSPAPER WANT AD

07 FRIEND OR RELATIVE

08 INTERNET

09 SAW HELP WANTED SIGN

95 OTHER (SPECIFY) ______________

97 DON’T KNOW

98 REFUSED

C27. For each of the following statements about your experiences at work, please indicate whether you agree or disagree?

a. You (have/had) a lot of responsibility in your job. Do you:

1 Agree, or

2 Disagree?

7 DON’T KNOW

8 REFUSED

b. Your job (is/was) physically demanding, meaning it (requires /required) you to move or carry heavy objects, such as boxes or equipment, or move or carry people, such as patients. Do you:

1 Agree, or

2 Disagree?

7 DON’T KNOW

8 REFUSED

c. You (risk/risked) your health or safety doing this work. Do you:

1 Agree, or

2 Disagree?

7 DON’T KNOW

8 REFUSED

CATI: IF C2 OR C4 = 96 (SELF EMPLOYED), GO TO C27f.

d. You (receive/received) the respect you (deserve/deserved) from your superiors. Do you:

1 Agree, or

2 Disagree?

7 DON’T KNOW

8 REFUSED

e. You (receive/received) the respect you (deserve/deserved) from your colleagues or co-workers. Do you:

1 Agree, or

2 Disagree?

7 DON’T KNOW

8 REFUSED

f. You (have/had) been provided with the right equipment that you (need/needed) to do your job well. Do you:

1 Agree, or

2 Disagree?

7 DON’T KNOW

8 REFUSED

CATI: IF C2 OR C4 = 96 (SELF EMPLOYED), GO TO C27h.

g. You (are/were) allowed to contribute ideas as to how your job should be performed. Do you:

1 Agree, or

2 Disagree?

7 DON’T KNOW

8 REFUSED

h. You (cannot/could not) count on keeping this job. Do you:

1 Agree, or

2 Disagree?

7 DON’T KNOW

8 REFUSED

C28. Now, I’d like to ask you some questions about transportation to and from your (current/most recent) job.

How (do/did) you usually get to your job at [C2/C4 EMPLOYEER NAME]? (Do/did) you: (INTERVIEWER: SELECT ALL THAT APPLY.) Any other way?

1 drive your own car,

2 walk,

3 get a ride with someone,

4 ride a bus or other transportation, or

5 get there some other way? SPECIFY: ____________

6 R WORKS AT HOME (GO TO C31a)

7 DON’T KNOW

8 REFUSED

C29. How many minutes (does/did) it usually take you to get to this job? That is, how long (does/did) it

take you to travel to your work, one way?

__ __ __MINUTES (RANGE 1-240)

997 DON’T KNOW

998 REFUSED

CATI: RECORD END TIME

CATI: IF C1a = 1, GO TO C39a. IF C1a IS GREATER THAN 1, THEN DISPLAY C31a.

CATI: IF C3 = 1 OR C3a = 1, GO TO C39a.

C31a. I’d like to ask you questions about the other jobs you currently have. Let’s start with the name of your other current employer.

CATI: AFTER NAME OF SECOND CURRENT JOB ENTERED IN C32, ASK “What other job do you currently have?” RECORD THE NAME(S) OF UP TO TWO JOBS IN C32. USE ‘96’ TO INDICATE NO OTHER CURRENT JOBS. WHEN NO MORE JOBS, GO TO C33 FOR FIRST JOB. LOOP THROUGH C33-C39 FOR EACH JOB IN C32 SEPARATELY. DISPLAY C32 JOB NAME FOR EACH C33-C39 LOOP.

CATI: FOR C32, C36 AND C39, DON’T KNOW = ‘97’ AND REFUSED = ’98.’ FOR C33, DON’T KNOW MONTH = ’97,’ DON’T KNOW YEAR = ‘9997’; REFUSED MONTH = ‘98’ AND REFUSED YEAR = ‘9998.’ FOR C37, AND C38 DON’T KNOW = ‘7’ AND REFUSED = ‘8.’

CATI: IF C35 IS 99999.97 (DON’T KNOW) OR 99999.98 (REFUSED), GO TO C38.

	SECOND CURRENT JOB	THIRD CURRENT JOB
C32. What other jobs do you currently have? CATI: RECORD ALL JOBS, THEN CONTINUE WITH C33.	[ ] 96 NO OTHER CURRENT JOB CATI: IF C32=96, GO TO C39a	[ ] 96 NO OTHER CURRENT JOB CATI: ALL GO TO C33 FOR SECOND CURRENT JOB.
CATI: LOOP THROUGH C33-C39 FOR EACH JOB SEPARATELY.
C33. When did you start this job? INTERVIEWER: PROBE FOR SEASON IF DON’T KNOW MONTH. IF R CAN ONLY PROVIDE SEASON, SPRING = 05, SUMMER = 08, FALL = 11, WINTER = 02.	START: ___ ___/___ ___ ___ ___ MM YYYY [RANGE MM = 1 – 12] [YYYY = 1968 – CURRENT YEAR]	START: ___ ___/___ ___ ___ ___ MM YYYY [RANGE MM = 1 – 12] [YYYY = 1968 – CURRENT YEAR]
C34. Including overtime, how many hours per week do you work on this job currently? INTERVIEWER: IF MORE THAN 60 HOURS, VERIFY ANSWER AS HOURS PER WEEK.	______ _____ HOURS/WEEK [RANGE = 1 – 90] 97 DON’T KNOW 98 REFUSED	______ _____ HOURS/WEEK [RANGE = 1 – 90] 97 DON’T KNOW 98 REFUSED
C35. What are your earnings now, before taxes? Please include tips, commissions, and regular overtime pay. INTERVIEWER: IF R’S JOB IS ON AN IRREGULAR SCHEDULE OR A COMMISSION BASIS, PROBE FOR HOW MUCH R MAKES IN A TYPICAL WEEK. CATI: GO TO C36 ONLY IF RESPONDENT DOES NOT INDICATE THE TIME INTERVAL WHEN ANSWERING C35.	$___ ___ , ___ ___ ___.___ ___ [RANGE = 1 – 99999.95] 99999.96 MINIMUM WAGE 99999.97 DON’T KNOW 99999.98 REFUSED	$___ ___ , ___ ___ ___.___ ___ [RANGE = 1 – 99999.95] 99999.96 MINIMUM WAGE 99999.97 DON’T KNOW 99999.98 REFUSED
C36. Is that:	per hour, 01 per week, 02 every 2 weeks, 03 twice a month, 04 once a month, 05 per year, 06 per day, or 07 something else? (SPECIFY) 95 ___________________	per hour, 01 per week, 02 every 2 weeks, 03 twice a month, 04 once a month, 05 per year, 06 per day, or 07 something else? (SPECIFY) 95 ___________________
C37. Is that before or after taxes?	BEFORE 1 AFTER 2	BEFORE 1 AFTER 2
C38. Does your employer make available a health plan or medical insurance, even if you are not receiving it?	YES 1 NO 2	YES 1 NO 2
C39. How many days in a typical week do you usually work?	___________ DAYS/WEEK [RANGE = 1 – 7] CATI: IF “96” IN THIRD CURRENT JOB, GO TO C39a; ELSE GO TO C33 FOR THIRD CURRENT JOB.	___________ DAYS/WEEK [RANGE = 1 – 7]

C39a. Now, I would like to ask you a few questions about the job you had before [this job (if C1a = 1) or (C3=1 OR C3a=1/ these current jobs (if C1a = 2 – 10)].

C39b. Did you have a job before [this job (if C1a = 1 or C3 = 1or C3a = 1/ these current jobs (if C1a = 2 – 10)]?

1 YES

2 NO (GO TO D1)

7 DON’T KNOW (GO TO D1)

8 REFUSED (GO TO D1)

C40. How long did you work in that job?

_________ [ ] MONTHS [RANGE = 1 - 480]

NUMBER [ ] YEARS [RANGE = 1 - 40]

997 DON’T KNOW

998 REFUSED

C41. Including overtime, how many hours per week were you usually working before you left that job?

_____ _____ [RANGE = 1 - 90]

HOURS/WEEK

97 DON’T KNOW

98 REFUSED

C42. What were your earnings, before taxes, when you left that job?

$ ___ ___ , ___ ___ ___ . ___ ___ [RANGE = 1 – 99999.95]

AMOUNT

99999.96 MINIMUM WAGE (GO TO C44)

99999.97 DON’T KNOW (GO TO C44)

99999.98 REFUSED (GO TO C44)

C43. Was that:

1 per hour,

2 per week,

3 every 2 weeks,

4 twice a month,

5 once a month,

6 per year,

7 per day, or

95 something else? (SPECIFY)________

97 DON’T KNOW

98 REFUSED

C44. How many days per week did you usually work before you left that job?

____ ____ [RANGE: 1 – 7]

DAYS/WEEK

97 DON’T KNOW

98 REFUSED

C45. Did the employer make available a health plan or medical insurance, even if you are not receiving it?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

C46. How much time were you out of work before finding your next job?

_________ [ ] MONTHS [RANGE = 1 - 120]

NUMBER [ ] YEARS [RANGE = 1 - 10]

997 DON’T KNOW

998 REFUSED

CATI: RECORD END TIME

C47. Now please think about all the jobs you have had since (RAD), even the ones you just told me about. Altogether, how many jobs have you had since (RAD)?

________ [RANGE = 1 - 40]

NUMBER

97 DON’T KNOW (GO TO C48_1)

98 REFUSED (GO TO C48_1)

C47_1. CATI: IF “1” JOB IN C47, ASK: Have you worked at this job since (THIS MONTH LAST YEAR)?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

CATI: GO TO NEXT SECTION.

C47_2 CATI: IF 2 - 40 IN C47, ASK: Of the (CATI: INSERT # OF JOBS IN C47) jobs since (RAD), how many did you work at since (THIS MONTH LAST YEAR)?

________ [RANGE = 0 - 40]

NUMBER

97 DON’T KNOW

98 REFUSED

CATI: ASK IF C47 = 2 - 40. ELSE GO TO NEXT SECTION.

C48_1. How much have you worked during the past 12 months?

1 All 12 months,

2 More than 6 months but less than 12 months, or

3 6 months or less

7 DON’T KNOW

8 REFUSED

C53. Since [RAD], how many times has this happened to you?

C53a. You received a raise in pay at your job. Was it:

1. Never,

2. Once, or

3. More than once?

7 DON’T KNOW

8 REFUSED

C53b. You received a promotion at your job. Was it:

1 Never,

2 Once, or

3 More than once?

7 DON’T KNOW

8 REFUSED

C53c. You found another job while you were working. Was it:

1 Never,

2 Once, or

3 More than once?

7 DON’T KNOW

8 REFUSED

C53d. You left a job to go immediately into a higher-paying one. Was it:

1 Never,

2 Once, or

3 More than once?

7 DON’T KNOW

8 REFUSED

C53e. You worked for an employer for at least six months. Was it:

1 Never,

2 Once, or

3 More than once?

7 DON’T KNOW

8 REFUSED

C54. Please think about how your (current/most recent) job compares to other jobs you’ve had since [RAD]. [Is (items b, c, e, f, g, h)/ Are (items a, d)] the [INSERT ITEM] in your (current/most recent) job better, about the same, or worse than in those other jobs? CATI: REPEAT QUESTION USING NEXT ITEM IN LIST.

	BETTER	ABOUT THE SAME	WORSE	DON’T KNOW	REFUSED
a. Number of hours of work	1	2	3	7	8
b. Start and end of the workday	1	2	3	7	8
c. Money earned for a typical week of work	1	2	3	7	8
d. Benefits	1	2	3	7	8
e. Travel to and from home and work	1	2	3	7	8
f. Work enjoyment	1	2	3	7	8
g. Job security	1	2	3	7	8

h. Opportunity to advance on the job

1

2

3

7

8

Attachment 2

Evaluation of Child Care Subsidy Strategies

(OMB No. 0970-0306)

SECTION B: Employment

Now, I’d like to ask you about any work that you have done for pay since (DATE OF INTERVENTION START OR DATE OF LAST INTERVIEW). This includes any babysitting, housecleaning, or other work you do for pay. [QUAL=2]

B1. Were you being paid to do any work on (DATE OF INTERVENTION START OR DATE OF LAST INTERVIEW)?

1 Yes SKIP TO B2A

2 No

3 Don’t Know (VOL)

4 Refused (VOL)

B2. Have you been paid to work at any time since (DATE OF INTERVENTION START OR DATE OF LAST INTERVIEW)?

1 Yes

2 No SKIP TO C1

3 Don’t Know (VOL) SKIP TO C1

4 Refused (VOL) SKIP TO C1

B2a. How many different paid jobs have you had since (DATE OF INTERVENTION START OR DATE OF LAST INTERVIEW)? [IF THEY DO THE SAME JOB FOR MORE THAN ONE PERSON (LIKE BABYSITTING OR HOUSE CLEANING) COUNT THEM AS ONE JOB]

_____________ (Range: 1-10; 11 = 11 or more; DK = 98; Refused = 99)

IF NOT SURE OR REFUSED IN B2a CONTINUE WITH B3.

IF MORE THAN 10 JOBS IN B2a, ASK B2b, ELSE SKIP TO B3

B2b. How long did the longest job you have had since (DATE) last?

_______ MONTHS

Less than one week…………….40

One to less than two weeks…………..41

Two to less than three week……42

Three to less than four weeks………..44

Let’s begin with that job.

LOOP B3 – B17 FOR EACH JOB IN B2A, IF NOT SURE OR REFUSED IN B2A ASK B18 AND B19 IN EACH LOOP. ASK B18 AND B19 AFTER LAST JOB LOOP FOR ALL.

B3. What month and year did you start your (current or most recent/next most recent) job?

ENTER MONTH: _________

1 January 8 August

2 February 9 September

3 March 10 October

4 April 11 November

5 May 12 December

6 June 13 Don’t know (VOL)

7 July 14 Refused (VOL)

B3y. ENTER YEAR: ___________

1992 = 1992 or before 2001

1993 2002

1994 2003

1995 2004

1996 2005

1997 2006

1998 2007

1999 2008

2000 9998 Don’t Know (VOL)

9999 Refused (VOL)

B4. What are/were you being paid to do?

1 Gave response [OPEN-END]

2 Don’t Know

3 Refused

ADDED CODES [B4.1 TO B4.5]

1 Administrative support/clerical 2 Child Care 3 Counselor 4 Customer Service 5 Education 6 Executive/Management 7 Fabricator/laborer 8 Financial services 9 Information Technology 10 Medical

11 Retail/sales 12 Social work 13 Transportation 14 A/O Miscellaneous mentions 16 Don’t Know/Refused 17 Personal Service 18 Security/Safety 19 Business owner 20 Food Service (including bar/lounge)

B5. Do/Did you usually work the same number of hours a week or did the number of hours that you worked vary from week to week by more than 8 hours?

1 Hours varied

2 Hours did not vary

3 Don’t know (VOL)

4 Refused (VOL)

B6. How many hours per week do/did you work? [IF RESPONDENT SAID THAT THE HOURS VARIED FROM WEEK TO WEEK ASK THEM TO GIVE THEIR BEST ESTIMATE OF THE AVERAGE HOURS]

1 20 hrs or less

2 21-35 hrs

3 36-40 hrs

4 More than 40 hrs

5 Don’t know (VOL)

6 Refused (VOL)

B7. Have any of the following things happened at this job at any time since (DATE OF INTERVENTION START OR LAST INTERVIEW)?

B7a1. Did the number of hours that you did this work for pay INCREASE by more than 10 hours?

1 Yes

2 No SKIP TO B7b1

3 Hours were irregular SKIP TO B7b1

4 Don’t know (VOL) SKIP TO B7b1

5 Refused (VOL) SKIP TO B7b1

B7a2. When did the hours INCREASE?

ENTER MONTH: _________

1 January 8 August

2 February 9 September

3 March 10 October

4 April 11 November

5 May 12 December

6 June 13 Don’t know (VOL)

7 July 14 Refused (VOL)

B7a2y. ENTER YEAR: ___________

1992 = 1992 or before 2001

1993 2002

1994 2003

1995 2004

1996 2005

1997 2006

1998 2007

1999 2008

2000 9998 Don’t Know (VOL)

9999 Refused (VOL)

B7b1. Did the number of hours that you did this work for pay DECREASE by more than 10 hours while you were employed at the job?

1 Yes

2 No SKIP TO B7c1

3 Hours were irregular SKIP TO B7c1

8 Don’t know (VOL) SKIP TO B7c1

9 Refused (VOL) SKIP TO B7c1

B7b2. When did the hours DECREASE?

ENTER MONTH: _________

1 January 8 August

2 February 9 September

3 March 10 October

4 April 11 November

5 May 12 December

6 June 13 Don’t know (VOL)

7 July 14 Refused (VOL)

B7b2y ENTER YEAR: ___________

1992 = 1992 or before 2001

1993 2002

1994 2003

1995 2004

1996 2005

1997 2006

1998 2007

1999 2008

2000 9998 Don’t Know (VOL)

9999 Refused (VOL)

B7c1. Did the number of hours that you worked for pay not change, but the time of day when you began and ended work change?

1 Yes

2 No SKIP TO B7d

3 Changed from week to week SKIP TO B7d

4 Don’t know (VOL) SKIP TO B7d

5 Refused (VOL) SKIP TO B7d

B7c2. When did the times that you usually began and ended work each day change?

ENTER MONTH: _________

1 January 8 August

2 February 9 September

3 March 10 October

4 April 11 November

5 May 12 December

6 June 13 Don’t know (VOL)

7 July 14 Refused (VOL)

B7c2y. ENTER YEAR: ___________

1992 = 1992 or before 2001

1993 2002

1994 2003

1995 2004

1996 2005

1997 2006

1998 2007

1999 2008

2000 9998 Don’t Know (VOL)

9999 Refused (VOL)

B7d. Have any of the following things happened at this job at any time since (DATE OF INTERVENTION START OR LAST INTERVIEW)?

B7d1. Did you temporarily stop doing the work for 2 or more weeks?

1 Yes

2 No SKIP TO B8

3 Don’t know (VOL) SKIP TO B8

4 Refused (VOL) SKIP TO B8

B7d2. How many interruptions of 2 or more weeks have there been since (DATE OF INTERVENTION START OR LAST INTERVIEW)?

1 One

2 Two

3 Three or more

4 Don’t know (VOL)

5 Refused (VOL)

B7d3. When did the longest interruption begin?

ENTER MONTH: ________

1 January 8 August

2 February 9 September

3 March 10 October

4 April 11 November

5 May 12 December

6 June 13 Don’t know (VOL)

7 July 14 Refused (VOL)

B7d3y. ENTER YEAR: ___________

1992 = 1992 or before 2001

1993 2002

1994 2003

1995 2004

1996 2005

1997 2006

1998 2007

1999 2008

2000 9998 Don’t Know (VOL)

9999 Refused (VOL)

B7d3a. When did the longest interruption end?

ENTER MONTH: _________

1 January 8 August

2 February 9 September

3 March 10 October

4 April 11 November

5 May 12 December

6 June 13 Don’t know (VOL)

7 July 14 Refused (VOL)

B7d3ay. ENTER YEAR: __________

1992 = 1992 or before 2001

1993 2002

1994 2003

1995 2004

1996 2005

1997 2006

1998 2007

1999 2008

2000 9998 Don’t Know (VOL)

9999 Refused (VOL)

B8. What benefits does this job include? [MARK ALL THAT APPLY]

1 Sick days with full pay

2 Paid holidays, like Christmas day and New Year’s Day

3 A health plan or medical insurance

4 A retirement plan

5 No benefits

6 Don’t know (VOL)

7 Refused (VOL)

B11. Were you paid hourly, daily, weekly, biweekly, monthly, or another way?

1 Hourly SKIP TO B12h

2 Daily

3 Weekly

4 Biweekly

5 Monthly

6 Other ___________ (Specify)

7 Don’t know (VOL)

8 Refused (VOL)

9 Bi/Semi-monthly (ADDED CODE)

B12. How much were you usually paid (ANSWER FROM B11) after taxes?

$            (Range $0-$9,990, 9991=More than $9,990)

9998 Don’t know SKIP TO B13

9999 Refused SKIP TO B13

B12h. How much were you usually paid hourly?

$            (Range $0-$9,990, 9991=More than $9,990)

9998 Don’t know SKIP TO B13

9999 Refused SKIP TO B13

B12b. So you were paid (ANSWER FROM B12 OR B12h) per (ANSWER FROM B11). Correct?

1. Yes

2. No GO TO B11

3. Don’t Know [VOL]

4. Refused [VOL]

B13. Has the amount of money that you were paid (ANSWER FROM B11) for doing this work changed since (DATE OF INTERVENTION START OR LAST INTERVIEW)?

1 Yes

2 No SKIP TO B16

3 It was irregular SKIP TO B16

4 Don’t know (VOL) SKIP TO B16

5 Refused (VOL) SKIP TO B16

B14. How has it changed?

1 Increased

2 Decreased

3 Don’t know (VOL)

4 Refused (VOL)

B15. When did the change happen?

ENTER MONTH: _________

1 January 8 August

2 February 9 September

3 March 10 October

4 April 11 November

5 May 12 December

6 June 13 Don’t know (VOL)

7 July 14 Refused (VOL)

B15y. ENTER YEAR: __________

1992 = 1992 or before 2001

1993 2002

1994 2003

1995 2004

1996 2005

1997 2006

1998 2007

1999 2008

2000 9998 Don’t Know (VOL)

9999 Refused (VOL)

B16. Are you still doing this work?

1 Yes SKIP TO B18

2 No

8 Don’t know (VOL) SKIP TO B18

9 Refused (VOL) SKIP TO B18

B17. When did you stop?

ENTER MONTH: _________

1 January 8 August

2 February 9 September

3 March 10 October

4 April 11 November

5 May 12 December

6 June 13 Don’t know (VOL)

7 July 14 Refused (VOL)

B17y. ENTER YEAR: ___________

1992 = 1992 or before 2001

1993 2002

1994 2003

1995 2004

1996 2005

1997 2006

1998 2007

1999 2008

2000 9998 Don’t Know (VOL)

9999 Refused (VOL)

Section C: Child Care Arrangements

My next questions are about the child care arrangements you have used since (DATE OF INTERVENTION START OR LAST INTERVIEW). By child care, I mean the people or programs that have taken care of your children while you were at work or attending a class, school, or job training for more than 8 hours per week. I am not including regular school from kindergarten on up as child care. I’d like to ask about each of the arrangements you have had for your children under age 13, focusing on one child at a time. [QUAL=3]

C1a. READ IN NAME AND AGE FROM A4 FOR ALL SUBSIDY CHILDREN

FIRST NAME - CHILD #1 (YOUNGEST)

FIRST NAME - CHILD #2 (NEXT YOUNGEST)

FIRST NAME - CHILD #3 (NEXT YOUNGEST)

FIRST NAME - CHILD #4 (NEXT YOUNGEST)

FIRST NAME - CHILD #5 (NEXT YOUNGEST)

FIRST NAME - CHILD #6 (NEXT YOUNGEST)

FIRST NAME - CHILD #7 (NEXT YOUNGEST)

FIRST NAME - CHILD #8 (NEXT YOUNGEST)

FIRST NAME - CHILD #9 (NEXT YOUNGEST)

FIRST NAME - CHILD #10 (NEXT YOUNGEST)

C1b. READ IN-NAME AND AGE FROM A4 FOR ALL NON-SUBSIDY CHILDREN UNDER 12

FIRST NAME - CHILD #1 (YOUNGEST)

FIRST NAME - CHILD #2 (NEXT YOUNGEST)

FIRST NAME - CHILD #3 (NEXT YOUNGEST)

FIRST NAME - CHILD #4 (NEXT YOUNGEST)

LOOP C2 – C27 FOR EACH CHILD LISTED IN C1a. IF LESS THAN 10, THEN READ IN NAMES FROM C1b BEGINNING WITH THE YOUNGEST UNTIL 10 LOOPS COMPLETED.

C2. Does (CHILD) (AGE years old) currently go to any programs or does anyone else besides you, or his/her other parent watch them regularly for 8 or more hours a week while you are at work or attending a class, school, or job training?

1 Yes

2 No SKIP TO C27

8 Don’t know (VOL) SKIP TO C27

9 Refused (VOL) SKIP TO C27

LOOP C3 – C27 FOR EACH CHILD IN C1, REPEAT UP TO 10 LOOPS PER CHILD

C3. Which of the following best describes the program or person that takes care of (CHILD) (AGE years old) for the most hours?

2 Step-parent of child or parent’s spouse/partner

3 Grandparent of child

4 Sibling of child

5 Other related adult

6 Other unrelated adult

7 Center-based care: Includes a child care center, daycare, nursery school, Head Start,

preschool, or special education program SKIP TO C4a

8 An after-school or before-school program SKIP TO C4a

9 A summer school or summer camp program SKIP TO C4a

11 Child looks after self SKIP C15 through C20

12 Other ___________ (Specify)

98 Don’t know (VOL)

99 Refused (VOL)

C4. Where was (CHILD) (AGE years old) taken care of?

1 Child’s own home SKIP TO C5

2 Another home (besides the child’s) SKIP TO C5

8 Other location ___________ (Specify) SKIP TO C5

18 Don’t know (VOL) SKIP TO C5

19 Refused (VOL) SKIP TO C5

C4a. Was the child care part of a …. READ LIST

SHOW/HIDE CODES BASED ON ANSWERS TO C3

1. Head Start classroom program (C3=7)

2. Daycare center (C3=7)

3. Pre-school program in a larger public or private school (C3=7)

4. Pre-school or nursery school program not within a larger school (C3=7)

5. Program for children with special needs (C3=7)

6. After or before school program in a public or private school (C3=8)

7. After or before school program, not in a school (C3=8)

8. Summer school/camp in a public or private school (C3=9)

9. Summer school/camp, not in a school (C3=9)

10. Some other program ________(Specify)

11. Don’t know (VOL)

12. Refused (VOL)

C5. When did (PROVIDER FROM C3) start taking care of (CHILD) (AGE years old)?

C5m. ENTER MONTH: _________

1 January 8 August

2 February 9 September

3 March 10 October

4 April 11 November

5 May 12 December

6 June 13 Don’t know (VOL)

7 July 14 Refused (VOL)

C5y. ENTER YEAR: ____________

1992 = 1992 or before 2001

1993 2002

1994 2003

1995 2004

1996 2005

1997 2006

1998 2007

1999 2008

2000 9998 Don’t Know (VOL)

9999 Refused (VOL)

C6. Is (PROVIDER FROM C3) still taking care of (CHILD) (AGE years old)?

1 Yes SKIP TO C8

2 No

8 Don’t know (VOL) SKIP TO C8

9 Refused (VOL) SKIP TO C8

C7. When did (PROVIDER FROM C3) stop taking care of (CHILD) (AGE years old)?

C7m. ENTER MONTH: _________

1 January 8 August

2 February 9 September

3 March 10 October

4 April 11 November

5 May 12 December

6 June 13 Don’t know (VOL)

7 July 14 Refused (VOL)

C7y. ENTER YEAR: ____________

1992 = 1992 or before 2001

1993 2002

1994 2003

1995 2004

1996 2005

1997 2006

1998 2007

1999 2008

2000 9998 Don’t Know (VOL)

9999 Refused (VOL)

C8. Since (DATE OF INTERVENTION START OR LAST INTERVIEW) have there been any periods of 2 or more weeks in which (PROVIDER FROM C3) temporarily stopped caring for your child?

1 Yes

2 No SKIP TO C11

8 Don’t know (VOL) SKIP TO C11

9 Refused (VOL) SKIP TO C11

C9. How many interruptions of 2 or more weeks have there been since (DATE OF INTERVENTION START OR LAST INTERVIEW)?

1 One

2 Two

3 Three or more

8 Don’t know (VOL)

9 Refused (VOL)

C10. When did the longest interruption in care begin?

C10bm. ENTER MONTH: _________

1 January 8 August

2 February 9 September

3 March 10 October

4 April 11 November

5 May 12 December

6 June 13 Don’t know (VOL)

7 July 14 Refused (VOL)

C10by. ENTER YEAR: ____________

1992 = 1992 or before 2001

1993 2002

1994 2003

1995 2004

1996 2005

1997 2006

1998 2007

1999 2008

2000 9998 Don’t Know (VOL)

9999 Refused (VOL)

C10a. When did the longest interruption in care end?

C10em. ENTER MONTH: _________

1 January 8 August

2 February 9 September

3 March 10 October

4 April 11 November

5 May 12 December

6 June 13 Don’t know (VOL)

7 July 14 Refused (VOL)

C10ey. ENTER YEAR: ____________

1992 = 1992 or before 2001

1993 2002

1994 2003

1995 2004

1996 2005

1997 2006

1998 2007

1999 2008

2000 9998 Don’t Know (VOL)

9999 Refused (VOL)

C15. How much do/did you pay (PROVIDER FROM C3) a week to take care of (CHILD) (AGE years old)?

$ ________________ ($0-$990, 991=more than $990)

Nothing……….000

998 Don’t know (VOL)

999 Refused (VOL)

C16. Has the amount of money that you paid (PROVIDER FROM C3) a week for watching (CHILD) (AGE years old) changed since (DATE OF INTERVENTION START OR LAST INTERVIEW)?

1 Yes

2 No SKIP TO C19

8 Don’t Know (VOL) SKIP TO C19

9 Refused (VOL) SKIP TO C19

C17. When did it change?

C17m. ENTER MONTH: _________

1 January 8 August

2 February 9 September

3 March 10 October

4 April 11 November

5 May 12 December

6 June 13 Don’t know (VOL)

7 July 14 Refused (VOL)

C17y. ENTER YEAR: ____________

1992 = 1992 or before 2001

1993 2002

1994 2003

1995 2004

1996 2005

1997 2006

1998 2007

1999 2008

2000 9998 Don’t Know (VOL)

9999 Refused (VOL)

C18. How did it change?

1 Increased

2 Decreased

3 Was irregular

8 Don’t know (VOL)

9 Refused (VOL)

C19. Does any person, program, or agency, including the Illinois Department of Human Services (DHS) help to pay for this care?

1 Yes

2 No SKIP TO C21

8 Don’t know (VOL) SKIP TO C21

9 Refused (VOL) SKIP TO C21

C20. Which one of the following best describes them?

1 (CHILD)’s relative

2 Family friend

3 A program, agency, or office (including the Illinois Department of Human Services)

4 Other

8 Don’t know (VOL)

9 Refused (VOL)

C21. How many hours per week does/did (PROVIDER FROM C3) usually care for (CHILD) (AGE years old)?

______ Hours (Range:1 - 80)

98 Don’t know (VOL)

99 Refused (VOL)

C22. Did the number of hours a week that (PROVIDER FROM C3) took care of (CHILD) (AGE years old) change from week to week by more than 8 hours?

1 Yes

2 No SKIP TO C24

8 Don’t Know (VOL) SKIP TO C24

9 Refused (VOL) SKIP TO C24

C23. How often did they change?

1 Less than 1 time/month

2 1-2 two times/month

3 3 times/month

4 4 or more times/month

8 Don’t Know (VOL)

9 Refused (VOL)

C24. Did (PROVIDER FROM C3) ever take care of (CHILD) (AGE years old) on weekends, in the evenings (after 6:30) or in the mornings before 6:30?

1 Yes

2 No SKIP TO C26

8 Don’t Know (VOL) SKIP TO C26

9 Refused (VOL) SKIP TO C26

C25. How often did the provider care for (CHILD) (AGE years old) during these times? [READ OPTIONS TO RESPONDENT]

1 Less than 1 time/month

2 About 1 time/month

3 Once a week

4 2-3 times/ week

5 More than 3 times/ week

8 Don’t Know (VOL)

9 Refused (VOL)

C26. Did (CHILD) (AGE years old) go to any OTHER programs you have not already told me about or were they taken care of by someone else besides you, or his/her other parent regularly for 8 or more hours a week while you were at work, a class, school, or job training during the same period that (PROVIDER FROM C3) took care of them?

1 Yes REPEAT C3-C26 FOR CHILD

2 No

8 Don’t Know (VOL)

9 Refused (VOL)

C27. Has anyone else besides you, or his/her other parent watched (CHILD) (AGE years old) regularly for 8 or more hours a week while you were at work, a class, school, or job training at any time since (DATE OF INTERVENTION START OR LAST INTERVIEW) whom you have not told me about?

1 Yes

2 No SKIP TO D1 if LAST CHILD, or C3-NEXT CHILD if not¹

8 Don’t Know (VOL) SKIP TO D1 if LAST CHILD, or C3-NEXT CHILD if not

9 Refused (VOL) SKIP TO D1 if LAST CHILD, or C3-NEXT CHILD if not

C27b. What was the (longest period/next longest period) since (DATE OF INTERVENTION) that (CHILD) (AGE years old) was watched regularly or 8 or more hours a week while you were at work, school or job training?

1 Enter Months

2 Less than one week SKIP TO C3

3 One to less than two weeks SKIP TO C3

4 Two to less than three weeks SKIP TO C3

5 Three less than four week SKIP TO C3

6 Don’t Know SKIP TO C3

C27c. Enter Number of Months

_______________ MONTHS

My next questions are about that child care arrangement.

(REPEAT C3-C27 FOR CHILD)

[REPEAT FOR NEXT OLDEST CHILD IN C1]

Attachment 3

Building Futures: Head Start Impact Study - Spring 2007 –

PARENT INTERVIEW - COHORT B

(OMB No. is 0970-0229)

A. SCHOOL EXPERIENCE

Now I’d like to talk to you about [CHILD]’s school experiences.

A1. What is [CHILD]'s current grade in school? Is s/he in... (CIRCLE ONLY ONE)

First grade 01

Second grade 02

Third grade 03

Fourth grade 04

Attending school, ungraded 05

Other (SPECIFY)_______________________ 06

CHART A2.– CURRENT SCHOOL EXPERIENCE

a1. Which of the following best describes the school setting that [CHILD] is in? Public school 01 Catholic school 02 Private school, other religious affiliation 03 Private school, not religiously affiliated 04 Home school 05 Other (SPECIFY) 06 ________________________________		a2. What is the name, address, and telephone number of this school? ______________________________ School Name ______________________________ Address ______________________________ City State (_____)______________________ Telephone	a3. What is the name of [CHILD]’s teacher there? _________________________ For coders only: Teacher=1	a4. What month and year did [CHILD] begin going to [GRADE IN A1] at this school? |__|__| |__|__| Month Year
a5. Altogether, how many hours per week does [CHILD] typically attend this school? |__|__| Total # of hours per week

A3. Is this [CHILD]’s first year in (INSERT GRADE)?

YES 1

NO 2

A4. Has your child had a different teacher this year or the same teacher he/she had last year?

Different teacher 1

Same teacher 2

A5. Has your child received any special instruction or tutoring in school this year?

YES 1

NO 2

A6. Approximately how many days has [CHILD] been absent from class since the beginning of the school year, that is, since last September?

|_____|_____| DAYS ABSENT

IF A6=0, SKIP TO A8.

A7. What is the most frequent reason for [CHILD]’s missing days? (CIRCLE ONE)

ILLNESS OF CHILD 01

ILLNESS OF FAMILY MEMBER 02

CONFLICT WITH PARENT’S WORK OR SCHOOL SCHEDULE 03

LACK OF TRANSPORTATION 04

BAD WEATHER 05

CHILD DID NOT WANT TO GO 06

PARENT DECISION NOT TO SEND CHILD OR TO SEND

CHILD ELSEWHERE 07

OTHER (SPECIFY ___________________________________) 08

A8. Since the beginning of this school year, has [CHILD] been in the same school?

YES 1 (GO TO B1)

NO 2

DON’T KNOW 8 (GO TO B1)

A9. How many different schools has [CHILD] attended?

|_____|_____| NUMBER OF SCHOOLS

B. School communication and involvement

B1. For each statement that I read you, please tell me how well [CHILD]’s school has been doing the following things during the school year:

[IF NECESSARY, READ AFTER EACH STATEMENT: Would you say [CHILD]’s school does this very well, just OK, or doesn’t do it at all? (USE RESPONSE CARD)(CIRCLE ONE RESPONSE FOR EACH ITEM)]

	Does it very well	Just OK	Does not do it at all	Don’t know
a. Lets you know (between report cards) how [CHILD] is doing in school	1	2	3	8
b. Helps you understand what children at [CHILD]’s age are like	1	2	3	8
c. Makes you aware of chances to volunteer at the school	1	2	3	8
d. Provides workshops, materials, or advice about how to help [CHILD] learn at home	1	2	3	8
e. Provides information on community services to help [CHILD] or your family	1	2	3	8
f. Understands the needs of families who don’t speak English	1	2	3	8

B2. In general how often and in what way do you usually have contact with [CHILD]’s teacher about his/her daily activities or behavior? (USE RESPONSE CARD)(CIRCLE ONE RESPONSE FOR EACH ITEM)

	Daily	Weekly	Monthly	Less than Monthly	Never
a. Talk to the teacher in person	1	2	3	4	5
b. Teacher calls you	1	2	3	4	5
c. Receive written notes from teacher	1	2	3	4	5
d. Schedule meetings or conferences with teacher	1	2	3	4	5
e. Teacher conducts home visits	1	2	3	4	5
f. Teacher sends home examples of [CHILD]’s work	1	2	3	4	5

B3. When [CHILD]'s teacher sends home notes or newsletters, are these in a language that you speak?

YES 1

NO 2

B4. During this school year, about how many times have you gone to meetings or participated in activities at [CHILD]’s school?

|____|____| NUMBER OF TIMES

B5. This year, have the following reasons made it harder for you to participate in activities at [CHILD]'s school? How about…

	YES	NO
a. Inconvenient meeting times? Has that made it harder for you to participate in activities at [CHILD]'s school?	1	2
b. No child care keeps your family from going to school meetings or events? Has that made it harder for you to participate in activities at [CHILD]'s school?	1	2
c. Family members can't get time off from work? Has that made it harder for you to participate in activities at [CHILD]'s school?	1	2
d. Problems with safety going to the school? Has that made it harder for you to participate in activities at [CHILD]'s school?	1	2
e. Problems with transportation to the school? Has that made it harder for you to participate in activities at [CHILD]'s school?	1	2
f. Problems because you or members of your family speak a language other than English and meetings are conducted only in English? Has that made it harder for you to participate in activities at [CHILD]'s school?	1	2
g. You don't hear about things going on at school that you might want to be involved in? Has that made it harder for you to participate in activities at [CHILD]'s school?	1	2
h. The school does not make your family feel welcome? Has that made it harder for you to participate in activities at [CHILD]'s school?	1	2

B6. How far in school do you expect [CHILD] to go? Would you say you expect [him/her]…

To receive less than a high school

diploma 1

To graduate from high school 2

To attend two or more years of

college 3

To finish a four- or five-year college

degree 4

To earn a master's degree or

equivalent, or 5

To finish a Ph.D., M.D., or other advanced

degree 6

B7. Please indicate how strongly you agree or disagree with the following statements:

	Strongly Disagree	Disagree	Not Sure	Agree	Strongly Agree
a. Your child's school is a good place for your child to be	1	2	3	4	5
b. The staff at your child's school is doing good things for your child	1	2	3	4	5
c. You have confidence in the people at your child's school	1	2	3	4	5
d. Your child's school is doing a good job of preparing children for their futures	1	2	3	4	5
e. Your child's school is safe	1	2	3	4	5
f. Your child's school provides bad influences for (him/her)	1	2	3	4	5
g. Your child's school meets (his/her) academic needs	1	2	3	4	5
h. Your child's school meets (his/her) social and behavior needs	1	2	3	4	5
i. Doing well in school will improve [CHILD]'s chances of having a good life when (he/she) grows up	1	2	3	4	5
j. Getting good grades in school doesn't guarantee that [CHILD] will get a good job when (he/she) grows up	1	2	3	4	5
k. Even if [CHILD] is successful in school, it doesn't mean it will help (him/her) fulfill (his/her) dreams	1	2	3	4	5

B8. As far as you know, is [CHILD] going to be promoted to the next grade this coming fall, or will he/she spend another year in (kindergarten/first grade/second grade/other program)?

YES, WILL BE PROMOTED TO
NEXT GRADE 1

NO, WILL SPEND ANOTHER YEAR IN

SAME GRADE 2

NO, WILL GO INTO A TRANSITIONAL CLASS

1 The Outer FOR LOOP will be initialized with number of subsidy children from A1s1. The number of CHILD loops completed will determine LAST CHILD or NEXT CHILD.

40