Questionnaire
Appendix A - questionnaire.8082006.doc
Project Gate
Questionnaire
OMB: 1205-0444
Growing America Through Entrepreneurship
(GATE)
Follow‑Up Survey
CONTENTS
Section Page
A INTRODUCTION/SCREENER 1
B SELF-EMPLOYMENT SERVICES 5
C SELF-EMPLOYMENT EXPERIENCE 17
D EMPLOYMENT, WORKING FOR SOMEONE ELSE 39
E INCOME SOURCES AND AMOUNTS 50
F HOUSEHOLD COMPOSITION, MARITAL STATUS, AND
SPOUSE EMPLOYMENT 53
G CONTACT INFORMATION 56
SECTION A: INTRODUCTION/SCREENER |
A1. Hello, may I please speak to (SAMPLE MEMBER). My name is (NAME) and I’m calling from IMPAQ International. Is this (SAMPLE MEMBER)?
SAMPLE MEMBER AVAILABLE 01
SAMPLE
MEMBER NOT AVAILABLE 00
A2. Hello, my name is (NAME), and I’m calling from IMPAQ International in Columbia, Maryland. We are conducting a survey for the U.S. Department of Labor of people who applied to Project GATE. (I would like to ask you some questions about your experiences with self-employment and self-employment services/You may remember that we talked to you about a year ago and we are interested in what has happened to you since then).
Your opinions and experiences are extremely important. The information you and others provide will be used to improve services for people interested in self- employment. We would appreciate your participation in this study, and in return can offer an honorarium of $15 for your time.
Your responses are confidential and will not be shared with the U.S. Department of Labor, Staff at Project GATE, or any other agency except as required by law.
PROBE: You may have received a letter recently which explained the study to you.
PROBE: You may remember that you became a participant in this study about (six/eighteen) months ago.
OK TO CONTINUE 01
NOT
A GOOD TIME FOR SM 00
REFUSED r
R. HESITATES TO DO SURVEY h
R. HAS QUESTIONS ABOUT THE STUDY q
A3. I just need to verify that I am speaking with the correct person. What is your date of birth?
(01-12) (01-31) (1900-1990)
| | | / | | | / | | | | |
MONTH DAY YEAR
REFUSED r
DON’T KNOW d
A4. |
PROGRAMMER: CHECK DOB. DOES THE DOB IN A3 MATCH THE DOB IN THE SAMPLE FILE?
YES 01 GO TO B1 NO/NO DOB 00 |
A5. And what are the last 4-digits of your Social Security number?
| | | | |
DON’T
KNOW d
REFUSED r
|
PROGRAMMER: CHECK SSN. DO THE LAST 4 DIGITS OF THE SSN IN A5 MATCH THE SSN IN THE SAMPLE FILE?
YES 01 GO TO B1 NO/NO SSN 00 GO TO A7 |
A7. I’m sorry. I need to check my records before I can interview you. Is this the best time to reach you in the future?
THANK
SM AND TERMINATE. RECORD TIME AND DATE ON CONTACT SHEET.
YES 01
NO 00
A8. |
PROGRAMMER: HAS A FIRST FOLLOW-UP INTERVIEW BEEN COMPLETED BY THIS SAMPLE MEMBER?
YES 01
|
INFORMATION SCREEN. READ ONLY IF SAMPLE MEMBER REQUESTS MORE INFORMATION.
Answers to Commonly Asked Questions1
“I didn’t participate in GATE. I’m no longer in the GATE Program.”
We are calling people who applied for the GATE program, even if they never participated or are no longer participating. Your responses and views are important in that they help us gain perspective from those who no longer or never participated.
“I did not like the GATE Program.”
I understand. Your comments will be especially important to the study. The United States Department of Labor wants to have feedback from people who were both satisfied and not satisfied with their experiences in the GATE Program.
“I didn’t start my own business.”
That’s OK. Your responses and views are important to the study. The United States Department of Labor wants to have feedback from people who did not start their own business as well as those that did.
“How did you get my name?”
We are calling everyone who applied for the GATE Program. You might remember that the application materials you signed mentioned that we would be calling you for an interview.
“What happens if I don’t participate?”
Your participation is voluntary and will not affect your eligibility to receive any services or benefits. However, your experiences and opinions are very important to the success and improvement of programs like GATE.
“I don’t have the time.”
We can do the survey in more than one call, if necessary. I’d like to begin now and do as much as we can. Then, if you need to stop, I can call you back at your convenience to finish. Or, I can schedule a more convenient time to call you back. Which do you prefer?
“I’m not interested.”
Let me reassure you that we are not selling anything. We’re interested in your opinions and experiences. The information you provide will help address the special needs of people who want to start their own business. There are no right or wrong answers. Any information you give me will be held in the strictest confidence.
“Are my answers confidential?”
Any information you give me will be held in the strictest confidence and will be used only for the purposes of the study. Your answers will be combined with those of others and your name will never be used in reporting the results of the study. All personally identifiable data will be kept confidential except as required by law. Your answer to questions will not affect your eligibility for any public program.
“How long will this take?”
The length of the interview is different for different people, but it usually takes 40 minutes.
“What is the purpose of the study?”
Our goal is to assess whether programs like GATE are successful in meeting the needs of people who want to start their own business. If the GATE Program is successful, the U.S. Department of Labor may decide to expand the program.
“What information do you intend to collect?
We will collect information about your experiences in receiving self-employment services, your experiences with self-employment and other employment, and your receipt of unemployment insurance and public assistance.
SECTION B: SELF-EMPLOYMENT SERVICES |
|
PROGRAMMER:
THIS IS A 6-MONTH FOLLOW-UP INTERVIEW OR AN 18-MONTH FOLLOW-UP WITHOUT A COMPLETED 6-MONTH FOLLOW-UP INTERVIEW. GO TO B1
THIS IS AN 18-MONTH FOLLOW-UP INTERVIEW WITH A COMPLETED 6-MONTH FOLLOW-UP INTERVIEW. GO TO B3
|
B1. The next series of questions are about self-employment services. Prior to when you applied for the Growing America Through Entrepreneurship (GATE) program on (RANDOM ASSIGNMENT DATE), did you participate in any self-employment services or programs to help you start or grow your own business? Services or programs could include classes, workshops, seminars, one-on-one counseling or technical assistance, a peer support or networking group, or mentoring.
YES 01
NO 00
GO
TO B3
REFUSED r
B2. Prior to applying for the GATE program on (RANDOM ASSIGNMENT DATE), what types of self–employment services or programs did you participate in? Did you participate in . . .
-
YES
NO
DON’T
KNOW
REFUSED
a.
classes, workshops or seminars?
01
00
d
r
b.
one-on-one counseling or technical assistance?
01
00
d
r
c.
a peer support/networking group?
01
00
d
r
d.
mentoring?
01
00
d
r
e.
anything else? (SPECIFY)
01
00
d
r
B3. Since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW), have you attended any classes, workshops, or seminars on topics related to your business?
YES 01
NO 00
DON’T KNOW d
REFUSED r
B4. How many individual sessions of these classes, workshops, or seminars did you attend?
| | | NUMBER OF CLASSES/SESSIONS
DON’T KNOW d
REFUSED r
B5. On average, how long were the individual sessions of these classes, workshops, or seminars?
| | | LENGTH
MINUTES 01
HOURS 02
DON’T KNOW d
REFUSED r
B5a. What organizations provided these classes, workshops, or seminars?
NAME(S)
DON’T KNOW d
REFUSED r
B6. Since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW), have you received any one-on-one counseling or technical assistance on starting or expanding your business?
YES 01
NO 00
DON’T KNOW d
REFUSED r
B7. How many counseling or technical assistance sessions have you attended since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW)?
| | | NUMBER OF SESSIONS
DON’T KNOW d
REFUSED r
B8. On average, how long did each counseling or technical assistance session last?
| | | LENGTH
MINUTES 01
HOURS 02
DON’T KNOW d
REFUSED r
B8a. What organizations provided you with counseling or technical assistance?
NAME(S)
DON’T KNOW d
REFUSED r
B9. Since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW), have you attended any peer support group for self-employed persons or persons interested in becoming self-employed?
PROBE: By this we mean groups of individuals who are self-employed or trying to start a business who meet to share ideas, strategies, and information.
YES 01
NO 00
DON’T KNOW d
REFUSED r
B10. How many support group sessions have you attended since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW)?
| | | NUMBER OF SESSIONS
DON’T KNOW d
REFUSED r
B11. On average, how long did each of these sessions last?
| | | LENGTH
MINUTES 01
HOURS 02
DON’T KNOW d
REFUSED r
B11a. What organizations provided a peer support group?
NAME(S)
DON’T KNOW d
REFUSED r
B12. Since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW), have you worked with an experienced business-owner or someone else who could act as your mentor?
YES 01
NO 00
DON’T KNOW d
REFUSED r
B13. About how many meetings, in total, have you had with a mentor since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW)?
| | | NUMBER OF MEETINGS
DON’T KNOW d
REFUSED r
B14. On average, how long did each of these meetings last?
| | | LENGTH
MINUTES 01
HOURS 02
DON’T KNOW d
REFUSED r
B14a. What organizations provided you with a mentor?
NAME(S)
DON’T KNOW d
REFUSED r
B15. Since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW), have you received any other types of self-employment services that we haven’t already talked about?
YES 01
NO 00
DON’T KNOW d
REFUSED r
B16. What were they?
RECORD VERBATIM
B16a. What organizations provided you with these other services?
NAME(S)
DON’T KNOW d
REFUSED r
B16b. |
PROGRAMMER: IF B3, B6, B9, B12 or B15 = 1, GO TO B17. OTHERWISE GO TO B20. |
B17. Thinking about all the services you have received since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW), about how much did you pay in total for these services?
$ | | |,| | | |.| | | TOTAL AMOUNT
SERVICES WERE FREE 01
DON’T KNOW d
REFUSED r
B18. NO B18 IN THIS VERSION
B19. NO B19 IN THIS VERSION
B20. |
PROGRAMMER: IF SAMPLE MEMBER IS TREATMENT GROUP, AND B3, B6, B9, B12 and B15 = 0, GO TO B21. OTHERWISE GO TO B22. |
B21. Why didn’t you participate in any self-employment services or programs?
CIRCLE ALL THAT APPLY
DIDN’T THINK SERVICES WOULD
BE HELPFUL 01
SERVICES LOCATED TOO FAR AWAY 02
TIMES INCONVENIENT 03
DIDN’T WANT TO WAIT FOR CLASSES
TO BEGIN 04
DECIDED TO POSTPONE SELF-EMPLOYMENT 05
DECIDED NOT TO PURSUE SELF-EMPLOYMENT
AT ALL 06
TOO BUSY 07
OTHER (SPECIFY) 08
B22. Since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW), have you developed or revised a written business plan?
YES 01
NO 00
DON’T KNOW d
REFUSED r
B23. Did you receive help writing your business plan from someone in a self-employment program? Please include a counselor, a mentor, or someone in a support group or workshop.
YES 01
NO 00
DON’T KNOW d
REFUSED r
B24. |
PROGRAMMER: IF SAMPLE MEMBER IS IN TREATMENT GROUP, GO TO B25. IF SAMPLE MEMBER IS IN CONTROL GROUP, GO TO B26. |
B25. Did the GATE program provide any help writing your business plan since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW)?
YES 01
NO 00
DON’T KNOW d
REFUSED r
B26. Since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW), have you applied for a business loan?
YES 01
NO 00
DON’T KNOW d
REFUSED r
B27. To how many different institutions or programs have you applied for loans since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW)?
| | | NUMBER OF INSTITUTIONS
DON’T KNOW d
REFUSED r
B28. Did you apply for a loan from the Small Business Administration, or SBA, since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW)]?
YES 01
NO 00
DON’T KNOW d
REFUSED r
B29. When applying for loans, did you receive any help from someone in a self-employment program?
YES 01
NO 00
DON’T KNOW d
REFUSED r
B30. |
PROGRAMMER: IF SAMPLE MEMBER IS TREATMENT GROUP, GO TO B31. IF SAMPLE MEMBER IS NOT IN TREATMENT GROUP, GO TO B31a. |
B31. Did the GATE program provide any of this help?
YES 01
NO 00
DON’T KNOW d
REFUSED r
B31a. |
PROGRAMMER: IF B3, B6, B9, B12 AND B15 = 0, d OR r, GO TO B36. OTHERWISE CONTINUE. |
B32. I am going to read a list of ways self-employment services may have helped you. Please tell me whether each service helped you a lot, somewhat, or not at all in . . .
-
A
LOT
SOME-
WHAT
NOT
AT ALL
DON’T
KNOW
REFUSED
NOT
APPLICABLE
a.
Developing a business plan
01
02
03
d
r
na
b.
Applying for loans
01
02
03
d
r
na
c.
Deciding whether to pursue self-employment
01
02
03
d
r
na
d.
Refining your business idea
01
02
03
d
r
na
e.
Dealing with credit issues
01
02
03
d
r
na
f.
Developing your marketing strategy
01
02
03
d
r
na
g.
Dealing with legal issues
01
02
03
d
r
na
h.
Dealing with accounting issues
01
02
03
d
r
na
i.
Hiring and dealing with employees
01
02
03
d
r
na
j.
Networking
01
02
03
d
r
na
k.
Using computers and other technology
01
02
03
d
r
na
l.
Dealing with clients
01
02
03
d
r
na
m.
Providing psychological support
01
02
03
d
r
na
B33. Are there other ways in which self-employment services may have helped you?
YES 01
NO 00
DON’T KNOW d
REFUSED r
B33a. In what other ways did these services help you?
RECORD VERBATIM:
B34. Thinking about all of the self-employment services that you have received since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW), how would you rate the overall usefulness of the services you have received? Were they . . .
Very useful, 01
Somewhat useful, 02
Not very useful, or 03
Not at all useful? 04
DON’T KNOW d
REFUSED r
B34a. |
PROGRAMMER: HAS RESPONDENT RECEIVED MORE THAN ONE TYPE OF SELF-EMPLOYMENT SERVICE? DO AT LEAST TWO OF THE FOLLOWING QUESTIONS EQUAL “01” (B3, B6, B9, B12, OR B15)? IF SO, INSERT NAMES OF SERVICES INTO B35. IF NONE OR ONLY ONE SERVICE RECEIVED, GO TO B36. |
B35. You mentioned previously that since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW), you had received (NAMES OF SELF-EMPLOYMENT SERVICES RECEIVED). Please tell me which one service has been most useful to you.
CLASSES OR WORKSHOPS 01
ONE-ON-ONE COUNSELING OR TECHNICAL
ASSISTANCE 02
PEER SUPPORT/NETWORKING GROUP 03
MENTORING 04
OTHER (SPECIFY) 05
DON’T KNOW d
REFUSED r
B36. Are there any services that you didn’t receive or didn’t receive enough of that could have helped you in starting or growing your own business?
YES 01
NO 00
DON’T KNOW d
REFUSED r
B37. What services would have been useful to you?
CIRCLE ALL THAT APPLY
CLASSES OR WORKSHOPS 01
ONE-ON-ONE COUNSELING OR
TECHNICAL ASSISTANCE 02
PEER SUPPORT/NETWORKING GROUP 03
MENTORING 04
LOANS 05
OTHER (SPECIFY) 06
SECTION C: SELF-EMPLOYMENT EXPERIENCE |
|
PROGRAMMER:
THIS IS A 6-MONTH FOLLOW-UP INTERVIEW OR AN 18-MONTH FOLLOW-UP WITHOUT A COMPLETED 6-MONTH FOLLOW-UP INTERVIEW. CONTINUE TO C1
THIS IS AN 18-MONTH FOLLOW-UP INTERVIEW WITH A COMPLETED 6-MONTH FOLLOW-UP INTERVIEW. GO TO C4
|
C1. The next series of questions are about your experiences with self-employment. Why were you interested in being self-employed?
PROBE: Were there any other reasons?
CIRCLE ALL THAT APPLY
TO INCREASE INCOME 01
COULD NOT GET A JOB WORKING FOR
SOMEONE ELSE 02
WANTED TO BE MY OWN BOSS/
TIRED OF WORKING FOR SOMEONE ELSE 03
TO GET WORK NOT AVAILABLE ELSEWHERE
IN THE JOB MARKET 04
FLEXIBILITY IN DAILY SCHEDULE 05
POTENTIAL TO CAPITALIZE ON ONE’S
EXISTING SKILLS 06
TO HAVE MORE FREEDOM TO MEET FAMILY
RESPONSIBILITIES 07
TO BRING NEW IDEAS TO THE MARKETPLACE/
TO MEET A NEED IN THE COMMUNITY 08
BEING SELF-EMPLOYED WAS ALWAYS
MY DREAM 09
EARLY RETIREMENT 10
OTHER (SPECIFY) 11
DON’T KNOW d
REFUSED r
C2. Prior to (RANDOM ASSIGNMENT DATE), had you been self-employed, that is, owned your own business?
YES 01
NO 00
DON’T KNOW d
REFUSED r
C2a. Prior to (RANDOM ASSIGNMENT DATE), how many businesses had you owned?
|__|__| NUMBER OF BUSINESSES
NONE 00
GO
TO C4
DON’T KNOW d
REFUSED r
C3. Thinking about (the time/all the times) you were self-employed before (RANDOM ASSIGNMENT DATE), about how long, in total, were you self-employed?
RECORD LENGTH AND CODE TIME UNIT.
|__|__| LENGTH
WEEKS 01
MONTHS 02
YEARS 03
DON’T KNOW d
REFUSED r
C4. Since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW) have you been self-employed, that is, owned your own business?
YES 01
NO 00
DON’T KNOW d
REFUSED r
C4a. Are you currently self-employed?
YES 01
NO 00
DON’T KNOW d
REFUSED r
C4b. How many businesses have you owned since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW)?
|__|__| NUMBER OF BUSINESSES
NONE 00
DON’T KNOW d
REFUSED r
|
CURRENT/MOST RECENT BUSINESS |
SECOND BUSINESS |
C5. The next questions are about the business(es) you have owned since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW).
Please tell me about your (most recent/next) self-employment experience. What was the name of the business?
RECORD NAME OF BUSINESS ACROSS THE TOP OF THE GRID FIRST. THEN ASK C6-C20a DOWN FOR EACH BUSINESS. |
___________________________________ NAME OF BUSINESS
DON’T KNOW d REFUSED r
|
___________________________________ NAME OF BUSINESS
DON’T KNOW d REFUSED r
|
C5a. What other businesses have you owned since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW)?
RECORD AS NEXT BUSINESS IN COLUMN HEADER |
|
|
C6. When did you start operating this business as the owner?
PROBE: Your best estimate is fine.
IF DK DAY, PROBE: Was it the beginning, middle, or end of the month?
IF "BEGINNING," ENTER 05; IF "MIDDLE," ENTER 15; IF "END," ENTER 25.
START DATE CAN BE BEFORE RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW. |
| | | / | | | / | | | | | MONTH DAY YEAR
DON’T KNOW d REFUSED r
|
| | | / | | | / | | | | | MONTH DAY YEAR
DON’T KNOW d REFUSED r |
C7. When did you stop operating this business as the owner?
IF STILL WORKING AT JOB, CIRCLE “01.”
IF DK DAY, PROBE: Was it the beginning, middle, or end of the month?
IF "BEGINNING," ENTER 05; IF "MIDDLE," ENTER 15; IF "END," ENTER 25.
STOP DATE MUST COME AFTER RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW. |
| | | / | | | / | | | | | MONTH DAY YEAR
STILL OPERATING BUSINESS (GO TO C10) 01 DON’T KNOW (GO TO C10) d REFUSED (GO TO C10) r
|
| | | / | | | / | | | | | MONTH DAY YEAR
STILL OPERATING BUSINESS (GO TO C10) 01 DON’T KNOW (GO TO C10) d REFUSED (GO TO C10) r
|
C8. Why did you stop operating this business?
PROBE: We mean operating this business as the owner.
|
CIRCLE ALL THAT APPLY BUSINESS DID NOT MAKE ENOUGH INCOME 01 GOT A BETTER OPPORTUNITY 02 HOURS TOO LONG 03 INCOME TOO UNCERTAIN 04 ILLNESS/DISABILITY 05 PERSONAL REASONS 06 OTHER (SPECIFY) 07
DON’T KNOW d REFUSED r |
CIRCLE ALL THAT APPLY BUSINESS DID NOT MAKE ENOUGH INCOME 01 GOT A BETTER OPPORTUNITY 02 HOURS TOO LONG 03 INCOME TOO UNCERTAIN 04 ILLNESS/DISABILITY 05 PERSONAL REASONS 06 OTHER (SPECIFY) 07
DON’T KNOW d REFUSED r |
C9. What did you do when you stopped operating this business?
PROBE: We mean operating this business as the owner.
|
CIRCLE ALL THAT APPLY TOOK JOB WORKING FOR SOMEONE ELSE 01 STARTED ANOTHER BUSINESS 02 LOOKED FOR WORK 03 PARTICIPATED IN EDUCATION/ TRAINING PROGRAM 04 TOOK CARE OF CHILD, FAMILY MEMBER, OR SICK RELATIVE 05 RETIRED 06 WAS SICK 07 OTHER (SPECIFY) 08
DON’T KNOW d REFUSED r |
CIRCLE ALL THAT APPLY TOOK JOB WORKING FOR SOMEONE ELSE 01 STARTED ANOTHER BUSINESS 02 LOOKED FOR WORK 03 PARTICIPATED IN EDUCATION/ TRAINING PROGRAM 04 TOOK CARE OF CHILD, FAMILY MEMBER, OR SICK RELATIVE 05 RETIRED 06 WAS SICK 07 OTHER (SPECIFY) 08
DON’T KNOW d REFUSED r |
THIRD BUSINESS |
FOURTH BUSINESS |
FIFTH BUSINESS |
___________________________________ NAME OF BUSINESS
DON’T KNOW d REFUSED r
|
___________________________________ NAME OF BUSINESS
DON’T KNOW d REFUSED r
|
___________________________________ NAME OF BUSINESS
DON’T KNOW d REFUSED r
|
|
|
|
| | | / | | | / | | | | | MONTH DAY YEAR
DON’T KNOW d REFUSED r
|
| | | / | | | / | | | | | MONTH DAY YEAR
DON’T KNOW d REFUSED r |
| | | / | | | / | | | | | MONTH DAY YEAR
DON’T KNOW d REFUSED r |
| | | / | | | / | | | | | MONTH DAY YEAR
STILL OPERATING BUSINESS (GO TO C10) 01 DON’T KNOW (GO TO C10) d REFUSED (GO TO C10) r
|
| | | / | | | / | | | | | MONTH DAY YEAR
STILL OPERATING BUSINESS (GO TO C10) 01 DON’T KNOW (GO TO C10) d REFUSED (GO TO C10) r
|
| | | / | | | / | | | | | MONTH DAY YEAR
STILL OPERATING BUSINESS (GO TO C10) 01 DON’T KNOW (GO TO C10) d REFUSED (GO TO C10) r
|
CIRCLE ALL THAT APPLY BUSINESS DID NOT MAKE ENOUGH INCOME 01 GOT A BETTER OPPORTUNITY 02 HOURS TOO LONG 03 INCOME TOO UNCERTAIN 04 ILLNESS/DISABILITY 05 PERSONAL REASONS 06 OTHER (SPECIFY) 07
DON’T KNOW d REFUSED r |
CIRCLE ALL THAT APPLY BUSINESS DID NOT MAKE ENOUGH INCOME 01 GOT A BETTER OPPORTUNITY 02 HOURS TOO LONG 03 INCOME TOO UNCERTAIN 04 ILLNESS/DISABILITY 05 PERSONAL REASONS 06 OTHER (SPECIFY) 07
DON’T KNOW d REFUSED r |
CIRCLE ALL THAT APPLY BUSINESS DID NOT MAKE ENOUGH INCOME 01 GOT A BETTER OPPORTUNITY 02 HOURS TOO LONG 03 INCOME TOO UNCERTAIN 04 ILLNESS/DISABILITY 05 PERSONAL REASONS 06 OTHER (SPECIFY) 07
DON’T KNOW d REFUSED r |
CIRCLE ALL THAT APPLY TOOK JOB WORKING FOR SOMEONE ELSE 01 STARTED ANOTHER BUSINESS 02 LOOKED FOR WORK 03 PARTICIPATED IN EDUCATION/ TRAINING PROGRAM 04 TOOK CARE OF CHILD, FAMILY MEMBER, OR SICK RELATIVE 05 RETIRED 06 WAS SICK 07 OTHER (SPECIFY) 08
DON’T KNOW d REFUSED r |
CIRCLE ALL THAT APPLY TOOK JOB WORKING FOR SOMEONE ELSE 01 STARTED ANOTHER BUSINESS 02 LOOKED FOR WORK 03 PARTICIPATED IN EDUCATION/ TRAINING PROGRAM 04 TOOK CARE OF CHILD, FAMILY MEMBER, OR SICK RELATIVE 05 RETIRED 06 WAS SICK 07 OTHER (SPECIFY) 08
DON’T KNOW d REFUSED r |
CIRCLE ALL THAT APPLY TOOK JOB WORKING FOR SOMEONE ELSE 01 STARTED ANOTHER BUSINESS 02 LOOKED FOR WORK 03 PARTICIPATED IN EDUCATION/ TRAINING PROGRAM 04 TOOK CARE OF CHILD, FAMILY MEMBER, OR SICK RELATIVE 05 RETIRED 06 WAS SICK 07 OTHER (SPECIFY) 08
DON’T KNOW d REFUSED r |
|
CURRENT/MOST RECENT BUSINESS |
SECOND BUSINESS |
C10. What (is/was) the main product or activity of this business? RECORD VERBATIM
PROBE FOR TYPE OF PRODUCT OF SERVICE.
|
___________________________________ ___________________________________ ___________________________________
DON’T KNOW d REFUSED r |
___________________________________ ___________________________________ ___________________________________
DON’T KNOW d REFUSED r |
C11. (Do/Did) you work for just one client? |
YES 01 NO 00 DON’T KNOW d REFUSED r |
YES 01 NO 00 DON’T KNOW d REFUSED r |
C12. On average, how much (are/were) the monthly receipts or sales for this business?
PROBE: Your best estimate is fine. |
$ | | | |,| | | |.| | |
More than $999,999 01 DON’T KNOW d REFUSED r
|
|
C13. On average, how much (are/were) the monthly expenses for this business? Please include any payments to yourself or your family members.
PROBE: Your best estimate is fine. |
$ | | | |,| | | |.| | |
More than $999,999 01 DON’T KNOW d REFUSED r |
|
C14. How many hours (do/did) you usually work in an average week at this business? Please include any time you (spend/spent) working at home.
|
| | | NUMBER OF HOURS
DON’T KNOW d REFUSED r |
| | | NUMBER OF HOURS
DON’T KNOW d REFUSED r |
C15. What percent of your total household income (is/was) produced as a result of this business?
PROBE: For your total household income please include income from your spouse or other immediate family members living with you. |
| | | PERCENT
ALL 100 DON’T KNOW d REFUSED r |
| | | PERCENT
ALL 100 DON’T KNOW d REFUSED r |
C16. (Do/Did) you pay yourself a regular salary from your business? |
YES 01 NO (GO TO C18) 00 DON’T KNOW (GO TO C18) d REFUSED (GO TO C18) r |
YES 01 NO (GO TO C18) 00 DON’T KNOW (GO TO C18) d REFUSED (GO TO C18) r |
C17. Before taxes and other deductions, how much (do/did) you pay yourself from this business?
(Is/Was) that per week, per month, per year or something else? |
$ | | | |,| | | |
HOUR 01 DAY 02 WEEK 03 EVERY TWO WEEKS 04 TWICE A MONTH 05 MONTHLY 06 YEAR 07 OTHER (SPECIFY) 08
DON’T KNOW d REFUSED r |
$ | | | |,| | | |
HOUR 01 DAY 02 WEEK 03 EVERY TWO WEEKS 04 TWICE A MONTH 05 MONTHLY 06 YEAR 07 OTHER (SPECIFY) 08
DON’T KNOW d REFUSED r |
THIRD BUSINESS |
FOURTH BUSINESS |
FIFTH BUSINESS |
___________________________________ ___________________________________ ___________________________________
DON’T KNOW d REFUSED r |
___________________________________ ___________________________________ ___________________________________
DON’T KNOW d REFUSED r |
___________________________________ ___________________________________ ___________________________________
DON’T KNOW d REFUSED r |
YES 01 NO 00 DON’T KNOW d REFUSED r |
YES 01 NO 00 DON’T KNOW d REFUSED r |
YES 01 NO 00 DON’T KNOW d REFUSED r |
|
|
|
|
|
|
| | | NUMBER OF HOURS
DON’T KNOW d REFUSED r |
| | | NUMBER OF HOURS
DON’T KNOW d REFUSED r |
| | | NUMBER OF HOURS
DON’T KNOW d REFUSED r |
| | | PERCENT
ALL 100 DON’T KNOW d REFUSED r
|
| | | PERCENT
ALL 100 DON’T KNOW d REFUSED r |
| | | PERCENT
ALL 100 DON’T KNOW d REFUSED r |
YES 01 NO (GO TO C18) 00 DON’T KNOW (GO TO C18) d REFUSED (GO TO C18) r |
YES 01 NO (GO TO C18) 00 DON’T KNOW (GO TO C18) d REFUSED (GO TO C18) r |
YES 01 NO (GO TO C18) 00 DON’T KNOW (GO TO C18) d REFUSED (GO TO C18) r |
$ | | | |,| | | |
HOUR 01 DAY 02 WEEK 03 EVERY TWO WEEKS 04 TWICE A MONTH 05 MONTHLY 06 YEAR 07 OTHER (SPECIFY) 08
DON’T KNOW d REFUSED r |
$ | | | |,| | | |
HOUR 01 DAY 02 WEEK 03 EVERY TWO WEEKS 04 TWICE A MONTH 05 MONTHLY 06 YEAR 07 OTHER (SPECIFY) 08
DON’T KNOW d REFUSED r |
$ | | | |,| | | |
HOUR 01 DAY 02 WEEK 03 EVERY TWO WEEKS 04 TWICE A MONTH 05 MONTHLY 06 YEAR 07 OTHER (SPECIFY) 08
DON’T KNOW d REFUSED r |
|
MOST RECENT BUSINESS |
SECOND BUSINESS |
C18. Have you taken or received (any other) income payments from this business, including bonuses, profit distribution, or owners draw? |
YES 01 NO (GO TO C18b) 00 DON’T KNOW (GO TO C18b) d REFUSED (GO TO C18b) r
|
YES 01 NO (GO TO C18b) 00 DON’T KNOW (GO TO C18b) d REFUSED (GO TO C18b) r
|
C18a. Before taxes and other deductions, in total, about how much have these payments been?
PROBE: Your best estimate is fine. |
$ | | | |,| | | |.| | |
MORE THAN $999,999 01 DON’T KNOW d REFUSED r
|
$ | | | |,| | | |.| | |
MORE THAN $999,999 01 DON’T KNOW d REFUSED r |
C18b. (Do/Did) you pay a spouse, domestic partner, or other relative living in your household a regular salary from your business? |
YES 01 NO (GO TO C18d) 00 DON’T KNOW (GO TO C18d) d REFUSED (GO TO C18d) r |
YES 01 NO (GO TO C18d) 00 DON’T KNOW (GO TO C18d) d REFUSED (GO TO C18d) r |
C18c. Before taxes and other deductions, how much (do/did) you pay them from this business?
(Is/Was) that per week, per month, per year or something else?
|
$ | | | |,| | | |
HOUR 01 DAY 02 WEEK 03 EVERY TWO WEEKS 04 TWICE A MONTH 05 MONTHLY 06 YEAR 07 OTHER (SPECIFY) 08
DON’T KNOW d REFUSED r |
$ | | | |,| | | |
HOUR 01 DAY 02 WEEK 03 EVERY TWO WEEKS 04 TWICE A MONTH 05 MONTHLY 06 YEAR 07 OTHER (SPECIFY) 08
DON’T KNOW d REFUSED r |
C18d. Has a spouse, domestic partner, or other close relative living in your household received (any other) income payments from your business, including bonuses, profit distributions or owner’s draw? |
YES 01 NO (GO TO C18f) 00 DON’T KNOW (GO TO C18f) d REFUSED (GO TO C18f) r
|
YES 01 NO (GO TO C18f) 00 DON’T KNOW (GO TO C18f) d REFUSED (GO TO C18f) r
|
C18e. Before taxes and other deductions, in total, about how much have these payments been?
PROBE: Your best estimate is fine.
|
$ | | | |,| | | |
MORE THAN $999,999 01 DON’T KNOW d REFUSED r
|
$ | | | |,| | | |
MORE THAN $999,999 01 DON’T KNOW d REFUSED r
|
THIRD BUSINESS |
FOURTH BUSINESS |
FIFTH BUSINESS |
YES 01 NO (GO TO C18b) 00 DON’T KNOW (GO TO C18b) d REFUSED (GO TO C18b) r
|
YES 01 NO (GO TO C18b) 00 DON’T KNOW (GO TO C18b) d REFUSED (GO TO C18b) r
|
YES 01 NO (GO TO C18b) 00 DON’T KNOW (GO TO C18b) d REFUSED (GO TO C18b) r
|
$ | | | |,| | | |.| | |
MORE THAN $999,999 01 DON’T KNOW d REFUSED r
|
$ | | | |,| | | |.| | |
MORE THAN $999,999 01 DON’T KNOW d REFUSED r
|
$ | | | |,| | | |.| | |
MORE THAN $999,999 01 DON’T KNOW d REFUSED r
|
YES 01 NO (GO TO C18d) 00 DON’T KNOW (GO TO C18d) d REFUSED (GO TO C18d) r |
YES 01 NO (GO TO C18d) 00 DON’T KNOW (GO TO C18d) d REFUSED (GO TO C18d) r |
YES 01 NO (GO TO C18d) 00 DON’T KNOW (GO TO C18d) d REFUSED (GO TO C18d) r |
$ | | | |,| | | |
HOUR 01 DAY 02 WEEK 03 EVERY TWO WEEKS 04 TWICE A MONTH 05 MONTHLY 06 YEAR 07 OTHER (SPECIFY) 08
DON’T KNOW d REFUSED r |
$ | | | |,| | | |
HOUR 01 DAY 02 WEEK 03 EVERY TWO WEEKS 04 TWICE A MONTH 05 MONTHLY 06 YEAR 07 OTHER (SPECIFY) 08
DON’T KNOW d REFUSED r |
$ | | | |,| | | |
HOUR 01 DAY 02 WEEK 03 EVERY TWO WEEKS 04 TWICE A MONTH 05 MONTHLY 06 YEAR 07 OTHER (SPECIFY) 08
DON’T KNOW d REFUSED r |
YES 01 NO (GO TO C18f) 00 DON’T KNOW (GO TO C18f) d REFUSED (GO TO C18f) r
|
YES 01 NO (GO TO C18f) 00 DON’T KNOW (GO TO C18f) d REFUSED (GO TO C18f) r
|
YES 01 NO (GO TO C18f) 00 DON’T KNOW (GO TO C18f) d REFUSED (GO TO C18f) r
|
$ | | | |,| | | |
MORE THAN $999,999 01 DON’T KNOW d REFUSED r
|
$ | | | |,| | | |
MORE THAN $999,999 01 DON’T KNOW d REFUSED r
|
$ | | | |,| | | |
MORE THAN $999,999 01 DON’T KNOW d REFUSED r
|
|
MOST RECENT BUSINESS |
SECOND BUSINESS |
C18f. PROGRAMMER: CHECK QUESTION C7. IS SM STILL OPERATING BUSINESS? |
YES (GO TO C20a) 01
NO 00
|
|
C19. Did you sell this business? |
YES 01
NO (GO TO C20a) 00
DON’T KNOW (GO TO C20a) d
REFUSED (GO TO C20a) r
|
|
C20. How much did you sell this business for? |
$| | | |,| | | |
MORE THAN $999,999 01
DON’T KNOW d
REFUSED r |
|
C20a. PROGRAMMER: CHECK QUESTION C4b. IS THERE ANOTHER PERIOD OF SELF-EMPLOYMENT? |
YES (GO TO C6, COLUMN 2) 01
NO (CONTINUE) 00
|
YES (GO TO C6, COLUMN 3) 01
NO (CONTINUE) 00 |
THIRD BUSINESS |
FOURTH BUSINESS |
FIFTH BUSINESS |
|
|
|
|
|
|
|
|
|
CONTINUE COLUMN 4) 01
NO (CONTINUE) 00
|
YES (GO TO C6, COLUMN 5) 01
NO (CONTINUE) 00
|
|
C21. The next questions are about your (current/most recent) business, that is [NAME OF BUSINESS IN C5, FIRST COLUMN]. (Is/Was) your business structured as a sole proprietorship, a partnership, a corporation, or a cooperative?
INTERVIEWER: IF RESPONDENT CURRENTLY OWNS MORE THAN ONE BUSINESS, ASK ABOUT THE LARGEST.
SOLE
PROPRIETORSHIP 01 GO
TO C23
PARTNERSHIP 02
CORPORATION 03
COOPERATIVE 04
OTHER (SPECIFY) 05
DON’T KNOW d
REFUSED r
C22. What percent of this business (do/did) you own?
| | | PERCENT
ALL 100
GO
TO C23
DON’T KNOW d
REFUSED r
C22a. (Do/Did) any members of your immediate family own part of this business?
YES 01
NO 00
DON’T KNOW d
REFUSED r
C22b. What percent of the business (do/did) they own?
| | | PERCENT
DON’T KNOW d
REFUSED r
C23. Did you start this business from scratch, or did you acquire it from someone else?
STARTED
FROM SCRATCH 01 GO
TO C27
ACQUIRED FROM SOMEONE ELSE/
OTHER ENTITY 02
DON’T KNOW d
REFUSED r
C24. Did you buy this business?
YES 01
NO 00
DON’T KNOW d
REFUSED r
C25. How much did you pay for it?
$ | | | |,| | | |.| | |
MORE THAN $999,999 01
DON’T KNOW d
REFUSED r
GO TO C27 |
C26. How did you acquire ownership of this business?
RECEIVED TRANSFER OF
OWNERSHIP/GIFT 01
INHERITED 02
OTHER (SPECIFY) 03
DON’T KNOW d
REFUSED r
C27. Have you invested any of your own money into this business since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW)? Please do not include money borrowed or otherwise received from relatives.
YES 01
NO 00
DON’T KNOW d
REFUSED r
C28. Since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW), how much of your own money have you invested in this business?
PROBE: Your best estimate is fine.
$ | | | |,| | | |
MORE THAN $999,999 01
DON’T KNOW d
REFUSED r
C29. Since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW), did you borrow any money for this business?
YES 01
NO 00
DON’T KNOW d
REFUSED r
C30. How much have you borrowed for this business?
$ | | | |,| | | |
MORE THAN $999,999 01
DON’T KNOW d
REFUSED r
C31. Did you obtain a personal loan, a business loan, or both?
PERSONAL LOAN 01
BUSINESS
LOAN 02 GO
TO C33
BOTH 03
DON’T KNOW d
REFUSED r
C32. What was the source of your personal loan? Was it . . .
CIRCLE ALL THAT APPLY
A credit card, 01
A home mortgage or home equity line of credit, 02
A family member, or 03
A friend? 04
OTHER (SPECIFY) 05
DON’T KNOW d
REFUSED r
C32a. What was the total amount of (this personal loan/these personal loans)?
$ | | | |,| | | | AMOUNT
MORE THAN $999,999 01
DON’T KNOW d
REFUSED r
C32b. What was the interest rate for (this loan/the largest loan you obtained)?
| | | PERCENT
DON’T KNOW d
REFUSED r
C32c. What was the length of (this loan/the largest loan you obtained)? RECORD LENGTH AND CODE TIME UNIT.
| | | LENGTH
WEEKS 01
MONTHS 02
YEARS 03
DON’T KNOW d
REFUSED r
C32d. |
IF C31=01 GO TO C36a; OTHERWISE CONTINUE |
C33. From what source did you receive your business loan?
CIRCLE ALL THAT APPLY
A BANK OR CREDIT UNION 01
SMALL BUSINESS ADMINISTRATION (SBA) 02
ANOTHER GOVERNMENT LOAN 03
INVESTMENT COMPANY 04
OTHER (SPECIFY) 05
DON’T KNOW d
REFUSED r
C33a. |
PROGRAMMER: IF C33=02, CONTINUE; OTHERWISE, GO TO C34a. |
C34. Was the Small Business Administration loan an SBA Microloan, an SBA-guaranteed loan, a 504 Certified Development Company loan, or a Small Business Investment Companies loan?
SBA MICROLOAN 01
SBA-GUARANTEED LOAN 02
504 CERTIFIED DEVELOPMENT
COMPANY LOAN 03
SMALL BUSINESS INVESTMENT
COMPANIES LOAN 04
OTHER (SPECIFY) 05
DON’T KNOW d
REFUSED r
C34a. What was the total amount of this business loan or loans?
$ | | | |,| | | | AMOUNT
MORE THAN $999,999 01
DON’T KNOW d
REFUSED r
C35. What was the interest rate for (this loan/the largest loan)?
| | | PERCENT
DON’T KNOW d
REFUSED r
C36. What was the length of (the loan/the largest loan)? RECORD LENGTH AND CODE TIME UNIT.
| | | LENGTH
WEEKS 01
MONTHS 02
YEARS 03
DON’T KNOW d
REFUSED r
C36a. Did you receive any grants to start your business?
YES 01
NO 00
DON’T KNOW d
REFUSED r
C36b. What was the total amount of these grants?
$ | | | |,| | | |
MORE THAN $999,999 01
DON’T KNOW d
REFUSED r
C36c. What was the source of these grants?
RECORD VERBATIM:
C37. Apart from any of your own money, money you borrowed, or grants you received since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW), did you use any other sources of capital, such as gifts from family members or friends, or the sale of another business, to start or grow your business?
YES 01
NO 00
DON’T KNOW d
REFUSED r
C38. Altogether, how much did you receive from these sources since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW)?
$ | | | |,| | | |
MORE THAN $999,999 01
DON’T KNOW d
REFUSED r
C39. What were these other sources of capital?
CIRCLE ALL THAT APPLY
Gifts from family members 01
Gifts from friends 02
SALE OF ANOTHER BUSINESS 03
OTHER (SPECIFY) 04
DON’T KNOW d
REFUSED r
C40. Where is your (current/most recent) business located, in your home, an incubator, a commercially available space, or some other place?
HOME 01
INCUBATOR 02
COMMERCIALLY AVAILABLE SPACE 03
SOME OTHER PLACE (SPECIFY) 04
DON’T KNOW d
REFUSED r
C41. What is the zip code where your business (is/was) located?
| | | | | |
DON’T KNOW d
REFUSED r
C42. |
PROGRAMMER: IF C4a=01, CONTINUE; OTHERWISE, GO TO C52. |
C43. The next questions, are about (all of) the business(es) that you currently own. What is the total number of employees that currently work in your business(es)? Please exclude yourself, but include paid family members.
| | | NUMBER OF EMPLOYEES
NONE 00
GO
TO C49
DON’T KNOW d
REFUSED r
C44. How many of these employees are working 35 or more hours per week, and how many are working less than 35 hours per week in (this business/these businesses)?
IF RESPONDENT SAYS “NONE,” CODE 00.
| | | NUMBER OF FULL-TIME EMPLOYEES
| | | NUMBER OF PART-TIME EMPLOYEES
DON’T KNOW d
REFUSED r
C45. How many of your immediate family members work in (this business/these businesses)? Please do not include yourself.
| | | NUMBER
NONE 00
DON’T KNOW d
REFUSED r
C46. What (is/are) (this business/these businesses) current monthly payroll?
$ | | | |,| | | |.| | | PAYROLL AMOUNT
MORE THAN $999,999 01
DON’T
KNOW d
REFUSED r
C47. Does this amount include payments to yourself?
YES 01
NO 00
DON’T KNOW d
REFUSED r
C48. Next, I will read a list of benefits that some people get through their jobs. Do all of your employees, some of your employees, or none of your employees currently receive . . .
|
|
CODE ALL, SOME, OR NONE FOR EACH |
||||
|
|
ALL |
SOME |
NONE |
DON’T KNOW |
REFUSED |
|
|
|
|
|
|
|
a. |
paid sick leave? |
01 |
02 |
00 |
d |
r |
b. |
paid vacation? |
01 |
02 |
00 |
d |
r |
c. |
paid holidays? |
01 |
02 |
00 |
d |
r |
d. |
health insurance or membership in an HMO or PPO plan? |
01 |
02 |
00 |
d |
r |
e. |
retirement or pension benefits, a 401K plan? |
01 |
02 |
00 |
d |
r |
f. |
life insurance? |
01 |
02 |
00 |
d |
r |
g. |
any other benefits? (SPECIFY) |
01 |
02 |
00 |
d |
r |
|
|
|
|
|
|
|
C49. Now, please tell me if you receive these benefits through your business . . .
|
|
CODE YES OR NO FOR EACH |
|||
|
|
YES |
NO |
DON’T KNOW |
REFUSED |
a. |
paid sick leave? |
01 |
00 |
d |
r |
b. |
paid vacation? |
01 |
00 |
d |
r |
c. |
paid holidays? |
01 |
00 |
d |
r |
d. |
health insurance or membership in an HMO or PPO plan? |
01 |
00 |
d |
r |
e. |
retirement or Pension benefits, a 401K plan? |
01 |
00 |
d |
r |
f. |
life insurance? |
01 |
00 |
d |
r |
g. |
any other benefits? (SPECIFY) |
01 |
00 |
d |
r |
|
|
|
|
|
|
C50. |
PROGRAMMER: IF C49d=00 OR d OR r, GO TO C51. OTHERWISE, GO TO C52 |
C51. Do you have health insurance?
YES 01
NO 00
DON’T KNOW d
REFUSED r
C51a. What is the source of that insurance?
THROUGH SPOUSE’S INSURER 01
THROUGH YOUR EMPLOYER’S
INSURER 02
THROUGH TRADE ASSOCIATION’S
INSURER 03
THROUGH MEDICAID OR OTHER
PUBLIC HEALTH INSURANCE 04
THROUGH A PRIVATE INSURER 05
THROUGH SOME OTHER
SOURCE (SPECIFY) 06
DON’T KNOW d
REFUSED r
C52. When you started (this business/these businesses), did you have health insurance coverage?
YES 01
NO 00
DON’T KNOW d
REFUSED r
C53. When you started (this business/these businesses), did other household members have any earnings?
YES 01
NO 00
DON’T KNOW d
REFUSED r
C54. What would you say were the most difficult challenges you faced when you started (this business/these businesses)?
CIRCLE ALL THAT APPLY
LACK OF CAPITAL OR START-UP FUNDS 01
AMOUNT OF TIME/WORK INVOLVED 02
INSUFFICIENT SALES 03
INSUFFICIENT CASH FLOW 04
DIFFICULTIES HIRING QUALIFIED STAFF 05
LOCAL COMPETITION 06
BECOMING KNOWN/GETTING EXPOSURE 07
TAXES 08
INSURANCE 09
REGULATIONS/LICENSES 10
DEALING WITH CLIENTS 11
UNCERTAINTY/CHANGING ECONOMY 12
FINDING A LOCATION 13
PROBLEMS WITH SUPPLY OF PRODUCT
OR MATERIAL AVAILABILITY 14
PERSONAL/FAMILY BARRIERS 15
FINDING CLIENTS 16
OTHER (SPECIFY) 17
DON’T KNOW d
REFUSED r
GO TO D0 |
C55. At any time since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW) have you tried to start a business?
YES 01
NO 00
DON’T KNOW d
REFUSED r
C56. What would you say were the most difficult challenges you faced trying to start your own business?
CIRCLE ALL THAT APPLY
LACK OF CAPITAL OR START-UP FUNDS 01
AMOUNT OF TIME/WORK INVOLVED 02
INSUFFICIENT SALES 03
INSUFFICIENT CASH FLOW 04
DIFFICULTIES HIRING QUALIFIED STAFF 05
LOCAL COMPETITION 06
BECOMING KNOWN/GETTING EXPOSURE 07
TAXES 08
INSURANCE 09
REGULATIONS/LICENSES 10
DEALING WITH CLIENTS 11
UNCERTAINTY/CHANGING ECONOMY 12
FINDING A LOCATION 13
PROBLEMS WITH SUPPLY OF PRODUCT
OR MATERIAL AVAILABILITY 14
PERSONAL/FAMILY BARRIERS 15
FINDING CLIENTS 16
OTHER (SPECIFY) 17
DON’T KNOW d
REFUSED r
SECTION D: EMPLOYMENT, WORKING FOR SOMEONE ELSE |
|
PROGRAMMER:
THIS IS A 6-MONTH FOLLOW-UP INTERVIEW OR AN 18-MONTH FOLLOW-UP WITHOUT A COMPLETED 6-MONTH FOLLOW-UP INTERVIEW. GO TO D0a
THIS IS AN 18-MONTH FOLLOW-UP INTERVIEW WITH A COMPLETED 6-MONTH FOLLOW-UP INTERVIEW. GO TO D3 |
D0a. The next questions are about jobs you have had where you worked for someone else.
Prior to (RANDOM ASSIGNMENT DATE), did you ever have a job where you worked for someone else? Please include part-time and full-time jobs, and military service.
YES 01
NO 00
DON’T KNOW d
REFUSED r
D1. Prior to (RANDOM ASSIGNMENT DATE), approximately, how long did you work all together on jobs where you worked for someone else?
RECORD LENGTH AND CODE TIME UNIT.
| | | LENGTH
WEEKS 01
MONTHS 02
YEARS 03
DON’T KNOW d
REFUSED r
D2. How much of the (TIME IN D1) you worked for someone else prior to (RANDOM ASSIGNMENT DATE) were you working as a manager? By manager we mean anyone who supervises other staff or oversees parts of a business.
RECORD LENGTH AND CODE TIME UNIT.
| | | LENGTH
NONE 00
WEEKS 01
MONTHS 02
YEARS 03
DON’T KNOW d
REFUSED r
D3. The next questions are about full and part-time jobs (including military service) you may have held since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW) where you were working for someone else.
Are you currently working for someone else?
YES 01
GO
TO D6
NO 00
DON’T KNOW d
REFUSED r
D4. What are you currently doing?
CIRCLE ALL THAT APPLY
SELF-EMPLOYED 01
TRYING TO START MY OWN BUSINESS 02
LOOKING FOR WORK 03
PARTICIPATING IN EDUCATION OR
TRAINING PROGRAM 04
TAKING CARE OF CHILD/FAMILY MEMBER/
SICK RELATIVE 05
RETIRED 06
CURRENTLY ILL 07
NOTHING 08
INCARCERATED 09
OTHER (SPECIFY) 10
DON’T KNOW d
REFUSED r
D5. Have you had a job that lasted two weeks or longer since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW)? Please include part-time and full-time jobs, and military service.
YES 01
GO
TO D7
NO 00
DON’T KNOW d
REFUSED r
D6. Currently, how many different full- and part-time jobs do you have where you work for someone else?
ONE 01
TWO OR MORE 02
DON’T KNOW d
REFUSED r
|
CURRENT/MOST RECENT JOB | 01 | |
SECOND MOST RECENT JOB | 02 | |
D7. What is the name of the employer (for whom you work the most hours/for whom you worked more than two weeks since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW)?
INTERVIEWER: RECORD EMPLOYER/BUSINESS NAME FOR THIS JOB IN D7, COLUMN 1, AS JOB 1. THEN GO TO D7a.
RECORD EMPLOYER NAME(S) ACROSS THE TOP OF THE GRID FIRST. THEN ASK D8-D21 DOWN FOR EACH JOB. |
_________________________________
_________________________________
|
_________________________________
_________________________________
|
D7a. Where else have you worked since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW)? Please include any (other current jobs whether), part-time or full-time jobs.
PROBE: Where did you work before (LAST JOB)?
MANDATORY PROBE: Where else have you worked?
RECORD AS NEXT JOB IN COLUMN HEADER. |
|
|
D8. When did you start working for (EMPLOYER)?
PROBE: Your best estimate is fine.
IF DK DAY, PROBE: Was it the beginning, middle, or end of the month?
IF "BEGINNING," ENTER 05; IF "MIDDLE," ENTER 15; IF "END," ENTER 25.
START DATE CAN BE BEFORE (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW). |
START: | | |/| | |/| | | | | MONTH DAY YEAR
DON’T KNOW d
REFUSED r
|
START: | | |/| | |/| | | | | MONTH DAY YEAR
DON’T KNOW d
REFUSED r
|
D9. When did you stop working for (EMPLOYER)?
IF STILL WORKING AT JOB, CIRCLE “n.”
IF DK DAY, PROBE: Was it the beginning, middle, or end of the month?
IF "BEGINNING," ENTER 05; IF "MIDDLE," ENTER 15; IF "END," ENTER 25.
STOP DATE MUST COME AFTER (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW). |
STOP: | | |/| | |/| | | | | MONTH DAY YEAR
STILL AT JOB n
DON’T KNOW d
REFUSED r
|
STOP: | | |/| | |/| | | | | MONTH DAY YEAR
STILL AT JOB n
DON’T KNOW d
REFUSED r
|
JOB | 03 | |
JOB | 04 | |
JOB | 05 | |
_________________________________
_________________________________
|
_________________________________
_________________________________
|
_________________________________
_________________________________
|
|
|
|
START: | | |/| | |/| | | | | MONTH DAY YEAR
DON’T KNOW d
REFUSED r
|
START: | | |/| | |/| | | | | MONTH DAY YEAR
DON’T KNOW d
REFUSED r
|
START: | | |/| | |/| | | | | MONTH DAY YEAR
DON’T KNOW d
REFUSED r
|
STOP: | | |/| | |/| | | | | MONTH DAY YEAR
STILL AT JOB n
DON’T KNOW d
REFUSED r
|
STOP: | | |/| | |/| | | | | MONTH DAY YEAR
STILL AT JOB n
DON’T KNOW d
REFUSED r
|
STOP: | | |/| | |/| | | | | MONTH DAY YEAR
STILL AT JOB n
DON’T KNOW d
REFUSED r
|
|
CURRENT/MOST RECENT JOB | 01 | |
SECOND MOST RECENT JOB | 02 | |
D10. What kind of company (is/was) (EMPLOYER)? What (do/did) they make, sell, or do?
PROBE FOR TYPE OF PRODUCT OR SERVICE. |
_________________________________
_________________________________
_________________________________
DON’T KNOW d
REFUSED r
|
_________________________________
_________________________________
_________________________________
DON’T KNOW d
REFUSED r
|
D11. What (do/did) you do there?
PROBE: What (is/was) your job title?
PROBE FOR CLEAR AND DESCRIPTIVE ACTIVITIES AND JOB TITLE. PROBE FOR A VERB. |
_________________________________
_________________________________
_________________________________
DON’T KNOW d
REFUSED r
|
_________________________________
_________________________________
_________________________________
DON’T KNOW d
REFUSED r
|
D12. Which of the following best describes your employment status at (this/that) job? (Are/Were) you . . .
|
an employee, working for pay at a private company, 01
a local, state, federal government employee, 02
on active military duty, or 03
working without pay? 04
OTHER (SPECIFY) 05
DON’T KNOW d
REFUSED r
|
an employee, working for pay at a private company, 01
a local, state, federal government employee, 02
on active military duty, or 03
working without pay? 04
OTHER (SPECIFY) 05
DON’T KNOW d
REFUSED r
|
D13. How many hours (do/did) you usually work in an average week at (EMPLOYER)?
PROBE: Your best estimate is fine.
|
| | | | HOURS PER WEEK
DON’T KNOW d
REFUSED r |
| | | | HOURS PER WEEK
DON’T KNOW d
REFUSED r |
JOB | 03 | |
JOB | 04 | |
JOB | 05 | |
_________________________________
_________________________________
_________________________________
DON’T KNOW d
REFUSED r
|
_________________________________
_________________________________
_________________________________
DON’T KNOW d
REFUSED r
|
_________________________________
_________________________________
_________________________________
DON’T KNOW d
REFUSED r
|
_________________________________
_________________________________
_________________________________
DON’T KNOW d
REFUSED r
|
_________________________________
_________________________________
_________________________________
DON’T KNOW d
REFUSED r
|
_________________________________
_________________________________
_________________________________
DON’T KNOW d
REFUSED r
|
an employee, working for pay at a private company, 01
a local, state, federal government employee, 02
on active military duty, or 03
working without pay? 04
OTHER (SPECIFY) 05
DON’T KNOW d
REFUSED r
|
an employee, working for pay at a private company, 01
a local, state, federal government employee, 02
on active military duty, or 03
working without pay? 04
OTHER (SPECIFY) 05
DON’T KNOW d
REFUSED r
|
an employee, working for pay at a private company, 01
a local, state, federal government employee, 02
on active military duty, or 03
working without pay? 04
OTHER (SPECIFY) 05
DON’T KNOW d
REFUSED r
|
| | | | HOURS PER WEEK
DON’T KNOW d
REFUSED r |
| | | | HOURS PER WEEK
DON’T KNOW d
REFUSED r |
| | | | HOURS PER WEEK
DON’T KNOW d
REFUSED r |
|
CURRENT/MOST RECENT JOB | 01 | |
SECOND MOST RECENT JOB | 02 | |
D14. INTERVIEWER: CHECK D12. IS CODE 04, “WORKING WITHOUT PAY,” CIRCLED? |
YES (GO TO D18) 01
NO 00 |
YES (GO TO D18) 01
NO 00 |
D15. What (is/was) your (current/most recent) hourly rate of pay, before taxes and other deductions?
WATCH THE DECIMAL POINT. |
PER HOUR: $ | | |.| | |
DON’T KNOW OR NOT PAID BY HOUR d
REFUSED r |
PER HOUR: $ | | |.| | |
DON’T KNOW OR NOT PAID BY HOUR d
REFUSED r |
D15a. (Do/Did) you receive any tips, bonuses, or commissions?
|
YES 01 NO (GO TO D16) 00 DON’T KNOW (GO TO D16) d REFUSED (GO TO D16) r |
YES 01 NO (GO TO D16) 00 DON’T KNOW (GO TO D16) d REFUSED (GO TO D16) r |
D15b. How much are these tips, bonuses, or commissions?
RECORD AMOUNT AND CODE THE UNIT.
|
$ | | |,| | | |
PER DAY 01 PER WEEK 02 ONCE EVERY TWO WEEKS 03 TWICE A MONTH 04 PER MONTH 05 PER YEAR 06 DON’T KNOW d REFUSED r |
$ | | |,| | | |
PER DAY 01 PER WEEK 02 ONCE EVERY TWO WEEKS 03 TWICE A MONTH 04 PER MONTH 05 PER YEAR 06 DON’T KNOW d REFUSED r |
D16. What (are/were) your (current/ most recent) weekly or monthly earnings, before taxes and other deductions? Please include any tips, bonuses, or commissions.
CIRCLE PAY PERIOD CODE.
ACCEPT MOST CONVENIENT TIME PERIOD.
PROBE: Your best estimate is fine.
PROBE, IF PER JOB/PIECE/ UNIT: How much did you earn in a typical day? |
$ | | |,| | | |
PER DAY 01 PER WEEK 02 ONCE EVERY TWO WEEKS 03 TWICE A MONTH 04 PER MONTH 05 PER YEAR 06 DON’T KNOW d REFUSED r
|
$ | | |,| | | |
PER DAY 01 PER WEEK 02 ONCE EVERY TWO WEEKS 03 TWICE A MONTH 04 PER MONTH 05 PER YEAR 06 DON’T KNOW d REFUSED r
|
D17. (Are/Were) the following benefits available to you on your job at (EMPLOYER)?
READ CATEGORIES.
CIRCLE YES OR NO FOR EACH.
CODE YES IF BENEFIT (IS/WAS) AVAILABLE WHETHER OR NOT SAMPLE MEMBER (USED/ SUBSCRIBED) TO BENEFIT.
|
YES NO
a. Paid sick leave? 01 00
b. Paid vacation? 01 00
c. Paid holidays? 01 00
d. Health insurance, or membership in an HMO or PPO plan? 01 00
e. Retirement, or pension benefits or a 401K plan? 01 00
f. Life insurance? 01 00
g. Any other benefits? (SPECIFY) 01 00
DON’T KNOW d
REFUSED r |
YES NO
a. Paid sick leave? 01 00
b. Paid vacation? 01 00
c. Paid holidays? 01 00
d. Health insurance, or membership in an HMO or PPO plan? 01 00
e. Retirement, or pension benefits or a 401K plan? 01 00
f. Life insurance? 01 00
g. Any other benefits? (SPECIFY) 01 00
DON’T KNOW d
REFUSED r |
JOB | 03 | |
JOB | 04 | |
JOB | 05 | |
YES (GO TO D18) 01
NO 00 |
YES (GO TO D18) 01
NO 00 |
YES (GO TO D18) 01
NO 00 |
PER HOUR: $ | | |.| | |
DON’T KNOW OR NOT PAID BY HOUR d
REFUSED r |
PER HOUR: $ | | |.| | |
DON’T KNOW OR NOT PAID BY HOUR d
REFUSED r |
PER HOUR: $ | | |.| | |
DON’T KNOW OR NOT PAID BY HOUR d
REFUSED r |
YES 01 NO (GO TO D16) 00 DON’T KNOW (GO TO D16) d REFUSED (GO TO D16) r |
YES 01 NO (GO TO D16) 00 DON’T KNOW (GO TO D16) d REFUSED (GO TO D16) r |
YES 01 NO (GO TO D16) 00 DON’T KNOW (GO TO D16) d REFUSED (GO TO D16) r |
$ | | |,| | | |
PER DAY 01 PER WEEK 02 ONCE EVERY TWO WEEKS 03 TWICE A MONTH 04 PER MONTH 05 PER YEAR 06 DON’T KNOW d REFUSED r |
$ | | |,| | | |
PER DAY 01 PER WEEK 02 ONCE EVERY TWO WEEKS 03 TWICE A MONTH 04 PER MONTH 05 PER YEAR 06 DON’T KNOW d REFUSED r |
$ | | |,| | | |
PER DAY 01 PER WEEK 02 ONCE EVERY TWO WEEKS 03 TWICE A MONTH 04 PER MONTH 05 PER YEAR 06 DON’T KNOW d REFUSED r |
$ | | |,| | | |
PER DAY 01 PER WEEK 02 ONCE EVERY TWO WEEKS 03 TWICE A MONTH 04 PER MONTH 05 PER YEAR 06 DON’T KNOW d REFUSED r
|
$ | | |,| | | |
PER DAY 01 PER WEEK 02 ONCE EVERY TWO WEEKS 03 TWICE A MONTH 04 PER MONTH 05 PER YEAR 06 DON’T KNOW d REFUSED r
|
$ | | |,| | | |
PER DAY 01 PER WEEK 02 ONCE EVERY TWO WEEKS 03 TWICE A MONTH 04 PER MONTH 05 PER YEAR 06 DON’T KNOW d REFUSED r
|
YES NO
a. Paid sick leave? 01 00
b. Paid vacation? 01 00
c. Paid holidays? 01 00
d. Health insurance, or membership in an HMO or PPO plan? 01 00
e. Retirement, or pension benefits or a 401K plan? 01 00
f. Life insurance? 01 00
g. Any other benefits? (SPECIFY) 01 00
DON’T KNOW d
REFUSED r |
YES NO
a. Paid sick leave? 01 00
b. Paid vacation? 01 00
c. Paid holidays? 01 00
d. Health insurance, or membership in an HMO or PPO plan? 01 00
e. Retirement, or pension benefits or a 401K plan? 01 00
f. Life insurance? 01 00
g. Any other benefits? (SPECIFY) 01 00
DON’T KNOW d
REFUSED r |
YES NO
a. Paid sick leave? 01 00
b. Paid vacation? 01 00
c. Paid holidays? 01 00
d. Health insurance, or membership in an HMO or PPO plan? 01 00
e. Retirement, or pension benefits or a 401K plan? 01 00
f. Life insurance? 01 00
g. Any other benefits? (SPECIFY) 01 00
DON’T KNOW d
REFUSED r |
|
CURRENT/MOST RECENT JOB | 01 | |
SECOND MOST RECENT JOB | 02 | |
|
D18. INTERVIEWER: CHECK D9. IS CODE n, “STILL AT THIS JOB,” CIRCLED? |
YES (GO TO D21a) 01
NO 00
|
YES (GO TO D21a) 01
NO 00
|
|
D19. Why did you stop working at (EMPLOYER)? Did you quit, retire, were you laid off or fired, or did the period you were scheduled to work there end?
PROBE: What reason were you given by your employer?
CIRCLE ONE CODE ONLY. |
QUIT 01
RETIRE 02
LAID OFF 03
FIRED 04
WORK PERIOD/TEMPORARY JOB ENDED 05
OTHER (SPECIFY) 06
DON’T KNOW d
REFUSED r
|
QUIT 01
RETIRE 02
LAID OFF 03
FIRED 04
WORK PERIOD/TEMPORARY JOB ENDED 05
OTHER (SPECIFY) 06
DON’T KNOW d
REFUSED r
|
|
|
D20. When that job ended, did you receive severance pay? |
YES 01
NO 00
DON’T KNOW d
REFUSED r
|
YES 01
NO 00
DON’T KNOW d
REFUSED r
|
|
D21. When that job ended, what did you do?
CIRCLE ALL THAT APPLY. |
TOOK ANOTHER JOB WORKING FOR SOMEONE ELSE 01
STARTED A BUSINESS 02
WORKED ON STARTING MY OWN BUSINESS 03
LOOKED FOR WORK 04
PARTICIPATED IN EDUCATION/ TRAINING PROGRAM 05
TOOK CARE OF CHILD/FAMILY MEMBER/SICK RELATIVE 06
RETIRED 07
WAS SICK 08
OTHER (SPECIFY) 09
DON’T KNOW d
REFUSED r
|
TOOK ANOTHER JOB WORKING FOR SOMEONE ELSE 01
STARTED A BUSINESS 02
WORKED ON STARTING MY OWN BUSINESS 03
LOOKED FOR WORK 04
PARTICIPATED IN EDUCATION/ TRAINING PROGRAM 05
TOOK CARE OF CHILD/FAMILY MEMBER/SICK RELATIVE 06
RETIRED 07
WAS SICK 08
OTHER (SPECIFY) 09
DON’T KNOW d
REFUSED r
|
|
D21a. INTERVIEWER: IS THERE ANOTHER JOB? CHECK D7. |
YES (GO TO D8, COLUMN 2) 01
NO 00 |
YES (GO TO D8, COLUMN 3) 01
NO 00 |
JOB | 03 | |
JOB | 04 | |
JOB | 05 | |
YES (GO TO D21a) 01
NO 00
|
YES (GO TO D21a) 01
NO 00
|
YES (GO TO D21a) 01
NO 00
|
QUIT 01
RETIRE 02
LAID OFF 03
FIRED 04
WORK PERIOD/TEMPORARY JOB ENDED 05
OTHER (SPECIFY) 06
DON’T KNOW d
REFUSED r
|
QUIT 01
RETIRE 02
LAID OFF 03
FIRED 04
WORK PERIOD/TEMPORARY JOB ENDED 05
OTHER (SPECIFY) 06
DON’T KNOW d
REFUSED r
|
QUIT 01
RETIRE 02
LAID OFF 03
FIRED 04
WORK PERIOD/TEMPORARY JOB ENDED 05
OTHER (SPECIFY) 06
DON’T KNOW d
REFUSED r
|
YES 01
NO 00
DON’T KNOW d
REFUSED r
|
YES 01
NO 00
DON’T KNOW d
REFUSED r
|
YES 01
NO 00
DON’T KNOW d
REFUSED r
|
TOOK ANOTHER JOB WORKING FOR SOMEONE ELSE 01
STARTED A BUSINESS 02
WORKED ON STARTING MY OWN BUSINESS 03
LOOKED FOR WORK 04
PARTICIPATED IN EDUCATION/ TRAINING PROGRAM 05
TOOK CARE OF CHILD/FAMILY MEMBER/SICK RELATIVE 06
RETIRED 07
WAS SICK 08
OTHER (SPECIFY) 09
DON’T KNOW d
REFUSED r
|
TOOK ANOTHER JOB WORKING FOR SOMEONE ELSE 01
STARTED A BUSINESS 02
WORKED ON STARTING MY OWN BUSINESS 03
LOOKED FOR WORK 04
PARTICIPATED IN EDUCATION/ TRAINING PROGRAM 05
TOOK CARE OF CHILD/FAMILY MEMBER/SICK RELATIVE 06
RETIRED 07
WAS SICK 08
OTHER (SPECIFY) 09
DON’T KNOW d
REFUSED r
|
TOOK ANOTHER JOB WORKING FOR SOMEONE ELSE 01
STARTED A BUSINESS 02
WORKED ON STARTING MY OWN BUSINESS 03
LOOKED FOR WORK 04
PARTICIPATED IN EDUCATION/ TRAINING PROGRAM 05
TOOK CARE OF CHILD/FAMILY MEMBER/SICK RELATIVE 06
RETIRED 07
WAS SICK 08
OTHER (SPECIFY) 09
DON’T KNOW d
REFUSED r
|
YES (GO TO D8, COLUMN 4) 01
NO 00 |
YES (GO TO D8, COLUMN 5) 01
NO 00 |
CONTINUE |
D21b. |
PROGRAMMER:
IF C4a=01 OR D3=01, CONTINUE. OTHERWISE GO TO E1. |
D22. Thinking about all the work you do, (whether for yourself or for someone else), how would you rate your overall satisfaction with your work? Would you say you are very satisfied, somewhat satisfied, somewhat dissatisfied or very dissatisfied with your work?
VERY SATISFIED 01
SOMEWHAT SATISFIED 02
SOMEWHAT DISSATISFIED 03
VERY DISSATISFIED 04
DON’T KNOW d
REFUSED r
SECTION E: INCOME SOURCES AND AMOUNTS |
E1. Now I’d like you to think about your household’s total income during the past twelve months. Please include income from self-employment, regular jobs, and earnings from odd jobs, under-the-table jobs, and other work activities; from Social Security, pensions, rent, interest and dividends, unemployment compensation, welfare; from food stamps, child support, and money from any other sources. What was the total income of all members of your household, including yourself, from all sources before taxes and deductions during the past twelve months?
PROBE: Your best estimate is fine.
$
|
| |
|,|
|
|
|
GO
TO E5
DON’T KNOW d
REFUSED r
E2. During the past twelve months, would you say your household income was less than $30,000, or $30,000 or more?
LESS
THAN $30,000 01 GO
TO E4
$30,000 OR MORE 02
DON’T
KNOW d
REFUSED r
E3. Would you say it was . . .
from $30,000 to under $45,000, 01
$45,000 to under $60,000, 02
$60,000 to under $75,000, 03
$75,000 to under $90,000, 04
$90,000 to under $105,000, or 05
more than $105,000? 06
DON’T KNOW d
REFUSED r
GO TO E5 |
E4. Would you say it was . . .
less than $5,000, 01
$5,000 to under $10,000, 02
$10,000 to under $15,000, 03
$15,000 to under $20,000, 04
$20,000 to under $25,000, or 05
$25,000 to under $30,000? 06
DON’T KNOW d
REFUSED r
E5. Since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW), have you or anyone else in your household received Unemployment Compensation, Trade Readjustment Allowances, or Trade Adjustment Assistance?
YES 01
NO 00
DON’T KNOW d
REFUSED r
E6. Altogether, since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW), for how many weeks did your household receive Unemployment Compensation or Trade Readjustment Allowances, or Trade Adjustment Assistance?
| | | | NUMBER OF WEEKS
OR
| | | NUMBER OF MONTHS
SINCE (RA/DATE OF LAST INTERVIEW) 01
DON’T KNOW d
REFUSED r
E7. On average, how much Unemployment Compensation, Trade Readjustment Allowances or Trade Adjustment Assistance did your household receive per week since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW)?
$ | | | |,| | | |
WEEKS 01
MONTHS 02
DON’T KNOW d
REFUSED r
E8. From which of these programs have you or your household received income since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW)?
ASK AND RECORD RESPONSES. THEN ASK E8b-E8c FOR EACH “YES” RESPONSE IN E8a.
E8a. OTHER SOURCES OF HOUSEHOLD INCOME |
YES |
NO |
ONE TIME PAYMENT |
DON’T KNOW |
REFUSED |
E8b. Since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW), how many months did you or your household receive (SOURCE)? |
E8c. On average, how much (SOURCE) per month did you or your household receive since (RANDOM ASSIGNMENT DATE/DATE OF LAST INTERVIEW)? |
a. Social Security Retirement, Disability, or Survivors’ benefits? |
01 |
00 |
02 |
d |
r |
| | | NUMBER OF MONTHS
DON’T KNOW d
REFUSED r |
$ | | | |,| | | | |
b. Other pensions, annuities, or other disability or retirement programs? |
01 |
00 |
02 |
d |
r |
| | | NUMBER OF MONTHS
DON’T KNOW d
REFUSED r |
$ | | | |,| | | | |
c. Cash welfare, including TANF (Minnesota Family Investment Program [MFIP]) benefits, General Assistance and Supplemental Security Income (SSI)? |
01 |
00 |
02 |
d |
r |
| | | NUMBER OF MONTHS
DON’T KNOW d
REFUSED r |
$ | | | |,| | | | |
d. Veteran’s payments? |
01 |
00 |
02 |
d |
r |
| | | NUMBER OF MONTHS
DON’T KNOW d
REFUSED r |
$ | | | |,| | | | |
e. Food Stamps? |
01 |
00 |
02 |
d |
r |
| | | NUMBER OF MONTHS
DON’T KNOW d
REFUSED r |
$ | | | |,| | | | |
SECTION F: HOUSEHOLD COMPOSITION, MARITALSTATUS, AND SPOUSE EMPLOYMENT |
F1. Now, we’d like to ask a few general questions. Are you currently married, living together but not married, separated, divorced, widowed, or have you never been married?
CIRCLE ONE ONLY
MARRIED/COMMON LAW 01
LIVING TOGETHER UNMARRIED 02
SEPARATED 03
DIVORCED 04
WIDOWED 05
NEVER MARRIED 06
DON’T KNOW d
REFUSED r
F2. Is your (husband/wife/partner) currently working for pay, either part-time or full-time? Please exclude any work (he/she) does for your business.
YES 01
NO 00
DON’T KNOW d
REFUSED r
F3. How much does (he/she) usually make per week before taxes and other deductions? Please include tips, commissions, and regular overtime.
INTERVIEWER: ACCEPT MOST CONVENIENT PAY PERIOD. IF NECESSARY, CONFIRM PAY PERIOD. ENTER AMOUNT, THEN CODE TIME PERIOD.
$ | |,| | | |.| | | AMOUNT
PER WEEK 01
ONCE EVERY TWO WEEKS 02
TWICE A MONTH 03
PER MONTH 04
PER YEAR 05
IN-KIND ONLY 06
DON’T KNOW d
REFUSED r
F4. How many hours a week on average does (he/she) work?
| | | | HOURS
DON’T KNOW d
REFUSED r
F5. Including yourself, how many people are currently living in your household? Please include babies, small children, people who are not related to you, and people who are temporarily away.
| | | NUMBER OF PEOPLE
LIVES ALONE 01
DON’T KNOW d
REFUSED r
F5a. Do you have any children under 18 years of age who live with you over half the time? Please include your own and adopted children, foster, stepchildren, or grandchildren.
YES 01
NO 00
DON’T KNOW d
REFUSED r
F5b. How many children under 18 years of age live with you?
| | | NUMBER
DON’T KNOW d
REFUSED r
SECTION G: CONTACT INFORMATION |
|
PROGRAMMER:
THIS IS THE 18-MONTH FOLLOW-UP INTERVIEW. GO TO G11
THIS IS THE 6-MONTH FOLLOW-UP INTERVIEW. GO TO G1 |
Thank you very much for your help. Your answers, together with the answers of other participants, will be used to study self-employment programs. To complete this study, we need to talk to you one more time. We plan to call you in about twelve months to get an update on your opinions and experiences.
To help us reach you for the next interview and so that we can send your honorarium of $15, we would like some additional information.
G1. First, just to make sure I have it right, the correct spelling of your name and address is . . .
YES, NAME AND ADDRESS CORRECT 01
NO 00
RECORD
CORRECT NAME AND/OR ADDRESS: NAME:
ADDRESS:
G2. Is there (a/another) number where you usually can be reached?
YES 01
RECORD
OTHER NUMBER:
|___|___|___|-|___|___|___|-|___|___|___|___|
NO 00
G3. In whose name is that phone listed?
G3a. And where is that (e.g., neighbor, work)?
G4. Do you expect to change your name in the next year or so?
YES 01
GO
TO G4a
NO 00 GO TO G5
G4a. What do you expect your name to be?
PROBE FOR FULL NAME.
G5. Do you expect to move at any time in the next year?
YES 01
NO 00
GO
TO G6a
G5a. Approximately when do you think that will be?
| | | / | | | / | | | | |
MONTH DAY YEAR
DON’T KNOW d
REFUSED r
G5b. Where do you expect to move?
INTERVIEWER, PROBE FOR SPECIFIC ADDRESS. IF SPECIFIC ADDRESS IS UNKNOWN, PROBE FOR CITY AND STATE.
ADDRESS APARTMENT #
|___|___|___|___|___|
CITY STATE ZIP
G6a. Do you have an e-mail address?
YES 01
NO 00
GO
TO G7
G6b. Please spell your e-mail address for me.
G7. What is your Social Security number?
| | | |-| | |-| | | | |
DON’T KNOW d
REFUSED r
G8. What is your date of birth?
| | | / | | | / | | | | |
MONTH DAY YEAR
DON’T KNOW d
REFUSED r
CLOSEST FRIEND/RELATIVE INFORMATION
G9. In case we have trouble reaching you, we would like to have the name of three people who would most likely know where you are or who you keep in close contact with. (We will not contact that person for any other reason.)
FIRST CONTACT
NAME:
What is (his/her) relationship to you?
ADDRESS:
PHONE NUMBER: (| | | |)-| | | |-| | | | |
In whose name is this phone listed?
SECOND CONTACT
NAME:
What is (his/her) relationship to you?
ADDRESS:
PHONE NUMBER: (| | | |)-| | | |-| | | | |
In whose name is this phone listed?
THIRD CONTACT
NAME:
What is (his/her) relationship to you?
ADDRESS:
PHONE NUMBER: (| | | |)-| | | |-| | | | |
In whose name is this phone listed?
G10. That completes the interview. Thank you for your time and cooperation.
TERMINATE INTERVIEW |
G11. Thank you very much for your help. Your answers, together with the answers of other GATE applicants, will be used to study self-employment programs.
G12. First, just to make sure I have it right, the correct spelling of your name and address is . . .
YES, NAME AND ADDRESS CORRECT 01
NO 00
RECORD
CORRECT NAME AND/OR ADDRESS: NAME:
ADDRESS:
G13. Is there another number where you usually can be reached?
YES 01
RECORD
OTHER NUMBER:
|___|___|___|-|___|___|___|-|___|___|___|___|
NO 00
G14. In whose name is that phone listed?
G14a. And where is that (e.g., neighbor, work)?
G15. What is your Social Security number?
| | | |-| | |-| | | | |
G16. What is your date of birth?
| | | / | | | / | | | | |
MONTH DAY YEAR
G17. That completes the interview. Thank you for your time and cooperation.
FOR MPR DOCUMENTATION PURPOSES ONLY:
(REV--9/26/03)
Shawn Marsh
8880-030
1 Programmer: These questions and answers should be available to interviewers any point in the questionnaire
| File Type | application/msword |
| File Title | Contract No |
| Author | Lynne Beres |
| Last Modified By | jsimonetta |
| File Modified | 2006-08-08 |
| File Created | 2006-08-08 |
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