National Household Education Survey (NHES) 2009 Study - Cognitive Interviews

System Clearance for Cognitive, Pilot and Field Test Studies

ECPP Survey

National Household Education Survey (NHES) 2009 Study - Cognitive Interviews

OMB: 1850-0803

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1850-0803 can be found here:

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2009 National Household Education Surveys Program

Early Childhood Program Participation Survey

December 29, 2008

This survey is for the family at:

{ADDRESS STREET}

{ADDRESS CITY, STATE & ZIP}

If this is not your address please call the toll-free number 1-888-696-5670.

If the address is correct, we ask that this survey be filled in by the adult who knows the most about:

{SAMPLED CHILD}

Please answer all the survey questions thinking about this child or youth.

If there is no one in this household who has either the same age or grade given above, or if you are unable to tell which child the survey is about, please call 1-888-696-5670.

Not all of the questions will apply to you – you will sometimes be asked to skip one or more questions based on your answers.

To answer a question, simply mark  the box that best represents your answer.

Use a black or blue pen to complete this survey. Do not use felt-tip pen or pencil.

Please choose only one answer per question, unless the question indicates Mark all that apply. Your best estimate is fine.

In a response to our first survey, we recorded that the child/youth has not yet started kindergarten. If this child is attending either public or private school or is homeschooled in grades Kindergarten through 12^th or equivalent mark the correct box below and return this survey in the postage paid envelope. We will send you the correct survey for this child.

This child attends public or private school in grades K through 12

This child is homeschooled in grades K through 12

The Privacy Act requires us to tell you that we are authorized to collect this information by Section 411.285a, 42 USC. You do not have to provide the information requested. However, the information you provide will help the Department of Education’s ongoing efforts to learn more about the educational experiences of children and families. There are no penalties should you choose not to participate in this study.

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: National Center for Education Statistics, U.S. Department of Education, 1990 K Street NW, Room 9065, Washington, DC 20006-5650. Do not return the completed form to this address.

Section 1. Early Childhood Care and Programs

These questions ask about different types of child care this child may now receive on a regular basis from someone other than his/her parents or guardians. This includes regular care and early childhood programs, whether or not there is a charge or fee, but not occasional babysitting.

Care Your Child Receives from Relatives

1. Is this child now receiving care from a relative other than a parent on a regular basis, for example, from grandparents, brothers or sisters, or any other relatives?

Y es
No GO TO QUESTION 18

2. Are any of these care arrangements regularly scheduled at least once a week?

Yes
N o GO TO QUESTION 18

3. These next questions are about the care that this child receives from the relative who provides the most care. How is that relative related to this child?

Mark [X] only one.

Grandmother/Grandfather
Aunt /Uncle
Brother /Sister
Another relative

4. How old is the relative who provides the most care to this child?

______ Years old

5. Is this care provided in your home or another home?

Own home
Other home
Both

6. How many days each week does this child receive care from this relative?

______ Days each week

7. How many hours each week does this child receive care from this relative?

______ Hours each week

8. How old was this child in years and months when this particular regular care arrangement with this relative began?

|___| Years

|___|___| Months

9. What language does this relative speak most when caring for this child?

English
Spanish
Other
English and Spanish equally
English and another language equally

10. Will this relative care for this child when the child is…

Yes

▼

Sick but does not have a fever?

□

Sick and has a fever?

□

11. Is this care arrangement Head Start?

Head Start is a federally sponsored preschool program primarily for children from low-income families.

12. Is there any charge or fee for the care this child receives from this relative, paid either by you or some other person or agency?

Yes
N o GO TO QUESTION 16

13. Do any of the following people or organizations help pay for this relative to care for this child?

		Yes ▼	No ▼
a.	A relative of this child outside your household who provides money specifically for that care, not including general child support?	□	□
b.	Temporary Assistance for Needy Families, or TANF?	□	□
c.	Another social service, welfare, or child care agency?	□	□
d.	An employer, not including a tax-free spending account for child care?	□	□
e.	Someone else?	□	□

14. How much does your household pay for this relative to care for this child, not counting any money that may be received from others to help pay for care?

Write ‘0’ if your household does not pay this relative for care.

______ Dollars per

Hour
Day
Week
Month
Year
Every 2 weeks
Other → specify:

15. How many children from your household is this amount for, including this child?

This child only
2 children
3 children
4 children
5 or more children

16. Does this child have any other care arrangements with a relative on a regular basis?

Yes
N o GO TO QUESTION 18

17. How many total hours each week does this child spend in those other care arrangements with relatives?

________ Hours each week

Care Your Child Receives from Nonrelatives

18. The next questions ask about any care this child receives from someone not related to him/her, either in your home or someone else’s home. This includes home child care providers or neighbors, but not day care centers or preschools.

Is this child now receiving care in your home or another home on a regular basis from someone who is not related to him/her?

Yes
N o GO TO QUESTION 36

19. Are any of these care arrangements regularly scheduled at least once a week?

Y es
No GO TO QUESTION 36

20. These next questions are about the care that this child receives from someone who is not related to him/her who provides the most care. Is this care provided in your own home or in another home?

Own home
O ther home GO TO QUESTION 22
B oth GO TO QUESTION 22

21. Does this person who cares for this child live in your household?

22. How many days each week does this child receive care from that person?

______ Days each week

23. How many hours each week does this child receive care from that person?

______ Hours each week

24. How old was this child in years and months when this particular regular care arrangement with that person began?

______ Years

______ Months

25. Was this care provider someone you already knew?

26. Is this child’s care provider age 18 or older?

27. What language does this care provider speak most when caring for this child?

English
Spanish
Other
English and Spanish equally
English and another language equally

28. Will this care provider care for this child when this child is…

Yes

▼

Sick but does not have a fever?

□

Sick and has a fever?

□

29. Is this care arrangement Head Start?

Head Start is a federally sponsored preschool program primarily for children from low-income families.

30. Is there any charge or fee for the care this child receives from this care provider, paid either by you or some other person or agency?

Yes
N o GO TO QUESTION 34

31. Do any of the following people or organizations help pay for that person to care for this child?

		Yes ▼	No ▼
a.	A relative of this child outside your household who provides money specifically for that care, not including general child support?	□	□
b.	Temporary Assistance for Needy Families, or TANF?	□	□
c.	Another social service, welfare, or child care agency?	□	□
d.	An employer, not including a tax-free spending account for child care?	□	□
e.	Someone else?	□	□

32. How much does your household pay for that person to care for this child, not counting any money that may be received from others to help pay for care?

Write ‘0’ if your household does not pay that person for care.

______ Dollars per

Hour
Day
Week
Month
Year
Every 2 weeks
Other→ specify:

33. How many children from your household is this amount for, including this child?

This child only
2 children
3 children
4 children
5 or more children

34. Does this child have any other care arrangements with someone who is not a relative on a regular basis? Do not include arrangements at day care centers or preschools.

Yes
N o QUESTION 36

35. How many total hours each week does this child spend in those other care arrangements with non-relatives?

_______Hours

Daycare Centers and Preschool Programs your Child Attends

36. The next questions ask about any day care centers and early childhood programs that this child attends.

Is this child now attending a day care center, preschool, or prekindergarten,?

Yes
N o GO TO QUESTION 54

37. Does this child go to a day care center, preschool, or prekindergarten, at least, once each week?

38. The next questions ask about the program where this child spends the most time.

Where is that program located?

Mark [X] only one.

Church, synagogue, or other place of worship
Public preschool or school (K-12)
Private preschool or school (K-12)
College or university
Community center
Public library
It’s own building, or storefront
Some other place → specify:

39. Is that program run by a church, synagogue, or other religious group?

40. Is that program located at your workplace or this child’s other parent’s workplace?

41. How many days each week does this child go to that program?

______ Days each week

42. How many hours each week does this child go to that program?

______ Hours each week

43. How old was this child in years and months when he/she started going to this particular program?

______ Years

______ Months

44. What language does this child’s main care provider or teacher at that program speak most when caring for this child?

English
Spanish
Other
English and Spanish equally
English and another language equally

45. Does that program provide any of the following services to this child or your family?

		Yes ▼	No ▼
a.	Hearing, speech, or vision testing?	□	□
b.	Physical examinations?	□	□
c.	Dental examinations?	□	□
d.	Formal testing for developmental or learning problems?	□	□
e.	Sick child care when this child is sick but does not have a fever?	□	□
f.	Sick child care when this child is sick and has a fever?	□	□

46. Since September, how many times has this child’s main care provider or teacher at that program changed?

Never
1 to 2 times
3 or more times

47. Is this program that this child goes to Head Start?

Head Start is a federally sponsored preschool program primarily for children from low-income families.

48. Is there any charge or fee for this program, paid either by you or some other person or agency?

Yes
N o GO TO QUESTION 52

49. Do any of the following people or organizations help pay for this child to go to that program?

		Yes ▼	No ▼
a.	A relative of this child outside your household who provides money specifically for that care, not including general child support?	□	□
b.	Temporary Assistance for Needy Families, or TANF?	□	□
c.	Another social service, welfare, or child care agency?	□	□
d.	An employer, not including a tax-free spending account for child care?	□	□
e.	Someone else?	□	□

50. How much does your household pay for this child to go to that program, not counting any money that you may receive from others to help pay for care?

Write ‘0’ if your household does not pay for that program.

______ Dollars per

Hour
Day
Week
Month
Year
Every 2 weeks
Other → specify:

51. How many children from your household is this amount for, including this child?

This child only
2 children
3 children
4 children
5 or more children

52 . Does this child have any other care arrangements at a day care center or preschool on a regular basis?

Yes
N o GO TO QUESTION 54

53. How many total hours each week do they spend at those daycare centers or preschools?

______Hours

Head Start

54. Has this child ever attended Head Start or Early Head Start?

Section 2. Finding and Choosing Care for Your Child

55. Do you feel there are good choices for child care or early childhood programs where you live?

Yes
No
Don’t know / Have not tried to find care

56. In Section 1 of this questionnaire, we asked about child care arrangements you may now have for this child including arrangements with relatives, non-relatives, day care centers, preschools, and any other early childhood programs. Did you report any childcare arrangements or programs?

Y es
No GO TO SECTION 3

57. How much difficulty did you have finding the type of child care or early childhood program you wanted for this child?

A lot
Some
A little
No difficulty
Did not found the child care program you wanted

!	The next question asks about how you decided on the child care arrangements and early childhood programs you now have for this child. If you have more than one care arrangement or program for this child, think about the one where this child spends the MOST time.

58. Parents select child care arrangements for a number of reasons. How important was each of these reasons when you chose the child care arrangement for this child.

		Not at all important ▼	A little important ▼	Somewhat important ▼	Very important ▼
a.	The location of the arrangement	□	□	□	□
b.	The cost of the arrangement	□	□	□	□
c.	The reliability of the arrangement	□	□	□	□
d.	The learning activities at the arrangement	□	□	□	□
e.	The child spending time with other kids his/her age	□	□	□	□
f.	The times during the day that this caregiver is able to provide care	□	□	□	□
g.	The number of other children in the child’s care group	□	□	□	□

Section 3. Family Activities

59. The next questions ask about this child’s activities with family members in the past week.

About how many books does this child have of his/her own, including those shared with brothers or sisters?

______ Books

60. How many times have you or someone in your family read to this child in the past week?

N ot at all GO TO QUESTION 62
1 or 2 times
3 or more times
Every day

61. About how many minutes on each of those days do you or someone in your family read to this child?

______ Minutes

62. In the past week, how many times has anyone in your family done the following things with this child?

		Not at all ▼	1 or 2 times ▼	3 or more times ▼
a.	Told this child a story	□	□	□
b.	Taught this child letters, words, or numbers	□	□	□
c.	Taught this child songs or music	□	□	□
d.	Worked on arts and crafts with this child	□	□	□

63. In the past month, have you or someone in your family visited a library with this child?

Section 4: Things Your Child May be Learning

64. These next questions ask about things that different children do at different ages. These things may or may not be true for this child.

Is this child under 2 years old or is he/she 2 years old or older?

U nder 2 years old GO TO SECTION 5
2 years old or older

65. Can this child identify the colors red, yellow, blue, and green by name?

Yes, all of them
Yes, some of them
No

66. Can this child recognize the letters of the alphabet?

Yes, all of them
Yes, most of them
Yes, some of them
No

67. How high can this child count?

Not at all
Up to 5
Up to 10
Up to 20
Up to 50
Up to 100 or more

68. Can this child write his/her first name, even if some of the letters are backwards?

69. Does this child ever look at a book and pretend to read?

Yes
N o GO TO QUESTION 71

70. When this child pretends to read a book, does it sound like a connected story, or does he/she tell what's in each picture without much connection between them?

Sounds like connected story
Tells what’s in each picture
Does both

71. Is this child able to read story books on his/her own now?

Section 5: This Child’s Health

72. In general, how would you describe this child’s health?

Excellent
Very good
Good
Fair
Poor

73. Has a health professional told you that this child has any of the following disabilities?

		Yes ▼	No ▼
a.	A specific learning disability	□	□
b.	Mental retardation	□	□
c.	A speech or language delay	□	□
d.	A serious emotional disturbance	□	□
e.	Deafness or another hearing impairment	□	□
f.	Blindness or another visual impairment not corrected with glasses	□	□
g.	An orthopedic impairment	□	□
h.	Autism	□	□
i.	Attention deficit disorder, ADD or ADHD	□	□
j.	Pervasive Developmental Disorder or PDD	□	□
k.	Another health impairment lasting 6 months or more	□	□

!	If you marked yes for any disability in QUESTION 73 continue with this section. If you marked no for all disabilities then GO TO QUESTION 82

74. Is this child receiving services for his/her condition?

Yes
N o GO TO QUESTION 79

75. Are these services provided by any of the following sources?

		Yes ▼	No ▼
a.	Your local school district	□	□
b.	A state or local health or social service agency	□	□
c.	A doctor, clinic, or other health care provider	□	□

76. Are any of these services provided through an Individualized Educational Program or Plan, or IEP?

Yes
N o GO TO QUESTION 79

77. Did any adult in your household work with the school to develop or change this child’s IEP?

78. During this school year, to what extent have you been satisfied or dissatisfied with the following aspects of this child’s IEP (Individualized Education Program or Plan)?

		Very satisfied ▼	Somewhat satisfied ▼	Somewhat dissatisfied ▼	Very dissatisfied ▼	Does not apply ▼
a.	The school’s communication with your family	□	□	□	□	□
b.	The child’s special needs teacher or therapist	□	□	□	□	□
c.	The school’s ability to accommodate the child’s special needs	□	□	□	□	□
d.	The school’s commitment to help your child learn	□	□	□	□	□

79. Is this child currently enrolled in any special education classes or services?

80. Does this child’s disability affect his/her ability to learn?

Section 6: Your Child’s Background

81. In what month and year was this child born?

|___|___| |___|___|___|___|

MONTH YEAR

82. Where was this child born?

O ne of the 50 United States or the District of Columbia GO TO QUESTION 84
One of the U.S. territories (Puerto Rico, Guam, American Samoa, U.S. Virgin Islands, or Mariana Islands)
Another country

83. How old was this child when he/she first moved to the 50 United States or the District of Columbia?

|___|___| AGE

84. Is this child of Spanish, Hispanic, or Latino origin?

85. What is this child’s race? You may mark more than one.

Mark [X] all that apply.

White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific Islander

86. What language does this child speak most at home?

Mark [X] only one.

E nglish GO TO SECTION 7
Spanish
A language other than English or Spanish
English and Spanish equally
English and another language equally

87. Is this child currently enrolled in English as a second language, bilingual education, or an English immersion program?

Section 7: Child’s Mother or Female Guardian

88. Does this child have a mother, stepmother or female guardian living in the same household?

Yes
N o GO TO SECTION 8

89. Is this person the child’s…

Birth mother,
Adoptive mother,
Stepmother,
Foster mother,
Grandmother, or
Other female guardian

90. How old was this woman when she first became a mother or guardian to any child?

|___|___| AGE

91. What is the marital status of this child’s mother or female guardian?

Married
Separated
Divorced
Widowed
Never married

9 2. What was the first language this child’s mother or female guardian learned to speak?

Mark [X] only one.

E nglish GO TO QUESTION 97
Spanish
A language other than English or Spanish
English and Spanish equally
English and another language equally

93. What language does she speak most at home now?

Mark [X] only one.

English
Spanish
A language other than English or Spanish
English and Spanish equally
English and another language equally

94. Where was this child’s mother or female guardian born?

O ne of the 50 United States or the District of Columbia GO TO QUESTION 96
One of the U.S. territories (Puerto Rico, Guam, American Samoa, U.S. Virgin Islands, or Mariana Islands)
Another country

95. How old was she when she first moved to the 50 United States or the District of Columbia?

|___|___| AGE

96. Is she of Spanish, Hispanic, or Latino origin?

97. What is her race? You may mark more than one.

Mark [X] all that apply.

White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific Islander?

98. What is the highest grade or year of school that she completed?

Up to 8^th grade
High School, but no diploma
High school diploma or equivalent (GED)
Vocational diploma after high school
Some college, but no degree
Associates degree (AA, AS)
Bachelor’s degree (BA, BS)
Master’s degree (MA, MS)
Doctorate Degree (PhD, EDD)
Professional degree beyond Bachelor’s degree (MD, DDS, JD, LLB)

99. Is she currently attending or enrolled in a school, college, university, or adult learning center, or receiving vocational education or job training?

100. Which of the following best describes her employment status?

Mark [X] only one.

Employed for pay or income
Self employed
O ut of work for more than one year GO TO QUESTION 102
Out of work for less than one year
A homemaker
R etired GO TO QUESTION 103
Disabled or unable to work

101. (Employed or Self employed :) About how many hours per week does she usually work for pay or income, counting all jobs?

|___|___| GO TO QUESTION 103

HOURS

102. (Out of work :) Has she been actively looking for work in the past 4 weeks?

103. In the past 12 months, how many months (if any) has she worked for pay or income?

|___|___|

MONTHS

Section 8: Child’s Father or Male Guardian.

104. Does this child have a father, stepfather or male guardian living in the same household?

Yes
N o GO TO SECTION 9

105. Is this person the child’s…

Birth father,
Adoptive father,
Stepfather,
Foster father,
Grandfather, or
Other male guardian?

106. What is the marital status of this child’s father or male guardian?

Married
Separated
Divorced
Widowed
Never married

107. What was the first language the child’s father or male guardian learned to speak?

Mark [X] only one.

E nglish GO TO QUESTION 109
Spanish
A language other than English or Spanish
English and Spanish equally
English and another language equally

108. What language does he speak most at home now?

Mark [X] only one.

English
Spanish
A language other than English or Spanish
English and Spanish equally
English and another language equally

109. Where was this child’s father or male guardian born?

O ne of the 50 United States or the District of Columbia GO TO QUESTION 111
One of the U.S. territories (Puerto Rico, Guam, American Samoa, U.S. Virgin Islands, or Mariana Islands)
Another country

110. How old was he when he first moved to the 50 United States or the District of Columbia?

|___|___| AGE

111. Is he of Spanish, Hispanic, or Latino origin?

112. What is his race?

Mark [X] all that apply.

White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific Islander

113. What is the highest grade or year of school that he completed?

Up to 8^th grade
High School, but no diploma
High school diploma or equivalent (GED)
Vocational diploma after high school
Some college, but no degree
Associates degree (AA, AS)
Bachelor’s degree (BA, BS)
Master’s degree (MA, MS)
Doctorate Degree (PhD, EDD)
Professional degree beyond Bachelor’s degree (MD, DDS, JD, LLB)

114. Is he currently attending or enrolled in a school, college, university, or adult learning center, or receiving vocational education or job training?

115. Which of the following best describes his employment status?

Mark [X] only one.

Employed for pay or income
Self employed
O ut of work for more than one year GO TO QUESTION 117
Out of work for less than one year
A homemaker
R etired GO TO QUESTION 118
Disabled or unable to work

116. (Employed or self employed :) About how many hours per week does he usually work for pay or income, counting all jobs?

|___|___| GO TO QUESTION 118

HOURS

117. (Out of work :) Has he been actively looking for work in the past 4 weeks?

118. In the past 12 months, how many months (if any) has he worked for pay or income?

|___|___|

MONTHS

Section 9: Your Household

119. Please mark all of the people who live in the household with this child, including yourself and those you have already been asked about.

Mark [X] all that apply.

Mother (including birth, adoptive, step, or foster mothers)
Father (including birth, adoptive, step, or foster fathers)
Brother (full, half, adoptive, step, or foster brothers)
Sister (full, half, adoptive, step, or foster sisters)
Aunt
Uncle
Grandmother
Grandfather
Cousin
Other relative
Same sex parent
Girlfriend or partner of this child’s parent or guardian
Boyfriend or partner of this child’s parent or guardian
Other nonrelatives

120. In the past 12 months did your family ever receive benefits from any of the following programs?

		Yes ▼	No ▼
a.	Temporary Assistance for Needy Families, or TANF	□	□
b.	Your state welfare or family assistance program	□	□
c.	Women, Infants, and Children, or WIC	□	□
d.	Food Stamps	□	□
e.	Medicaid	□	□
f.	Child Health Insurance Program (CHIP)	□	□
g.	Section 8 Housing assistance	□	□

121. In studies like this, households are sometimes grouped according to income. What was the total income of all persons in your household over the past year, including salaries or other earnings, interest, retirement, and so on?

$0 to $10,000
$10,001 to $20,000
$20,001 to $30,000
$30,001 to $40,000
$40,001 to $50,000
$50,001 to $60,000
$60,000 to $75,000
$75,001 to $100,000
$100,001 to $150,000
$150,001 or more

Thank you.

Please return this questionnaire in the postage-paid envelope provided. If you have lost the envelope, mail the completed questionnaire to:

National Household Education Survey

1650 Research Blvd. Room XXXX

Rockville, MD 20850

File Type	application/msword
File Title	2010 National Household Education Surveys Program
Author	Timothy Smith
Last Modified By	#Administrator
File Modified	2009-02-23
File Created	2009-02-23