Nhes Ecpp
2009 National Household Education Surveys Program (NHES: 2009)
NHES 2009 ECPP
NHES ECPP
OMB: 1850-0768
2009 National Household Education Surveys Program
Early Childhood Program Participation Survey
FINAL: July 30, 2009
National Household Education Survey Our Children’s Future: A Survey of Young Children’s Care and Education |
-
Thank you for helping us with this survey. Based on the information we received from your household in your last survey, we’re asking you to complete this final step.
Sponsored
by
U.S.
Department of Education
National
Center for Education Statistics
Instructions
{SAMPLED CHILD}
Please answer all the survey questions thinking about this child or youth. This information is also at the top of each page for your reference.
|
We are authorized to collect this information by Section 9543, 20 US Code. 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. Your answers may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (Section 9573, 20 US Code). Your responses will be combined with those from other participants to produce summary statistics and reports.
This survey is estimated to take an average of 20 minutes, including time for reviewing instructions, 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: Andrew Zukerberg National Center for Education Statistics, U.S. Department of Education, 1990 K Street NW, Room 9036, Washington, DC 20006-5650. Do not return the completed form to this address.
1. Childhood Care and Programs |
► Thank you for your help with the previous survey your household completed.
► Answer all the survey questions thinking about the child listed below:
{SAMPLED CHILD}
► Care Your Child Receives from Relatives
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.
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?
N
o GO
TO question 17.Y
es
2. Are any of these care arrangements regularly scheduled at least once a week?
N
o GO
TO question 17.Y
es
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] ONE only.
Grandmother/Grandfather
Aunt /Uncle
Brother /Sister
Another relative
4. How old is the relative who provides the most care to this child?
|__|__|
age
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
A language other than English or Spanish
English and Spanish equally
English and another language equally
10. Will this relative care for this child when the child is…
|
|
Yes ▼ |
No ▼ |
a. |
Sick but does not have a fever? |
□ |
□ |
b. |
Sick and has a fever? |
□ |
□ |
11. 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?
Y
esN
o GO
TO question 15.
12. Do any of the following people, programs, or organizations help pay for this relative to care for this child?
Mark [X] ONE box for each item below.
|
|
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? |
□ |
□ |
13. 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.
$
|__|__|__|__|__|.00
Is that amount per…
Hour
Day
Week
Month
Year
Every 2 weeks
O
ther
specify:
14. 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
15. Does this child have any other care arrangements with a relative on a regular basis?
Y
esN
o GO
TO question 17.
16. 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 Non-relatives
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.
17. 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?
N
o GO
TO question 34.Y
es
18. Are any of these care arrangements regularly scheduled at least once a week?
N
o GO
TO question 34.Y
es
19. 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
Both question 21.
20. Does this person who cares for this child live in your household?
Yes
No
21. How many days each week does this child receive care from this person?
|__| days each week
22. How many hours each week does this child receive care from this person?
|__|__| hours each week
23. How old was this child in years and months when this particular regular care arrangement with this person began?
|___| years |___|___| months
24. Was this care provider someone you already knew?
Yes
No
25. Is this child’s care provider age 18 or older?
Yes
No
26. What language does this care provider speak most when caring for this child?
English
Spanish
A language other than English or Spanish
English and Spanish equally
English and another language equally
27. Will this care provider care for this child when this child is…
|
|
Yes ▼ |
No ▼ |
a. |
Sick but does not have a fever? |
□ |
□ |
b. |
Sick and has a fever? |
□ |
□ |
28. 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?
Y
esN
o GO
TO question 32.
29. Do any of the following people, programs, or organizations help pay for this person to care for this child?
Mark [X] ONE box for each item below.
|
|
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? |
□ |
□ |
30. How much does your household pay for this 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 this non-relative for care.
$
|__|__|__|__|__|.00
Is that amount per…
Hour
Day
Week
Month
Year
Every 2 weeks
O
ther
specify:
31. 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
32. 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.
Y
esN
o GO
TO question 34.
33. How many total hours each week does this child spend in those other care arrangements with non-relatives?
|__|__| hours each week
► Day Care Centers and Preschool Programs Your Child Attends
The next questions ask about any day care centers and early childhood programs that this child attends. This does not include care provided in a private home.
34. Is this child now attending a day care center, preschool, or prekindergarten not in a private home?
N
o GO
TO question 50.Y
es
35. Does this child go to a day care center, preschool, or prekindergarten, at least once each week?
N
o GO
TO question 50.Y
es
36. The next questions ask about the program where this child spends the most time. Where is this program located?
Mark [X] ONE only.
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
Its own building, or storefront
Some other place
S
pecify:
37. Is this program run by a church, synagogue, or other religious group?
Yes
No
38. Is this program located at your workplace or this child’s other parent’s workplace?
Yes
No
39. How many days each week does this child go to this program?
|__| days each week
40. How many hours each week does this child go to this program?
|__|__| hours each week
41. How old was this child in years and months when he/she started going to this particular program?
|___| years |___|___| months
42. What language does this child’s main care provider or teacher at this program speak most when caring for this child?
English
Spanish
A language other than English or Spanish
English and Spanish equally
English and another language equally
► Continue with question 43 on the next page.
43. Does this program provide any of the following services to this child or your family?
Mark [X] ONE box for each item below.
|
|
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? |
□ |
□ |
44. Is there any charge or fee for this program, paid either by you or some other person or agency?
Y
esN
o GO
TO question 48.
45. Do any of the following people, programs, or organizations help pay for this child to go to this program?
Mark [X] ONE box for each item below.
|
|
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? |
□ |
□ |
46. How much does your household pay for this child to go to this 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.
$
|__|__|__|__|__|.00
Is that amount per…
Hour
Day
Week
Month
Year
Every 2 weeks
O
ther
specify:
47. 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
48 . Does this child have any other care arrangements at a day care center or preschool on a regular basis?
Y
esN
o GO
TO question 50.
49. How many total hours each week does this child spend at those day care centers or preschools?
|__|__| hours each week
► Participation in Head Start
50. In the past, has this child ever attended Head Start or Early Head Start?
Early Head Start and Head Start are federally sponsored preschool programs primarily for children from low-income families.
Yes
No
51. Earlier we asked about child care arrangements you may now have for this child.
Did you report any childcare arrangements with relatives, non-relatives, day care centers, preschools, and any other early childhood programs?
Mark ‘yes’ if you marked yes to question 2, or question 18, or question 35.
N
o GO
TO section 3 on page 9.Y
es
52. Are any of those current arrangements you reported Head Start or Early Head Start?
Early Head Start and Head Start are federally sponsored preschool programs primarily for children from low-income families.
N
o GO
TO question 54.Y
es
53. (If yes) Which type of care or program you reported is part of the Head Start or Early Head Start program?
Mark [X] ONE box for each item below.
|
|
Yes ▼ |
No ▼ |
a. |
Relative care? |
□ |
□ |
b. |
Non-relative care? |
□ |
□ |
c. |
Day care center or preschool |
□ |
□ |
► Continue with section 2, question 54 on the next page.
2. Finding and Choosing Care for Your Child |
54. How much difficulty did you have finding the type of child care or early childhood program you wanted for this child?
A lot of difficulty
Some difficulty
A little difficulty
No difficulty
Did not find 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.
55. How important was each of these reasons when you chose the child care arrangement or program where this child spends the most time?
a. The location of the arrangement?
Not at all important
A little important
Somewhat important
Very important
b. The cost of the arrangement?
Not at all important
A little important
Somewhat important
Very important
c. The reliability of the arrangement?
Not at all important
A little important
Somewhat important
Very important
d. The learning activities at the arrangement?
Not at all important
A little important
Somewhat important
Very important
e. The child spending time with other kids his/her age?
Not at all important
A little important
Somewhat important
Very important
f. The times during the day that this caregiver is able to provide care?
Not at all important
A little important
Somewhat important
Very important
g. The number of other children in the child’s care group?
Not at all important
A little important
Somewhat important
Very important
56. 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
3. Family Activities |
The next questions ask about this child’s activities with family members in the past week or month.
57. About how many books does this child have of his/her own, including those shared with brothers or sisters?
|__|__|__| number of books
58. 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 60.1 or 2 times
3 or more times
Every day
59. About how many minutes on each of those days do you or someone in your family read to this child?
|__|__| minutes
60. In the past week, how many times has anyone in your family done the following things with this child?
a. Told this child a story?
Not at all
1 or 2 times
3 or more times
b. Taught this child letters, words, or numbers?
Not at all
1 or 2 times
3 or more times
c. Taught this child songs or music?
Not at all
1 or 2 times
3 or more times
d. Worked on arts and crafts with this child?
Not at all
1 or 2 times
3 or more times
61. In the past month, have you or someone in your family visited a library with this child?
Yes
No
► Continue with section 4 on the next page.
4. Things Your Child May be Learning |
These next questions ask about things that different children do at different ages. These things may or may not be true for this child.
62. Is this child under 2 years old or is he/she 2 years old or older?
U
nder
2 years GO TO
question 70.2
years or older
63. Can this child identify the colors red, yellow, blue, and green by name?
Yes, all of them
Yes, some of them
No
64. Can this child recognize the letters of the alphabet?
Yes, all of them
Yes, most of them
Yes, some of them
No
65. How high can this child count?
This child cannot count
Up to 5
Up to 10
Up to 20
Up to 50
Up to 100 or more
66. Can this child write his/her first name, even if some of the letters are backwards?
Yes
No
67. Does this child ever look at a book and pretend to read?
Y
esN
o GO
TO question 69.
68. 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
69. Is this child able to read story books on his/her own now?
Yes
No
► Continue with section 5, question 70 on the next page.
5. This Child’s Health |
70. In general, how would you describe this child’s health?
Excellent
Very good
Good
Fair
Poor
71. Has a health professional told you that this child has any of the following disabilities?
Mark [X] ONE box for each item below.
|
|
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 71 continue with question 72. If you marked no for all disabilities then GO TO question 79, the next section. |
72. Is this child receiving services for his/her condition?
Y
esN
o GO
TO question 77.
73. Are these services provided by any of the following sources?
Mark [X] ONE box for each item below.
|
|
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 |
□ |
□ |
74. Are any of these services provided through an Individualized Family Service Plan (IFSP), or an Individualized Educational Program or Plan (IEP)?
Y
esN
o GO
TO question 77.
75. Did any adult in your household work with the service provider or school to develop or change this child’s IFSP or IEP?
Yes
No
76. During this school year, to what extent have you been satisfied or dissatisfied with the following aspects of this child’s IFSP or IEP?
a. The service provider’s or school’s communication with your family?
Very satisfied
Somewhat satisfied
Somewhat dissatisfied
Very dissatisfied
Does not apply
b. The child’s special needs teacher or therapist?
Very satisfied
Somewhat satisfied
Somewhat dissatisfied
Very dissatisfied
Does not apply
c. The service provider’s or school’s ability to accommodate the child’s special needs?
Very satisfied
Somewhat satisfied
Somewhat dissatisfied
Very dissatisfied
Does not apply
d. The service provider’s or school’s commitment to help your child learn?
Very satisfied
Somewhat satisfied
Somewhat dissatisfied
Very dissatisfied
Does not apply
77. Is this child currently enrolled in any special education classes or services?
Yes
No
78. Does this child’s disability affect his/her ability to learn?
Yes
No
► Continue with section 6, question 79 on the next page.
6. Child’s Background |
79. In what month and year was this child born?
|___|___| / |___|___|___|___|
month year
80. Where was this child born?
O
ne
of the 50 United States or the District of
Columbia
G
O
TO
question 82.
One of the U.S. territories
(Puerto Rico, Guam, American Samoa, U.S. Virgin Islands, or Mariana Islands)
Another country
81. How old was this child when he/she first moved to the 50 United States or the District of Columbia?
|___|___|
age
82. Is this child of Spanish, Hispanic, or Latino origin?
Yes
No
83. What is this child’s race? You may mark one or more races.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
84. For the current school year, does this child usually live at another address, for example because of a joint custody arrangement?
Do not include vacation properties.
Yes
No
85. What language does this child speak most at home?
Mark [X] ONE only.
English
Spanish
A language other than English or Spanish
English and Spanish equally
English and another language equally
Child has not started to speak
! |
If you marked ‘English’ or ‘Child has not started to speak’ in question 85 GO TO question 87, otherwise continue with question 86. |
86. Is this child currently enrolled in English as a second language, bilingual education, or an English immersion program?
Yes
No
► Continue with section 7, question 87 on the next page.
7. Child’s Mother or Female Guardian |
87. Does this child have a mother, stepmother or female guardian living in the same household?
N
o GO
TO question 103.Y
es
88. Is this person the child’s…
Birth mother,
Adoptive mother,
Stepmother,
Foster mother,
Grandmother, or
Other female guardian
89. How old was this woman when she first became a mother or guardian to any child?
|___|___|
age
90. What is the current marital status of this child’s mother or female guardian?
Mark [X] ONE only.
Married
Living with a partner
Separated
Divorced
Widowed
Never married
9
1. What
was the first language this child’s mother
or female guardian learned to speak?
Mark [X] ONE only.
E
nglish GO
TO question 93.Spanish
A language other than English or Spanish
English and Spanish equally
English and another language equally
92. What language does she speak most at home now?
Mark [X] ONE only.
English
Spanish
A language other than English or Spanish
English and Spanish equally
English and another language equally
93. Where was this child’s mother or female guardian born?
O
ne
of the 50 United States or the District of
Columbia
G
O
TO question 95.
One of the U.S. territories
(Puerto Rico, Guam, American Samoa, U.S. Virgin Islands, or Mariana Islands)
Another country
94. How old was she when she first moved to the 50 United States or the District of Columbia?
|___|___|
age
95. Is she of Spanish, Hispanic, or Latino origin?
Yes
No
96. What is her race? You may mark one or more races.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
97. What is the highest grade or level of school that she completed?
Mark [X] ONE only.
8th grade or less
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)
Some graduate or professional education but no degree
Master’s degree (MA, MS)
Doctorate Degree (PhD, EdD)
Professional degree beyond Bachelor’s degree (MD, DDS, JD, LLB)
98. Is she currently attending or enrolled in a school, college, university, or adult learning center, or receiving vocational education or job training?
Yes
No
99. Which of the following best describes her employment status?
Mark [X] ONE only.
Employed for pay or income
Self employed
Unemployed or
o
ut
of work GO TO question
101.
S
tay
at home
mother GO TO question 102.
R
etired GO
TO question 102.D
isabled
or GO TO question 102.
unable to work
100. (If employed or self employed) About how many hours per week does she usually work for pay or income, counting all jobs?
|
___|___| GO
TO question 102.
hours
101. (If unemployed or out of work) Has she been actively looking for work in the past 4 weeks?
Yes
No
102. In the past 12 months, how many months (if any) has she worked for pay or income?
|___|___|
months
► Continue with section 8, question 103 on the next page.
8. Child’s Father or Male Guardian |
103. Does this child have a father, stepfather or male guardian living in the same household?
N
o GO
TO question 118.Y
es
104. Is this person the child’s…
Birth father,
Adoptive father,
Stepfather,
Foster father,
Grandfather, or
Other male guardian?
105. What is the current marital status of this child’s father or male guardian?
Mark [X] ONE only.
Married
Living with a partner
Separated
Divorced
Widowed
Never married
1
06. What
was the first language this child’s father
or male guardian learned to speak?
Mark [X] ONE only.
E
nglish GO
TO question 108.Spanish
A language other than English or Spanish
English and Spanish equally
English and another language equally
107. What language does he speak most at home now?
Mark [X] ONE only.
English
Spanish
A language other than English or Spanish
English and Spanish equally
English and another language equally
108. Where was this child’s father or male guardian born?
O
ne
of the 50 United States or the District of
Columbia
G
O
TO question 110.
One of the U.S. territories
(Puerto Rico, Guam, American Samoa, U.S. Virgin Islands, or Mariana Islands)
Another country
109. How old was he when he first moved to the 50 United States or the District of Columbia?
|___|___|
age
110. Is he of Spanish, Hispanic, or Latino origin?
Yes
No
111. What is his race? You may mark one or more races.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
112. What is the highest grade or level of school that he completed?
Mark [X] ONE only.
8th grade or less
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)
Some graduate or professional education but no degree
Master’s degree (MA, MS)
Doctorate Degree (PhD, EdD)
Professional degree beyond Bachelor’s degree (MD, DDS, JD, LLB)
113. Is he currently attending or enrolled in a school, college, university, or adult learning center, or receiving vocational education or job training?
Yes
No
114. Which of the following best describes his employment status?
Mark [X] ONE only.
Employed for pay or income
Self employed
U
nemployed
or
out of work GO TO question 116.
S
tay
at home
father GO TO question 117.
R
etired GO
TO question 117.D
isabled
or GO TO question 117.
unable to work
115. (If employed or self employed) About how many hours per week does he usually work for pay or income, counting all jobs?
|
___|___| GO
TO question 117.
hours
116. (If unemployed or out of work) Has he been actively looking for work in the past 4 weeks?
Yes
No
117. In the past 12 months, how many months (if any) has he worked for pay or income?
|___|___|
months
► Continue with section 9, question 118 on the next page.
9. Your Household |
118. 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 – birth, adoptive, step, or foster
Father – birth, adoptive, step, or foster
Brother – full, half, adoptive, step, or foster
Sister – full, half, adoptive, step, or foster
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
119. How many females live in this household?
|__|__| number of females
120. How many males live in this household?
|__|__| number of males
121. Of everyone in this household, how many are age 20 or younger?
Include the child selected for this survey.
Do not include those living in college housing.
|__|__| number age 20 or younger
122. Are there any adults in this household who do not speak English at home?
Yes
No
123. What is the highest grade or level of school completed among the adults in this household?
Mark [X] ONE only.
8th grade or less
Some high school, but did not graduate
High school graduate or GED
Some college or associate’s degree
Four year college degree (BA or BS)
Some graduate or professional education but no degree
Graduate or professional degree beyond a bachelor’s degree
124. Is this house…
Mark [X] ONE only.
Owned or being bought by someone in this household,
Rented by someone in this household, or
Occupied by some other arrangement?
125. Other than this address does anyone in this household currently receive mail at another address including P.O. Boxes?
Yes
No
126. In the past 12 months did your family ever receive benefits from any of the following programs?
Mark [X] ONE box for each item below.
|
|
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 |
□ |
□ |
127. Which category best fits the total income of all persons in your household over the past 12 months?
Include your own income.
Include money from jobs or other earnings, pensions, interest, rent, Social Security payments, 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
$60,001 to $75,000
$75,001 to $100,000
$100,001 to $150,000
$150,001 or more
10. Questions about You |
These questions are about the adult that filled in this survey. Your responses to these questions will help describe the homes children live in.
128. How are you related to this child?
Mark [X] ONE only.
Mother/Father
(birth, adoptive, step, or foster)
Aunt/Uncle
Grandparent
Girlfriend/Boyfriend of this child’s parent or guardian
O
ther
relationship – specify:
|
129. Are you male or female?
Male
Female
130. How old are you?
|___|___|
age
131. How many years have you lived at this address?
Write ‘0’ if less than 1 year.
|__|__| years at this address
132. Are you the person in this household who usually opens the mail?
Yes
No
133. Did anyone else complete or help with any part of this survey?
Yes
No
134. Do you have access to the internet at this address?
Yes
N
o GO
TO question 136.
135. What type of internet access do you have?
Mark [X] ONE only.
Cable
DSL
FIOS
Satellite
Dial-up
Air Card
Other
136. Is there at least one telephone inside this home that is currently working and not a cell phone?
Yes
No
137. Do you have a working cell phone?
Yes
N
o GO
TO END OF SURVEY.
138. Of all the telephone calls that you receive are…
all or almost all calls received on cell phones,
some received on cell phones and some on regular phones, or
very few or none on cell phones?
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
Westat
1600 Research Blvd. Room TB135
Rockville, MD 20850-3129
THIS PAGE INTENTIONALLY LEFT BLANK
Commonly Asked Questions
Q: How did you get my address?
A: Your address was randomly selected from among all of the home addresses in the nation. It was selected using scientific sampling methods to represent other households in the U.S.
Q: Why should I take part in this study? Do I have to do this?
A: You represent thousands of other households like yours, and you cannot be replaced. Your answers and opinions are very important to the success of this study. You may choose not to answer any or all questions in this survey. In order for the survey to be representative it is important that you complete and return this questionnaire.
Q: How will the information I provide be used?
A: Your responses will be combined with those of others to produce statistical summaries and reports. Your individual data will not be reported. Your answers may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (Section 9573, 20).
Q: Who is sponsoring the study? Is this study conducted by the Federal Government?
A: The National Center for Education Statistics, within the Department of Education is authorized to conduct this study (Section 9543. 20). Westat has been contracted to conduct this study. This study has been approved by the Office of Management and Budget, the office that reviews all federally sponsored surveys. The approval number assigned to this study is XXXX-XXXX. You may send any comments about this survey, including its length, to the Federal Government. Write to Andrew Zukerberg, National Center for Education Statistics, U.S. Department of Education, 1990 K Street NW, Room 9036, Washington, DC 20006-5650. You may send e-mail to [email protected].
Q: Who is Westat?
A: Westat is a research company located in Rockville, Maryland. Westat is conducting this survey under contract to the U.S. Department of Education. If you have any questions about the study contact Westat toll-free at 1-888-880-3033.
| File Type | application/msword |
| File Title | 2010 National Household Education Surveys Program |
| Author | Timothy Smith |
| Last Modified By | Douglas Williams |
| File Modified | 2009-08-06 |
| File Created | 2009-07-30 |
© 2024 OMB.report | Privacy Policy